Respiratory medicine最新文献_第5页

Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea 阻塞性睡眠呼吸暂停的舌下神经刺激和自动调整气道正压疗法的多导睡眠图和患者报告结果的真实世界数据。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-30 DOI: 10.1016/j.rmed.2024.107750

Background

Few data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups.

Methods

20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting.

Results

Propensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01).

Conclusion

These are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.

背景：将阻塞性睡眠呼吸暂停（OSA）的一线气道正压（PAP）疗法（尤其是自动调节气道正压（aPAP））与二线舌下神经刺激（HGNS）疗法进行比较的数据很少。本研究的目的是通过标准多导睡眠图（PSG）相关参数和患者报告结果，直接比较可比组中的这些治疗方案。方法：20 名患者（年龄为 57.30 ± 8.56 岁；6 名女性）被纳入 HGNS 组，35 名患者（年龄为 56.83 ± 9.20 岁；9 名女性）被纳入 aPAP 组。两组患者都必须符合现行的 HGNS 治疗指南标准。采用逆倾向得分加权法进行协方差分析（ANCOVA），对各组进行比较：结果：各组的倾向得分没有差异。治疗前 AHI（HGNS：40.22 ± 12.78 /h；aPAP：39.23± 12.33/h）和 ODI（HGNS：37.9± 14.7/h；aPAP：34.58± 14.74/h）在各组之间具有可比性。治疗 413.6 ± 116.66 天（HGNS 组）和 162.09 ± 140.58 天（aPAP 组）后，AHI（HGNS 组：30.22± 17.65/h，aPAP 组：4.71± 3.42/h4.71±3.42/小时；p结论：这些都是新颖的真实世界数据。需要对 HGNS 神经刺激参数调整的关键参数以及影响 HGNS 依从性的因素的影响进行更多研究。

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引用次数: 0

Association of naples prognostic score and lung health: A population-based study 那不勒斯预后评分与肺部健康的关系：基于人群的研究

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-30 DOI: 10.1016/j.rmed.2024.107751

Background

The Naples Prognostic Score (NPS) is a novel indicator of inflammatory and nutritional status, but its relationship to lung health is unknown.

Objective

To evaluate the relationship of NPS to lung health problems.

Methods

A total of 15,600 participants aged 20 years or older with an available assessment of chronic lung diseases were enrolled from the National Health and Nutrition Examination Survey 2007–2012. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Associations of NPS with chronic lung disease (diagnosed asthma, chronic bronchitis, and emphysema), respiratory symptoms (cough, phlegm production, wheeze, and exertional dyspnea), and spirometric measurements (FEV₁, FVC, and obstructive or restrictive spirometry pattern) were evaluated. Kaplan-Meier survival analysis and multiple Cox regressions were used to assess the significance of NPS in relation to all-cause mortality and chronic lower respiratory diseases mortality in participants. Furthermore, to comprehensively assess the association between NSP and chronic lower respiratory diseases mortality, Fine-Gray subdistribution hazards model was performed to analyze non-chronic lower respiratory diseases mortality as a competitive risk.

Results

People with a higher NPS score were associated with greater odds of asthma, chronic bronchitis, respiratory symptoms (including phlegm production, wheeze, and exertional dyspnea), and a greater risk of obstructive and restrictive spirometry. A higher NPS score was significantly associated with decreased FEV₁ and FVC in both overall participants and those with lung health problems. Longitudinally, we found that those in the category with highest NPS were at greater risk of all-cause mortality and chronic lower respiratory diseases mortality in those with chronic lung disease, and respiratory symptoms.

Conclusions

An elevated NPS is associated with a host of adverse pulmonary outcomes. Prospective studies to define NPS as a biomarker for impaired lung health are warranted.

