Pub Date : 2023-01-01DOI: 10.1177/14799731231183446
Parris J Williams, Keir Ej Philip, Saeed M Alghamdi, Alexis M Perkins, Sara C Buttery, Michael I Polkey, Anthony A Laverty, Nicholas S Hopkinson
Introduction: Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established.
Methods: We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431).
Results: 10 randomised controlled trials and three observational studies with a control group were identified. Meta-analysis of nine RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (odds ratios: 2.01, 95%: 1.49-2.72 p < 0.001). Six RCTs using intensive (≥3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53-2.90, p < 0.001). A meta-analysis of two RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26-3.40 p = 0.004), Meta-analysis of two RCTs of non-intensive interventions (≤2 behavioural counselling sessions or limited to online information audio take home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39-2.08 p = 0.80).
Discussion: Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.
肺癌筛查是促进戒烟的重要教育时刻,但在这方面提供支持的最有效战略仍有待确立。方法:我们对在20/07/2022 MEDLINE、PsychINFO、CENTRAL、EMBASE、CINAHL和Scopus数据库之前发表的肺健康筛查期间提供的戒烟干预措施进行了系统回顾和荟萃分析。两名审稿人筛选标题和摘要,四名审稿人使用预先指定的标准审查全文,提取相关数据,使用GRADE标准评估偏倚风险和研究结果的置信度。该综述在PROSPERO (CRD42021242431)前瞻性注册。结果:共纳入10项随机对照试验和3项观察性研究,其中有一个对照组。9项随机对照试验的荟萃分析表明,与常规护理相比,在肺部筛查项目期间提供的戒烟干预措施增加了戒烟率(优势比:2.01,95%:1.49-2.72 p < 0.001)。6项使用强化(≥3次行为咨询)干预的随机对照试验显示,与常规护理相比,戒烟率更高(OR: 2.11, 95% CI 1.53-2.90, p < 0.001)。对两项随机对照试验的荟萃分析发现,强化干预比非强化干预更有效(OR: 2.07, 95%CI 1.26-3.40 p = 0.004),对两项非强化干预(≤2次行为咨询或仅限于在线信息音频带回家材料,如小册子)的荟萃分析没有显示出比常规护理更高的戒烟率(OR: 0.90, 95%CI 0.39-2.08 p = 0.80)。讨论:与常规护理相比,中等质量的证据支持在肺部筛查设置中提供戒烟干预措施,高质量的证据表明更密集的干预措施可能最有效。
{"title":"Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis.","authors":"Parris J Williams, Keir Ej Philip, Saeed M Alghamdi, Alexis M Perkins, Sara C Buttery, Michael I Polkey, Anthony A Laverty, Nicholas S Hopkinson","doi":"10.1177/14799731231183446","DOIUrl":"https://doi.org/10.1177/14799731231183446","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established.</p><p><strong>Methods: </strong>We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431).</p><p><strong>Results: </strong>10 randomised controlled trials and three observational studies with a control group were identified. Meta-analysis of nine RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (odds ratios: 2.01, 95%: 1.49-2.72 <i>p</i> < 0.001). Six RCTs using intensive (≥3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53-2.90, <i>p</i> < 0.001). A meta-analysis of two RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26-3.40 <i>p</i> = 0.004), Meta-analysis of two RCTs of non-intensive interventions (≤2 behavioural counselling sessions or limited to online information audio take home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39-2.08 <i>p</i> = 0.80).</p><p><strong>Discussion: </strong>Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231183446"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/00/10.1177_14799731231183446.PMC10286547.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9699432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/14799731231172518
Aneisha Collins-Fairclough, Prabjit Barn, A J Hirsch-Allen, Karen Rideout, Erin M Shellington, Winnie Lo, Tony Lanier, Jim Johnson, Adam Butcher, Sian-Hoe Cheong, Carmen Rempel, Nardia Strydom, Pat G Camp, Christopher Carlsten
Patients' perspectives on the impact of the COVID-19 pandemic on their access to asthma and COPD healthcare could inform better, more equitable care delivery. We demonstrate this topic using British Columbia (BC), Canada, where the impact of the pandemic has not been described. We co-designed a cross-sectional survey with patient partners and administered it to a convenience sample of people living with asthma and COPD in BC between September 2020 and March 2021. We aimed to understand how access to healthcare for these conditions was affected during the pandemic. The survey asked respondents to report their characteristics, access to healthcare for asthma and COPD, types of services they found disrupted and telehealth (telephone or video appointment) use during the pandemic. We analysed 433 responses and found that access to healthcare for asthma and COPD was lower during the pandemic than pre-pandemic (p < 0.001). Specialty care services were most frequently reported as disrupted, while primary care, home care and diagnostics were least disrupted. Multivariable logistic regression revealed that access during the pandemic was positively associated with self-assessed financial ability (OR = 22.0, 95% CI: 7.0 - 84.0, p < 0.001, reference is disagreeing with having financial ability) and living in medium-sized urban areas (OR = 2.3, 95% CI: 1.0 - 5.2, p = 0.04, reference is rural areas). These disparities in access should be validated post-pandemic to confirm whether they still persist. They also indicate the continued relevance of exploring approaches for more equitable healthcare.
