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Machine-Learning Model Identifies Patients With Alpha-1 Antitrypsin Deficiency Using Claims Records. 机器学习模型利用索赔记录识别 Alpha-1 抗胰蛋白酶缺乏症患者。
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-01 Epub Date: 2024-09-23 DOI: 10.1080/15412555.2024.2393348
Rajani Sharma, D Kyle Hogarth, Richard Colbaugh, Kristin Glass, Adel Mezine, Vassia Liakoni, Christopher Rudolf, Iris Himmelhan, Jimmy Hinson, Marie Sanchirico

Identifying patients with rare diseases like alpha-1 antitrypsin deficiency (AATD) is challenging. Machine-learning models may be trained to identify patients with rare diseases using large-scale, real-world databases, whereas electronic medical records have low numbers of confirmed cases and have limited use in training such models. We applied a machine-learning model to a large US claims database to identify undiagnosed symptomatic patients with AATD. Using deidentified data from the Komodo US claims database (April 26, 2016-January 31, 2023), a model was trained to identify symptomatic patients with high probability of AATD. Eighty claims records for high-probability candidates identified by the model were independently reviewed and validated by 2 clinical experts. The experts independently indicated that of the 80 high-probability candidate patients, 65 (81%) and 62 (78%) patients, respectively, should be tested for AATD. Feedback from this validation step informed model optimization. The optimized model was applied to claims data to identify symptomatic patients with probable AATD. Eleven and 14 "features" of the claims data were informative in distinguishing patients with AATD from patients with COPD without AATD and from unspecified chronic liver diseases. Moreover, patients with diagnosed AATD and COPD without AATD had unique cadences of similar medical events in their diagnostic journeys. Our work shows that a machine-learning model trained on a large US claims database can accurately identify symptomatic patients with AATD and provides useful insights into the diagnostic journey of patients with AATD.

识别α-1抗胰蛋白酶缺乏症(AATD)等罕见病患者是一项挑战。机器学习模型可以通过大规模的真实数据库进行训练,以识别罕见病患者,而电子病历的确诊病例较少,对训练此类模型的作用有限。我们将机器学习模型应用于美国的大型索赔数据库,以识别未确诊的有症状的 AATD 患者。利用来自 Komodo 美国理赔数据库(2016 年 4 月 26 日至 2023 年 1 月 31 日)的去身份化数据,我们对一个模型进行了训练,以识别极有可能患有 AATD 的无症状患者。该模型识别出的高概率候选者的 80 份理赔记录由 2 位临床专家进行了独立审查和验证。专家们独立指出,在这 80 名高概率候选患者中,分别有 65 名(81%)和 62 名(78%)患者应接受 AATD 检测。这一验证步骤的反馈为模型优化提供了依据。将优化后的模型应用于理赔数据,以确定可能患有 AATD 的无症状患者。理赔数据中的 11 项和 14 项 "特征 "有助于将 AATD 患者与不伴有 AATD 的慢性阻塞性肺病患者以及未指定的慢性肝病患者区分开来。此外,确诊为 AATD 的患者和未确诊为 AATD 的慢性阻塞性肺病患者在其诊断过程中发生类似医疗事件的频率也各不相同。我们的工作表明,在大型美国索赔数据库中训练的机器学习模型可以准确识别有症状的 AATD 患者,并为 AATD 患者的诊断过程提供有用的见解。
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引用次数: 0
Identification and Validation of Aging Related Genes Signature in Chronic Obstructive Pulmonary Disease. 慢性阻塞性肺病中衰老相关基因特征的鉴定与验证
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-01 Epub Date: 2024-08-13 DOI: 10.1080/15412555.2024.2379811
Tian-Tian Li, Hong-Yan Bai, Jing-Hong Zhang, Xiu-He Kang, Yi-Qing Qu

Purpose: Chronic Obstructive Pulmonary Disease (COPD) is regarded as an accelerated aging disease. Aging-related genes in COPD are still poorly understood.

