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Minimal-Resource Home Exercise Program Improves Activities of Daily Living, Perceived Health Status, and Shortness of Breath in Individuals with COPD Stages GOLD II to IV. 最小资源家庭锻炼计划改善COPD GOLD II至IV期患者的日常生活活动、感知健康状况和呼吸急促。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-18 DOI: 10.1080/15412555.2023.2253907
Vanessa Joaquim Ribeiro Moço, Aline Almeida Gulart, Agnaldo José Lopes, Arthur de Sá Ferreira, Luis Felipe da Fonseca Reis

Home exercises (HE) with minimal resources seem to be useful in individuals with COPD. The objective was to evaluate the effects of HE, on activities of daily living (ADL), dyspnea, on the health status(CAT) and quality of life (HRQoL) of individuals with COPD GOLD II to IV. Quasi-experimental study of the effects of HE, for 2 months, 3 times a week. Individuals with COPD(n = 45) were recruited, 37 started the protocol(9 did not complete it). 28 individuals (mean age 62.04 ± 5.8 years, FEV1: 44.7 ± 2.25%, FEV1/FVC 59.8 ± 6.9%) were evaluated before and after training. We observed improvements in the ADL-Glittre (4.9 ± 1.4 vs 3.9 ± 1.1 min; mean difference: -0.9 ± 0.2 min [95%CI: -1.3 to -0.2]; p = 0.008), as well as the mMRC score(2.8 ± 1.1 vs 2.07 ± 0.81; mean difference: 0.7 ± 0.3 [95%CI: -1.20.18 to -0.2]; p = 0.009), and in the CAT (25.6 ± 4.8 vs 18.9 ± 3.1; mean difference: -6.6 ± 3.4 [95%CI: -10.6 to -1.6]; p = 0.042). Analyzing the mean change before and after the intervention, a weak correlation was observed between ADL-Glittre and mMRC (r = 0.35; [95% CI 0.09; 0.56]; p = 0.009); moderate between ADL-Glittre and CAT (r = 0.52; [95% CI 0.30; 0.69]; p < 0.001) and between ADL-Glittre and SGRQ (r = 0.50; [95% CI 0 .27; 0.67]; p < 0.001). Individuals with COPD can benefit from HE performed autonomously and with minimal resources, as this proposal improves functional capacity for ADL, health perception and dyspnea.

资源最少的家庭锻炼(HE)似乎对COPD患者有用。目的是评估HE对COPD GOLD II至IV患者日常生活活动(ADL)、呼吸困难、健康状况(CAT)和生活质量(HRQoL)的影响 几个月,每周3次。COPD患者(n = 45)被招募,37人开始了方案(9人没有完成)。28人(平均年龄62.04 ± 5.8 年,FEV1:44.7 ± 2.25%,发烧1/FVC 59.8 ± 6.9%)。我们观察到ADL Glittre(4.9 ± 1.4对3.9 ± 1.1 min;平均差:-0.9 ± 0.2 最小[95%CI:-1.3至-0.2];p = 0.008)以及mMRC评分(2.8 ± 1.1与2.07 ± 0.81;平均差:0.7 ± 0.3[95%置信区间:-1.20.18至-0.2];p = 0.009)和CAT(25.6 ± 4.8对18.9 ± 3.1;平均差:-6.6 ± 3.4[95%置信区间:-10.6至-1.6];p = 0.042)。分析干预前后的平均变化,ADL-Glittre和mMRC之间存在弱相关性(r = 0.35;[95%CI 0.09;0.56];p = 0.009);ADL-Glittre与CAT中度(r = 0.52;[95%CI 0.30;0.69];p r = 0.50;[95%CI 0.27;0.67];p
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引用次数: 0
Body Composition, Physical Function and Exercise Capacity in Chronic Obstructive Pulmonary Disease. 慢性阻塞性肺疾病患者的身体组成、身体功能和运动能力。
IF 2.2 4区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2023-12-01 DOI: 10.1080/15412555.2023.2237583
Christa M Todoroff, Michael J Berry