{"title":"Disparities in self-reported healthcare access for airways disease in British Columbia, Canada, during the COVID-19 pandemic. Insights from a survey co-developed with people living with asthma and chronic obstructive pulmonary disease.","authors":"Aneisha Collins-Fairclough, Prabjit Barn, A J Hirsch-Allen, Karen Rideout, Erin M Shellington, Winnie Lo, Tony Lanier, Jim Johnson, Adam Butcher, Sian-Hoe Cheong, Carmen Rempel, Nardia Strydom, Pat G Camp, Christopher Carlsten","doi":"10.1177/14799731231172518","DOIUrl":"https://doi.org/10.1177/14799731231172518","url":null,"abstract":"<p><p>Patients' perspectives on the impact of the COVID-19 pandemic on their access to asthma and COPD healthcare could inform better, more equitable care delivery. We demonstrate this topic using British Columbia (BC), Canada, where the impact of the pandemic has not been described. We co-designed a cross-sectional survey with patient partners and administered it to a convenience sample of people living with asthma and COPD in BC between September 2020 and March 2021. We aimed to understand how access to healthcare for these conditions was affected during the pandemic. The survey asked respondents to report their characteristics, access to healthcare for asthma and COPD, types of services they found disrupted and telehealth (telephone or video appointment) use during the pandemic. We analysed 433 responses and found that access to healthcare for asthma and COPD was lower during the pandemic than pre-pandemic (<i>p</i> < 0.001). Specialty care services were most frequently reported as disrupted, while primary care, home care and diagnostics were least disrupted. Multivariable logistic regression revealed that access during the pandemic was positively associated with self-assessed financial ability (OR = 22.0, 95% CI: 7.0 - 84.0, <i>p</i> < 0.001, reference is disagreeing with having financial ability) and living in medium-sized urban areas (OR = 2.3, 95% CI: 1.0 - 5.2, <i>p</i> = 0.04, reference is rural areas). These disparities in access should be validated post-pandemic to confirm whether they still persist. They also indicate the continued relevance of exploring approaches for more equitable healthcare.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231172518"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/4e/10.1177_14799731231172518.PMC10184213.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9479245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The rationale for additional treatment with short-acting bronchodilators combined with long-acting bronchodilators for patients with chronic obstructive pulmonary disease (COPD) is not adequately studied.
Methods: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of a short-acting muscarinic antagonist (SAMA) therapy combined with a long-acting beta-2 agonist (LABA) in patients with stable COPD. Pulmonary function, dyspnea, health-related quality of life, exercise tolerance, physical activity, exacerbations of COPD, and adverse events during regular use were set as outcomes of interest.
Results: We included five controlled trials including two sets of publicly available online data without article publications for the meta-analysis. Additional use of SAMA plus LABA showed a significant improvement in the peak response in FEV1 (mean difference (MD) 98.70 mL, p < .00001), transitional dyspnea index score (MD .85, p = .02), and St George's Respiratory Questionnaire score (MD -2.00, p = .008) compared to LABA treatment. There was no significant difference in the risk of exacerbation of COPD (p = .20) and only a slight trend of increased severe adverse events (OR: 2.16, p = .08) and cardiovascular events (OR: 2.38, p = .06).
Conclusion: Additional treatment with SAMA combined with LABA could be a feasible choice due to its efficacy and safety.
