Pub Date : 2024-07-09DOI: 10.1016/j.rmed.2024.107738
Yeonkyung Park , Hyung-Jun Kim , Yeon Wook Kim , Byoung Soo Kwon , Yeon Joo Lee , Young-Jae Cho , Jae Ho Lee , Junghoon Kim , Jihang Kim , Kyung Hee Lee , Jong Sun Park
Background
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease of unknown etiology. The aim of this study was to evaluate the environmental and occupational risk factors of IPF.
Methods
This hospital-based, case-control study included 206 patients with IPF selected from the Seoul National University Bundang Hospital Interstitial Lung Disease registry and 167 controls without lung disease. Data on occupation, lifestyle, transportation, and types of environmental and occupational dust exposure were obtained using a questionnaire. IPF diagnosis was confirmed based on the recent guidelines, and the possibility of hypersensitivity pneumonitis was excluded. Multiple logistic regression was performed to determine the risk factors for IPF.
Results
After adjusting for age and sex, ever-smokers (odds ratio [OR], 2.35; 95 % confidence interval [CI]: 1.51–3.68) and individuals who smoked more than 30 pack-years (OR, 2.79; 95%CI: 1.70–4.68) showed an increased risk for IPF. Any occupational dust exposure (adjusted OR, 2.08; 95%CI: 1.19–3.72), especially exposure to chemicals (adjusted OR, 3.52; 99%CI: 1.56–9.05), was associated with IPF after adjusting for age, sex, and smoking.
Conclusions
Smoking and occupational dust exposure are associated with an increased risk for IPF. Both factors have dose and duration-dependent relationships with the risk for IPF.
{"title":"Occupational and environmental risk factors for idiopathic pulmonary fibrosis: A case-control study","authors":"Yeonkyung Park , Hyung-Jun Kim , Yeon Wook Kim , Byoung Soo Kwon , Yeon Joo Lee , Young-Jae Cho , Jae Ho Lee , Junghoon Kim , Jihang Kim , Kyung Hee Lee , Jong Sun Park","doi":"10.1016/j.rmed.2024.107738","DOIUrl":"10.1016/j.rmed.2024.107738","url":null,"abstract":"<div><h3>Background</h3><p>Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease of unknown etiology. The aim of this study was to evaluate the environmental and occupational risk factors of IPF.</p></div><div><h3>Methods</h3><p>This hospital-based, case-control study included 206 patients with IPF selected from the Seoul National University Bundang Hospital Interstitial Lung Disease registry and 167 controls without lung disease. Data on occupation, lifestyle, transportation, and types of environmental and occupational dust exposure were obtained using a questionnaire. IPF diagnosis was confirmed based on the recent guidelines, and the possibility of hypersensitivity pneumonitis was excluded. Multiple logistic regression was performed to determine the risk factors for IPF.</p></div><div><h3>Results</h3><p>After adjusting for age and sex, ever-smokers (odds ratio [OR], 2.35; 95 % confidence interval [CI]: 1.51–3.68) and individuals who smoked more than 30 pack-years (OR, 2.79; 95%CI: 1.70–4.68) showed an increased risk for IPF. Any occupational dust exposure (adjusted OR, 2.08; 95%CI: 1.19–3.72), especially exposure to chemicals (adjusted OR, 3.52; 99%CI: 1.56–9.05), was associated with IPF after adjusting for age, sex, and smoking.</p></div><div><h3>Conclusions</h3><p>Smoking and occupational dust exposure are associated with an increased risk for IPF. Both factors have dose and duration-dependent relationships with the risk for IPF.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591206","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}
Pub Date : 2024-07-09DOI: 10.1016/j.rmed.2024.107720
Background
Severe asthma (SA) presents a considerable healthcare challenge despite optimal standard treatment. Dupilumab, which is effective in type 2 (T2) SA patients, demonstrates variable responses, categorizing patients as non-responders, partial responders, or those achieving clinical remission. However, real-world response rates remain underexplored. Additionally, understanding the characteristics of patients achieving clinical remission is crucial for predicting favourable responses to dupilumab.
Objective
To investigate responder types and identify predictors of clinical remission and non-response induced by dupilumab in a real-world cohort of SA patients.
Methods
We analyzed retrospective data from SA patients undergoing dupilumab treatment in a study conducted at Franciscus Gasthuis & Vlietland hospital. Data were collected at baseline and at a 12 to 24-months follow-up (T = 12). Response rates were evaluated at T = 12. Predictors of non-response and clinical remission were investigated using multivariate logistic regression analysis with a stepwise forward variable selection approach.
Results
Among the 175 patients screened, 136 met the inclusion criteria. At T = 12, 31.6 % achieved clinical remission, 47.1 % were partial responders and 21.3 % were non-responders. Predictors associated with clinical remission included high baseline blood eosinophil counts (BEC) and male sex. Conversely, younger age at baseline, low baseline total immunoglobin E (IgE) and low baseline fractional exhaled nitric oxide (FeNO) levels were identified as predictors of non-response.
