Respiratory medicine最新文献_第8页

Need for re-assessment of impact of repeated pregnancy on lung health in cystic fibrosis 需要重新评估反复妊娠对囊性纤维化患者肺健康的影响。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107890

Amalia S. Magaret, Sonya L. Heltshe

引用次数: 0

Airway total bacterial density, microbiota community composition and relationship with clinical parameters in bronchiectasis 支气管扩张患者气道总细菌密度、微生物群落组成及其与临床参数的关系。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107906

Zina Alfahl , Gisli G. Einarsson , J. Stuart Elborn , Deirdre F. Gilpin , Katherine O'Neill , Kathryn Ferguson , Adam T. Hill , Michael R. Loebinger , Mary Carroll , Timothy Gatheral , Anthony De Soyza , James D. Chalmers , Christopher Johnson , John R. Hurst , Jeremy S. Brown , Judy M. Bradley , Michael M. Tunney

Background and objective

This study explored the relationship between total bacterial density, airway microbiota composition and clinical parameters in bronchiectasis. We determined changes with time during clinical stability and following antibiotic treatment of a pulmonary exacerbation.

Methods

We conducted a multicentre longitudinal cohort study of UK participants with CT confirmed bronchiectasis. Sputum samples and clinical parameters [FEV₁% predicted, lung clearance index, C-reactive protein, white cell count and Quality of Life] were collected when participants were clinically stable and pre/post-antibiotic treatment of an exacerbation. Total bacterial density and microbiota community composition was measured by quantitative polymerase chain reaction and sequencing of the V4 region of bacterial 16S rRNA, respectively.

Results

Among 105 participants at baseline, 65 (62 %) were female with a mean age of 65 years and FEV₁ at 69 % predicted. In participants who remained clinically stable (n = 15), no significant changes were observed in bacterial density, microbiota diversity, richness, evenness, and dominance (p = 0.30, 0.45, 0.54, 0.23 and 0.43; respectively) across four time points over a 1-year period. Similarly, for participants with paired pre/post-antibiotic treatment samples (n = 19), no significant changes were observed (p = 0.30, 0.46, 0.44, 0.71 and 0.58; respectively). However, considerable fluctuation in community composition between samples was apparent for most patients. Total bacterial density and microbiota composition did not correlate with clinical parameters at baseline (n = 75).

Conclusions

Stability in bacterial density and microbiota diversity, richness, evenness and dominance was observed over time at a population level but considerable fluctuation was apparent in samples from individual patients.

背景与目的：探讨支气管扩张患者总细菌密度、气道微生物群组成与临床参数的关系。我们确定了在临床稳定期间和抗生素治疗后肺部恶化随时间的变化。方法：我们对CT确诊支气管扩张的英国参与者进行了一项多中心纵向队列研究。当参与者临床稳定且抗生素治疗前/后加重时，收集痰样本和临床参数[预测FEV1%，肺清除率指数，c反应蛋白，白细胞计数和生活质量]。采用定量聚合酶链反应法测定细菌总菌密度，采用细菌16S rRNA V4区测序法测定菌群组成。结果：105名参与者中，65名（62%）为女性，平均年龄为65岁，FEV1预测值为69%。在临床稳定的参与者（n=15）中，未观察到细菌密度、微生物群多样性、丰富度、均匀度和优势度的显著变化(p=0.30、0.45、0.54、0.23和0.43；（分别）在1年期间跨越4个时间点。同样，对于配对抗生素治疗前/后样本的参与者（n=19），未观察到显着变化(p=0.30, 0.46, 0.44, 0.71和0.58；分别)。然而，对于大多数患者来说，样本之间的群落组成明显波动较大。总细菌密度和微生物群组成与基线时的临床参数无关（n=75）。结论：随着时间的推移，细菌密度和微生物群多样性、丰富度、均匀度和优势度在群体水平上保持稳定，但在个体患者的样本中存在明显的波动。

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引用次数: 0

Early childhood respiratory morbidity according to gestational age at birth: A nationwide cohort study 根据出生胎龄的早期儿童呼吸道疾病发病率：一项全国性队列研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107913

