Pub Date : 2019-07-24DOI: 10.15326/jcopdf.6.3.2019.0142
B. Bender
Treatment of respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma, depends primarily on inhaled medications. Because of the complexity of inhaled medication delivery, patients’ mastery of inhalers presents a major challenge to these treatments. Further, the skill requirements vary across medication devices, including metered-dose inhalers (MDIs), breath-activated MDIs, soft-mist inhalers, dry-powder inhalers (DPIs), and nebulizers, adding further potential confusion for both prescribers and patients. A large body of literature has documented the frequency of patient inhaler errors and the correlation of these with worsening outcomes1 accounting for nearly $900 million in direct and indirect costs.2 The manuscript by Cho-Reyes et al in this issue of the Journal of the COPD Foundation adds to this literature, combining a systematic review and meta-analysis. Ten previously published reports including 1360 patients revealed that 86.7% of patients made at least 1 inhalation technique error, and that 76.8% of patients made multiple errors. These results confirm a previous report of 54 studies showing that 86.8% of patients using an MDI and 60.9% of patients using a DPI made at least 1 error.3
{"title":"Editorial--How Important Are Inhaler Technique Errors?","authors":"B. Bender","doi":"10.15326/jcopdf.6.3.2019.0142","DOIUrl":"https://doi.org/10.15326/jcopdf.6.3.2019.0142","url":null,"abstract":"Treatment of respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma, depends primarily on inhaled medications. Because of the complexity of inhaled medication delivery, patients’ mastery of inhalers presents a major challenge to these treatments. Further, the skill requirements vary across medication devices, including metered-dose inhalers (MDIs), breath-activated MDIs, soft-mist inhalers, dry-powder inhalers (DPIs), and nebulizers, adding further potential confusion for both prescribers and patients. A large body of literature has documented the frequency of patient inhaler errors and the correlation of these with worsening outcomes1 accounting for nearly $900 million in direct and indirect costs.2 The manuscript by Cho-Reyes et al in this issue of the Journal of the COPD Foundation adds to this literature, combining a systematic review and meta-analysis. Ten previously published reports including 1360 patients revealed that 86.7% of patients made at least 1 inhalation technique error, and that 76.8% of patients made multiple errors. These results confirm a previous report of 54 studies showing that 86.8% of patients using an MDI and 60.9% of patients using a DPI made at least 1 error.3","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"31 1","pages":"203-205"},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89871561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-24DOI: 10.15326/jcopdf.6.3.2019.0143
R. Balkissoon
In the last few months I have seen 2 patients who presented with significant respiratory symptoms, (cough, shortness of breath and chest pain) that they temporally associated with use of electronic cigarettes (e-cigarettes). They were relatively new to e-cigarette use: one was a former cigarette smoker and the other was a never smoker but had a history of asthma. The severity of their symptoms had abated but they still had residual symptoms and were worried about the long-term consequences. When I went to review the literature regarding the latest data on the