首页 > 最新文献

European Clinical Respiratory Journal最新文献

英文 中文
Comorbid conditions as predictors of mortality in severe COPD - an eight-year follow-up cohort study. 合并症作为严重慢性阻塞性肺病死亡率的预测因素——一项为期8年的随访队列研究
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2181291
Gabriella Eliasson, Christer Janson, Gunnar Johansson, Kjell Larsson, Anders Lindén, Claes-Göran Löfdahl, Thomas Sandström, Josefin Sundh

Purpose: Co-morbidities are common in chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. The aim of the present study was to explore the prevalence of several comorbid conditions in severe COPD, and to investigate and compare their associations with long-term mortality.

Methods: In May 2011 to March 2012, 241 patients with COPD stage 3 or 4 were included in the study. Information was collected on sex, age, smoking history, weight and height, current pharmacological treatment, number of exacerbations the recent year and comorbid conditions. At December 31st, 2019, mortality data (all-cause and cause specific) were collected from the National Cause of Death Register. Data were analyzed using Cox-regression analysis with gender, age, previously established predictors of mortality and comorbid conditions as independent variables, and all-cause mortality and cardiac and respiratory mortality, respectively, as dependent variables.

Results: Out of 241 patients, 155 (64%) were deceased at the end of the study period; 103 patients (66%) died of respiratory disease and 25 (16%) of cardiovascular disease. Impaired kidney function was the only comorbid condition independently associated with increased all-cause mortality (HR (95% CI) 3.41 (1.47-7.93) p=0.004) and respiratory mortality (HR (95%CI) 4.63 (1.61 to 13.4), p = 0.005). In addition, age ≥70, BMI <22 and lower FEV1 expressed as %predicted were significantly associated with increased all-cause and respiratory mortality.

Conclusion: In addition to the risk factors high age, low BMI and poor lung function; impaired kidney function appears to be an important risk factor for mortality in the long term, which should be taken into account in the medical care of patients with severe COPD.

目的:合并症在慢性阻塞性肺疾病(COPD)中很常见,并与发病率和死亡率增加相关。本研究的目的是探讨严重慢性阻塞性肺病中几种合并症的患病率,并调查和比较它们与长期死亡率的关系。方法:2011年5月至2012年3月共纳入241例COPD 3期或4期患者。收集了性别、年龄、吸烟史、体重和身高、目前的药物治疗、最近一年的加重次数和合并症等信息。截至2019年12月31日,从国家死因登记册收集了死亡率数据(全因和特定原因)。数据采用cox回归分析,以性别、年龄、先前确定的死亡率预测因素和合并症为自变量,分别以全因死亡率、心脏和呼吸系统死亡率为因变量。结果:241例患者中,155例(64%)在研究期结束时死亡;103例(66%)死于呼吸系统疾病,25例(16%)死于心血管疾病。肾功能受损是唯一与全因死亡率(HR (95%CI) 3.41 (1.47-7.93) p=0.004)和呼吸系统死亡率(HR (95%CI) 4.63 (1.61 - 13.4), p= 0.005)升高独立相关的共病。结论:除年龄大、BMI低、肺功能差的危险因素外;肾功能受损似乎是长期死亡的一个重要危险因素,在严重慢性阻塞性肺病患者的医疗护理中应考虑到这一点。
{"title":"Comorbid conditions as predictors of mortality in severe COPD - an eight-year follow-up cohort study.","authors":"Gabriella Eliasson,&nbsp;Christer Janson,&nbsp;Gunnar Johansson,&nbsp;Kjell Larsson,&nbsp;Anders Lindén,&nbsp;Claes-Göran Löfdahl,&nbsp;Thomas Sandström,&nbsp;Josefin Sundh","doi":"10.1080/20018525.2023.2181291","DOIUrl":"https://doi.org/10.1080/20018525.2023.2181291","url":null,"abstract":"<p><strong>Purpose: </strong>Co-morbidities are common in chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. The aim of the present study was to explore the prevalence of several comorbid conditions in severe COPD, and to investigate and compare their associations with long-term mortality.</p><p><strong>Methods: </strong>In May 2011 to March 2012, 241 patients with COPD stage 3 or 4 were included in the study. Information was collected on sex, age, smoking history, weight and height, current pharmacological treatment, number of exacerbations the recent year and comorbid conditions. At December 31st, 2019, mortality data (all-cause and cause specific) were collected from the National Cause of Death Register. Data were analyzed using Cox-regression analysis with gender, age, previously established predictors of mortality and comorbid conditions as independent variables, and all-cause mortality and cardiac and respiratory mortality, respectively, as dependent variables.</p><p><strong>Results: </strong>Out of 241 patients, 155 (64%) were deceased at the end of the study period; 103 patients (66%) died of respiratory disease and 25 (16%) of cardiovascular disease. Impaired kidney function was the only comorbid condition independently associated with increased all-cause mortality (HR (95% CI) 3.41 (1.47-7.93) p=0.004) and respiratory mortality (HR (95%CI) 4.63 (1.61 to 13.4), p = 0.005). In addition, age ≥70, BMI <22 and lower FEV1 expressed as %predicted were significantly associated with increased all-cause and respiratory mortality.</p><p><strong>Conclusion: </strong>In addition to the risk factors high age, low BMI and poor lung function; impaired kidney function appears to be an important risk factor for mortality in the long term, which should be taken into account in the medical care of patients with severe COPD.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2181291"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d3/d2/ZECR_10_2181291.PMC9970194.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10821302","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: 1
Systemic corticosteroids in treatment of chronic rhinosinusitis-A systematic review. 系统性糖皮质激素治疗慢性鼻窦炎的系统综述。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2240511
Sarah Tamene, Kim Dalhoff, Peter Schwarz, Vibeke Backer, Kasper Aanaes

Purpose: When first-line chronic rhinosinusitis (CRS) treatment fails, patients can either be treated with oral or injected systemic corticosteroids. Although the EPOS and international guidelines for CRS do not mention injected corticosteroids, it is commonly used by ear, nose, and throat specialists. While the risks of systemic corticosteroids, in general, are known, the pros and cons of injected and oral corticosteroids (OCS) in CRS treatment are unclear.

Methods: A systematic review of studies that report the effects and/or side effects of injected and oral corticosteroids in the treatment of CRS was made according to the PRISMA guidelines.

Results: Altogether, 48 studies were included, only five studies reported on injected corticosteroids, and five attended with side effects. Three studies found beneficial effects of OCS perioperatively on sinus surgery, while four articles found no effect. Nineteen articles reported that OCS resulted in an improvement in symptoms. Two articles presented a longer-lasting effect of injected corticosteroids than OCS. Three studies reported adverse side effects of systemic corticosteroids, while two studies showed no adverse side effects. One study showed less adrenal suppression after injected corticosteroids compared to OCS. The evidence is not strong but shows a positive effect of systemic corticosteroids that lasts longer with injections.

