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The risk of osteoporosis in patients with asthma. 哮喘患者骨质疏松的风险。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-05-19 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1763612
Indumathi Kumarathas, Torben Harsløf, Charlotte Uggerhøj Andersen, Bente Langdahl, Ole Hilberg, Leif Bjermer, Anders Løkke

It is well-known that use of continuous systemic corticosteroids (SG) affects bone metabolism, bone mineral density (BMD), and ultimately increases the risk of osteoporosis. In patients with asthma, on the other hand, the effects of long-term high-dose inhaled corticosteroids (ICS) on BMD and risk of osteoporotic fractures is controversial. The reasons for this inconsistency could be explained by the fact that only few long-term studies investigating the effect of ICS in patients with asthma exist. The studies are characterized by different study designs and duration of ICS exposure, small study populations, and differences between the used ICS. The aim of this article is to unravel which factors, if any, that contribute to an increased risk of osteoporosis in patients with asthma and to summarize the evidence regarding adverse effects of ICS on bone metabolism, BMD and osteoporotic fractures in patients with asthma.

众所周知,持续使用全身皮质类固醇(SG)会影响骨代谢、骨矿物质密度(BMD),并最终增加骨质疏松症的风险。另一方面,在哮喘患者中,长期大剂量吸入皮质类固醇(ICS)对骨密度和骨质疏松性骨折风险的影响存在争议。这种不一致的原因可以用这样一个事实来解释:只有很少的长期研究调查了ICS对哮喘患者的影响。这些研究的特点是研究设计和ICS暴露时间不同,研究人群较小,使用的ICS之间存在差异。本文的目的是揭示哪些因素(如果有的话)导致哮喘患者骨质疏松症的风险增加,并总结有关ICS对哮喘患者骨代谢、骨密度和骨质疏松性骨折的不良影响的证据。
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引用次数: 11
Elevated blood eosinophils in acute COPD exacerbations: better short- and long-term prognosis. 急性COPD加重患者血嗜酸性粒细胞升高:较好的短期和长期预后。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-04-30 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1757274
Ajmal Jabarkhil, Mia Moberg, Julie Janner, Mie Nymann Petersen, Camilla Bjørn Jensen, Lars Henrik Äangquist, Jørgen Vestbo, Tine Jess, Celeste Porsbjerg

Background: Elevated eosinophils in COPD is recognized as a potential risk factor for exacerbations, but the prognostic role of elevated eosinophils during exacerbations of COPD is unclear. We investigated short-term and long-term outcomes in patients with exacerbations of eosinophilic phenotype, compared with patients with low blood eosinophils. Methods: A single-centre retrospective study of all patients admitted for a COPD exacerbation to Bispebjerg University Hospital in 2010-2011 was established by linking inpatient data with national patient and prescription registries, with a three-year follow-up period. Elevated eosinophils were defined as a blood eosinophil level at admission of ≥0.30 × 109 cells/L. Results: A total of 811 patients were included; 13.2% had an eosinophilic exacerbation. The eosinophilic group had less need for non-invasive ventilation, shorter inpatient stay, and lower in-hospital mortality, compared to the non-eosinophilic group. However, the eosinophilic and non-eosinophilic groups showed similar risks of readmission (incidence rate ratio[95], 0.99 [0.73-1.36]). Three-year mortality was high in both groups, although lower in the eosinophilic group (40% vs. 54%, p = 0.006). Conclusions: COPD exacerbations in patients with high blood eosinophil have a better short-term prognosis without higher risk of subsequent exacerbation. Eosinophilic exacerbations have also a lower three-year mortality.

