Respiratory medicine最新文献_第7页

End-tidal carbon dioxide, a point-of-care biomarker to assess severity in acute asthma: A systematic review 潮末二氧化碳，一种评估急性哮喘严重程度的即时生物标志物：一项系统综述。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107891

Sanjay Farshid , Benjamin C. Buckland , Selvanaayagam Shanmuganathan , Gary KK. Low

Background and objective

Accurate severity assessment in acute asthma is vital to guide patient management and disposition. End-tidal carbon dioxide (EtCO₂) has been proposed as a real-time measure for this purpose. This study aimed to systematically review literature on EtCO₂ measurement in assessing the severity of acute asthma exacerbations.

Methods

Five databases were searched. Studies with patients of any age with acute asthma exacerbations and at least one clinical outcome measure were included. Studies on intubated patients and outpatients were excluded. Two independent reviewers screened abstracts and then full texts for eligibility.

Results

1242 records were identified and 11 studies were included in the review. Three out of five studies found significant differences in capnography measures between patients eventually admitted and those discharged from the emergency department. Patients with lower initial EtCO₂ were more likely to require hospital admission. Other components of the capnography waveform were associated with disposition, including a larger alpha angle and a lower ratio between phase III duration and respiratory rate being associated with hospital admission. Seven studies examined correlations between capnography measures and other markers of airway obstruction and weak or absent correlations were generally found. Three studies reported significant change in capnography measures after treatment.

Conclusion

Lower EtCO₂ may predict poorer outcome in acute asthma exacerbations. Other measures taken from the capnography waveform appear to be useful indicators of severity. Addressing patient selection issues and conducting prognostic accuracy studies of EtCO₂ with clinical endpoints may provide meaningful evidence for clinical practice.

背景与目的：准确的急性哮喘严重程度评估对指导患者的管理和处置至关重要。潮汐末二氧化碳（EtCO2）已被提议作为这一目的的实时测量。本研究旨在系统地回顾EtCO2测量在评估急性哮喘发作严重程度方面的文献。方法：检索5个数据库。研究纳入了任何年龄的急性哮喘发作患者和至少一项临床结果测量。排除了插管患者和门诊患者的研究。两位独立的审稿人先对摘要进行筛选，然后对全文进行筛选。结果：共纳入1242条记录，11项研究纳入综述。五分之三的研究发现，在最终入院的患者和从急诊科出院的患者之间，血管造影测量有显著差异。初始EtCO2较低的患者更有可能需要住院治疗。造影波形的其他组成部分与性格有关，包括较大的α角和较低的III期持续时间与呼吸频率之比与住院有关。七项研究检查了导管造影测量与其他气道阻塞标志物之间的相关性，通常发现相关性较弱或不存在相关性。三项研究报告了治疗后血管造影测量的显著变化。结论：较低的EtCO2可预测急性哮喘发作的预后较差。从造影波形中采取的其他措施似乎是严重程度的有用指标。解决患者选择问题并开展具有临床终点的EtCO2预后准确性研究可能为临床实践提供有意义的证据。

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引用次数: 0

Maximal inspiratory pressure and exercise-induced inspiratory muscle fatigue in chronic nonspecific low back pain 慢性非特异性腰痛的最大吸气压力和运动诱导的吸气肌疲劳。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107887

Sim Klaps , Jonas Verbrugghe , Nina Goossens , Timo Meus , Albère Köke , Jeanine Verbunt , Daniel Langer , Annick Timmermans , Lotte Janssens

Background

Patients with chronic nonspecific low back pain (CNSLBP) show reduced inspiratory muscle function. However, studies comparing maximal inspiratory pressure (MIP) and exercise-induced inspiratory muscle fatigue (IMF) between CNSLBP and healthy controls (HC) are lacking. Objective: To compare MIP and exercise-induced IMF between CNSLBP and HC. Design: Cross-sectional study. Methods: MIP was recorded in 25 persons with CNSLBP and 15 HC before and immediately, 15 and 30 minutes after a maximal cardiopulmonary exercise test. Inspiratory muscle weakness was defined as a predicted MIP value lower than 80%, and exercise-induced IMF as a ≥10% reduction in MIP following the exercise test.