Conclusion: Although systemic corticosteroids are widely used to treat CRS, there is a lack of studies comparing the OCS and injected corticosteroids. The evidence is sparse, however, injected steroids show longer effects with fewer side effects. An RCT study is needed to compare OCS and injected corticosteroids.

目的:当一线慢性鼻窦炎(CRS)治疗失败时,患者可以口服或全身注射皮质类固醇治疗。虽然EPOS和国际CRS指南没有提到注射皮质类固醇,但耳鼻喉科专家通常使用它。虽然全身皮质类固醇的风险通常是已知的,但注射和口服皮质类固醇(OCS)治疗CRS的利弊尚不清楚。方法:根据PRISMA指南对报告注射和口服皮质类固醇治疗CRS的作用和/或副作用的研究进行系统回顾。结果:总共纳入48项研究,只有5项研究报告了注射皮质类固醇,5项研究报告了副作用。3篇研究发现围手术期OCS对鼻窦手术有有益作用,4篇研究发现无效果。19篇文章报道了OCS导致症状的改善。两篇文章报道了注射皮质类固醇比OCS更持久的效果。三项研究报告了全身性皮质类固醇的不良副作用,而两项研究显示没有不良副作用。一项研究显示,与OCS相比,注射皮质类固醇后肾上腺抑制更少。虽然证据不充分,但表明全身皮质类固醇注射的积极作用持续时间更长。结论:虽然全身糖皮质激素被广泛用于治疗CRS,但OCS与注射糖皮质激素的比较研究尚缺乏。然而,很少有证据表明,注射类固醇的作用时间更长,副作用更少。需要一项RCT研究来比较OCS和注射皮质类固醇。
{"title":"Systemic corticosteroids in treatment of chronic rhinosinusitis-A systematic review.","authors":"Sarah Tamene,&nbsp;Kim Dalhoff,&nbsp;Peter Schwarz,&nbsp;Vibeke Backer,&nbsp;Kasper Aanaes","doi":"10.1080/20018525.2023.2240511","DOIUrl":"https://doi.org/10.1080/20018525.2023.2240511","url":null,"abstract":"<p><strong>Purpose: </strong>When first-line chronic rhinosinusitis (CRS) treatment fails, patients can either be treated with oral or injected systemic corticosteroids. Although the EPOS and international guidelines for CRS do not mention injected corticosteroids, it is commonly used by ear, nose, and throat specialists. While the risks of systemic corticosteroids, in general, are known, the pros and cons of injected and oral corticosteroids (OCS) in CRS treatment are unclear.</p><p><strong>Methods: </strong>A systematic review of studies that report the effects and/or side effects of injected and oral corticosteroids in the treatment of CRS was made according to the PRISMA guidelines.</p><p><strong>Results: </strong>Altogether, 48 studies were included, only five studies reported on injected corticosteroids, and five attended with side effects. Three studies found beneficial effects of OCS perioperatively on sinus surgery, while four articles found no effect. Nineteen articles reported that OCS resulted in an improvement in symptoms. Two articles presented a longer-lasting effect of injected corticosteroids than OCS. Three studies reported adverse side effects of systemic corticosteroids, while two studies showed no adverse side effects. One study showed less adrenal suppression after injected corticosteroids compared to OCS. The evidence is not strong but shows a positive effect of systemic corticosteroids that lasts longer with injections.</p><p><strong>Conclusion: </strong>Although systemic corticosteroids are widely used to treat CRS, there is a lack of studies comparing the OCS and injected corticosteroids. The evidence is sparse, however, injected steroids show longer effects with fewer side effects. An RCT study is needed to compare OCS and injected corticosteroids.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2240511"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/64/ZECR_10_2240511.PMC10405757.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10193432","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: 0
The effect of aerobic exercise training on asthma control in postmenopausal women (ATOM): a randomized controlled pilot study. 有氧运动训练对绝经后妇女哮喘控制的影响:一项随机对照试验研究。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2251256
Erik Sören Halvard Hansen, Hanne Kruuse Rasmusen, Morten Hostrup, Ylva Hellsten, Vibeke Backer

Objective: To evaluate if high-intensity interval training three times weekly for 12 weeks improves asthma control in overweight, postmenopausal women with uncontrolled, late-onset asthma.

Methods: The reported study is a randomized clinical pilot study (www.clinicaltrials.gov; NCT03747211) that compared 12 weeks of high-intensity interval training (spinning) with usual care. The five-question Asthma Control Questionnaire (ACQ-5) was used as primary outcome. Secondary measures included systemic inflammation and inflammation of the airways, body composition, and cardiac function during exercise.

Results: We included 12 women with asthma (mean age 65 years (SD 6); mean body mass index 30 kg/m2 (SD 2)) from whom eight were randomized to exercise and four to control. Baseline ACQ-5 was 1.95 (SD 0.53) in the control group and 2.03 (0.54) in the exercise group. Patients had a mean blood eosinophil level of 0.16 × 109cells/L (SD 0.07) and a mean fraction of exhaled nitric oxide of 23 ppb (SD 25). Mixed models showed that participants in the exercise group reduced their ACQ-5 by 0.55 points (95%CI -1.10 to -0.00; P = 0.08) compared with the control group. The exercise group significantly reduced their mean body fat percentage (-2.7%; 95%CI -4.5 to -0.8; P = 0.02), fat mass (-2.8 kg; 95%CI -5.1 to -0.4; P = 0.044) and android fat mass (-0.33 kg; 95%CI -0.60- -0.06; P = 0.038). In analyses of cardiac measures, we saw no significant effects on right ventricular function (fractional area change), diastolic function or left ventricular function.

Conclusions: Although changes in ACQ-5 were slightly insignificant, these preliminary findings indicate that aerobic exercise training can be used as a means to improve asthma control in overweight, postmenopausal women with asthma.

