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Diagnostic accuracy of interleukin-2 receptor in sarcoidosis: a systematic review and meta-analysis. 白细胞介素2受体在结节病中的诊断准确性:一项系统综述和荟萃分析。
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-01-01 Epub Date: 2023-06-23 DOI: 10.1080/17476348.2023.2225772
Dan Qin, Li-Li Fan, Yuxia Zhong, Yongchun Shen, Deyun Cheng

Introduction: Soluble interleukin-2 receptor (sIL-2 R), a valuable diagnostic biomarker for sarcoidosis, has been reported with variable results. Based on the literatures currently accessible, a systematic review and meta-analysis of the diagnostic performance of serum sIL-2 R for sarcoidosis were performed.

Methods: Relevant studies investigating sIL-2 R for sarcoidosis diagnosis in several databases were searched and data on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were pooled by STATA 16.0 software. Overall test performance was assessed using summary receiver operating characteristic curves and the area under the curve (AUC). Potential publication bias was assessed by Deeks test.

Results: We included eleven studies involving 1,424 subjects, with 1,099 cases of sarcoidosis and 325 of non-sarcoidosis. The pooled parameters of sIL-2 R in diagnosing sarcoidosis were summarized as follows: sensitivity, 0.85 (95% CI: 0.72-0.93); specificity, 0.88 (95% CI: 0.72-0.96); PLR, 7.3 (95% CI: 2.7-20.1); NLR, 0.17 (95% CI:0.08-0.36); DOR, 44 (95% CI: 8-231); and the AUC, 0.93 (95% CI: 0.90-0.95). No publication bias was identified (P = 0.64).

Conclusions: Evidence suggests sIL-2 R performs well in diagnosing sarcoidosis. Nevertheless, results of sIL-2 R assay should be interpreted with other diagnostic examinations.

简介:可溶性白细胞介素2受体 R) ,一种有价值的结节病诊断生物标志物,已被报道,结果各异。基于现有文献,对血清sIL-2的诊断性能进行系统综述和荟萃分析 对结节病进行了R检查。方法:sIL-2的相关研究 在几个数据库中搜索结节病诊断的R,并通过STATA 16.0软件汇总敏感性、特异性、阳性似然比(PLR)、阴性似然比(NLR)和诊断优势比(DOR)的数据。使用总结受试者工作特性曲线和曲线下面积(AUC)评估总体测试性能。Deeks检验评估了潜在的发表偏倚。结果:我们纳入了11项研究,涉及1424名受试者,其中1099例为结节病,325例为非结节病。sIL-2的合并参数 诊断结节病的R值总结如下:敏感性0.85(95%可信区间:0.72-0.93);特异性,0.88(95%可信区间:0.72-0.96);PLR,7.3(95%CI:2.7-20.1);NLR为0.17(95%CI:0.08-0.36);DOR,44(95%CI:8-231);AUC为0.93(95%CI:0.90-0.95)。未发现发表偏倚(P = 0.64)。结论:有证据表明sIL-2 R在诊断结节病方面表现良好。然而,sIL-2的结果 R测定应与其他诊断检查一起进行解释。
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引用次数: 0
Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS? 针对不同ARDS表型的个性化药物治疗:ARDS药物治疗的未来?
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2176302
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin

Introduction: Acute respiratory distress syndrome (ARDS) still represents a major challenge with high mortality rates and altered quality of life. Many well-designed studies have failed to improve ARDS outcomes. Heterogeneity of etiologies, mechanisms of lung damage, different lung mechanics, and different treatment approaches may explain these failures. At the era of personalized medicine, ARDS phenotyping is not only a field of research, but a bedside consideration when implementing therapy. ARDS has moved from being a simple syndrome to a more complex area of subgrouping. Intensivists must understand these phenotypes and therapies associated with a better outcome.