Results

Baseline MIP was similar between CNSLBP (109±32 cmH2O) and HC (116±32 cmH2O) (p= 0.525). Inspiratory muscle weakness was present in 36% of the CNSLBP group and in 20% of the HC group, with no significant difference between groups (p= 0.777). None of the groups showed significant exercise-induced IMF immediately (CNSLBP: -2.1%, HC: 3.7%), 15 minutes (CNSLBP: -5.4%, HC: -5.2%), and 30 minutes (CNSLBP: -4.7%, HC: -6.6%) after the maximal exercise test (p> 0.05), with no between group differences with regard to magnitude and proportion (CNSLBP: 24%, HC: 33%) (p> 0.05).

Conclusions

This study shows that there is no difference in MIP and the proportion of inspiratory muscle weakness between persons with CNSLBP and HC. Additionally, within both groups, there was no exercise-induced IMF immediately, 15 and 30 minutes after a maximal exercise test. Furthermore, there was no difference in the magnitude and proportion of exercise-induced IMF between both groups.

背景：慢性非特异性腰痛（CNSLBP）患者表现为吸气肌功能降低。然而，比较CNSLBP和健康对照（HC）的最大吸气压力（MIP）和运动诱导的吸气肌疲劳（IMF）的研究缺乏。目的：比较CNSLBP和HC的MIP和运动诱导的IMF。设计：横断面研究。方法：记录25例CNSLBP患者和15例HC患者在最大心肺运动试验前、立即、15分钟和30分钟的MIP。吸气肌无力定义为预测MIP值低于80%，运动诱发的IMF定义为运动试验后MIP降低≥10%。结果：基线MIP在CNSLBP（109±32 cmH2O）和HC（116±32 cmH2O）之间相似（p= 0.525）。36%的CNSLBP组和20%的HC组存在吸气肌无力，两组间无显著差异（p= 0.777）。各组均未在最大运动试验后立即（CNSLBP: -2.1%, HC: 3.7%）、15分钟（CNSLBP: -5.4%, HC: -5.2%）和30分钟（CNSLBP: -4.7%, HC: -6.6%）出现显著的运动诱导IMF (p> 0.05)，各组间在强度和比例（CNSLBP: 24%, HC: 33%）方面无显著差异（p> 0.05）。结论：本研究显示CNSLBP和HC患者的MIP和吸气肌无力比例无差异。此外，在两组中，在最大运动测试后15分钟和30分钟都没有运动诱导的IMF。此外，两组之间运动诱导的IMF的大小和比例没有差异。

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引用次数: 0

Particularities of deposition of two ICS-LABA fixed dose combination dry powder aerosol drugs in the airways of COPD patients 两种ICS-LABA固定剂量联合干粉气雾剂药物在COPD患者气道内沉积的特点。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107916

Alpár Horváth , Árpád Farkas , Izolda Réti , Norbert Ilyés , Botond Havadtői , Tamás Kovács , Balázs Sánta , Erika Kis , Zoltán Bártfai , Renáta Marietta Böcskei , Gabriella Gálffy

The aim of this study was to analyse the effect of breathing parameters, age, gender and disease status on the lung doses of the two ICS + LABA fixed combination dry powder drugs. Breathing parameters of 113 COPD patients were measured while inhaling through emptied NEXThaler® and Ellipta® inhalers and the corresponding lung doses were calculated. Lung dose of Foster® NEXThaler® was superior to the lung dose of Relvar® Ellipta® in around 85 % of the patients. The average value of the ratio of bronchiolar to bronchial deposition fractions was 5.0 for Foster® NEXThaler® and 2.6 for Relvar® Ellipta®. Lung dose was sensitive to the inhalation parameters, such as peak inhalation flow, inhaled volume and breath-hold time. For both studied drugs the dose to the lungs was relatively high for moderate PIF values, but it declined for low (<35 L/min) and high (>95 L/min) PIFs. The lung dose increased by the increase of the inhaled volume, but saturated over 1.0 L of inhaled air. Longer breath-hold time led to higher lung deposition, but the dependence was drug-specific. FEV₁ (%) and FEV₁/FVC (%) did not influence the lung dose significantly (p = 0.05). Exacerbating patients had lower lung doses (28.8 ± 5.8 % for Foster® NEXThaler® and 23.7 ± 3.8 % for Relvar® Ellipta®) than their non-exacerbating counterparts (33.7 ± 6.1 % for Foster® NEXThaler® and for 24.9 ± 3.9 % for Relvar® Ellipta®). The exact clinical consequences of the differences between the deposition distributions of the two drugs could be assessed only by systematic clinical trials.

