Pub Date : 2024-04-22eCollection Date: 2024-03-01DOI: 10.1183/23120541.00809-2023
Naiara Tais Leonardi, Débora Mayumi Oliveira Kawakami, Joana Cruz, Chris Burtin, Audrey Borghi-Silva, Renata Gonçalves Mendes
Background: The management of COPD has been based on the premise of identifying problems that guide personalised treatment based on a multidimensional assessment, known as treatable traits. Exacerbation of COPD (ECOPD) results in physical and functional impairments, limitation of daily activities and negative impact on patients' quality of life and prognosis. In this context, identifying treatable traits in patients with ECOPD is essential to properly guide individualised patient care. There is a need to develop a performance-based toolkit to identify the main treatable traits of functioning in hospitalised patients with ECOPD.
Methods and analysis: This is a study protocol of a survey method observational study to develop a performance-based toolkit. The study will include the following steps: 1) definition of treatable traits by both physiotherapists who provide or have provided care to hospitalised patients with ECOPD on a regular basis, and patients who have experienced at least one ECOPD which required hospitalisation; 2) selection of the most appropriate measures (markers) for each treatable trait based on established criteria and a previous systematic review; and 3) implementation of the toolkit in a pilot/feasibility study with hospitalised patients with ECOPD.
Conclusion: The development of a feasible performance-based toolkit with the best markers for each key treatable trait of functioning in hospitalised patients with ECOPD will make it possible to create individualised patient care for the specific demands of these patients.
{"title":"Development of a performance-based toolkit of the treatable traits of functioning in hospitalised patients with exacerbation of COPD: a survey-based study protocol.","authors":"Naiara Tais Leonardi, Débora Mayumi Oliveira Kawakami, Joana Cruz, Chris Burtin, Audrey Borghi-Silva, Renata Gonçalves Mendes","doi":"10.1183/23120541.00809-2023","DOIUrl":"https://doi.org/10.1183/23120541.00809-2023","url":null,"abstract":"<p><strong>Background: </strong>The management of COPD has been based on the premise of identifying problems that guide personalised treatment based on a multidimensional assessment, known as treatable traits. Exacerbation of COPD (ECOPD) results in physical and functional impairments, limitation of daily activities and negative impact on patients' quality of life and prognosis. In this context, identifying treatable traits in patients with ECOPD is essential to properly guide individualised patient care. There is a need to develop a performance-based toolkit to identify the main treatable traits of functioning in hospitalised patients with ECOPD.</p><p><strong>Methods and analysis: </strong>This is a study protocol of a survey method observational study to develop a performance-based toolkit. The study will include the following steps: 1) definition of treatable traits by both physiotherapists who provide or have provided care to hospitalised patients with ECOPD on a regular basis, and patients who have experienced at least one ECOPD which required hospitalisation; 2) selection of the most appropriate measures (markers) for each treatable trait based on established criteria and a previous systematic review; and 3) implementation of the toolkit in a pilot/feasibility study with hospitalised patients with ECOPD.</p><p><strong>Conclusion: </strong>The development of a feasible performance-based toolkit with the best markers for each key treatable trait of functioning in hospitalised patients with ECOPD will make it possible to create individualised patient care for the specific demands of these patients.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11033727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852066","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 : 2024-03-28DOI: 10.1183/23120541.01051-2023
Purbanka Pahari, H. Korkalainen, E. Arnardóttir, A. Islind, Elias August, Arie Oksenberg, Juha Töyräs, T. Leppänen, Sami Nikkonen
Intermittent hypoxemia is closely associated with cardiovascular dysfunction and may be a more accurate indicator of OSA severity than conventional metrics. Another key factor is the lung-to-finger circulation time (LFCt), defined as the duration from the cessation of a respiratory event to the lowest point of oxygen desaturation. LFCt serves as a surrogate marker for circulatory delay and is linked with cardiovascular function. Yet, the specific associations between respiratory and hypoxemia characteristics and LFCt in OSA patients remain unclear. This study aims to investigate these associations, ultimately contributing to a more nuanced understanding of OSA severity.The study comprised 878 in-lab polysomnographies of patients with suspected OSA. The conventional OSA metrics were computed along with nine hypoxemia metrics and then divided into quartiles (Q1-Q4) based on respiratory event duration. In addition, these were further divided into sub-quartiles based on LFCt. The empirical cumulative distribution functions (CDFs) and linear regression models were used to investigate the association between desaturation metrics and LFCt.The results showed that prolonged LFCt was associated with increased hypoxic severity. Based on CDFs, the hypoxic severity significantly increased with longer LFCt despite the duration of respiratory events. Furthermore, fall duration was elevated in patients with longer LFCt (Q1-FallDur:14.6 s; Q4-FallDur:29.8 s;p<0.0001). The regression models also showed significant association between hypoxic severity and LFCt (Q1-FallSlope: β=−3.224; Q4-FallSlope: β=−6.178;p<0.0001).Considering LFCt along with desaturation metrics might be useful in estimating the association between the severity of OSA, physiological consequences of respiratory events, and cardiac health.