背景:嗜酸性粒细胞升高被认为是COPD加重的潜在危险因素,但嗜酸性粒细胞升高在COPD加重中的预后作用尚不清楚。我们研究了嗜酸性粒细胞表型加重患者与低血嗜酸性粒细胞患者的短期和长期结果。方法:通过将住院患者数据与国家患者和处方登记处联系起来,建立了一项单中心回顾性研究,该研究对2010-2011年在比斯堡大学医院住院的所有COPD加重患者进行了为期三年的随访。嗜酸性粒细胞升高定义为入院时血液中嗜酸性粒细胞水平≥0.30 × 109个细胞/L。结果:共纳入811例患者;13.2%有嗜酸性粒细胞加重。与非嗜酸性粒细胞组相比,嗜酸性粒细胞组对无创通气的需求更少,住院时间更短,住院死亡率更低。然而,嗜酸性粒细胞组和非嗜酸性粒细胞组的再入院风险相似(发病率比[95],0.99[0.73-1.36])。两组的三年死亡率都很高,但嗜酸性粒细胞组较低(40% vs. 54%, p = 0.006)。结论:高血嗜酸性粒细胞患者COPD急性加重具有较好的短期预后,且无后续加重的高风险。嗜酸性粒细胞加重也有较低的三年死亡率。
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引用次数: 19
Fractional exhaled breath temperature in patients with asthma, chronic obstructive pulmonary disease, or systemic sclerosis compared to healthy controls. 哮喘、慢性阻塞性肺疾病或系统性硬化症患者与健康对照的呼气温度分数。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-04-12 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1747014
Ellen Tufvesson, Erik Nilsson, Todor A Popov, Roger Hesselstrand, Leif Bjermer

Exhaled breath temperature has been suggested to reflect airway inflammation, and it would be plausible to measure the peripheral airway temperature as a correlate to peripheral airway inflammation. This study aims to explore the relative peripheral airway temperature in patients with asthma, chronic obstructive pulmonary disease (COPD) or systemic sclerosis (SSc) compared to healthy controls, and relate to lung function and exhaled nitric oxide. Sixty-five subjects (16 asthmatics, 18 COPD patients, 17 SSc patients and 14 healthy subjects) performed fractional exhaled breath temperature measurements using a novel device, fractional exhaled NO measurements, spirometry, impulse oscillometry, body plethysmography and CO-diffusion capacity test. A significant overall difference among all the patient groups was seen in both the Tmax (= peak values of the entire exhalation) and T3max (= peak value of the last fraction of the exhaled volume). A significant difference in T3/T1 ratio (= the ratio of peripheral versus central air temperature) was found between asthmatic subjects and those with COPD or SSc. In addition, T1max (= temperature in the central), T3max (= peripheral airways) and the T3/T1ratio related to several volumetric measurements (both in absolute values and as percent predicted), such as vital capacity, total lung capacity, forced expiratory volume in 1 s, and diffusion capacity. The temperature ratio of the peripheral versus central airways was lower in patients with COPD or SSc compared to asthmatics, who in turn presented similar levels as the controls. There was also a large overlap between the groups. Overall, the airway temperatures were related to absolute lung volumes, and specifically, the peripheral temperature was related to the gas diffusion capacity (% predicted), suggesting a link to the vascular component.

呼出温度被认为可以反映气道炎症,测量气道外周温度与气道外周炎症相关似乎是合理的。本研究旨在探讨哮喘、慢性阻塞性肺疾病(COPD)或系统性硬化症(SSc)患者与健康对照组相比的相对外周气道温度,以及与肺功能和呼出一氧化氮的关系。65名受试者(16名哮喘患者、18名慢性阻塞性肺病患者、17名慢性阻塞性肺病患者和14名健康受试者)使用一种新型装置进行了分次呼气温度测量、分次呼气NO测量、肺活量测定、脉冲振荡测定、体体积脉搏图和co扩散能力测试。在所有患者组中,Tmax(=整个呼气的峰值)和T3max(=呼出体积最后一部分的峰值)都有显著的总体差异。哮喘患者与COPD或SSc患者的T3/T1比值(外周温度与中心温度之比)有显著差异。此外,T1max(=中央温度)、T3max(=外周气道)和T3/ t1比值与几个容积测量(包括绝对值和预测百分比)相关,如肺活量、总肺活量、1s内用力呼气量和扩散能力。与哮喘患者相比,COPD或SSc患者外周气道与中央气道的温度比更低,而哮喘患者的温度水平与对照组相似。两组之间也有很大的重叠。总体而言,气道温度与绝对肺容量有关,具体而言,外周温度与气体扩散能力有关(预测百分比),表明与血管成分有关。
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引用次数: 6
Lung function in relation to six-minute walk test in pulmonary hypertension. 肺动脉高压患者肺功能与6分钟步行试验的关系。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-04-07 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1745492
Amir Farkhooy, Michaela Bellocchia, Hans Hedenström, Daniela Libertucci, Caterina Bucca, Christer Janson, Paolo Solidoro, Andrei Malinovschi