Current literature yields unequivocal results regarding the effect of body composition on physical function in patients with chronic obstructive pulmonary disease and disproportionately includes a majority of males. The purpose of this study was to determine whether specific body composition measures are significantly associated with physical function and exercise capacity in patients with chronic obstructive pulmonary disease with equal representation of males and females. Independent variables included sex, total body mass, total body lean and fat mass, appendicular total mass, and appendicular lean and fat mass. Dependent variables included peak oxygen consumption, 6-minute walk distance and self-reported physical function. Patients (n = 170) with dual-energy X-ray absorptiometry data, 6-minute walk distance, and self-reported physical function were used for these analyses. A sub-set of 145 of these patients with peak oxygen consumption data were also analysed. Hierarchical multiple regression analysis was used to determine if sex and body composition measures correlated with physical function and exercise capacity and if they explained additional variance after controlling for disease severity. After controlling for disease severity, appendicular lean mass, total body fat mass, and sex explained an additional 16.5% of the variance in peak oxygen consumption (p < 0.001). Appendicular lean mass explained an additional 8.9% of the variance in 6-minute walk distance (p < 0.001) and an additional 2.5% of the variance in self-reported physical function (p = 0.057). Body composition measures may further predict exercise capacity, 6-minute walk distance, and self-reported physical function in patients with chronic obstructive pulmonary disease.

目前的文献对慢性阻塞性肺病患者的身体成分对身体功能的影响产生了明确的结果,其中不成比例地包括大多数男性。本研究的目的是确定男性和女性代表性相同的慢性阻塞性肺病患者的特定身体成分测量是否与身体功能和运动能力显著相关。自变量包括性别、全身质量、全身瘦脂肪质量、阑尾总质量和阑尾瘦脂肪质量。因变量包括峰值耗氧量、6分钟步行距离和自我报告的身体功能。使用具有双能X射线吸收仪数据、6分钟步行距离和自我报告的身体功能的患者(n=170)进行这些分析。还对其中145名患者的耗氧量峰值数据进行了分析。使用分层多元回归分析来确定性别和身体成分指标是否与身体功能和运动能力相关,以及它们是否解释了控制疾病严重程度后的额外方差。在控制疾病严重程度后,阑尾脂肪量、全身脂肪量和性别解释了峰值耗氧量变化的16.5%(p p=0.057)。身体成分测量可以进一步预测慢性阻塞性肺病患者的运动能力、6分钟步行距离和自我报告的身体功能。
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引用次数: 0
Sevoflurane with Low Concentration Decrease DNA Methylation on Chronic Obstructive Pulmonary Disease (COPD)-Related Gene Promoter in COPD Rat. 低浓度七氟醚降低慢性阻塞性肺疾病(COPD)相关基因启动子DNA甲基化。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-27 DOI: 10.1080/15412555.2023.2278282
Chuanxin Yang, Libing Deng, Fang Bao, Hui Jiang, Long Zhang

Chronic obstructive pulmonary disease (COPD) is a difficult-to-cure disease that mainly affects the respiratory system. Inhaled anesthetic drug such as sevoflurane plays a controversial role in COPD by different concentration, but the underlying epigenetic mechanism remains unclear. Here, we prepared lipopolysaccharide (LPS)-induced COPD rat model, and isolated Alveolar type II (ATII) cells. We mainly focused DNA methylation on the promoter of COPD-related genes including Sftpa1, Napsa, Ca2, Sfta2, Lamp3, Wif1, Pgc, and Etv5. We observed COPD rat treated by sevoflurane with low (0.5%) and high (2%) concentrations displayed an opposite DNA methylation pattern. These six genes' promoter were all hypomethylated by 0.5% sevoflurane whereas hypermethylated by 2% sevoflurane, accompanied with the opposite transcriptional activity. We further verified that the DNMT1 binding ability contributed to DNA methylation these six genes' promoter. Moreover, we also captured DNMT1 and identified REC8 meiotic recombination protein (REC8) as the specific binding protein only existed in ATII cells treated with 0.5% sevoflurane rather than 2% and control. The binding ability of REC8 on these target genes' promoter showed highly positive correlation with DNMT1. In summary, we uncovered a potential epigenetic role of sevoflurane with low concentration in ATII cells of COPD that may help us deeply understand the pathogenesis and treatment mechanism of inhaled anesthesia drugs in COPD via a dose-dependent manner.

