Chronic Respiratory Disease最新文献

Excessive dynamic airway collapse (EDAC) is characterized by abnormal airway collapse during expiration, leading to symptoms such as breathlessness, cough, and reduced quality of life. Treatment options remain limited, and evidence-based guidelines are lacking. This prospective cohort study evaluated the impact of positive airway pressure (PAP) therapy on symptom burden in 23 patients with EDAC referred to a tertiary ventilation centre. Diagnosis was confirmed by computed tomography and/or bronchoscopy. Patients received nocturnal and ambulatory PAP, with symptom ratings and quality of life assessed at baseline and after three months. PAP therapy produced rapid and sustained improvements in breathlessness, orthopnoea, cough frequency, sleep quality, and quality of life, with significant differences in all domains (p < 0.01). Adherence to nocturnal PAP was high. These findings suggest that PAP therapy is an effective symptomatic intervention in EDAC and support consideration of EDAC as an indication for PAP therapy in future clinical guidelines.

Background: Almost 20% of Polish citizens aged >15 years are obese and this number is increasing. Numerous obesity-associated diseases include, quite notably, also sleep-related breathing disorders and hypoventilation. This study aimed to analyse the prevalence of obesity hypoventilation syndrome (OHS) and hypoventilation staging in a group of patients qualified for bariatric surgery within the Comprehensive Specialist Care in Bariatrics (KOS-BAR) pilot program designed and running in Poland since 2021. Methods: Prior to the bariatric procedure, the participants were referred to a pulmonologist for assessment. We retrospectively analysed the records of 134 patients. Results: Almost all of the tested bariatric patients (n = 122, 91.0%) had obstructive sleep apnea mainly classified as severe (59.0%). Hypoventilation was confirmed in 30 patients (22.4%), and in 37.9% of them, increased levels of serum bicarbonate were found. Chronic diurnal hypercapnia was confirmed in 7.9% of patients (10/122). Conclusions: Hypoventilation as well as obstructive sleep apnea in the obese population is a significant issue. The presented study group included patients in stages 0-IV of obesity-associated hypoventilation. The conducted analysis suggests that the most common form of hypoventilation among patients qualified for bariatric surgery is obesity-associated sleep hypoventilation (stage I).

BackgroundCentre-PR may not be accessible for people living distant from PR centres. Remote digital PR may have equivalent benefits to centre-PR; however, previous trials were potentially biased towards digitally literate patients, and largely excluded participants with a preference for centre-PR. There is limited data on the real-world implementation of, and acceptability for, Digital-PR alone or as an adjunct to other models of PR.ObjectivesTo gather patients' views about the acceptability of Active+me REMOTE, a digital pulmonary rehabilitation app (Digital-PR).MethodsA qualitative exploratory study using semi-structured interviews with a subset (n = 15) of patients in a mixed method, feasibility study of a hybrid pulmonary rehabilitation, blending Digital-PR with other models of PR. Transcribed data were coded descriptively using Braun and Clarkes' methodology, data interpretation was facilitated through a Miro virtual whiteboard.ResultsThere was appreciation for the concept of Digital-PR, indicated by positive responses in the domains of "friends and family recommendation," "intention to continue using the app," and "privacy concerns." Benefits were reported by two participants who had declined centre-based PR. The app was rated low regarding user-friendliness. Challenges in understanding/using the app and a perception of challenges for others were reported and were associated with poor digital literacy and tech savviness. High digital skills did not predict a favourable assessment of the app as user-friendly.DiscussionWhilst there was a general appreciation for the concept of digital PR as an adjunct or alternative to traditional centre-based PR, the app did not appear to be user-friendly, nor acceptable to people with low digital literacy. The findings have implications for the wider routine implementation of Digital-PR.

BackgroundFrailty is common among patients referred to pulmonary rehabilitation (PR) programs. While it is considered an independent predictor of program non-completion, people with frailty respond positively to PR. Clinicians' perspectives on assessing and managing frailty in PR has not been established. This study aimed to identify clinicians' current practices, perceptions, and opinions on assessing and managing frailty in people who attend PR in Australia and New Zealand.MethodsAn international online survey targeting healthcare professionals in Australia and New Zealand involved in PR programs using a combination of multiple-response closed-ended and open-ended questions. This survey study was reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).ResultsOf 103 responses, 89 healthcare professionals completed the survey (92.6% completion rate). Nineteen percent routinely assessed frailty, mostly using Short Physical Performance Battery (SPPB). Respondents reported the main considerations for choice of frailty assessment tools were ease of use and cost. The most common frailty indicators identified by respondents included falls history, low body weight, slow or aided gait, and muscle weakness. Seventy-nine percent believed PR to be appropriate to manage frailty in this population, while 94% desired additional resources in future guidelines. Suggestions to improve PR to better manage frailty included reshaping rehabilitation program content, and providing specific patient education. Future desired research priorities included improvements to frailty assessment tools, frailty-specific guidelines and workforce training.ConclusionThis study explores PR practices among clinicians in Australia and New Zealand, showing variability in frailty assessment and management. It provides a foundation for evaluating key aspects of PR models that can be tailored to these clients' needs and limitations.