Conclusions
Dupilumab results in clinical disease remission in one-third of the treated patients. Clinical remission is predicted by high BEC and male sex, whereas low total IgE, low FeNO and younger age indicate a lower likelihood of response.
背景：严重哮喘（SA）是一项巨大的医疗挑战，尽管有最佳的标准治疗方法。杜比鲁单抗对2型（T2）哮喘患者有效，其反应不一，可将患者分为无应答者、部分应答者或达到临床缓解者。然而，真实世界的反应率仍未得到充分探索。此外，了解获得临床缓解的患者的特征对于预测对杜匹单抗的良好反应至关重要：目的：在现实世界的 SA 患者队列中调查应答者类型，并确定杜匹单抗诱导的临床缓解和无应答的预测因素：我们分析了在 Franciscus Gasthuis & Vlietland 医院进行的一项研究中接受杜比单抗治疗的 SA 患者的回顾性数据。我们收集了基线数据和 12-24 个月的随访数据（T=12）。在T=12时对反应率进行评估。采用逐步前向变量选择法进行多变量逻辑回归分析，对无应答和临床缓解的预测因素进行了研究：在筛选出的 175 名患者中，136 人符合纳入标准。在T=12时，31.6%的患者获得了临床缓解，47.1%为部分应答者，21.3%为无应答者。与临床缓解相关的预测因素包括高基线血液嗜酸性粒细胞计数（BEC）和男性。相反，基线年龄较小、基线总免疫球蛋白E（IgE）较低和基线部分呼出一氧化氮（FeNO）水平较低被认为是无应答的预测因素：结论：杜匹单抗可使三分之一的患者临床病情缓解。结论：杜匹单抗可使三分之一的患者临床病情得到缓解，高BEC和男性可预测临床缓解，而低总IgE、低FeNO和年轻则表明出现反应的可能性较低。
{"title":"Dupilumab responder types and predicting factors in patients with type 2 severe asthma: A real-world cohort study","authors":"","doi":"10.1016/j.rmed.2024.107720","DOIUrl":"10.1016/j.rmed.2024.107720","url":null,"abstract":"<div><h3>Background</h3><p>Severe asthma (SA) presents a considerable healthcare challenge despite optimal standard treatment. Dupilumab, which is effective in type 2 (T2) SA patients, demonstrates variable responses, categorizing patients as non-responders, partial responders, or those achieving clinical remission. However, real-world response rates remain underexplored. Additionally, understanding the characteristics of patients achieving clinical remission is crucial for predicting favourable responses to dupilumab.</p></div><div><h3>Objective</h3><p>To investigate responder types and identify predictors of clinical remission and non-response induced by dupilumab in a real-world cohort of SA patients.</p></div><div><h3>Methods</h3><p>We analyzed retrospective data from SA patients undergoing dupilumab treatment in a study conducted at Franciscus Gasthuis & Vlietland hospital. Data were collected at baseline and at a 12 to 24-months follow-up (T = 12). Response rates were evaluated at T = 12. Predictors of non-response and clinical remission were investigated using multivariate logistic regression analysis with a stepwise forward variable selection approach.</p></div><div><h3>Results</h3><p>Among the 175 patients screened, 136 met the inclusion criteria. At T = 12, 31.6 % achieved clinical remission, 47.1 % were partial responders and 21.3 % were non-responders. Predictors associated with clinical remission included high baseline blood eosinophil counts (BEC) and male sex. Conversely, younger age at baseline, low baseline total immunoglobin E (IgE) and low baseline fractional exhaled nitric oxide (FeNO) levels were identified as predictors of non-response.</p></div><div><h3>Conclusions</h3><p>Dupilumab results in clinical disease remission in one-third of the treated patients. Clinical remission is predicted by high BEC and male sex, whereas low total IgE, low FeNO and younger age indicate a lower likelihood of response.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591205","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}
Pub Date : 2024-07-08DOI: 10.1016/j.rmed.2024.107734
Background
Oral treprostinil is a prostacyclin analogue approved to treat pulmonary arterial hypertension (PAH) by delaying disease progression and improving exercise capacity. Higher doses of oral treprostinil correlate with increased treatment benefit. Titrations may be challenging due to common side effects of prostacyclin-class therapies.
Study design and methods
The multicenter, prospective, real-world, observational ADAPT Registry study followed adult patients with PAH for up to 78 weeks after initiating oral treprostinil (NCT03045029). Dosing, titration, and transitions of oral treprostinil were at the discretion of the prescriber. Patient-reported incidence and treatment of common side effects were collected to understand side effect management and tolerability. Insights from literature and expert recommendations were added to provide a consolidated resource for oral treprostinil use.