Areas covered: After a brief sum-up of the different type of ARDS phenotypes, we will present some relevant therapy that may be impacted by phenotyping. A focus on pharmacotherapy will be realized before a section on non-pharmaceutical strategies. Eventually, we will highlight the limits of our knowledge of phenotyping and the pitfalls of personalized medicine.

Expert opinion: Biological and morphological ARDS phenotypes are now well studied. The future of ARDS therapy will go through phenotyping that allows a personalized medication for each patient. However, a better assessment of these phenotypes is required, and clinical trials should be conducted with an ad-hoc phenotyping before randomization.

简介:急性呼吸窘迫综合征(ARDS)仍然是一个具有高死亡率和生活质量改变的主要挑战。许多精心设计的研究未能改善ARDS的结果。病因的异质性、肺损伤机制、不同的肺力学和不同的治疗方法可能解释这些失败。在个性化医疗时代,ARDS表型不仅是一个研究领域,而且是实施治疗时的床边考虑因素。ARDS已经从一个简单的综合征转变为一个更复杂的亚组领域。强化医生必须了解这些表型和治疗与更好的结果相关。涵盖领域:在简要总结了不同类型的ARDS表型后,我们将介绍一些可能受表型影响的相关治疗。在非药物策略部分之前,将重点介绍药物治疗。最后,我们将强调我们对表型的知识的局限性和个性化医疗的陷阱。专家意见:目前对ARDS的生物学和形态学表型进行了很好的研究。未来的ARDS治疗将通过表型分析,为每个患者提供个性化的药物治疗。然而,需要对这些表型进行更好的评估,并且在随机化之前应该使用特设表型进行临床试验。
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引用次数: 1
Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics. 声带功能障碍/诱导性喉梗阻:新的诊断和治疗方法。
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-01-01 Epub Date: 2023-05-22 DOI: 10.1080/17476348.2023.2215434
Joo Koh, Debra Phyland, Malcolm Baxter, Paul Leong, Philip G Bardin

Introduction: Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is an important medical condition but understanding of the condition is imperfect. It occurs in healthy people but often co-exists with asthma. Models of VCD/ILO pathophysiology highlight predisposing factors rather than specific mechanisms and disease expression varies between people, which is seldom appreciated. Diagnosis is often delayed, and the treatment is not evidence based.

Areas covered: A unified pathophysiological model and disease phenotypes have been proposed. Diagnosis is conventionally made by laryngoscopy during inspiration with vocal cord narrowing >50% Recently, dynamic CT larynx was shown to have high specificity (>80%) with potential as a noninvasive, swift, and quantifiable diagnostic modality. Treatment entails laryngeal retraining with speech pathology intervention and experimental therapies such as botulinum toxin injection. Multidisciplinary team (MDT) clinics are a novel innovation with demonstrated benefits including accurate diagnosis, selection of appropriate treatment, and reductions in oral corticosteroid exposure.

Expert opinion: Delayed diagnosis of VCD/ILO is pervasive, often leading to detrimental treatments. Phenotypes require validation and CT larynx can reduce the necessity for laryngoscopy, thereby fast-tracking diagnosis. MDT clinics can optimize management. Randomized controlled trials are essential to validate speech pathology intervention and other treatment modalities and to establish international standards of care.

