Pub Date : 2024-10-07eCollection Date: 2024-09-01DOI: 10.1183/23120541.00169-2024
Peter Rassam, Tamires de Mori, Marine Van Hollebeke, Dmitry Rozenberg, Paul Davenport, Lori Ann Vallis, W Darlene Reid
Background: Inspiratory threshold loading (ITL) and associated dyspnoea have been shown to interfere with cognition during cognitive-motor dual tasking. However, ITL has not been compared with another rhythmic muscle activity, such as lower limb pedalling. While ITL has been shown to interfere with cognition, the mechanism of the prefrontal cortex (PFC) during ITL or other rhythmical muscle dual tasking, has not been elucidated. Given the cognitive interference that arises during ITL, we hypothesise that ITL cognitive-motor dual tasking will result in greater cognitive decrements and increased PFC activity compared with the pedalling cognitive-motor dual task.
Methods: 30 healthy participants (16 females; median age 23 (interquartile range 23-24) years) were recruited. They performed five 3-min tasks in a single visit in a random order: single tasks were ITL, pedalling and Stroop task and dual tasks were ITL-Stroop and pedalling-Stroop. Participant's PFC activity was assessed bilaterally using functional near-infrared spectroscopy throughout each task. Single- and dual-task cognitive performance was evaluated by measuring Stroop task reaction time and accuracy. Dyspnoea and rating of perceived exertion were evaluated at the end of each task.
Results: ITL-Stroop resulted in greater impairments in reaction time (p<0.001), accuracy (p<0.01) and increased medial/dorsolateral PFC activity (p≤0.006) than pedalling-Stroop. ITL-Stroop elicited greater Borg dyspnoea and rating of perceived exertion than pedalling-Stroop (p<0.001), despite pedalling-Stroop having a greater heart rate response (p<0.001).
Conclusion: The heightened cognitive decrements, perceptual response and PFC activity suggest that inspiratory muscle loading and its accompanied dyspnoea results in greater cognitive interference than rhythmic pedalling.
{"title":"Cognitive interference of respiratory <i>versus</i> limb muscle dual tasking in healthy adults.","authors":"Peter Rassam, Tamires de Mori, Marine Van Hollebeke, Dmitry Rozenberg, Paul Davenport, Lori Ann Vallis, W Darlene Reid","doi":"10.1183/23120541.00169-2024","DOIUrl":"https://doi.org/10.1183/23120541.00169-2024","url":null,"abstract":"<p><strong>Background: </strong>Inspiratory threshold loading (ITL) and associated dyspnoea have been shown to interfere with cognition during cognitive-motor dual tasking. However, ITL has not been compared with another rhythmic muscle activity, such as lower limb pedalling. While ITL has been shown to interfere with cognition, the mechanism of the prefrontal cortex (PFC) during ITL or other rhythmical muscle dual tasking, has not been elucidated. Given the cognitive interference that arises during ITL, we hypothesise that ITL cognitive-motor dual tasking will result in greater cognitive decrements and increased PFC activity compared with the pedalling cognitive-motor dual task.</p><p><strong>Methods: </strong>30 healthy participants (16 females; median age 23 (interquartile range 23-24) years) were recruited. They performed five 3-min tasks in a single visit in a random order: single tasks were ITL, pedalling and Stroop task and dual tasks were ITL-Stroop and pedalling-Stroop. Participant's PFC activity was assessed bilaterally using functional near-infrared spectroscopy throughout each task. Single- and dual-task cognitive performance was evaluated by measuring Stroop task reaction time and accuracy. Dyspnoea and rating of perceived exertion were evaluated at the end of each task.</p><p><strong>Results: </strong>ITL-Stroop resulted in greater impairments in reaction time (p<0.001), accuracy (p<0.01) and increased medial/dorsolateral PFC activity (p≤0.006) than pedalling-Stroop. ITL-Stroop elicited greater Borg dyspnoea and rating of perceived exertion than pedalling-Stroop (p<0.001), despite pedalling-Stroop having a greater heart rate response (p<0.001).</p><p><strong>Conclusion: </strong>The heightened cognitive decrements, perceptual response and PFC activity suggest that inspiratory muscle loading and its accompanied dyspnoea results in greater cognitive interference than rhythmic pedalling.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389016","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 : 2024-10-07eCollection Date: 2024-09-01DOI: 10.1183/23120541.00168-2024
Akshat Kapur, Héctor Rojas-Anaya, Graham Roberts, Damian Roland, Atul Gupta, Michaela Lazner, Jane Bayreuther, Fleur Cantle, Christina Jones, John Pappachan, Stephen Bremner, David James, Shane Fitzgerald, Kelly Owens, Lalarukh Asim, Ekaterina Khaleva, Paul Seddon
Background: Treating children with acute severe asthma (ASA) who fail to respond to first-line inhaled bronchodilators is problematic: use of intravenous agents is inconsistent and side-effects are common. High-flow humidified oxygen (HiFlo) has shown promise in other respiratory conditions and is increasingly used in ASA, but with little evidence.