背景:短效支气管扩张剂联合长效支气管扩张剂对慢性阻塞性肺疾病(COPD)患者进行额外治疗的理由尚未得到充分研究。方法:我们进行了系统回顾和荟萃分析,以评估短效毒蕈碱拮抗剂(SAMA)联合长效β -2激动剂(LABA)治疗稳定期COPD患者的疗效和安全性。肺功能、呼吸困难、健康相关生活质量、运动耐量、体力活动、COPD恶化和常规使用期间的不良事件被设定为感兴趣的结果。结果:我们纳入了五项对照试验,其中包括两组公开可获得的在线数据,但没有发表文章进行meta分析。与LABA治疗相比,额外使用SAMA + LABA治疗在FEV1(平均差值(MD) 98.70 mL, p < 0.00001)、过渡性呼吸困难指数评分(MD) 0.85, p = 0.02)和圣乔治呼吸问卷评分(MD -2.00, p = 0.008)的峰值反应方面均有显著改善。两组COPD恶化风险无显著差异(p = 0.20),严重不良事件(OR: 2.16, p = 0.08)和心血管事件(OR: 2.38, p = 0.06)略有增加趋势。结论:SAMA联合LABA是一种有效、安全的治疗方法。
{"title":"The efficacy and safety of additional treatment with short-acting muscarinic antagonist combined with long-acting beta-2 agonist in stable patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis.","authors":"Kazuya Tanimura, Susumu Sato, Yukio Fujita, Yoshifumi Yamamoto, Takashi Hajiro, Nobuyuki Horita, Tomotaka Kawayama, Shigeo Muro","doi":"10.1177/14799731231166008","DOIUrl":"https://doi.org/10.1177/14799731231166008","url":null,"abstract":"<p><strong>Background: </strong>The rationale for additional treatment with short-acting bronchodilators combined with long-acting bronchodilators for patients with chronic obstructive pulmonary disease (COPD) is not adequately studied.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of a short-acting muscarinic antagonist (SAMA) therapy combined with a long-acting beta-2 agonist (LABA) in patients with stable COPD. Pulmonary function, dyspnea, health-related quality of life, exercise tolerance, physical activity, exacerbations of COPD, and adverse events during regular use were set as outcomes of interest.</p><p><strong>Results: </strong>We included five controlled trials including two sets of publicly available online data without article publications for the meta-analysis. Additional use of SAMA plus LABA showed a significant improvement in the peak response in FEV<sub>1</sub> (mean difference (MD) 98.70 mL, <i>p</i> < .00001), transitional dyspnea index score (MD .85, <i>p</i> = .02), and St George's Respiratory Questionnaire score (MD -2.00, <i>p</i> = .008) compared to LABA treatment. There was no significant difference in the risk of exacerbation of COPD (<i>p</i> = .20) and only a slight trend of increased severe adverse events (OR: 2.16, <i>p</i> = .08) and cardiovascular events (OR: 2.38, <i>p</i> = .06).</p><p><strong>Conclusion: </strong>Additional treatment with SAMA combined with LABA could be a feasible choice due to its efficacy and safety.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231166008"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/d6/10.1177_14799731231166008.PMC10052583.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9210724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/14799731231220058
Carlos A Amado, Paula Martín-Audera, Juan Agüero, Diego Ferrer-Pargada, Begoña Josa Laorden, Daymara Boucle, Ana Berja, Bernardo A Lavín, Armando R Guerra, Cristina Ghadban, Pedro Muñoz, Mayte García-Unzueta
Background: Chronic obstructive pulmonary disease (COPD) exacerbation (ECOPD) alters the natural course of the disease. To date, only C-reactive protein has been used as a biomarker in ECOPD, but it has important limitations. The mitochondria release peptides (Humanin (HN), FGF-21, GDF-15, MOTS-c and Romo1) under certain metabolic conditions. Here, we aimed to evaluate the pathophysiologic, diagnostic and prognostic value of measuring serum mitochondrial peptides at hospital admission in patients with ECOPD.
Methods: A total of 51 consecutive patients admitted to our hospital for ECOPD were included and followed for 1 year; in addition, 160 participants with stable COPD from our out-patient clinic were recruited as controls.
Results: Serum FGF-21 (p < .001), MOTS-c (p < .001) and Romo1 (p = .002) levels were lower, and GDF-15 (p < .001) levels were higher, in patients with ECOPD than stable COPD, but no differences were found in HN. In receiver operating characteristic analysis, MOTS-c (AUC 0.744, 95% CI 0.679-0.802, p < .001) and GDF-15 (AUC 0.735, 95% CI 0.670-0.793, p < .001) had the best diagnostic power for ECOPD, with a diagnostic accuracy similar to that of C-RP (AUC 0.796 95% IC 0.735-0.848, p < .001). FGF-21 (AUC 0.700, 95% CI 0.633-0.761, p < .001) and Romo1 (AUC 0.645 95% CI 0.573-0.712, p = .001) had lower diagnostic accuracy. HN levels did not differentiate patients with ECOPD versus stable COPD (p = .557). In Cox regression analysis, HN (HR 2.661, CI95% 1.009-7.016, p = .048) and MOTS-c (HR 3.441, CI95% 1.252-9.297, p = .016) levels exceeding mean levels were independent risk factors for re-admission.
