Expert Review of Respiratory Medicine最新文献_第10页

Selection of the access channel in bronchoscopic intervention 支气管镜介入治疗通道的选择

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-06-03 DOI: 10.1080/17476348.2022.2089656

Hui Chen, Yang Yao, Sheng-yu Wang, Song Liu, Lin Yang

ABSTRACT Background At present, bronchoscopic intervention has become an important treatment approach for central airway obstruction (CAO). Choosing an appropriate access channel for different patients during this operation has become a research focus. Methods Data of bronchoscopic interventions in 201 patients with CAO in which one of endotracheal intubation, laryngeal mask, or rigid bronchoscope were used as the only access channel were retrospectively reviewed. Results The total immediate effective rate was 94.1% (398/423), and the main complications related to the access channels included hypoxemia, elevated arterial partial pressure of carbon dioxide, arrhythmia, airway mucosa tear, glottic edema, vocal cord injury, tooth loss, massive bleeding, airway mucosal necrosis, and asphyxia. The incidence of complications was 16.8% (71/423). Glottic edema was the most common complication with an incidence of 7.8% (33/423) and accounted for 46.5% of all complications. Glottic edema only occurred in the laryngeal mask and rigid bronchoscope groups, and the incidence was significantly correlated with the operation time (p < 0.001). Massive bleeding related to the access channel remains the most serious complication. Conclusions Endotracheal intubation, laryngeal mask, and rigid bronchoscope each have their own advantages and disadvantages. The most appropriate access channel should depend on a comprehensive assessment of the patient.

背景目前，支气管镜介入治疗已成为中央气道阻塞(CAO)的重要治疗手段。在该手术中，为不同患者选择合适的接入通道已成为研究热点。方法回顾性分析201例以气管插管、喉罩、刚性支气管镜为唯一通道的支气管镜介入治疗的资料。结果总即刻有效率为94.1%(398/423)，与通道相关的主要并发症为低氧血症、动脉二氧化碳分压升高、心律失常、气道黏膜撕裂、声门水肿、声带损伤、牙齿脱落、大出血、气道黏膜坏死、窒息。并发症发生率为16.8%(71/423)。声门水肿是最常见的并发症，发生率为7.8%(33/423)，占所有并发症的46.5%。声门水肿仅发生在喉罩组和刚性支气管镜组，且发生率与手术时间显著相关(p < 0.001)。与通道相关的大出血仍然是最严重的并发症。结论气管插管、喉罩、刚性支气管镜各有优缺点。最合适的访问渠道应取决于对患者的全面评估。

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引用次数: 1

Urine biomarkers of pulmonary tuberculosis 肺结核的尿液生物标志物

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-06-03 DOI: 10.1080/17476348.2022.2090341

E. Khimova, X. Gonzalo, Popova Yulia, P. Eliseev, A. Mariandyshev, V. Nikolayevskyy, A. Broda, F. Drobniewski

ABSTRACT Introduction Sputum-based tuberculosis diagnosis does not address the needs of certain categories of patients. Active development of a noninvasive urine-based diagnosis could provide an alternative approach. We reviewed publications covering more than 30 urine biomarkers proposed as significant for TB diagnosis. Analytical approaches were heterogeneous in design and methods; few studies on diagnostic outcome prediction described a formal specificity and sensitivity analysis. Areas covered This review describes studies of non-sputum diagnostic approaches of pulmonary TB based on urine using specific TB biomarkers. The search was performed until December 2021, using terms [Tuberculosis] + [urine] + [biomarkers] in PubMed and Cochrane databases. Publications concerning LAM urine diagnostics were excluded as they have been described elsewhere. Expert opinion Microbiological culture of sputum is considered to be the ‘gold standard’ diagnostic for pulmonary TB but the methodology is slow due to the slow growth of the TB bacteria. Urine provides a large volume of sample. Investigators have evaluated urine for either TB pathogen biomarkers or host biomarkers with some success as the review demonstrates. Detection sensitivity remains a significant problem. In future, combination of host and pathogen biomarkers could increase the sensitivity and specificity of TB diagnosis.