Methods: We conducted a feasibility randomised controlled trial with deferred consent to assess early HiFlo in children aged 2-11 years with ASA not responding to "burst" therapy (high-dose inhaled salbutamol ± ipratropium). Children with Paediatric Respiratory Assessment Measure (PRAM) score 5+ after "burst" were randomised to commence HiFlo or follow standard care. Candidate primary outcomes assessed were treatment failure requiring escalation, and time to meeting hospital discharge criteria.
Results: The target was met despite coronavirus disease 2019 pandemic disruption: 56 children were randomised across four sites, with deferred consent received in 50 out of 56 (89%), and mean recruitment rate 1.1 per site per month. 28 were allocated early HiFlo and 22 standard care. Data collection was complete for both candidate primary outcomes. Treatment failure requiring escalation occurred in 18 of 28 children (64%) in the HiFlo arm and in 19 of 22 (86%) in the standard care arm. Median (interquartile range) time from randomisation to meeting discharge criteria was 29.3 h (21.8-43.7 h) in the HiFlo arm and 36.8 h (24.1-46.3 h) in the standard care arm.
Conclusions: HiFlo in childhood ASA is a potentially promising intervention whose use is increasing despite lack of evidence. A definitive randomised controlled trial to assess its effectiveness is required and appears to be feasible.
{"title":"High-flow humidified oxygen as an early intervention in children with acute severe asthma: a feasibility randomised controlled trial.","authors":"Akshat Kapur, Héctor Rojas-Anaya, Graham Roberts, Damian Roland, Atul Gupta, Michaela Lazner, Jane Bayreuther, Fleur Cantle, Christina Jones, John Pappachan, Stephen Bremner, David James, Shane Fitzgerald, Kelly Owens, Lalarukh Asim, Ekaterina Khaleva, Paul Seddon","doi":"10.1183/23120541.00168-2024","DOIUrl":"https://doi.org/10.1183/23120541.00168-2024","url":null,"abstract":"<p><strong>Background: </strong>Treating children with acute severe asthma (ASA) who fail to respond to first-line inhaled bronchodilators is problematic: use of intravenous agents is inconsistent and side-effects are common. High-flow humidified oxygen (HiFlo) has shown promise in other respiratory conditions and is increasingly used in ASA, but with little evidence.</p><p><strong>Methods: </strong>We conducted a feasibility randomised controlled trial with deferred consent to assess early HiFlo in children aged 2-11 years with ASA not responding to \"burst\" therapy (high-dose inhaled salbutamol ± ipratropium). Children with Paediatric Respiratory Assessment Measure (PRAM) score 5+ after \"burst\" were randomised to commence HiFlo or follow standard care. Candidate primary outcomes assessed were treatment failure requiring escalation, and time to meeting hospital discharge criteria.</p><p><strong>Results: </strong>The target was met despite coronavirus disease 2019 pandemic disruption: 56 children were randomised across four sites, with deferred consent received in 50 out of 56 (89%), and mean recruitment rate 1.1 per site per month. 28 were allocated early HiFlo and 22 standard care. Data collection was complete for both candidate primary outcomes. Treatment failure requiring escalation occurred in 18 of 28 children (64%) in the HiFlo arm and in 19 of 22 (86%) in the standard care arm. Median (interquartile range) time from randomisation to meeting discharge criteria was 29.3 h (21.8-43.7 h) in the HiFlo arm and 36.8 h (24.1-46.3 h) in the standard care arm.</p><p><strong>Conclusions: </strong>HiFlo in childhood ASA is a potentially promising intervention whose use is increasing despite lack of evidence. A definitive randomised controlled trial to assess its effectiveness is required and appears to be feasible.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389019","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 : 2024-10-07eCollection Date: 2024-09-01DOI: 10.1183/23120541.00149-2024
Chun-Yao Huang, Yao-Kuang Wu, Mei-Chen Yang, Kuo-Liang Huang, Wen-Lin Su, Yi-Chih Huang, Wu Chih-Wei, I-Shiang Tzeng, Chou-Chin Lan
Background: Coronavirus disease 2019 (COVID-19) has a considerable impact on the global healthcare system. Individuals who have recovered from COVID often experience chronic respiratory symptoms that affect their daily lives. This study aimed to assess respiratory dynamics such as airway hyperresponsiveness (AHR) and bronchodilator response in post-COVID patients.
