Respiratory medicine最新文献_第7页

Influence of heart failure (HF) comorbidity in chronic obstructive pulmonary disease (COPD) and isolated forms of HF and COPD on cardiovascular function during hospitalization 慢性阻塞性肺病（COPD）合并心力衰竭（HF）以及心力衰竭和慢性阻塞性肺病的单独形式对住院期间心血管功能的影响。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-04 DOI: 10.1016/j.rmed.2024.107731

Nathany Souza Schafauser , Luciana Maria Malosá Sampaio , Alessandro Domingues Heubel , Erika Zavaglia Kabbach , Débora Mayumi de Oliveira Kawakami , Naiara Tais Leonardi , Viviane Castello-Simões , Audrey Borghi-Silva , Renata Gonçalves Mendes

Introduction

Coexistence of chronic obstructive pulmonary disease(COPD) and heart failure(HF) is associated with systemic inflammation, myocardial injury, and arterial stiffening, impacting cardiovascular risk and prognosis in patients. Arterial stiffness, reduced nitric oxide synthesis, and altered cardiac autonomic control further link COPD and HF pathophysiology, emphasizing the need for comprehensive cardiovascular assessment.

Objective

To investigate a cardiovascular profile in patients hospitalized with exacerbation COPD(ECOPD) in coexistence with HF compared with isolated diseases.

Methods

A cross-sectional study including patients diagnosed with ECOPD and decompensated HF, approached between 24 and 48 h after hospital admission. Assessments included: endothelial function by brachial artery flow-mediated vasodilation(FMD); hemodynamic through analysis of pulse wave and arterial stiffness by carotid-femoral pulse wave velocity(cfPWV) and cardiac autonomic modulation(CAM) by heart rate variability(HRV).

Results

The mean FMD was 4.45 %, indicating endothelial dysfunction in all patients. Date is present in mean(confidence interval) sequency COPD(n = 12), COPD-HF(n = 21) and HF(n = 21). FMD: 5.47(3.96–6.91); 2.66(0.09–3.48); 4.60(2.30–6.43) p < 0.01. However, COPD-HF had worse FMD. Arterial stiffens (AIx: 29.0(19.0–42.6); 34.6(24.3–43.2); 14.5(8.0–24.0)p < 0.01; cfPWV: (6.5(5.4–7.2); 7.7(7.0–8.5); 6.0(5.0–6.5)); COPD-HF also showed greater activation of the sympathetic nervous system compared to patients with isolated diseases (PNS: 1.32(-2.53 to −0.62); −2.33(-2.60 to −2.12); −1.32(-1.42 to −1.01) p < 0.01; SNS: 3.50(1.40–8.55); 7.11(5.70–8.29); 2.32(1.78–5.01) p < 0.01). In addition, rMSSD, NN₅₀, pNN₅₀, and TINN also indicate worse CAM in the COPD-HF group compared to isolated diseases.

Conclusion

During hospitalization, the worst impairment in vascular function and cardiac autonomic modulation were found in patients with COPD and HF comorbidity compared to the isolated diseases(HF or COPD).

简介慢性阻塞性肺疾病（COPD）和心力衰竭（HF）并存与全身炎症、心肌损伤和动脉僵化有关，影响患者的心血管风险和预后。动脉僵化、一氧化氮合成减少和心脏自主神经控制的改变进一步将慢性阻塞性肺病和高血压的病理生理学联系起来，强调了对心血管进行全面评估的必要性：目的：研究慢性阻塞性肺病（ECOPD）并发高血压住院患者的心血管概况，并与单独的疾病进行比较：这是一项横断面研究，研究对象包括被诊断为慢性阻塞性肺病（ECOPD）和失代偿性高血压（HF）的患者，研究时间为入院后24至48小时。评估内容包括：通过肱动脉血流介导的血管舒张（FMD）评估内皮功能；通过颈动脉-股动脉脉搏波速度（cfPWV）分析脉搏波和动脉僵硬度评估血液动力学；通过心率变异性（HRV）评估心脏自主神经调节（CAM）：平均 FMD 为 4.45%，表明所有患者均存在内皮功能障碍。慢性阻塞性肺病（12 例）、慢性阻塞性肺病-高血压（21 例）和高血压（21 例）患者的平均（置信区间）序列中均存在 "日期"。FMD：5.47(3.96-6.91); 2.66(0.09-3.48); 4.60(2.30-6.43) p50、pNN50 和 TINN 也表明 COPD-HF 组的 CAM 比个别疾病更差：结论：在住院期间，慢性阻塞性肺病合并慢性阻塞性肺病患者的血管功能和心脏自主神经调节功能的受损程度比单独患病（慢性阻塞性肺病或慢性阻塞性肺病）的患者最严重。