long-term health risks of using e-cigarettes, I noted an explosion of information being published in just the past few years. It is clear there is a great deal of controversy and concern about the introduction of these products into the marketplace without sufficient information about potential health risks nor adequate regulation over their indications, contents, and the technology used to generate their aerosol. Currently there are regular advertisements for e-cigarettes promoting them as viable and safe alternatives to cigarette smoking. One of the key initial promotions for these devices was as a smoking cessation tool despite an absence of any large double-blinded, randomized placebo-controlled trials to prove any superior efficacy to conventional smoking cessation strategies (such as nicotine replacement, bupropion hydrochloride, or the nicotine receptor partial agonists such as varenicline and counseling). More recently however, since their entry into the marketplace in the United States in 2006, manufacturers, many users, and some tobacco control experts, advocate e-cigarettes as a viable long-term harm reduction alternative to cigarette smoking without any long-term safety data. E-cigarettes have become a multi-billion-dollar industry (U.S. $ 11.3 billion in 2018) and projections suggest that their sales will surpass combustible cigarettes by 2023.1 There are few regulations concerning access to these devices and there is high utilization by teenagers and reports of use by middle school children.2 The question has been raised of whether these companies are specifically targeting this population with flavors such as “bubble gum.” There is also data to suggest that rather than reducing the risk of teenagers smoking cigarettes, use of e-cigarettes may act as a gateway to young people transitioning to smoking tobacco cigarettes. Recent studies show that adolescents and young adult e-cigarette users are at a 3 times greater risk of starting cigarette smoking compared to those who had never used e-cigarettes.3-8 (See abstracts below). The essential design of e-cigarettes includes an atomizer that uses an electrical current, generated by a battery, to heat a metal coil which aerosolizes the e-liquid conducted from a reservoir to the coil via a wick, typically made of cotton or silica. The user presses a button on the device, inhales and a plume of droplets carry the aerosol to the oroph
在过去的几个月里，我见过两名患者出现了明显的呼吸道症状(咳嗽、呼吸急促和胸痛)，他们暂时与使用电子烟(电子烟)有关。他们对电子烟的使用相对较新:一个是前吸烟者，另一个从不吸烟，但有哮喘史。他们的症状的严重程度已经减轻，但他们仍然有残余的症状，并担心长期后果。当我去查阅有关使用电子烟长期健康风险的最新数据的文献时，我注意到在过去几年里发表的信息激增。很明显，在没有充分了解潜在健康风险的情况下将这些产品引入市场，也没有对其适应症、内容和用于产生气溶胶的技术进行充分监管，这引起了很大的争议和担忧。目前，经常有电子烟广告宣传它们是可行和安全的香烟替代品。尽管没有任何大型双盲、随机安慰剂对照试验来证明这些设备比传统的戒烟策略(如尼古丁替代、盐酸安非他酮或尼古丁受体部分激动剂如伐尼克兰和咨询)更有效，但这些设备最初的主要推广是作为一种戒烟工具。然而，最近，自从电子烟于2006年进入美国市场以来，制造商、许多用户和一些烟草控制专家都主张，在没有任何长期安全数据的情况下，电子烟是一种可行的长期减少危害的替代品。电子烟已经成为一个价值数十亿美元的产业(2018年为113亿美元)，预测表明，到2023年，电子烟的销售额将超过可燃卷烟。关于使用这些设备的规定很少，青少年的使用率很高，中学生也有使用电子烟的报告人们提出的问题是，这些公司是否专门针对这一人群推出了“泡泡糖”等口味。也有数据表明，电子烟的使用可能会成为年轻人过渡到吸烟的途径，而不是降低青少年吸烟的风险。最近的研究表明，与从未使用过电子烟的人相比，青少年和年轻成人使用电子烟的人开始吸烟的风险要高3倍。3-8(见下文摘要)。电子烟的基本设计包括一个雾化器，它使用由电池产生的电流来加热金属线圈，金属线圈通过通常由棉花或二氧化硅制成的灯芯将电子液体从储存罐输送到线圈。用户按下设备上的一个按钮，吸气，一缕雾滴将气雾剂带到口咽部和呼吸道。电子烟已经从香烟的外观演变为新的工业设备，可以更好地控制雾化的输送、内容和性质以及电子液体的热量。大多数电子烟液体的典型成分是植物甘油、丙二醇、尼古丁、水、酒精、调味剂和各种其他物质。有些电子烟实际上不含尼古丁，但仍含有各种调味剂。人们一直认为，消除烟草焦油、烟雾颗粒和各种化学添加剂及其可燃副产品，使电子香烟成为一种更安全的替代品。虽然这很可能是真的，但重要的是要认识到，电子烟的各种成分都不是良性的，可能会对健康构成重大风险，而且对这些设备的内容和使用没有监管。最近的研究概述了尼古丁的潜在毒性作用(见下文)，包括增加气道高反应性、炎症、降低宿主防御能力和可能的心血管影响。