Method: Data set GSE76925 was obtained from the Gene Expression Omnibus (GEO) database. The "limma" package identified the differentially expressed genes. The weighted gene co-expression network analysis (WGCNA) constructes co-expression modules and detect COPD-related modules. The least absolute shrinkage and selection operator (LASSO) and the support vector machine recursive feature elimination (SVM-RFE) algorithms were chosen to identify the hub genes and the diagnostic ability. Three external datasets were used to identify differences in the expression of hub genes. Real-time reverse transcription polymerase chain reaction (RT-qPCR) was used to verify the expression of hub genes.

Result: We identified 15 differentially expressed genes associated with aging (ARDEGs). The SVM-RFE and LASSO algorithms pinpointed four potential diagnostic biomarkers. Analysis of external datasets confirmed significant differences in PIK3R1 expression. RT-qPCR results indicated decreased expression of hub genes. The ROC curve demonstrated that PIK3R1 exhibited strong diagnostic capability for COPD.

Conclusion: We identified 15 differentially expressed genes associated with aging. Among them, PIK3R1 showed differences in external data sets and RT-qPCR results. Therefore, PIK3R1 may play an essential role in regulating aging involved in COPD.

目的:慢性阻塞性肺病(COPD)被认为是一种加速衰老的疾病。人们对慢性阻塞性肺病中与衰老相关的基因仍知之甚少:方法:从基因表达总库(GEO)数据库中获取数据集 GSE76925。limma "软件包识别了差异表达基因。加权基因共表达网络分析(WGCNA)构建共表达模块并检测 COPD 相关模块。选择最小绝对收缩和选择算子(LASSO)和支持向量机递归特征消除(SVM-RFE)算法来识别中枢基因和诊断能力。三个外部数据集被用来识别枢纽基因表达的差异。采用实时反转录聚合酶链反应(RT-qPCR)来验证枢纽基因的表达:结果:我们发现了 15 个与衰老相关的差异表达基因(ARDEGs)。SVM-RFE 和 LASSO 算法确定了四个潜在的诊断生物标记。外部数据集分析证实了 PIK3R1 表达的显著差异。RT-qPCR 结果表明枢纽基因的表达减少。ROC曲线显示,PIK3R1对慢性阻塞性肺病具有很强的诊断能力:结论:我们发现了 15 个与衰老相关的差异表达基因。结论:我们发现了 15 个与衰老相关的差异表达基因,其中 PIK3R1 在外部数据集和 RT-qPCR 结果中表现出差异。因此,PIK3R1 可能在慢性阻塞性肺病的衰老调控中扮演着重要角色。
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引用次数: 0
Assessment of the Relationship Between Genetic Determinants of Obesity, Unhealthy Eating Habits and Chronic Obstructive Pulmonary Disease: A Mendelian Randomisation Study. 评估肥胖遗传决定因素、不健康饮食习惯与慢性阻塞性肺病之间的关系:孟德尔随机研究》。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2024-12-01 Epub Date: 2024-02-13 DOI: 10.1080/15412555.2024.2309236
Tongyao Sun, Jun Wang, Min Zheng, Chengsen Cai, Jianjian Yu, Lina Fu, Lei Duan

Background: Clinical studies have shown that the onset and exacerbation of chronic obstructive pulmonary disease (COPD) are related to obesity and dietary behaviours, but the genetic relationship between them is not clear.Aims: To investigate the relationship between the genetic determinants of obesity, dietary habits (alcohol consumption, intake of sweets, salt intake) and COPD.Methods: Exposure and outcome datasets were obtained from the IEU Open GWAS project. The exposure dataset includes dietary habits (Salt added to food, Sweets intake, Alcohol consumption), obesity level (represented by body mass index (BMI) and body fat percentage (BFP) data sets.). The outcome dataset includes COPD and acute COPD admissions. The collected data were imported into the RStudio software and conducted Mendelian randomisation analysis. Additionally, heterogeneity and horizontal pleiotropy tests were conducted on the data to ensure the veracity of the results.Results: The results showed that BMI was positively correlated with the risk of acute COPD admission (OR = 1.74, 95% CI 1.39-2.18) and COPD (OR = 1.81, 95%CI 1.41-2.33). In addition, BFP was also a risk factor for COPD (OR = 1.98, 95% CI 1.42-2.77) and acute exacerbation of COPD admission (OR = 1.99, 95%CI 1.43-2.77). The increase of salt, sugar and alcohol consumption will not increase the risk of COPD and the risk of hospitalisation due to COPD.Conclusion: Therefore, we should strengthen the guidance of diet and living habits of obese patients. For patients with heavier weight and higher body fat rate, they should be instructed to lose weight and fat to prevent the occurrence of COPD. For obese patients with COPD, more attention should be paid to prevent the occurrence of acute exacerbation of COPD in advance.