目的:评价高强度间歇训练是否能改善超重、绝经后未控制的迟发性哮喘妇女的哮喘控制,每周3次,持续12周。方法:报告的研究是一项随机临床先导研究(www.clinicaltrials.gov;NCT03747211),将12周的高强度间歇训练(动感单车)与常规护理进行比较。五题哮喘控制问卷(ACQ-5)作为主要结局。次要测量包括全身炎症和气道炎症、身体成分和运动时的心功能。结果:我们纳入了12名患有哮喘的女性(平均年龄65岁(SD 6);平均体重指数30 kg/m2 (SD 2)),其中8人随机分为运动组,4人作为对照组。对照组基线ACQ-5为1.95 (SD 0.53),运动组为2.03(0.54)。患者的平均血嗜酸性粒细胞水平为0.16 × 109细胞/L (SD 0.07),呼出一氧化氮的平均分数为23 ppb (SD 25)。混合模型显示,运动组参与者的ACQ-5降低了0.55分(95%CI -1.10至-0.00;P = 0.08)。运动组显著降低了他们的平均体脂率(-2.7%;95%CI -4.5 ~ -0.8;P = 0.02),脂肪质量(-2.8 kg;95%CI -5.1 ~ -0.4;P = 0.044)和android脂肪质量(-0.33 kg;95%ci -0.60- -0.06;p = 0.038)。在心脏测量的分析中,我们没有看到对右心室功能(分数面积变化)、舒张功能或左心室功能的显著影响。结论:虽然ACQ-5的变化略显不显著,但这些初步发现表明,有氧运动训练可以作为改善超重绝经后哮喘妇女哮喘控制的一种手段。
{"title":"The effect of aerobic exercise training on asthma control in postmenopausal women (ATOM): a randomized controlled pilot study.","authors":"Erik Sören Halvard Hansen,&nbsp;Hanne Kruuse Rasmusen,&nbsp;Morten Hostrup,&nbsp;Ylva Hellsten,&nbsp;Vibeke Backer","doi":"10.1080/20018525.2023.2251256","DOIUrl":"https://doi.org/10.1080/20018525.2023.2251256","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate if high-intensity interval training three times weekly for 12 weeks improves asthma control in overweight, postmenopausal women with uncontrolled, late-onset asthma.</p><p><strong>Methods: </strong>The reported study is a randomized clinical pilot study (www.clinicaltrials.gov; NCT03747211) that compared 12 weeks of high-intensity interval training (spinning) with usual care. The five-question Asthma Control Questionnaire (ACQ-5) was used as primary outcome. Secondary measures included systemic inflammation and inflammation of the airways, body composition, and cardiac function during exercise.</p><p><strong>Results: </strong>We included 12 women with asthma (mean age 65 years (SD 6); mean body mass index 30 kg/m<sup>2</sup> (SD 2)) from whom eight were randomized to exercise and four to control. Baseline ACQ-5 was 1.95 (SD 0.53) in the control group and 2.03 (0.54) in the exercise group. Patients had a mean blood eosinophil level of 0.16 × 10<sup>9</sup>cells/L (SD 0.07) and a mean fraction of exhaled nitric oxide of 23 ppb (SD 25). Mixed models showed that participants in the exercise group reduced their ACQ-5 by 0.55 points (95%CI -1.10 to -0.00; <i>P</i> = 0.08) compared with the control group. The exercise group significantly reduced their mean body fat percentage (-2.7%; 95%CI -4.5 to -0.8; <i>P</i> = 0.02), fat mass (-2.8 kg; 95%CI -5.1 to -0.4; <i>P</i> = 0.044) and android fat mass (-0.33 kg; 95%CI -0.60- -0.06; <i>P</i> = 0.038). In analyses of cardiac measures, we saw no significant effects on right ventricular function (fractional area change), diastolic function or left ventricular function.</p><p><strong>Conclusions: </strong>Although changes in ACQ-5 were slightly insignificant, these preliminary findings indicate that aerobic exercise training can be used as a means to improve asthma control in overweight, postmenopausal women with asthma.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2251256"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0b/54/ZECR_10_2251256.PMC10478610.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10199822","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: 0
Hypoxemia and not hyperoxemia predicts worse outcome in severe COPD exacerbations - an observational study. 一项观察性研究表明,低氧血症而非高氧血症预示着严重COPD恶化的更糟糕结果。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2022.2153644
Charlotte Sandau, Ejvind Frausing Hansen, Lars Pedersen, Jens Ulrik Stæhr Jensen

Objectives: For patients admitted with an acute exacerbation of COPD (AECOPD) and a need for supplementary oxygen therapy, to determine if peripheral oxygen saturation < 88% (hypoxemia) or >92% (hyperoxemia), within first 24 hours of admission, is associated with 'treatment failure' or fewer days alive and out of hospital within 14 days after admission.

Design: A retrospective multicenter observational study, reviewing consecutive data on SpO2, oxygen, and drug administration at three predefined time points, on adverse events in patients admitted with COPD between December 2019 and June 2020. Multivariable logistic regression analysis, Mann Whitney U- and Chi-square-test were used.

Setting: Acute hospital setting, across four different hospitals in the capital region of Denmark.

Participants: Patients with a confirmed diagnosis of COPD admitted with an acute exacerbation and an oxygen need within the first 24 hours admission.

Results: In total 289 COPD patients were included. The median age was 74.8 years [interquartile range (IQR):69.6 to 81.8], 191 were female and 132 patients experienced 'treatment failure'. A minimum of one episode of hypoxemia (SpO2 < 88%) within first 24 hours was associated with having a low number (≤4) of days alive and out of hospital within 14 days after admission: OR 2.4 (95%CI 1.2 to 4.8), p = 0.02, absolute risk 44% vs. 26% p = 0.01, Chi-square. Comparable results were observed after 30 days of follow-up: OR 2.6 (95% CI 1.0 to7.1), p = 0.05. A minimum of one measurement of hyperoxemia (SpO2 > 92%), within first 24 hours of admission was not associated with low number of days alive and out of hospital within 14 days OR 1.0 (95% CI 0.5 to 2.1) nor at 30 days.

Conclusion: For admitted patients with AECOPD, being hypoxemic ever within the first 24 hours after admission is associated with a substantially increased risk of a poor prognosis.