间歇性低氧血症与心血管功能障碍密切相关，可能是比传统指标更准确的 OSA 严重程度指标。另一个关键因素是肺到手指循环时间（LFCt），其定义是从呼吸停止到氧饱和度最低点的持续时间。LFCt 是循环延迟的替代标记，与心血管功能有关。然而，OSA 患者的呼吸和低氧血症特征与 LFCt 之间的具体联系仍不清楚。本研究旨在调查这些关联，最终有助于更细致地了解 OSA 的严重程度。在计算常规 OSA 指标的同时，还计算了九项低氧血症指标，然后根据呼吸事件持续时间将其分为四等分（Q1-Q4）。此外，这些指标还根据 LFCt 进一步划分为子四分位数。使用经验累积分布函数（CDF）和线性回归模型研究了饱和度指标与 LFCt 之间的关联。结果表明，LFCt 的延长与缺氧严重程度的增加有关。根据 CDFs，尽管呼吸事件持续时间不长，但缺氧严重程度随 LFCt 的延长而显著增加。此外，LFCt 较长的患者跌倒持续时间也较长（Q1-FallDur:14.6 秒；Q4-FallDur:29.8 秒；p<0.0001）。回归模型还显示，缺氧严重程度与 LFCt 之间存在显著关联（Q1-FallSlope：β=-3.224；Q4-FallSlope：β=-6.178；p<0.0001）。
{"title":"Prolonged lung-to-finger circulation time indicates an increased risk of intermittent hypoxemia in sleep apnea patients","authors":"Purbanka Pahari, H. Korkalainen, E. Arnardóttir, A. Islind, Elias August, Arie Oksenberg, Juha Töyräs, T. Leppänen, Sami Nikkonen","doi":"10.1183/23120541.01051-2023","DOIUrl":"https://doi.org/10.1183/23120541.01051-2023","url":null,"abstract":"Intermittent hypoxemia is closely associated with cardiovascular dysfunction and may be a more accurate indicator of OSA severity than conventional metrics. Another key factor is the lung-to-finger circulation time (LFCt), defined as the duration from the cessation of a respiratory event to the lowest point of oxygen desaturation. LFCt serves as a surrogate marker for circulatory delay and is linked with cardiovascular function. Yet, the specific associations between respiratory and hypoxemia characteristics and LFCt in OSA patients remain unclear. This study aims to investigate these associations, ultimately contributing to a more nuanced understanding of OSA severity.The study comprised 878 in-lab polysomnographies of patients with suspected OSA. The conventional OSA metrics were computed along with nine hypoxemia metrics and then divided into quartiles (Q1-Q4) based on respiratory event duration. In addition, these were further divided into sub-quartiles based on LFCt. The empirical cumulative distribution functions (CDFs) and linear regression models were used to investigate the association between desaturation metrics and LFCt.The results showed that prolonged LFCt was associated with increased hypoxic severity. Based on CDFs, the hypoxic severity significantly increased with longer LFCt despite the duration of respiratory events. Furthermore, fall duration was elevated in patients with longer LFCt (Q1-FallDur:14.6 s; Q4-FallDur:29.8 s;p<0.0001). The regression models also showed significant association between hypoxic severity and LFCt (Q1-FallSlope: β=−3.224; Q4-FallSlope: β=−6.178;p<0.0001).Considering LFCt along with desaturation metrics might be useful in estimating the association between the severity of OSA, physiological consequences of respiratory events, and cardiac health.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00108-2024
Paola D Urroz Guerrero, Hayley Lewthwaite, Peter G. Gibson, Vanessa L. Clark, Laura Cordova-Rivera, Vanessa M Mcdonald
Physical capacity is an important determinant of physical activity in people with obstructive airway disease (OAD). This study aimed to extend the “can do, do do” concept in people with OAD, to identify if people categorised into quadrants based on physical capacity and activity differ by clinical and movement behaviour characteristics. A total of 281 participants (bronchiectasis n=60, severe asthma n=93, COPD n=70 and control n=58) completed assessments to characterise physical capacity as “can do”versus“can't do” (6-minute walk distance
{"title":"Physical capacity and inactivity in obstructive airway diseases: a ‘Can do, do do’ analysis","authors":"Paola D Urroz Guerrero, Hayley Lewthwaite, Peter G. Gibson, Vanessa L. Clark, Laura Cordova-Rivera, Vanessa M Mcdonald","doi":"10.1183/23120541.00108-2024","DOIUrl":"https://doi.org/10.1183/23120541.00108-2024","url":null,"abstract":"Physical capacity is an important determinant of physical activity in people with obstructive airway disease (OAD). This study aimed to extend the “can do, do do” concept in people with OAD, to identify if people categorised into quadrants based on physical capacity and activity differ by clinical and movement behaviour characteristics. A total of 281 participants (bronchiectasis n=60, severe asthma n=93, COPD n=70 and control n=58) completed assessments to characterise physical capacity as “can do”versus“can't do” (6-minute walk distance<or ≥70%predicted) and physical activity as “do do”versus“don't do” (accelerometer derived moderate-to-vigorous intensity physical activity (MVPA)<or ≥150 min/week). The control group had a greater proportion of people in the “can do, do do” quadrant compared with the OAD groups (76%versus10–33%). People with OAD in the “can't do, don't do” quadrant had worse clinical characteristics (airflow limitation, comorbidities, quality of life and functional dyspnoea) and spent less time doing light-intensity physical activity (LPA) and more time being sedentary compared with the “can do, do do” quadrant. This study highlights that many people with OAD may be inactive because they do not have the physical capacity to participate in MVPA, which is further impacted by greater disease severity. It is important to consider the potential benefits of addressing LPA and sedentary behaviour due to sub-optimal levels of these movement behaviours across different quadrants. Future research is needed to investigate if tailoring intervention approaches based on quadrant allocation is effective in people with OAD.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00064-2024