背景:临床研究表明,慢性阻塞性肺病(COPD)的发病和恶化与肥胖和饮食行为有关,但它们之间的遗传关系尚不清楚。目的:研究肥胖、饮食习惯(饮酒、甜食摄入、盐摄入)和慢性阻塞性肺病的遗传决定因素之间的关系:方法:暴露数据集和结果数据集来自 IEU Open GWAS 项目。暴露数据集包括饮食习惯(食物中添加的盐分、甜食摄入量、酒精消耗量)、肥胖程度(以体重指数(BMI)和体脂百分比(BFP)数据集表示)。结果数据集包括慢性阻塞性肺病和急性慢性阻塞性肺病入院情况。收集的数据被导入 RStudio 软件,并进行孟德尔随机分析。此外,还对数据进行了异质性和水平多向性检验,以确保结果的真实性:结果显示,体重指数与急性慢性阻塞性肺病入院风险(OR = 1.74,95%CI 1.39-2.18)和慢性阻塞性肺病(OR = 1.81,95%CI 1.41-2.33)呈正相关。此外,BFP 也是慢性阻塞性肺病(OR = 1.98,95%CI 1.42-2.77)和慢性阻塞性肺病急性加重入院(OR = 1.99,95%CI 1.43-2.77)的风险因素。盐、糖和酒精摄入量的增加不会增加慢性阻塞性肺病的发病风险和因慢性阻塞性肺病住院的风险:因此,我们应加强对肥胖患者饮食和生活习惯的指导。因此,我们应加强对肥胖患者饮食和生活习惯的指导,对于体重较重、体脂率较高的患者,应指导其减肥减脂,预防慢性阻塞性肺疾病的发生。对于慢性阻塞性肺疾病的肥胖患者,更应注意提前预防慢性阻塞性肺疾病急性加重的发生。
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引用次数: 0
EQ-5D Based Utility Values for Adults with Chronic Obstructive Pulmonary Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. 基于 EQ-5D 的慢性阻塞性肺病成人效用值:系统综述、元分析和元回归。
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-01 Epub Date: 2024-07-31 DOI: 10.1080/15412555.2024.2385358
Natasha Salant, Syed Mohiuddin, Yuanyuan Zhang, Lynda Ayiku, Kusal Lokuge, Paul Jacklin, Lesley Owen

Chronic obstructive pulmonary disease (COPD) is a common lung disease that negatively affects health-related quality of life (QoL). Utility values, which measure QoL by weighting health states with societal preferences, are required for the cost-utility models that drive economic evaluations and policy decisions. Moayeri et al. published a systematic review and meta-analysis of utilities (EQ-5D) in COPD in June 2016. The current study investigated changes in mean utilities in more recent studies thereafter, exploring heterogeneity in utilities across diverse clinical and study characteristics. Systematic searches of databases, such as MEDLINE and Embase were undertaken from 1 July 2015 until 20 May 2024. A random-effects meta-analysis of utilities (EQ-5D) was performed which addressed inter-study heterogeneity and subgroup analyses. The pooled general mean (95% CI) utility value was 0.761 (0.726-0.795) from 43 studies, whereas Moayeri et al. reported 0.673 (0.653-0.693) from 32 studies. This improvement in mean utilities could be due to increased awareness, early detection, and better medical interventions over the past decade, but demonstrates that a general utility value should be approached with caution given significant heterogeneity. Four meta-regressions were performed on each subgroup: region, method of elicitation, reported comorbidities, and disease stage; of which, method of elicitation, disease stage, and region were found to be significant moderators of utilities. It is, therefore, important to use meta-analysed utilities for cost-utility analyses that reflect the context and patient population of the model. Moreover, these results provide additional evidence for the precision and sensitivity of EQ-5D-5L over EQ-5D-3L.