慢性阻塞性肺疾病(COPD)是一种主要影响呼吸系统的难以治愈的疾病。吸入麻醉药物如七氟醚在COPD中不同浓度的作用存在争议,但其潜在的表观遗传机制尚不清楚。在此,我们制备了脂多糖(LPS)诱导的COPD大鼠模型,并分离肺泡II型(ATII)细胞。我们主要研究了copd相关基因启动子的DNA甲基化,包括Sftpa1、Napsa、Ca2、Sfta2、Lamp3、Wif1、Pgc和Etv5。我们观察到低(0.5%)和高(2%)浓度七氟醚治疗COPD大鼠显示相反的DNA甲基化模式。这6个基因的启动子均被0.5%七氟醚低甲基化,而被2%七氟醚高甲基化,并伴随着相反的转录活性。我们进一步验证了DNMT1的结合能力对这6个基因的启动子的DNA甲基化有贡献。此外,我们还捕获了DNMT1,并鉴定出REC8减数分裂重组蛋白(REC8)是仅在0.5%七氟醚处理的ATII细胞中存在的特异性结合蛋白,而不是2%七氟醚和对照。REC8对这些靶基因启动子的结合能力与DNMT1呈高度正相关。综上所述,我们发现了低浓度七氟醚在COPD患者ATII细胞中潜在的表观遗传作用,这可能有助于我们通过剂量依赖的方式深入了解吸入麻醉药物在COPD中的发病机制和治疗机制。
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引用次数: 0
FOXO3 Activation Prevents Cellular Senescence in Emphysema Induced by Cigarette Smoke. FOXO3 激活可防止吸烟诱发肺气肿的细胞衰老
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-01-19 DOI: 10.1080/15412555.2022.2164262
Hui Jiang, Yuanrui Xu, Yaona Jiang, Yaqing Li

Because cigarette smoke can induce COPD/emphysema through accelerating senescence with or without an incomplete repair system. However, the pathogenesis of COPD following lung senescence induced by CS is not fully understood. Airspace enlargement and airway epithelial cell senescence are common finding during the COPD development. We investigated the lung tress response to CS and demonstrated that a stress-responsive transcription factor, FOXO3, was regulated by deacetylase. SIRT1 inhibited FOXO3 acetylation and FOXO3 degradation, leading to FOXO3 accumulation and activation in airway epithelial cells. CS exposure activated SIRT1 contributed to FOXO3 activation and functioned to protect lungs, as deletion of SIRT1 decreased CS-induced FOXO3 activation and resulted in more severe airway epithelial cells senescence airspace enlargement. Strikingly, deletion of FOXO3 during the development of COPD aggravated lung structural and functional damage, leading to a much more profound COPD phenotype. We show that deletion of FOXO3 resulted in decreased autophagic response and increased senescence, which may explain lung protection by FOXO3. Our study indicates that in the COPD, stress-responsive transcription factors can be activated for adaptions to counteract senescence insults, thus attenuating COPD development.

因为无论是否存在不完全修复系统,香烟烟雾都能通过加速衰老诱发慢性阻塞性肺病/肺气肿。然而,CS 诱导的肺衰老导致慢性阻塞性肺病的发病机制尚不完全清楚。气室扩大和气道上皮细胞衰老是慢性阻塞性肺病发展过程中的常见现象。我们研究了肺对 CS 的应激反应,结果表明应激反应转录因子 FOXO3 受去乙酰化酶的调控。SIRT1 可抑制 FOXO3 乙酰化和 FOXO3 降解,从而导致 FOXO3 在气道上皮细胞中积累和激活。CS 暴露激活的 SIRT1 有助于 FOXO3 的活化,并起到保护肺的作用,因为 SIRT1 的缺失会降低 CS 诱导的 FOXO3 活化,并导致更严重的气道上皮细胞衰老气室扩大。令人震惊的是,在慢性阻塞性肺病的发展过程中,缺失 FOXO3 会加重肺结构和功能损伤,导致更严重的慢性阻塞性肺病表型。我们的研究表明,缺失 FOXO3 会导致自噬反应减弱和衰老增加,这或许可以解释 FOXO3 对肺的保护作用。我们的研究表明,在慢性阻塞性肺病中,应激反应转录因子可被激活,以适应对抗衰老的损伤,从而减轻慢性阻塞性肺病的发展。
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引用次数: 0
Integrative Analyses of Mendelian Randomization and Transcriptomic Data Reveal No Association between Leptin and Chronic Obstructive Pulmonary Disease. 孟德尔随机化和转录组数据的综合分析显示瘦素与慢性阻塞性肺病之间没有关联。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-09 DOI: 10.1080/15412555.2023.2260890
Ao Zhang, Suyan Tian