引言:声带功能障碍/可诱导性喉梗阻(VCD/ILO)是一种重要的医学状况,但对其了解尚不完善。它发生在健康人身上,但经常与哮喘共存。VCD/ILO病理生理学模型强调的是易感因素,而不是特定的机制,并且疾病表达在人与人之间存在差异,这一点很少得到重视。诊断往往被延迟,治疗也没有依据。涵盖的领域:已经提出了统一的病理生理模型和疾病表型。传统上,在声带狭窄>50%的吸气过程中通过喉镜进行诊断。最近,动态CT喉部显示出高特异性(>80%),有可能成为一种无创、快速和可量化的诊断模式。治疗需要通过言语病理学干预和实验疗法(如肉毒杆菌毒素注射)对喉部进行再训练。多学科团队(MDT)诊所是一项新的创新,其益处已得到证明,包括准确诊断、选择适当的治疗和减少口服皮质类固醇暴露。专家意见:VCD/ILO的延迟诊断是普遍存在的,通常会导致有害的治疗。表型需要验证,CT喉部可以减少喉镜检查的必要性,从而快速跟踪诊断。MDT诊所可以优化管理。随机对照试验对于验证言语病理干预和其他治疗模式以及建立国际护理标准至关重要。
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引用次数: 0
Safety and efficacy of glucocorticoids in the treatment of COVID-19: A meta-analysis of randomized control trials. 糖皮质激素治疗COVID-19的安全性和有效性:随机对照试验的荟萃分析
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2177155
Wenxiao Qiao, Lihong Meng, Ye Zhang, Dian Li, Jingjing Chen, Jinyun Wang, Di Xie, Xiaoming Xue

Background: It is unclear the efficacy and safety of glucocorticoids compared with placebo or usual care for treatment of COVID-19.

Research design and methods: Randomized controlled trials (RCTs) of corticosteroids in COVID-19 patients from 1 December 2019, to 30 June 2022, were assessed using Cochrane bias risk assessment method and improved Jadad score scale. GRADEpro was used to rate the quality of evidence for outcomes.

Results: Fifteen RCTs were included, including 10,620 patients. Glucocorticoid treatment for severe and critical COVID-19 showed lesser all-cause mortality (OR = 0.85, 95% CI [0.76, 0.94], P = 0.002) than conventional treatment. However, for mildly ill patients, neither inhaled drugs nor intravenous drugs reduced mortality (OR = 0.64, 95% CI [0.24, 1.76], P = 0.39). Glucocorticoids had no significant effect on the adverse reactions of patients (OR = 1.18, 95% CI [0.77, 1.80], P = 0.44) compared with usual care/placebo. Subgroup analysis demonstrated that dexamethasone significantly reduced the mortality of COVID-19 patients. Low-dose glucocorticoids were also associated with lower all-cause mortality.

Conclusion: Glucocorticoids (especially dexamethasone) reduce mortality of patients with severe and critical COVID-19 with no significant effect on the incidence of adverse reactions (moderate quality). In contrast, glucocorticoids do not benefit patients with mild symptoms (low quality).

背景:与安慰剂或常规护理相比,糖皮质激素治疗COVID-19的疗效和安全性尚不清楚。研究设计与方法:采用Cochrane偏倚风险评估法和改进的Jadad评分量表,对2019年12月1日至2022年6月30日COVID-19患者中皮质类固醇的随机对照试验(rct)进行评估。GRADEpro用于评价结果证据的质量。结果:纳入15项随机对照试验,共10620例患者。糖皮质激素治疗重症和危重型COVID-19的全因死亡率低于常规治疗(OR = 0.85, 95% CI [0.76, 0.94], P = 0.002)。然而,对于病情较轻的患者,吸入药物和静脉注射药物均不能降低死亡率(OR = 0.64, 95% CI [0.24, 1.76], P = 0.39)。与常规护理/安慰剂相比,糖皮质激素对患者不良反应无显著影响(OR = 1.18, 95% CI [0.77, 1.80], P = 0.44)。亚组分析显示,地塞米松可显著降低COVID-19患者的死亡率。低剂量糖皮质激素也与较低的全因死亡率相关。结论:糖皮质激素(尤其是地塞米松)可降低重症、危重型COVID-19患者的死亡率,对不良反应(中度)发生率无显著影响。相比之下,糖皮质激素对症状轻微(低质量)的患者无效。
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引用次数: 2
Endothelial function in patients with COPD: an updated systematic review of studies using flow-mediated dilatation. COPD患者的内皮功能:对血流介导扩张研究的最新系统综述
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2023-01-01 DOI: 10.1080/17476348.2023.2176845
Anouk W Vaes, Patrick De Boever, Frits M E Franssen, Nicole H M K Uszko-Lencer, Lowie E G W Vanfleteren, Martijn A Spruit

Introduction: Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be involved in cardiovascular disease pathogenesis, and multiple studies report endothelial dysfunction in COPD. This article summarized the current knowledge on endothelial function in COPD patients.