Background: Pulmonary hypertension (PH) is a progressive disorder of the pulmonary circulation, associated with diverse medical conditions. Exercise limitation is the most prominent symptom in PH. Exercise capacity, commonly assessed through a six-minute walk test (6MWT), correlates with both functional status and survival in PH. Few studies have analysed the relation between respiratory function and exercise limitation. Therefore, we investigated the relationship between resting pulmonary function, exercise capacity, and exertional desaturation, assessed through the 6MWT, in unselected PH patients. Methods: Fifty consecutive patients with PH diagnosis, referred for pulmonary function testing (lung volume, spirometry, and diffusing capacity for carbon monoxide (DLCO)) and 6MWT, were recruited at Molinette University Hospital, Turin. Results: The majority of the patients (54%) had PH due to left heart disease. Airway obstruction (FEV1/VC-ratio < 0.7) was found in 46% of the patients and they performed significantly worse in the 6MWT than unobstructed patients (307 m vs. 377 m). Patients with PH due to left heart disease also performed significantly poorer 6MWT when airway obstruction was present (305 m vs. 389 m). Twenty-two patients (44%) presented exertional desaturation upon 6MWT. Lower DLCO divided by the alveolar volume (DLCO/VA), FEV1/VC-ratios and resting PaO2-values were significantly correlated with exertional desaturation after adjustments for age, sex, BMI, and smoking habits. DLCO/VA was the main determinant of exertional desaturation in a stepwise regression model. Conclusions: Spirometric parameters of airway obstruction were related to walk distance and exercise-induced desaturation in PH patients. This suggests a place for spirometry in clinical monitoring of PH patients.

背景:肺动脉高压(PH)是一种进行性肺循环疾病,与多种疾病有关。运动受限是ph患者最突出的症状。通常通过6分钟步行试验(6MWT)评估的运动能力与ph患者的功能状态和生存相关。很少有研究分析呼吸功能与运动受限之间的关系。因此,我们在未选择的PH患者中通过6MWT评估静息肺功能、运动能力和运动去饱和度之间的关系。方法:在都灵Molinette大学医院连续招募50例PH诊断患者,进行肺功能检查(肺容量、肺活量测定、一氧化碳弥散量(DLCO))和6MWT。结果:大多数患者(54%)因左心疾病而出现PH。46%的患者存在气道阻塞(FEV1/ vc比< 0.7),且在6MWT时的表现明显差于未阻塞患者(307 m对377 m),左心疾病导致的PH患者在存在气道阻塞时的6MWT表现也明显差(305 m对389 m), 22例(44%)患者在6MWT时出现用力失饱和。低DLCO除以肺泡容积(DLCO/VA)、FEV1/ vc比和静息pao2值在调整年龄、性别、BMI和吸烟习惯后与运动去饱和显著相关。在逐步回归模型中,DLCO/VA是运动去饱和的主要决定因素。结论:肺活量测定参数与PH患者的步行距离和运动引起的去饱和有关。这提示肺活量测定法在PH患者的临床监测中占有一席之地。
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引用次数: 2
Clinical characteristics of the BREATHE cohort - a real-life study on patients with asthma and COPD. BREATHE队列的临床特征-哮喘和慢性阻塞性肺病患者的现实研究。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-03-17 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1736934
Vibeke Backer, Ditte K Klein, Uffe Bodtger, Kerstin Romberg, Celeste Porsbjerg, Jonas S Erjefält, Karsten Kristiansen, Ruiqi Xu, Alexander Silberbrandt, Laurits Frøssing, Morten Hvidtfeldt, Nicolai Obling, Linnea Jarenbäck, Abir Nasr, Ellen Tufvesson, Michiko Mori, Matilde Winther-Jensen, Lisa Karlsson, Ulf Nihlén, Thomas Veje Flintegaard, Leif Bjermer