Methods: This study included 282 adults with respiratory symptoms who underwent provocation tests. The demographic details, clinical symptoms and medical histories were recorded. Baseline spirometry, methacholine challenge tests (MCT) and post-bronchodilator spirometry were performed. Patients were divided into the following four groups: Group 1: non-COVID-19 and negative MCT; Group 2: post-COVID-19 and negative MCT; Group 3: non-COVID-19 and positive MCT; and Group 4: post-COVID-19 and positive MCT.
Results: Most post-COVID-19 patients (43.7%) experienced AHR, and wheezing was more common. Patients in Group 4 exhibited increased intensities of dyspnoea, cough and wheezing with the lowest pulmonary function test (PFT) parameters at baseline. Moreover, significant decreases in PFT parameters after the MCT were observed in these patients. Although the prevalence of a low forced expiratory volume in 1 s to forced vital capacity ratio (<70%) was initially 2% in Group 4, it increased to 29% after MCT. No significant differences in allergic history or underlying diseases were observed between the groups.
Conclusions: These findings provide comprehensive insights into the AHR and respiratory symptoms of post-COVID-19 individuals, highlighting the characteristics and potential exacerbations in patients with positive MCT results. This emphasises the need of MCT to address respiratory dynamics in post-COVID-19 individuals.
{"title":"Assessing post-COVID-19 respiratory dynamics: a comprehensive analysis of pulmonary function, bronchial hyperresponsiveness and bronchodilator response.","authors":"Chun-Yao Huang, Yao-Kuang Wu, Mei-Chen Yang, Kuo-Liang Huang, Wen-Lin Su, Yi-Chih Huang, Wu Chih-Wei, I-Shiang Tzeng, Chou-Chin Lan","doi":"10.1183/23120541.00149-2024","DOIUrl":"https://doi.org/10.1183/23120541.00149-2024","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) has a considerable impact on the global healthcare system. Individuals who have recovered from COVID often experience chronic respiratory symptoms that affect their daily lives. This study aimed to assess respiratory dynamics such as airway hyperresponsiveness (AHR) and bronchodilator response in post-COVID patients.</p><p><strong>Methods: </strong>This study included 282 adults with respiratory symptoms who underwent provocation tests. The demographic details, clinical symptoms and medical histories were recorded. Baseline spirometry, methacholine challenge tests (MCT) and post-bronchodilator spirometry were performed. Patients were divided into the following four groups: Group 1: non-COVID-19 and negative MCT; Group 2: post-COVID-19 and negative MCT; Group 3: non-COVID-19 and positive MCT; and Group 4: post-COVID-19 and positive MCT.</p><p><strong>Results: </strong>Most post-COVID-19 patients (43.7%) experienced AHR, and wheezing was more common. Patients in Group 4 exhibited increased intensities of dyspnoea, cough and wheezing with the lowest pulmonary function test (PFT) parameters at baseline. Moreover, significant decreases in PFT parameters after the MCT were observed in these patients. Although the prevalence of a low forced expiratory volume in 1 s to forced vital capacity ratio (<70%) was initially 2% in Group 4, it increased to 29% after MCT. No significant differences in allergic history or underlying diseases were observed between the groups.</p><p><strong>Conclusions: </strong>These findings provide comprehensive insights into the AHR and respiratory symptoms of post-COVID-19 individuals, highlighting the characteristics and potential exacerbations in patients with positive MCT results. This emphasises the need of MCT to address respiratory dynamics in post-COVID-19 individuals.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389015","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 : 2024-10-07eCollection Date: 2024-09-01DOI: 10.1183/23120541.00561-2024
Manuela Funke-Chambour, Philipp Suter, Gisli R Jenkins, Leticia Kawano-Dourado, Christopher J Ryerson, Athol U Wells, Michael Kreuter, Kerri A Johannson
The use of steroids in fibrotic interstitial lung diseases is founded on limited evidence. This modified Delphi survey sheds light on current clinical practices. Given the risks of steroids, clinical trials are needed to evaluate efficacy and harm. https://bit.ly/3VkgvbS.