{"title":"Influence of heart failure (HF) comorbidity in chronic obstructive pulmonary disease (COPD) and isolated forms of HF and COPD on cardiovascular function during hospitalization","authors":"Nathany Souza Schafauser , Luciana Maria Malosá Sampaio , Alessandro Domingues Heubel , Erika Zavaglia Kabbach , Débora Mayumi de Oliveira Kawakami , Naiara Tais Leonardi , Viviane Castello-Simões , Audrey Borghi-Silva , Renata Gonçalves Mendes","doi":"10.1016/j.rmed.2024.107731","DOIUrl":"10.1016/j.rmed.2024.107731","url":null,"abstract":"<div><h3>Introduction</h3><p>Coexistence of chronic obstructive pulmonary disease(COPD) and heart failure(HF) is associated with systemic inflammation, myocardial injury, and arterial stiffening, impacting cardiovascular risk and prognosis in patients. Arterial stiffness, reduced nitric oxide synthesis, and altered cardiac autonomic control further link COPD and HF pathophysiology, emphasizing the need for comprehensive cardiovascular assessment.</p></div><div><h3>Objective</h3><p>To investigate a cardiovascular profile in patients hospitalized with exacerbation COPD(ECOPD) in coexistence with HF compared with isolated diseases.</p></div><div><h3>Methods</h3><p>A cross-sectional study including patients diagnosed with ECOPD and decompensated HF, approached between 24 and 48 h after hospital admission. Assessments included: endothelial function by brachial artery flow-mediated vasodilation(FMD); hemodynamic through analysis of pulse wave and arterial stiffness by carotid-femoral pulse wave velocity(cfPWV) and cardiac autonomic modulation(CAM) by heart rate variability(HRV).</p></div><div><h3>Results</h3><p>The mean FMD was 4.45 %, indicating endothelial dysfunction in all patients. Date is present in mean(confidence interval) sequency COPD(n = 12), COPD-HF(n = 21) and HF(n = 21). FMD: 5.47(3.96–6.91); 2.66(0.09–3.48); 4.60(2.30–6.43) p < 0.01. However, COPD-HF had worse FMD. Arterial stiffens (AIx: 29.0(19.0–42.6); 34.6(24.3–43.2); 14.5(8.0–24.0)p < 0.01; cfPWV: (6.5(5.4–7.2); 7.7(7.0–8.5); 6.0(5.0–6.5)); COPD-HF also showed greater activation of the sympathetic nervous system compared to patients with isolated diseases (PNS: 1.32(-2.53 to −0.62); −2.33(-2.60 to −2.12); −1.32(-1.42 to −1.01) p < 0.01; SNS: 3.50(1.40–8.55); 7.11(5.70–8.29); 2.32(1.78–5.01) p < 0.01). In addition, rMSSD, NN<sub>50</sub>, pNN<sub>50</sub>, and TINN also indicate worse CAM in the COPD-HF group compared to isolated diseases.</p></div><div><h3>Conclusion</h3><p>During hospitalization, the worst impairment in vascular function and cardiac autonomic modulation were found in patients with COPD and HF comorbidity compared to the isolated diseases(HF or COPD).</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":"141538501","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: 0

The effect of pleural drainage on pulse oximetry in a post-operative thoracic surgery population 胸膜引流对胸外科术后人群脉搏氧饱和度的影响

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-02 DOI: 10.1016/j.rmed.2024.107727

Christopher R. Gilbert , Jason A. Akulian , Candice L. Wilshire , Samira Shojaee , Adam J. Bograd , Jed A. Gorden

Background

Pleural effusions in post-operative thoracic surgery patients are common. Effusions can result in prolonged hospitalizations or readmissions, with prior studies suggesting mixed effects of pleural drainage on hypoxia. We aimed to define the impact of pleural drainage on pulse oximetry (SpO2) in post-thoracic surgery patients.

Methods

A retrospective study of post-operative thoracic surgery patients undergoing pleural drainage was performed. SpO2 and supplemental oxygen (FiO2) values were recorded at pre- and post-procedure. The primary outcome was difference in pre-procedural and post-procedural SpO2.

Results

We identified 95 patients with a mean age of 65 (SD – 13.8) years undergoing 122 pleural drainage procedures. Mean drainage volume was 619 (SD–423) mL and the majority of procedures (88.5 %) included a drainage of <1000 mL. SpO2 was associated with an increase from 94.0 % (SD-2.6) to 97.3 % (SD-2.0) at 24-h (p < 0.0001). FiO2 was associated with a decrease from 0.31 (SD-0.15) to 0.29 (SD-0.12) at 24-h (p = 0.0081). SpO2/FiO2 was associated with an increase from 344.5 (SD-99.0) to 371.9 (SD-94.7) at 24-h post-procedure (p < 0.0001).

Conclusions

Pleural drainage within post-operative thoracic surgery patients offers statistically significant improvements in oxygen saturation by peripheral pulse oximetry and oxygen supplementation; however the clinical significance of these changes remains unclear. Pleural drainage itself may be requested for numerous reasons, including diagnostic (fevers, leukocytosis, etc.) or therapeutic (worsening dyspnea) evaluation. However, pleural drainage may offer minimal clinical impact on pulse oximetry in post-operative thoracic surgery patients.

背景：胸外科术后患者胸腔积液很常见。胸腔积液可导致住院时间延长或再次入院，之前的研究表明胸腔引流对缺氧的影响不一。我们旨在明确胸膜引流对胸外科术后患者脉搏血氧饱和度（SpO2）的影响：我们对接受胸腔引流术的胸外科术后患者进行了一项回顾性研究。记录了术前和术后的 SpO2 和补充氧 (FiO2) 值。主要结果是术前和术后 SpO2 的差异：我们发现 95 名患者接受了 122 次胸膜引流手术，平均年龄为 65 岁（SD - 13.8）。平均引流量为 619（SD-423）毫升，大多数手术（88.5%）包括引流结论：胸外科术后患者胸膜引流后，通过外周脉搏血氧仪和补氧，血氧饱和度有了统计学意义上的显著改善；但这些变化的临床意义仍不明确。要求进行胸腔引流的原因有很多，包括诊断性评估（发烧、白细胞增多等）或治疗性评估（呼吸困难恶化）。不过，胸膜引流对胸外科术后患者脉搏血氧饱和度的临床影响可能微乎其微。