Background: The BREATHE study is a cross-sectional study of real-life patients with asthma and/or COPD in Denmark and Sweden aiming to increase the knowledge across severities and combinations of obstructive airway disease. Design: Patients with suspicion of asthma and/or COPD and healthy controls were invited to participate in the study and had a standard evaluation performed consisting of questionnaires, physical examination, FeNO and lung function, mannitol provocation test, allergy test, and collection of sputum and blood samples. A subgroup of patients and healthy controls had a bronchoscopy performed with a collection of airway samples. Results: The study population consisted of 1403 patients with obstructive airway disease (859 with asthma, 271 with COPD, 126 with concurrent asthma and COPD, 147 with other), and 89 healthy controls (smokers and non-smokers). Of patients with asthma, 54% had moderate-to-severe disease and 46% had mild disease. In patients with COPD, 82% had groups A and B, whereas 18% had groups C and D classified disease. Patients with asthma more frequently had childhood asthma, atopic dermatitis, and allergic rhinitis, compared to patients with COPD, asthma + COPD and Other, whereas FeNO levels were higher in patients with asthma and asthma + COPD compared to COPD and Other (18 ppb and 16 ppb vs 12.5 ppb and 14 ppb, < 0.001). Patients with asthma, asthma + COPD and Other had higher sputum eosinophilia (1.5%, 1.5%, 1.2% vs 0.75%, respectively, p < 0.001) but lower sputum neutrophilia (39.3, 43.5%, 40.8% vs 66.8%, p < 0.001) compared to patients with COPD. Conclusions: The BREATHE study provides a unique database and biobank with clinical information and samples from 1403 real-life patients with asthma, COPD, and overlap representing different severities of the diseases. This research platform is highly relevant for disease phenotype- and biomarker studies aiming to describe a broad spectrum of obstructive airway diseases.