{"title":"Corticosteroid therapy in fibrotic interstitial lung disease: a modified Delphi survey.","authors":"Manuela Funke-Chambour, Philipp Suter, Gisli R Jenkins, Leticia Kawano-Dourado, Christopher J Ryerson, Athol U Wells, Michael Kreuter, Kerri A Johannson","doi":"10.1183/23120541.00561-2024","DOIUrl":"https://doi.org/10.1183/23120541.00561-2024","url":null,"abstract":"<p><p><b>The use of steroids in fibrotic interstitial lung diseases is founded on limited evidence. This modified Delphi survey sheds light on current clinical practices. Given the risks of steroids, clinical trials are needed to evaluate efficacy and harm.</b> https://bit.ly/3VkgvbS.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389017","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 : 2024-10-07eCollection Date: 2024-09-01DOI: 10.1183/23120541.00166-2024
Hye Ju Yeo, Dasom Noh, Tae Hwa Kim, Jin Ho Jang, Young Seok Lee, Sunghoon Park, Jae Young Moon, Kyeongman Jeon, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Woo Hyun Cho, Sunyoung Kwon
Background: The development of post-sepsis frailty is a common and significant problem, but it is a challenge to predict.
Methods: Data for deep learning were extracted from a national multicentre prospective observational cohort of patients with sepsis in Korea between September 2019 and December 2021. The primary outcome was frailty at survival discharge, defined as a clinical frailty score on the Clinical Frailty Scale ≥5. We developed a deep learning model for predicting frailty after sepsis by 10 variables routinely collected at the recognition of sepsis. With cross-validation, we trained and tuned six machine learning models, including four conventional and two neural network models. Moreover, we computed the importance of each predictor variable in the model. We measured the performance of these models using a temporal validation data set.
Results: A total of 8518 patients were included in the analysis; 5463 (64.1%) were frail, and 3055 (35.9%) were non-frail at discharge. The Extreme Gradient Boosting (XGB) achieved the highest area under the receiver operating characteristic curve (AUC) (0.8175) and accuracy (0.7414). To confirm the generalisation performance of artificial intelligence in predicting frailty at discharge, we conducted external validation with the COVID-19 data set. The XGB still showed a good performance with an AUC of 0.7668. The machine learning model could predict frailty despite the disparity in data distribution.
Conclusion: The machine learning-based model developed for predicting frailty after sepsis achieved high performance with limited baseline clinical parameters.
{"title":"Development and validation of a machine learning-based model for post-sepsis frailty.","authors":"Hye Ju Yeo, Dasom Noh, Tae Hwa Kim, Jin Ho Jang, Young Seok Lee, Sunghoon Park, Jae Young Moon, Kyeongman Jeon, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Woo Hyun Cho, Sunyoung Kwon","doi":"10.1183/23120541.00166-2024","DOIUrl":"https://doi.org/10.1183/23120541.00166-2024","url":null,"abstract":"<p><strong>Background: </strong>The development of post-sepsis frailty is a common and significant problem, but it is a challenge to predict.</p><p><strong>Methods: </strong>Data for deep learning were extracted from a national multicentre prospective observational cohort of patients with sepsis in Korea between September 2019 and December 2021. The primary outcome was frailty at survival discharge, defined as a clinical frailty score on the Clinical Frailty Scale ≥5. We developed a deep learning model for predicting frailty after sepsis by 10 variables routinely collected at the recognition of sepsis. With cross-validation, we trained and tuned six machine learning models, including four conventional and two neural network models. Moreover, we computed the importance of each predictor variable in the model. We measured the performance of these models using a temporal validation data set.</p><p><strong>Results: </strong>A total of 8518 patients were included in the analysis; 5463 (64.1%) were frail, and 3055 (35.9%) were non-frail at discharge. The Extreme Gradient Boosting (XGB) achieved the highest area under the receiver operating characteristic curve (AUC) (0.8175) and accuracy (0.7414). To confirm the generalisation performance of artificial intelligence in predicting frailty at discharge, we conducted external validation with the COVID-19 data set. The XGB still showed a good performance with an AUC of 0.7668. The machine learning model could predict frailty despite the disparity in data distribution.</p><p><strong>Conclusion: </strong>The machine learning-based model developed for predicting frailty after sepsis achieved high performance with limited baseline clinical parameters.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389018","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 : 2024-09-30eCollection Date: 2024-09-01DOI: 10.1183/23120541.00474-2024
Olivia C Leavy, Richard J Russell, Ewen M Harrison, Nazir I Lone, Steven Kerr, Annemarie B Docherty, Aziz Sheikh, Matthew Richardson, Omer Elneima, Neil J Greening, Victoria Claire Harris, Linzy Houchen-Wolloff, Hamish J C McAuley, Ruth M Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Raminder Aul, Paul Beirne, Charlotte E Bolton, Jeremy S Brown, Gourab Choudhury, Nawar Diar Bakerly, Nicholas Easom, Carlos Echevarria, Jonathan Fuld, Nick Hart, John R Hurst, Mark Jones, Dhruv Parekh, Paul Pfeffer, Najib M Rahman, Sarah Rowland-Jones, Ajay M Shah, Dan G Wootton, Caroline Jolley, A A Roger Thompson, Trudie Chalder, Melanie J Davies, Anthony De Soyza, John R Geddes, William Greenhalf, Simon Heller, Luke Howard, Joseph Jacob, R Gisli Jenkins, Janet M Lord, Will D-C Man, Gerry P McCann, Stefan Neubauer, Peter J M Openshaw, Joanna Porter, Matthew J Rowland, Janet T Scott, Malcolm G Semple, Sally J Singh, David Thomas, Mark Toshner, Keir Lewis, Liam G Heaney, Andrew Briggs, Bang Zheng, Mathew Thorpe, Jennifer K Quint, James D Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Louise V Wain, Christopher E Brightling, Rachael A Evans
Background: In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.