As a key adipokine, leptin has been extensively investigated for its potential role in the pathogenesis of chronic obstructive pulmonary disease (COPD). However, concordant conclusions have not been attained. In this study, we investigated the relationship between leptin and COPD using an integrative analysis that combined a Mendelian randomization (MR) study with transcriptomic data analysis. Here, the MR analysis was performed on the online platform MR-Base, and the bioinformatics analyses were performed with the aid of R Bioconductor packages. No evidence was found by the integrative analysis to support the association of the two attributes. All methods detected a null causal effect of leptin on COPD in the MR analysis. In particular, when the genetically predicted leptin level increased one unit, the risk of developing COPD was estimated as 0.999 (p = 0.943), 0.920 (p = 0.516), 1.002 (p = 0.885), and 1.002 (p = 0.906) by the Inverse Variance Weighted (IVW), MR-Egger, weighted median, and weighted mode method, respectively. Furthermore, no leptin-associated genes except one were identified as being differentially expressed between COPD and control in bioinformatics analysis. The observed association between leptin and COPD in previous observational studies may be attributable to unmeasured confounding effects or reverse causation.

作为一种关键的脂肪因子,瘦素在慢性阻塞性肺病(COPD)发病机制中的潜在作用已被广泛研究。然而,尚未得出一致的结论。在这项研究中,我们使用孟德尔随机化(MR)研究和转录组数据分析相结合的综合分析来研究瘦素与COPD之间的关系。在此,在在线平台MR Base上进行MR分析,并在R Bioconductor软件包的帮助下进行生物信息学分析。综合分析没有发现任何证据支持这两个属性之间的关联。在MR分析中,所有方法都检测到瘦素对COPD的无效因果影响。特别是,当基因预测的瘦素水平增加一个单位时,患COPD的风险估计为0.999(p = 0.943)、0.920(p = 0.516)、1.002(p = 0.885)和1.002(p = 0.906)。此外,在生物信息学分析中,除了一个瘦素相关基因外,没有发现COPD和对照组之间存在差异表达。在先前的观察性研究中观察到的瘦素与COPD之间的关联可能归因于未测量的混杂效应或反向因果关系。
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引用次数: 0
Development of a Communication Tool between Patients and Physicians for Recognizing COPD Exacerbations in Japan. 日本慢性阻塞性肺病恶化患者和医生之间沟通工具的开发。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 DOI: 10.1080/15412555.2023.2219742
Paul Jones, Osamu Hataji, Yoshimi Suzukamo, Bruce Crawford, Yoko Sakai, Takeo Ishii, Keiko Sato, Eri Sasaki, Kenichi Hashimoto, Toru Oga