背景:BREATHE研究是一项针对丹麦和瑞典哮喘和/或COPD患者的横断面研究,旨在增加对阻塞性气道疾病严重程度和组合的了解。设计:邀请疑似哮喘和/或慢性阻塞性肺病患者和健康对照者参加研究,并进行标准评估,包括问卷调查、体格检查、FeNO和肺功能、甘露醇激发试验、过敏试验、痰和血样采集。一个亚组患者和健康对照者进行了支气管镜检查,收集了气道样本。结果:研究人群包括1403例阻塞性气道疾病患者(859例合并哮喘,271例合并COPD, 126例合并哮喘和COPD, 147例合并其他)和89例健康对照(吸烟者和非吸烟者)。在哮喘患者中,54%患有中度至重度疾病,46%患有轻度疾病。在COPD患者中,82%属于A组和B组,而18%属于C组和D组。与COPD、哮喘+ COPD和其他患者相比,哮喘患者更容易发生儿童哮喘、特应性皮炎和变应性鼻炎,而哮喘和哮喘+ COPD患者的FeNO水平高于COPD和其他患者(18 ppb和16 ppb vs 12.5 ppb和14 ppb, pp pp)。BREATHE研究提供了一个独特的数据库和生物库,其中包含来自1403名哮喘、慢性阻塞性肺病和重叠疾病患者的临床信息和样本,代表了不同的疾病严重程度。该研究平台与疾病表型和生物标志物研究高度相关,旨在描述梗阻性气道疾病的广谱。
{"title":"Clinical characteristics of the BREATHE cohort - a real-life study on patients with asthma and COPD.","authors":"Vibeke Backer,&nbsp;Ditte K Klein,&nbsp;Uffe Bodtger,&nbsp;Kerstin Romberg,&nbsp;Celeste Porsbjerg,&nbsp;Jonas S Erjefält,&nbsp;Karsten Kristiansen,&nbsp;Ruiqi Xu,&nbsp;Alexander Silberbrandt,&nbsp;Laurits Frøssing,&nbsp;Morten Hvidtfeldt,&nbsp;Nicolai Obling,&nbsp;Linnea Jarenbäck,&nbsp;Abir Nasr,&nbsp;Ellen Tufvesson,&nbsp;Michiko Mori,&nbsp;Matilde Winther-Jensen,&nbsp;Lisa Karlsson,&nbsp;Ulf Nihlén,&nbsp;Thomas Veje Flintegaard,&nbsp;Leif Bjermer","doi":"10.1080/20018525.2020.1736934","DOIUrl":"https://doi.org/10.1080/20018525.2020.1736934","url":null,"abstract":"<p><p><b>Background:</b> The BREATHE study is a cross-sectional study of real-life patients with asthma and/or COPD in Denmark and Sweden aiming to increase the knowledge across severities and combinations of obstructive airway disease. <b>Design:</b> Patients with suspicion of asthma and/or COPD and healthy controls were invited to participate in the study and had a standard evaluation performed consisting of questionnaires, physical examination, FeNO and lung function, mannitol provocation test, allergy test, and collection of sputum and blood samples. A subgroup of patients and healthy controls had a bronchoscopy performed with a collection of airway samples. <b>Results:</b> The study population consisted of 1403 patients with obstructive airway disease (859 with asthma, 271 with COPD, 126 with concurrent asthma and COPD, 147 with other), and 89 healthy controls (smokers and non-smokers). Of patients with asthma, 54% had moderate-to-severe disease and 46% had mild disease. In patients with COPD, 82% had groups A and B, whereas 18% had groups C and D classified disease. Patients with asthma more frequently had childhood asthma, atopic dermatitis, and allergic rhinitis, compared to patients with COPD, asthma + COPD and Other, whereas FeNO levels were higher in patients with asthma and asthma + COPD compared to COPD and Other (18 ppb and 16 ppb vs 12.5 ppb and 14 ppb, <i>p </i>< 0.001). Patients with asthma, asthma + COPD and Other had higher sputum eosinophilia (1.5%, 1.5%, 1.2% vs 0.75%, respectively, <i>p</i> < 0.001) but lower sputum neutrophilia (39.3, 43.5%, 40.8% vs 66.8%, <i>p</i> < 0.001) compared to patients with COPD. <b>Conclusions:</b> The BREATHE study provides a unique database and biobank with clinical information and samples from 1403 real-life patients with asthma, COPD, and overlap representing different severities of the diseases. This research platform is highly relevant for disease phenotype- and biomarker studies aiming to describe a broad spectrum of obstructive airway diseases.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"7 1","pages":"1736934"},"PeriodicalIF":1.9,"publicationDate":"2020-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/20018525.2020.1736934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37828924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
Recurrent respiratory papillomatosis with lower airway involvement in a young woman. 年轻女性复发性呼吸道乳头状瘤病伴下气道受累。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-03-12 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1740567
Tatiana Mamaeva, Camilla Slot Mehlum, Jesper Rømhild Davidsen

Radiological presentation of bronchiectasis should prompt the respiratory physician to investigate various differential diagnosis leading to this condition. This case report describes a young non-smoking woman with HPV11 induced laryngeal Recurrent Respiratory Papillomatosis (RRP) since early childhood, who developed progressive exertional dyspnea. A thorough diagnostic process revealed HPV11 infection in the lung parenchyma consistent with RRP in the lower airways, an HPV infection that was most likely obtained from the patient´s mother during vaginal birth. This case report illustrates that also respiratory physicians should keep RRP in mind in persons with the radiological presentation of bronchiectasis previously diagnosed RRP in the upper airways.

支气管扩张的影像学表现应促使呼吸内科医生调查导致这种情况的各种鉴别诊断。本病例报告描述了一名年轻的非吸烟女性,自儿童早期患有HPV11诱导的喉复发性呼吸乳头状瘤病(RRP),并发展为进行性用力呼吸困难。彻底的诊断过程显示肺实质的HPV11感染与下呼吸道的RRP一致,HPV感染很可能是在阴道分娩时从患者的母亲那里获得的。本病例报告说明,呼吸内科医生在影像学上表现为支气管扩张的患者之前诊断为上呼吸道的RRP时,也应牢记RRP。
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引用次数: 2
Optimizing COPD treatment in patients with lung- or head and neck cancer does not improve quality of life - a randomized, pilot, clinical trial. 优化慢性阻塞性肺病或头颈癌患者的治疗并不能提高生活质量——一项随机、试点、临床试验。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-03-02 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1731277
Magnus Gottlieb, Anders Mellemgaard, Kristoffer Marsaa, Nina Godtfredsen