背景：那不勒斯预后评分（NPS）是一种新型炎症和营养状况指标，但其与肺部健康的关系尚不清楚：那不勒斯预后评分（NPS）是衡量炎症和营养状况的新指标，但其与肺部健康的关系尚不清楚：评估那不勒斯预后评分与肺部健康问题的关系：方法：从 2007-2012 年全国健康与营养调查中选取了 15600 名年龄在 20 岁或 20 岁以上、可评估慢性肺部疾病的参与者。NPS是根据血清白蛋白、总胆固醇、中性粒细胞与淋巴细胞比率以及淋巴细胞与单核细胞比率计算得出的。研究人员评估了 NPS 与慢性肺部疾病（诊断为哮喘、慢性支气管炎和肺气肿）、呼吸道症状（咳嗽、咳痰、喘息和用力性呼吸困难）以及肺活量测量（FEV1、FVC 和阻塞性或限制性肺活量测量模式）之间的关系。采用卡普兰-梅耶生存分析和多重 Cox 回归评估了 NPS 与参与者全因死亡率和慢性下呼吸道疾病死亡率的相关性。此外，为了全面评估NSP与慢性下呼吸道疾病死亡率之间的关系，还采用了Fine-Gray亚分布危险模型来分析作为竞争风险的非慢性下呼吸道疾病死亡率：结果：NPS得分越高的人患哮喘、慢性支气管炎、呼吸道症状（包括咳痰、喘息和用力呼吸困难）的几率越大，患阻塞性和限制性肺活量的风险也越大。在总体参与者和有肺部健康问题的参与者中，较高的 NPS 分数与 FEV1 和 FVC 的下降明显相关。纵向研究发现，NPS最高的人群全因死亡率和慢性下呼吸道疾病死亡率风险更高，而患有慢性肺部疾病和呼吸道症状的人群的全因死亡率和慢性下呼吸道疾病死亡率风险更高：结论：NPS升高与一系列不良肺部结果有关。有必要开展前瞻性研究，将 NPS 界定为肺部健康受损的生物标志物。

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引用次数: 0

The 1-min sit-to-stand test as a screening tool to assess exercise-induced oxygen desaturation in normoxemic people with interstitial lung disease 将 1 分钟坐立测试作为筛查工具，以评估患有间质性肺病的正常血氧者在运动中引起的氧饱和度降低情况。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-27 DOI: 10.1016/j.rmed.2024.107748

Background

In patients with interstitial lung disease (ILD), exercise-induced desaturation during the 6-min walk test (6MWT), specifically nadir oxygen saturation (nSpO2) of ≤88 % is a negative prognostic marker. As the 6MWT is often impractical for ILD patients, the aim of this study is to compare the 1-min sit-to-stand test (1minSTS) with the 6MWT to detect exercise-induced desaturation.

Methods

Participants were recruited from a tertiary referral clinic with both tests performed on the same day. Utilising Bland-Altman analysis, the relationship between nSpO2 on 1minSTS and 6MWT was determined. An area under the receiver operating characteristic curve (AUC) determined the ability of nSpO2 on 1minSTS test to predict SpO2 ≤88 % on 6MWT.

Results

Fifty participants completed the study (idiopathic pulmonary fibrosis n = 24, 48 %; connective tissue disease associated ILD n = 20, 40 %; other ILD n = 6, 12 %). Mean (SD) FVC%pred was 73 ± 16 %, mean DLCO%pred 57 ± 16 % and resting SpO2 99 ± 1 %. The 1minSTS resulted in less exercise-induced oxygen desaturation, with a median IQR nSpO2 of 95 % (89–98) and 93 % (85–96) respectively (p < 0.001). Moderate agreement was determined between the nSpO2 on both tests, with a mean difference of 3.2 % [-14 to +3.0 %]. The 1minSTS test accurately identified participants with nSpO2 ≤88 % on 6MWT (AUC 0.96). Oxygen desaturation ≤94 % during the 1minSTS test provided 100 % sensitivity and 87 % specificity for oxygen desaturation ≤88 % at 6MWT.

Conclusion

This study demonstrates that exercise-induced oxygen desaturation during the 1minSTS test correlates with oxygen desaturation on 6MWT. The 1minSTS may be a practical screening tool for ILD patients who would benefit from further exercise testing.

背景：在间质性肺病（ILD）患者中，六分钟步行测试（6MWT）中运动诱发的血饱和度降低，特别是最低血氧饱和度（nSpO2）≤88%是一个负面的预后指标。由于 6MWT 对 ILD 患者来说往往不切实际，本研究旨在比较 1 分钟坐立测试（1minSTS）和 6MWT 以检测运动引起的血饱和度降低：方法：从一家三级转诊诊所招募参与者，在同一天进行这两项测试。利用布兰-阿尔特曼分析法确定了 1minSTS 和 6MWT nSpO2 之间的关系。接收器操作特征曲线下面积（AUC）确定了 1minSTS 测试 nSpO2 预测 6MWT SpO2 ≤88% 的能力：50 名参与者完成了研究（特发性肺纤维化 n=24.48%；结缔组织病相关 ILD n=20.40%；其他 ILD n=6.12%）。平均（标清）FVC%pred 为 73±16%，平均 DLCO%pred 为 57±16%，静息 SpO2 为 99±1%。1minSTS 导致的运动诱发氧饱和度降低，中位数 IQR nSpO2 分别为 95% (89-98) 和 93% (85-96)（pConclusion）：本研究表明，1minSTS 测试中运动诱发的血氧饱和度下降与 6MWT 的血氧饱和度下降相关。1minSTS 可能是一种实用的筛查工具，可用于筛查需要进行进一步运动测试的 ILD 患者。