In Japan, exacerbations are underreported compared with other countries, possibly due in part to a failure to recognize them. This study aimed to create a simple chronic obstructive pulmonary disease (COPD) Exacerbation Recognition Tool (CERT-J) specifically for Japanese patients. Patients ≥40 years with confirmed COPD or asthma-COPD overlap were included. Focus groups were held to identify words and phrases used by patients to describe symptoms associated with an exacerbation, resulting in candidate items being identified. Following cognitive debriefing, the items were refined based on item frequency, level of endorsement and effect of demographic factors. Exploratory factor analysis (EFA) was then performed to inform an expert panel's choice of items to form the new tool. A total of 41 patients were included in the focus groups and nine patients performed the cognitive debrief. Following this, the expert panel identified 26 items for testing in a further 100 patients (mean age 72 years, forced expiratory volume in 1 s 54.8% predicted and 1.8 exacerbations in the preceding 12 months). Eleven items were associated with breathlessness or activity limitation and seven of these were the most frequently endorsed. EFA identified four factors, with one (breathlessness) being dominant. The expert panel recommended that the CERT-J should include six items: breathlessness and activity limitation (3 items), cough (1 item) and phlegm (2 items). The final CERT-J should benefit patients with COPD by providing them with an increased understanding and recognition of exacerbations.Clinical Trial Registration: GSK K.K (jRCT1080224526).

与其他国家相比,日本的病情恶化报告不足,部分原因可能是没有认识到。本研究旨在创建一种专门针对日本患者的简单慢性阻塞性肺病(COPD)加重识别工具(CERT-J)。患者≥40 包括确诊COPD或哮喘COPD重叠的年份。焦点小组旨在识别患者用于描述与病情恶化相关症状的单词和短语,从而确定候选项目。认知汇报后,根据项目频率、认可程度和人口统计学因素的影响对项目进行细化。然后进行探索性因素分析(EFA),为专家小组选择新工具的项目提供信息。共有41名患者被纳入焦点组,9名患者进行了认知汇报。在此之后,专家小组确定了另外100名患者(平均年龄72岁)的26个测试项目 年,1年用力呼气量 s预测为54.8%,前12年恶化1.8次 月)。11个项目与呼吸困难或活动受限有关,其中7个项目是最常被认可的。全民教育确定了四个因素,其中一个因素(呼吸困难)占主导地位。专家小组建议CERT-J应包括六项:呼吸困难和活动受限(3项)、咳嗽(1项)和痰(2项)。最终的CERT-J应使COPD患者更好地了解和识别病情恶化,从而使他们受益。临床试验注册:葛兰素史克(jRCT1080224526)。
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引用次数: 0
Chest MRI and CT Predictors of 10-Year All-Cause Mortality in COPD. COPD患者10年全因死亡率的胸部MRI和CT预测指标。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-09-22 DOI: 10.1080/15412555.2023.2259224
Maksym Sharma, Paulina V Wyszkiewicz, Alexander M Matheson, David G McCormack, Grace Parraga

Pulmonary imaging measurements using magnetic resonance imaging (MRI) and computed tomography (CT) have the potential to deepen our understanding of chronic obstructive pulmonary disease (COPD) by measuring airway and parenchymal pathologic information that cannot be provided by spirometry. Currently, MRI and CT measurements are not included in mortality risk predictions, diagnosis, or COPD staging. We evaluated baseline pulmonary function, MRI and CT measurements alongside imaging texture-features to predict 10-year all-cause mortality in ex-smokers with (n = 93; 31 females; 70 ± 9years) and without (n = 69; 29 females, 69 ± 9years) COPD. CT airway and vessel measurements, helium-3 (3He) MRI ventilation defect percent (VDP) and apparent diffusion coefficients (ADC) were quantified. MRI and CT texture-features were extracted using PyRadiomics (version2.2.0). Associations between 10-year all-cause mortality and all clinical and imaging measurements were evaluated using multivariable regression model odds-ratios. Machine-learning predictive models for 10-year all-cause mortality were evaluated using area-under-receiver-operator-characteristic-curve (AUC), sensitivity and specificity analyses. DLCO (%pred) (HR = 0.955, 95%CI: 0.934-0.976, p < 0.001), MRI ADC (HR = 1.843, 95%CI: 1.260-2.871, p < 0.001), and CT informational-measure-of-correlation (HR = 3.546, 95% CI: 1.660-7.573, p = 0.001) were the strongest predictors of 10-year mortality. A machine-learning model trained on clinical, imaging, and imaging textures was the best predictive model (AUC = 0.82, sensitivity = 83%, specificity = 84%) and outperformed the solely clinical model (AUC = 0.76, sensitivity = 77%, specificity = 79%). In ex-smokers, regardless of COPD status, addition of CT and MR imaging texture measurements to clinical models provided unique prognostic information of mortality risk that can allow for better clinical management.Clinical Trial Registration: www.clinicaltrials.gov NCT02279329.