目的:对于急性加重COPD (AECOPD)并需要辅助氧疗的患者,确定入院前24小时内外周氧饱和度< 88%(低氧血症)或>92%(高氧血症)是否与“治疗失败”或入院后14天内存活天数减少和出院有关。设计:一项回顾性多中心观察性研究,回顾2019年12月至2020年6月期间入院的COPD患者在三个预定时间点的SpO2、氧气和药物给药的连续数据。采用多变量logistic回归分析、Mann - Whitney U检验和卡方检验。环境:急性医院环境,跨越丹麦首都地区的四家不同医院。参与者:确诊为慢性阻塞性肺病的患者,入院前24小时内急性加重并需要氧气。结果:共纳入289例COPD患者。中位年龄为74.8岁[四分位间距(IQR):69.6 ~ 81.8],女性191例,“治疗失败”132例。入院前24小时内至少发生一次低氧血症(SpO2 > 92%)与14天或1.0天(95% CI 0.5至2.1)或30天内的低存活天数和出院天数无关。结论:对于入院的AECOPD患者,入院后24小时内出现低氧血症与预后不良的风险显著增加相关。
{"title":"Hypoxemia and not hyperoxemia predicts worse outcome in severe COPD exacerbations - an observational study.","authors":"Charlotte Sandau,&nbsp;Ejvind Frausing Hansen,&nbsp;Lars Pedersen,&nbsp;Jens Ulrik Stæhr Jensen","doi":"10.1080/20018525.2022.2153644","DOIUrl":"https://doi.org/10.1080/20018525.2022.2153644","url":null,"abstract":"<p><strong>Objectives: </strong>For patients admitted with an acute exacerbation of COPD (AECOPD) and a need for supplementary oxygen therapy, to determine if peripheral oxygen saturation < 88% (hypoxemia) or >92% (hyperoxemia), within first 24 hours of admission, is associated with 'treatment failure' or fewer days alive and out of hospital within 14 days after admission.</p><p><strong>Design: </strong>A retrospective multicenter observational study, reviewing consecutive data on SpO2, oxygen, and drug administration at three predefined time points, on adverse events in patients admitted with COPD between December 2019 and June 2020. Multivariable logistic regression analysis, Mann Whitney U- and Chi-square-test were used.</p><p><strong>Setting: </strong>Acute hospital setting, across four different hospitals in the capital region of Denmark.</p><p><strong>Participants: </strong>Patients with a confirmed diagnosis of COPD admitted with an acute exacerbation and an oxygen need within the first 24 hours admission.</p><p><strong>Results: </strong>In total 289 COPD patients were included. The median age was 74.8 years [interquartile range (IQR):69.6 to 81.8], 191 were female and 132 patients experienced 'treatment failure'. A minimum of one episode of hypoxemia (SpO<sub>2</sub> < 88%) within first 24 hours was associated with having a low number (≤4) of days alive and out of hospital within 14 days after admission: OR 2.4 (95%CI 1.2 to 4.8), p = 0.02, absolute risk 44% vs. 26% p = 0.01, Chi-square. Comparable results were observed after 30 days of follow-up: OR 2.6 (95% CI 1.0 to7.1), p = 0.05. A minimum of one measurement of hyperoxemia (SpO<sub>2</sub> > 92%), within first 24 hours of admission was not associated with low number of days alive and out of hospital within 14 days OR 1.0 (95% CI 0.5 to 2.1) nor at 30 days.</p><p><strong>Conclusion: </strong>For admitted patients with AECOPD, being hypoxemic ever within the first 24 hours after admission is associated with a substantially increased risk of a poor prognosis.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2153644"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/32/39/ZECR_10_2153644.PMC9731582.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10698430","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: 1
A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors. 一项接受PD-1/PD-L1抑制剂治疗的非小细胞肺癌患者免疫相关性肺炎的回顾性研究
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2194162
Dorthe Yakymenko, Kristin Skougaard

Background: Lung cancer patients undergoing treatment with immune checkpoint inhibitors (ICIs) are at risk of developing immune-related (ir-)pneumonitis. Since lung cancer patients have competing reasons for respiratory symptoms, this poses a diagnostic challenge. This study aimed to explore diagnosis and management of ir-pneumonitis in this patient group.

Materials and methods: Suspected ir-pneumonitis was frequent in this group of patients. The cohort was characterized by high heterogeneity and lack of unequivocal diagnostic conclusions. Treatment of ir-pneumonitis was longer than recommended and involvement of pulmonologist was very infrequent. The result of this study reflects the difficulties in a daily clinical setting to diagnose and manage patients with lung cancer presenting with pulmonary symptoms.

Results: Suspected ir-pneumonitis was frequent in this group of patients. The cohort was characterized by high heterogeneity and lack of unequivocal diagnostic conclusions. Treatment of ir-pneumonitis was longer than recommended and involvement of pulmonologist was very infrequent. The result of this study reflects the difficulties in a daily clinical setting to diagnose and manage patients with lung cancer presenting with pulmonary symptoms.

背景:接受免疫检查点抑制剂(ICIs)治疗的肺癌患者有发生免疫相关性(ir-)肺炎的风险。由于肺癌患者出现呼吸系统症状的原因相互矛盾,这就给诊断带来了挑战。本研究旨在探讨该患者组肺炎的诊断和治疗。材料与方法:本组患者多为疑似肺炎。该队列的特点是高度异质性和缺乏明确的诊断结论。肺炎的治疗时间比推荐的要长,肺病专家的介入也很少。本研究的结果反映了在日常临床环境中诊断和管理以肺部症状为表现的肺癌患者的困难。结果:本组患者多为疑似肺炎。该队列的特点是高度异质性和缺乏明确的诊断结论。肺炎的治疗时间比推荐的要长,肺病专家的介入也很少。本研究的结果反映了在日常临床环境中诊断和管理以肺部症状为表现的肺癌患者的困难。
{"title":"A retrospective study on immune-related pneumonitis in patients with non-small-cell lung cancer undergoing treatment with PD-1/PD-L1 inhibitors.","authors":"Dorthe Yakymenko,&nbsp;Kristin Skougaard","doi":"10.1080/20018525.2023.2194162","DOIUrl":"https://doi.org/10.1080/20018525.2023.2194162","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer patients undergoing treatment with immune checkpoint inhibitors (ICIs) are at risk of developing immune-related (ir-)pneumonitis. Since lung cancer patients have competing reasons for respiratory symptoms, this poses a diagnostic challenge. This study aimed to explore diagnosis and management of ir-pneumonitis in this patient group.</p><p><strong>Materials and methods: </strong>Suspected ir-pneumonitis was frequent in this group of patients. The cohort was characterized by high heterogeneity and lack of unequivocal diagnostic conclusions. Treatment of ir-pneumonitis was longer than recommended and involvement of pulmonologist was very infrequent. The result of this study reflects the difficulties in a daily clinical setting to diagnose and manage patients with lung cancer presenting with pulmonary symptoms.</p><p><strong>Results: </strong>Suspected ir-pneumonitis was frequent in this group of patients. The cohort was characterized by high heterogeneity and lack of unequivocal diagnostic conclusions. Treatment of ir-pneumonitis was longer than recommended and involvement of pulmonologist was very infrequent. The result of this study reflects the difficulties in a daily clinical setting to diagnose and manage patients with lung cancer presenting with pulmonary symptoms.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2194162"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/2a/ZECR_10_2194162.PMC10071953.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9640143","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: 1
The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen. 丹麦呼吸学会指南长期高流量鼻插管治疗,有或没有补充氧气。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2178600
Ulla Møller Weinreich, Kasper Svendsen Juhl, Malene Søby Christophersen, Svend Gundestrup, Munsoor Ali Hanifa, Kristine Jensen, Frank Dyekjær Andersen, Ole Hilberg, Line Hust Storgaard

Introduction: Long-term High Flow Nasal Cannula (LT-HFNC), defined as High Flow Nasal Cannula treatment provided to patients with chronic pulmonary conditions during stable phases, has emerged as a home treatment in different categories of patients with chronic lung diseases in recent years.