慢性阻塞性肺病(COPD)是一种常见的肺部疾病,对健康相关的生活质量(QoL)有负面影响。根据社会偏好对健康状况进行加权后得出的效用值可衡量 QoL,是推动经济评估和政策决策的成本效用模型所必需的。Moayeri 等人于 2016 年 6 月发表了一篇关于慢性阻塞性肺病效用(EQ-5D)的系统综述和荟萃分析。本研究调查了此后最新研究中平均效用的变化,探讨了不同临床和研究特征下效用的异质性。从 2015 年 7 月 1 日至 2024 年 5 月 20 日,对 MEDLINE 和 Embase 等数据库进行了系统检索。对效用(EQ-5D)进行了随机效应荟萃分析,解决了研究间异质性和亚组分析的问题。43 项研究的总体平均效用值(95% CI)为 0.761(0.726-0.795),而 Moayeri 等人的 32 项研究的平均效用值为 0.673(0.653-0.693)。平均效用值的提高可能是由于过去十年中人们的意识提高、早期发现和更好的医疗干预措施,但由于存在显著的异质性,因此应谨慎对待一般效用值。对每个亚组进行了四次元回归:地区、诱导方法、报告的合并症和疾病分期;其中,诱导方法、疾病分期和地区被认为是效用的重要调节因素。因此,在进行成本效用分析时,必须使用经过荟萃分析的效用,以反映模型的背景和患者群体。此外,这些结果还进一步证明了 EQ-5D-5L 比 EQ-5D-3L 的精确性和敏感性。
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引用次数: 0
Real World Study on the Reasons for eScalation or de-Escalation of Inhaled ThEraPies in COPD Patients: the STEPINCOPD Multicenter Observational Study. 关于慢性阻塞性肺病患者吸入噻唑类药物缩效或停药原因的真实世界研究:STEPINCOPD 多中心观察研究。
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-01 Epub Date: 2024-11-19 DOI: 10.1080/15412555.2024.2427755
Argyris Tzouvelekis, Christos Kyriakopoulos, Irini Gerogianni, Aggeliki Rapti, Vasileios Michailidis, Andreas Dimoulis, Despina Papakosta, Paschalis Steiropoulos, Panagiota Styliara, Konstantinos Kostikas, Athena Gogali

Background: There is limited data on the reasons for escalation or de-escalation of COPD inhaled therapies in routine clinical practice, especially after the follow-up pharmacological treatment guidance on the 2019 GOLD report and the 2020 ERS guideline on ICS withdrawal.

Methods: The STEPINCOPD study was a 12-week, two-visit, prospective observational study that aimed to describe the reasons for change of inhaled therapies, in accordance with GOLD recommendations 2021. Only patients that had a recent change in their inhaled medication were enrolled. Moreover, we investigated associations between physicians' and patients' characteristics and adherence to GOLD recommendations.

Results: 1429 patients were enrolled from 146 centers (138 private practice and 8 hospitals) throughout Greece. At enrollment, the most frequent reasons for treatment change were lack of clinical (78.9%) or spirometric (49.5%) response to previous treatment, change in CAT score (45.1%), and mMRC score (28.2%). At the follow-up visit, most common reasons were lack of clinical response to previous treatment (71.4%), COPD exacerbations (59.5%), changes in CAT score (52.4%), lack of spirometric response (42.9%) and lower respiratory tract infections (31%). We observed high adherence to the GOLD 2021 recommendations (81.6% at enrollment and 92.9% at follow-up). Physicians' age and consideration of GOLD recommendations for prescription choice, as well as patients' CAT score were significant predictors of adherence to GOLD.

Conclusion: The STEPINCOPD study highlights the reasons for inhaled treatment change in Greek physicians with high adherence to GOLD recommendations and provides insights for future research that may inform the development of decision support tools.