Margrethe Bang Henriksen, T. Hansen, L.H. Jensen, C.L. Brasen, M. Borg, Ole Hilberg, A. Løkke
Lung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with chronic obstructive pulmonary disease (COPD) face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aim to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, to outline the COPD-related variables associated with referral for LC examination.We conducted a retrospective analyses encompassing the period from January 1, 2012, to December 31, 2018, on all outpatients with COPD, LC, and individuals referred to LC examinations.Among all COPD outpatients, 2231 patients (18%) were referred for LC examinations, and 565 were diagnosed with LC (4.6%). LC patients with COPD were more likely to be stage I-II in contrast to the non-COPD LC population (46%versus26%, p<0.001 for all). Patients referred to LC examinations exhibited higher consumption of COPD-related medications, reported more severe dyspnea (69%versus66% with MRC >2), and experienced a greater frequency of exacerbations (30%versus24% with ≥2 exacerbations).Our study reveals a notable high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasizes the importance of tailoring specific screening initiatives for this demographic.
{"title":"Lung Cancer among outpatients with Chronic Obstructive Pulmonary Disease - A seven-year cohort Study","authors":"Margrethe Bang Henriksen, T. Hansen, L.H. Jensen, C.L. Brasen, M. Borg, Ole Hilberg, A. Løkke","doi":"10.1183/23120541.00064-2024","DOIUrl":"https://doi.org/10.1183/23120541.00064-2024","url":null,"abstract":"Lung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with chronic obstructive pulmonary disease (COPD) face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aim to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, to outline the COPD-related variables associated with referral for LC examination.We conducted a retrospective analyses encompassing the period from January 1, 2012, to December 31, 2018, on all outpatients with COPD, LC, and individuals referred to LC examinations.Among all COPD outpatients, 2231 patients (18%) were referred for LC examinations, and 565 were diagnosed with LC (4.6%). LC patients with COPD were more likely to be stage I-II in contrast to the non-COPD LC population (46%versus26%, p<0.001 for all). Patients referred to LC examinations exhibited higher consumption of COPD-related medications, reported more severe dyspnea (69%versus66% with MRC >2), and experienced a greater frequency of exacerbations (30%versus24% with ≥2 exacerbations).Our study reveals a notable high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasizes the importance of tailoring specific screening initiatives for this demographic.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00963-2023
Kevin Winthrop, Catherine Waweru, M. Hassan, Sara Burns, Matthew Lucci, A. Chatterjee
While antibiotics are recommended for treatment of nontuberculous mycobacterial lung disease (NTMLD), the impact of early antibiotic initiation on healthcare resource utilisation (HCRU) is unclear. This study compared HCRU with earlyversusdelayed antibiotic initiation in NTMLD.A retrospective, claims database study (Merative® MarketScan®) of patients diagnosed with NTMLD between 1 July 2015 and 30 June 2019. Patients were divided into early antibiotic initiationi.e., ≤3 months after the first medical claim for NTMLD (index date), and delayed antibiotic initiation groups. Hospitalisations and outpatient visits during a 2-year post-index period were compared to baseline per treatment group; a difference-in-difference analysis compared early and delayed antibiotic initiation groups adjusting for confounding.Of 481 NTMLD treated patients, 364 (76%) and 117 (24%) comprised the early and delayed antibiotic initiation groups, respectively. The early antibiotic initiation group showed significant reductions from baseline in hospitalisations (all-cause, respiratory) and emergency room (ER) visits at follow-up. A significant increase from baseline in mean number of hospitalisations per patient was observed in the delayed antibiotic initiation group in Year 1 post-index. Compared to delayed antibiotic initiation, the early antibiotic initiation group showed significantly greater reductions in all-cause hospitalisations in Years 1 and 2 post-index (relative risk: 0.62 (95% CI: 0.41–0.95) and 0.62 (95% CI: 0.39–0.98), respectively), and in respiratory-related hospitalisations.The early antibiotic initiation group showed significant reductions from baseline in hospitalisations and ER visits over time. Compared to delayed antibiotic initiation, early antibiotic initiation was associated with significantly greater reductions in hospitalisations.