使用磁共振成像(MRI)和计算机断层扫描(CT)进行的肺部成像测量有可能通过测量肺活量测量无法提供的气道和实质病理信息来加深我们对慢性阻塞性肺病(COPD)的理解。目前,MRI和CT测量不包括在死亡率预测、诊断或COPD分期中。我们评估了基线肺功能、MRI和CT测量以及成像纹理特征,以预测患有(n = 93;女性31例;70 ± 9年)和无(n = 69;29名女性,69名 ± 9岁)COPD。对CT气道和血管测量、氦-3(3He)MRI通气缺陷百分比(VDP)和表观扩散系数(ADC)进行量化。使用PyRadiomics(版本2.2.0)提取MRI和CT纹理特征。使用多变量回归模型优势比评估10年全因死亡率与所有临床和影像学测量之间的相关性。使用受试者特征曲线下面积(AUC)、敏感性和特异性分析评估了10年全因死亡率的机器学习预测模型。DLCO(pred百分比)(HR=0.955,95%CI:0.93-0.976,p p p = 0.001)是10年死亡率的最强预测因素。在临床、成像和成像纹理上训练的机器学习模型是最好的预测模型(AUC=0.82,灵敏度=83%,特异性=84%),并且优于单独的临床模型(AUC=0.76,灵敏度=77%,特异性=79%)。在戒烟者中,无论COPD状态如何,在临床模型中添加CT和MR成像纹理测量提供了独特的死亡风险预后信息,可以更好地进行临床管理。临床试验注册:www.clinicaltrials.gov NCT02279329。
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引用次数: 0
Development and Validation of Prediction Models for Exacerbation, Frequent Exacerbations and Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Registry Study in North China. 慢性阻塞性肺疾病加重、频繁加重和严重加重预测模型的开发和验证:中国北方的一项注册研究。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-23 DOI: 10.1080/15412555.2023.2263562
Yuyan Zhou, Siqi He, Wanying Wang, Xiaoyue Wang, Xiaoting Chen, Xiaoning Bu, Deshuai Li

In COPD patients, exacerbation has a detrimental influence on the quality of life, disease progression and socioeconomic burden. This study aimed to develop and validate models to predict exacerbation, frequent exacerbations and severe exacerbations in COPD patients. We conducted an observational prospective multicenter study. Clinical data of all outpatients with stable COPD were collected from Beijing Chaoyang Hospital and Beijing Renhe Hospital between January 2018 and December 2019. Patients were followed up for 1 year. The data from Chaoyang Hospital was used for modeling dataset, and that of Renhe Hospital was used for external validation dataset. The final dataset included 456 patients, with 326 patients as the model group and 130 patients as the validation group. Using LABA + ICS, frequent exacerbations in the past year and CAT score were independent risk factors for exacerbation in the next year (OR = 2.307, 2.722 and 1.147), and FVC %pred as a protective factor (OR = 0.975). Combined with chronic heart failure, frequent exacerbations in the past year, blood EOS counts and CAT score were independent risk factors for frequent exacerbations in the next year (OR = 4.818, 2.602, 1.015 and 1.342). Using LABA + ICS, combined with chronic heart failure, frequent exacerbations in the past year and CAT score were independent risk factors for severe exacerbations in the next year (OR = 1.950, 3.135, 2.980 and 1.133). Based on these prognostic models, nomograms were generated. The prediction models were simple and useful tools for predicting the risk of exacerbation, frequent exacerbations and severe exacerbations of COPD patients in North China.