Conclusions: Most mitochondrial peptides are altered in ECOPD, as compared with stable COPD. MOTS-c and GDF15 levels have a diagnostic accuracy similar to C-RP for ECOPD. HN and MOTS-c independently predict future re-hospitalization.
{"title":"Alterations in circulating mitochondrial signals at hospital admission for COPD exacerbation.","authors":"Carlos A Amado, Paula Martín-Audera, Juan Agüero, Diego Ferrer-Pargada, Begoña Josa Laorden, Daymara Boucle, Ana Berja, Bernardo A Lavín, Armando R Guerra, Cristina Ghadban, Pedro Muñoz, Mayte García-Unzueta","doi":"10.1177/14799731231220058","DOIUrl":"10.1177/14799731231220058","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) exacerbation (ECOPD) alters the natural course of the disease. To date, only C-reactive protein has been used as a biomarker in ECOPD, but it has important limitations. The mitochondria release peptides (Humanin (HN), FGF-21, GDF-15, MOTS-c and Romo1) under certain metabolic conditions. Here, we aimed to evaluate the pathophysiologic, diagnostic and prognostic value of measuring serum mitochondrial peptides at hospital admission in patients with ECOPD.</p><p><strong>Methods: </strong>A total of 51 consecutive patients admitted to our hospital for ECOPD were included and followed for 1 year; in addition, 160 participants with stable COPD from our out-patient clinic were recruited as controls.</p><p><strong>Results: </strong>Serum FGF-21 (<i>p</i> < .001), MOTS-c (<i>p</i> < .001) and Romo1 (<i>p</i> = .002) levels were lower, and GDF-15 (<i>p</i> < .001) levels were higher, in patients with ECOPD than stable COPD, but no differences were found in HN. In receiver operating characteristic analysis, MOTS-c (AUC 0.744, 95% CI 0.679-0.802, <i>p</i> < .001) and GDF-15 (AUC 0.735, 95% CI 0.670-0.793, <i>p</i> < .001) had the best diagnostic power for ECOPD, with a diagnostic accuracy similar to that of C-RP (AUC 0.796 95% IC 0.735-0.848, <i>p</i> < .001). FGF-21 (AUC 0.700, 95% CI 0.633-0.761, <i>p</i> < .001) and Romo1 (AUC 0.645 95% CI 0.573-0.712, <i>p</i> = .001) had lower diagnostic accuracy. HN levels did not differentiate patients with ECOPD versus stable COPD (<i>p</i> = .557). In Cox regression analysis, HN (HR 2.661, CI95% 1.009-7.016, <i>p</i> = .048) and MOTS-c (HR 3.441, CI95% 1.252-9.297, <i>p</i> = .016) levels exceeding mean levels were independent risk factors for re-admission.</p><p><strong>Conclusions: </strong>Most mitochondrial peptides are altered in ECOPD, as compared with stable COPD. MOTS-c and GDF15 levels have a diagnostic accuracy similar to C-RP for ECOPD. HN and MOTS-c independently predict future re-hospitalization.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231220058"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10734331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/14799731231174542
Brooke P Quertermous, Nichole Seigler, Jacob Looney, Reva Crandall, Abigayle B Simon, Marsha Blackburn, Cassandra C Derella, Anson Blanks, Kathleen T McKie, Caralee Forseen, Ryan A Harris
Introduction: Glycated hemoglobin can interfere with oxygen delivery and CO2 removal during exercise. Additionally, pancreatic insufficiency increases oxidative stress and exacerbates exercise intolerance in people with cystic fibrosis (PwCF). This investigation sought to test the hypotheses that elevated Hemoglobin A1c (HbA1c) can negatively affect exercise parameters in PwCF and that reductions in oxidative stress can improve tissue oxygenation in individuals with elevated HbA1c.
Methods: Twenty four PwCF were divided into two groups; normal HbA1c <5.7% (N-HbA1c) and elevated HbA1c >5.7% (E-HbA1c). A maximal exercise test was conducted to obtain peak oxygen uptake (VO2peak), VO2 at ventilatory threshold (VT), ventilatory parameters (VE/VCO2 slope and end-tidal CO2 (petCO2)). Near-Infrared Spectroscopy (NIRS) was used to assess muscle oxygenated/deoxygenated hemoglobin during exercise. A subset of individuals with E-HbA1cwere given an antioxidant cocktail (AOC) for 4 weeks to determine the effects on tissue oxygenation during exercise.