Yishai Sompolinsky , Michal Lipschuetz , Malena Cohen-Cymberknoh , Sarah M. Cohen , Doron Kabiri , Asnat Walfisch , Simcha Yagel , Shulamit Gordon , Ziona Haklai , Yael Applbaum

Background

Preterm birth survivors are at risk for short- and long-term respiratory morbidity. This includes increased rates of chronic obstructive pulmonary disease and infectious morbidity. Previous studies showed increased utilization of healthcare services throughout early childhood. However, only a few large-scale studies showed the effect on respiratory morbidity throughout the full spectrum of gestational age at birth. The aim of this study was to show the healthcare burden associated with prematurity, in a large nationwide cohort.

Study design

Data regarding gestational age at birth, month and year of birth, and infant sex were gathered for all 1,762,149 infants born in Israel between January 1, 2010, and December 31, 2019. Rates of hospitalization, length of hospitalization, and emergency department visits were calculated per 1000 live births and stratified by gestational age. Poisson regression was constructed to adjust for infant sex, year and month of birth.

Results

Preterm birth occurred in 6.43 % of deliveries (n = 109,405). A negative association was found between gestational age at birth and respiratory morbidity. As gestational age at birth advances, rates of respiratory hospitalization decrease, and length of hospitalization shortens. This association continues even after full term is reached.

Conclusion

The short- and long-term effect of preterm birth poses a significant burden on healthcare systems globally, not only at birth or in infancy, but well into early childhood. These results are a call for action to stakeholders and professional organizations to increase efforts in preventing and treating preterm and early term labor.

背景：早产幸存者面临短期和长期呼吸系统发病的风险。这包括慢性阻塞性肺病和感染性疾病的发病率增加。以往的研究表明，早产儿在整个婴幼儿时期对医疗保健服务的利用率增加。然而，只有少数几项大规模研究显示了出生时胎龄对整个呼吸系统发病率的影响。本研究的目的是在全国范围内的大型队列中显示与早产相关的医疗负担：研究设计：收集了 2010 年 1 月 1 日至 2019 年 12 月 31 日期间在以色列出生的所有 1 762 149 名婴儿的出生胎龄、出生月份和年份以及婴儿性别数据。计算了每 1000 名活产婴儿的住院率、住院时间和急诊就诊率，并按胎龄进行了分层。构建泊松回归以调整婴儿性别、出生年份和月份：早产发生率为 6.43%（n=109,405）。出生时的胎龄与呼吸系统发病率呈负相关。随着胎龄的增加，呼吸系统住院率降低，住院时间缩短。结论：早产儿对呼吸系统的短期和长期影响都很大：早产的短期和长期影响给全球医疗保健系统带来了沉重负担，不仅在出生时或婴儿期，而且在幼儿期也是如此。这些结果呼吁利益相关者和专业组织采取行动，加大预防和治疗早产和早产的力度。

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引用次数: 0

Riociguat in pulmonary arterial hypertension: Application of the 4-strata COMPERA 2.0 risk assessment tool in the PATENT studies 治疗肺动脉高压的 Riociguat：4-strata COMPERA 2.0 风险评估工具在 PATENT 研究中的应用。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107910

Marius M. Hoeper , Stephan Rosenkranz , David B. Badesch , Marc Humbert , David Langleben , John W. McConnell , Sara Hegab , Claudia Rahner , Jean-François Richard , Hossein-Ardeschir Ghofrani

Background

Risk stratification is an essential part of evaluating disease severity in patients with pulmonary arterial hypertension (PAH). This study applied the 4-strata COMPERA 2.0 risk model to the Phase 3 PATENT-1/2 studies of riociguat.

Methods

This was a post hoc analysis of PATENT-1 and PATENT-2. Log-rank tests of Kaplan–Meier curves were performed to compare the risk strata at PATENT-1 baseline and Week 12 regarding time to clinical worsening and survival at 2 years in the PATENT-2 population.