Areas covered: Databases were screened until November 2022 for studies using ultrasound-based flow-mediated dilation in patients with stable COPD. Pooled effect sizes were calculated using random effects model. Meta-regression analyses assessed the effects of demographic and clinical variables.

Expert opinion: 34 studies were identified (1365 COPD patients; 617 controls). Pooled analysis demonstrated an impaired endothelial-dependent (-2.33%; 95%CI -3.30/-1.35; p < 0.001) and endothelial-independent dilation (-3.11%; 95%CI -5.14/-1.08; p = 0.003) in COPD patients when compared to non-COPD controls. Meta-regression identified that higher age, worse severity of airflow obstruction, and current smoking were significantly associated with impaired endothelial function. Studies evaluating the effects of pharmacological and non-pharmacological interventions on endothelial function in COPD patients demonstrated conflicting results.

前言:心血管疾病是慢性阻塞性肺病发病和死亡的重要原因。内皮功能障碍被认为参与心血管疾病的发病机制,多项研究报道了COPD的内皮功能障碍。本文综述了目前COPD患者内皮功能的相关知识。涵盖领域:数据库筛选至2022年11月,用于在稳定期COPD患者中使用基于超声的血流介导扩张的研究。采用随机效应模型计算合并效应量。meta回归分析评估了人口统计学和临床变量的影响。专家意见:共纳入34项研究(1365例COPD患者;617控制)。合并分析显示内皮依赖性受损(-2.33%;95%可信区间-3.30/-1.35;p
{"title":"Endothelial function in patients with COPD: an updated systematic review of studies using flow-mediated dilatation.","authors":"Anouk W Vaes,&nbsp;Patrick De Boever,&nbsp;Frits M E Franssen,&nbsp;Nicole H M K Uszko-Lencer,&nbsp;Lowie E G W Vanfleteren,&nbsp;Martijn A Spruit","doi":"10.1080/17476348.2023.2176845","DOIUrl":"https://doi.org/10.1080/17476348.2023.2176845","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular disease is a significant cause of morbidity and mortality in COPD. Endothelial dysfunction is suggested to be involved in cardiovascular disease pathogenesis, and multiple studies report endothelial dysfunction in COPD. This article summarized the current knowledge on endothelial function in COPD patients.</p><p><strong>Areas covered: </strong>Databases were screened until November 2022 for studies using ultrasound-based flow-mediated dilation in patients with stable COPD. Pooled effect sizes were calculated using random effects model. Meta-regression analyses assessed the effects of demographic and clinical variables.</p><p><strong>Expert opinion: </strong>34 studies were identified (1365 COPD patients; 617 controls). Pooled analysis demonstrated an impaired endothelial-dependent (-2.33%; 95%CI -3.30/-1.35; p < 0.001) and endothelial-independent dilation (-3.11%; 95%CI -5.14/-1.08; p = 0.003) in COPD patients when compared to non-COPD controls. Meta-regression identified that higher age, worse severity of airflow obstruction, and current smoking were significantly associated with impaired endothelial function. Studies evaluating the effects of pharmacological and non-pharmacological interventions on endothelial function in COPD patients demonstrated conflicting results.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 1","pages":"53-69"},"PeriodicalIF":3.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9181421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Moderate sedation with dexmedetomidine-remifentanil is safer than deep sedation with propofol-remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial. 右美托咪定-瑞芬太尼中度镇静比异丙酚-瑞芬太尼深度镇静对支气管超声更安全,同时提供同等质量:一项随机双盲试验。
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2022-11-01 DOI: 10.1080/17476348.2022.2145949
Silvia Bermejo, Begoña Covas, Teresa Silva-Costa-Gomes, Albert Sánchez-Font, Víctor Curull, Àlex Pérez-Ramos, Anna Mases, Lluís Gallart

Objective: We compared dexmedetomidine-remifentanil vs. propofol-remifentanil in terms of safety and quality during sedation for Endobronchial ultrasonography (EBUS).