ObjectivesFrailty is associated with increased morbidity and mortality in chronic lung disease, but its prognosis has not been evaluated in pulmonary arterial hypertension (PAH). This study aimed to assess: (1) impact of frailty on hospital length of stay (LOS) and health-care utilization in PAH; (2) association of frailty with 1-year post-discharge outcomes.MethodsRetrospective, single-centered cohort study of consecutive PAH patients admitted non-electively (January 2009-December 2018), predominantly for right heart failure (57%). Frailty was defined as ≥ 0.25 using a cumulative deficits frailty index. Disease characteristics, hospital factors, and mortality were compared using univariate analysis and multivariable regression, adjusting for age and sex.Results44/96 (46%) PAH patients were frail. Frailty was associated with older age, greater comorbidities, and lower six-minute walk distance pre-admission (p < 0.05). Frail patients had a longer hospital LOS (4 days 95% (0.4-6.3), p = 0.04) and were more likely to receive social work consultation (36% vs 13%, p = 0.01), independent of age and sex. There were no adjusted differences (frail vs non-frail) in hospital mortality (OR:1.01 95% (0.28-3.72) or 12-months mortality post-discharge (HR:1.26 95% (0.48-3.29).ConclusionFrailty was associated with greater hospital LOS and interdisciplinary support, but not 1-year mortality. Future studies should explore whether alternative frailty models may be more informative of longer-term PAH outcomes.

IntroductionCurrent research mainly examines the link between sarcopenia and obstructive spirometry, with limited studies on preserved ratio impaired lung function (PRISm). This study aims to investigate the association between skeletal muscle index (SMI) and lung function indicators in populations with different characteristics, with particular emphasis on the PRISm population.MethodsData were utilized from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 cycle. The participants were categorized into three groups: obstructive spirometry, PRISm, and normal spirometry. The SMI was calculated by dividing appendicular skeletal muscle mass by body mass index. Multiple linear regression analysis was employed to explore the relationship between the SMI and lung function indicators, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC).ResultsAmong the 2513 participants aged 20-59 years, 2096 had normal spirometry, 186 were in the obstructive spirometry group, and 231 were in the PRISm group. The SMI was significantly associated with lung function indicators after adujustment: in the obstructive spirometry group, per 0.1 unit increase in SMI was linked to an increase in FEV1 of 0.214 L (95% CI: 0.115-0.313, p < 0.001) and in FVC of 0.339 L (95% CI: 0.213-0.465, p < 0.001); in the PRISm group, per 0.1 unit increase in SMI was associated with an increase in FEV1 of 0.184 L (95% CI: 0.149-0.219, p < 0.001) and in FVC of 0.222 L (95% CI: 0.169-0.274, p < 0.001); and in the normal spirometry group, per 0.1 unit increase in SMI was linked to an increase in FEV1 of 0.240 L (95% CI: 0.222-0.257, p < 0.001) and in FVC of 0.316 L (95% CI: 0.294-0.338, p < 0.001).ConclusionOur study newly identifies a significant positive association between SMI and lung function in the PRISm group, a relationship also consistently observed in obstructive and normal spirometry groups.

BackgroundChronic obstructive pulmonary disease (COPD) and emphysema display a chronic and progressive disease for the individual patient. The forced expiratory volume in one second (FEV₁) is declining with age as displayed in the Fletcher-Peto curve. Despite established benefits of bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs), long-term data suggest a gradual reduction in the magnitude of these benefits.PurposeThis study aimed to compare the rate of lung function change in emphysema patients undergoing BLVR versus those receiving conservative management, utilizing coarsened exact matching to ensure balanced baseline characteristics.Patients and MethodsIn this retrospective single center study data between 2015 and 2021 was analyzed. BLVR patients achieving significant volume reduction (≥563 mL) were matched to conservatively managed controls based on age, sex, BMI, and smoking history. Pulmonary function changes after successful BLVR with valves, including forced expiratory volume in one second (FEV₁) and residual volume (RV), were monitored and analyzed over a 3-year period.ResultsA total of 60 patients, evenly distributed between the two groups (30 each), were included in the analysis. Median FEV₁ change was -0.063 L/year for BLVR patients and -0.066 L/year for controls. No statistically significant differences in annual FEV₁ and RV changes were observed (-0.07 vs -0.08, p = 0.492; -0.07 vs -0.07, p = 0.569; -0.05 vs -0.04, p = 0.636 at follow-ups in years 1, 2, and 3, respectively for FEV₁ and +0.20 vs +0.25, p = 0.643; +0.80 vs +0.65, p = 0.960; +1.0 vs +0.85, p = 0.963 at follow-ups in years 1, 2, and 3, respectively for RV).ConclusionIn this matched cohort analysis, no significant differences in annual changes in FEV₁ or RV progression were observed between patients after successful BLVR with valves and patients under conservative treatment. The results indicate that COPD progression is the main factor for the decline in functional improvement after successful BLVR with valves.

