ERJ Open Research最新文献

The #ERSCongress 2024 sessions showcased by Assembly 6 (Epidemiology and Environment) underline the urgent need to address environmental and occupational exposures, improve smoking cessation tools, and advance epidemiological methodologies https://bit.ly/4fUzhPi.

Introduction: Ventilatory efficiency (V'_E/V'_CO2 ) has been shown to predict postoperative pulmonary complications (PPCs) in lung resection candidates. V'_E/V'_CO2 is determined by arterial partial pressure of carbon dioxide (P _aCO2 ) and by dead space to tidal volume ratio (V _D/V _T). We hypothesised P _aCO2 and V _D/V _T contribute equally to the increase in V'_E/V'_CO2 in lung resection patients.

Methods: Consecutive lung resection candidates from two prior prospective studies were included in this post hoc analysis. All subjects underwent preoperative spirometry, cardiopulmonary exercise testing and arterial blood gas analysis at rest and peak exercise. PPCs were prospectively assessed during the first 30 postoperative days, or hospital stay. A t-test, Mann-Whitney U-test and two-tailed Fisher's exact test were used to compare patients with and without PPCs. p-values <0.05 were considered statistically significant.

Results: Of 398 patients, PPC developed in 64 (16%). Patients with PPCs more frequently underwent lobectomy by open thoracotomy, had longer hospital and ICU length of stay and higher 30- and 90-day mortality. Moreover, patients with PPCs exhibited a higher V'_E/V'_CO2 ratio both at rest and peak exercise. Both ratios were independently associated with PPCs. At rest, the contribution of P _aCO2 and V _D/V _T to the increase in V'_E/V'_CO2 ratio in patients with PPCs was 45% and 55%, respectively. At peak exercise, the contribution of P _aCO2 and V _D/V _T to the increase in V'_E/V'_CO2 ratio was 16% and 84%, respectively.

Conclusions: V _D/V _T (V'/Q' mismatch and/or rapid shallow breathing pattern) is the dominant contributor to the increase in V'_E/V'_CO2 in lung resection candidates who develop PPCs.

Background: Wearing masks imposes an additional respiratory burden on COPD patients. This study aimed to investigate the impact of various mask types on physiological parameters and subjective feelings in COPD patients.

Methods: This randomised, open-label, parallel-controlled trial randomly assigned 129 COPD patients from two Chinese hospitals to the N95 mask group, the surgical mask group and the no mask group, who were required to complete a 6-min rest (6MR) and a 6-min walking test (6MWT) while wearing their designated masks, and were assessed for blood pressure, oxygen saturation, pulse rate, Borg score, rating of perceived exertion (RPE) score, 6-min walk distance (6MWD) and subjective feeling score. Data were analysed using intention-to-treat analysis and per-protocol analysis.

Results: No significant differences were observed in blood pressure, oxygen saturation, pulse rate or the 6MWD among the three groups following a 6MR or 6MWT. Wearing N95 masks and surgical masks during the 6MWT significantly elevated perceived dyspnoea (p<0.001) and exertion scores (p<0.001) in COPD patients. The differences in the two scores between the highest and lowest groups were 2 and 4 points, respectively.

Conclusion: Wearing surgical masks or N95 masks for 6MR or 6MWT did not adversely affect physiological parameters in COPD patients. However, it significantly increased perceived dyspnoea and exertion.

Background: Recent advances in digital and wearable technologies with artificial intelligence (AI) enable the use of continuous cough monitoring (CCM) to objectively monitor symptoms as surrogate markers of treatment efficacy in pulmonary tuberculosis (PTB). The objectives of this study were to describe the evolution of cough during PTB treatment in adults and to assess the feasibility of community-based CCM.

Methods: We prospectively enrolled PTB adult participants upon treatment initiation. Participants' coughs were continuously monitored during 6 months with a smartphone loaded with an app able to detect cough by using an AI algorithm.

Results: 22 participants were included. The median (interquartile range (IQR)) age was 28.5 (22-42) years and 62% were male. The median (IQR) coughs per hour (medCPH) was 11.0 (7.0-27.0) at week 1. By the end of the intensive phase of PTB treatment at week 8, the medCPH was 3.5 (1.5-7.0), which was significantly lower than the medCPH at week 1 (p=0.002). At week 26 (end of treatment), the medCPH was 1.0 (1.0-2.5). The adherence to CCM was high during the first 13 weeks of PTB treatment and then waned over time. The adherence was similar during daytime and night-time.