本研究的目的是分析呼吸参数、年龄、性别和疾病状况对两种ICS+LABA固定联合干粉药物肺剂量的影响。对113例COPD患者通过空吸NEXThaler®和Ellipta®吸入器吸入时的呼吸参数进行测量，并计算相应的肺剂量。在约85%的患者中，Foster®NEXThaler®肺剂量优于Relvar®Ellipta®肺剂量。Foster®NEXThaler®细支气管沉积分数与支气管沉积分数之比的平均值为5.0，Relvar®Ellipta®为2.6。肺剂量对吸入峰流量、吸入量、屏气时间等参数敏感。对于这两种药物，中等PIF值的肺部剂量相对较高，但对于低（< 35 L/min）和高（> 95 L/min） PIF的肺部剂量下降。肺剂量随吸入量的增加而增加，但在吸入空气1.0 L以上达到饱和。较长的屏气时间导致较高的肺沉积，但依赖是药物特异性的。FEV1（%）和FEV1/FVC（%）对肺剂量无显著影响（p=0.05）。加重患者的肺剂量（Foster®NEXThaler®为28.8±5.8%，Relvar®Ellipta®为23.7±3.8%）低于非加重患者（Foster®NEXThaler®为33.7±6.1%，Relvar®Ellipta®为24.9±3.9%）。两种药物沉积分布差异的确切临床后果只能通过系统的临床试验来评估。

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引用次数: 0

Reversibility of airwave oscillometry in COPD 空气波振荡测量在COPD中的可逆性。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107915

Robert Greig, Chris RuiWen Kuo, Rory Chan, Brian Lipworth

引用次数: 0

Application of e-Health tools in the assessment of inhalation therapy adherence in patients with chronic obstructive pulmonary disease: Scoping review coupled with bibliometric analysis 电子保健工具在慢性阻塞性肺病患者吸入疗法依从性评估中的应用：范围审查与文献计量学分析相结合。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107898

Haibo Xu , Xiaoke Jiang , Qiuxuan Zeng , Ronghua Li

Background

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder, and the assessment of inhalation therapy adherence is an important component of management in COPD patients. The emergence of e-Health tools provides new prospects for the assessment of inhalation therapy adherence. However, there is no comprehensive summary of the application of e-Health tools in assessing inhalation therapy adherence in COPD patients.

Objectives

This review aims to clarify the current state, effects, benefits, and limitations of using e-Health tools in assessing inhalation therapy adherence in COPD patients and provide future directions and recommendations for development in this field.

Methods

This scoping review follows the 5-step framework developed by Arksey and O'Malley. Literature on the practical application of e-Health tools was systematically searched from PubMed, Embase, Web of Science, CINAHL, and Cochrane Library, spanning from inception to April 2024. Additionally, VOSviewer (version 1.6.20) was used to construct visualization maps of countries, institutions, authors, and keywords to investigate the internal relations of included literature and to explore research hotspots.

Results

A total of 26 studies were included. The e-Health tools mainly include electronic monitoring devices (EMDs), smartphone app, electronic prescription, and web-based tool. e-Health tools can assess inhalation therapy adherence in COPD patients in real-time and objectively, and improve inhalation therapy adherence and clinical outcomes. Bibliometric analysis indicates that there is no network of co-authorship between countries or academic organizations. Two collaborative networks have been formed centered on Greene G. EMDs and disease exacerbations are the popular research directions.

Conclusions

e-Health tools have a wide range of applications and promising prospects in the assessment of inhalation therapy adherence in COPD patients. In the future, it is necessary to strengthen the cooperation between countries or research institutions, explore the cost-effectiveness of e-Health tools, and improve their accessibility and usability while adopting integrated design and combining artificial intelligence to improve the effectiveness of e-Health tools in the management of COPD.