Methods: This paper summarizes the physiological effects of LT-HFNC and evaluates the clinical knowledge to date about treatment in patients with chronic obstructive lung disease, interstitial lung disease and bronchiectasis. The guideline is translated and summarized in this paper and presented unabridged as an appendix to the paper.

Results: The paper describes the working process behind the Danish Respiratory Society's National guideline for treatment of stable disease, which has been written to support clinicians in both evidence-based decision making and practical issues concerning the treatment.

简介:长期高流量鼻插管(LT-HFNC)是近年来在不同类别的慢性肺部疾病患者中出现的一种家庭治疗方法,其定义为在稳定期为慢性肺部疾病患者提供的高流量鼻插管治疗。方法:总结LT-HFNC治疗慢性阻塞性肺疾病、间质性肺疾病和支气管扩张患者的生理作用,并对迄今为止的临床知识进行评价。该指南在论文中进行了翻译和总结,并作为论文的附录提供了未删节的内容。结果:本文描述了丹麦呼吸学会国家稳定疾病治疗指南背后的工作过程,该指南旨在支持临床医生基于证据的决策和有关治疗的实际问题。
{"title":"The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen.","authors":"Ulla Møller Weinreich,&nbsp;Kasper Svendsen Juhl,&nbsp;Malene Søby Christophersen,&nbsp;Svend Gundestrup,&nbsp;Munsoor Ali Hanifa,&nbsp;Kristine Jensen,&nbsp;Frank Dyekjær Andersen,&nbsp;Ole Hilberg,&nbsp;Line Hust Storgaard","doi":"10.1080/20018525.2023.2178600","DOIUrl":"https://doi.org/10.1080/20018525.2023.2178600","url":null,"abstract":"<p><strong>Introduction: </strong>Long-term High Flow Nasal Cannula (LT-HFNC), defined as High Flow Nasal Cannula treatment provided to patients with chronic pulmonary conditions during stable phases, has emerged as a home treatment in different categories of patients with chronic lung diseases in recent years.</p><p><strong>Methods: </strong>This paper summarizes the physiological effects of LT-HFNC and evaluates the clinical knowledge to date about treatment in patients with chronic obstructive lung disease, interstitial lung disease and bronchiectasis. The guideline is translated and summarized in this paper and presented unabridged as an appendix to the paper.</p><p><strong>Results: </strong>The paper describes the working process behind the Danish Respiratory Society's National guideline for treatment of stable disease, which has been written to support clinicians in both evidence-based decision making and practical issues concerning the treatment.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2178600"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/c6/ZECR_10_2178600.PMC9970213.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10812843","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: 2
Vaccine effectiveness of the pneumococcal polysaccharide and conjugated vaccines in elderly and high-risk populations in preventing invasive pneumococcal disease: a systematic search and meta-analysis. 肺炎球菌多糖和结合疫苗在老年人和高危人群预防侵袭性肺炎球菌疾病中的疫苗有效性:一项系统搜索和荟萃分析
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2168354
Melina Gade Sikjær, Andreas Arnholdt Pedersen, Mari Stenvold Wik, Synne Smith Stensholt, Ole Hilberg, Anders Løkke

Background: Invasive pneumococcal disease (IPD) is a major cause of morbidity and mortality globally. However, the literature on the vaccine effectiveness (VE) of 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugated vaccine (PCV13) against IPD in adults is sparse. The aim was to summarize the available evidence on the VE of the PPV23 and the PCV13 in elderly individuals against IPD and to investigate how age and comorbidities influence VE against IPD.

Methods: A systematic search was conducted in Medline and Embase in February 2021. We used combinations of terms related to PPV23, PCV13, elderly, high-risk populations, and IPD. Eligible articles published since 2010 were included. Two authors reviewed and extracted data.

Results: Eight studies met the inclusion criteria for PPV23. The meta-analysis showed a reduced OR for all-type IPD with the use of PPV23 vaccine compared with unvaccinated controls (OR 0.69; 95%CI 0.54, 0.88) and a reduced OR for vaccine-type IPD compared with non-vaccine type IPD (0.69; 95%CI 0.63, 0.76). VE against vaccine-type IPD ranged from 28% to 54.1% for individuals aged 65-79 and from 7.5% to 34% for those aged ≥80-85 years. Most studies found a lower VE of PPV23 in populations with comorbidities and in immunocompromised populations compared with the VE for individuals without comorbidities.One study met the inclusion criteria for PCV13. The vaccine efficacy of PCV13 against IPD in individuals aged ≥65 was 75.0% (95% CI, 41.4 to 90.8).

Conclusion: The results from this review show a reduction of IPD in elderly and high-risk populations vaccinated with PPV23 and PCV13. The protective effect may be lower in elderly individuals aged >80 and in individuals with comorbidities. However, the literature is sparse; large-scale prospective studies are required to evaluate the VE of PPV23 and PCV13 vaccination in adults against IPD.