{"title":"The effect of pleural drainage on pulse oximetry in a post-operative thoracic surgery population","authors":"Christopher R. Gilbert , Jason A. Akulian , Candice L. Wilshire , Samira Shojaee , Adam J. Bograd , Jed A. Gorden","doi":"10.1016/j.rmed.2024.107727","DOIUrl":"10.1016/j.rmed.2024.107727","url":null,"abstract":"<div><h3>Background</h3><p>Pleural effusions in post-operative thoracic surgery patients are common. Effusions can result in prolonged hospitalizations or readmissions, with prior studies suggesting mixed effects of pleural drainage on hypoxia. We aimed to define the impact of pleural drainage on pulse oximetry (SpO2) in post-thoracic surgery patients.</p></div><div><h3>Methods</h3><p>A retrospective study of post-operative thoracic surgery patients undergoing pleural drainage was performed. SpO2 and supplemental oxygen (FiO2) values were recorded at pre- and post-procedure. The primary outcome was difference in pre-procedural and post-procedural SpO2.</p></div><div><h3>Results</h3><p>We identified 95 patients with a mean age of 65 (SD – 13.8) years undergoing 122 pleural drainage procedures. Mean drainage volume was 619 (SD–423) mL and the majority of procedures (88.5 %) included a drainage of <1000 mL. SpO2 was associated with an increase from 94.0 % (SD-2.6) to 97.3 % (SD-2.0) at 24-h (p < 0.0001). FiO2 was associated with a decrease from 0.31 (SD-0.15) to 0.29 (SD-0.12) at 24-h (p = 0.0081). SpO2/FiO2 was associated with an increase from 344.5 (SD-99.0) to 371.9 (SD-94.7) at 24-h post-procedure (p < 0.0001).</p></div><div><h3>Conclusions</h3><p>Pleural drainage within post-operative thoracic surgery patients offers statistically significant improvements in oxygen saturation by peripheral pulse oximetry and oxygen supplementation; however the clinical significance of these changes remains unclear. Pleural drainage itself may be requested for numerous reasons, including diagnostic (fevers, leukocytosis, etc.) or therapeutic (worsening dyspnea) evaluation. However, pleural drainage may offer minimal clinical impact on pulse oximetry in post-operative thoracic surgery patients.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498808","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: 0

The complex link between sleep-disordered breathing and asthma control in pediatric patients: A cross-sectional study 儿科患者睡眠呼吸紊乱与哮喘控制之间的复杂联系：一项横断面研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-02 DOI: 10.1016/j.rmed.2024.107730

Cristian Locci , Mariangela V. Puci , Laura Saderi , Giovanni Sotgiu , Caterina Zanza , Roberto Antonucci

Background

In children, asthma and sleep-disordered breathing (SDB) may affect quality of life (QoL), and SDB may complicate asthma management.

Objective

To evaluate the prevalence of SDB, its association with asthma control, and risk factors associated with SDB in a cohort of asthmatic children. The effects of asthma control and SDB on QoL were also investigated.

Methods

We consecutively recruited asthmatic children referred to our Pulmonology Service from December 1, 2022 to May 31, 2023. Data on anthropometrics, respiratory function, and allergies were collected. The prevalence of SDB was assessed by the Pediatric Sleep Questionnaire (PSQ). Asthma control status was assessed by the Childhood Asthma Control Test (C-ACT), while QoL was evaluated by the Pediatric Quality of Life Inventory (PedsQL) questionnaire. Factors associated with SDB were analyzed.

Results

A total of 78 asthmatic children aged 5–12 years were included. SDB was found in 37.2% of them, with a higher prevalence in children with uncontrolled versus well-controlled asthma (60.1% vs. 27.3%; p-value = 0.005). The C-ACT score was significantly lower in SDB-positive versus SDB-negative group, and uncontrolled asthma (C-ACT ≤19) was associated with a 4.15-fold increased risk of SDB. The PedsQL score was significantly lower in asthmatic children with than without SDB and was associated with lower SDB risk. SDB increased the risk of uncontrolled asthma in children, and asthmatic children with SDB had lower QoL.

Conclusion

In asthmatic children, SDB affects both asthma control and QoL. Children with uncontrolled asthma should be referred for polysomnography to identify a possible underlying SDB.

背景：在儿童中，哮喘和睡眠呼吸障碍（SDB）可能会影响生活质量（QoL）：在儿童中，哮喘和睡眠呼吸障碍（SDB）可能会影响生活质量（QoL），而睡眠呼吸障碍可能会使哮喘治疗复杂化：目的：评估一组哮喘儿童中 SDB 的患病率、其与哮喘控制的关系以及与 SDB 相关的风险因素。此外，还调查了哮喘控制和 SDB 对 QoL 的影响：我们连续招募了 2022 年 12 月 1 日至 2023 年 5 月 31 日期间转诊至肺科的哮喘儿童。我们收集了有关人体测量学、呼吸功能和过敏症的数据。儿科睡眠问卷（PSQ）评估了SDB的患病率。哮喘控制状况通过儿童哮喘控制测试（C-ACT）进行评估，而生活质量则通过儿科生活质量量表（PedsQL）问卷进行评估。对与 SDB 相关的因素进行了分析：结果：共纳入 78 名 5-12 岁的哮喘儿童。其中 37.2% 的儿童患有 SDB，哮喘未得到控制的儿童与哮喘得到良好控制的儿童相比，SDB 患病率更高（60.1% 对 27.3%；P 值 =0.005）。SDB 阳性组的 C-ACT 评分明显低于 SDB 阴性组，哮喘未得到控制（C-ACT ≤19）与 SDB 风险增加 4.15 倍有关。有 SDB 的哮喘患儿的 PedsQL 评分明显低于无 SDB 的患儿，且与较低的 SDB 风险相关。SDB增加了儿童哮喘失控的风险，而患有SDB的哮喘儿童的QoL较低：在哮喘儿童中，SDB 会影响哮喘控制和 QoL。哮喘未得到控制的儿童应转诊进行多导睡眠图检查，以确定是否存在潜在的 SDB。