Results: A negative relationship between HbA1c and VO2peak at VT was observed (r = -0.511; p = 0.018). In addition, a positive relationship between HbA1c and VE/VCO2 slope (r = 0.587;p = 0.005) and a negative relationship between HbA1c and petCO2 at maximal exercise (r = -0.472;p = 0.031) was observed. N-HbA1c had greater VO2peak (p = 0.021), VO2 at VT (p = 0.004), petCO2 (p = 0.002), and lower VE/VCO2 slope (p = 0.004) compared with E-HbA1c. Muscle deoxygenated hemoglobin at VT was higher in N-HbA1c vs. E-HbA1c and 4 weeks of AOC improved skeletal muscle utilization of oxygen.
Conclusion: Findings demonstrate that glycated hemoglobin may lead to tissue oxygenation impairment and ventilation inefficiency during exercise in PwCF. In addition, antioxidant supplementation may lead to improved tissue oxygenation during exercise.
{"title":"Muscle oxygen utilization and ventilatory parameters during exercise in people with cystic fibrosis: Role of HbA<sub>1c</sub>.","authors":"Brooke P Quertermous, Nichole Seigler, Jacob Looney, Reva Crandall, Abigayle B Simon, Marsha Blackburn, Cassandra C Derella, Anson Blanks, Kathleen T McKie, Caralee Forseen, Ryan A Harris","doi":"10.1177/14799731231174542","DOIUrl":"https://doi.org/10.1177/14799731231174542","url":null,"abstract":"<p><strong>Introduction: </strong>Glycated hemoglobin can interfere with oxygen delivery and CO<sub>2</sub> removal during exercise. Additionally, pancreatic insufficiency increases oxidative stress and exacerbates exercise intolerance in people with cystic fibrosis (PwCF). This investigation sought to test the hypotheses that elevated Hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) can negatively affect exercise parameters in PwCF and that reductions in oxidative stress can improve tissue oxygenation in individuals with elevated HbA<sub>1c</sub>.</p><p><strong>Methods: </strong>Twenty four PwCF were divided into two groups; normal HbA1c <5.7% (N-HbA<sub>1c</sub>) and elevated HbA<sub>1c</sub> >5.7% (E-HbA<sub>1c</sub>). A maximal exercise test was conducted to obtain peak oxygen uptake (VO<sub>2</sub>peak), VO<sub>2</sub> at ventilatory threshold (VT), ventilatory parameters (V<sub>E</sub>/VCO<sub>2</sub> slope and end-tidal CO<sub>2</sub> (petCO<sub>2</sub>)). Near-Infrared Spectroscopy (NIRS) was used to assess muscle oxygenated/deoxygenated hemoglobin during exercise. A subset of individuals with E-HbA<sub>1c</sub>were given an antioxidant cocktail (AOC) for 4 weeks to determine the effects on tissue oxygenation during exercise.</p><p><strong>Results: </strong>A negative relationship between HbA<sub>1c</sub> and VO<sub>2</sub>peak at VT was observed (r = -0.511; <i>p</i> = 0.018). In addition, a positive relationship between HbA<sub>1c</sub> and V<sub>E</sub>/VCO<sub>2</sub> slope (<i>r =</i> 0.587;<i>p</i> = 0.005) and a negative relationship between HbA<sub>1c</sub> and petCO<sub>2</sub> at maximal exercise (<i>r</i> = -0.472<i>;p =</i> 0.031) was observed. N-HbA<sub>1c</sub> had greater VO<sub>2</sub>peak (<i>p</i> = 0.021), VO<sub>2</sub> at VT (<i>p</i> = 0.004), petCO<sub>2</sub> (<i>p =</i> 0.002), and lower V<sub>E</sub>/VCO<sub>2</sub> slope (<i>p</i> = 0.004) compared with E-HbA<sub>1c</sub>. Muscle deoxygenated hemoglobin at VT was higher in N-HbA<sub>1c</sub> vs. E-HbA<sub>1c</sub> and 4 weeks of AOC improved skeletal muscle utilization of oxygen.</p><p><strong>Conclusion: </strong>Findings demonstrate that glycated hemoglobin may lead to tissue oxygenation impairment and ventilation inefficiency during exercise in PwCF. In addition, antioxidant supplementation may lead to improved tissue oxygenation during exercise.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231174542"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/e3/10.1177_14799731231174542.PMC10184196.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9562038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/14799731231159673
Linda Rogers, Cecile Tj Holweg, Hooman Pazwash, Jinnie Ko, Samuel Louie
Trial registration: These studies were conducted before clinical trial registration was required; therefore, clinical trial registration numbers are not available.