{"title":"Reductions in Hospitalisations and ER visits with Early Antibiotic Initiation in Nontuberculous Mycobacterial Lung Disease","authors":"Kevin Winthrop, Catherine Waweru, M. Hassan, Sara Burns, Matthew Lucci, A. Chatterjee","doi":"10.1183/23120541.00963-2023","DOIUrl":"https://doi.org/10.1183/23120541.00963-2023","url":null,"abstract":"While antibiotics are recommended for treatment of nontuberculous mycobacterial lung disease (NTMLD), the impact of early antibiotic initiation on healthcare resource utilisation (HCRU) is unclear. This study compared HCRU with earlyversusdelayed antibiotic initiation in NTMLD.A retrospective, claims database study (Merative® MarketScan®) of patients diagnosed with NTMLD between 1 July 2015 and 30 June 2019. Patients were divided into early antibiotic initiationi.e., ≤3 months after the first medical claim for NTMLD (index date), and delayed antibiotic initiation groups. Hospitalisations and outpatient visits during a 2-year post-index period were compared to baseline per treatment group; a difference-in-difference analysis compared early and delayed antibiotic initiation groups adjusting for confounding.Of 481 NTMLD treated patients, 364 (76%) and 117 (24%) comprised the early and delayed antibiotic initiation groups, respectively. The early antibiotic initiation group showed significant reductions from baseline in hospitalisations (all-cause, respiratory) and emergency room (ER) visits at follow-up. A significant increase from baseline in mean number of hospitalisations per patient was observed in the delayed antibiotic initiation group in Year 1 post-index. Compared to delayed antibiotic initiation, the early antibiotic initiation group showed significantly greater reductions in all-cause hospitalisations in Years 1 and 2 post-index (relative risk: 0.62 (95% CI: 0.41–0.95) and 0.62 (95% CI: 0.39–0.98), respectively), and in respiratory-related hospitalisations.The early antibiotic initiation group showed significant reductions from baseline in hospitalisations and ER visits over time. Compared to delayed antibiotic initiation, early antibiotic initiation was associated with significantly greater reductions in hospitalisations.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00087-2024
Jun Su Lee, Bumhee Yang, Hye Soon Shin, Heajung Lee, Hyun Gyung Chai, Hayoung Choi, Joung-Ho Han, Jai Hoon Yoon, Eung-Gook Kim, Hyun Lee
The association between inflammatory bowel disease (IBD) and an increased risk of bronchiectasis, as well as contributing factors, remains unclear. Additionally, whether bronchiectasis increases disease burden in IBD remains unknown. Therefore, this study aimed to 1) assess whether IBD increases the risk of incident bronchiectasis; 2) compare the risk of bronchiectasis between individuals with Crohn's disease (CD) and those with ulcerative colitis (UC); 3) identify risk factors for bronchiectasis in individuals with IBD; and 4) examine the disease burden in individuals with IBD and bronchiectasisversusthose without.We conducted a population-based matched cohort study involving adults aged ≥20 years with IBD, using data acquired from the National Health Insurance Service-National Sample Cohort database in Korea between 2002 and 2012.During the mean follow-up of 9.6 years, the incidence rate of bronchiectasis was 419.63/100 000 and 309.65/100 000 person-years (PY) in the IBD and matched cohorts (adjusted hazard ratio [aHR]=1.21, 95% confidence interval [CI]=1.05–1.39), respectively. UC was associated with increased bronchiectasis risk (aHR=1.42, 95% CI=1.19–1.69), while CD was not. Multivariate Cox regression analyses showed that age, male sex, medical aid, underweight status, chronic obstructive pulmonary disease, and diabetes mellitus were associated with an increased risk of bronchiectasis in the IBD cohort (p<0.05). The mortality, emergency department visit, and hospitalisation rates were significantly higher for individuals with IBD and bronchiectasis compared to those without bronchiectasis (p<0.05).IBD is associated with increased risk of bronchiectasis, which results in a greater disease burden in individuals with IBD.