背景:关于常规临床实践中慢性阻塞性肺疾病吸入疗法升级或降级原因的数据有限,尤其是在2019年GOLD报告的后续药物治疗指南和2020年ERS关于ICS停药指南发布之后:STEPINCOPD 研究是一项为期 12 周、两次访问的前瞻性观察研究,旨在描述根据 2021 年 GOLD 建议改变吸入疗法的原因。只有近期更换过吸入药物的患者才被纳入研究。此外,我们还调查了医生和患者的特征与遵守GOLD建议之间的关联:希腊全国 146 个中心(138 家私人诊所和 8 家医院)共招募了 1429 名患者。在登记时,最常见的治疗变更原因是对之前的治疗缺乏临床反应(78.9%)或肺活量测定(49.5%)、CAT 评分变化(45.1%)和 mMRC 评分变化(28.2%)。在随访中,最常见的原因是对之前的治疗缺乏临床反应(71.4%)、慢性阻塞性肺疾病加重(59.5%)、CAT 评分变化(52.4%)、肺活量测定缺乏反应(42.9%)和下呼吸道感染(31%)。我们观察到对 GOLD 2021 建议的遵守率很高(入组时为 81.6%,随访时为 92.9%)。医生的年龄、在选择处方时对 GOLD 建议的考虑以及患者的 CAT 评分是预测 GOLD 依从性的重要因素:STEPINCOPD研究强调了GOLD建议依从性高的希腊医生改变吸入治疗的原因,并为未来研究提供了启示,可为决策支持工具的开发提供参考。
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引用次数: 0
Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review. 了解患者在报告慢性阻塞性肺疾病恶化方面的差距:综述。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2024-12-01 Epub Date: 2024-02-29 DOI: 10.1080/15412555.2024.2316594
Paul Jones, Ashraf Alzaabi, Alejandro Casas Herrera, Mehmet Polatli, Marcelo Fouad Rabahi, Arturo Cortes Telles, Bhumika Aggarwal, Sudeep Acharya, Abdelkader El Hasnaoui, Chris Compton

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.

慢性阻塞性肺疾病(COPD)的恶化与肺功能丧失、生活质量下降、运动能力丧失、严重心血管事件风险、住院和死亡有关。然而,患者对病情加重的报告不足,有证据表明,未报告的病情加重与已报告的病情加重对患者健康的负面影响相似。虽然有指南指导医生识别有病情加重风险的患者,但这些指南并不能帮助患者识别和报告病情加重。新开发的工具,如慢性阻塞性肺疾病加重识别工具 (CERT) 就是为了实现这一目标而设计的。本综述的重点是慢性阻塞性肺病加重患者报告不足、与此相关的因素、报告不足的后果以及潜在的解决方案。
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引用次数: 0
Real-World Effectiveness of Single-Inhaler Triple Therapy for COPD: Impact of Diabetes Comorbidity. 单吸入器三联疗法治疗慢性阻塞性肺病的实际效果:糖尿病并发症的影响。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2024-12-01 Epub Date: 2024-03-20 DOI: 10.1080/15412555.2024.2327345
Sophia Eilat-Tsanani, Pierre Ernst, Samy Suissa

Type 2 diabetes is a frequent comorbidity in chronic obstructive pulmonary disease (COPD) patients, with the GOLD treatment recommendations asserting that the presence of diabetes be disregarded in the choice of treatment.

In a cohort of COPD patients with frequent exacerbations, initiators of single-inhaler triple therapy or dual bronchodilators were compared on the incidence of COPD exacerbation and pneumonia over one year, adjusted by propensity score weighting and stratified by type 2 diabetes.

The COPD cohort included 1,114 initiators of triple inhalers and 4,233 of dual bronchodilators (28% with type 2 diabetes). The adjusted hazard ratio (HR) of exacerbation with triple therapy was 1.04 (95% CI: 0.86-1.25) among COPD patients with type 2 diabetes and 0.74 (0.65-0.85) in those without. The incidence of severe pneumonia was elevated with triple therapy among patients with type 2 diabetes (HR 1.77; 1.14-2.75).

Triple therapy in COPD is effective among those without, but not those with, type 2 diabetes. Future therapeutic trials in COPD should consider diabetes comorbidity.