虽然尼古丁不被认为是致癌物，但有研究表明它可能会致癌。15,16最近也有研究表明，慢性阻塞性肺疾病(COPD)患者可能更容易受到电子烟的潜在有害影响。有报道称，年仅5岁的儿童因摄入电子烟液体而死亡电子烟的尼古丁含量不断增加，有一个品牌提供的一种电子烟的尼古丁含量相当于20支香烟(一包)的47毫克。 20尼古丁极易上瘾，随着对中枢神经系统刺激的增加，有证据表明，使用这些电子烟不仅会导致一些从不吸烟的人过渡到使用烟草香烟(所谓的“入口”)3,21,22，而且还会导致使用大麻素等非法药物。14,23此外，对质量控制的研究表明，实际尼古丁浓度与标签上标明的浓度不一致。据报道，目前电子烟中使用的调味剂超过8000种。芳香醛化合物，如肉桂味，(肉桂醛)，杏仁味，(苯甲醛)和香草味(香草和香草乙基)，以及甲醛，吸入时具有潜在的毒性作用。2,20,28-30有报道称，其中一些调味剂已经与细支气管炎、肺泡炎和急性肺损伤有关。[1,31-33]据报道，双乙酰调味剂是微波爆米花制造工人引起毛细支气管炎的原因。34,35尽管人们已经知道双乙酰与肺损伤之间存在关联，但最近的一项研究发现，在159种被测试的“甜”电子烟中，有110种含有双乙酰。36,37据报道，电子烟的金属线圈含有不同数量的铬、锰、镍、铅、铜、银、锌和锡，灯芯可以由二氧化硅制成。38,39有人担心，某些设备提供的较高的温度设置可能导致这些不同金属的纳米颗粒(见下面的文章摘要)和来自电子液体中各种添加剂的丙烯醛15(一种已知的致癌物质)的演变。也有几起关于这些装置爆炸并造成重大伤害的报告因此，虽然电子烟确实可以帮助一些人从吸烟过渡到吸食尼古丁，但越来越多的证据表明，电子烟的成分，包括尼古丁本身，可能会对健康产生严重的不良后果。然而，关于长期使用这些设备的后果的信息很少，而且在内容、标签和获取方面，它们在很大程度上仍然不受监管。本杂志回顾的第一篇论文来自欧洲呼吸学会(ERS)烟草控制委员会关于电子烟的声明。特别工作组警告说，支持使用替代尼古丁输送产品戒烟的减少烟草危害战略尚未被证明与传统戒烟战略一样或更有效，并且是基于错误的假设和毫无根据或没有证据的主张ERS声明强调，缺乏证据支持电子烟和“加热不燃烧”烟草产品(消除烟草卷烟实际燃烧时产生的高温产生的可燃颗粒和其他成分)等尼古丁输送设备对帮助人们永久戒烟有效的说法，事实上，越来越多的证据表明它们实际上对健康有害。工作组敦促政策制定者和公共卫生机构重新评估涉及使用电子烟和加热烟草产品的戒烟计划，并指出工作组不能推荐这种方法作为一种有效的基于人群的战略。今年5月，在德克萨斯州达拉斯举行的最近一次美国胸科学会国际会议上，有许多关于电子烟的海报和讲座，还有一个大型科学研讨会，题为“让新一代上瘾:JUULing, Vaping, Heat Not Burn，调味剂以及我们应该非常关注的证据”。会议涵盖了上面列出的许多主题，组织者强调了在几个不同领域进行进一步研究的迫切需要。在本期刊俱乐部中，我们回顾了ERS特别工作组的报告和一些最近的研究，这些研究将电子烟作为一种减少戒烟危害的方法，这些新设备实际上可能对健康产生重大影响的可能性，电子烟导致从不吸烟的人成为吸烟的人的可能性，以及对研究的迫切需要的担忧，这些研究可以导致对这些产品的知情和适当的后续政策和监管。注意:摘要以其原始的出版格式呈现，未经过编辑以匹配JCOPDF格式。
{"title":"Journal Club-Electronic Cigarettes and Vaping as a Harm Reduction Alternative: Really?","authors":"R. Balkissoon","doi":"10.15326/jcopdf.6.3.2019.0143","DOIUrl":"https://doi.org/10.15326/jcopdf.6.3.2019.0143","url":null,"abstract":"In the last few months I have seen 2 patients who presented with significant respiratory symptoms, (cough, shortness of breath and chest pain) that they temporally associated with use of electronic cigarettes (e-cigarettes). They were relatively new to e-cigarette use: one was a former cigarette smoker and the other was a never smoker but had a history of asthma. The severity of their symptoms had abated but they still had residual symptoms and were worried about the long-term consequences. When I went to review the literature regarding the latest data on the long-term health risks of using e-cigarettes, I noted an explosion of information being published in just the past few years. It is clear there is a great deal of controversy and concern about the introduction of these products into the marketplace without sufficient information about potential health risks nor adequate regulation over their indications, contents, and the technology used to generate their aerosol. Currently there are regular advertisements for e-cigarettes promoting them as viable and safe alternatives to cigarette smoking. One of the key initial promotions for these devices was as a smoking cessation tool despite an absence of any large double-blinded, randomized placebo-controlled trials to prove any superior efficacy to conventional smoking cessation strategies (such as nicotine replacement, bupropion hydrochloride, or the nicotine receptor partial agonists such as varenicline and counseling). More recently however, since their entry into the marketplace in the United States in 2006, manufacturers, many users, and some tobacco control experts, advocate e-cigarettes as a viable long-term harm reduction alternative to cigarette smoking without any long-term safety data. E-cigarettes have become a multi-billion-dollar industry (U.S. $ 11.3 