{"title":"The complex link between sleep-disordered breathing and asthma control in pediatric patients: A cross-sectional study","authors":"Cristian Locci , Mariangela V. Puci , Laura Saderi , Giovanni Sotgiu , Caterina Zanza , Roberto Antonucci","doi":"10.1016/j.rmed.2024.107730","DOIUrl":"10.1016/j.rmed.2024.107730","url":null,"abstract":"<div><h3>Background</h3><p>In children, asthma and sleep-disordered breathing (SDB) may affect quality of life (QoL), and SDB may complicate asthma management.</p></div><div><h3>Objective</h3><p>To evaluate the prevalence of SDB, its association with asthma control, and risk factors associated with SDB in a cohort of asthmatic children. The effects of asthma control and SDB on QoL were also investigated.</p></div><div><h3>Methods</h3><p>We consecutively recruited asthmatic children referred to our Pulmonology Service from December 1, 2022 to May 31, 2023. Data on anthropometrics, respiratory function, and allergies were collected. The prevalence of SDB was assessed by the Pediatric Sleep Questionnaire (PSQ). Asthma control status was assessed by the Childhood Asthma Control Test (C-ACT), while QoL was evaluated by the Pediatric Quality of Life Inventory (PedsQL) questionnaire. Factors associated with SDB were analyzed.</p></div><div><h3>Results</h3><p>A total of 78 asthmatic children aged 5–12 years were included. SDB was found in 37.2% of them, with a higher prevalence in children with uncontrolled versus well-controlled asthma (60.1% vs. 27.3%; p-value = 0.005). The C-ACT score was significantly lower in SDB-positive versus SDB-negative group, and uncontrolled asthma (C-ACT ≤19) was associated with a 4.15-fold increased risk of SDB. The PedsQL score was significantly lower in asthmatic children with than without SDB and was associated with lower SDB risk. SDB increased the risk of uncontrolled asthma in children, and asthmatic children with SDB had lower QoL.</p></div><div><h3>Conclusion</h3><p>In asthmatic children, SDB affects both asthma control and QoL. Children with uncontrolled asthma should be referred for polysomnography to identify a possible underlying SDB.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124002051/pdfft?md5=e363d3a4ef0556175b9ac00c25e923ba&pid=1-s2.0-S0954611124002051-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535154","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

Prevalence, incidence, and risk of chronic obstructive pulmonary disease among psoriasis patients 银屑病患者慢性阻塞性肺病的患病率、发病率和风险。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-02 DOI: 10.1016/j.rmed.2024.107729

Background

Understanding the relationship between psoriasis and chronic obstructive pulmonary disease (COPD) may enhance disease management.

Objectives

We aimed to determine the (1) prevalence and (2) incidence and risk of COPD in psoriasis patients.

Results

The COPD prevalence was 9.64 % in psoriasis patients and 6.94 % in psoriasis-free patients. The COPD incidence was 10.74 per 1000 person-years in psoriasis patients and 6.36 per 1000 person-years in psoriasis-free patients. Multivariable Cox regression showed no association between psoriasis and COPD development (HR 0.99, p = 0.271).

Conclusions

Our findings suggest that psoriasis is not an independent risk factor for COPD development.

背景：了解银屑病与慢性阻塞性肺病（COPD）之间的关系有助于加强疾病管理：我们旨在确定银屑病患者（1）慢性阻塞性肺病的患病率和（2）发病率及风险：结果：银屑病患者的慢性阻塞性肺病患病率为 9.64%，无银屑病患者的患病率为 6.94%。银屑病患者的慢性阻塞性肺病发病率为每千人年 10.74 例，无银屑病患者为每千人年 6.36 例。多变量考克斯回归结果显示，银屑病与慢性阻塞性肺病的发病之间没有关联（HR 0.99，P = 0.271）：我们的研究结果表明，银屑病不是慢性阻塞性肺病发病的独立风险因素。

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 : 2024-07-01 DOI: 10.2139/ssrn.4785362

Anders Kjellberg, Johan Douglas, Michael T. Pawlik, Adrian Hassler, S. Al-Ezerjawi, Emil Boström, L. Abdel-Halim, Lovisa Liwenborg, Anna-Dora Jonasdottir-Njåstad, Jan Kowalski, S. Catrina, K. Rodriguez-Wallberg, Peter Lindholm

BACKGROUNDFew 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.OBJECTIVETo evaluate benefits and harms of HBOT in patients with COVID-19 induced ARDS.METHODSIn 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 minutes (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.RESULTSBetween 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.HARMS102 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.CONCLUSIONSHBOT 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.FUNDINGSwedish Research Council, grant number KBF 2019-00446.

背景COVID-19诱发的急性呼吸窘迫综合征（ARDS）患者的治疗选择很少。有关高压氧治疗（HBOT）对这种疾病的益处和危害的数据非常有限。目的评估高压氧治疗对 COVID-19 诱导的 ARDS 患者的益处和危害。方法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）辅助最佳治疗或单独最佳治疗（对照组）。随机分组按性别和地点进行。结果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。记录的不良事件（AEs）为 HARMS102。HBOT组16名受试者（94%）和对照组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。结论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。

{"title":"Five sessions of Hyperbaric Oxygen for critically ill patients with COVID-19-induced ARDS: a randomised, open label, phase II trial.","authors":"Anders Kjellberg, Johan Douglas, Michael T. Pawlik, Adrian Hassler, S. Al-Ezerjawi, Emil Boström, L. Abdel-Halim, Lovisa Liwenborg, Anna-Dora Jonasdottir-Njåstad, Jan Kowalski, S. Catrina, K. Rodriguez-Wallberg, Peter Lindholm","doi":"10.2139/ssrn.4785362","DOIUrl":"https://doi.org/10.2139/ssrn.4785362","url":null,"abstract":"BACKGROUND\u0000Few 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.\u0000\u0000\u0000OBJECTIVE\u0000To evaluate benefits and harms of HBOT in patients with COVID-19 induced ARDS.\u0000\u0000\u0000METHODS\u0000In 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 minutes (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.\u0000\u0000\u0000RESULTS\u0000Between 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.\u0000\u0000\u0000HARMS\u0000102 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.\u0000\u0000\u0000CONCLUSIONS\u0000HBOT 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.\u0000\u0000\u0000FUNDING\u0000Swedish Research Council, grant number KBF 2019-00446.","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850104","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: 0

Using the phase III slope of exhaled methane during a single breath DLCO test to assess ventilation heterogeneity 利用单次呼吸 DLCO 测试期间呼出甲烷的第三阶段斜率来评估通气异质性。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-06-29 DOI: 10.1016/j.rmed.2024.107725

David A. Kaminsky , Vishwanath T. Anekonda , Sylvia Verbanck , Brian L. Graham

Background

The Phase III slope from a single breath nitrogen washout test provides information about ventilation heterogeneity (VH) in the lungs.