Background: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with lung and head- and neck cancer. Patients with lung cancer who also suffer from COPD have a worse prognosis than patients with lung cancer and no COPD. It has previously been shown that diagnosis and treatment of concomitant COPD in patients with newly diagnosed lung- or head and neck cancer need optimization. In this randomized, controlled trial we aimed to assess if intervention directed at improving treatment for COPD in these patients improved health-related quality of life (QoL). Methods: During 2014, we randomized 114 patients referred for oncological treatment at a large university hospital in the Capital Region of Denmark, to either usual care or intervention regarding concomitant COPD. The intervention consisted of two visits in an out-patient clinic established at the oncological department and staffed with a pulmonary physician. At baseline, week 13 and week 25, all patients filled out the cancer- and COPD-specific QoL questionnaires CAT and EORTC, respectively. The primary outcome was change in CAT-score between control- and intervention group. The secondary outcome was change in EORTC. Results: There was no change in CAT-score by week 13 or 25 between the groups. For the EORTC there was a statistically significant improvement only in the fatigue domain at week 13 (p = 0.03), but not at week 25. There was a trend towards less dyspnea in the intervention group at week 13, measured by EORTC (p = 0.07). Mortality by week 25 was similar in both groups. Conclusion: In this population of severely ill cancer patients, we did not find that this intervention, focusing on inhaled COPD medication, for the management of COPD had any convincing positive impact on the patients' perceived quality of life compared with usual care. Further studies are needed.

背景:慢性阻塞性肺疾病(COPD)是肺癌和头颈癌患者的常见合并症。同时患有慢性阻塞性肺病的肺癌患者的预后比没有慢性阻塞性肺病的肺癌患者差。先前的研究表明,新诊断的肺癌或头颈癌患者合并COPD的诊断和治疗需要优化。在这项随机对照试验中,我们旨在评估旨在改善COPD治疗的干预措施是否能改善这些患者的健康相关生活质量(QoL)。方法:2014年,我们在丹麦首都地区的一家大型大学医院随机选择114例患者进行肿瘤治疗,对合并COPD进行常规护理或干预。干预包括在肿瘤部门设立的门诊诊所进行两次访问,并配备了肺病医生。在基线,第13周和第25周,所有患者分别填写癌症和copd特异性生活质量问卷CAT和EORTC。主要观察结果为对照组与干预组间cat评分的变化。次要终点为EORTC的变化。结果:第13周、第25周各组间cat评分无明显变化。对于EORTC,只有在第13周的疲劳领域有统计学意义的改善(p = 0.03),但在第25周没有。干预组呼吸困难在第13周有减少的趋势,EORTC测量(p = 0.07)。两组在第25周的死亡率相似。结论:在这组严重癌症患者中,我们没有发现这种以吸入COPD药物为主的COPD治疗干预与常规治疗相比,对患者感知生活质量有任何令人信服的积极影响。需要进一步的研究。
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引用次数: 5
The impact of reflexology and homeopathy added to conventional asthma treatment on markers of airway inflammation - a randomised study. 反射疗法和顺势疗法对传统哮喘治疗对气道炎症标志物的影响——一项随机研究。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-02-26 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1726153
Ayfer Topcu, Anders Løkke, Leila Eriksen, Lars Peter Nielsen, Ronald Dahl

Background: Asthma is a common chronic airway disease associated with hyperresponsiveness and airway inflammation. Anti-inflammatory medication especially inhaled corticosteroids are important for control of airway inflammation, decrease of airway hyperresponsiveness and lung function variability, reduce asthma symptoms, and improve lung function as well as quality of life. Most studies investigating the influence of complementary and alternative medicine (CAM) in asthma measure clinical effectiveness, but only few evaluate the impact on markers of airway inflammation. Objective: The aim of this study was to investigate the effect of reflexology and homeopathy added to conventional treatment on different markers of airway inflammation in asthma. Methods: Eighty-four patients with asthma were randomized to receive conventional treatment alone or conventional treatment with addition of homeopathy or reflexology in a single center, investigator blinded, controlled, one-year trial. During the study period, patients regularly consulted their general practitioner for evaluation and asthma treatment. At randomization, and after 6 and 12 months, methacholine challenge test and measurement of exhaled nitric oxide were performed. Blood samples were collected for eosinophil count and measurement of serum eosinophil cationic protein. Results: No significant differences between groups for any of the inflammatory markers were demonstrated. Methacholine responsiveness improved in all three groups but improvements were not statistically significant within and between groups. Conclusions: This randomized controlled study of reflexology and homeopathy failed to show significant improvement on selected markers of inflammation and airway hyperresponsiveness in asthma.