Results
In total, 139 participants in ADAPT completed ≥1 weekly survey; (median age 60.0 years, 76 % female). Median treatment duration of oral treprostinil was 13.1 months. During early therapy (Months 1–5), 62 % (78/126) of patients reported headache and diarrhea, and 40 % (50/126) reported nausea. At Month 6, many patients who reported side effects during early therapy reported an improvement (61 % headache, 44 % diarrhea, 70 % nausea). Common side effect treatments, including acetaminophen, loperamide, and ondansetron, were effective. Approximately one-quarter of patients reporting the most common side effects were untreated at Month 6.
Conclusion
Patient selection for, and initiation and titration of, oral treprostinil should be individualized and may include parenteral treprostinil induction-transition for faster titration. Assertive side effect management may help patients reach higher and more efficacious doses of oral treprostinil.
{"title":"Practical management of oral treprostinil in patients with pulmonary arterial hypertension: Lessons from ADAPT, EXPEDITE, and expert consensus","authors":"","doi":"10.1016/j.rmed.2024.107734","DOIUrl":"10.1016/j.rmed.2024.107734","url":null,"abstract":"<div><h3>Background</h3><p>Oral treprostinil is a prostacyclin analogue approved to treat pulmonary arterial hypertension (PAH) by delaying disease progression and improving exercise capacity. Higher doses of oral treprostinil correlate with increased treatment benefit. Titrations may be challenging due to common side effects of prostacyclin-class therapies.</p></div><div><h3>Study design and methods</h3><p>The multicenter, prospective, real-world, observational ADAPT Registry study followed adult patients with PAH for up to 78 weeks after initiating oral treprostinil (NCT03045029). Dosing, titration, and transitions of oral treprostinil were at the discretion of the prescriber. Patient-reported incidence and treatment of common side effects were collected to understand side effect management and tolerability. Insights from literature and expert recommendations were added to provide a consolidated resource for oral treprostinil use.</p></div><div><h3>Results</h3><p>In total, 139 participants in ADAPT completed ≥1 weekly survey; (median age 60.0 years, 76 % female). Median treatment duration of oral treprostinil was 13.1 months. During early therapy (Months 1–5), 62 % (78/126) of patients reported headache and diarrhea, and 40 % (50/126) reported nausea. At Month 6, many patients who reported side effects during early therapy reported an improvement (61 % headache, 44 % diarrhea, 70 % nausea). Common side effect treatments, including acetaminophen, loperamide, and ondansetron, were effective. Approximately one-quarter of patients reporting the most common side effects were untreated at Month 6.</p></div><div><h3>Conclusion</h3><p>Patient selection for, and initiation and titration of, oral treprostinil should be individualized and may include parenteral treprostinil induction-transition for faster titration. Assertive side effect management may help patients reach higher and more efficacious doses of oral treprostinil.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580730","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}
Pub Date : 2024-07-08DOI: 10.1016/j.rmed.2024.107737
Naina Sawal , Kelly M. Pennington , Robert Petrossian , Janani Reisenauer , John Mullon , David Midthun , Darlene Nelson , Dagny Anderson , Eric Edell , Sahar A. Saddoughi , Philip J. Spencer , Mauricio A. Villavicencio , Cassie C. Kennedy , John P. Scott , Steve G. Peters , Mark E. Wylam , Ryan M. Kern
Background
Airway stenting may be needed to manage anastomotic complications in lung transplant recipients. Conventional stenting strategies may be inadequate due to anatomic variations between the recipient and donor or involvement of both the anastomosis and lobar bronchi.
Methods
We investigated the efficacy of 3D-designed patient-specific silicone Y-stents in managing this scenario. 9 patients with complex airway stenosis underwent custom stent insertion after either failing traditional management strategies or having anatomy not suitable for conventional stents. CT images were uploaded to stent design software to make a virtual stent model. 3D printing technology was then used to make a mold for the final silicone stent which was implanted via rigid bronchoscopy. Forced expiratory volume in 1 s (FEV1) was measured pre- and post-stent placement.
Results
78 % of patients experienced an increase in their FEV1 after stent insertion, (p = 0.001, 0.02 at 30 and 90 days respectively). Unplanned bronchoscopies primarily occurred due to mucous plugging. 2 patients had sufficient airway remodeling allowing for stent removal.
Conclusions
Personalized 3D-designed Y-stents demonstrate promising results for managing complicated airway stenosis, offering improved lung function and potential long-term benefits for lung transplant recipients.