试验注册:这些研究是在需要临床试验注册之前进行的;因此,临床试验注册号不可用。
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Pub Date : 2023-01-01DOI: 10.1177/14799731231221819
Tanja W Effing
This paper describes developments in the fields of asthma and COPD self-management interventions (SMIs) over the last two decades and discusses future directions. Evidence around SMIs has exponentially grown. Efficacy on group level is convincing and both asthma and COPD SMIs are currently recommended by respiratory guidelines. Core components of asthma SMIs are defined as education, action plans, and regular review, with some discussion about self-monitoring. Exacerbation action plans are defined as an integral part of COPD management. Patient's adherence to SMI's is however inadequate and significantly reducing the intervention's impact. Adherence could be improved by tailoring of SMIs to patients' needs, health beliefs, and capabilities; the use of shared decision making; and optimising the communication between patients and health care providers. Due to the COVID-19 pandemic, digital health innovations have rapidly been introduced and expanded. Digital technology use may increase efficiency, flexibility, and efficacy of SMIs. Furthermore, artificial intelligence can be used to e.g., predict exacerbations in action plans. Research around digital health innovations to ensure evidence-based practice is of utmost importance. Current implementation of respiratory SMIs is not satisfactory. Implementation research should be used to generate further insights, with cost-effectiveness, policy (makers), and funding being significant determinants.
{"title":"Developments in respiratory self-management interventions over the last two decades.","authors":"Tanja W Effing","doi":"10.1177/14799731231221819","DOIUrl":"10.1177/14799731231221819","url":null,"abstract":"<p><p>This paper describes developments in the fields of asthma and COPD self-management interventions (SMIs) over the last two decades and discusses future directions. Evidence around SMIs has exponentially grown. Efficacy on group level is convincing and both asthma and COPD SMIs are currently recommended by respiratory guidelines. Core components of asthma SMIs are defined as education, action plans, and regular review, with some discussion about self-monitoring. Exacerbation action plans are defined as an integral part of COPD management. Patient's adherence to SMI's is however inadequate and significantly reducing the intervention's impact. Adherence could be improved by tailoring of SMIs to patients' needs, health beliefs, and capabilities; the use of shared decision making; and optimising the communication between patients and health care providers. Due to the COVID-19 pandemic, digital health innovations have rapidly been introduced and expanded. Digital technology use may increase efficiency, flexibility, and efficacy of SMIs. Furthermore, artificial intelligence can be used to e.g., predict exacerbations in action plans. Research around digital health innovations to ensure evidence-based practice is of utmost importance. Current implementation of respiratory SMIs is not satisfactory. Implementation research should be used to generate further insights, with cost-effectiveness, policy (makers), and funding being significant determinants.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231221819"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/14799731231165305
Dmitry Rozenberg
The rehabilitation needs of patients undergoing thoracic surgery are evolving over the last two decades. Surgical management is being undertaken for older patients and those with increased co-morbidities, which are established risk factors for functional limitations peri-operatively. Thus, there is a growing need to understand the implications of pre-operative function, peri-operative course and preand post-operative rehabilitation strategies. This special collection of articles highlights keys areas in preand postthoracic surgical rehabilitation focusing on principles of frailty, skeletal muscle function, gait, balance, physical activity levels, and surgical outcomes. A narrative review by Daniel Langer summarizes the landscape of rehabilitation in thoracic surgery focusing on interventions that aim to optimize physical function preoperatively and recovery in the post-operative period. This review highlights that the majority of the evidence is in the areas of thoracic oncology and lung transplantation. It also reinforces that rehabilitation programs can be beneficial in improving skeletal muscle function, exercise capacity, quality of life, and functional recovery, but there remains a lack of guidelines with respect to training regimens, duration and referral pathways. The review identifies gaps that could be addressed in the future including opportunities for tele-rehabilitation, web-based activity counselling, and rehabilitation strategies beyond the immediate post-operative period. An article by Hanada et al. extends our knowledge on the importance of pre-operative physical function. Hanada and colleagues demonstrate in a prospective multicentered study of 364 older adults (> 65 years) undergoing elective surgical resection for lung cancer in Japan, that a reduced Short Physical Performance Battery (SPPB < 10 out of 12) was associated with post-operative pulmonary complications. The SPPB captures three functional domains (balance, gait speed and chair stands), which have