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引用次数: 0

Prescriptions of respiratory medications in children aged 0–10 years: A longitudinal drug utilization study in the POMME database 0-10 岁儿童呼吸道用药处方：POMME 数据库中的纵向用药研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-24 DOI: 10.1016/j.rmed.2024.107741

Introduction

Respiratory tract disorders are common in children. However, there is no available data on the prescription of respiratory medications for children in France. This study aimed to provide an overview of medications for obstructive airway diseases prescriptions for children during the initial ten years of their lives within POMME, a French population-based cohort of children.

Material and methods

This longitudinal, population-based study used data from the French POMME birth cohort, comprising children born in Haute Garonne between July 2010 and June 2011. Anonymous medical information, including medication reimbursement data, was collected between ages 0 and 10 years. Exposure was defined as at least one prescription for respiratory medications (ATC code R03*), focusing on specific subclasses. Data were analyzed by age, season, and prescribing physicians' specialties.

Results

Out of 5956 children, 4951 (83.1 %) received respiratory medication prescriptions. Inhaled corticosteroids (ICSs) were the most prescribed (95.3 %), followed by short-acting β2-agonists (68.8 %). The number of prescriptions increased with age, except for ICSs alone, which peaked between 6 months and 2 years. The average number of prescriptions per child was relatively low.

Discussion

This study highlighted high prescription rates of respiratory medications in children under 10 years, with ICSs being the most prevalent. While these medications are primarily intended for asthma management, the findings suggested a significant proportion of off-label prescriptions, especially in young children. Further research and clinical guidance are warranted to ensure appropriate medication use in the pediatric population.

简介呼吸道疾病在儿童中很常见。然而，目前还没有关于法国儿童呼吸道疾病药物处方的数据。本研究旨在提供法国儿童人群队列（POMME）中儿童出生后最初十年的阻塞性气道疾病药物处方概况：这项基于人口的纵向研究使用了法国 POMME 出生队列的数据，该队列由 2010 年 7 月至 2011 年 6 月间在上加龙省出生的儿童组成。研究人员收集了0至10岁儿童的匿名医疗信息，包括药物报销数据。暴露定义为至少开过一次呼吸道药物处方（ATC代码R03*），重点关注特定亚类。数据按年龄、季节和处方医生的专业进行了分析：结果：在 5956 名儿童中，4951 名（83.1%）接受了呼吸道药物处方。吸入性皮质类固醇（ICS）是处方最多的药物（95.3%），其次是短效ß2-激动剂（68.8%）。除单用 ICS 外，处方数量随年龄增长而增加，在 6 个月至 2 岁期间达到高峰。每个儿童的平均处方数量相对较低。与春季过敏的预期相反，冬季的处方更频繁：本研究强调了 10 岁以下儿童呼吸道药物处方率高的问题，其中以 ICSs 最为普遍。虽然这些药物主要用于治疗哮喘，但研究结果表明，有相当一部分处方属于标签外用药，尤其是在幼儿中。有必要开展进一步研究并提供临床指导，以确保在儿童群体中合理用药。