{"title":"Increased bronchiectasis risk and related risk factors in inflammatory bowel disease: A 10-year Korean national cohort study","authors":"Jun Su Lee, Bumhee Yang, Hye Soon Shin, Heajung Lee, Hyun Gyung Chai, Hayoung Choi, Joung-Ho Han, Jai Hoon Yoon, Eung-Gook Kim, Hyun Lee","doi":"10.1183/23120541.00087-2024","DOIUrl":"https://doi.org/10.1183/23120541.00087-2024","url":null,"abstract":"The association between inflammatory bowel disease (IBD) and an increased risk of bronchiectasis, as well as contributing factors, remains unclear. Additionally, whether bronchiectasis increases disease burden in IBD remains unknown. Therefore, this study aimed to 1) assess whether IBD increases the risk of incident bronchiectasis; 2) compare the risk of bronchiectasis between individuals with Crohn's disease (CD) and those with ulcerative colitis (UC); 3) identify risk factors for bronchiectasis in individuals with IBD; and 4) examine the disease burden in individuals with IBD and bronchiectasisversusthose without.We conducted a population-based matched cohort study involving adults aged ≥20 years with IBD, using data acquired from the National Health Insurance Service-National Sample Cohort database in Korea between 2002 and 2012.During the mean follow-up of 9.6 years, the incidence rate of bronchiectasis was 419.63/100 000 and 309.65/100 000 person-years (PY) in the IBD and matched cohorts (adjusted hazard ratio [aHR]=1.21, 95% confidence interval [CI]=1.05–1.39), respectively. UC was associated with increased bronchiectasis risk (aHR=1.42, 95% CI=1.19–1.69), while CD was not. Multivariate Cox regression analyses showed that age, male sex, medical aid, underweight status, chronic obstructive pulmonary disease, and diabetes mellitus were associated with an increased risk of bronchiectasis in the IBD cohort (p<0.05). The mortality, emergency department visit, and hospitalisation rates were significantly higher for individuals with IBD and bronchiectasis compared to those without bronchiectasis (p<0.05).IBD is associated with increased risk of bronchiectasis, which results in a greater disease burden in individuals with IBD.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00982-2023
O. Elneima, John R Hurst, C. Echevarria, J. Quint, S. Walker, Salman Siddiqui, Petr Novotný, P. Pfeffer, Jeremy S Brown, M. Shankar-Hari, H. McAuley, O. Leavy, A. Shikotra, A. Singapuri, M. Sereno, Matthew Richardson, R. Saunders, V. C. Harris, L. Houchen-Wolloff, Neil J Greening, Ewen M Harrison, A. Docherty, Nazir I Lone, James D Chalmers, Ling-Pei Ho, Alexander Horsley, Michael Marks, K. Poinasamy, Betty Raman, Rachael A Evans, L. Wain, A. Sheikh, Chris E Brightling, A. De Soyza, L. Heaney
The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airways diseases are unknown.Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at five-months and one-year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health related quality of life (HRQoL) of individuals with pre-existing airways disease (i.e., asthma, chronic obstructive pulmonary disease (COPD) or bronchiectasis) were compared to the non-airways group.A total of 615/2697 (22.8%) participants had a history of pre-existing airways diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At one-year, the airways group participants were less likely to feel fully recovered (20.4%versus33.2%, p<0.001), had higher burden of anxiety (29.1%versus22.0%, p=0.002), depression (31.2%versus24.7%, p=0.006), higher percentage of impaired mobility using Short Physical Performance Battery ≤10 (57.4%versus45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning)versus16.6%, p=0.014. HRQoL assessed using EQ-5D-5 L Utility Index was lower in the airways group (0.64 (sd0.27)versus0.73 (sd0.25), p<0.001). Burden of breathlessness, fatigue and cough measured using a study specific tool was higher in the airways group.Individuals with pre-existing airways diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to one-year post hospital discharge.