Methods: A randomized, double-blind trial. Outpatients undergoing EBUS randomly received 1 μg/kg/hour dexmedetomidine or a target concentration of 2.5 μg/mL propofol, both combined with remifentanil initially targeted at 1.5 ng/mL and subsequently titrated. Additional sedatives were restricted. The primary outcome was the need for airway rescue interventions to treat oxygen desaturation.

Results: Twenty-eight patients received dexmedetomidine-remifentanil and 27 received propofol-remifentanil. Airway rescue interventions were fewer in the dexmedetomidine group vs. the propofol one (23 vs. 76% patients, relative risk 3.21 (95% CI 1.55-6.64, P < 0.002)). Desaturation in the dexmedetomidine group was always resolved by increasing nasal oxygen flow, whereas additional interventions were needed in 60% of patients receiving propofol. Hypotension was more frequent in the propofol group, while hypertension, bradycardia and coughing were similar in both. Bronchoscopists' and patients' satisfaction were similar, although in the dexmedetomidine group two patients needed additional sedatives and two patients would not repeat the sedation technique.

Conclusion: Moderate sedation with dexmedetomidine-remifentanil for EBUS is safer than deep sedation with propofol-remifentanil but it would occasionally need additional sedatives to ensure patient satisfaction.

目的:比较右美托咪定-瑞芬太尼与异丙酚-瑞芬太尼在支气管超声检查(EBUS)镇静中的安全性和质量。方法:随机、双盲试验。门诊EBUS患者随机给予右美托咪定1 μg/kg/h或异丙酚2.5 μg/mL靶浓度,均联合瑞芬太尼,初始靶浓度为1.5 ng/mL,随后滴定。额外的镇静剂受到限制。主要结局是需要气道抢救干预来治疗氧饱和度过低。结果:右美托咪定-瑞芬太尼治疗28例,异丙酚-瑞芬太尼治疗27例。与异丙酚组相比,右美托咪定组气道抢救干预较少(23例对76%,相对风险3.21 (95% CI 1.55-6.64, P)。结论:右美托咪定-瑞芬太尼中度镇静治疗EBUS比异丙酚-瑞芬太尼深度镇静更安全,但偶尔需要额外的镇静剂以确保患者满意度。
{"title":"Moderate sedation with dexmedetomidine-remifentanil is safer than deep sedation with propofol-remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial.","authors":"Silvia Bermejo,&nbsp;Begoña Covas,&nbsp;Teresa Silva-Costa-Gomes,&nbsp;Albert Sánchez-Font,&nbsp;Víctor Curull,&nbsp;Àlex Pérez-Ramos,&nbsp;Anna Mases,&nbsp;Lluís Gallart","doi":"10.1080/17476348.2022.2145949","DOIUrl":"https://doi.org/10.1080/17476348.2022.2145949","url":null,"abstract":"<p><strong>Objective: </strong>We compared dexmedetomidine-remifentanil vs. propofol-remifentanil in terms of safety and quality during sedation for Endobronchial ultrasonography (EBUS).</p><p><strong>Methods: </strong>A randomized, double-blind trial. Outpatients undergoing EBUS randomly received 1 μg/kg/hour dexmedetomidine or a target concentration of 2.5 μg/mL propofol, both combined with remifentanil initially targeted at 1.5 ng/mL and subsequently titrated. Additional sedatives were restricted. The primary outcome was the need for airway rescue interventions to treat oxygen desaturation.</p><p><strong>Results: </strong>Twenty-eight patients received dexmedetomidine-remifentanil and 27 received propofol-remifentanil. Airway rescue interventions were fewer in the dexmedetomidine group vs. the propofol one (23 vs. 76% patients, relative risk 3.21 (95% CI 1.55-6.64, P < 0.002)). Desaturation in the dexmedetomidine group was always resolved by increasing nasal oxygen flow, whereas additional interventions were needed in 60% of patients receiving propofol. Hypotension was more frequent in the propofol group, while hypertension, bradycardia and coughing were similar in both. Bronchoscopists' and patients' satisfaction were similar, although in the dexmedetomidine group two patients needed additional sedatives and two patients would not repeat the sedation technique.</p><p><strong>Conclusion: </strong>Moderate sedation with dexmedetomidine-remifentanil for EBUS is safer than deep sedation with propofol-remifentanil but it would occasionally need additional sedatives to ensure patient satisfaction.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"16 11-12","pages":"1237-1245"},"PeriodicalIF":3.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9162715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Current best clinical practices for monitoring of interstitial lung disease. 目前监测间质性肺疾病的最佳临床实践。
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2022-11-01 DOI: 10.1080/17476348.2022.2162504
Elisabeth Bendstrup, Sissel Kronborg-White, Janne Møller, Thomas Skovhus Prior