{"title":"Prescriptions of respiratory medications in children aged 0–10 years: A longitudinal drug utilization study in the POMME database","authors":"","doi":"10.1016/j.rmed.2024.107741","DOIUrl":"10.1016/j.rmed.2024.107741","url":null,"abstract":"<div><h3>Introduction</h3><p>Respiratory tract disorders are common in children. However, there is no available data on the prescription of respiratory medications for children in France. This study aimed to provide an overview of medications for obstructive airway diseases prescriptions for children during the initial ten years of their lives within POMME, a French population-based cohort of children.</p></div><div><h3>Material and methods</h3><p>This longitudinal, population-based study used data from the French POMME birth cohort, comprising children born in Haute Garonne between July 2010 and June 2011. Anonymous medical information, including medication reimbursement data, was collected between ages 0 and 10 years. Exposure was defined as at least one prescription for respiratory medications (ATC code R03*), focusing on specific subclasses. Data were analyzed by age, season, and prescribing physicians' specialties.</p></div><div><h3>Results</h3><p>Out of 5956 children, 4951 (83.1 %) received respiratory medication prescriptions. Inhaled corticosteroids (ICSs) were the most prescribed (95.3 %), followed by short-acting β2-agonists (68.8 %). The number of prescriptions increased with age, except for ICSs alone, which peaked between 6 months and 2 years. The average number of prescriptions per child was relatively low.</p></div><div><h3>Discussion</h3><p>This study highlighted high prescription rates of respiratory medications in children under 10 years, with ICSs being the most prevalent. While these medications are primarily intended for asthma management, the findings suggested a significant proportion of off-label prescriptions, especially in young children. Further research and clinical guidance are warranted to ensure appropriate medication use in the pediatric population.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124002166/pdfft?md5=68ef434fede20811990bbbcf004faa60&pid=1-s2.0-S0954611124002166-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating the impact of short-term nitrate-rich dietary supplementation on endothelial function in COPD: A randomized crossover study 评估短期补充富含硝酸盐的膳食对慢性阻塞性肺病患者血管内皮功能的影响：一项随机交叉研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-24 DOI: 10.1016/j.rmed.2024.107745

Aim

This study aimed to investigate the acute effects of dietary nitrate ingestion through l-arginine supplementation or dehydrated beet consumption on endothelial function in chronic obstructive pulmonary disease (COPD) patients. The secondary outcome was to analyze arterial stiffness, plasma nitrate, and nitrate/protein concentration.

Methods

In this randomized crossover study, subjects with COPD underwent three series of supplementation: (1) l-arginine, (2) dehydrated beetroot, and (3) a placebo that appeared like the other supplements. Each intervention lasted 14 days, with a 7-day washout period between series. Participants underwent endothelial function assessment using flow-mediated dilatation (FMD), and plasma nitrate levels were measured at the end of each supplementation series.

Results

Seventeen subjects (twelve male) completed the study protocol. Only five subjects presented endothelial dysfunction (RHI ≤0.51) at baseline. The mean baseline characteristics included age 66.5 ± 9.4 years, BMI 27.5 ± 4.5 kg/m², FEV_1, 0.79 (0.67–1.06) L. There were no differences (p > 0.05) between the groups or from pre-to post-interventions for RHI and arterial stiffness index (AIx) values, as well as parameters of endothelium-dependent vasodilation, such as blood flow velocity (BFV), shear stress, shear rate, FMD (mm), and FMD%. There was also no differences (p > 0.05) between the groups or from pre-to post-interventions plasma nitrate levels.

Conclusions

Acute dietary supplementation with nitrates, at the doses provided, did not show a significant improvement in endothelial function assessed by FMD, EndoPAT, or plasma nitrate levels in COPD. These findings suggest that a higher dose or prolonged supplementation might be required to achieve a therapeutic effect.

目的：本研究旨在探讨通过补充左旋精氨酸或食用脱水甜菜摄入硝酸盐对慢性阻塞性肺病（COPD）患者内皮功能的急性影响。次要结果是分析动脉僵化、血浆硝酸盐和硝酸盐/蛋白质浓度：在这项随机交叉研究中，慢性阻塞性肺病患者接受了三个系列的补充剂治疗：（1）L-精氨酸；（2）脱水甜菜根；（3）与其他补充剂相似的安慰剂。每次干预持续 14 天，每个系列之间有 7 天的缓冲期。受试者通过血流介导的扩张（FMD）进行内皮功能评估，并在每个补充系列结束时测量血浆硝酸盐水平：结果：17 名受试者（12 名男性）完成了研究方案。只有五名受试者在基线时出现内皮功能障碍（RHI ≤ 0.51）。平均基线特征包括年龄 66.5 ± 9.4 岁，体重指数 27.5 ± 4.5 kg/m2，FEV1 0.79 (0.67 - 1.06) L。05）。在 RHI 和动脉僵化指数 (AIx) 值以及内皮依赖性血管舒张参数（如血流速度 (BFV)、剪应力、剪切率、FMD (mm) 和 FMD% 等）方面，各组之间或干预前与干预后之间均无差异。各组之间或干预前与干预后血浆硝酸盐水平也无差异（P > 0.05）：结论：在提供的剂量下，急性膳食补充硝酸盐并不能显著改善慢性阻塞性肺病患者的内皮功能（通过 FMD、EndoPAT 或血浆硝酸盐水平评估）。这些研究结果表明，可能需要更大剂量或更长时间的补充才能达到治疗效果。