2 型糖尿病是慢性阻塞性肺病(COPD)患者的常见合并症,GOLD 治疗建议主张在选择治疗方法时不考虑糖尿病的存在。在一组频繁恶化的慢性阻塞性肺病患者中,对开始使用单吸入剂三联疗法或双支气管扩张剂的患者一年内慢性阻塞性肺病恶化和肺炎的发生率进行了比较,并根据倾向得分加权法进行了调整,同时按2型糖尿病进行了分层。在接受三联疗法的慢性阻塞性肺病患者中,2型糖尿病患者病情加重的调整后危险比(HR)为1.04(95% CI:0.86-1.25),非2型糖尿病患者为0.74(0.65-0.85)。2型糖尿病患者接受三联疗法后,重症肺炎的发病率升高(HR 1.77;1.14-2.75)。未来的慢性阻塞性肺病治疗试验应考虑糖尿病合并症。
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引用次数: 0
Chest CT Airway and Vascular Measurements in Females with COPD or Long-COVID. 慢性阻塞性肺病或长期慢性阻塞性肺气肿女性患者的胸部 CT 气道和血管测量。
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-01 Epub Date: 2024-09-02 DOI: 10.1080/15412555.2024.2394129
Harkiran K Kooner, Paulina V Wyszkiewicz, Alexander M Matheson, Marrissa J McIntosh, Mohamed Abdelrazek, Inderdeep Dhaliwal, J Michael Nicholson, Miranda Kirby, Sarah Svenningsen, Grace Parraga

Chest CT provides a way to quantify pulmonary airway and vascular tree measurements. In patients with COPD, CT airway measurement differences in females are concomitant with worse quality-of-life and other outcomes. CT total airway count (TAC), airway lumen area (LA), and wall thickness (WT) also differ in females with long-COVID. Our objective was to evaluate CT airway and pulmonary vascular and quality-of-life measurements in females with COPD as compared to ex-smokers and patients with long-COVID. Chest CT was acquired 3-months post-COVID-19 infection in females with long-COVID for comparison with the same inspiratory CT in female ex-smokers and COPD patients. TAC, LA, WT, and pulmonary vascular measurements were quantified. Linear regression models were adjusted for confounders including age, height, body-mass-index, lung volume, pack-years and asthma diagnosis. Twenty-one females (53 ± 14 years) with long-COVID, 17 female ex-smokers (69 ± 9 years) and 13 female COPD (67 ± 6 years) patients were evaluated. In the absence of differences in quality-of-life scores, females with long-COVID reported significantly different LA (p = 0.006) compared to ex-smokers but not COPD (p = 0.7); WT% was also different compared to COPD (p = 0.009) but not ex-smokers (p = 0.5). In addition, there was significantly greater pulmonary small vessel volume (BV5) in long-COVID as compared to female ex-smokers (p = 0.045) and COPD (p = 0.003) patients and different large (BV10) vessel volume as compared to COPD (p = 0.03). In females with long-COVID and highly abnormal quality-of-life scores, there was CT evidence of airway remodelling, similar to ex-smokers and patients with COPD, but there was no evidence of pulmonary vascular remodelling.Clinical Trial Registration: www.clinicaltrials.gov NCT05014516 and NCT02279329.