Introduction: Interstitial lung diseases (ILDs) are a heterogeneous group of inflammatory and/or fibrotic conditions with variable outcome and often a dismal prognosis. Since many ILDs are progressive in nature, monitoring of signs and symptoms of progression is essential to inform treatment decisions and patient counseling. Monitoring of ILDs is a multimodality process and includes all aspects of the disease, e.g. measurement of pulmonary function and exercise capacity, symptom registration and quality of life (QoL), imaging, comorbidities and/or involvement of other organs to assess disease activity, symptom burden, treatment effects, adverse events, the need for supportive and palliative care, and lung transplantation.

Areas covered: For this narrative review, we searched the PUBMED database to identify articles relevant for monitoring ILDs, including pulmonary function tests, exercise capacity, imaging, telemedicine, symptoms, and QoL.

Expert opinion: Due to the high heterogeneity of the ILDs and their disease course, an individualized multimodality approach must be applied. Future strategies include use of telemedicine for home monitoring of lung function and symptoms, use of artificial intelligence to support automatized guidance of patients, computerized evaluation of ILD changes on imaging, and new imaging tools with less radiation dosage.

肺间质性疾病(ILDs)是一种异质性的炎症和/或纤维化疾病,具有不同的结果,通常预后不佳。由于许多ild本质上是进行性的,因此监测进展的体征和症状对于告知治疗决策和患者咨询至关重要。ILDs的监测是一个多模式的过程,包括疾病的所有方面,例如肺功能和运动能力的测量、症状记录和生活质量(QoL)、影像学、合并症和/或其他器官的累及,以评估疾病活动性、症状负担、治疗效果、不良事件、支持和姑息治疗的需要,以及肺移植。涵盖领域:在这篇叙述性综述中,我们检索了PUBMED数据库,以确定与监测ild相关的文章,包括肺功能测试、运动能力、成像、远程医疗、症状和生活质量。专家意见:由于ild及其病程的高度异质性,必须采用个体化的多模式方法。未来的策略包括使用远程医疗进行肺功能和症状的家庭监测,使用人工智能支持患者的自动化指导,计算机评估ILD成像变化,以及使用更少辐射剂量的新成像工具。
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引用次数: 0
Is mild asthma truly mild? The patients' real-life setting. 轻度哮喘真的是轻度吗?患者的真实生活环境
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2022-11-01 Epub Date: 2023-01-18 DOI: 10.1080/17476348.2023.2167714
Gabriella Guarnieri, Veronica Batani, Gianenrico Senna, Annarita Dama, Andrea Vianello, Marco Caminati

Objectives: Asthma exacerbations and, more rarely, fatal asthma attacks have been reported in mild asthma patients, suggesting poor disease control and awareness of its potential burden. Our study aimed to explore outside the hospital/specialist setting the perspective and disease treatment behavior of patients self-reporting a mild asthma diagnosis.