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引用次数: 0

Five sessions of hyperbaric oxygen for critically ill patients with COVID-19-induced ARDS: A randomised, open label, phase II trial 对 COVID-19 诱导的 ARDS 重症患者进行五次高压氧治疗：随机、开放标签 II 期试验。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-24 DOI: 10.1016/j.rmed.2024.107744

Background

Few treatment options exist for patients with COVID–19–induced acute respiratory distress syndrome (ARDS). Data on the benefits and harms of hyperbaric oxygen treatment (HBOT) for this condition is limited.

Objective

To evaluate benefits and harms of HBOT in patients with COVID-19 induced ARDS.

Methods

In this open-label trial conducted at three hospitals in Sweden and Germany, patients with moderate to severe ARDS and at least two risk factors for unfavourable outcome, were randomly assigned (1:1) to medical oxygen 100 %, 2·4 Atmospheres absolute (ATA), 80 min (HBOT) adjuvant to best practice or to best practice alone (Control). Randomisation was stratified by sex and site. The primary endpoint was ICU admission by Day 30.

Results

Between June 4, 2020, and Dec 1, 2021, 34 subjects were randomised to HBOT (N = 18) or Control (N = 16). The trial was prematurely terminated for futility. There was no statistically significant difference in ICU admission, 5 (50 %) in Control vs 13 (72 %) in HBOT. OR 2·54 [95 % CI 0·62-10·39], p = 0·19.

Harms

102 adverse events (AEs) were recorded. 16 (94 %) subjects in the HBOT group and 14 (93 %) in the control group had at least one AE. Three serious adverse events (SAEs), were at least, possibly related to HBOT. All deaths were unlikely related to HBOT.

Conclusions

HBOT did not reduce ICU admission or mortality in patients with COVID–19–induced ARDS. The trial cannot conclude definitive benefits or harms. Treating COVID–19–induced ARDS with HBOT is feasible with a favourable harms profile.

背景：COVID-19诱发的急性呼吸窘迫综合征（ARDS）患者的治疗方案很少。有关高压氧治疗（HBOT）对这种疾病的益处和危害的数据十分有限：评估高压氧治疗对 COVID-19 诱导的 ARDS 患者的益处和危害：在瑞典和德国的三家医院进行的这项开放标签试验中，中度至重度 ARDS 患者且至少有两个不利预后的风险因素，被随机分配（1:1）至医用氧气 100%、2-4 个绝对大气压 (ATA)、80 分钟（HBOT），作为最佳治疗方法的辅助治疗或仅作为最佳治疗方法（对照组）。随机分组按性别和地点进行。主要终点是第30天入住ICU：2020年6月4日至2021年12月1日期间，34名受试者被随机分配到HBOT（18人）或对照组（16人）。试验因无效而提前终止。在入住重症监护室方面，对照组为 5 例（50%），而 HBOT 为 13 例（72%），两者之间的差异无统计学意义。不良反应：共记录 102 例不良反应（AEs）。HBOT组的16名受试者（94%）和对照组的14名受试者（93%）至少出现过一次AE。三起严重不良事件（SAE）至少可能与 HBOT 有关。所有死亡病例都不太可能与 HBOT 有关：HBOT并未减少COVID-19诱发的ARDS患者入住ICU的次数或死亡率。该试验无法得出明确的利弊结论。用HBOT治疗COVID-19诱发的ARDS是可行的，其危害也是有利的：瑞典研究理事会，资助编号：KBF 2019-00446。

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引用次数: 0

Major adverse cardiovascular outcomes within distinct pulmonary hypertension patterns in advanced chronic kidney disease: A retrospective cohort analysis 晚期慢性肾脏病肺动脉高压不同模式下的主要不良心血管后果：回顾性队列分析

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-23 DOI: 10.1016/j.rmed.2024.107743

引用次数: 0

A systematic review of the psychometric properties of the Leicester Cough Questionnaires based on the COSMIN guidelines 根据 COSMIN 指南对莱斯特咳嗽调查表的心理测量特性进行系统回顾。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-17 DOI: 10.1016/j.rmed.2024.107739

Background

Chronic cough affects around 10 % of the general adult population, impairing all aspects of quality of life.