背景：肺移植受者可能需要气道支架来处理吻合口并发症。由于受者和供者的解剖结构不同，或吻合口和肺叶支气管均受累，传统的支架植入策略可能并不合适：我们研究了三维设计的患者特异性硅胶 Y 型支架在处理这种情况时的效果。9名复杂气道狭窄患者在传统治疗策略失败或解剖结构不适合传统支架后接受了定制支架植入术。CT 图像被上传到支架设计软件，以制作虚拟支架模型。然后利用 3D 打印技术为最终的硅树脂支架制作模具，并通过硬质支气管镜将其植入。支架植入前后的一秒钟用力呼气容积（FEV1）均进行了测量：结果：78% 的患者在支架植入后 FEV1 有所增加（30 天和 90 天时分别为 0.001 和 0.02）。非计划支气管镜检查主要是由于粘液堵塞。2名患者的气道重塑充分，可以取出支架：个性化三维设计的Y型支架在治疗复杂气道狭窄方面效果显著，可改善肺功能并为肺移植受者带来潜在的长期益处。
{"title":"Custom silicone Y-stents for the management of anastomotic stenosis in lung transplant recipients","authors":"Naina Sawal , Kelly M. Pennington , Robert Petrossian , Janani Reisenauer , John Mullon , David Midthun , Darlene Nelson , Dagny Anderson , Eric Edell , Sahar A. Saddoughi , Philip J. Spencer , Mauricio A. Villavicencio , Cassie C. Kennedy , John P. Scott , Steve G. Peters , Mark E. Wylam , Ryan M. Kern","doi":"10.1016/j.rmed.2024.107737","DOIUrl":"10.1016/j.rmed.2024.107737","url":null,"abstract":"<div><h3>Background</h3><p>Airway stenting may be needed to manage anastomotic complications in lung transplant recipients. Conventional stenting strategies may be inadequate due to anatomic variations between the recipient and donor or involvement of both the anastomosis and lobar bronchi.</p></div><div><h3>Methods</h3><p>We investigated the efficacy of 3D-designed patient-specific silicone Y-stents in managing this scenario. 9 patients with complex airway stenosis underwent custom stent insertion after either failing traditional management strategies or having anatomy not suitable for conventional stents. CT images were uploaded to stent design software to make a virtual stent model. 3D printing technology was then used to make a mold for the final silicone stent which was implanted via rigid bronchoscopy. Forced expiratory volume in 1 s (FEV1) was measured pre- and post-stent placement.</p></div><div><h3>Results</h3><p>78 % of patients experienced an increase in their FEV1 after stent insertion, (p = 0.001, 0.02 at 30 and 90 days respectively). Unplanned bronchoscopies primarily occurred due to mucous plugging. 2 patients had sufficient airway remodeling allowing for stent removal.</p></div><div><h3>Conclusions</h3><p>Personalized 3D-designed Y-stents demonstrate promising results for managing complicated airway stenosis, offering improved lung function and potential long-term benefits for lung transplant recipients.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580729","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}
Pub Date : 2024-07-08DOI: 10.1016/j.rmed.2024.107733
Marisa Fat , Tyler Andersen , Jane C. Fazio , Seon Cheol Park , Fereidoun Abtin , Russell G. Buhr , Jonathan E. Phillips , John Belperio , Donald P. Tashkin , Christopher B. Cooper , Igor Barjaktarevic
Introduction
Chronic Bronchitis (CB) represents a phenotype of chronic obstructive pulmonary disease (COPD). While several definitions have been used for diagnosis, the relationship between clinical definitions and radiologic assessment of bronchial disease (BD) has not been well studied. The aim of this study was to evaluate the relationship between three clinical definitions of CB and radiographic findings of BD in spirometry-defined COPD patients.
Methods
A cross-sectional analysis was performed from a COPD phenotyping study. It was a prospective observational cohort. Participants had spirometry-defined COPD and available chest CT imaging. Comparison between CB definitions, Medical Research Council (CBMRC), St. George's Respiratory Questionnaire (CBSGRQ), COPD Assessment Test (CBCAT) and CT findings were performed using Cohen's Kappa, univariate and multivariate logistic regressions.
Results
Of 112 participants, 83 met inclusion criteria. Demographics included age of 70.1 ± 7.0 years old, predominantly male (59.0 %), 45.8 ± 30.8 pack-year history, 21.7 % actively smoking, and mean FEV1 61.5 ± 21.1 %. With MRC, SGRQ and CAT definitions, 22.9 %, 36.6 % and 28.0 % had CB, respectively. BD was more often present in CB compared to non-CB patients; however, it did not have a statistically significant relationship between any of the CB definitions. CBSGRQ had better agreement with radiographically assessed BD compared to the other two definitions.
Conclusion
Identification of BD on CT was associated with the diagnoses of CB. However, agreement between imaging and definitions were not significant, suggesting radiologic findings of BD and criteria defining CB may not identify the same COPD phenotype. Research to standardize imaging and clinical methods is needed for more objective identification of COPD phenotypes.