背景:侵袭性肺炎球菌病(IPD)是全球发病率和死亡率的主要原因。然而,关于23价多糖疫苗(PPV23)和13价结合疫苗(PCV13)对成人IPD的疫苗有效性(VE)的文献很少。目的是总结PPV23和PCV13在老年人抗IPD中的VE的现有证据,并研究年龄和合并症如何影响抗IPD的VE。方法:于2021年2月在Medline和Embase进行系统检索。我们使用了与PPV23、PCV13、老年人、高危人群和IPD相关的术语组合。纳入2010年以来发表的符合条件的文章。两位作者回顾并提取了数据。结果:8项研究符合PPV23的纳入标准。荟萃分析显示,与未接种疫苗的对照组相比,使用PPV23疫苗降低了所有类型IPD的OR (OR 0.69;95%CI 0.54, 0.88),与非疫苗型IPD相比,疫苗型IPD的OR降低(0.69;95%ci 0.63, 0.76)。65-79岁人群抗疫苗型IPD的VE为28% - 54.1%,≥80-85岁人群为7.5% - 34%。大多数研究发现,与没有合并症的个体相比,有合并症人群和免疫功能低下人群的PPV23 VE较低。一项研究符合PCV13的纳入标准。≥65岁人群PCV13对IPD的疫苗有效率为75.0% (95% CI, 41.4 ~ 90.8)。结论:本综述的结果显示,接种PPV23和PCV13的老年人和高危人群IPD降低。在80岁以上的老年人和有合并症的人群中,保护作用可能较低。然而,相关文献很少;需要大规模的前瞻性研究来评估成人接种PPV23和PCV13预防IPD的效果。
{"title":"Vaccine effectiveness of the pneumococcal polysaccharide and conjugated vaccines in elderly and high-risk populations in preventing invasive pneumococcal disease: a systematic search and meta-analysis.","authors":"Melina Gade Sikjær,&nbsp;Andreas Arnholdt Pedersen,&nbsp;Mari Stenvold Wik,&nbsp;Synne Smith Stensholt,&nbsp;Ole Hilberg,&nbsp;Anders Løkke","doi":"10.1080/20018525.2023.2168354","DOIUrl":"https://doi.org/10.1080/20018525.2023.2168354","url":null,"abstract":"<p><strong>Background: </strong>Invasive pneumococcal disease (IPD) is a major cause of morbidity and mortality globally. However, the literature on the vaccine effectiveness (VE) of 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugated vaccine (PCV13) against IPD in adults is sparse. The aim was to summarize the available evidence on the VE of the PPV23 and the PCV13 in elderly individuals against IPD and to investigate how age and comorbidities influence VE against IPD.</p><p><strong>Methods: </strong>A systematic search was conducted in Medline and Embase in February 2021. We used combinations of terms related to PPV23, PCV13, elderly, high-risk populations, and IPD. Eligible articles published since 2010 were included. Two authors reviewed and extracted data.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria for PPV23. The meta-analysis showed a reduced OR for all-type IPD with the use of PPV23 vaccine compared with unvaccinated controls (OR 0.69; 95%CI 0.54, 0.88) and a reduced OR for vaccine-type IPD compared with non-vaccine type IPD (0.69; 95%CI 0.63, 0.76). VE against vaccine-type IPD ranged from 28% to 54.1% for individuals aged 65-79 and from 7.5% to 34% for those aged ≥80-85 years. Most studies found a lower VE of PPV23 in populations with comorbidities and in immunocompromised populations compared with the VE for individuals without comorbidities.One study met the inclusion criteria for PCV13. The vaccine efficacy of PCV13 against IPD in individuals aged ≥65 was 75.0% (95% CI, 41.4 to 90.8).</p><p><strong>Conclusion: </strong>The results from this review show a reduction of IPD in elderly and high-risk populations vaccinated with PPV23 and PCV13. The protective effect may be lower in elderly individuals aged >80 and in individuals with comorbidities. However, the literature is sparse; large-scale prospective studies are required to evaluate the VE of PPV23 and PCV13 vaccination in adults against IPD.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2168354"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/31/ZECR_10_2168354.PMC9870017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10627791","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: 1
Sedating antihistamine treatment with promethazine in patients with severe COPD with and without asthma: death and severe exacerbations in a nationwide register study. 异丙嗪在伴有和不伴有哮喘的严重慢性阻塞性肺病患者中的镇静抗组胺治疗:一项全国性登记研究中的死亡和严重恶化
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2250604
Barbara Bonnesen, Valdemar Rømer, Sidse Graff Jensen, Jon Torgny Wilcke, Julie Janner, Jens Bak, Sofie Johansson, Christian B Laursen, Lars Pedersen, Josefin Eklof, Pradeesh Sivapalan, Jens-Ulrik Stæhr Jensen

Background: Sedating antihistamines such as promethazine are used as anxiolytics and hypnotic agents for patients with chronic obstructive pulmonary disease (COPD) with and without asthma despite limited knowledge of its effects and side effects. We evaluated if treatment with promethazine had a lower risk of harmful outcome.

Methods: Nationwide retrospective cohort study of Danish specialist diagnosed outpatients with COPD treated with promethazine or an active comparator (melatonin). Patients with collection of promethazine or melatonin were propensity score matched 1:1. The primary outcome was a composite of severe COPD exacerbations and death from all causes analyzed by Cox proportional hazards regression. We performed an interaction analysis for comorbid asthma.

Results: In our registry of 56,523 patients with COPD, 5,661 collected promethazine (n = 3,723) or melatonin (n = 1,938). A cohort of 3,290 promethazine- or melatonin-treated patients matched 1:1 was available for the primary analysis.Within 1-year patients treated with promethazine were at higher risk of the primary outcome than matched controls with a Hazard Ratio (HR) of 1.42 (CI 1.27-1.58, p < 0.0001). Similarly, the risk of death was higher for promethazine-treated patients (HR 1.53, CI 1.32-1.77, p < 0.0001). An interaction analysis for comorbid asthma showed no interaction between comorbid asthma and the likelihood of a primary outcome when collecting promethazine (p = 0.19). Adjusted Cox analysis on the entire population indicated a further increased risk with more promethazine (HR for primary outcome among patients collecting ≥ 400 promethazine tablets/year=2.15, CI 1.94-2.38, p<0.0001).

Conclusions: Promethazine-treated patients with COPD had a concerning excess risk of a composite outcome of severe exacerbations and death from all causes compared to melatonin.