Research question

What are the Leicester Cough Questionnaire's psychometric properties?

Study design and methods

Electronic searches of PubMed, CINAHL, and ScienceDirect databases were conducted from inception until October 1rst 2022. All full-text articles, published in French or English, aimed at evaluating the LCQ's content validity or psychometric properties were included. The COSMIN Risk of Bias checklist was applied to assess their methodological quality and results. Results were qualitatively summarised and rated by a modified GRADE approach.

Results

40 studies were included accounting for 8731 adults, subject to cough or a respiratory condition. Chronic cough (>8 weeks) was the most represented. The LCQ's total score is relevant and comprehensible for the assessment of the impact of cough on QoL. The original 3-factor model showed a satisfactory model fit. Good convergent validity was found for the total and physical domain scores. These scores demonstrate good internal consistency and test retest reliability, with some variability noted and they are responsive to change. Recent estimates of MID thresholds were 1.7 and 0.4 for total and domain scores respectively. The quality of the studies is globally poor.

Interpretation

The LCQ is a valid outcome to assess the intra-individual impact of cough on QoL and to detect large changes in quality of life mainly in a short-term clinical trial setting.

Clinical trial registration

The protocol was registered with PROSPERO (CRD42022355191).

研究背景研究问题：莱斯特咳嗽问卷的心理测量特性如何？研究设计与方法：从开始到 2022 年 10 月 1 日，对 PubMed、CINAHL 和 ScienceDirect 数据库进行了电子检索。纳入了所有以法语或英语发表的、旨在评估 LCQ 内容效度或心理测量学特性的全文文章。采用 COSMIN 偏倚风险检查表评估这些文章的方法学质量和结果。采用修改后的 GRADE 方法对结果进行定性总结和评级：共纳入 40 项研究，涉及 8731 名患有咳嗽或呼吸道疾病的成年人。慢性咳嗽（> 8 周）最具代表性。LCQ 的总分对于评估咳嗽对 QoL 的影响具有相关性和可理解性。最初的三因素模型显示出令人满意的模型拟合度。总分和躯体领域得分具有良好的收敛效度。这些分数显示出良好的内部一致性和重测可靠性，但也存在一定的变异性，而且对变化反应灵敏。最近估计的总分和领域分的 MID 临界值分别为 1.7 和 0.4。研究质量总体较差：LCQ是一项有效的结果，可用于评估咳嗽对QoL的个体内部影响，并主要在短期临床试验环境中检测生活质量的巨大变化：临床试验注册：该方案已在PROSPERO（CRD42XXXXX）注册。

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引用次数: 0

Subglottic dilatation in extremely preterm infants on prolonged mechanical ventilation 使用长期机械通气的极早产儿声门下扩张。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-16 DOI: 10.1016/j.rmed.2024.107736

Background

Airway injuries are reported among preterm infants with bronchopulmonary dysplasia. We hypothesized that prolonged ventilation in preterm infants is associated with subglottic dilatation that can be reliably evaluated by point of care ultrasonography (POCUS).

Methods

All preterm infants (<29-weeks) admitted to the neonatal ICU at the Advent-Health from January-2020 to June-2022 were eligible if they required invasive ventilation for ≤7 days in the first 28 days of life (control) or remained intubated for ≥28 days (prolonged ventilation). Sonography was performed by one technician and all images were reviewed by the pediatric radiologist. The trachea size was measured 3 times by randomly selecting three images. The first 20 scans were also independently reported by a different pediatric radiologist. Intra and inter-observer variability was estimated. Mean trachea size and weight at the time of imaging were compared.

Results

Out of 417 eligible infants; 11 died before 28 days and 163 required ventilation for 8–27 days. Consent missed for 80 infants during COVID-19 pandemic. We enrolled 23 and 28 infants in the control & prolonged ventilation groups, respectively. Inter and intra-observer correlations were 0.83 and 0.97 respectively. Infants in the control group had higher gestation and birth weight. Infants on prolonged ventilation were at higher risk for infections, BPD, longer hospital stay and significant subglottic dilation (4.51 ± 0.04 vs 4.17 ± 0.02 mm, p < 0.01) despite smaller body weight at the time of imaging (884 ± 102 vs 1059 ± 123g, p < 0.01).

Conclusion

Extremely preterm infants on prolonged ventilation are at risk for sub-glottic dilatation that can be reliably measured by POCUS.