{"title":"Association of bronchial disease on CT imaging and clinical definitions of chronic bronchitis in a single-center COPD phenotyping study","authors":"Marisa Fat , Tyler Andersen , Jane C. Fazio , Seon Cheol Park , Fereidoun Abtin , Russell G. Buhr , Jonathan E. Phillips , John Belperio , Donald P. Tashkin , Christopher B. Cooper , Igor Barjaktarevic","doi":"10.1016/j.rmed.2024.107733","DOIUrl":"10.1016/j.rmed.2024.107733","url":null,"abstract":"<div><h3>Introduction</h3><p>Chronic Bronchitis (CB) represents a phenotype of chronic obstructive pulmonary disease (COPD). While several definitions have been used for diagnosis, the relationship between clinical definitions and radiologic assessment of bronchial disease (BD) has not been well studied. The aim of this study was to evaluate the relationship between three clinical definitions of CB and radiographic findings of BD in spirometry-defined COPD patients.</p></div><div><h3>Methods</h3><p>A cross-sectional analysis was performed from a COPD phenotyping study. It was a prospective observational cohort. Participants had spirometry-defined COPD and available chest CT imaging. Comparison between CB definitions, Medical Research Council (CB<sub>MRC</sub>), St. George's Respiratory Questionnaire (CB<sub>SGRQ</sub>), COPD Assessment Test (CB<sub>CAT</sub>) and CT findings were performed using Cohen's Kappa, univariate and multivariate logistic regressions.</p></div><div><h3>Results</h3><p>Of 112 participants, 83 met inclusion criteria. Demographics included age of 70.1 ± 7.0 years old, predominantly male (59.0 %), 45.8 ± 30.8 pack-year history, 21.7 % actively smoking, and mean FEV<sub>1</sub> 61.5 ± 21.1 %. With MRC, SGRQ and CAT definitions, 22.9 %, 36.6 % and 28.0 % had CB, respectively. BD was more often present in CB compared to non-CB patients; however, it did not have a statistically significant relationship between any of the CB definitions. CB<sub>SGRQ</sub> had better agreement with radiographically assessed BD compared to the other two definitions.</p></div><div><h3>Conclusion</h3><p>Identification of BD on CT was associated with the diagnoses of CB. However, agreement between imaging and definitions were not significant, suggesting radiologic findings of BD and criteria defining CB may not identify the same COPD phenotype. Research to standardize imaging and clinical methods is needed for more objective identification of COPD phenotypes.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124002087/pdfft?md5=dab52c405e29f65af8bcc0e73d8905e0&pid=1-s2.0-S0954611124002087-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580728","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}
Pub Date : 2024-07-06DOI: 10.1016/j.rmed.2024.107735
Introduction
Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS.
Methods
Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored.
Results
Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study.
Conclusions
The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.
{"title":"Long-term myocardial effects of noninvasive ventilation in patients with obesity hypoventilation syndrome","authors":"","doi":"10.1016/j.rmed.2024.107735","DOIUrl":"10.1016/j.rmed.2024.107735","url":null,"abstract":"<div><h3>Introduction</h3><p>Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS.</p></div><div><h3>Methods</h3><p>Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored.</p></div><div><h3>Results</h3><p>Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m<sup>2</sup>) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study.</p></div><div><h3>Conclusions</h3><p>The present findings of increased <span>SV</span>, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable <span>OHS</span> and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559655","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}
Pub Date : 2024-07-05DOI: 10.1016/j.rmed.2024.107732
Morteza Ghojazadeh , Hadi Pourmanaf , Vahid Fekri , Saeid Nikoukheslat , Yasmin Nasoudi , Dean E. Mills
Introduction
Aerobic exercise training may reduce systemic inflammation, but the effects of this on systemic inflammatory markers in adult tobacco smokers has not been systematically reviewed. Therefore, we evaluated the effects of aerobic exercise training on C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in adult tobacco smokers using a systematic review and meta-analysis of randomized controlled trials.
Methods
A comprehensive literature search was carried out using PubMed/Medline, Web of Science, EMBASE, Google Scholar, and hand search of bibliographies of the retrieved English or Persian articles up to August 2023. This review only included randomized controlled trials which investigated the effect of aerobic exercise training on CRP and TNF-α in adult smokers, based on a predefined inclusion and exclusion criteria.
Results
A total of 1641 articles were identified. Six studies were included in the review and four evaluated CRP and two evaluated TNF-α in only males. The meta-analysis demonstrated that aerobic exercise training significantly decreased TNF-α concentrations in males (MD = −6.68, 95 % CI = −13.90 to −0.54, P = 0.05). CRP concentrations did not decrease significantly when the data from the four studies were pooled (MD = −0.17, 95 % CI = −0.37 to 0.03, P = 0.09).
Conclusion
Aerobic exercise training may reduce the concentration of TNF-α in male smokers, but it does not have a significant effect on CRP concentrations. However, these findings are based upon a small number of studies, that enrolled either exclusively male or female participants, and further investigation is necessary to increase statistical inference.