Conclusion: Cough counts rapidly drop during the intensive phase of PTB treatment and then slowly decrease to a low baseline level by the end of the treatment. Community-based CCM using digital technology is feasible in low-resource settings but requires evaluation of alternative approaches to overcome adherence issues and technical limitations (mobile internet and electricity availability).

Background: Pulmonary hypertension (PH) associated with COPD (PH-COPD) exhibits diverse phenotypes, challenging therapeutic management. This study aimed to describe the characteristics of COPD patients with distinct phenotypes, namely end-stage COPD with or without PH (group 1), other COPD patients with mild-to-moderate pre-capillary PH-COPD (group 2) and COPD patients with a pulmonary vascular phenotype (PVP) (group 3).

Methods: We performed a retrospective analysis of COPD patients who underwent right heart catheterisation from 2015 to 2022.

Results: 81 patients were included in group 1, 37 in group 2 and 35 in group 3. The groups differed in terms of clinical, functional, haemodynamic and imaging characteristics. Group 1 had significantly marked lung hyperinflation with increased total lung capacity and residual volume, a feature not observed in group 3. These results were confirmed by analysis of chest CT scans, which confirmed varying degrees of emphysema, as follows: severe in group 1, moderate in group 2 and mild in group 3, with median total emphysema indices of 55% (48-62), 32% (16-49) and 16% (3.4-31), respectively, p<0.0001.

Conclusions: Our results highlight the broad spectrum of PH in COPD, from PH associated with end-stage COPD (phenotype/group 1), characterised by predominant alveolar wall damage with severe emphysema, to PVP (phenotype/group 3), mainly due to pulmonary vascular changes. Phenotype/group 2 represents an intermediate state combining features of both. In the current debate on how to distinguish PH-COPD phenotypes, it might be of interest to include quantitative thresholds for emphysema in future diagnostic and management algorithms.

[This corrects the article DOI: 10.1183/23120541.00567-2024.].

Background: Cardiovascular consequences of obstructive sleep apnoea (OSA) and the effects of continuous positive airway pressure (CPAP) therapy on blood pressure, endothelial dysfunction and major adverse cardiovascular events (MACE) have been studied over decades using different study designs. However, clinical findings from different study models on cardiovascular outcomes are sometimes contradictory.

Methods: A literature search was conducted in PubMed for randomised controlled trials, meta-analyses, population-based epidemiological studies and OSA cohort studies up to September 2023 investigating the cardiovascular effects of OSA and CPAP in adults with OSA on the following cardiovascular end-points: blood pressure, arterial hypertension, endothelial function and MACE (myocardial infarction, stroke, transient ischaemic attack or cardiovascular death). The level of evidence for these outcomes was discussed on the basis of different study models.

Results and conclusions: There is high-level evidence of a causal relationship between OSA and arterial hypertension and endothelial dysfunction, as well as on higher MACE incidence among subgroups of patients with untreated OSA. The cardiovascular effects of OSA depend on the severity of OSA, symptoms, phenotype and comorbidities. The blood pressure-lowering effect of CPAP is mainly observed in uncontrolled and treatment-resistant hypertension. The MACE risk reduction in OSA depends on good long-term CPAP adherence. Younger, sleepy patients with more severe OSA, higher hypoxaemic burden and without overt cardiovascular end-organ disease may particularly benefit from CPAP treatment in terms of cardiovascular risk reduction. Randomised controlled trials of CPAP or other effective OSA treatments in primary cardiovascular prevention and in patients at highest risk are lacking.

COPD can coexist with bronchiectasis (BE). These patients have different clinical profiles compared to those with BE with fixed airflow limitation. https://bit.ly/3Z9qNOb.

Nasal epithelial cells from young adults with a history of very preterm birth show delayed closure following scratch-wounding. Repair correlated with lung function, suggesting epithelial barrier integrity may play a role in preterm-associated lung disease. https://bit.ly/4dJnvWO.

The research presented at #ERSCongress 2024 offers promising strides towards improved ILD care through tailored technologies. These studies underscore the critical balance between human expertise and machine-driven solutions for effective implementation. https://bit.ly/3WAhw19.