Chronic Respiratory Disease最新文献

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.

Background: Individuals with Preserved Ratio Impaired Spirometry (PRISm), defined as FEV₁/FVC ≥0.7 and FEV1 <80% predicted, are at higher risk of developing COPD. However, data for Australian adults are limited. We aimed to describe prevalence of PRISm and its relationship with clinical characteristics in Australia. Method: Data from the Burden of Lung Disease (BOLD) Australia study of randomly selected adults aged ≥40 years from six sites was classified into airflow limitation, PRISm, or normal spirometry groups. Demographic, clinical characteristics, and lung function were compared between groups. Results: Of the study sample (n = 3518), 387 (11%) had PRISm, 549 (15.6%) had airflow limitation, and 2582 (73.4%) had normal spirometry. PRISm was more common in Indigenous Australian adults. Adults with PRISm had more frequent respiratory symptoms, more comorbidities, greater health burden and poorer quality of life than those with normal spirometry. Pre- and post-bronchodilator FEV₁ and FVC were lower in adults with PRISm than those with airflow limitation. Adults with PRISm were less likely to use respiratory medicine than those with airflow limitation (OR = 0.56, 95% CI 0.38-0.81). Conclusions: PRISm was present in 11% of adults in this study and they had similar respiratory symptoms and health burden as adults with airflow limitation.

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.

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.

ObjectiveMetabolic syndrome (MetS) is a cluster of factors that increase the risk of cardiovascular disease and type 2 diabetes. It is highly prevalent among patients with Chronic Obstructive Pulmonary Disease (COPD). This systematic review and meta-analysis assessed MetS prevalence in COPD patients, focusing on variations by gender, diagnostic criteria, and disease severity.MethodsWe systematically searched MEDLINE, Embase, Scopus, and CINAHL. Two reviewers independently extracted data using a standardized form, and study quality was assessed with the Joanna Briggs Institute checklist. Prevalence rates, with 95% confidence intervals (CI), were calculated using a random-effects model. Subgroup analyses by sex, COPD severity, and MetS components were conducted.ResultsForty-two studies, including 54,278 COPD patients, were analyzed. Overall, the prevalence of MetS was 37% (95% CI: 30.6-43.8%; I² = 99.03%, p < 0.001). Prevalence was 48% (95% CI 38.1 to 57.5) in males and 43% (95% CI 38.3 to 48.8) in females. Among studies using the Alberti definition, the pooled prevalence was 46% (95% CI 35.6 to 56.3). Patients with GOLD stage II showed a prevalence of 44% (95% CI 37.3 to 50.4). The most common MetS components were Hypertension 58% (95% CI 47.2 to 68.0) and increased waist circumference 51% (95% CI 37.1 to 64.6).ConclusionMetS is highly prevalent among COPD patients. Standardized diagnostic criteria are needed, and early detection with integrated care is recommended.

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease with high morbidity and mortality. COPD guidelines (CPG) are greatly underutilized and studies attempting to improve this practice gap have yielded inconsistent results. We hypothesize that using implementation science can provide a detailed understanding of these practice gaps and the reasons behind them. Methods: Since primary care (PC) manages the bulk of COPD patients, in this pilot study, we use principles of implementation science to systematically explore the reasons for this implementation gap in a PC setting. We used the Consolidated Framework of Implementation Science (CFIR), a determinant framework to design semi-structured interview guides to conduct multistakeholder interviews to explore the barriers and facilitators to four key COPD-CPG with known poor uptake: inhaler education, spirometry, pulmonary rehabilitation and COPD-specific patient education from patient and provider perspectives. Qualitative analysis was performed using rapid analysis. Results: Seventeen respondents including both, patients and providers were interviewed. All these COPD-CPG were rated as 'highly important' suggesting that perceived importance alone is insufficient to bridge gaps in uptake. Respondents were least familiar with pulmonary rehabilitation. Physician time constraint was a significant reported barrier. There exist multilevel contextual barriers to each of these COPD-CPG. Discussion: To increase uptake of COPD guidelines, implementation efforts that address multilevel barriers and promote collaborative care by use of non-physician resources are likely to have higher buy-in and greater chances for success.

IntroductionUse of long-term oxygen therapy (LTOT) for more than 15 h per day does not reduce mortality or hospitalizations, but may increase the risk of adverse events. We evaluated the relationship between daily oxygen use duration and adverse events, symptoms, and health status in patients on LTOT.MethodsThis was a cross-sectional survey study of a random sample (N = 650) of adults with ongoing LTOT in Sweden. Oxygen use (h/day) was reported, and associations were analyzed with adverse events, symptom severities (revised Edmonton Symptom Assessment System), sleep duration and quality, and health status (COPD assessment test [CAT]).ResultsIn total, surveys from 204 patients were analyzed; 60% female, mean age 75.3 (SD 8.7) years. Swedevox baseline characteristics were similar between sampled respondents and non-respondents. Patients reporting 24 h of daily oxygen use (53.4%) also reported a higher number of total adverse events, higher ratings of dyspnea, depression and anxiety, and worse health status, compared to those reporting fewer hours of oxygen use. A longer daily duration of oxygen use also associated with a higher number of experienced adverse events, higher ratings of dyspnea and anxiety, and worse rated health status in crude and adjusted linear regression models. No associations were seen between oxygen use duration and sleep quality or duration.ConclusionMore adverse events, a higher severity of some symptoms, and worse health status are seen among patients with a longer daily duration of oxygen use. Further research is needed to establish evidence of causality.

Case presentationDescription of a patient with a progressive destructive lung disease resembling pleuroparenchymal fibroelastosis, liver cirrhosis and bone marrow changes. Genetic workup identified a rare heterozygous coding variant in the TERT (telomerase reverse transcriptase) gene c.472 C>T; p.(Leu158Phe) and telomere length testing revealed significant telomere shortening, supporting the diagnosis of telomere biology disorder (TBD).DiscussionTBD is an underrecognized cause of interstitial lung disease (ILD). It is a heterogeneous disease that can affect different organs, including lungs, liver and bone marrow. Genetic testing in ILD is crucial for early diagnosis, risk assessment, and family screening. Identifying this variant enables targeted genetic testing for relatives, allowing preventive measures and lifestyle modifications.

Objective: To explore the associations between preestablished daily step count cut-offs and health status, dyspnoea, and psychosocial distress in individuals with COPD. Methods: A cross-sectional analysis was performed on 252 individuals with COPD. PADL was objectively assessed using a triaxial accelerometer, and participants were categorized as physically active or inactive according to three daily step count cut-offs previously reported for individuals with COPD (4,300, 4,580, and 5000 steps/day). Health status was measured via the COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ), dyspnoea was assessed via the modified Medical Research Council (mMRC) scale, and psychosocial distress was evaluated via the Hospital Anxiety and Depression Scale (HADS). Results: Meeting the cut-off of 5000 steps/day was associated with lower CAT scores and depressive symptoms. Meeting the cut-off of 4300 steps/day was associated with less dyspnoea (mMRC < 2). No significant associations were observed between anxiety symptoms and step count cut-offs. The 4580 steps/day cut-off did not predict health outcomes. Conclusions: A daily step count of 5000 steps appears to be the most effective threshold for distinguishing between different levels of health status and depressive symptoms in individuals with COPD. These findings suggest that step counts can be used as a clinical health indicator in this population. Future interventional studies are needed to confirm our findings.