Methods: Computer-Assisted Personal Interviewing (CAPI) technique was used to investigate the identified study population. Questions about diagnosis, symptoms, comorbidities, treatment strategy, ongoing assessments, and quality of life were administered.

Results: Overall, 258 patients were considered for the analysis. As the most relevant results, 22% of them reported severe respiratory symptoms, 52% experienced at least one exacerbation/year, and 7% needed Emergency Room care. Sixty-six percent of the respondents assumed as needing short-acting bronchodilators only. Of note, 22% of patients were using oral steroids (OCS) intermittently and 72% of them considered their quality of life unsatisfying.

Conclusion: Outside the hospital/specialist setting, mild asthma burden is still not negligible and the treatment approach is not correct. In particular, the reported OCS use is disproportionate. Our data suggest that mild asthma, especially when self-assessed might be other than mild, suggesting that efforts to increase disease awareness, improve the disease control limiting the OCS abuse are required.

目的:有报道称,轻度哮喘患者会出现哮喘加重,更罕见的是会出现致命的哮喘发作,这表明患者的疾病控制能力较差,而且对哮喘的潜在负担认识不足。我们的研究旨在探讨在医院/专科医院之外,自我报告被诊断为轻度哮喘的患者的观点和疾病治疗行为:方法:采用计算机辅助个人访谈(CAPI)技术对确定的研究人群进行调查。方法:采用计算机辅助个人访谈(CAPI)技术对确定的研究人群进行调查,并就诊断、症状、合并症、治疗策略、持续评估和生活质量等问题进行提问:共有 258 名患者被纳入分析范围。最相关的结果是,22%的患者报告了严重的呼吸道症状,52%的患者每年至少出现一次病情加重,7%的患者需要急诊室护理。66%的受访者认为只需要短效支气管扩张剂。值得注意的是,22%的患者间歇性使用口服类固醇(OCS),72%的患者认为他们的生活质量不令人满意:结论:在医院/专科医院之外,轻度哮喘的负担仍然不容忽视,治疗方法也不正确。结论:在医院/专科医院之外,轻度哮喘患者的负担仍然不容忽视,治疗方法也不正确,尤其是报告的使用体外辅助治疗的比例过高。我们的数据表明,轻度哮喘,尤其是自我评估的轻度哮喘,可能并非轻度,这表明需要努力提高对疾病的认识,改善疾病控制,限制非化学治疗药物的滥用。
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引用次数: 0
Rapid systematic review of respiratory rate as a vital sign of clinical deterioration in COVID-19. 在 COVID-19 中将呼吸频率作为临床恶化的重要标志的快速系统性回顾。
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2022-11-01 Epub Date: 2023-01-22 DOI: 10.1080/17476348.2023.2169138
John Tredinnick-Rowe, Rehan Symonds

Objectives: This meta-analysis aimed to establish a clinical evidence base for respiratory rate (RR) as a single predictor of early-onset COVID-19. The review also looked to determine the practical implementation of mobile respiratory rate measuring devices where information was available.

Methods: We focused on domestic settings with older adults. Relevant studies were identified through MEDLINE, Embase, and CENTRAL databases. A snowballing method was also used. Articles published from the beginning of the COVID-19 pandemic (2019) until Feb 2022 were selected. Databases were searched for terms related to COVID-19 and respiratory rate measurements in domestic patients.

Results: A total of 2,889 articles were screened for relevant content, of which 60 full-text publications were included. We compared the Odds Ratios and statistically significant results of both vital signs.

Conclusion: Multinational studies across dozens of countries have shown respiratory rate to have predictive accuracy in detecting COVID-19 deterioration. However, considerable variability is present in the data, making it harder to be sure about the effects. There is no meaningful difference in data quality in terms of variability (95% CI intervals) between vital signs as predictors of decline in COVID-19 patients. Contextual and economic factors will likely determine the choice of measurement used.