胸部 CT 提供了一种量化肺气道和血管树测量的方法。在慢性阻塞性肺病患者中,女性的 CT 气道测量差异与较差的生活质量和其他结果同时存在。CT气道总计数(TAC)、气道管腔面积(LA)和管壁厚度(WT)在长COPD女性患者中也存在差异。我们的目的是评估慢性阻塞性肺病女性患者的 CT 气道和肺血管测量结果以及生活质量,并与戒烟者和长期慢性阻塞性肺病患者进行比较。我们在长COVID女性患者感染COVID-19后3个月采集了胸部CT,并与女性戒烟者和COPD患者的相同吸气CT进行了比较。对 TAC、LA、WT 和肺血管测量进行了量化。线性回归模型对年龄、身高、体重指数、肺活量、包年和哮喘诊断等混杂因素进行了调整。21名女性(53±14岁)长COVID患者、17名女性戒烟者(69±9岁)和13名女性慢性阻塞性肺疾病患者(67±6岁)接受了评估。在生活质量评分没有差异的情况下,长期慢性阻塞性肺气肿女性患者的 LA(P = 0.006)与戒烟者相比有显著差异,但与慢性阻塞性肺病患者相比没有差异(P = 0.7);WT% 与慢性阻塞性肺病患者相比也有差异(P = 0.009),但与戒烟者相比没有差异(P = 0.5)。此外,与女性戒烟者(p = 0.045)和慢性阻塞性肺病患者(p = 0.003)相比,长COVID患者的肺小血管容积(BV5)明显更大,与慢性阻塞性肺病患者相比,肺大血管容积(BV10)也不同(p = 0.03)。在患有长COVID和生活质量评分高度异常的女性患者中,有CT证据显示气道重塑,与前吸烟者和慢性阻塞性肺病患者相似,但没有肺血管重塑的证据。临床试验注册:www.clinicaltrials.gov NCT05014516和NCT02279329。
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引用次数: 0
In a Strained Healthcare System, Patients with Advanced COPD Struggle to Access the Needed Support from the Healthcare Professionals - A Qualitative Study. 在紧张的医疗保健系统中,晚期慢性阻塞性肺病患者很难从医疗保健专业人员那里获得所需的支持--一项定性研究。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2024-12-01 Epub Date: 2024-06-11 DOI: 10.1080/15412555.2024.2361669
M Lavesen, M Paine, D G Bove

This study aimed to explore the self-management strategies of Danish patients living with advanced Chronic Obstructive Pulmonary Disease (COPD), with a particular focus on their daily life and their interactions with the respiratory outpatient clinic. Data were collected through semi-structured interviews with 11 patients with COPD affiliated with a Danish respiratory outpatient clinic. The data were thematically analyzed as suggested by Braun & Clarke. The analysis revealed one overarching theme, three main themes, and six subthemes. The overarching theme 'In a strained healthcare system patients with COPD struggle to access needed support to be able to self-manage their disease' revolved around the challenges that patients face in an overburdened healthcare system as they seek support to effectively self-manage their condition. The three main themes were: (1) Only physical symptoms provide legal access to the respiratory outpatient clinic, (2) For patients, the measurements serve as indicators of their health status and overall well-being, (3) Healthcare professionals' skills and not the mode of contact matters to the patients. Healthcare professionals should be aware that the rhetoric surrounding a busy healthcare system with a stressed-out staff also affects patients. Patients with COPD may be particularly sensitive to this message and try to avoid burdening the healthcare system further by setting aside their own needs. However, this approach can lead to neglecting symptoms of deterioration and mental symptoms, which increase the risk of disease progression and subsequent risk of hospital admission.

本研究旨在探讨丹麦晚期慢性阻塞性肺病(COPD)患者的自我管理策略,尤其关注他们的日常生活以及他们与呼吸门诊的互动。我们通过对丹麦一家呼吸门诊的 11 名慢性阻塞性肺病患者进行半结构化访谈收集数据。按照布劳恩和克拉克的建议,对数据进行了主题分析。分析结果显示了一个总体主题、三个主要主题和六个次主题。在紧张的医疗保健系统中,慢性阻塞性肺病患者难以获得所需的支持以自我管理疾病 "这一总主题围绕着患者在负担过重的医疗保健系统中寻求支持以有效自我管理病情时所面临的挑战。三大主题是(1) 只有身体症状才是呼吸科门诊的合法途径,(2) 对患者而言,测量结果是其健康状况和整体福祉的指标,(3) 对患者而言,医护人员的技能而非接触方式才是最重要的。医护人员应该意识到,围绕着医护人员压力过大的繁忙医疗系统的言论也会影响到患者。慢性阻塞性肺病患者可能会对这一信息特别敏感,并试图通过搁置自己的需求来避免进一步加重医疗系统的负担。然而,这种做法可能会导致患者忽视病情恶化的症状和精神症状,从而增加疾病恶化的风险和随后入院的风险。
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引用次数: 0
Physiological Assessment of ECCO2R on the Work of Breathing in Exacerbations of COPD. ECCO2R对COPD加重期呼吸功的生理评价。
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-12-01 Epub Date: 2024-12-05 DOI: 10.1080/15412555.2024.2436169
Nicholas A Barrett, Francesco Murgolo, Salvatore Grasso, Eirini Kostakou, Nicholas Hart, Patrick Murphy, Abdel Douiri, Luigi Camporota