简介：有氧运动训练可减轻全身炎症，但其对成年烟草吸烟者全身炎症标志物的影响尚未得到系统研究。因此，我们通过对随机对照试验进行系统回顾和荟萃分析，评估了有氧运动训练对成年吸烟者体内 C 反应蛋白（CRP）和肿瘤坏死因子-α（TNF-α）的影响：使用 PubMed/Medline、Web of Science、EMBASE、Google Scholar 进行了全面的文献检索，并对检索到的截至 2023 年 8 月的英文或波斯文文章的书目进行了人工检索。根据预先确定的纳入和排除标准，本综述仅纳入研究有氧运动训练对成年吸烟者CRP和TNF-α影响的随机对照试验：结果：共发现了 1641 篇文章。六项研究被纳入综述，其中四项研究对CRP进行了评估，两项研究仅对男性的TNF-α进行了评估。荟萃分析表明，有氧运动训练可显著降低男性的 TNF-α 浓度（MD = -6.68，95% CI = -13.90 至 -0.54，P = 0.05）。将四项研究的数据汇总后，CRP浓度没有明显下降（MD = -0.17，95% CI = -0.37至0.03，P = 0.09）：结论：有氧运动训练可降低男性吸烟者体内 TNF-α 的浓度，但对 CRP 的浓度没有显著影响。然而，这些发现是基于少数几项研究得出的，这些研究只招募了男性或女性参与者，因此有必要进行进一步调查，以提高统计推断能力。
{"title":"The effects of aerobic exercise training on inflammatory markers in adult tobacco smokers: A systematic review and meta-analysis of randomized controlled trials","authors":"Morteza Ghojazadeh , Hadi Pourmanaf , Vahid Fekri , Saeid Nikoukheslat , Yasmin Nasoudi , Dean E. Mills","doi":"10.1016/j.rmed.2024.107732","DOIUrl":"10.1016/j.rmed.2024.107732","url":null,"abstract":"<div><h3>Introduction</h3><p>Aerobic exercise training may reduce systemic inflammation, but the effects of this on systemic inflammatory markers in adult tobacco smokers has not been systematically reviewed. Therefore, we evaluated the effects of aerobic exercise training on C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in adult tobacco smokers using a systematic review and meta-analysis of randomized controlled trials.</p></div><div><h3>Methods</h3><p>A comprehensive literature search was carried out using PubMed/Medline, Web of Science, EMBASE, Google Scholar, and hand search of bibliographies of the retrieved English or Persian articles up to August 2023. This review only included randomized controlled trials which investigated the effect of aerobic exercise training on CRP and TNF-α in adult smokers, based on a predefined inclusion and exclusion criteria.</p></div><div><h3>Results</h3><p>A total of 1641 articles were identified. Six studies were included in the review and four evaluated CRP and two evaluated TNF-α in only males. The meta-analysis demonstrated that aerobic exercise training significantly decreased TNF-α concentrations in males (MD = −6.68, 95 % CI = −13.90 to −0.54, <em>P</em> = 0.05). CRP concentrations did not decrease significantly when the data from the four studies were pooled (MD = −0.17, 95 % CI = −0.37 to 0.03, <em>P</em> = 0.09).</p></div><div><h3>Conclusion</h3><p>Aerobic exercise training may reduce the concentration of TNF-α in male smokers, but it does not have a significant effect on CRP concentrations. However, these findings are based upon a small number of studies, that enrolled either exclusively male or female participants, and further investigation is necessary to increase statistical inference.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124002075/pdfft?md5=6a756be8890db676aed0b119606e2b7f&pid=1-s2.0-S0954611124002075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545178","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}
Acute exacerbation of fibrosing interstitial lung disease (AE-FILD) is a serious condition with a high mortality rate. We aimed to comprehensively analyze cytokines in bronchoalveolar lavage fluid and their association with the clinical course of AE-FILD.
Methods
We retrospectively enrolled 60 patients with AE-FILD who underwent bronchoalveolar lavage. We comprehensively measured 44 cytokines and chemokines in the obtained bronchoalveolar lavage fluid using a Luminex analyzer. Patients were grouped into those who died within 90 days (non-survival group) and survived beyond 90 days (survival group) to investigate the association of the levels of cytokines and chemokines with mortality.
Results
The levels of matrix metalloproteinase 1 (p = 0.003), granulocyte-macrophage colony-stimulating factor (p = 0.040), interleukin 6 (p = 0.047), interleukin 8 (p = 0.050), monocyte chemoattractant protein-1 (p = 0.043), and eotaxin (p = 0.044) were significantly higher in the non-survival group than in the survival group. In the receiver operating characteristic analysis, their areas under the curve were 0.80, 0.68, 0.71, 0.70, 0.70, and 0.72, respectively. Using machine learning with these six cytokines and chemokines, the predictive accuracy for the survival group was 0.94.
Conclusions
Our study demonstrated that several cytokines and chemokines in bronchoalveolar lavage fluid could be prognostic predictors in patients with AE-FILD.