在COPD患者中,病情恶化对生活质量、疾病进展和社会经济负担有不利影响。本研究旨在开发和验证预测COPD患者恶化、频繁恶化和严重恶化的模型。我们进行了一项观察性前瞻性多中心研究。收集2018年1月至2019年12月期间北京朝阳医院和北京仁和医院所有门诊稳定期COPD患者的临床数据。患者随访1 年朝阳医院的数据用于建模数据集,仁和医院的数据用作外部验证数据集。最终数据集包括456名患者,326名患者作为模型组,130名患者作为验证组。使用LABA + ICS、过去一年的频繁恶化和CAT评分是下一年恶化的独立危险因素(OR=2.307、2.722和1.147),FVC%pred是保护因素(OR=0.975),血液EOS计数和CAT评分是第二年频繁恶化的独立危险因素(OR=4.818、2.602、1.015和1.342) + ICS、慢性心力衰竭、过去一年的频繁恶化和CAT评分是下一年严重恶化的独立风险因素(OR=1.950、3.135、2.980和1.133)。基于这些预后模型,生成列线图。该预测模型是预测华北地区COPD患者急性加重、频繁加重和严重加重风险的简单而有用的工具。
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引用次数: 0
Triple Inhaler versus Dual Bronchodilator Therapy in COPD: Real-World Effectiveness on Mortality. 慢性阻塞性肺病患者的三重吸入器与双重支气管扩张剂治疗:对死亡率的实际有效性。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-12-01 Epub Date: 2021-09-21 DOI: 10.1080/15412555.2021.1977789
Samy Suissa, Sophie Dell'Aniello, Pierre Ernst

Randomized trials of triple therapy including an inhaled corticosteroid (ICS) for chronic obstructive pulmonary disease (COPD) reported remarkable benefits on mortality compared with dual bronchodilators, likely resulting from ICS withdrawal at randomization. We compared triple therapy with dual bronchodilator combinations on major COPD outcomes in a real-world clinical practice setting. We identified a cohort of COPD patients, age 50 or older, treated during 2002-2018, from the United Kingdom's Clinical Practice Research Datalink. Patients initiating treatment with a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA) and an ICS on the same day, were compared with patients initiating a LAMA and LABA, weighted by fine stratification of propensity scores. Subjects were followed-up one year for all-cause mortality, severe exacerbation and pneumonia. The cohort included 117,729 new-users of LAMA-LABA-ICS and 26,666 of LAMA-LABA. The adjusted hazard ratio (HR) of all-cause mortality with LAMA-LABA-ICS compared with LAMA-LABA was 1.17 (95% CI: 1.04-1.31) while for severe exacerbation and pneumonia it was 1.19 (1.08-1.32) and 1.29 (1.16-1.45) respectively. However, mortality was not elevated with triple therapy among patients with asthma diagnosis (HR 0.99; 95% CI: 0.74-1.34), with two or more prior exacerbations (HR 0.88; 95% CI: 0.70-1.11), and with FEV1 percent predicted >30%. In a real-world setting of COPD treatment, triple therapy initiation was not more effective than dual bronchodilators at preventing all-cause mortality and severe COPD exacerbations. Triple therapy may be unsafe among patients without prior exacerbations, in whom ICS are not recommended, with no asthma diagnosis and with very severe airflow obstruction.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1977789 .

包括吸入皮质类固醇(ICS)在内的三联治疗慢性阻塞性肺疾病(COPD)的随机试验报告,与双支气管扩张剂相比,三联治疗在死亡率上有显著的益处,这可能是由于随机停用ICS所致。在现实世界的临床实践中,我们比较了三联治疗和双支气管扩张剂联合治疗对COPD主要结局的影响。我们从英国临床实践研究数据链中确定了一组年龄在50岁或以上的COPD患者,他们在2002-2018年期间接受了治疗。在同一天开始使用长效毒蕈碱拮抗剂(LAMA)、长效β - 2激动剂(LABA)和ICS治疗的患者与开始使用LAMA和LABA治疗的患者进行比较,并通过倾向评分的精细分层进行加权。随访一年,观察全因死亡率、严重恶化和肺炎情况。该队列包括117,729名LAMA-LABA- ics新用户和26,666名LAMA-LABA新用户。与LAMA-LABA- ics相比,LAMA-LABA- ics的全因死亡率校正危险比(HR)为1.17 (95% CI: 1.04-1.31),严重加重和肺炎的校正危险比分别为1.19(1.08-1.32)和1.29(1.16-1.45)。然而,在诊断为哮喘的患者中,三联疗法的死亡率没有升高(HR 0.99;95% CI: 0.74-1.34),既往有两次或两次以上加重(HR 0.88;95% CI: 0.70-1.11), fev1%预测>30%。在COPD治疗的现实环境中,三联治疗在预防全因死亡率和严重COPD恶化方面并不比双支气管扩张剂更有效。三联疗法对于先前没有加重的患者可能是不安全的,这些患者不建议使用ICS,没有哮喘诊断并且有非常严重的气流阻塞。本文的补充数据可在https://doi.org/10.1080/15412555.2021.1977789上在线获得。
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引用次数: 19
Validation of Clinical COPD Phenotypes for Prognosis of Long-Term Mortality in Swedish and Dutch Cohorts. 瑞典和荷兰队列慢性阻塞性肺病临床表型对长期死亡率预后的验证。
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-12-01 DOI: 10.1080/15412555.2022.2039608
S Gagatek, S R A Wijnant, B Ställberg, K Lisspers, G Brusselle, X Zhou, M Hasselgren, S Montgomeryi, J Sundhj, C Janson, Ö Emilsson, L Lahousse, A Malinovschi