Methods: Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias.
Findings: Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 versus -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups.
Interpretation: Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.
{"title":"1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study.","authors":"Olivia C Leavy, Richard J Russell, Ewen M Harrison, Nazir I Lone, Steven Kerr, Annemarie B Docherty, Aziz Sheikh, Matthew Richardson, Omer Elneima, Neil J Greening, Victoria Claire Harris, Linzy Houchen-Wolloff, Hamish J C McAuley, Ruth M Saunders, Marco Sereno, Aarti Shikotra, Amisha Singapuri, Raminder Aul, Paul Beirne, Charlotte E Bolton, Jeremy S Brown, Gourab Choudhury, Nawar Diar Bakerly, Nicholas Easom, Carlos Echevarria, Jonathan Fuld, Nick Hart, John R Hurst, Mark Jones, Dhruv Parekh, Paul Pfeffer, Najib M Rahman, Sarah Rowland-Jones, Ajay M Shah, Dan G Wootton, Caroline Jolley, A A Roger Thompson, Trudie Chalder, Melanie J Davies, Anthony De Soyza, John R Geddes, William Greenhalf, Simon Heller, Luke Howard, Joseph Jacob, R Gisli Jenkins, Janet M Lord, Will D-C Man, Gerry P McCann, Stefan Neubauer, Peter J M Openshaw, Joanna Porter, Matthew J Rowland, Janet T Scott, Malcolm G Semple, Sally J Singh, David Thomas, Mark Toshner, Keir Lewis, Liam G Heaney, Andrew Briggs, Bang Zheng, Mathew Thorpe, Jennifer K Quint, James D Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Louise V Wain, Christopher E Brightling, Rachael A Evans","doi":"10.1183/23120541.00474-2024","DOIUrl":"10.1183/23120541.00474-2024","url":null,"abstract":"<p><strong>Background: </strong>In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.</p><p><strong>Methods: </strong>Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias.</p><p><strong>Findings: </strong>Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 <i>versus</i> -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups.</p><p><strong>Interpretation: </strong>Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343945","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 : 2024-09-30eCollection Date: 2024-09-01DOI: 10.1183/23120541.00253-2024
Bruna Rubbo, Avni Kant, Kewei Zhang, Annalisa Allegorico, Simona Basilicata, Mieke Boon, Melissa Borrelli, Claudia Calogero, Siobhán B Carr, Mary Carroll, Carolina Constant, Silvia Castillo Corullón, Harriet Corvol, Renato Cutrera, Stefanie Dillenhöfer, Nagehan Emiralioglu, Ela Eralp, Sanem Eryilmaz Polat, Laura Gardner, Yasemin Gokdemir, Amanda Harris, Claire Hogg, Bulent Karadag, Helene Kobbernagel, Cordula Koerner-Rettberg, Panayiotis Kouis, Natalie Lorent, Markella Marcou, June K Mathin, Vendula Martinu, Antonio Moreno-Galdó, Lucy Morgan, Kim G Nielsen, Heymut Omran, Ugur Ozcelik, Petr Pohunek, Johanna Raidt, Phil Robinson, Sandra Rovira-Amigo, Francesca Santamaria, Anne Schlegtendal, Aline Tamalet, Guillaume Thouvenin, Nicola Ullmann, Woolf Walker, Panayiotis Yiallouros, Claudia E Kuehni, Philipp Latzin, Nicole Beydon, Jane S Lucas
Introduction: Respiratory pathogens are frequently isolated from airway samples in primary ciliary dyskinesia (PCD) patients. Few studies have investigated associations between these pathogens and lung function, with current management based on evidence from cystic fibrosis. We investigated the association between commonly isolated respiratory pathogens and lung function in PCD patients.