Results

Data on COMPERA 2.0 status at baseline were available for 214 patients with riociguat and 100 with placebo; overall, 120 patients were identified as intermediate-low risk and 96 as intermediate-high risk. At PATENT-1 Week 12, improvements in COMPERA 2.0 risk strata and median 6-min walk distance were seen with riociguat vs placebo in patients assessed as intermediate-low risk and intermediate-high risk at baseline by COMPERA 2.0. More patients improved their COMPERA 2.0 risk status with riociguat vs placebo in the intermediate-low (38 % vs 22 %) and intermediate-high risk groups (42 % vs 31 %). COMPERA 2.0 assessed at PATENT-1 baseline and Week 12 discriminated between risk strata for survival and clinical worsening in PATENT-2 at 2 years (p ≤ .001 for all analyses).

Conclusions

In conclusion, this analysis supports the risk-reduction benefits of riociguat in patients with PAH at intermediate-low risk and intermediate-high risk, and externally validated the utility of COMPERA 2.0 in the long-term risk assessment of patients from a clinical trial population.

背景：风险分层是评估肺动脉高压（PAH）患者疾病严重程度的重要部分。本研究将 4 层 COMPERA 2.0 风险模型应用于利奥西瓜特的 3 期 PATENT-1/2 研究：这是对 PATENT-1 和 PATENT-2 的事后分析。对PATENT-1基线和第12周的风险分层进行了Kaplan-Meier曲线的对数秩检验，以比较PATENT-2人群的临床恶化时间和2年生存率：214名服用利奥吉曲特的患者和100名服用安慰剂的患者在基线时的COMPERA 2.0状态数据可用；总体而言，120名患者被确定为中低风险，96名患者被确定为中高风险。在PATENT-1第12周，COMPERA 2.0风险分层和6分钟步行距离中位数方面，使用利奥吉曲特与安慰剂相比，基线时被COMPERA 2.0评估为中低风险和中高风险的患者均有所改善。在中低风险组（38% 对 22%）和中高风险组（42% 对 31%）中，使用利奥吉曲特与安慰剂相比，有更多患者的 COMPERA 2.0 风险状况有所改善。在PATENT-1基线和第12周评估的COMPERA 2.0对PATENT-2中2年生存和临床恶化的风险分层具有区分作用（所有分析的P≤.001）：总之，该分析支持利奥吉曲特对中低风险和中高风险的 PAH 患者具有降低风险的益处，并从外部验证了 COMPERA 2.0 在临床试验人群患者长期风险评估中的实用性。

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引用次数: 0

Sedation during dynamic bronchoscopy for expiratory central airway collapse: Which is the ideal protocol? 动态支气管镜下镇静治疗呼气性中央气道塌陷：哪种方案最理想？

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107904

Rodrigo Funes-Ferrada , Alejandra Yu Lee-Mateus , Bryan F. Vaca-Cartagena , Sofia Valdes-Camacho , Alanna Barrios-Ruiz , Ana Garza-Salas , Kelly S. Robertson , Sebastian Fernandez-Bussy , Ryan M. Chadha , Martin D. Abel , Courtney L. Scott , David Abia-Trujillo

Objective

To compare sedation protocols for dynamic bronchoscopy (DB) in the evaluation of expiratory central airway collapse (ECAC).

Materials and methods

This observational study included adult patients (≥18 years) referred to Mayo Clinic, Jacksonville, FL, from March 2023 to July 2024, for suspected ECAC. Patients were grouped based on sedation protocols: propofol (Protocol 1), remimazolam (Protocol 2), and remimazolam/fentanyl (Protocol 3). The primary outcome was the quality of assessment during DB, rated on a 4-point Likert scale (1 = poor, 4 = excellent). Secondary outcomes included anesthesia duration and post-anesthesia care unit (PACU) length of stay. Statistical analyses included Fisher's exact test, ordinal logistic regression, and Kruskal-Wallis tests.

Results

Seventy-three patients met the inclusion criteria. Overall, DB quality of assessment was significantly associated with sedation protocol (P=0.01 Ordinal regression results suggest that protocol 3 (remimazolam/fentanyl) may be comparable to protocol 1 (propofol) (OR0.40, 95%CI 0.12–1.33, P = 0.13), with both showing a tendency for better performance than protocol 2 (remimazolam) (OR0.14, 95%CI 0.04–0.46 P=0.002 vs protocol 3; OR0.35, 95%CI 0.09–0.29 P=0.115 vs protocol 1). No significant differences were found in PACU length of stay among the three protocols (P = 0.13). No post-procedural complications were reported.