billion in 2018) and projections suggest that their sales will surpass combustible cigarettes by 2023.1 There are few regulations concerning access to these devices and there is high utilization by teenagers and reports of use by middle school children.2 The question has been raised of whether these companies are specifically targeting this population with flavors such as “bubble gum.” There is also data to suggest that rather than reducing the risk of teenagers smoking cigarettes, use of e-cigarettes may act as a gateway to young people transitioning to smoking tobacco cigarettes. Recent studies show that adolescents and young adult e-cigarette users are at a 3 times greater risk of starting cigarette smoking compared to those who had never used e-cigarettes.3-8 (See abstracts below). \u0000 \u0000The essential design of e-cigarettes includes an atomizer that uses an electrical current, generated by a battery, to heat a metal coil which aerosolizes the e-liquid conducted from a reservoir to the coil via a wick, typically made of cotton or silica. The user presses a button on the device, inhales and a plume of droplets carry the aerosol to the oroph","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"123 1","pages":"281-291"},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77099345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.15326/JCOPDF.3.4.2016.0137
G. Kinney, E. Baker, O. Klein, J. Black-Shinn, E. Wan, B. Make, E. Regan, R. Bowler, S. Lutz, K. Young, L. Duca, G. Washko, E. Silverman, J. Crapo, J. Hokanson
BACKGROUND Diabetes mellitus and its complications are a large and increasing burden for health care worldwide. Reduced pulmonary function has been observed in diabetes (both type 1 and type 2), and this reduction is thought to occur prior to diagnosis. Other measures of pulmonary health are associated with diabetes, including lower exercise tolerance, greater dyspnea, lower quality of life (as measured by the St. George's Respiratory Questionaire [SGRQ]) and susceptibility to lung infection and these measures may also predate diabetes diagnosis. METHODS We examined 7080 participants in the COPD Genetic Epidemiology (COPDGene) study who did not report diabetes at their baseline visit and who provided health status updates during 4.2 years of longitudinal follow-up (LFU). We used Cox proportional hazards modeling, censoring participants at final LFU contact, reported mortality or report of incident diabetes to model predictors of diabetes. These models were constructed using known risk factors as well as proposed markers related to pulmonary health, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, respiratory exacerbations (RE), 6-minute walk distance (6MWD), pulmonary associated quality of life (as measured by the SGRQ), corticosteroid use, chronic bronchitis and dyspnea. RESULTS Over 21,519 person years of follow-up, 392 of 7080 participants reported incident diabetes which was associated with expected predictors; increased body mass index (BMI), high blood pressure, high cholesterol and current smoking status. Age, gender and accumulated smoking exposure were not associated with incident diabetes. Additionally, preserved ratio with impaired spirometry (PRISm) pattern pulmonary function, reduced 6MWD and any report of serious pulmonary events were associated with incident diabetes. CONCLUSIONS This cluster of pulmonary indicators may aid clinicians in identifying and treating patients with pre- or undiagnosed diabetes.