{"title":"Prognostic impact of cytokines and chemokines in bronchoalveolar lavage fluid on acute exacerbation of fibrosing interstitial lung disease","authors":"Katsuyuki Furuta , Daichi Fujimoto , Atsushi Matsunashi , Ryota Shibaki , Shinnosuke Taniya , Masanori Tanaka , Yuri Shimada , Kazuma Nagata , Keisuke Tomii , Nobuyuki Yamamoto","doi":"10.1016/j.rmed.2024.107721","DOIUrl":"10.1016/j.rmed.2024.107721","url":null,"abstract":"<div><h3>Background and objective</h3><p>Acute exacerbation of fibrosing interstitial lung disease (AE-FILD) is a serious condition with a high mortality rate. We aimed to comprehensively analyze cytokines in bronchoalveolar lavage fluid and their association with the clinical course of AE-FILD.</p></div><div><h3>Methods</h3><p>We retrospectively enrolled 60 patients with AE-FILD who underwent bronchoalveolar lavage. We comprehensively measured 44 cytokines and chemokines in the obtained bronchoalveolar lavage fluid using a Luminex analyzer. Patients were grouped into those who died within 90 days (non-survival group) and survived beyond 90 days (survival group) to investigate the association of the levels of cytokines and chemokines with mortality.</p></div><div><h3>Results</h3><p>The levels of matrix metalloproteinase 1 (<em>p</em> = 0.003), granulocyte-macrophage colony-stimulating factor (<em>p</em> = 0.040), interleukin 6 (<em>p</em> = 0.047), interleukin 8 (<em>p</em> = 0.050), monocyte chemoattractant protein-1 (<em>p</em> = 0.043), and eotaxin (<em>p</em> = 0.044) were significantly higher in the non-survival group than in the survival group. In the receiver operating characteristic analysis, their areas under the curve were 0.80, 0.68, 0.71, 0.70, 0.70, and 0.72, respectively. Using machine learning with these six cytokines and chemokines, the predictive accuracy for the survival group was 0.94.</p></div><div><h3>Conclusions</h3><p>Our study demonstrated that several cytokines and chemokines in bronchoalveolar lavage fluid could be prognostic predictors in patients with AE-FILD.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555419","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}
Pub Date : 2024-07-04DOI: 10.1016/j.rmed.2024.107724
Joshua A. Bishop , Lissa M. Spencer , Tiffany J. Dwyer , Zoe J. McKeough , Amanda McAnulty , Sonia Cheng , Jennifer A. Alison
Introduction
Very few studies have examined patterns of physical activity (PA) during a pulmonary rehabilitation (PR) program in people with COPD.
Aims
To compare the patterns of PA in: 1) the week before commencing PR (pre-PR) with a week during PR (PR week); 2) PR days and non-PR days during a PR week; 3) pre-PR and the week following PR completion (post PR).
Methods
This was a multicenter, prospective cohort study. Participants attended twice weekly supervised PR for 8-12 weeks. Daily step count (primary outcome), time in light activities, time in moderate to vigorous PA (MVPA), total sedentary time and sit-to-stand (STS) transitions were measured using a thigh worn accelerometer for seven days, at each assessment time point: pre-PR, PR week and post PR.
Results
29 participants, mean age (SD) 69years(7), FEV1 53%pred(16). The PR week compared to pre-PR, showed higher daily: step count (mean difference (95%CI)), 941steps(388–1494); and MVPA, 11mins(6–15), with no difference in: time in light activities, -1min(-6–5); total sedentary time, 7mins(-21–36); or STS transitions, 0(-5–6). PR days compared to non-PR days showed higher: step count, 2810steps(1706–3913); time in light activities 11mins(1–20); time in MVPA, 27mins(17–35) and STS transitions, 8(4–12), with no difference in total sedentary time: -33mins(-80–15). There were no differences in any PA measures post-PR compared to pre-PR (p<0.05).
Conclusion
Daily step count and time spent in MVPA increased significantly during the PR week, solely due to increased PA on days participants attended PR.