背景:镇静抗组胺药如异丙嗪被用作慢性阻塞性肺疾病(COPD)伴或不伴哮喘患者的抗焦虑药和催眠药,尽管对其作用和副作用的了解有限。我们评估异丙嗪治疗是否有较低的有害后果风险。方法:在全国范围内对丹麦专家诊断的门诊COPD患者进行回顾性队列研究,这些患者使用异丙嗪或活性比较物(褪黑激素)治疗。收集异丙嗪或褪黑素的患者倾向评分为1:1匹配。通过Cox比例风险回归分析,主要结局是严重COPD恶化和全因死亡的综合结果。我们对共病哮喘进行了相互作用分析。结果:在56,523例COPD患者的登记中,5,661例收集了异丙嗪(n = 3,723)或褪黑素(n = 1,938)。3,290名异丙嗪或褪黑激素治疗的患者进行了1:1的配对,可用于初步分析。在1年内,异丙嗪治疗的患者发生主要结局的风险高于对照组,风险比(HR)为1.42 (CI 1.27-1.58, p p p = 0.19)。对整个人群进行校正后的Cox分析表明,服用异丙嗪的风险进一步增加(在服用异丙嗪≥400片/年的患者中,主要结局HR =2.15, CI 1.94-2.38)。结论:与褪黑激素相比,异丙嗪治疗的COPD患者存在严重恶化和全因死亡的复合结局风险。
{"title":"Sedating antihistamine treatment with promethazine in patients with severe COPD with and without asthma: death and severe exacerbations in a nationwide register study.","authors":"Barbara Bonnesen,&nbsp;Valdemar Rømer,&nbsp;Sidse Graff Jensen,&nbsp;Jon Torgny Wilcke,&nbsp;Julie Janner,&nbsp;Jens Bak,&nbsp;Sofie Johansson,&nbsp;Christian B Laursen,&nbsp;Lars Pedersen,&nbsp;Josefin Eklof,&nbsp;Pradeesh Sivapalan,&nbsp;Jens-Ulrik Stæhr Jensen","doi":"10.1080/20018525.2023.2250604","DOIUrl":"https://doi.org/10.1080/20018525.2023.2250604","url":null,"abstract":"<p><strong>Background: </strong>Sedating antihistamines such as promethazine are used as anxiolytics and hypnotic agents for patients with chronic obstructive pulmonary disease (COPD) with and without asthma despite limited knowledge of its effects and side effects. We evaluated if treatment with promethazine had a lower risk of harmful outcome.</p><p><strong>Methods: </strong>Nationwide retrospective cohort study of Danish specialist diagnosed outpatients with COPD treated with promethazine or an active comparator (melatonin). Patients with collection of promethazine or melatonin were propensity score matched 1:1. The primary outcome was a composite of severe COPD exacerbations and death from all causes analyzed by Cox proportional hazards regression. We performed an interaction analysis for comorbid asthma.</p><p><strong>Results: </strong>In our registry of 56,523 patients with COPD, 5,661 collected promethazine (<i>n</i> = 3,723) or melatonin (<i>n</i> = 1,938). A cohort of 3,290 promethazine- or melatonin-treated patients matched 1:1 was available for the primary analysis.Within 1-year patients treated with promethazine were at higher risk of the primary outcome than matched controls with a Hazard Ratio (HR) of 1.42 (CI 1.27-1.58, <i>p</i> < 0.0001). Similarly, the risk of death was higher for promethazine-treated patients (HR 1.53, CI 1.32-1.77, <i>p</i> < 0.0001). An interaction analysis for comorbid asthma showed no interaction between comorbid asthma and the likelihood of a primary outcome when collecting promethazine (<i>p</i> = 0.19). Adjusted Cox analysis on the entire population indicated a further increased risk with more promethazine (HR for primary outcome among patients collecting ≥ 400 promethazine tablets/year=2.15, CI 1.94-2.38, <i>p</i><0.0001).</p><p><strong>Conclusions: </strong>Promethazine-treated patients with COPD had a concerning excess risk of a composite outcome of severe exacerbations and death from all causes compared to melatonin.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2250604"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/da/ZECR_10_2250604.PMC10481760.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10192504","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: 0
Fixed-dose combination fluticasone/formoterol for asthma treatment in a real-world setting: meta-analysis of exacerbation rates and asthma control. 固定剂量氟替卡松/福莫特罗联合治疗哮喘在现实世界的设置:加重率和哮喘控制的荟萃分析
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2174642
Alberto Papi, Murtaza Qasuri, Ernestine Chung, Mohamed Abdelbaset, Mohamed Aly Moussa, Vibeke Backer, Olaf Schmidt, Omar Usmani

Background: Treatment guidelines for asthma management are derived almost exclusively from the results of controlled clinical trials undertaken in carefully selected patient populations; meaning that their outcomes may not reflect the true performance of treatments when used in general daily medical practice. The aim of this meta-analysis was to combine the results of observational studies investigating the fluticasone propionate/formoterol (FP/FORM) fixed-dose combination in real-world asthma patients.

Methods: A systemic literature review was completed in March 2019 using the PubMed database. We identified 394 studies. Five studies, which included a total of 4756 patients treated with FP/FORM, were judged eligible and included in the meta-analysis.

Results: The estimated severe asthma exacerbation rate was 11.47% (95% CI, 5.8 to 18.72%), calculated from the random effect model. A sensitivity analysis excluding 2 studies (one was an outlier, and the exacerbation rate for the studied treatment alone could not be determined in the other) showed a 7.04% rate of severe asthma exacerbations. The estimated relative risk of the incidence of severe asthma exacerbations was 0.323 (95% CI, 0.159 to 0.658). The estimated asthma control rate was 60.6% (95% CI, 55.7% to 65.6%). The odds of achieving asthma control significantly increased by FP/FORM compared with pre-study conditions (estimated odds ratio: 2.214 [95% CI, 1.292 to 3.795]; p < 0.001).

Conclusions: The findings of this meta-analysis confirm the effectiveness of FP/FORM for the treatment of asthma patients in a real-world setting beyond the limitations of RCTs.