{"title":"Pulmonary Predictors of Incident Diabetes in Smokers.","authors":"G. Kinney, E. Baker, O. Klein, J. Black-Shinn, E. Wan, B. Make, E. Regan, R. Bowler, S. Lutz, K. Young, L. Duca, G. Washko, E. Silverman, J. Crapo, J. Hokanson","doi":"10.15326/JCOPDF.3.4.2016.0137","DOIUrl":"https://doi.org/10.15326/JCOPDF.3.4.2016.0137","url":null,"abstract":"BACKGROUND Diabetes mellitus and its complications are a large and increasing burden for health care worldwide. Reduced pulmonary function has been observed in diabetes (both type 1 and type 2), and this reduction is thought to occur prior to diagnosis. Other measures of pulmonary health are associated with diabetes, including lower exercise tolerance, greater dyspnea, lower quality of life (as measured by the St. George's Respiratory Questionaire [SGRQ]) and susceptibility to lung infection and these measures may also predate diabetes diagnosis. METHODS We examined 7080 participants in the COPD Genetic Epidemiology (COPDGene) study who did not report diabetes at their baseline visit and who provided health status updates during 4.2 years of longitudinal follow-up (LFU). We used Cox proportional hazards modeling, censoring participants at final LFU contact, reported mortality or report of incident diabetes to model predictors of diabetes. These models were constructed using known risk factors as well as proposed markers related to pulmonary health, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, respiratory exacerbations (RE), 6-minute walk distance (6MWD), pulmonary associated quality of life (as measured by the SGRQ), corticosteroid use, chronic bronchitis and dyspnea. RESULTS Over 21,519 person years of follow-up, 392 of 7080 participants reported incident diabetes which was associated with expected predictors; increased body mass index (BMI), high blood pressure, high cholesterol and current smoking status. Age, gender and accumulated smoking exposure were not associated with incident diabetes. Additionally, preserved ratio with impaired spirometry (PRISm) pattern pulmonary function, reduced 6MWD and any report of serious pulmonary events were associated with incident diabetes. CONCLUSIONS This cluster of pulmonary indicators may aid clinicians in identifying and treating patients with pre- or undiagnosed diabetes.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"28 1","pages":"739-747"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75756666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-01-01DOI: 10.15326/jcopdf.2.1.2015.0127
A. Díaz, Thomas P. Young, Sila Kurugol, Eric Eckbo, Nina Muralidhar, Joshua K Chapman, G. Kinney, J. Ross, Raúl San José Estépar, R. Harmouche, J. Black-Shinn, M. Budoff, R. Bowler, J. Hokanson, G. Washko
BACKGROUND Cardiovascular diseases are frequent and a major cause of death in patients with chronic obstructive pulmonary disease (COPD). In the general population, various fat depots including abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat have been linked to increased risk of cardiovascular diseases. We hypothesize that these adipose tissue compartments are associated with myocardial infarction (MI) in patients with COPD. METHODS We collected measures of VAT and SAT areas and liver attenuation on the computed tomography scan of the chest from 1267 patients with COPD. MI was a self-reported physician-diagnosed outcome. The association between fat depots and self-reported history of MI was assessed by logistic regression analysis in which the patients within the 2 lowest tertiles of VAT and SAT areas were the reference group. RESULTS Eighty three patients (6.6%) reported a history of MI at the time of enrollment. Compared to patients who did not have an MI episode, those who had a prior MI had a higher VAT area (mean ± SD, 303.4 ± 208.5 vs. 226.8 ± 172.6 cm2; P=0.002) with no differences in SAT area and liver fat. After adjustment for age, gender, obesity, pack years of smoking, hypertension, high cholesterol, and diabetes, patients within the upper tertile (vs. those in the lower tertiles) of VAT area had increased odds of MI (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.02 - 3.41). CONCLUSION Increased abdominal visceral fat is independently associated with a history of MI in individuals with COPD.