Conclusion

Protocol 3 (remimazolam/fentanyl) demonstrated significantly higher odds of achieving a better quality of assessment compared to Protocol 2 (remimazolam) and showed comparable performance to Protocol 1 (propofol). These findings suggest that remimazolam/fentanyl is an effective sedation option for DB, providing improved assessment quality without increasing PACU stay. Larger prospective studies are necessary to confirm these results.

目的：比较动态支气管镜（DB）镇静方案在评估呼气性中央气道塌陷（ECAC）中的应用价值。材料和方法：本观察性研究纳入了2023年3月至2024年7月在佛罗里达州杰克逊维尔梅奥诊所就诊的疑似ECAC的成年患者（≥18岁）。根据镇静方案对患者进行分组：异丙酚（方案1）、雷马唑仑（方案2）和雷马唑仑/芬太尼（方案3）。主要结局是DB期间的评估质量，采用4分李克特量表（1 =差，4 =优）。次要结局包括麻醉持续时间和麻醉后护理单位（PACU）住院时间。统计分析包括Fisher精确检验、有序逻辑回归和Kruskal-Wallis检验。结果：73例患者符合纳入标准。总体而言，DB评估质量与镇静方案显著相关（P=0.01），有序回归结果表明方案3（雷马唑仑/芬太尼）可能与方案1（异丙酚）相当（OR0.40, 95%CI 0.12-1.33， P= 0.13），两者都表现出比方案2（雷马唑仑）更好的表现趋势(OR0.14, 95%CI 0.04-0.46 P=0.002 vs方案3；（OR0.35, 95%CI 0.09- 0.29， P=0.115）。三种治疗方案的PACU住院时间无显著差异（P= 0.13）。无术后并发症报道。结论：与方案2（雷马唑仑/芬太尼）相比，方案3（雷马唑仑/芬太尼）获得更好评估质量的几率明显更高，与方案1（异丙酚）表现出相当的性能。这些研究结果表明，雷马唑仑/芬太尼是一种有效的DB镇静选择，在不增加PACU停留时间的情况下提供更好的评估质量。需要更大规模的前瞻性研究来证实这些结果。

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引用次数: 0

The interplay of plant-based antioxidants, inflammation, and clinical outcomes in asthma: A systematic review 植物抗氧化剂、炎症和哮喘临床结果的相互作用：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.2024.107918

Madiha Ajaz , Indu Singh , Lada Vugic , Rati Jani , Hasini Rathnayake , Shashya Diyapaththugama , Getahun Fentaw Mulaw , Natalie J. Colson

Background

Asthma is a chronic inflammatory disease and a leading cause of disability, posing a huge economic and social burden. Plant-based antioxidants have the potential to block proinflammatory pathways and protect against oxidative damage, which could improve asthma management.

Objective

This review examines the role of plant-based antioxidants as adjuvant therapy on inflammatory markers and clinical outcomes of adults with asthma.

Methods

Digital databases, including Scopus, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Airway Group's Specialized Register of Trials, were searched. Two independent authors performed initial and full-text screening of identified papers. The criteria for study inclusion and exclusion were predefined. Two authors independently performed data extraction and risk of bias as per the PRISMA checklist.

Results

After full-text screening, nine randomized controlled trials were included in the final review. Seven of the included studies highlighted the efficacy of plant-based antioxidants in modulating the inflammatory cytokines in asthmatics. The benefits of antioxidants were also observed for improving oxidative status, lung functioning, and airway inflammatory markers. Furthermore, the overall quality of asthmatic patients’ lives was improved with fewer exacerbations such as night coughs and wheezing. Despite having some limitations, the overall risk of bias was low in this review.

Conclusion

The review indicated that plant-based antioxidants could have adjuvant beneficial effects in the management of asthma inflammatory markers, which may help improve asthma-related clinical outcomes. However, due to the small number of study subjects, further research is required on the effect of plant-based antioxidants on asthma-inflammatory markers and clinical outcomes.