Purpose

To determine if the Phase III slope from the exhaled tracer gas concentration during a standard, single breath D_LCO test using rapid gas analysis provides similar information about VH.

Basic procedures

Retrospective analysis of clinical pulmonary function laboratory data including spirometry, lung volumes, and D_LCO. The normalized Phase III slope from the exhaled CH₄ concentration (SnCH₄) was compared among different patterns of physiologic abnormality and with VA/TLC as an indicator of VH.

Main findings

SnCH₄ was the steepest in the group with “Obstruction and Low D_LCO”, with significant differences between this group and the “Normal”, “Obstruction with Normal D_LCO”, “Mixed Obstruction and Restriction” and “Isolated Low D_LCO” groups. SnCH₄ was steeper in current and former smokers compared to non-smokers. Among the entire study sample, SnCH₄ correlated with VA/TLC (Spearman rho = −0.56, p < 0.01) and remained a significant determinant of VA/TLC by regression modeling.

Principal conclusions

The SnCH₄ derived from a standard, single breath D_LCO test using rapid gas analysis varied among distinct patterns of physiologic abnormalities and was associated with VA/TLC as a measure of VH.

背景：目的：确定在使用快速气体分析方法进行标准单次呼吸 DLCO 测试时，从呼出示踪气体浓度得出的 III 期斜率是否能提供类似的 VH 信息：基本程序：回顾性分析临床肺功能实验室数据，包括肺活量、肺容积和 DLCO。将呼出甲烷浓度（SnCH4）的归一化第三阶段斜率与不同的生理异常模式进行比较，并将其与作为 VH 指标的 VA/TLC 进行比较：SnCH4在 "阻塞和低DLCO "组中最陡峭，该组与 "正常 "组、"阻塞和正常DLCO "组、"混合阻塞和限制 "组和 "孤立低DLCO "组之间存在显著差异。与非吸烟者相比，吸烟者和曾经吸烟者的 SnCH4 更陡峭。在整个研究样本中，SnCH4 与 VA/TLC 相关（Spearman rho = -0.56，p 主要结论：使用快速气体分析法进行标准单次呼吸 DLCO 测试得出的 SnCH4 因不同的生理异常模式而异，并与作为 VH 测量指标的 VA/TLC 相关。

{"title":"Using the phase III slope of exhaled methane during a single breath DLCO test to assess ventilation heterogeneity","authors":"David A. Kaminsky , Vishwanath T. Anekonda , Sylvia Verbanck , Brian L. Graham","doi":"10.1016/j.rmed.2024.107725","DOIUrl":"10.1016/j.rmed.2024.107725","url":null,"abstract":"<div><h3>Background</h3><p>The Phase III slope from a single breath nitrogen washout test provides information about ventilation heterogeneity (VH) in the lungs.</p></div><div><h3>Purpose</h3><p>To determine if the Phase III slope from the exhaled tracer gas concentration during a standard, single breath D<sub>L</sub>CO test using rapid gas analysis provides similar information about VH.</p></div><div><h3>Basic procedures</h3><p>Retrospective analysis of clinical pulmonary function laboratory data including spirometry, lung volumes, and D<sub>L</sub>CO. The normalized Phase III slope from the exhaled CH<sub>4</sub> concentration (SnCH<sub>4</sub>) was compared among different patterns of physiologic abnormality and with VA/TLC as an indicator of VH.</p></div><div><h3>Main findings</h3><p>SnCH<sub>4</sub> was the steepest in the group with “Obstruction and Low D<sub>L</sub>CO”, with significant differences between this group and the “Normal”, “Obstruction with Normal D<sub>L</sub>CO”, “Mixed Obstruction and Restriction” and “Isolated Low D<sub>L</sub>CO” groups. SnCH<sub>4</sub> was steeper in current and former smokers compared to non-smokers. Among the entire study sample, SnCH<sub>4</sub> correlated with VA/TLC (Spearman rho = −0.56, p < 0.01) and remained a significant determinant of VA/TLC by regression modeling.</p></div><div><h3>Principal conclusions</h3><p>The SnCH<sub>4</sub> derived from a standard, single breath D<sub>L</sub>CO test using rapid gas analysis varied among distinct patterns of physiologic abnormalities and was associated with VA/TLC as a measure of VH.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477331","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: 0

Lung volume recruitment and airway clearance for children at home in France 法国家庭儿童的肺活量招募和气道通畅情况。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-06-29 DOI: 10.1016/j.rmed.2024.107726

Sonia Khirani , Lucie Griffon , Charlotte Thébault , Guillaume Aubertin , Pierre Dupont , Blaise Mbieleu , François Galodé , Coline Canavesio , Emmanuelle Fleurence , Géraldine Labouret , Pierrick Cros , Audrey Barzic , Marc Lubrano Lavadera , Lisa Giovannini-Chami , Jean-Marc Gilardoni , Pierre Gourdan , Johan Moreau , Stefan Matecki , Françoise Zitvogel , Marine Durand , Brigitte Fauroux

Background

Airway clearance (ACT) and lung volume recruitment (LVR) techniques are used to manage bronchial secretions, increase cough efficiency and lung/chest wall recruitment, to prevent and treat respiratory tract infections. The aim of the study was to review the prescription of ACT/LVR techniques for home use in children in France.

Methods

All the centers of the national pediatric noninvasive ventilation (NIV) network were invited to fill in an anonymous questionnaire for every child aged ≤20 years who started a treatment with an ACT/LVR device between 2022 and 2023. The devices comprised mechanical in-exsufflation (MI-E), intermittent positive pressure breathing (IPPB), intrapulmonary percussive ventilation (IPV), and/or invasive mechanical ventilation (IMV)/NIV for ACT/LVR.