背景：慢性阻塞性肺疾病（COPD）是一种常见的呼吸系统疾病，吸入治疗依从性评估是COPD患者治疗的重要组成部分。电子保健工具的出现为评估吸入治疗依从性提供了新的前景。然而，目前还没有关于电子健康工具在COPD患者吸入治疗依从性评估中的应用的综合总结。目的：本综述旨在阐明使用电子健康工具评估COPD患者吸入治疗依从性的现状、效果、益处和局限性，并为该领域的发展提供未来的方向和建议。方法：本综述遵循Arksey和O'Malley开发的五步框架。系统地检索了PubMed、Embase、Web of Science、CINAHL和Cochrane Library中关于电子健康工具实际应用的文献，时间跨度从成立到2024年4月。利用VOSviewer（1.6.20版本）构建国家、机构、作者、关键词的可视化地图，考察纳入文献的内在关系，挖掘研究热点。结果：共纳入26项研究。电子医疗工具主要包括电子监控设备、智能手机应用程序、电子处方和基于web的工具。电子健康工具可以实时、客观地评估COPD患者的吸入治疗依从性，并改善吸入治疗依从性和临床结果。文献计量分析表明，在国家或学术组织之间没有共同作者网络。以Greene G.为中心形成了两个协作网络，emd和疾病加重是热门的研究方向。结论：电子健康工具在COPD患者吸入治疗依从性评估中具有广泛的应用前景。未来，需要加强国家或研究机构之间的合作，探索电子健康工具的成本效益，提高其可及性和可用性，同时采用一体化设计，结合人工智能，提高电子健康工具在COPD管理中的有效性。

{"title":"Application of e-Health tools in the assessment of inhalation therapy adherence in patients with chronic obstructive pulmonary disease: Scoping review coupled with bibliometric analysis","authors":"Haibo Xu , Xiaoke Jiang , Qiuxuan Zeng , Ronghua Li","doi":"10.1016/j.rmed.2024.107898","DOIUrl":"10.1016/j.rmed.2024.107898","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder, and the assessment of inhalation therapy adherence is an important component of management in COPD patients. The emergence of e-Health tools provides new prospects for the assessment of inhalation therapy adherence. However, there is no comprehensive summary of the application of e-Health tools in assessing inhalation therapy adherence in COPD patients.</div></div><div><h3>Objectives</h3><div>This review aims to clarify the current state, effects, benefits, and limitations of using e-Health tools in assessing inhalation therapy adherence in COPD patients and provide future directions and recommendations for development in this field.</div></div><div><h3>Methods</h3><div>This scoping review follows the 5-step framework developed by Arksey and O'Malley. Literature on the practical application of e-Health tools was systematically searched from PubMed, Embase, Web of Science, CINAHL, and Cochrane Library, spanning from inception to April 2024. Additionally, VOSviewer (version 1.6.20) was used to construct visualization maps of countries, institutions, authors, and keywords to investigate the internal relations of included literature and to explore research hotspots.</div></div><div><h3>Results</h3><div>A total of 26 studies were included. The e-Health tools mainly include electronic monitoring devices (EMDs), smartphone app, electronic prescription, and web-based tool. e-Health tools can assess inhalation therapy adherence in COPD patients in real-time and objectively, and improve inhalation therapy adherence and clinical outcomes. Bibliometric analysis indicates that there is no network of co-authorship between countries or academic organizations. Two collaborative networks have been formed centered on Greene G. EMDs and disease exacerbations are the popular research directions.</div></div><div><h3>Conclusions</h3><div>e-Health tools have a wide range of applications and promising prospects in the assessment of inhalation therapy adherence in COPD patients. In the future, it is necessary to strengthen the cooperation between countries or research institutions, explore the cost-effectiveness of e-Health tools, and improve their accessibility and usability while adopting integrated design and combining artificial intelligence to improve the effectiveness of e-Health tools in the management of COPD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107898"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786954","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

Comparative effectiveness of therapies for sleep-disordered breathing in heart failure patients: A comprehensive systematic review and network meta-analysis 心力衰竭患者睡眠呼吸障碍治疗的比较效果：一项综合系统评价和网络荟萃分析。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107907

Yuhan Lin , Ying Chen , Wenqing Tu , Bifang Mai , Danying Guo , Yuan Li , Yongtong Chen , Shuanglun Xie , Yuyang Chen

Background

The prevalence of sleep-disordered breathing (SDB) in patients with heart failure (HF) is a significant concern, leading to adverse outcomes. This network meta-analysis (NMA) is dedicated to evaluate the relative effectiveness of diverse therapeutic approaches for SDB treatments in the context of HF.

Methods

An extensive search up to May 19, 2023, was implemented in PubMed, Cochrane, Embase, and Web of Science to identify randomized controlled trials (RCTs). These trials compared adaptive servo ventilation (ASV), automatic positive airway pressure (APAP), Bi-level positive pressure ventilation (Bi-level PPV), continuous positive airway pressure (CPAP), and oxygen therapy against placebo or standard treatment. Key outcomes included cardiac function indicators (left ventricular ejection fraction [LVEF], plasma B-type natriuretic peptide [BNP] levels), polysomnography data (apnea-hypopnea index [AHI], Mean and Minimum Oxygen Saturation), and patient-reported quality of life measures (Epworth sleepiness scale [ESS]). A random-effects Bayesian NMA was utilized to evaluate and compare the efficacy of these interventions.