{"title":"Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airways diseases in the UK: a multicentre, longitudinal cohort study (PHOSP-COVID)","authors":"O. Elneima, John R Hurst, C. Echevarria, J. Quint, S. Walker, Salman Siddiqui, Petr Novotný, P. Pfeffer, Jeremy S Brown, M. Shankar-Hari, H. McAuley, O. Leavy, A. Shikotra, A. Singapuri, M. Sereno, Matthew Richardson, R. Saunders, V. C. Harris, L. Houchen-Wolloff, Neil J Greening, Ewen M Harrison, A. Docherty, Nazir I Lone, James D Chalmers, Ling-Pei Ho, Alexander Horsley, Michael Marks, K. Poinasamy, Betty Raman, Rachael A Evans, L. Wain, A. Sheikh, Chris E Brightling, A. De Soyza, L. Heaney","doi":"10.1183/23120541.00982-2023","DOIUrl":"https://doi.org/10.1183/23120541.00982-2023","url":null,"abstract":"The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airways diseases are unknown.Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at five-months and one-year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health related quality of life (HRQoL) of individuals with pre-existing airways disease (i.e., asthma, chronic obstructive pulmonary disease (COPD) or bronchiectasis) were compared to the non-airways group.A total of 615/2697 (22.8%) participants had a history of pre-existing airways diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At one-year, the airways group participants were less likely to feel fully recovered (20.4%versus33.2%, p<0.001), had higher burden of anxiety (29.1%versus22.0%, p=0.002), depression (31.2%versus24.7%, p=0.006), higher percentage of impaired mobility using Short Physical Performance Battery ≤10 (57.4%versus45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning)versus16.6%, p=0.014. HRQoL assessed using EQ-5D-5 L Utility Index was lower in the airways group (0.64 (sd0.27)versus0.73 (sd0.25), p<0.001). Burden of breathlessness, fatigue and cough measured using a study specific tool was higher in the airways group.Individuals with pre-existing airways diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to one-year post hospital discharge.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00666-2023
Michael Kreuter, Joyce S Lee, A. Tzouvelekis, J. Oldham, P. Molyneaux, Derek Weycker, M. Atwood, Katerina Samara, K. Kirchgässler, Toby M Maher
The Gender, Age and Physiology (GAP) model is a simple mortality prediction tool in patients with idiopathic pulmonary fibrosis (IPF) using demographic and physiological variables available at initial evaluation. White blood cell (WBC) variables may have associations with IPF outcomes. We evaluated whether incorporation of blood cell counts in modified GAP (cGAP) models would improve outcome prediction in patients with IPF.This retrospective analysis included pooled data from randomised Phase III trials of pirfenidone in IPF (ASCEND, CAPACITY 004, CAPACITY 006). Study outcomes (IPF progression, all-cause mortality, all-cause hospitalisation, respiratory-related hospitalisation) were evaluated during the initial 1-year period. Shared frailty models were used to evaluate associations between continuous and categorical baseline WBC and red blood cell (RBC) parameters and study outcomes in a bivariate context; and the impact of adding continuous monocyte count (cGAP1) or WBC and RBC parameters (cGAP2) to traditional GAP variables in a multivariable context based on C-statistics changes.Data were pooled from 1247 patients (pirfenidone, n=623; placebo, n=624). Significant associations (bivariate analyses) were: IPF progression with neutrophil and eosinophil counts; all-cause mortality with monocyte and neutrophil counts; all-cause hospitalisation with monocyte count, neutrophil count and haemoglobin level; and respiratory-related hospitalisation with monocyte count, neutrophil count and haemoglobin level. In multivariate analyses, C-statistics were highest for the cGAP2 model for each of the outcomes.Modified GAP models incorporating monocyte counts alone or plus other WBC and RBC variables may be useful to improve prediction of outcomes in patients with IPF.ClinicalTrials.gov identifiersNCT01366209;NCT00287716;NCT00287729.