背景:哮喘是一种常见的慢性气道疾病,与高反应性和气道炎症有关。抗炎药物特别是吸入性糖皮质激素对控制气道炎症、降低气道高反应性和肺功能变异性、减轻哮喘症状、改善肺功能和生活质量具有重要意义。大多数调查补充和替代医学(CAM)对哮喘影响的研究都测量了临床效果,但很少评估对气道炎症标志物的影响。目的:探讨在常规治疗基础上加用反射疗法和顺势疗法对哮喘不同气道炎症指标的影响。方法:84例哮喘患者在单中心随机接受常规治疗或常规治疗加顺势疗法或反射疗法,研究者盲法,对照,为期一年。在研究期间,患者定期咨询他们的全科医生评估和哮喘治疗。随机分组,6个月和12个月后,进行甲胆碱激发试验和呼出一氧化氮测量。采集血样进行嗜酸性粒细胞计数和血清嗜酸性粒细胞阳离子蛋白测定。结果:各组间炎症指标均无显著差异。三组患者的甲胆碱反应性均有改善,但组内和组间改善无统计学意义。结论:这项反射疗法和顺势疗法的随机对照研究未能显示出对哮喘炎症和气道高反应性选定标志物的显着改善。
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引用次数: 0
High-intensity resistance training in newly diagnosed sarcoidosis- an exploratory study of effects on lung function, muscle strength, fatigue, dyspnea, health-related quality of life and lung immune cells. 新诊断结节病的高强度阻力训练对肺功能、肌肉力量、疲劳、呼吸困难、健康相关生活质量和肺免疫细胞影响的探索性研究
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-02-21 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1730137
Susanna Kullberg, Natalia V Rivera, Maria J Eriksson, Johan Grunewald, Anders Eklund

Background: High-intensity resistance training is unexplored in untreated patients with newly diagnosed sarcoidosis. Objectives: To evaluate the effects of high-intensity resistance training on lung function, muscle strength, fatigue, dyspnea, health-related impairments, and lung immune cells. Methods: Eleven untreated patients with newly diagnosed sarcoidosis performed high-intensity resistance training at an intensity of 80% of 1 Repetition Maximum (RM) twice a week and daily inspiratory muscle training at regular intensity for 12 weeks. Assessment with spirometry, chest X-ray, questionnaires, and BAL (bronchoalveolar lavage) cells was performed before and in close adjacent to completed training. A final third assessment except bronchoscopy was performed at an average 5 months after the training period. Results: The training was well tolerated and muscular strength increased significantly while fatigue, dyspnea, and health-related impairments decreased, though not significantly in all measures. Mean percentage of lung lymphocytes decreased (p = 0.006). Conclusions: High-intensity resistance training and inspiratory muscle training at regular intensity in patients with newly diagnosed sarcoidosis led to improvements in muscular strength without adverse events and seems to be a non-invasive attractive way to improve fatigue, dyspnea, and quality of life. Analysis of lung immune cells possibly indicated a decreased inflammatory activity. These results provide a basis for larger randomized trials.