Results

The study revealed significant therapeutic effects of different interventions in sleep apnea patients. For patients with obstructive sleep apnea (OSA), CPAP demonstrated superior efficacy in enhancing average oxygen saturation (mean difference (MD) = 0.98; 95 % credible interval (CI) [0.07,2.09]), improving LVEF (MD = 5.66; 95 % CI [0.71, 10.08]), and reducing AHI (MD = −20.61; 95 % CI [-33.84, −9.9]). In the case of central sleep apnea (CSA), the therapeutic approaches showed varying degrees of effectiveness. CPAP proved most effective for enhancing average oxygen saturation(MD = 1.1; 95 % CI [0.26,1.98]). ASV was the most effective in lowering AHI (MD = −32.11; 95 % CI [-47.5, −17.16]), increasing lowest oxygen saturation (MD = 8.14; 95 % CI [1.72,14.92]), and enhancing LVEF (MD = 6.58; 95 % CI [0.06,12.49]).

Conclusion

No single SDB treatment uniformly benefits all clinical indicators in SDB and HF patients.

背景：心力衰竭（HF）患者睡眠呼吸障碍（SDB）的患病率是一个值得关注的问题，可能导致不良后果。该网络荟萃分析（NMA）旨在评估在心衰背景下SDB治疗的不同治疗方法的相对有效性。方法：广泛检索截至2023年5月19日的PubMed、Cochrane、Embase和Web of Science，以确定随机对照试验（rct）。这些试验比较了自适应伺服通气（ASV）、自动气道正压通气（APAP）、双水平正压通气（Bi-level PPV）、持续气道正压通气（CPAP）和氧疗与安慰剂或标准治疗的差异。主要结局包括心功能指标（左心室射血分数[LVEF]、血浆b型利钠肽[BNP]水平）、多导睡眠图数据（呼吸暂停低通气指数[AHI]、平均和最低氧饱和度）和患者报告的生活质量测量（Epworth嗜睡量表[ESS]）。随机效应贝叶斯NMA用于评估和比较这些干预措施的效果。结果：不同干预措施对睡眠呼吸暂停患者的治疗效果显著。对于阻塞性睡眠呼吸暂停（OSA）患者，CPAP在提高平均血氧饱和度方面表现出优越的疗效(平均差值(MD) = 0.98；95%可信区间（CI）[0.07,2.09])，改善LVEF (MD= 5.66；95% CI[0.71, 10.08])和降低AHI (MD= -20.61；95% ci[-33.84, -9.9])。在中枢性睡眠呼吸暂停（CSA）的情况下，治疗方法显示出不同程度的有效性。CPAP被证明对提高平均氧饱和度最有效(MD= 1.1；95% ci[0.26,1.98])。ASV对降低AHI最有效(MD = -32.11；95% CI[-47.5, -17.16])，最低血氧饱和度升高(MD =8.14；95% CI[1.72,14.92])，增强LVEF (MD =6.58；95% ci[0.06,12.49])。结论：在SDB和HF患者中，没有单一的SDB治疗方法能使所有临床指标都得到统一的改善。

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引用次数: 0

The accuracy and adequacy of rapid on-site evaluation conducted by trained pulmonologist on transbronchial needle aspiration samples: A systemic review and meta-analysis 训练有素的肺科医生对经支气管针吸样本进行快速现场评估的准确性和充分性：一项系统回顾和荟萃分析。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107903

Ahmed Ehab , Anas Elgenidy , Omar Ayman Abobakr , Tareq M. Abubasheer , Ramez M. Odat , Mohamed M. Ghonaim , Mostafa Atef Amin , Yousif Ahmed Othman , Ahmed Oweidah , Dina Hesham Khattab , Lujain Bashir Sakka Laik , Mohamed Ali , Ahmad Shalabi , Omar Al-Mawla , Heba Wagih Abdelwahab , Desouki Abdelatti

Introduction

The effective deployment of rapid on-site cytologic evaluation (ROSE) requires the availability of a cytologist/pathologist. Several studies investigated the capability of trained pulmonologists to assess the adequacy and validity of transbronchial needle aspiration (TBNA) samples. This study aimed to determine the validity and adequacy of ROSE by pulmonologists (P-ROSE).