Rationale: The impact of extracorporeal carbon dioxide removal (ECCO2R) on work of breathing and aeration in exacerbations of chronic obstructive pulmonary disease (AECOPD) is poorly understood.

Objectives: The study explores the impact of non-invasive ventilation (NIV) and ECCO2R on respiratory drive, effort and distribution of ventilation in AECOPD.

Methods: Patients enrolled in a randomised controlled study of the addition of ECCO2R to NIV compared with NIV underwent oesophageal pressure measurement, electrical impedance tomography and parasternal electromyography.

Measurements and main results: 18 patients were enrolled, nine in each arm. Of these, eight in the NIV arm and seven in the ECCO2R arm underwent physiological assessment. Patients randomised to ECCO2R, had a period of NIV combined with ECCO2R and, after removal of NIV, a period of ECCO2R alone. The removal of NIV whilst remaining on ECCO2R resulted in a respiratory acidosis (pH 7.34 (7.31-7.34) vs. 7.31 (7.31-7.34), p < 0.0001), increased work of breathing (7.43 (6.08-10.19) vs. 11.1 (8.11-15.15) J/min, p < 0.0001) and increased neural drive (884.4 (684.7-967.3) vs. 1321.1 (903.3-1575.3) AU, p = 0.0005). On day 1, the work of breathing was lower in the NIV than the ECCO2R group (4.38 (2.76-7.27) vs. 8.03 (4.8-15.94) J/min, p < 0.0001), minute ventilation was higher (15.54 (13.14-18.48) vs. 12.24 (8.51-13.9) L/min, p < 0.0001) and neural drive was the same (1,163.8 (1,085.5-1,325.5) vs. 1,093.8 (885.7-1,258.7) AU, p = 0.5556).

Conclusions: The combination of NIV and ECCO2R results in lower work of breathing and improved neuro-ventilatory coupling. NIV fully supports ventilation early whilst ECCO2R improves neuro-ventilatory coupling and work of breathing over time.

Trial registration: Clinicaltrials.gov; NCT02086084; registered 1 December 2015; https://clinicaltrials.gov/study/NCT02086084?cond=copd&term=ecco2r&rank=4.

理由:体外二氧化碳去除(ECCO2R)对慢性阻塞性肺疾病(AECOPD)加重期呼吸和通气功的影响尚不清楚。目的:探讨无创通气(NIV)和ECCO2R对AECOPD呼吸驱动、通气力度和通气分布的影响。方法:入选随机对照研究的患者接受食管压力测量、电阻抗断层扫描和胸骨旁肌电图。测量和主要结果:18例患者入组,每组9例。其中,8例NIV组和7例ECCO2R组接受了生理评估。随机分配到ECCO2R组的患者,有一段时间的NIV联合ECCO2R,在移除NIV后,有一段时间的ECCO2R。去除NIV同时继续使用ECCO2R导致呼吸性酸中毒(pH值7.34 (7.31-7.34)vs. 7.31 (7.31-7.34), p p p = 0.0005)。第1天,NIV组呼吸功低于ECCO2R组(4.38(2.76-7.27)比8.03 (4.8-15.94)J/min, p p p = 0.5556)。结论:NIV联合ECCO2R可降低呼吸功,改善神经通气耦合。NIV完全支持早期通气,而ECCO2R随着时间的推移改善神经通气耦合和呼吸工作。试验注册:Clinicaltrials.gov;NCT02086084;2015年12月1日注册;https://clinicaltrials.gov/study/NCT02086084?cond=copd&term=ecco2r&rank=4。
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引用次数: 0
期刊
COPD: Journal of Chronic Obstructive Pulmonary Disease
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