性别、年龄和生理（GAP）模型是一种简单的特发性肺纤维化（IPF）患者死亡率预测工具，它使用了初步评估时可获得的人口和生理变量。白细胞（WBC）变量可能与 IPF 的预后有关。我们评估了将血细胞计数纳入改良 GAP（cGAP）模型是否会改善 IPF 患者的预后预测。这项回顾性分析包括 IPF 吡非尼酮随机 III 期试验（ASCEND、CAPACITY 004、CAPACITY 006）的汇总数据。研究结果（IPF进展、全因死亡率、全因住院、呼吸相关住院）在最初的1年期间进行了评估。共享虚弱模型用于评估连续和分类基线白细胞和红细胞 (RBC) 参数与双变量研究结果之间的关联；以及在多变量情况下，根据 C 统计量变化将连续单核细胞计数（cGAP1）或白细胞和红细胞参数（cGAP2）添加到传统 GAP 变量的影响。显著相关性（双变量分析）为IPF进展与中性粒细胞和嗜酸性粒细胞计数有关；全因死亡率与单核细胞和中性粒细胞计数有关；全因住院与单核细胞计数、中性粒细胞计数和血红蛋白水平有关；呼吸相关住院与单核细胞计数、中性粒细胞计数和血红蛋白水平有关。在多变量分析中，cGAP2 模型对每种结果的 C 统计量都是最高的。仅纳入单核细胞计数或加上其他白细胞和红细胞变量的改良 GAP 模型可能有助于改善对 IPF 患者结果的预测。
{"title":"Modified blood cell GAP model as a prognostic biomarker in idiopathic pulmonary fibrosis (max 90 characters incl. spaces)","authors":"Michael Kreuter, Joyce S Lee, A. Tzouvelekis, J. Oldham, P. Molyneaux, Derek Weycker, M. Atwood, Katerina Samara, K. Kirchgässler, Toby M Maher","doi":"10.1183/23120541.00666-2023","DOIUrl":"https://doi.org/10.1183/23120541.00666-2023","url":null,"abstract":"The Gender, Age and Physiology (GAP) model is a simple mortality prediction tool in patients with idiopathic pulmonary fibrosis (IPF) using demographic and physiological variables available at initial evaluation. White blood cell (WBC) variables may have associations with IPF outcomes. We evaluated whether incorporation of blood cell counts in modified GAP (cGAP) models would improve outcome prediction in patients with IPF.This retrospective analysis included pooled data from randomised Phase III trials of pirfenidone in IPF (ASCEND, CAPACITY 004, CAPACITY 006). Study outcomes (IPF progression, all-cause mortality, all-cause hospitalisation, respiratory-related hospitalisation) were evaluated during the initial 1-year period. Shared frailty models were used to evaluate associations between continuous and categorical baseline WBC and red blood cell (RBC) parameters and study outcomes in a bivariate context; and the impact of adding continuous monocyte count (cGAP1) or WBC and RBC parameters (cGAP2) to traditional GAP variables in a multivariable context based on C-statistics changes.Data were pooled from 1247 patients (pirfenidone, n=623; placebo, n=624). Significant associations (bivariate analyses) were: IPF progression with neutrophil and eosinophil counts; all-cause mortality with monocyte and neutrophil counts; all-cause hospitalisation with monocyte count, neutrophil count and haemoglobin level; and respiratory-related hospitalisation with monocyte count, neutrophil count and haemoglobin level. In multivariate analyses, C-statistics were highest for the cGAP2 model for each of the outcomes.Modified GAP models incorporating monocyte counts alone or plus other WBC and RBC variables may be useful to improve prediction of outcomes in patients with IPF.ClinicalTrials.gov identifiersNCT01366209;NCT00287716;NCT00287729.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.00031-2024
Anne-Lotte Redel, Fatana Miry, M. Hellemons, L. Oswald, Gerrit J. Braunstahl
Long-COVID is a heterogeneous condition with a variety of symptoms which persist at least 3 months after SARS-CoV-2 infection with often profound impact on quality of life. Lactoferrin is an iron-binding glycoprotein with anti-inflammatory and anti-viral properties. Current hypothesises regarding long-COVID aetiology include ongoing immune activation, viral persistence, and auto-immune dysregulation. Therefore, we hypothesized that long-COVID patients may potentially benefit from lactoferrin treatment.To investigate the effect of lactoferrin on various long-COVID domains: fatigue, anxiety, depression, cognitive failure, and muscle strength.We performed a randomized, double-blind placebo-controlled trial in long-COVID patients aged 18–70 years within 12 months after proven SARS-CoV-2 infection. Patients were randomized (1:1) to 6 weeks lactoferrin (1200 mg daily) or placebo. At 3 hospital visits (T0, T6, and T12 weeks) patient reported outcome measures (PROMs) were collected, physical performance tests were performed, and blood was drawn. The difference in fatigue at T6 was the primary outcome.Seventy-two participants were randomized to lactoferrin (N=36) or placebo (N=36). We showed a significant decrease in fatigue between T0 and T6 in both study arms, but without significant difference between the study arms, respectively 3.9 [95% CI: 2.3–5.5] and 4.1 [95% CI: 2.3–5.9](p=0.007 and p=0.013). In none of the other outcomes a significant difference was found in favour of the lactoferrin arm at T6 or T12.Although both long-COVID arms showed improved clinical outcomes at T6, the improvement did not continue until T12. Lactoferrin provided no benefit in terms of fatigue, other PROMs or physical functioning.