Methods

A systematic search was conducted in Embase, Cochrane, Scopus, PubMed, and Web of Science. The validity meta-analysis was conducted using Meta-Disc software V 2.0. A bivariate model was employed to perform the analysis.

Results

14 studies were included in the review, and the collective sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio with 95 % CI were 89.6 % (95 % CI: 0.827–0.94), 95.9 % (95 % CI: 0.845–0.999), 0.108 (95 % CI: 0.064–0.183), and 21.598 (95 % CI: 5.447–85.636) respectively. P-ROSE demonstrated high accuracy for both diagnosis (80%–89.5 %) and adequacy of 83.1 %. Also, a high K coefficient for diagnosis and adequacy with a range (0.18–0.94) and (−0.02-0.72), respectively.

Conclusion

Our findings showed that P-ROSE had a high sensitivity, specificity, and accuracy, which means that following a brief training session, the pulmonologists can reliably assess prepared slides from TBNA of lymph nodes and lung masses, both in terms of sample adequacy and establishing an initial diagnosis. This can be especially valuable in healthcare settings where a Pathologist/cytopathologist is not consistently available.

快速现场细胞学评估（ROSE）的有效部署需要细胞学家/病理学家的可用性。几项研究调查了训练有素的肺科医生评估经支气管针吸样本的充分性和有效性的能力。本研究旨在确定肺科医师的ROSE （P-ROSE）的有效性和充分性。方法：系统检索Embase、Cochrane、Scopus、PubMed、Web of Science。采用Meta-Disc软件v2.0进行效度meta分析。采用双变量模型进行分析。结果：纳入14项研究，总体敏感性、特异性、阴性似然比、阳性似然比（95% CI）分别为89.6% （95% CI: 0.827 ~ 0.94）、95.9% （95% CI: 0.845 ~ 0.999）、0.108 （95% CI: 0.064 ~ 0.183）、21.598 （95% CI: 5.447 ~ 85.636）。P-ROSE具有较高的诊断准确性（80% ~ 89.5%）和充分性（83.1%）。此外，诊断和充分性的高K系数分别为（0.18-0.94）和（-0.02-0.72）。结论：我们的研究结果表明，P-ROSE具有很高的敏感性、特异性和准确性，这意味着经过短暂的培训，肺科医生可以可靠地评估淋巴结和肺肿块的TBNA切片，无论是在样本充分性方面还是在建立初步诊断方面。这在病理学家/细胞病理学家不一致的医疗保健环境中尤其有价值。

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引用次数: 0

Associations between 6-min walk distance and cardiopulmonary parameter in non-obese older adults: An observational study 非肥胖老年人6分钟步行距离与心肺参数之间的关系：一项观察性研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107912

Nutsupa Singhasoot , Wirasinee Srijunto , Phurichaya Werasirirat , Juntip Namsawang , Sirawee Chaovalit , Pornpimol Muanjai

Background

The 6-min walk test (6MWT) has established itself as a classical field-test for assessing exercise capacity across diverse populations, including older adults. Despite its widespread use, the specific contribution of cardiopulmonary factors to the 6-min walk distance (6MWD) remains relatively unexplored.

Objective

The primary objective of this investigation was to examine any potential associations between 6MWD and various cardiopulmonary parameters in older adults.

Methods

Ninety-two non-obese older adults (66.9 ± 4.1 years) were recruited for this study. Real-time assessments of cardiohemodynamic parameters were conducted using impedance cardiography, while cardiopulmonary parameters were evaluated using a gas analyzer during the administration of the 6MWT.

Results

Our findings revealed mild-to-strong positive correlations between 6MWD and several cardiohemodynamic parameters, including left cardiac work index, heart rate, cardiac output, and cardiac index, as well as cardiopulmonary parameters such as oxygen consumption (

\dot{\dot{V}} O_{2}

), carbon dioxide consumption (

\dot{\dot{V}} {CO}_{2}

), minute ventilation, oxygen pulse, tidal volume, respiratory exchange ratio (RER), and breath frequency at the end of walking task (p < 0.05). Additionally, a negative moderate association was observed between 6MWD and systemic vascular resistance index (SVRi), while no significant correlation was found between stroke volume and 6MWD. Furthermore, a combination of SVRi,

\dot{\dot{V}} O_{2}

,

\dot{\dot{V}} {CO}_{2}

, and RER appeared to predict 6MWD with reasonable accuracy (R² = 0.567, p < 0.001).