背景：据报道，患有支气管肺发育不良的早产儿会出现气道损伤。我们假设早产儿长时间通气与声门下扩张有关，而声门下扩张可通过护理点超声波检查（POCUS）进行可靠评估：方法：所有早产儿（28 天（长期通气）。方法：所有早产儿（28 天（长期通气））均由一名技术人员进行超声波检查，所有图像均由儿科放射科医生审阅。随机抽取三张图像，测量气管大小 3 次。前 20 次扫描也由不同的儿科放射科医生独立报告。对观察者内部和观察者之间的差异性进行了估计。比较了气管的平均尺寸和成像时的体重：在 417 名符合条件的婴儿中，11 名在 28 天前死亡，163 名需要通气 8-27 天。在 COVID-19 大流行期间，80 名婴儿未获得同意。对照组和延长通气组分别有 23 名和 28 名婴儿。观察者之间和观察者内部的相关性分别为 0.83 和 0.97。对照组婴儿的孕期和出生体重较高。尽管造影时婴儿体重较轻（884+102 vs 1059+123g，p< 0.01），但接受延长通气的婴儿发生感染、BPD、住院时间延长和声门下显著扩张（4.51±0.04 vs 4.17±0.02mm，p< 0.01）的风险较高：结论：长期通气的极早产儿有声门下扩张的风险，而声门下扩张可通过 POCUS 进行可靠测量。

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引用次数: 0

The effect of pulmonary rehabilitation on cardiovascular risk, oxidative stress and systemic inflammation in patients with COPD 肺康复对慢性阻塞性肺病患者心血管风险、氧化应激和全身炎症的影响

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-14 DOI: 10.1016/j.rmed.2024.107740

Purpose

Chronic obstructive pulmonary disease (COPD) is a leading cause of death, and cardiovascular (CV) comorbidities play a role. Evidence of the pulmonary rehabilitation (PR) effect in reducing the CV risk (CVR) in COPD patients is limited. In this study, we aimed to determine the impact of an 8-week PR program (PRP) on the CVR of the overall population and to compare the impact on the exacerbator versus non-exacerbator patients.

Patients and methods

This was a prospective study that included adults who had post-bronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) ratio <70 % and FEV1 <80 % predicted, had quit smoking for at least 1 year and had a history of tobacco consumption greater than 10 packs/year, and were clinically stable in the last 8 weeks. Pre- and post-PRP assessments included respiratory function evaluation, laboratory tests, and exercise capacity assessment (6-min walking test [6MWT]). CVR was assessed using different risk prediction models.

Results

A total of 50 patients (28 exacerbators and 22 non-exacerbators) completed the PRP (median age: 64.5 years, men: 72 %; arterial hypertension: 70 %, dyslipidemia: 30 %, diabetes: 20 %; CV disease (CVD): 24 %. After the PRP, exacerbator patients showed a significant decrease in the CVR calculated by the COPDCoRi model (p < 0.001); patients with ≥30-m increase on the 6MWT showed statistically significant lower levels of glucose (p = 0.004), HbA1c (p = 0.004) and BODE index score (p = 0.026) compared to patients with <30-m increase.

Conclusions

PR reduced certain modifiable CVR factors and CVD risk, especially in exacerbator patients.

目的：慢性阻塞性肺病（COPD）是导致死亡的主要原因之一，心血管（CV）合并症在其中扮演着重要角色。有关肺康复（PR）在降低慢性阻塞性肺病患者心血管风险（CVR）方面效果的证据十分有限。在这项研究中，我们旨在确定为期 8 周的肺康复计划（PRP）对总体人群 CVR 的影响，并比较对病情加重患者和非病情加重患者的影响：这是一项前瞻性研究，研究对象包括支气管扩张后 1 秒用力呼气容积（FEV1）与用力肺活量（FVC）比值（FEV1/FVC）为 1 的成人：共有 50 名患者（28 名加重者和 22 名非加重者）完成了 PRP（中位年龄：64.5 岁，男性：72%；动脉高血压：70%，血脂异常：30%，糖尿病：20%；心血管疾病（CVD）：24%）。接受 PRP 治疗后，病情恶化患者通过 COPDCoRi 模型计算得出的 CVR 显著下降（p 结论：PRP 减少了某些可改变的 CVR：PR 降低了某些可改变的心血管疾病风险因素和心血管疾病风险，尤其是在病情加重的患者中。

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引用次数: 0