基于痰液的结核病诊断不能满足某些类别患者的需求。积极发展无创尿液诊断可以提供另一种方法。我们回顾了30多种被认为对结核病诊断有重要意义的尿液生物标志物。分析方法在设计和方法上各不相同;很少有关于诊断结果预测的研究描述了正式的特异性和敏感性分析。本综述描述了基于尿液使用特异性结核生物标志物的非痰诊断方法的研究。检索持续到2021年12月，检索词为PubMed和Cochrane数据库中的[结核病]+[尿液]+[生物标志物]。关于LAM尿液诊断的出版物被排除在外，因为它们已在其他地方描述。专家意见痰液微生物培养被认为是诊断肺结核的“金标准”，但由于结核细菌生长缓慢，该方法比较缓慢。尿液提供了大量的样本。正如综述所示，研究人员已经评估了尿液中的结核病原体生物标志物或宿主生物标志物，并取得了一些成功。检测灵敏度仍然是一个重大问题。未来，结合宿主和病原体生物标志物可提高结核病诊断的敏感性和特异性。

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引用次数: 3

Vaccination and modern management of chronic obstructive pulmonary disease – a narrative review 慢性阻塞性肺病的疫苗接种和现代管理——叙述性综述

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-06-03 DOI: 10.1080/17476348.2022.2092099

Oana Joean, T. Welte

ABSTRACT Introduction Chronic obstructive pulmonary disease (COPD) carries a tremendous societal and individual burden, posing significant challenges for public health systems worldwide due to its high morbidity and mortality. Due to aging and multimorbidity but also in the wake of important progress in deciphering the heterogeneous disease endotypes, an individualized approach to the prevention and management of COPD is necessary. Areas covered This article tackles relevant immunization strategies that are available or still under development with a focus on the latest evidence but also controversies around different regional immunization approaches. Further, we present the crossover between chronic lung inflammation and lung microbiome disturbance as well as its role in delineating COPD endotypes. Moreover, the article attempts to underline endotype-specific treatment approaches. Lastly, we highlight non-pharmacologic prevention and management programs in view of the challenges and opportunities of the COVID-19 era. Expert opinion Despite the remaining challenges, personalized medicine has the potential to offer tailored approaches to prevention and therapy and promises to improve the care of patients living with COPD.

慢性阻塞性肺疾病(COPD)具有巨大的社会和个人负担，由于其高发病率和死亡率，对全球公共卫生系统构成了重大挑战。由于老龄化和多发病，以及在破译异质性疾病内型方面取得的重要进展，有必要采取个体化的方法来预防和管理COPD。本文讨论了现有的或正在制定的相关免疫战略，重点关注最新证据，但也讨论了围绕不同区域免疫方法的争议。此外，我们提出了慢性肺部炎症和肺微生物群紊乱之间的交叉，以及它在描述COPD内型中的作用。此外，文章试图强调内源性特异性治疗方法。最后，针对新冠肺炎时代的挑战和机遇，重点介绍非药物预防和管理方案。专家意见尽管仍然存在挑战，个性化医疗有可能提供量身定制的预防和治疗方法，并有望改善COPD患者的护理。

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引用次数: 2

Bronchiectasis in patients with antineutrophil cytoplasmic antibody-associated vasculitis: a case control study on clinical features and prognosis 抗中性粒细胞胞浆抗体相关性血管炎患者支气管扩张症的临床特征和预后的病例对照研究

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-06-03 DOI: 10.1080/17476348.2022.2088512