背景：哮喘是一种慢性炎症性疾病，是致残的主要原因，造成巨大的经济和社会负担。植物性抗氧化剂有可能阻断促炎途径，防止氧化损伤，从而改善哮喘管理。目的：本文综述了植物性抗氧化剂作为辅助治疗对成人哮喘炎症标志物和临床结果的作用。方法：检索数字数据库，包括Scopus、MEDLINE、EMBASE、CINAHL、PsycINFO和Cochrane气道集团的专业试验注册。两位独立作者对已确定的论文进行了初步和全文筛选。研究纳入和排除的标准是预先确定的。两位作者按照PRISMA检查表独立进行数据提取和偏倚风险。结果：经过全文筛选，最终纳入9项随机对照试验。纳入的研究中有七项强调了植物抗氧化剂在调节哮喘患者炎症细胞因子方面的功效。抗氧化剂的好处也被观察到改善氧化状态，肺功能和气道炎症标志物。此外，哮喘患者的整体生活质量得到改善，夜间咳嗽和喘息等恶化情况减少。尽管存在一些局限性，但本综述的总体偏倚风险较低。结论：植物性抗氧化剂对哮喘炎症标志物的管理具有辅助有益作用，可能有助于改善哮喘相关的临床结局。然而，由于研究对象较少，需要进一步研究植物性抗氧化剂对哮喘炎症标志物和临床结果的影响。

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引用次数: 0

Debunking the GAMLSS myth: Simplicity reigns in pulmonary function diagnostics 揭穿 GAMLSS 的神话：肺功能诊断中的简易性统治。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107836

Gerald S. Zavorsky

Rationale

Current technical standards advocate using Generalized, Additive Models of Location, Scale, and Shape (GAMLSS) for lung function reference equations. These equations are complicated and require supplementary spline tables.

Objective

(1) To demonstrate that segmented (piecewise) linear regression (SLR) yields prediction accuracies similar to GAMLSS in pulmonary function diagnostics. (2) To determine the agreement between both SLR and GAMLSS.

Methods

The NHANES 2007–2012 database was utilized to construct spirometric reference equations for FEV₁, FVC, and FEV₁/FVC using both SLR and GAMLSS modeling techniques. K-fold cross-validation was used to provide the 95% confidence interval (CI) of the root-mean-square error (RMSE) as an indicator of prediction accuracy. Additionally, agreement was assessed between the two modeling techniques in classifying spirometric patterns (standard, airflow obstruction, restrictive, or mixed disorder) using an unweighted kappa statistic.

Results

The RMSE values for FEV₁, FVC, and FEV₁/FVC and correlation coefficients between predicted values and test data were similar between the two techniques. Agreement in classifying spirometric patterns between the two techniques ranged from 0.78 to 0.80 (95 % CI).

Conclusions

The findings suggest that simple linear regression for FEV₁/FVC and SLR for FEV₁ and FVC offer prediction accuracies on par with GAMLSS while being more straightforward, parsimonious, and accessible to a broader audience in the field of pulmonary function diagnostics.

理论依据：目前的技术标准主张在肺功能参考方程中使用位置、尺度和形状的广义相加模型（GAMLSS）。目标：（1）证明在肺功能诊断中，分段（片断）线性回归（SLR）可获得与 GAMLSS 相似的预测精度。(2）确定 SLR 和 GAMLSS 之间的一致性：方法：利用 NHANES 2007-2012 年数据库，使用 SLR 和 GAMLSS 建模技术构建 FEV1、FVC 和 FEV1/FVC 的肺活量参考方程。采用 K 倍交叉验证提供均方根误差 (RMSE) 的 95% 置信区间 (CI)，作为预测准确性的指标。此外，还使用非加权卡帕统计量评估了两种建模技术在肺活量测量模式（标准、气流阻塞、限制性或混合障碍）分类方面的一致性：结果：两种技术的 FEV1、FVC 和 FEV1/FVC 均方根误差值以及预测值与测试数据之间的相关系数相似。两种技术在肺活量模式分类方面的一致性为 0.78 至 0.80（95% CI）：研究结果表明，FEV1/FVC 的简单线性回归和 FEV1 和 FVC 的 SLR 预测准确度与 GAMLSS 相当，但更直接、更简便，可用于肺功能诊断领域的更广泛人群。