Conclusions

Our investigation highlights a robust association between cardiopulmonary parameters and 6MWD among non-obese older adults. These results also emphasize the potential impact of systemic vascular health on submaximal exercise capacity evaluation within the community-dwelling older adults.

背景：6分钟步行测试（6MWT）已成为评估不同人群（包括老年人）运动能力的经典现场测试。尽管它被广泛使用，但心肺因素对6分钟步行距离（6MWD）的具体贡献仍然相对未被探索。目的：本研究的主要目的是检查老年人6MWD与各种心肺参数之间的任何潜在关联。方法：本研究招募92名非肥胖老年人（66.9±4.1岁）。在给予6MWT期间，使用阻抗心动图实时评估心脏动力学参数，使用气体分析仪评估心肺参数。结果：6MWD与左心功指数、心率、心输出量、心脏指数等多项心动力参数，以及步行任务结束时耗氧量（）、二氧化碳消耗量（）、分气量、氧脉冲、潮气量、呼吸交换比（RER）、呼吸频率等心肺参数呈正相关（p < 0.05）。此外，6MWD与全身血管阻力指数（SVRi）呈负相关，而卒中容量（SV）与6MWD无显著相关。此外，SVRi、、和RER的组合似乎可以合理地预测6MWD （R2 = 0.567, p < 0.001）。结论：我们的研究强调了非肥胖老年人中心肺参数和6MWD之间的强大关联。这些结果也强调了在社区居住的老年人中，全身血管健康对亚最大运动能力评估的潜在影响。

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引用次数: 0

In patients with asthma, obesity status is associated with poor control and high exacerbation rates, which are reversed after bariatric surgery 在哮喘患者中，肥胖状态与控制不良和高加重率相关，这在减肥手术后是逆转的。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107917

Manon Belhassen , Clarisse Marchal , Floriane Deygas , Flore Jacoud , Eric Van Ganse

Background

In asthma, obesity status is associated with poor control and high exacerbation rates. The primary objective was to determine the effect of bariatric surgery (BS) on asthma control and exacerbations.

Methods

Retrospective study with a 3-year cohort of obese patients before and after BS: a baseline period (P0) covering the 12 months before BS and P1 and P2 periods covering the first and second years after BS, respectively. Asthma control was assessed from the use of relievers, and severe exacerbation rates, i.e. use of oral corticosteroids and asthma-related hospitalizations (ARHs). P1 and P2 measures were compared with those of P0. Patients were matched with non-obese patients and compared over P0 using a generalized linear mixed model with random effects.

Results

2601 asthma patients undergoing BS were included. Of these, 2556 patients were matched with 2556 nonobese asthma patients. After BS, the risk of poor control decreased [OR = 0.26 (95 % CI: 0.21–0.32)] together with the mean exacerbation rate, with IRRs of 0.54 (95 % CI: 0.51–0.58) and 0.60 (95 % CI: 0.56–0.64) for P1 and P2, respectively, compared with P0. The incidence risk ratios (IRRs) were of 1.19 (95 % CI: 1.04–1.35) and 1.28 (95 % CI: 1.20–1.37) for poor control and severe exacerbation rates, respectively, in obese vs. nonobese asthma patients.

Conclusion

In patients with asthma, obesity is a major risk factor for poor control and increased exacerbation rates, with both outcomes highly reversible for at least two years following BS.

背景：在哮喘中，肥胖状态与控制不良和高加重率相关。主要目的是确定减肥手术（BS）对哮喘控制和恶化的影响。方法：对BS前后3年的肥胖患者进行回顾性研究：基线期（P0）分别为BS前12个月和BS后1年和2年的P1和P2期。从缓解剂的使用和严重恶化率（即口服皮质类固醇的使用和哮喘相关住院治疗（ARHs））来评估哮喘控制。将P1、P2措施与P0措施进行比较。将患者与非肥胖患者进行匹配，并使用具有随机效应的广义线性混合模型对P0进行比较。结果：纳入2,601例接受BS治疗的哮喘患者。其中，2556名患者与2556名非肥胖哮喘患者配对。BS后，控制不良的风险降低[OR=0.26 (95% CI: 0.21-0.32)]，平均加重率降低，与P0相比，P1和P2的irs分别为0.54 （95% CI: 0.51-0.58）和0.60 （95% CI: 0.56-0.64）。在肥胖和非肥胖哮喘患者中，控制不良和严重加重率的发生率风险比（IRRs）分别为1.19 （95% CI: 1.04-1.35）和1.28 （95% CI: 1.20-1.37）。结论：在哮喘患者中，肥胖是控制不良和加重率增加的主要危险因素，这两种结果在BS后至少两年内都是高度可逆的。