{"title":"Patterns of physical activity of people with COPD during participation in a pulmonary rehabilitation program.","authors":"Joshua A. Bishop , Lissa M. Spencer , Tiffany J. Dwyer , Zoe J. McKeough , Amanda McAnulty , Sonia Cheng , Jennifer A. Alison","doi":"10.1016/j.rmed.2024.107724","DOIUrl":"10.1016/j.rmed.2024.107724","url":null,"abstract":"<div><h3>Introduction</h3><p>Very few studies have examined patterns of physical activity (PA) during a pulmonary rehabilitation (PR) program in people with COPD.</p></div><div><h3>Aims</h3><p>To compare the patterns of PA in: 1) the week before commencing PR (pre-PR) with a week during PR (PR week); 2) PR days and non-PR days during a PR week; 3) pre-PR and the week following PR completion (post PR).</p></div><div><h3>Methods</h3><p>This was a multicenter, prospective cohort study. Participants attended twice weekly supervised PR for 8-12 weeks. Daily step count (primary outcome), time in light activities, time in moderate to vigorous PA (MVPA), total sedentary time and sit-to-stand (STS) transitions were measured using a thigh worn accelerometer for seven days, at each assessment time point: pre-PR, PR week and post PR.</p></div><div><h3>Results</h3><p>29 participants, mean age (SD) 69years(7), FEV<sub>1</sub> 53%pred(16). The PR week compared to pre-PR, showed higher daily: step count (mean difference (95%CI)), 941steps(388–1494); and MVPA, 11mins(6–15), with no difference in: time in light activities, -1min(-6–5); total sedentary time, 7mins(-21–36); or STS transitions, 0(-5–6). PR days compared to non-PR days showed higher: step count, 2810steps(1706–3913); time in light activities 11mins(1–20); time in MVPA, 27mins(17–35) and STS transitions, 8(4–12), with no difference in total sedentary time: -33mins(-80–15). There were no differences in any PA measures post-PR compared to pre-PR (p<0.05).</p></div><div><h3>Conclusion</h3><p>Daily step count and time spent in MVPA increased significantly during the PR week, solely due to increased PA on days participants attended PR.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001999/pdfft?md5=0ca08940eececdbd7e32531997765516&pid=1-s2.0-S0954611124001999-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545177","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}
Although the benefits of pulmonary rehabilitation (PR) in the management of chronic respiratory disease conditions (CRC) are well-documented, it remains underutilized. In Jordan, the scarcity of PR services denies those with CRC the opportunity to improve their functional capacity, mental health, and quality of life.
Objective
To explore the factors related to the implementation of PR in Jordan from the perspective of the healthcare professionals (HCPs).
Methods
This was a qualitative study that utilized semi-structured interviews informed by the Theoretical Domains Framework (TDF). Twenty-one HCPs were interviewed. Interview transcripts were coded against the relevant TDF domain(s) and then domains’ summaries were generated.
Results
A total of 997 quotes were coded against the TDF domains. Knowledge, environmental context and resources, social influences, and skills domains were the ones most coded. The study identified several barriers to PR implementation such as: limited knowledge and skills pertaining to PR among HCPs, limited public awareness of PR, financial costs, limited legislation related to establishment of PR and role confusion of HCPs in PR. The main facilitators include: HCPs willingness to be involved in new programs such as PR, the perception of the importance and need for PR and HCPs beliefs about capabilities to overcome barriers for a successful implementation of PR.
Conclusion
The current study provided information that will inform stakeholders and policymakers about the factors affecting PR implementation in Jordan. Improvements in HCPs skills and knowledge about PR, financial support, improvements in undergraduate syllabi and policies to control PR service provision are considered to be key to a successful implementation of PR.
{"title":"Factors related to the implementation of pulmonary rehabilitation in Jordan: Perspective of healthcare professionals","authors":"Adnan Wshah , Nisrin Alqatarneh , Saad Al-Nassan , Roger Goldstein","doi":"10.1016/j.rmed.2024.107728","DOIUrl":"10.1016/j.rmed.2024.107728","url":null,"abstract":"<div><h3>Background</h3><p>Although the benefits of pulmonary rehabilitation (PR) in the management of chronic respiratory disease conditions (CRC) are well-documented, it remains underutilized. In Jordan, the scarcity of PR services denies those with CRC the opportunity to improve their functional capacity, mental health, and quality of life.</p></div><div><h3>Objective</h3><p>To explore the factors related to the implementation of PR in Jordan from the perspective of the healthcare professionals (HCPs).</p></div><div><h3>Methods</h3><p>This was a qualitative study that utilized semi-structured interviews informed by the Theoretical Domains Framework (TDF). Twenty-one HCPs were interviewed. Interview transcripts were coded against the relevant TDF domain(s) and then domains’ summaries were generated.</p></div><div><h3>Results</h3><p>A total of 997 quotes were coded against the TDF domains. Knowledge, environmental context and resources, social influences, and skills domains were the ones most coded. The study identified several barriers to PR implementation such as: limited knowledge and skills pertaining to PR among HCPs, limited public awareness of PR, financial costs, limited legislation related to establishment of PR and role confusion of HCPs in PR. The main facilitators include: HCPs willingness to be involved in new programs such as PR, the perception of the importance and need for PR and HCPs beliefs about capabilities to overcome barriers for a successful implementation of PR.</p></div><div><h3>Conclusion</h3><p>The current study provided information that will inform stakeholders and policymakers about the factors affecting PR implementation in Jordan. Improvements in HCPs skills and knowledge about PR, financial support, improvements in undergraduate syllabi and policies to control PR service provision are considered to be key to a successful implementation of PR.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538500","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}
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