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引用次数: 0

Nasal effects of environmental tobacco smoke exposure in children with allergic rhinitis 环境烟草烟雾暴露对变应性鼻炎患儿鼻腔的影响。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107886

Ecem Yigit , Hasan Yuksel , Cevval Ulman , Ozge Yilmaz

Objectives

Tobacco smoke exposure is associated with inflammatory changes in the respiratory system including nasal mucosa. Our aim was to demonstrate nasal mucosal inflammation such as neutrophilic activation and epithelial permeability in patients with allergic rhinitis with exposure to environmental tobacco smoke (ETS) and reveal its effect on allergic rhinitis symptoms.

Methods

We enrolled 204 subjects with allergic rhinitis to this cross-sectional study. Sociodemographic and AR clinical characteristics were recorded. Urinary cotinine levels >50 ng/ml were defined as exposure to secondhand tobacco smoke. Club cell 16 (CC16) and myeloperoxidase (MPO) levels were measured in the nasal lavage fluid. Levels of these biomarkers and clinical severity were compared between ETS exposed and non-exposed children with AR.

Results

Among 204 children enrolled, 53 (26 %) had ETS exposure. Mean age of the ETS exposed group was significantly higher than the unexposed group (12.1 ± 3.5 and 10.7 ± 3.6 years respectively, (p = 0.02). Similarly, T5SS score was significantly higher in ETS exposure group (9.3 vs 8.3, p = 0.03) but this significance was lost when corrected for age. Age and T5SS were inversely correlated with MPO levels (r = −0,24, p < 0.001 and r = −0,14, p = 0.04). Nasal lavage CC-16 and MPO levels were not found to be significantly different among subjects with and without ETS exposure (p = 0.13 and p = 0.26 respectively).

Conclusion

Our results demonstrated that ETS exposure is associated with more persistent AR in children. However, it is not related to severity or nasal lavage MPO or CC16 levels. Rhinitis symptoms beyond allergen period suggests isolated smoke exposure effect.

目的：烟草烟雾暴露与包括鼻黏膜在内的呼吸系统炎症变化有关。我们的目的是证明暴露于环境烟草烟雾（ETS）的变应性鼻炎患者的鼻黏膜炎症，如中性粒细胞活化和上皮通透性，并揭示其对变应性鼻炎症状的影响。方法：我们招募了204名变应性鼻炎患者进行横断面研究。记录社会人口学和AR临床特征。尿可替宁水平为50 ng/mL，即为接触二手烟。测定鼻灌洗液中俱乐部细胞16 （CC16）和髓过氧化物酶（MPO）水平。这些生物标志物的水平和临床严重程度在ETS暴露和未暴露的ar儿童之间进行了比较。结果：在204名入组儿童中，53名（26%）有ETS暴露。ETS暴露组的平均年龄显著高于未暴露组（分别为12.1±3.5岁和10.7±3.6岁，p=0.02）。同样，ETS暴露组的T5SS评分明显更高（9.3 vs 8.3, p=0.03），但在校正年龄后，这种显著性就消失了。年龄和T5SS与MPO水平呈负相关（r=-0,24, p）。结论：我们的研究结果表明，ETS暴露与儿童更持久的AR相关。然而，与严重程度或鼻腔灌洗MPO或CC16水平无关。鼻炎症状超过过敏原期提示孤立的烟雾暴露效应。

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引用次数: 0

Reproducibility of three 6-min walk tests in patients with COPD referred for pulmonary rehabilitation 三种六分钟步行试验在COPD患者转介肺部康复中的可重复性

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107884

Jeannet M. Delbressine , Anouk W. Vaes , Wieteke A.M. Stoop , Dirk Van Ranst , Martijn A. Spruit , Alex van ’t Hul

Introduction and objectives

The 6-min walk test (6MWT) is used to assess functional capacity in patients with COPD. A significant number of studies have shown that most patients walk further in a second 6MWT. Research on a further increase in the 6-min walk distance (6MWD) during a 3rd test performed in accordance with current guidelines has not been done. Therefore, this study aimed to investigate 1) the reproducibility of three 6MWTs in patients with COPD referred for pulmonary rehabilitation (PR) and 2) predictors of improvement on a third 6MWT.