背景:高强度阻力训练在未经治疗的新诊断结节病患者中的应用尚不明确。目的:评估高强度阻力训练对肺功能、肌肉力量、疲劳、呼吸困难、健康相关损伤和肺免疫细胞的影响。方法:11例未经治疗的新诊断结节病患者进行高强度阻力训练,强度为1次最大重复(RM)的80%,每周2次,每天进行常规强度的吸气肌训练,为期12周。在训练结束前和训练结束后进行肺活量测定、胸部x线、问卷调查和支气管肺泡灌洗(BAL)细胞评估。除支气管镜检查外的最后第三次评估在训练期后平均5个月进行。结果:训练耐受性良好,肌肉力量显著增加,而疲劳、呼吸困难和与健康相关的损伤减少,尽管在所有测量中都不是显著的。肺淋巴细胞平均百分比降低(p = 0.006)。结论:新诊断结节病患者的高强度阻力训练和常规强度的吸气肌训练可改善肌力,无不良事件,似乎是一种改善疲劳、呼吸困难和生活质量的无创方法。肺免疫细胞分析可能表明炎症活性降低。这些结果为更大规模的随机试验提供了基础。
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引用次数: 7
Fluoroscopy guided percutaneous biopsy in combination with bronchoscopy and endobronchial ultrasound in the diagnosis of suspicious lung lesions - the triple approach. 透视引导下经皮穿刺活检联合支气管镜及支气管内超声诊断可疑肺病变-三合一入路。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2020-02-07 eCollection Date: 2020-01-01 DOI: 10.1080/20018525.2020.1723303
Jatinder Singh Sidhu, Geir Salte, Ida Skovgaard Christiansen, Therese Marie Henriette Naur, Asbjørn Høegholm, Paul Frost Clementsen, Uffe Bodtger

Flexible bronchoscopy and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) are the pulmonologists´ basic procedures for the biopsy of suspicious lung lesions. If inconclusive, other guiding-modalities for tissue sampling are needed, computed tomography performed by a radiologist, or - if available - radial EBUS or electromagnetic navigation biopsy. We wanted to investigate if same-day X-ray fluoroscopy-guided transthoracic fine-needle aspiration biopsy (F-TTNAB) performed by the pulmonologist immediately after bronchoscopy and EBUS is a feasible alternative. We retrospectively identified consecutive patients in whom F-TTNAB followed a bronchoscopy and EBUS in the same séance. Patients in whom the suspicion of malignancy was invalidated after complete work up were followed for six months to identify false-negative cases. In total 125 patients underwent triple approach (bronchoscopy, EBUS and F-TTNAB) during the same séance. Malignancy was diagnosed in 86 (69%), and 77 of these (90%) were primary lung cancers. The diagnostic yield of F-TTNAB for malignancy was 77%, and sensitivity was 90%. Pneumothorax occurred in 35 (28%) patients, and was administered with pleural drainage in 22 (18% of all patients). No cases of prolonged haemoptysis were observed. The risk of pneumothorax differed insignificantly with lesion size ≤2.0 cm (27%) versus >2.0 cm (29%). We conclude that it is feasible for pulmonologist to perform F-TTNAB immediately after endoscopy as a combined triple approach in a fast-track workup of suspected lung cancer.

柔性支气管镜检查和支气管超声引导下经支气管穿刺(EBUS-TBNA)是肺科医生对可疑肺病变进行活检的基本程序。如果不确定,则需要其他指导方式进行组织采样,由放射科医生进行计算机断层扫描,或者(如果可用)径向EBUS或电磁导航活检。我们想调查在支气管镜检查和EBUS后立即由肺科医生进行的当天x线透视引导下的经胸细针穿刺活检(F-TTNAB)是否是一种可行的选择。我们回顾性地确定了在同一时期进行支气管镜检查和EBUS的F-TTNAB连续患者。在完成工作后,怀疑恶性肿瘤无效的患者随访6个月,以确定假阴性病例。在同一时间段内,共有125例患者接受了三重入路(支气管镜、EBUS和F-TTNAB)。86例(69%)被诊断为恶性肿瘤,其中77例(90%)为原发性肺癌。F-TTNAB对恶性肿瘤的诊断率为77%,敏感性为90%。35例(28%)患者发生气胸,22例(18%)患者行胸膜引流。无长时间咯血病例。病灶大小≤2.0 cm(27%)和>2.0 cm(29%)发生气胸的风险差异不显著。我们的结论是,肺科医生在内窥镜检查后立即进行F-TTNAB治疗是可行的,作为一种三联疗法,可以快速检查疑似肺癌。
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引用次数: 6
期刊
European Clinical Respiratory Journal
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