Methods: Using a cross-sectional design, we prospectively collected clinical and concurrent microbiology data from 408 participants with probable or confirmed PCD, aged ≥5 years, from 12 countries. We used Global Lung Function Initiative 2012 references to calculate forced expiratory volume in 1 s (FEV1) z-scores. For 351 patients (86%) with complete data, we assessed the association of the four most frequently isolated pathogens with lung function by fitting multilevel linear models with country as random intercept, adjusted for age at diagnosis, age at lung function, use of antibiotic prophylaxis and body mass index z-scores.
Results: Individuals with Pseudomonas aeruginosa growth in culture had significantly lower FEV1 z-scores (β= -0.87, 95% CI -1.40- -0.34), adjusted for presence of Haemophilus influenzae, methicillin-sensitive Staphylococcus aureus and Streptococcus pneumoniae, and for covariates. When stratified by age, associations remained strong for adults but not for children. Results were similar when ciliary defects by transmission electron microscopy were included in the models and when restricting analysis to only confirmed PCD cases.
Conclusions: We found that P. aeruginosa was associated with worse lung function in individuals with PCD, particularly adults. These findings suggest that it is prudent to aim for P. aeruginosa eradication in the first instance, and to treat exacerbations promptly in colonised patients.
导言:原发性睫状肌运动障碍(PCD)患者的气道样本中经常分离出呼吸道病原体。很少有研究调查这些病原体与肺功能之间的关系,而目前的管理是基于囊性纤维化的证据。我们研究了 PCD 患者中常见的呼吸道病原体与肺功能之间的关系:我们采用横断面设计,前瞻性地收集了来自 12 个国家的 408 名年龄≥5 岁的疑似或确诊 PCD 患者的临床和并发微生物学数据。我们使用 2012 年全球肺功能倡议(Global Lung Function Initiative 2012)参考值计算 1 秒用力呼气容积(FEV1)z-分数。对于 351 名数据完整的患者(86%),我们通过拟合以国家为随机截距的多层次线性模型,评估了四种最常分离的病原体与肺功能的关系,并对诊断年龄、肺功能年龄、使用抗生素预防和体重指数 z 值进行了调整:经流感嗜血杆菌、对甲氧西林敏感的金黄色葡萄球菌和肺炎链球菌以及协变量调整后,培养出铜绿假单胞菌的患者的 FEV1 z 评分明显较低(β= -0.87,95% CI -1.40- -0.34)。当按年龄分层时,成人的相关性仍然很强,但儿童则不然。如果将透射电子显微镜检查发现的睫状体缺陷纳入模型,并仅限于对确诊的 PCD 病例进行分析,结果也是相似的:结论:我们发现铜绿假单胞菌与 PCD 患者(尤其是成人)肺功能的恶化有关。这些发现表明,谨慎的做法是首先根除铜绿假单胞菌,并及时治疗定植患者的病情恶化。
{"title":"Associations between respiratory pathogens and lung function in primary ciliary dyskinesia: cross-sectional analysis from the PROVALF-PCD cohort.","authors":"Bruna Rubbo, Avni Kant, Kewei Zhang, Annalisa Allegorico, Simona Basilicata, Mieke Boon, Melissa Borrelli, Claudia Calogero, Siobhán B Carr, Mary Carroll, Carolina Constant, Silvia Castillo Corullón, Harriet Corvol, Renato Cutrera, Stefanie Dillenhöfer, Nagehan Emiralioglu, Ela Eralp, Sanem Eryilmaz Polat, Laura Gardner, Yasemin Gokdemir, Amanda Harris, Claire Hogg, Bulent Karadag, Helene Kobbernagel, Cordula Koerner-Rettberg, Panayiotis Kouis, Natalie Lorent, Markella Marcou, June K Mathin, Vendula Martinu, Antonio Moreno-Galdó, Lucy Morgan, Kim G Nielsen, Heymut Omran, Ugur Ozcelik, Petr Pohunek, Johanna Raidt, Phil Robinson, Sandra Rovira-Amigo, Francesca Santamaria, Anne Schlegtendal, Aline Tamalet, Guillaume Thouvenin, Nicola Ullmann, Woolf Walker, Panayiotis Yiallouros, Claudia E Kuehni, Philipp Latzin, Nicole Beydon, Jane S Lucas","doi":"10.1183/23120541.00253-2024","DOIUrl":"10.1183/23120541.00253-2024","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory pathogens are frequently isolated from airway samples in primary ciliary dyskinesia (PCD) patients. Few studies have investigated associations between these pathogens and lung function, with current management based on evidence from cystic fibrosis. We investigated the association between commonly isolated respiratory pathogens and lung function in PCD patients.</p><p><strong>Methods: </strong>Using a cross-sectional design, we prospectively collected clinical and concurrent microbiology data from 408 participants with probable or confirmed PCD, aged ≥5 years, from 12 countries. We used Global Lung Function Initiative 2012 references to calculate forced expiratory volume in 1 s (FEV<sub>1</sub>) z-scores. For 351 patients (86%) with complete data, we assessed the association of the four most frequently isolated pathogens with lung function by fitting multilevel linear models with country as random intercept, adjusted for age at diagnosis, age at lung function, use of antibiotic prophylaxis and body mass index z-scores.