{"title":"Effect of Lactoferrin treatment on symptoms and physical performance in Long-COVID patients: a randomized, double-blind, placebo controlled trial","authors":"Anne-Lotte Redel, Fatana Miry, M. Hellemons, L. Oswald, Gerrit J. Braunstahl","doi":"10.1183/23120541.00031-2024","DOIUrl":"https://doi.org/10.1183/23120541.00031-2024","url":null,"abstract":"Long-COVID is a heterogeneous condition with a variety of symptoms which persist at least 3 months after SARS-CoV-2 infection with often profound impact on quality of life. Lactoferrin is an iron-binding glycoprotein with anti-inflammatory and anti-viral properties. Current hypothesises regarding long-COVID aetiology include ongoing immune activation, viral persistence, and auto-immune dysregulation. Therefore, we hypothesized that long-COVID patients may potentially benefit from lactoferrin treatment.To investigate the effect of lactoferrin on various long-COVID domains: fatigue, anxiety, depression, cognitive failure, and muscle strength.We performed a randomized, double-blind placebo-controlled trial in long-COVID patients aged 18–70 years within 12 months after proven SARS-CoV-2 infection. Patients were randomized (1:1) to 6 weeks lactoferrin (1200 mg daily) or placebo. At 3 hospital visits (T0, T6, and T12 weeks) patient reported outcome measures (PROMs) were collected, physical performance tests were performed, and blood was drawn. The difference in fatigue at T6 was the primary outcome.Seventy-two participants were randomized to lactoferrin (N=36) or placebo (N=36). We showed a significant decrease in fatigue between T0 and T6 in both study arms, but without significant difference between the study arms, respectively 3.9 [95% CI: 2.3–5.5] and 4.1 [95% CI: 2.3–5.9](p=0.007 and p=0.013). In none of the other outcomes a significant difference was found in favour of the lactoferrin arm at T6 or T12.Although both long-COVID arms showed improved clinical outcomes at T6, the improvement did not continue until T12. Lactoferrin provided no benefit in terms of fatigue, other PROMs or physical functioning.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1183/23120541.01045-2023
Yaya Zhou, Xinliang He, Jian Tang, Dongmei Zhang, Yao Liu, Y. Xue, Nanchuan Jiang, Jianchu Zhang, Xiaorong Wang
Sputum nitrate/nitrite, which is the main component of reactive nitrogen species (RNS), is a potential biomarker of disease severity and progression in bronchiectasis. This study aimed to determine the association between nitrate/nitrite and exacerbations, airway microbiota in bronchiectasis.We measured total nitrate/nitrite concentration in sputum samples collected from 85 patients with stable bronchiectasis, performed 16 s rRNA sequencing of sputum samples and predicted the denitrification ability of airway microbiota through PICRUSt. Relationships between sputum total nitrate/nitrite and disease severity, exacerbations and airway microbiota were examined.Higher total sputum nitrate/nitrite was associated with more severe bronchiectasis defined by E-FACED (p= 0.003) or BSI (p=0.006) and more exacerbations in prior 12 month (p=0.005). Moreover, total sputum nitrate/nitrite was also significantly higher in patients with worse cough score (p=0.03), worse sputum purulent score (p=0.01), and worse MRC score (p=0.02). In addition, the total sputum nitrate/nitrite ofP. aeruginosacolonization (PA) group was higher than that of non-P. aeruginosacolonization (NPA) group (p=0.04), meanwhile, relative abundance ofP. aeruginosawas positively correlated with the total nitrate/nitrite (r=0.337, p=0.002). Simultaneously, denitrification module (M00529) was also significantly enriched in PA group compared to NPA group through PICRUSt analyses. Using receiver-operating characteristic analysis, total nitrate/nitrite was associated with exacerbations during one year follow-up (AUC=0.741, p=0.014).Sputum nitrate/nitrite is a biomarker of disease severity and associated withP. aeruginosacolonization in bronchiectasis.
{"title":"Total sputum nitrate/nitrite is associated with exacerbations andPseudomonas aeruginosacolonization in bronchiectasis","authors":"Yaya Zhou, Xinliang He, Jian Tang, Dongmei Zhang, Yao Liu, Y. Xue, Nanchuan Jiang, Jianchu Zhang, Xiaorong Wang","doi":"10.1183/23120541.01045-2023","DOIUrl":"https://doi.org/10.1183/23120541.01045-2023","url":null,"abstract":"Sputum nitrate/nitrite, which is the main component of reactive nitrogen species (RNS), is a potential biomarker of disease severity and progression in bronchiectasis. This study aimed to determine the association between nitrate/nitrite and exacerbations, airway microbiota in bronchiectasis.We measured total nitrate/nitrite concentration in sputum samples collected from 85 patients with stable bronchiectasis, performed 16 s rRNA sequencing of sputum samples and predicted the denitrification ability of airway microbiota through PICRUSt. Relationships between sputum total nitrate/nitrite and disease severity, exacerbations and airway microbiota were examined.Higher total sputum nitrate/nitrite was associated with more severe bronchiectasis defined by E-FACED (p= 0.003) or BSI (p=0.006) and more exacerbations in prior 12 month (p=0.005). Moreover, total sputum nitrate/nitrite was also significantly higher in patients with worse cough score (p=0.03), worse sputum purulent score (p=0.01), and worse MRC score (p=0.02). In addition, the total sputum nitrate/nitrite ofP. aeruginosacolonization (PA) group was higher than that of non-P. aeruginosacolonization (NPA) group (p=0.04), meanwhile, relative abundance ofP. aeruginosawas positively correlated with the total nitrate/nitrite (r=0.337, p=0.002). Simultaneously, denitrification module (M00529) was also significantly enriched in PA group compared to NPA group through PICRUSt analyses. Using receiver-operating characteristic analysis, total nitrate/nitrite was associated with exacerbations during one year follow-up (AUC=0.741, p=0.014).Sputum nitrate/nitrite is a biomarker of disease severity and associated withP. aeruginosacolonization in bronchiectasis.","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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