研究目的这项荟萃分析旨在为呼吸频率(RR)作为早发 COVID-19 的单一预测指标建立临床证据基础。该综述还旨在确定在信息可用的情况下移动呼吸频率测量设备的实际应用情况:方法:我们将重点放在老年人的家庭环境中。我们通过 MEDLINE、Embase 和 CENTRAL 数据库确定了相关研究。我们还采用了 "滚雪球 "的方法。我们选择了从 COVID-19 大流行开始(2019 年)到 2022 年 2 月发表的文章。在数据库中搜索与 COVID-19 和国内患者呼吸频率测量相关的术语:共筛选出 2,889 篇相关文章,其中 60 篇为全文出版物。我们比较了两种生命体征的比值比和统计学意义上的结果:数十个国家的跨国研究表明,呼吸频率在检测 COVID-19 恶化方面具有预测准确性。然而,数据中存在相当大的变异性,因此很难确定其效果。在预测 COVID-19 患者病情恶化方面,生命体征之间的变异性(95% CI 区间)在数据质量上没有明显差异。环境和经济因素可能会决定测量方法的选择。
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引用次数: 0
Clinical characteristics, treatment patterns and adherence in patients with asthma on multiple inhaler triple therapy: a review of findings. 采用多重吸入器三联疗法的哮喘患者的临床特征、治疗模式和依从性:研究结果综述。
IF 3.9 3区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2022-11-01 Epub Date: 2023-01-17 DOI: 10.1080/17476348.2023.2167715
Mario Cazzola, Luigino Calzetta, Barbara Rinaldi, Vito De Novellis, Paola Rogliani, Maria Gabriella Matera

Introduction: The value of treating asthma with the triple regimen of inhaled corticosteroid (ICS), long-acting β2-agonist (LABA), and long-acting muscarinic antagonist (LAMA) delivered using multiple inhalers (MITT), or a single inhaler (SITT) is supported by a growing body of evidence, although research is still limited regarding the use of MITT.

Areas covered: Clinical characteristics, treatment patterns, disease burden, and persistence/adherence associated with MITT use in asthma. The MEDLINE database was searched to identify references from inception until October 2022.

Expert opinion: The use of MITT is not very frequent in asthma patients, although it improves lung function and reduces the incidence of severe exacerbations. This may be due to existing concerns about using different devices on adherence and persistence to treatment, with a negative influence on outcomes, and to the fear that the patient will discontinue ICS/LABA but not LAMA. Nevertheless, although the current trend favors the SITT approach, some physicians may be induced to prescribe MITT over SITT because it allows the titration of individual components of triple therapy to be increased or decreased. Therefore, there is an evident need for pragmatic real-life studies to document when to prefer SITT and when MITT should be used.

简介:使用多吸入器(MITT)或单吸入器(SITT)给予吸入性皮质激素(ICS)、长效β2-受体激动剂(LABA)和长效毒蕈碱拮抗剂(LAMA)的三联疗法治疗哮喘的价值得到了越来越多证据的支持,尽管有关使用MITT的研究仍然有限:哮喘患者使用 MITT 的相关临床特征、治疗模式、疾病负担以及持续性/依从性。对MEDLINE数据库进行了检索,以确定从开始到2022年10月的参考文献:专家观点:尽管MITT能改善肺功能并降低严重恶化的发生率,但哮喘患者使用MITT的频率并不高。这可能是由于人们担心使用不同的设备会影响治疗的依从性和持久性,从而对治疗效果产生负面影响,以及担心患者会停用 ICS/LABA 而不停用 LAMA。尽管如此,尽管目前的趋势倾向于 SITT 方法,但一些医生可能会倾向于处方 MITT,而不是 SITT,因为 MITT 允许增加或减少三联疗法中单个成分的滴定。因此,显然有必要开展务实的实际研究,记录何时应首选 SITT,何时应使用 MITT。
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Expert Review of Respiratory Medicine
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