The aim of this study is to evaluate the correlations of peak oxygen uptake (VO2peak) with lung mechanics, radiographic abnormalities, and quality of life (QoL) in adults with post-tuberculosis lung disease (PTLD). This is a cross-sectional study in which 60 adults with PTLD underwent a cardiopulmonary exercise test (CPET). Additionally, the following assessments were performed: spirometry, impulse oscillometry (IOS), chest X-ray (CXR), and QoL using the WHOQOL-BREF. The mean peak oxygen uptake (VO_2peak) was 16.1 ± 6.8 ml/kg/min. There were positive correlations between VO_2peak and several parameters, including height, physical-WHOQOL-BREF, and forced vital capacity (FVC). There were negative correlations between VO_2peak and several parameters, including age, heterogeneity of resistance between 5 and 20 Hz, frequency response (Fres), and reactance-area. In IOS, patients with small airway disease (SAD) had a lower VO_2peak. Regarding CXR, only cavitation and nodular opacities were associated with a lower VO_2peak. In multivariate analysis, FVC, age, male sex, and Fres explained 65.2% of the variability in VO_2peak. In conclusion, there is a relationship between VO_2peak and lung mechanics in patients with PTLD. In these patients, IOS is able to detect more pulmonary mechanical alterations than spirometry, including those reflecting SAD. Thus, the use of both CPET and IOS may aid in the monitoring of patients with PTLD.

BackgroundMalnutrition and sarcopenia are common in inpatient rehabilitation, however individual nutritional therapy (iNT) is often underutilized. This study aimed to assess the effect of iNT on nutrition and muscular health.MethodPatients with chronic obstructive pulmonary disease (COPD) or post-pneumonia at risk for malnutrition and sarcopenia undergoing inpatient rehabilitation were enrolled. The control group received usual care including enriched food and educational group sessions on nutrition. The intervention group received additional counselling by a dietician twice a week. Both groups received individualized physiotherapy and self-management coaching, endurance exercise sessions on 5 days and strength training sessions on 2-3 days per week as part of the clinical routine. Primary outcomes were changes in energy and protein intake, assessed via menu consumption and macronutrient analysis. Secondary outcomes included handgrip strength, muscle mass by bioimpedance analysis, and physical performance measured by the timed-up-and-go test.ResultsTwenty-six patients per group (median age of 72 years, 60% men, 52% COPD) were included. Energy and protein intake increased significantly more in the intervention group with a 309 kcal and 16 g compared to -53 kcal and -1 g in the control group (p = 0.001 for group differences). Handgrip improved more in the intervention group by a median of 1 kg (p = 0.007), without group differences in muscle mass or physical performance.ConclusionINT effectively increased energy and protein intake in patients at risk of malnutrition and sarcopenia undergoing 3 weeks of pulmonary rehabilitation, with a positive impact on prognostic handgrip strength.Trial registrationThe study was registered by the US National Institutes of Health (ClinicalTrials.gov). # NCT05096013.

ObjectiveThis study aimed to identify the usefulness and compare three cutoff points of sedentary behavior (i.e., >8.5 h/day in sedentary time [ST], >70% of the awake time spent in ST, and <4300 steps/day) as predictors of all-cause mortality over a 12-years follow-up period in individuals with stable COPD.MethodsBaseline-only data from 92 individuals with COPD assessed for admission to pulmonary rehabilitation were analyzed.ResultsCox multivariate regression models identified the cutoff point of ST >8.5 h/day as an independent predictor of mortality after adjusting for confounders (hazard ratio 1.23, 95% CI 1.021 - 1.589, P = 0.02). The other two cutoffs were not significant.ConclusionAmong different cutoffs indicating sedentary behavior, ST >8.5 h/day was identified as an independent indicator of higher mortality risk in a 12-years follow-up period in individuals with stable COPD, indicating a 23% higher mortality risk in comparison to those who present ST <8.5 h/day.