Results

One hundred and thirty-nine patients were included by 13 centers. IPPB was started in 83 (60 %) patients, MI-E in 43 (31 %) and IPV in 30 (22 %). No patient used IMV/NIV for ACT/LVR. The devices were prescribed mainly by pediatric pulmonologists (103, 74 %). Mean age at initiation was 8.9 ± 5.6 (0.4–18.5) years old. The ACT/LVR devices were prescribed mainly in patients with neuromuscular disorders (n = 66, 47 %) and neurodisability (n = 37, 27 %). The main initiation criteria were cough assistance (81 %) and airway clearance (60 %) for MI-E, thoracic mobilization (63 %) and vital capacity (47 %) for IPPB, and airway clearance (73 %) and repeated respiratory exacerbations (57 %) for IPV. The parents were the main carers performing the treatment at home.

Conclusions

IPPB was the most prescribed technique. Diseases and initiation criteria are heterogeneous, underlining the need for studies validating the indications and settings of these techniques.

背景：气道清除（ACT）和肺容积扩张（LVR）技术用于管理支气管分泌物、提高咳嗽效率和肺/胸壁扩张，以预防和治疗呼吸道感染。本研究旨在回顾法国儿童家庭使用 ACT/LVR 技术的处方情况：方法：邀请全国儿科无创通气（NIV）网络的所有中心填写一份匿名调查问卷，调查对象为 2022 年至 2023 年期间开始使用 ACT/LVR 设备进行治疗的所有 20 岁以下儿童。这些设备包括机械通气（MI-E）、间歇正压呼吸（IPPB）、肺内冲击通气（IPV）和/或有创机械通气（IMV）/NIV，用于ACT/LVR：13 个中心共纳入 139 名患者。83例（60%）患者开始使用IPPB，43例（31%）开始使用MI-E，30例（22%）开始使用IPV。没有患者在进行 ACT/LVR 时使用 IMV/NIV。这些设备主要由儿科肺科医生开具处方（103 人，占 74%）。开始使用时的平均年龄为 8.9±5.6 (0.4-18.5) 岁。ACT/LVR设备主要用于神经肌肉疾病患者（66人，占47%）和神经残疾患者（37人，占27%）。MI-E的主要启动标准是咳嗽辅助（81%）和气道通畅（60%），IPPB的主要启动标准是胸廓移动（63%）和生命容量（47%），IPV的主要启动标准是气道通畅（73%）和反复呼吸加重（57%）。父母是在家中进行治疗的主要照料者：IPPB是处方最多的技术。疾病和启动标准各不相同，因此需要对这些技术的适应症和设置进行研究验证。

{"title":"Lung volume recruitment and airway clearance for children at home in France","authors":"Sonia Khirani , Lucie Griffon , Charlotte Thébault , Guillaume Aubertin , Pierre Dupont , Blaise Mbieleu , François Galodé , Coline Canavesio , Emmanuelle Fleurence , Géraldine Labouret , Pierrick Cros , Audrey Barzic , Marc Lubrano Lavadera , Lisa Giovannini-Chami , Jean-Marc Gilardoni , Pierre Gourdan , Johan Moreau , Stefan Matecki , Françoise Zitvogel , Marine Durand , Brigitte Fauroux","doi":"10.1016/j.rmed.2024.107726","DOIUrl":"10.1016/j.rmed.2024.107726","url":null,"abstract":"<div><h3>Background</h3><p>Airway clearance (ACT) and lung volume recruitment (LVR) techniques are used to manage bronchial secretions, increase cough efficiency and lung/chest wall recruitment, to prevent and treat respiratory tract infections. The aim of the study was to review the prescription of ACT/LVR techniques for home use in children in France.</p></div><div><h3>Methods</h3><p>All the centers of the national pediatric noninvasive ventilation (NIV) network were invited to fill in an anonymous questionnaire for every child aged ≤20 years who started a treatment with an ACT/LVR device between 2022 and 2023. The devices comprised mechanical in-exsufflation (MI-E), intermittent positive pressure breathing (IPPB), intrapulmonary percussive ventilation (IPV), and/or invasive mechanical ventilation (IMV)/NIV for ACT/LVR.</p></div><div><h3>Results</h3><p>One hundred and thirty-nine patients were included by 13 centers. IPPB was started in 83 (60 %) patients, MI-E in 43 (31 %) and IPV in 30 (22 %). No patient used IMV/NIV for ACT/LVR. The devices were prescribed mainly by pediatric pulmonologists (103, 74 %). Mean age at initiation was 8.9 ± 5.6 (0.4–18.5) years old. The ACT/LVR devices were prescribed mainly in patients with neuromuscular disorders (n = 66, 47 %) and neurodisability (n = 37, 27 %). The main initiation criteria were cough assistance (81 %) and airway clearance (60 %) for MI-E, thoracic mobilization (63 %) and vital capacity (47 %) for IPPB, and airway clearance (73 %) and repeated respiratory exacerbations (57 %) for IPV. The parents were the main carers performing the treatment at home.</p></div><div><h3>Conclusions</h3><p>IPPB was the most prescribed technique. Diseases and initiation criteria are heterogeneous, underlining the need for studies validating the indications and settings of these techniques.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124002014/pdfft?md5=7cad6c4b3040204ff111613a0e870f63&pid=1-s2.0-S0954611124002014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477330","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

Corrigendum to “Salbutamol Easyhaler provides non-inferior relief of methacholine induced bronchoconstriction in comparison to Ventoline Evohaler with spacer: A randomized trial” [Respir. Med. 230 (2024) 107693] 沙丁胺醇简易吸入器与带缓释器的万托林缓释器相比，对甲氧胆碱诱发的支气管收缩的缓解效果并无差别：随机试验"[Respir. Med.