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引用次数: 0

Factors influencing the prescription of add-on long-acting muscarinic antagonists in real-world asthma management: Insights from a national registry 影响现实世界哮喘管理中附加长效毒蕈碱拮抗剂处方的因素：来自国家登记的见解。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107883

Bilun Gemicioglu , Derya Gokmen , Ali Can , Can Sevinc , Ipek Kivilcim Oguzulgen , Sadan Soyyigit , Tugce Yakut , Yavuz Havlucu , Omur Aydin , Gozde Koycu Buhari , Zeynep Celebi Sozener , Ismet Bulut , Sengul Beyaz , Cihan Orcen , Secil Kepil Ozdemir , Metin Keren , Ebru Damadoglu , Ayse Fusun Kalpaklioglu , Ayse Baccioglu , Sumeyra Alan Yalim , Gülfem Elif Çelik

Current guidelines recommend adding long-acting muscarinic antagonists (LAMAs) in patients with uncontrolled asthma, despite the use of moderate to high doses of inhaled steroid-long-acting beta agonists (ICS/LABA). This study aims to analyze the factors related to the prescription of add-on LAMA in clinical practice for asthma patients, shedding light on physicians’ preferences.

This study included adult asthma patients on add-on LAMA and ICS/LABA monitored for at least one year in a national registry comprising 2053 asthmatics. Patients’ characteristics and disease profiles were analyzed to identify factors associated with the prescription of add-on LAMA across the entire cohort. A comparative analysis was performed among three groups: MART (ICS/formoterol as a maintenance and reliever therapy) plus LAMA, Conventional (ICS/LABA as a maintenance and short-acting beta agonist as reliever) plus LAMA and Triple (ICS/LABA/LAMA single inhaler).

LAMAs were added to ICS/LABA in 11.7 % of patients in the national registry. Logistic regression analysis revealed that older age, low FEV1 (%), Asthma Control Test (ACT) scores less than 20, and severe exacerbation were the main factors influencing the initiation of LAMA in our registry. However, demographic characteristics of asthma, control status, pulmonary function test results were similar among the three groups of LAMA users (p > 0.05). Physicians used LAMAs without phenotyping based on allergic status or eosinophil levels (p > 0.05). Mepolizumab was added after LAMA in all patients, while omalizumab was initiated before LAMA in 16.9 % of the patients receiving LAMA along with biologics.

Add-on LAMAs were predominantly prescribed for older, uncontrolled, and exacerbated asthma patients with low FEV1.

目前的指南建议在不受控制的哮喘患者中添加长效毒蕈碱拮抗剂（LAMAs），尽管使用中至高剂量的吸入类固醇长效受体激动剂（ICS/LABA）。本研究旨在分析哮喘患者临床实践中附加LAMA处方的相关因素，揭示医生的偏好。本研究纳入了在一个由2053名哮喘患者组成的国家登记库中接受附加LAMA和ICS/LABA监测至少一年的成人哮喘患者。分析患者的特征和疾病概况，以确定与整个队列中附加LAMA处方相关的因素。在三组之间进行了比较分析：MART （ICS/福莫特罗作为维持和缓解治疗）加LAMA， Conventional （ICS/LABA作为维持和短效β受体激动剂作为缓解剂）加LAMA和Triple （ICS/LABA/LAMA单吸入器）。在国家登记的患者中，11.7%的患者在ICS/LABA中添加了LAMAs。Logistic回归分析显示，年龄较大，低FEV1(%)，哮喘控制测试（ACT）评分低于20分，严重恶化是影响我们登记的LAMA开始的主要因素。然而，三组LAMA使用者的哮喘人口统计学特征、控制状况、肺功能检查结果相似（p < 0.05）。医生使用的LAMAs没有根据过敏状态或嗜酸性粒细胞水平进行表型分析（p < 0.05）。在所有接受LAMA治疗的患者中，Mepolizumab都在LAMA治疗后加入，而在接受LAMA治疗的患者中，16.9%的患者在接受生物制剂治疗前开始使用omalizumab。附加LAMAs主要用于老年、未控制和加重的低FEV1哮喘患者。

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引用次数: 0