{"title":"Abdominal Visceral Adipose Tissue is Associated with Myocardial Infarction in Patients with COPD.","authors":"A. Díaz, Thomas P. Young, Sila Kurugol, Eric Eckbo, Nina Muralidhar, Joshua K Chapman, G. Kinney, J. Ross, Raúl San José Estépar, R. Harmouche, J. Black-Shinn, M. Budoff, R. Bowler, J. Hokanson, G. Washko","doi":"10.15326/jcopdf.2.1.2015.0127","DOIUrl":"https://doi.org/10.15326/jcopdf.2.1.2015.0127","url":null,"abstract":"BACKGROUND Cardiovascular diseases are frequent and a major cause of death in patients with chronic obstructive pulmonary disease (COPD). In the general population, various fat depots including abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat have been linked to increased risk of cardiovascular diseases. We hypothesize that these adipose tissue compartments are associated with myocardial infarction (MI) in patients with COPD. METHODS We collected measures of VAT and SAT areas and liver attenuation on the computed tomography scan of the chest from 1267 patients with COPD. MI was a self-reported physician-diagnosed outcome. The association between fat depots and self-reported history of MI was assessed by logistic regression analysis in which the patients within the 2 lowest tertiles of VAT and SAT areas were the reference group. RESULTS Eighty three patients (6.6%) reported a history of MI at the time of enrollment. Compared to patients who did not have an MI episode, those who had a prior MI had a higher VAT area (mean ± SD, 303.4 ± 208.5 vs. 226.8 ± 172.6 cm2; P=0.002) with no differences in SAT area and liver fat. After adjustment for age, gender, obesity, pack years of smoking, hypertension, high cholesterol, and diabetes, patients within the upper tertile (vs. those in the lower tertiles) of VAT area had increased odds of MI (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.02 - 3.41). CONCLUSION Increased abdominal visceral fat is independently associated with a history of MI in individuals with COPD.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"27 1","pages":"8-16"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82757751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-01-01DOI: 10.15326/JCOPDF.1.1.2014.0111
K. Iyer, Randall W. Grout, G. Zamba, E. Hoffman
RATIONALE AND OBJECTIVES Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, CT-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled. MATERIALS AND METHODS Thirty-seven subjects (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: TLC) or expiration (20% vital capacity: FRC). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-subject differences and previously reported bias, sample size was estimated from month or yearly change in density metrics obtained from published literature (i.e. meaningful change). RESULTS Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average ICCs for whole lung alpha-910 and alpha-950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20-40) to a few hundred subjects, respectively. CONCLUSION A meaningful sample size was predicted from this study using volume-controlled normal subjects in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.
{"title":"Repeatability and Sample Size Assessment Associated with Computed Tomography-Based Lung Density Metrics.","authors":"K. Iyer, Randall W. Grout, G. Zamba, E. Hoffman","doi":"10.15326/JCOPDF.1.1.2014.0111","DOIUrl":"https://doi.org/10.15326/JCOPDF.1.1.2014.0111","url":null,"abstract":"RATIONALE AND OBJECTIVES Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, CT-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled. MATERIALS AND METHODS Thirty-seven subjects (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: TLC) or expiration (20% vital capacity: FRC). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-subject differences and previously reported bias, sample size was estimated from month or yearly change in density metrics obtained from published literature (i.e. meaningful change). RESULTS Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average ICCs for whole lung alpha-910 and alpha-950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20-40) to a few hundred subjects, respectively. CONCLUSION A meaningful sample size was predicted from this study using volume-controlled normal subjects in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"11 1","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72926225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-01-01DOI: 10.15326/JCOPDF.1.1.2013.0001
S. Kim, Kunihiro Yagihashi, Douglas S Stinson, J. Zach, Alexander S McKenzie, D. Curran-Everett, E. Wan, E. Silverman, J. Crapo, D. Lynch
Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.