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-06-25 DOI: 10.1016/j.rmed.2024.107715

Jussi Karjalainen , Ville Vartiainen , Antti Tikkakoski , L. Pekka Malmberg , Liisa Vuotari , Satu Lähelmä , Ulla Sairanen , Mikko Vahteristo , Lauri Lehtimaki

引用次数: 0

Direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension patients: A retrospective cohort study 治疗慢性血栓栓塞性肺动脉高压患者的直接口服抗凝剂：回顾性队列研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-06-25 DOI: 10.1016/j.rmed.2024.107722

Ling-Tao Chong , Song Hu , Ting-Ting Guo , Xin Gao , Jiang-Shan Tan , Zhi-Qiang Liu , Yuan-Rui Deng , Yi-Xiao Wei , Lu Hua

Introduction

Direct oral anticoagulants (DOACs) are increasingly prescribed for life-long anticoagulation in chronic thromboembolic pulmonary hypertension (CTEPH) patients, despite not being recommended in the guidelines. This study aims to evaluate the efficacy and safety of DOACs in CTEPH patients.

Methods

From May 2013 to December 2022, patients who were first diagnosed with CTEPH in Fuwai Hospital and started long-term anticoagulation treatment with warfarin or DOACs were retrospectively included and followed up until (1) death, (2) transition to other kinds of anticoagulants, or (3) discontinuation of anticoagulation. Propensity score matching was used to balance confounding bias of baseline characteristics. All-cause death, major bleeding, clinically relevant nonmajor bleeding and venous thromboembolism (VTE) recurrence were obtained and analysed.

Results

After propensity score matching, 115 patients taking warfarin and 206 patients taking DOACs were included in our study and followed up for 5.5 [3.4, 7.1] years. There was no significant difference of survival between the warfarin and the DOAC group (p = 0.77). The exposure adjusted event rate of major bleeding (0.3 %/person-year vs 0.4 %/person-year, p = 0.705) and clinically relevant nonmajor bleeding (3.1 %/person-year vs 3.2 %/person-year, p > 0.999) was similar between two groups. The exposure adjusted rate of VTE recurrence was significantly higher in the DOAC group (1.5 %/person-year vs 0.3 %/person-year, p = 0.030).

Conclusion

In anticoagulation of CTEPH patients, DOACs have similar survival rate, similar risk of bleeding but higher risk of VTE recurrence than warfarin.

简介：直接口服抗凝药（DOACs）越来越多地被用于慢性血栓栓塞性肺动脉高压（CTEPH）患者的终身抗凝治疗，尽管指南并未推荐使用。本研究旨在评估 DOACs 在 CTEPH 患者中的疗效和安全性：回顾性纳入2013年5月至2022年12月期间在阜外医院首次确诊为CTEPH并开始接受华法林或DOACs长期抗凝治疗的患者，并随访至(1)死亡、(2)转用其他抗凝药物或(3)停止抗凝治疗。采用倾向评分匹配法平衡基线特征的混杂偏差。获得并分析了全因死亡、大出血、临床相关非大出血和静脉血栓栓塞症（VTE）复发情况：经过倾向评分匹配后，115 名服用华法林的患者和 206 名服用 DOACs 的患者被纳入研究，随访时间为 5.5 [3.4, 7.1] 年。华法林组和 DOAC 组的生存率无明显差异（P = 0.77）。经暴露调整后，两组的大出血（0.3%/人-年 vs 0.4%/人-年，p = 0.705）和临床相关非大出血（3.1%/人-年 vs 3.2%/人-年，p > 0.999）发生率相似。DOAC组的暴露调整后VTE复发率明显更高（1.5%/人-年 vs 0.3%/人-年，p = 0.030）：结论：在 CTEPH 患者的抗凝治疗中，与华法林相比，DOAC 的存活率相似，出血风险相似，但 VTE 复发风险更高。

{"title":"Direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension patients: A retrospective cohort study","authors":"Ling-Tao Chong , Song Hu , Ting-Ting Guo , Xin Gao , Jiang-Shan Tan , Zhi-Qiang Liu , Yuan-Rui Deng , Yi-Xiao Wei , Lu Hua","doi":"10.1016/j.rmed.2024.107722","DOIUrl":"10.1016/j.rmed.2024.107722","url":null,"abstract":"<div><h3>Introduction</h3><p>Direct oral anticoagulants (DOACs) are increasingly prescribed for life-long anticoagulation in chronic thromboembolic pulmonary hypertension (CTEPH) patients, despite not being recommended in the guidelines. This study aims to evaluate the efficacy and safety of DOACs in CTEPH patients.</p></div><div><h3>Methods</h3><p>From May 2013 to December 2022, patients who were first diagnosed with CTEPH in Fuwai Hospital and started long-term anticoagulation treatment with warfarin or DOACs were retrospectively included and followed up until (1) death, (2) transition to other kinds of anticoagulants, or (3) discontinuation of anticoagulation. Propensity score matching was used to balance confounding bias of baseline characteristics. All-cause death, major bleeding, clinically relevant nonmajor bleeding and venous thromboembolism (VTE) recurrence were obtained and analysed.</p></div><div><h3>Results</h3><p>After propensity score matching, 115 patients taking warfarin and 206 patients taking DOACs were included in our study and followed up for 5.5 [3.4, 7.1] years. There was no significant difference of survival between the warfarin and the DOAC group (p = 0.77). The exposure adjusted event rate of major bleeding (0.3 %/person-year vs 0.4 %/person-year, p = 0.705) and clinically relevant nonmajor bleeding (3.1 %/person-year vs 3.2 %/person-year, p > 0.999) was similar between two groups. The exposure adjusted rate of VTE recurrence was significantly higher in the DOAC group (1.5 %/person-year vs 0.3 %/person-year, p = 0.030).</p></div><div><h3>Conclusion</h3><p>In anticoagulation of CTEPH patients, DOACs have similar survival rate, similar risk of bleeding but higher risk of VTE recurrence than warfarin.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470478","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: 0

Short-acting β2-agonists (SABA) overuse in asthma and patients’ perceptions for this behavior 哮喘患者过度使用短效β2-激动剂（SABA）及患者对此行为的看法。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-06-25 DOI: 10.1016/j.rmed.2024.107723

Claire D. Visser , Maaike R.A. Faay , Ayşe Özdemir , Henk-Jan Guchelaar , Martina Teichert

Background

Short-acting β₂-agonists (SABA) overuse is associated with poor asthma control. The Global Initiative for Asthma (GINA) 2019-updated strategy report has therefore taken a paradigm shift in reliever therapy recommendations.