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with variable mortality risk. The aim of our investigation was to validate a simple clinical algorithm for long-term mortality previously proposed by Burgel et al. in 2017. Subjects with COPD from two cohorts, the Swedish PRAXIS study (n = 784, mean age (standard deviation (SD)) 64.0 years (7.5), 42% males) and the Rotterdam Study (n = 735, mean age (SD) 72 years (9.2), 57% males), were included. Five clinical clusters were derived from baseline data on age, body mass index, dyspnoea grade, pulmonary function and comorbidity (cardiovascular disease/diabetes). Cox models were used to study associations with 9-year mortality. The distribution of clinical clusters (1-5) was 29%/45%/8%/6%/12% in the PRAXIS study and 23%/26%/36%/0%/15% in the Rotterdam Study. The cumulative proportion of deaths at the 9-year follow-up was highest in clusters 1 (65%) and 4 (72%), and lowest in cluster 5 (10%) in the PRAXIS study. In the Rotterdam Study, cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared with cluster 5, the meta-analysed age- and sex-adjusted hazard ratio (95% confidence interval) for cluster 1 was 6.37 (3.94-10.32) and those for clusters 2 and 3 were 2.61 (1.58-4.32) and 3.06 (1.82-5.13), respectively. Burgel's clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with the best prognosis and clusters 2 and 3 with intermediate prognosis in two independent cohorts from Sweden and the Netherlands.

慢性阻塞性肺疾病(COPD)是一种具有可变死亡风险的异质性疾病。我们调查的目的是验证Burgel等人在2017年提出的一种简单的长期死亡率临床算法。COPD患者来自两个队列:瑞典PRAXIS研究(n = 784,平均年龄(标准差)64.0岁(7.5),男性42%)和鹿特丹研究(n = 735,平均年龄(SD) 72岁(9.2),男性57%)。从年龄、体重指数、呼吸困难等级、肺功能和合并症(心血管疾病/糖尿病)的基线数据中得出5个临床聚类。Cox模型用于研究与9年死亡率的关系。临床聚类(1-5)的分布在PRAXIS研究中为29%/45%/8%/6%/12%,在鹿特丹研究中为23%/26%/36%/0%/15%。在PRAXIS研究中,9年随访时的累积死亡比例在第1类(65%)和第4类(72%)中最高,在第5类(10%)中最低。在鹿特丹研究中,聚类1(44%)的累积死亡率最高,聚类5(5%)的累积死亡率最低。与聚类5比较,聚类1经年龄和性别调整后的meta分析风险比(95%可信区间)分别为6.37(3.94 ~ 10.32)、2.61(1.58 ~ 4.32)和3.06(1.82 ~ 5.13)。Burgel的临床聚类可以用来预测长期死亡风险。在来自瑞典和荷兰的两个独立队列中,第1和第4类患者预后最差,第5类患者预后最好,第2和第3类患者预后中等。
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引用次数: 3
期刊
COPD: Journal of Chronic Obstructive Pulmonary Disease
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