been shown to be important elements of physical and lower extremity function predictive of surgical outcomes in gastrointestinal and lung transplant populations. The premise is pre-operative physical fitness correlates with cardiorespiratory, musculoskeletal, and physiological reserve that can help mitigate surgical stressors. Pre-operative physical function can help with earlier post-operative mobilization, improved airway clearance and ventilatory mechanics that can help reduce postoperative pulmonary complications. Similarly, a study by Roy et al. highlights the importance of underlying chronic lung disease on post-surgical outcomes, given the high prevalence of chronic obstructive pulmonary disease (COPD) in patients undergoing surgical lung cancer resection. Of the 1126 patients included in their study cohort, 672 (60%) had COPD. The authors highlight that following surgical lung cancer resection, patients with COPD are at higher risk of all cause morbidity, including r
{"title":"Rehabilitation pre- and post thoracic surgery: Progress and future opportunities.","authors":"Dmitry Rozenberg","doi":"10.1177/14799731231165305","DOIUrl":"https://doi.org/10.1177/14799731231165305","url":null,"abstract":"The rehabilitation needs of patients undergoing thoracic surgery are evolving over the last two decades. Surgical management is being undertaken for older patients and those with increased co-morbidities, which are established risk factors for functional limitations peri-operatively. Thus, there is a growing need to understand the implications of pre-operative function, peri-operative course and preand post-operative rehabilitation strategies. This special collection of articles highlights keys areas in preand postthoracic surgical rehabilitation focusing on principles of frailty, skeletal muscle function, gait, balance, physical activity levels, and surgical outcomes. A narrative review by Daniel Langer summarizes the landscape of rehabilitation in thoracic surgery focusing on interventions that aim to optimize physical function preoperatively and recovery in the post-operative period. This review highlights that the majority of the evidence is in the areas of thoracic oncology and lung transplantation. It also reinforces that rehabilitation programs can be beneficial in improving skeletal muscle function, exercise capacity, quality of life, and functional recovery, but there remains a lack of guidelines with respect to training regimens, duration and referral pathways. The review identifies gaps that could be addressed in the future including opportunities for tele-rehabilitation, web-based activity counselling, and rehabilitation strategies beyond the immediate post-operative period. An article by Hanada et al. extends our knowledge on the importance of pre-operative physical function. Hanada and colleagues demonstrate in a prospective multicentered study of 364 older adults (> 65 years) undergoing elective surgical resection for lung cancer in Japan, that a reduced Short Physical Performance Battery (SPPB < 10 out of 12) was associated with post-operative pulmonary complications. The SPPB captures three functional domains (balance, gait speed and chair stands), which have been shown to be important elements of physical and lower extremity function predictive of surgical outcomes in gastrointestinal and lung transplant populations. The premise is pre-operative physical fitness correlates with cardiorespiratory, musculoskeletal, and physiological reserve that can help mitigate surgical stressors. Pre-operative physical function can help with earlier post-operative mobilization, improved airway clearance and ventilatory mechanics that can help reduce postoperative pulmonary complications. Similarly, a study by Roy et al. highlights the importance of underlying chronic lung disease on post-surgical outcomes, given the high prevalence of chronic obstructive pulmonary disease (COPD) in patients undergoing surgical lung cancer resection. Of the 1126 patients included in their study cohort, 672 (60%) had COPD. The authors highlight that following surgical lung cancer resection, patients with COPD are at higher risk of all cause morbidity, including r","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231165305"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/b7/10.1177_14799731231165305.PMC10031604.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9204077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1177/14799731231222282
Sang Hyuk Kim, Kyungdo Han, Jongkyu Park, Dong Won Park, Ji-Yong Moon, Yun Su Sim, Tae-Hyung Kim, Sang-Heon Kim, Jang Won Sohn, Ho Joo Yoon, Hyun Lee, Hayoung Choi
Background: Chronic lung diseases, such as chronic obstructive pulmonary disease or asthma, are associated with an increased risk of dementia. However, few data are available regarding the risk of dementia in individuals with bronchiectasis.
Objectives: To explore the association between bronchiectasis and the risk of incident dementia using a longitudinal population-based cohort.
Methods: A total of 4,068,560 adults older than 50 years without previous dementia were enrolled from the Korean National Health Insurance Service database in 2009. They were followed up until the date of the diagnosis of dementia or December 31, 2020. The study exposure was the diagnosis of bronchiectasis, and the primary outcome was incident dementia comprising Alzheimer's disease and vascular dementia.