Materials and methods

Before the start of PR, 1167 COPD patients (50 % male, age: 62 ± 9 years; FEV1: 42 ± 18%pred) performed three 6MWTs (6MWT1, 6MWT2, and 6MWT3). A predetermined threshold of ≥42m improvement in 6MWD in consecutive 6MWT's was used to identify improvers. Reproducibility between tests was assessed using a Bland-Altman plot and logistic regression analyses were performed to assess effects of sex, age, body mass index, GOLD-stage, 6MWD, use of supplemental oxygen and use of walking aids.

Results

Generally, the 6MWD improved (6MWT1: 343 ± 115m; 6MWT2: 367 ± 115m; 6MWT3: 381 ± 116m). 210 patients (18 %) improved ≥42m from 6MWT2 to 6MWT3. The Bland-Altman plot showed that the 95 % limits of agreement of 6MWT3 vs 6MWT2 exceeded 42m, indicating that 6MWT2 is not reproducible. Predictors of improvement in 6MWT3 were GOLD stage I/II and a low 6MWD (<350m) in the previous two 6MWTs.

Conclusions

These results indicate that three 6MWTs may be required to obtain the largest pre-PR functional capacity in COPD patients. Patients with a 6MWD <350m and GOLD-stage I/II are more likely to improve ≥42m in a third 6MWT.

介绍和目的：6分钟步行试验（6MWT）用于评估COPD患者的功能能力。大量研究表明，大多数患者在第二个6MWT中走得更远。在按照现行指南进行的第三次测试中，关于进一步增加6分钟步行距离（6MWD）的研究尚未完成。因此，本研究旨在探讨1)三种6MWT在COPD患者肺康复（PR）中的可重复性，以及2)第三种6MWT改善的预测因素。材料与方法：PR开始前，1167例COPD患者(50%男性，年龄：62±9岁；FEV1: 42±18%pred)分别进行6MWT1、6MWT2和6MWT3三组6MWTs。采用连续6MWT的6MWD改善≥42m的预定阈值来识别改善者。采用Bland-Altman图评估试验之间的可重复性，并进行logistic回归分析以评估性别、年龄、体重指数、gold分期、6MWD、使用补充氧和使用助行器的影响。结果：6MWD总体改善(6MWT1: 343±115m；6 mwt2: 367±115米;6 mwt3: 381±116米)。210例（18%）患者从6MWT2到6MWT3改善≥42m。Bland-Altman图显示6MWT3与6MWT2的95%一致性限超过42m，表明6MWT2不可重复。6MWT3改善的预测因子是GOLD期I/II期和低6MWD(结论：这些结果表明，COPD患者可能需要3个6MWTs才能获得最大的pr前功能容量。6MWD患者