</p><p><strong>Results: </strong>Individuals with <i>Pseudomonas aeruginosa</i> growth in culture had significantly lower FEV<sub>1</sub> z-scores (β= -0.87, 95% CI -1.40- -0.34), adjusted for presence of <i>Haemophilus influenzae</i>, methicillin-sensitive <i>Staphylococcus aureus</i> and <i>Streptococcus pneumoniae</i>, and for covariates. When stratified by age, associations remained strong for adults but not for children. Results were similar when ciliary defects by transmission electron microscopy were included in the models and when restricting analysis to only confirmed PCD cases.</p><p><strong>Conclusions: </strong>We found that <i>P. aeruginosa</i> was associated with worse lung function in individuals with PCD, particularly adults. These findings suggest that it is prudent to aim for <i>P. aeruginosa</i> eradication in the first instance, and to treat exacerbations promptly in colonised patients.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336352","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 : 2024-09-30eCollection Date: 2024-09-01DOI: 10.1183/23120541.00011-2024
Simon Holden, Allanah P Barker, Judith Babar, Sumit Karia, Nandita Gupta, Rudy Sinharay, Stefan J Marciniak
Secondary pneumothorax due to early-onset emphysema can be a presenting feature of filamin A mutation. https://bit.ly/3ycAeCs.
早发肺气肿引起的继发性气胸可能是丝胺 A 基因突变的一个表现特征。https://bit.ly/3ycAeCs。
{"title":"Secondary spontaneous pneumothorax as the presenting manifestation of filamin A-associated lung disease.","authors":"Simon Holden, Allanah P Barker, Judith Babar, Sumit Karia, Nandita Gupta, Rudy Sinharay, Stefan J Marciniak","doi":"10.1183/23120541.00011-2024","DOIUrl":"10.1183/23120541.00011-2024","url":null,"abstract":"<p><p><b>Secondary pneumothorax due to early-onset emphysema can be a presenting feature of filamin A mutation.</b> https://bit.ly/3ycAeCs.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343951","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 : 2024-09-30eCollection Date: 2024-09-01DOI: 10.1183/23120541.01032-2023
Andrea Gramegna, Ivan Barone, Gianfranco Alicandro, Giovanni Sotgiu, Angela Bellofiore, Crizia Colombo, Antonella Arcadu, Margherita Ori, Federico Blasi, Edoardo Simonetta, Marco Vicenzi, Stefano Aliberti, Francesco Blasi
Background: Bronchiectasis is a chronic respiratory condition characterised by airway and systemic inflammation with prevalence increasing with age. Given the median age of the patients, it is common to observe the presence of comorbidities, particularly cardiovascular diseases, which have been linked to adverse clinical outcomes. To investigate the pooled estimates of the association between bronchiectasis and coronary heart disease or stroke within this population, we conducted a systematic review and meta-analysis of the available scientific evidence.
Methods: Three investigators independently performed the search on PubMed and other sources and included studies published up to October 2023 according to predefined criteria. Relative measures of association between bronchiectasis and cardiovascular events were pooled and meta-analysed using a fixed-effects model. Studies were evaluated using the Newcastle-Ottawa Scale for assessing the quality of non-randomised studies in meta-analyses.
Results: A final pool of nine studies was included in the systematic review, with a total of 22 239 patients. Meta-analysis of three high-quality cohort studies showed a pooled hazard ratio of 1.42 (95% CI 1.30-1.57) for coronary heart disease and 1.71 (95% CI 1.55-1.89) for cerebrovascular stroke.
Conclusions: The increased cardiovascular risk among people with bronchiectasis underscores the critical need to raise awareness of this association and to develop preventive strategies accordingly. Further translational studies are imperative to gain a deeper understanding of the complex interplay between inflammation, the immune system and endothelial dysfunction in this patient group.