Jiaqi Ren, Yanling Ding, Jinxia Zhao, Yongchang Sun

ABSTRACT Background Bronchiectasis was reported in 2%-40% of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), but there were no studies on the prevalence, risk factors and impact of AAV-associated bronchiectasis in Chinese patients. Research design and methods AAV patients were retrospectively enrolled. The clinical, laboratory and imaging features and the prognosis were analyzed and compared between those with and without bronchiectasis. Results Bronchiectasis was present in 48/212 (22.6%) of our AAV patients, among whom 41 were confirmed in 210 patients (19.5%) who received chest HRCT at the initial diagnosis of AAV. There were more women and fewer smokers in those with bronchiectasis as compared to those without. Cases with positive anti-MPO were more likely to have bronchiectasis (26.2%), and those with bronchiectasis were more likely to be anti-MPO positive (93.8%). Patients who had a diagnosis of bronchiectasis before AAV were more likely to have nervous system involvement, while patients without bronchiectasis had higher 24h proteinuria. The presence of bronchiectasis showed no significant effect on the 1, 3, 5-year survival. Conclusions Nearly 20% of patients showed bronchiectasis on chest HRCT at the initial diagnosis of AAV, and positivity of anti-MPO was associated with bronchiectasis in a Chinese cohort of AAV patients.

摘要背景据报道，2%-40%的抗中性粒细胞胞浆抗体相关血管炎（AAV）患者出现支气管扩张，但尚未对中国患者中AAV相关支气管扩张的患病率、危险因素和影响进行研究。研究设计和方法回顾性纳入AAV患者。分析比较有无支气管扩张症患者的临床、实验室、影像学特点及预后。结果212例AAV患者中有48例（22.6%）出现支气管扩张，其中210例患者中有41例（19.5%）在最初诊断为AAV时接受了胸部HRCT检查。与没有支气管扩张症的患者相比，患有支气管扩张症患者的女性人数更多，吸烟者更少。抗MPO阳性的患者更有可能患有支气管扩张症（26.2%），而患有支气管扩张的患者更可能患有抗MPO阴性（93.8%）。在AAV之前诊断为支气管扩张症的患者更容易有神经系统受累，而没有支气管扩张的人则有更高的24小时蛋白尿。支气管扩张对1、3、5年生存率无显著影响。结论近20%的患者在首次诊断AAV时胸部HRCT显示支气管扩张，在中国AAV患者队列中，抗MPO阳性与支气管扩张有关。

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引用次数: 0

Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. 囊性纤维化患者呼吸系统健康的社会经济决定因素:对治疗策略的影响

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-06-01 DOI: 10.1080/17476348.2022.2090928

Gabriela R Oates, Michael S Schechter

Introduction: Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions.

Areas covered: This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice.

Expert opinion: Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.

由于遗传和环境的影响，囊性纤维化(CF)肺部疾病的进展和结果存在很大差异。社会决定因素影响环境暴露和治疗成功;与社会经济条件较好的人相比，社会经济条件较差的CF患者健康状况较差，寿命较短。涵盖领域:本文回顾了CF健康差异产生和维持机制的文献，以及社会决定因素转化为CF患者健康优势或劣势的方式。作者提出了CF临床实践中解决社会风险因素的建议。专家意见:社会经济因素不是二分的，在社会阶梯的每一步都能感受到它们的影响。CF护理项目需要采用系统的方案来筛查与健康相关的社会风险因素，然后将患者与现有资源联系起来，以满足个人需求。诸如日托、学校选择、生活和工作条件、体育锻炼和娱乐的机会以及自我效能感的提升等因素往往被忽视。此外，倡导改变医疗保险、环境法规、社会福利和教育方面的公共政策，都将有助于解决CF保健不平等的根本原因。

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引用次数: 3

What should the recommendations be for lifestyle factors in obstructive sleep apnea? 对于导致阻塞性睡眠呼吸暂停的生活方式因素应该有哪些建议?

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-06-01 DOI: 10.1080/17476348.2022.2099377

Tianyi Huang

Lifestyle factors play crucial roles in weight management, inflammation and metabolic homeostasis, which are important pathogenic pathways for obstructive sleep apnea (OSA). This review provides a brief summary of clinical and epidemiological data addressing the role of lifestyle factors in the prevention and treatment of OSA, and discusses study limitations, current knowledge gaps, and future prospects of research directions on healthy lifestyles in OSA.