Objectives

(I) To investigate the status of SABA overuse and medication dispensing patters in asthma in the Netherlands (II) validate dispensing data for SABA overuse identification and (III) understand patients’ perspectives towards this SABA-taking behavior to inform future improvement strategies.

Methods

An annually repeated cross-sectional study was conducted from 2017 to 2021 using pharmacy dispensing data in a real-world setting, including asthma patients aged 18–45 with ≥1 inhaler. A following qualitative study was performed in identified SABA overusing patients with a questionnaire and semi-structured interviews, supported by theoretical frameworks.

Results

Dispensing data was available from 87 % of all community pharmacies (n = 1994) in 2017 and 95 % (n = 2005) in 2021. SABA overuse prevalence was constant for the five study-years with 20.6 % (±0.5 %). Increased ICS-formoterol and decreased SABA dispenses were observed in starters of inhalation therapy in 2021. 53 asthma patients completed the questionnaire of whom 43 patients confirmed SABA overuse, generating a positive predictive value of 81 %. Key behavioral drivers covered 7 themes regarding capability (knowledge; skills; memory, attention and decision process) motivation (emotion; beliefs about-capabilities; consequences) and opportunity (environmental context).

Conclusion

SABA overuse remains in one-fifth of asthma patients across the Netherlands, requiring careful attention from healthcare professionals. Dispensing data is a valid measure for SABA overuse in a clinical setting, facilitating patient selection. To meet patients’ varied supporting needs, integration of tailored behavioral interventions is essential.

背景：短效β2-激动剂（SABA）的过度使用与哮喘控制不佳有关。因此，全球哮喘倡议（GINA）2019年更新指南在缓解剂治疗建议方面采取了范式转变。目的：（I）调查荷兰哮喘患者SABA过度使用的状况和配药模式（II）验证配药数据以识别SABA过度使用的情况；（III）了解患者对这种服用SABA行为的看法，为未来的改进策略提供依据：在 2017-2021 年期间，利用真实世界环境中的药房配药数据开展了一项每年重复的横断面研究，研究对象包括年龄在 18-45 岁且吸入器数量≥ 1 个的哮喘患者。随后，在理论框架的支持下，通过问卷调查和半结构式访谈对确定的SABA过度使用患者进行了定性研究：2017年，87%的社区药房（n=1,994）提供了配药数据，2021年，95%的社区药房（n=2,005）提供了配药数据。在五个研究年度中，SABA 过度使用率保持不变，均为 20.6% (±0.5%)。在 2021 年的吸入疗法启动者中，观察到 ICS-福莫特罗的配药量增加，SABA 的配药量减少。53 名哮喘患者完成了问卷调查，其中 43 名患者确认过度使用 SABA，阳性预测值为 81%。关键行为驱动因素包括7个主题，涉及能力（知识、技能、记忆、注意力和决策过程）、动机（情绪、对能力的信念、后果）和机会（环境背景）：结论：荷兰全国仍有五分之一的哮喘患者过度使用 SABA，需要医疗保健专业人员认真对待。配药数据是在临床环境中衡量 SABA 过度使用的有效指标，有助于选择患者。为满足患者不同的支持需求，整合量身定制的行为干预措施至关重要。

{"title":"Short-acting β2-agonists (SABA) overuse in asthma and patients’ perceptions for this behavior","authors":"Claire D. Visser , Maaike R.A. Faay , Ayşe Özdemir , Henk-Jan Guchelaar , Martina Teichert","doi":"10.1016/j.rmed.2024.107723","DOIUrl":"10.1016/j.rmed.2024.107723","url":null,"abstract":"<div><h3>Background</h3><p>Short-acting β<sub>2</sub>-agonists (SABA) overuse is associated with poor asthma control. The Global Initiative for Asthma (GINA) 2019-updated strategy report has therefore taken a paradigm shift in reliever therapy recommendations.</p></div><div><h3>Objectives</h3><p>(I) To investigate the status of SABA overuse and medication dispensing patters in asthma in the Netherlands (II) validate dispensing data for SABA overuse identification and (III) understand patients’ perspectives towards this SABA-taking behavior to inform future improvement strategies.</p></div><div><h3>Methods</h3><p>An annually repeated cross-sectional study was conducted from 2017 to 2021 using pharmacy dispensing data in a real-world setting, including asthma patients aged 18–45 with ≥1 inhaler. A following qualitative study was performed in identified <span>SABA</span> overusing patients with a questionnaire and semi-structured interviews, supported by theoretical frameworks.</p></div><div><h3>Results</h3><p>Dispensing data was available from 87 % of all community pharmacies (n = 1994) in 2017 and 95 % (n = 2005) in 2021. SABA overuse prevalence was constant for the five study-years with 20.6 % (±0.5 %). Increased ICS-formoterol and decreased SABA dispenses were observed in starters of inhalation therapy in 2021. 53 asthma patients completed the questionnaire of whom 43 patients confirmed SABA overuse, generating a positive predictive value of 81 %. Key behavioral drivers covered 7 themes regarding capability (knowledge; skills; memory, attention and decision process) motivation (emotion; beliefs about-capabilities; consequences) and opportunity (environmental context).</p></div><div><h3>Conclusion</h3><p>SABA overuse remains in one-fifth of asthma patients across the Netherlands, requiring careful attention from healthcare professionals. Dispensing data is a valid measure for SABA overuse in a clinical setting, facilitating patient selection. To meet patients’ varied supporting needs, integration of tailored behavioral interventions is essential.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001987/pdfft?md5=fe4182cb8ae93c2027d3907eba6d3a5d&pid=1-s2.0-S0954611124001987-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470477","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