背景:支气管扩张症是一种慢性呼吸道疾病,以气道和全身炎症为特征,发病率随年龄增长而增加。鉴于患者的中位年龄,通常会出现合并症,尤其是心血管疾病,这些疾病与不良临床结果有关。为了研究支气管扩张症与冠心病或中风之间的关系,我们对现有的科学证据进行了系统回顾和荟萃分析:三位研究者独立在 PubMed 和其他来源上进行了检索,并根据预定标准纳入了截至 2023 年 10 月发表的研究。采用固定效应模型对支气管扩张症与心血管事件之间相关性的相对测量结果进行汇总和荟萃分析。采用纽卡斯尔-渥太华量表对研究进行评估,该量表用于评估荟萃分析中非随机研究的质量:最终有九项研究被纳入系统综述,共涉及 22 239 名患者。对三项高质量队列研究进行的荟萃分析显示,冠心病的危险比为 1.42(95% CI 1.30-1.57),脑血管中风的危险比为 1.71(95% CI 1.55-1.89):支气管扩张症患者的心血管风险增加突出表明,迫切需要提高对这种关联的认识,并制定相应的预防策略。为了更深入地了解这一患者群体中炎症、免疫系统和内皮功能障碍之间复杂的相互作用,进一步的转化研究势在必行。
{"title":"The impact of cardiovascular events in bronchiectasis: a systematic review and meta-analysis.","authors":"Andrea Gramegna, Ivan Barone, Gianfranco Alicandro, Giovanni Sotgiu, Angela Bellofiore, Crizia Colombo, Antonella Arcadu, Margherita Ori, Federico Blasi, Edoardo Simonetta, Marco Vicenzi, Stefano Aliberti, Francesco Blasi","doi":"10.1183/23120541.01032-2023","DOIUrl":"10.1183/23120541.01032-2023","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis is a chronic respiratory condition characterised by airway and systemic inflammation with prevalence increasing with age. Given the median age of the patients, it is common to observe the presence of comorbidities, particularly cardiovascular diseases, which have been linked to adverse clinical outcomes. To investigate the pooled estimates of the association between bronchiectasis and coronary heart disease or stroke within this population, we conducted a systematic review and meta-analysis of the available scientific evidence.</p><p><strong>Methods: </strong>Three investigators independently performed the search on PubMed and other sources and included studies published up to October 2023 according to predefined criteria. Relative measures of association between bronchiectasis and cardiovascular events were pooled and meta-analysed using a fixed-effects model. Studies were evaluated using the Newcastle-Ottawa Scale for assessing the quality of non-randomised studies in meta-analyses.</p><p><strong>Results: </strong>A final pool of nine studies was included in the systematic review, with a total of 22 239 patients. Meta-analysis of three high-quality cohort studies showed a pooled hazard ratio of 1.42 (95% CI 1.30-1.57) for coronary heart disease and 1.71 (95% CI 1.55-1.89) for cerebrovascular stroke.</p><p><strong>Conclusions: </strong>The increased cardiovascular risk among people with bronchiectasis underscores the critical need to raise awareness of this association and to develop preventive strategies accordingly. Further translational studies are imperative to gain a deeper understanding of the complex interplay between inflammation, the immune system and endothelial dysfunction in this patient group.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343953","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 : 2024-09-30eCollection Date: 2024-09-01DOI: 10.1183/23120541.00494-2024
Mark L Levy, Michael G Crooks
SABA overuse is prevalent and dangerous in asthma. Use of anti-inflammatory relievers (ICS/formoterol) in asthma mitigates against risk associated with SABA overuse and poor ICS adherence, and is the preferred approach for asthma management. https://bit.ly/4aHOLn8.
在哮喘患者中,SABA 的过度使用非常普遍且危险。在哮喘中使用抗炎镇痛剂(ICS/福莫特罗)可减轻与 SABA 过度使用和 ICS 依从性差相关的风险,是哮喘治疗的首选方法。https://bit.ly/4aHOLn8。
{"title":"Anti-inflammatory reliever therapy (AIR) for asthma.","authors":"Mark L Levy, Michael G Crooks","doi":"10.1183/23120541.00494-2024","DOIUrl":"10.1183/23120541.00494-2024","url":null,"abstract":"<p><p><b>SABA overuse is prevalent and dangerous in asthma. Use of anti-inflammatory relievers (ICS/formoterol) in asthma mitigates against risk associated with SABA overuse and poor ICS adherence, and is the preferred approach for asthma management.</b> https://bit.ly/4aHOLn8.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343946","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}