引用次数: 0

The prevalence of oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis 慢性阻塞性肺疾病患者口咽吞咽困难的患病率:系统回顾和荟萃分析

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-05-04 DOI: 10.1080/17476348.2022.2086123

Wenyan Li, M. Gao, Jin Liu, Fengwa Zhang, Rongjing Yuan, Qingling Su, Yetong Wang, Yanhong Wang

ABSTRACT Background Oropharyngeal dysphagia (OD) in chronic obstructive pulmonary disease (COPD) patients seriously influence the long-term prognosis of COPD patients. The aim of this study was to assess the prevalence and risk factors of OD in patients with COPD through a systematic review and meta-analysis of observational studies. Methods We identified all observational studies on the prevalence of OD in COPD patients by searching PubMed, Embase, the Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), the China Biomedical Literature Service System (CBM), the Wanfang Database, and the WeiPu (VIP) databases from database establishment to 1 December 2020. Results Results of the meta-analysis showed that the prevalence of OD in COPD patients was 32.7% (95%CI=30.1, 35.4, I2=91.5%). Dyspnea, gastroesophageal reflux disease(GERD), xerostomia, sputum bacteria, poor physical capacity, poor quality of life, and high CRP level are the risk factors for OD in COPD patients. Conclusion : The prevalence of OD in COPD patients is high. There were some differences in OD among COPD patients with different sex, ages, continents, evaluation methods, patient source and COPD exacerbation.

背景慢性阻塞性肺疾病(COPD)患者口咽吞咽困难(OD)严重影响COPD患者的长期预后。本研究的目的是通过对观察性研究的系统回顾和荟萃分析，评估COPD患者OD的患病率和危险因素。方法通过检索PubMed、Embase、Cochrane图书馆、Web of Science、护理与相关健康文献累积索引(CINAHL)、中国知网(CNKI)、中国生物医学文献服务系统(CBM)、万方数据库和微普(VIP)数据库，从数据库建立到2020年12月1日，确定所有COPD患者OD患病率的观察性研究。meta分析结果显示，COPD患者的OD患病率为32.7% (95%CI=30.1, 35.4, I2=91.5%)。呼吸困难、胃食管反流病(GERD)、口干、痰菌、体能差、生活质量差、CRP水平高是COPD患者发生OD的危险因素。结论:慢性阻塞性肺病患者的OD患病率较高。不同性别、年龄、大洲、评价方法、患者来源、COPD加重程度的COPD患者OD存在一定差异。

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引用次数: 2

Lung transplantation for COVID-19 associated ARDS: patience is a virtue 肺移植治疗新冠肺炎相关ARDS：耐心是美德

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-05-04 DOI: 10.1080/17476348.2022.2084383

A. Banga

Not applicable.

不适用。

引用次数: 0

Pulmonary fibrosis associated with rheumatoid arthritis: from pathophysiology to treatment strategies 与类风湿性关节炎相关的肺纤维化:从病理生理学到治疗策略

IF 3.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-05-04 DOI: 10.1080/17476348.2022.2089116

R. Diesler, V. Cottin

ABSTRACT Introduction Rheumatoid arthritis (RA) is the most common inflammatory autoimmune disease, characterized by symmetric destructive arthritis and synovitis. Lung involvement is frequent, including in the form of interstitial lung disease (ILD). RA-ILD often presents with a radiologic and pathologic pattern of usual interstitial pneumonia, similar to idiopathic pulmonary fibrosis, highlighting the similarities between the two diseases, but other patterns and pathological associations are described. Areas covered This article reviews the pathogenesis of pulmonary fibrosis in the setting of rheumatoid arthritis as well as the current and future therapeutic options. Expert opinion Pulmonary fibrosis in the setting of RA-ILD is an example of genotype–environment interaction and involves multiple mechanisms including autoimmunity, inflammation, and fibrogenesis. Although ILD conveys most of the exceeding mortality in RA patients, there are no official guidelines for the management of RA-ILD. Attention should be paid to potential lung toxicity of RA treatment even though some of them might help stabilize the ILD. Current standard of care is often composed of glucocorticoids that may be associated with immunosuppressive therapy. Following the approval of antifibrotic therapy for ILDs with a progressive fibrosing phenotype, current works are evaluating the benefit of such treatment in RA-ILD.