Results: During the median follow-up duration of 9.3 years, the incidence of all-cause dementia was 1.6-fold higher in individuals with bronchiectasis than in those without bronchiectasis (15.0 vs. 9.3/1000 person-years, p < .001). In the multivariable Cox regression analysis, the risk of all dementia was significantly higher in individuals with bronchiectasis than in those without bronchiectasis (adjusted hazard ratio [aHR] 1.09, 95% confidence interval [CI] 1.04-1.14). In a subgroup analysis by dementia type, individuals with bronchiectasis had an increased risk of Alzheimer's disease compared to those without bronchiectasis (aHR 1.07, 95% CI 1.01-1.12); the risk of vascular dementia did not significantly differ between the two groups (aHR 1.05, 95% CI 0.90-1.21).
Conclusion: Bronchiectasis was associated with an increased risk of dementia, especially Alzheimer's disease.
背景:慢性肺部疾病(如慢性阻塞性肺病或哮喘)与痴呆症风险增加有关。然而,有关支气管扩张症患者痴呆症风险的数据却很少:采用纵向人群队列研究支气管扩张症与痴呆症发病风险之间的关系:方法:2009年,韩国国民健康保险服务数据库共登记了4,068,560名50岁以上无痴呆症史的成年人。对他们进行了随访,直至确诊痴呆症之日或 2020 年 12 月 31 日。研究暴露是支气管扩张症的诊断,主要结果是包括阿尔茨海默病和血管性痴呆在内的痴呆事件:结果:在中位 9.3 年的随访期间,支气管扩张症患者的全因痴呆症发病率是无支气管扩张症患者的 1.6 倍(15.0 vs. 9.3/1000 人年,p < .001)。在多变量考克斯回归分析中,支气管扩张症患者罹患所有痴呆症的风险显著高于无支气管扩张症患者(调整后危险比 [aHR] 1.09,95% 置信区间 [CI] 1.04-1.14)。在按痴呆类型进行的亚组分析中,与无支气管扩张症患者相比,支气管扩张症患者罹患阿尔茨海默病的风险增加(aHR 1.07,95% CI 1.01-1.12);两组患者罹患血管性痴呆的风险没有显著差异(aHR 1.05,95% CI 0.90-1.21):结论:支气管扩张症与痴呆症(尤其是阿尔茨海默病)风险增加有关。
{"title":"Association between non-cystic fibrosis bronchiectasis and the risk of incident dementia: A nationwide cohort study.","authors":"Sang Hyuk Kim, Kyungdo Han, Jongkyu Park, Dong Won Park, Ji-Yong Moon, Yun Su Sim, Tae-Hyung Kim, Sang-Heon Kim, Jang Won Sohn, Ho Joo Yoon, Hyun Lee, Hayoung Choi","doi":"10.1177/14799731231222282","DOIUrl":"https://doi.org/10.1177/14799731231222282","url":null,"abstract":"<p><strong>Background: </strong>Chronic lung diseases, such as chronic obstructive pulmonary disease or asthma, are associated with an increased risk of dementia. However, few data are available regarding the risk of dementia in individuals with bronchiectasis.</p><p><strong>Objectives: </strong>To explore the association between bronchiectasis and the risk of incident dementia using a longitudinal population-based cohort.</p><p><strong>Methods: </strong>A total of 4,068,560 adults older than 50 years without previous dementia were enrolled from the Korean National Health Insurance Service database in 2009. They were followed up until the date of the diagnosis of dementia or December 31, 2020. The study exposure was the diagnosis of bronchiectasis, and the primary outcome was incident dementia comprising Alzheimer's disease and vascular dementia.</p><p><strong>Results: </strong>During the median follow-up duration of 9.3 years, the incidence of all-cause dementia was 1.6-fold higher in individuals with bronchiectasis than in those without bronchiectasis (15.0 vs. 9.3/1000 person-years, <i>p</i> < .001). In the multivariable Cox regression analysis, the risk of all dementia was significantly higher in individuals with bronchiectasis than in those without bronchiectasis (adjusted hazard ratio [aHR] 1.09, 95% confidence interval [CI] 1.04-1.14). In a subgroup analysis by dementia type, individuals with bronchiectasis had an increased risk of Alzheimer's disease compared to those without bronchiectasis (aHR 1.07, 95% CI 1.01-1.12); the risk of vascular dementia did not significantly differ between the two groups (aHR 1.05, 95% CI 0.90-1.21).</p><p><strong>Conclusion: </strong>Bronchiectasis was associated with an increased risk of dementia, especially Alzheimer's disease.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231222282"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10725102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138799457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}