在COPD遗传流行病学(COPDGene®)研究人群中，9%的吸烟者被发现无法按照全球慢性阻塞性肺疾病倡议(GOLD)的标准进行分类。本研究旨在确定非阻塞性肺(GOLDU)组与肺功能正常的吸烟者对照组的计算机断层扫描(CT)结果的差异。本研究由各机构的机构审查委员会批准。采用盲法对400名COPDGene®研究参与者(200名GOLDU, 200名肺功能正常的吸烟者)的CT图像进行回顾性评估。视觉CT评估包括肺气肿的肺叶分析(类型、范围)、膈旁肺气肿的存在、气道壁增厚、呼气空气潴留、小叶中心结节、肺不张、非纤维化和纤维化间质性肺疾病(ILD)、胸膜增厚、膈膨出、椎体改变和胸廓内径(mm)。对各组各CT参数进行单因素比较，并进行多元逻辑回归，以确定与GOLDU相关的影像学特征。与对照组相比，GOLDU患者的单侧膈外翻(30% vs. 16%)、气道壁增厚、小叶中心结节、网状异常、膈旁肺气肿(33% vs. 17%)、线状肺不张(60% vs. 35.6%)、脊柱后凸(12% vs. 4%)和较小的内胸横径(255±22.5[标准差]vs. 264.8±22.4,mm)的患病率显著高于对照组(均p<0.05)。通过多元logistic回归，除非纤维化ILD和后凸外，所有这些CT参数仍与GOLDU状态显著相关(p<0.05)。在吸烟者中，导致限制性生理损害的胸壁异常和肺实质疾病与gold无阻塞状态相关。
{"title":"Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in The COPDGene® Study.","authors":"S. Kim, Kunihiro Yagihashi, Douglas S Stinson, J. Zach, Alexander S McKenzie, D. Curran-Everett, E. Wan, E. Silverman, J. Crapo, D. Lynch","doi":"10.15326/JCOPDF.1.1.2013.0001","DOIUrl":"https://doi.org/10.15326/JCOPDF.1.1.2013.0001","url":null,"abstract":"Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"48 1","pages":"88-96"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79181833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.15326/JCOPDF.2.3.2014.0164
F. Rahaghi, C. E. Come, J. Ross, R. Harmouche, A. Díaz, Raúl San José Estépar, G. Washko
INTRODUCTION Endoscopic Lung Volume Reduction has been used to reduce lung hyperinflation in selected patients with severe emphysema. Little is known about the effect of this procedure on the intraparenchymal pulmonary vasculature. In this study we used CT based vascular reconstruction to quantify the effect of the procedure on the pulmonary vasculature. METHODS Intraparenchymal vasculature was reconstructed and quantified in 12 patients with CT scans at baseline and 12 weeks following bilateral introduction of sealants in the upper lobes. The volume of each lung and each lobe was measured, and the vascular volume profile was calculated for both lower lobes. The detected vasculature was further labeled manually as arterial or venous in the right lower lobe. RESULTS There was an increase in the volume of the lower lobes (3.14L to 3.25L, p=0.0005). There was an increase in BV5, defined as the volume of blood vessels with cross sectional area of less than 5mm2, (53.2ml to 57.9ml, p=0.03). This was found to be correlated with the increase in lower lobe volumes (R=0.65, p=0.02). The changes appear to be symmetric for veins and arteries with a correlation coefficient of 0.87 and a slope of near identity. CONCLUSION In the subjects studied, there was an increase, from baseline, in BV5 in the lower lobes that correlated with the change in the volume of the lower lobes. The change appeared to be symmetric for both arteries and veins. The study illustrates the use of intraparenchymal pulmonary vascular reconstruction to study morphologic changes in response to interventions.
{"title":"Morphologic Response of the Pulmonary Vasculature to Endoscopic Lung Volume Reduction.","authors":"F. Rahaghi, C. E. Come, J. Ross, R. Harmouche, A. Díaz, Raúl San José Estépar, G. Washko","doi":"10.15326/JCOPDF.2.3.2014.0164","DOIUrl":"https://doi.org/10.15326/JCOPDF.2.3.2014.0164","url":null,"abstract":"INTRODUCTION\u0000Endoscopic Lung Volume Reduction has been used to reduce lung hyperinflation in selected patients with severe emphysema. Little is known about the effect of this procedure on the intraparenchymal pulmonary vasculature. In this study we used CT based vascular reconstruction to quantify the effect of the procedure on the pulmonary vasculature.\u0000\u0000\u0000METHODS\u0000Intraparenchymal vasculature was reconstructed and quantified in 12 patients with CT scans at baseline and 12 weeks following bilateral introduction of sealants in the upper lobes. The volume of each lung and each lobe was measured, and the vascular volume profile was calculated for both lower lobes. The detected vasculature was further labeled manually as arterial or venous in the right lower lobe.\u0000\u0000\u0000RESULTS\u0000There was an increase in the volume of the lower lobes (3.14L to 3.25L, p=0.0005). There was an increase in BV5, defined as the volume of blood vessels with cross sectional area of less than 5mm2, (53.2ml to 57.9ml, p=0.03). This was found to be correlated with the increase in lower lobe volumes (R=0.65, p=0.02). The changes appear to be symmetric for veins and arteries with a correlation coefficient of 0.87 and a slope of near identity.\u0000\u0000\u0000CONCLUSION\u0000In the subjects studied, there was an increase, from baseline, in BV5 in the lower lobes that correlated with the change in the volume of the lower lobes. The change appeared to be symmetric for both arteries and veins. The study illustrates the use of intraparenchymal pulmonary vascular reconstruction to study morphologic changes in response to interventions.","PeriodicalId":10249,"journal":{"name":"Chronic obstructive pulmonary diseases","volume":"50 1","pages":"214-222"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82649830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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