背景:哮喘管理的治疗指南几乎完全来源于在精心挑选的患者群体中进行的对照临床试验的结果;这意味着当在一般的日常医疗实践中使用时,它们的结果可能不能反映治疗的真实效果。本荟萃分析的目的是结合研究丙酸氟替卡松/福莫特罗(FP/FORM)固定剂量组合在真实哮喘患者中的观察性研究结果。方法:于2019年3月使用PubMed数据库完成系统文献综述。我们确定了394项研究。5项研究共纳入4756例接受FP/FORM治疗的患者,被判定为符合条件并纳入meta分析。结果:根据随机效应模型计算,估计严重哮喘加重率为11.47% (95% CI, 5.8 ~ 18.72%)。排除2项研究的敏感性分析(其中一项是异常值,另一项无法确定所研究的治疗方法的加重率)显示,严重哮喘加重率为7.04%。严重哮喘发作的相对危险度估计为0.323 (95% CI, 0.159 ~ 0.658)。估计哮喘控制率为60.6% (95% CI, 55.7% ~ 65.6%)。与研究前相比,FP/FORM组实现哮喘控制的几率显著增加(估计比值比:2.214 [95% CI, 1.292至3.795];结论:本荟萃分析的结果证实了FP/FORM在现实环境中治疗哮喘患者的有效性,超出了随机对照试验的局限性。
{"title":"Fixed-dose combination fluticasone/formoterol for asthma treatment in a real-world setting: meta-analysis of exacerbation rates and asthma control.","authors":"Alberto Papi,&nbsp;Murtaza Qasuri,&nbsp;Ernestine Chung,&nbsp;Mohamed Abdelbaset,&nbsp;Mohamed Aly Moussa,&nbsp;Vibeke Backer,&nbsp;Olaf Schmidt,&nbsp;Omar Usmani","doi":"10.1080/20018525.2023.2174642","DOIUrl":"https://doi.org/10.1080/20018525.2023.2174642","url":null,"abstract":"<p><strong>Background: </strong>Treatment guidelines for asthma management are derived almost exclusively from the results of controlled clinical trials undertaken in carefully selected patient populations; meaning that their outcomes may not reflect the true performance of treatments when used in general daily medical practice. The aim of this meta-analysis was to combine the results of observational studies investigating the fluticasone propionate/formoterol (FP/FORM) fixed-dose combination in real-world asthma patients.</p><p><strong>Methods: </strong>A systemic literature review was completed in March 2019 using the PubMed database. We identified 394 studies. Five studies, which included a total of 4756 patients treated with FP/FORM, were judged eligible and included in the meta-analysis.</p><p><strong>Results: </strong>The estimated severe asthma exacerbation rate was 11.47% (95% CI, 5.8 to 18.72%), calculated from the random effect model. A sensitivity analysis excluding 2 studies (one was an outlier, and the exacerbation rate for the studied treatment alone could not be determined in the other) showed a 7.04% rate of severe asthma exacerbations. The estimated relative risk of the incidence of severe asthma exacerbations was 0.323 (95% CI, 0.159 to 0.658). The estimated asthma control rate was 60.6% (95% CI, 55.7% to 65.6%). The odds of achieving asthma control significantly increased by FP/FORM compared with pre-study conditions (estimated odds ratio: 2.214 [95% CI, 1.292 to 3.795]; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The findings of this meta-analysis confirm the effectiveness of FP/FORM for the treatment of asthma patients in a real-world setting beyond the limitations of RCTs.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2174642"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/d8/ZECR_10_2174642.PMC9930770.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10766489","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: 0
Spontaneous recovery of anosmia after 2.5 years in a young COVID-19 patient. 一名年轻COVID-19患者在两年半后嗅觉丧失自动恢复。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/20018525.2023.2178598
Erfan Ghadirzadeh, Lotfollah Davoodi, Fatemeh Khazaei, Amirmasoud Taheri
To the Editor: It has been 3 years since the world was confronted with a new challenge: coronavirus disease 2019 (COVID-19) [1]. COVID-19 typically manifests with respiratory symptoms, such as dry cough and dyspnea; however, it is not unusual for other organ signs and symptoms to appear [2]. A 2020 meta-analysis found that 53% of COVID19 patients suffer from taste and smell impairments [3]. Anosmia, the loss of the sense of smell, is one of them and is regarded both as a symptom and as a complication of COVID-19, which may remain even after the patient is no longer infected [3]. Sixty to seventy percent of patients recover from this disorder within 4 weeks after having COVID19, either entirely or partially [2]. Seventy-eight percent of patients recover their sense of smell entirely after 2 months, while 95% do so after 6 months [2,3]. Nonetheless, some people may endure anosmia for more than a year. These patients undergo numerous diagnostic and therapeutic procedures but do not heal completely [4]. Several therapy approaches might be pursued when anosmia persists for longer than 2 weeks [4]. Current options for treatment include intranasal corticosteroids, sodium citrate, and olfactory exercises [2]. Some patients do not respond to these treatments and have permanent olfactory loss. These patients may be candidates for other experimental therapies, such as stem cell therapy [2]. On 10 April 2020, a 23-year-old woman presented to the pulmonology clinic of Imam Khomeini Hospital in Sari, Mazandaran Province, Iran, with a complaint of a dry cough, fever, and loss of smell. On physical examination, her vital signs and organ examinations were normal. She tested positive for COVID-19 with a PCR test. The patient was ultimately diagnosed with mild COVID19. On the subsequent follow-up, her respiratory symptoms improved, but her anosmia did not. On 1 November 2022, she returned and reported that she could once again detect odors. She stated that approximately a month ago, she occasionally detected odors for a short period. Over time, the duration and intensity of the odor from these episodes began to increase. Now, she has regained her original sense of smell. Several hypotheses have been proposed as potential anosmic mechanisms. A study by Torabi et al. [5]. Based on the fact that TNFand IL-1 are high in COVID-19 patients, they suggested that inflammation of the olfactory epithelium could be a cause of short-term anosmia. This can explain why intranasal corticosteroids have the desired effects on COVID-19 anosmia. Cazzolla et al. [6] evaluated the IL-6 levels in venous blood samples of anosmic COVID-19 patients and concluded that recovery of the sense of smell correlates with a decrease in IL-6 blood levels. Other pathways associated with persistent anosmia in COVID-19 patients include olfactory cleft syndrome, olfactory epithelium or bulbar injury, microglial cell destruction, and apoptosis of olfactory neurons and stem cells [2]. Moreover, prolonged S
{"title":"Spontaneous recovery of anosmia after 2.5 years in a young COVID-19 patient.","authors":"Erfan Ghadirzadeh,&nbsp;Lotfollah Davoodi,&nbsp;Fatemeh Khazaei,&nbsp;Amirmasoud Taheri","doi":"10.1080/20018525.2023.2178598","DOIUrl":"https://doi.org/10.1080/20018525.2023.2178598","url":null,"abstract":"To the Editor: It has been 3 years since the world was confronted with a new challenge: coronavirus disease 2019 (COVID-19) [1]. COVID-19 typically manifests with respiratory symptoms, such as dry cough and dyspnea; however, it is not unusual for other organ signs and symptoms to appear [2]. A 2020 meta-analysis found that 53% of COVID19 patients suffer from taste and smell impairments [3]. Anosmia, the loss of the sense of smell, is one of them and is regarded both as a symptom and as a complication of COVID-19, which may remain even after the patient is no longer infected [3]. Sixty to seventy percent of patients recover from this disorder within 4 weeks after having COVID19, either entirely or partially [2]. Seventy-eight percent of patients recover their sense of smell entirely after 2 months, while 95% do so after 6 months [2,3]. Nonetheless, some people may endure anosmia for more than a year. These patients undergo numerous diagnostic and therapeutic procedures but do not heal completely [4]. Several therapy approaches might be pursued when anosmia persists for longer than 2 weeks [4]. Current options for treatment include intranasal corticosteroids, sodium citrate, and olfactory exercises [2]. Some patients do not respond to these treatments and have permanent olfactory loss. These patients may be candidates for other experimental therapies, such as stem cell therapy [2]. On 10 April 2020, a 23-year-old woman presented to the pulmonology clinic of Imam Khomeini Hospital in Sari, Mazandaran Province, Iran, with a complaint of a dry cough, fever, and loss of smell. On physical examination, her vital signs and organ examinations were normal. She tested positive for COVID-19 with a PCR test. The patient was ultimately diagnosed with mild COVID19. On the subsequent follow-up, her respiratory symptoms improved, but her anosmia did not. On 1 November 2022, she returned and reported that she could once again detect odors. She stated that approximately a month ago, she occasionally detected odors for a short period. Over time, the duration and intensity of the odor from these episodes began to increase. Now, she has regained her original sense of smell. Several hypotheses have been proposed as potential anosmic mechanisms. A study by Torabi et al. [5]. Based on the fact that TNFand IL-1 are high in COVID-19 patients, they suggested that inflammation of the olfactory epithelium could be a cause of short-term anosmia. This can explain why intranasal corticosteroids have the desired effects on COVID-19 anosmia. Cazzolla et al. [6] evaluated the IL-6 levels in venous blood samples of anosmic COVID-19 patients and concluded that recovery of the sense of smell correlates with a decrease in IL-6 blood levels. Other pathways associated with persistent anosmia in COVID-19 patients include olfactory cleft syndrome, olfactory epithelium or bulbar injury, microglial cell destruction, and apoptosis of olfactory neurons and stem cells [2]. Moreover, prolonged S","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"10 1","pages":"2178598"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/2b/ZECR_10_2178598.PMC9930803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328787","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: 0
期刊
European Clinical Respiratory Journal
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1