类风湿性关节炎(RA)是最常见的炎症性自身免疫性疾病，以对称性破坏性关节炎和滑膜炎为特征。肺受累是常见的，包括间质性肺疾病(ILD)。RA-ILD通常表现为通常间质性肺炎的影像学和病理模式，类似于特发性肺纤维化，突出了两种疾病之间的相似性，但也描述了其他模式和病理关联。本文综述了类风湿性关节炎中肺纤维化的发病机制以及当前和未来的治疗选择。专家意见RA-ILD背景下的肺纤维化是基因型-环境相互作用的一个例子，涉及多种机制，包括自身免疫、炎症和纤维发生。尽管ILD导致了RA患者的大部分超额死亡率，但对于RA-ILD的管理尚无官方指南。应注意类风湿关节炎治疗的潜在肺毒性，即使其中一些可能有助于稳定ILD。目前的治疗标准通常由糖皮质激素组成，可能与免疫抑制治疗有关。随着抗纤维化疗法被批准用于进行性纤维化表型的ild，目前的工作正在评估这种治疗在RA-ILD中的益处。

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引用次数: 5

Pathophysiology and clinical evaluation of the patient with unexplained persistent dyspnea. 原因不明的持续性呼吸困难患者的病理生理学和临床评估。

IF 2.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine

Pub Date : 2022-05-01 Epub Date: 2022-01-20 DOI: 10.1080/17476348.2022.2030222

Andi Hudler, Fernando Holguin, Meghan Althoff, Anne Fuhlbrigge, Sunita Sharma

Introduction: Dyspnea is a complex symptom, which largely results from an imbalance between an afferent sensory stimulus and the corresponding efferent respiratory neuromuscular response. In addition, it is heavily influenced by the patient's prior experiences and sociocultural factors.

Areas covered: The diagnostic approach to these patients requires a graded, systematic, and often multidisciplinary approach to determine what is the underlying pathophysiologic process. Utilization of objective data obtained through lab testing, imaging, and advanced testing, such as cardiopulmonary exercise testing, is often required to help identify underlying pathology contributing to a patient's symptoms. This article will review dyspnea's underlying pathophysiological mechanisms and standardized approaches to diagnoses. In the expert opinion section, we will discuss our own clinical approach to evaluating patients with persistent dyspnea.

Expert opinion: Unexplained dyspnea is a challenging diagnosis that occurs in patients with and without underlying cardiopulmonary diseases. It requires a systematic approach, which initially uses clinical evaluation in addition to standard imaging and clinical biomarkers. When diagnoses are not made during the initial evaluation, subsequent tests can include cardiopulmonary exercise test and methacholine challenge. To be certain of the correct diagnosis, It is imperative that the clinician determines dyspnea's response to a particular therapeutic intervention.

简介呼吸困难是一种复杂的症状，主要是由于传入感觉刺激和相应的传出呼吸神经肌肉反应之间的不平衡造成的。此外，它还在很大程度上受到患者先前经历和社会文化因素的影响：对这些患者的诊断方法需要分级、系统化，而且通常是多学科的方法，以确定潜在的病理生理过程。通常需要通过实验室检查、影像学检查和心肺运动测试等高级检查获得客观数据，以帮助确定导致患者症状的潜在病理因素。本文将回顾呼吸困难的潜在病理生理机制和标准化诊断方法。在专家意见部分，我们将讨论自己评估持续性呼吸困难患者的临床方法：不明原因的呼吸困难是一种具有挑战性的诊断，可发生在有或没有潜在心肺疾病的患者身上。除了标准的影像学和临床生物标志物外，最初还需要进行临床评估。如果在初步评估中未能做出诊断，后续检查可包括心肺运动试验和甲氨胆碱挑战。为了确定正确的诊断，临床医生必须确定呼吸困难对特定治疗干预的反应。

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引用次数: 0