{"title":"Reproducibility of three 6-min walk tests in patients with COPD referred for pulmonary rehabilitation","authors":"Jeannet M. Delbressine , Anouk W. Vaes , Wieteke A.M. Stoop , Dirk Van Ranst , Martijn A. Spruit , Alex van ’t Hul","doi":"10.1016/j.rmed.2024.107884","DOIUrl":"10.1016/j.rmed.2024.107884","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The 6-min walk test (6MWT) is used to assess functional capacity in patients with COPD. A significant number of studies have shown that most patients walk further in a second 6MWT. Research on a further increase in the 6-min walk distance (6MWD) during a 3rd test performed in accordance with current guidelines has not been done. Therefore, this study aimed to investigate 1) the reproducibility of three 6MWTs in patients with COPD referred for pulmonary rehabilitation (PR) and 2) predictors of improvement on a third 6MWT.</div></div><div><h3>Materials and methods</h3><div>Before the start of PR, 1167 COPD patients (50 % male, age: 62 ± 9 years; FEV1: 42 ± 18%pred) performed three 6MWTs (6MWT1, 6MWT2, and 6MWT3). A predetermined threshold of ≥42m improvement in 6MWD in consecutive 6MWT's was used to identify improvers. Reproducibility between tests was assessed using a Bland-Altman plot and logistic regression analyses were performed to assess effects of sex, age, body mass index, GOLD-stage, 6MWD, use of supplemental oxygen and use of walking aids.</div></div><div><h3>Results</h3><div>Generally, the 6MWD improved (6MWT1: 343 ± 115m; 6MWT2: 367 ± 115m; 6MWT3: 381 ± 116m). 210 patients (18 %) improved ≥42m from 6MWT2 to 6MWT3. The Bland-Altman plot showed that the 95 % limits of agreement of 6MWT3 vs 6MWT2 exceeded 42m, indicating that 6MWT2 is not reproducible. Predictors of improvement in 6MWT3 were GOLD stage I/II and a low 6MWD (<350m) in the previous two 6MWTs.</div></div><div><h3>Conclusions</h3><div>These results indicate that three 6MWTs may be required to obtain the largest pre-PR functional capacity in COPD patients. Patients with a 6MWD <350m and GOLD-stage I/II are more likely to improve ≥42m in a third 6MWT.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"236 ","pages":"Article 107884"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755385","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

Hypersensitivity pneumonitis radiologic features in interstitial lung diseases 间质性肺病的超敏性肺炎影像学特征。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-01-01 DOI: 10.1016/j.rmed.2024.107901

Tamar Shalmon , Ophir Freund , Ori Wand , Sonia Schneer , Tzlil Hershko , Yitzhak Hadad , Galit Aviram , Amir Bar-Shai , Yochai Adir , David Shitrit , Avraham Unterman

Background

The radiologic criteria of hypersensitivity pneumonitis (HP) guidelines focus on four HP compatible features (HPCF) in high-resolution computed tomography (HRCT): ground glass opacities, mosaic attenuation, air-trapping, and centrilobular nodules. However, evidence to support these criteria are limited.

Methods

Consecutive interstitial lung disease (ILD) patients who underwent HRCT between 2016 and 2021 in three medical centers were included. We assessed the prevalence of HPCF in each ILD and their association with HP diagnosis. We evaluated the impact of HPCF amount for HP diagnosis and the performance of the radiologic criteria by the ATS/JRS/ALAT and CHEST HP guidelines.

Results

436 patients with ILD were included (mean age 66, 48 % females), of them, 56 (13 %) with HP. All four HPCF were more prevalent in HP than in non-HP ILD (p < 0.001 for all). In multivariate analysis, air-trapping was the strongest independent predictor (AOR 4.1, 95 % CI 2–8.4, p < 0.001). Centrilobular nodules were present almost exclusively in HP and smoking-related ILD. The amount of HPCF in HRCT had an excellent predictive ability for HP diagnosis (receiver operating characteristic AUC 0.85, 95 % CI 0.80–0.90). The radiologic criteria of both guidelines had high specificity for "typical HP" and high sensitivity for "compatible with HP", although with low positive predictive values. Our findings remained robust even when including only patients that had a diagnostic biopsy.

Conclusion

The presence and amount of HPCF in HRCT predicted HP diagnosis in real-life settings. While current HP radiologic criteria demonstrated good diagnostic performance, our findings highlight areas for future improvement.

背景：超敏性肺炎（HP）的放射学标准指南侧重于高分辨率计算机断层扫描（HRCT）中的四个HP相容特征（HPCF）：磨玻璃混浊，马赛克衰减，空气捕捉和小叶中心结节。然而，支持这些标准的证据有限。方法：纳入2016年至2021年在三个医疗中心接受HRCT的连续间质性肺疾病（ILD）患者。我们评估了每个ILD中HPCF的患病率及其与HP诊断的关系。我们通过ATS/JRS/ALAT和CHEST HP指南评估HPCF量对HP诊断的影响以及放射学标准的表现。结果：纳入436例ILD患者（平均年龄66岁，女性48%），其中HP患者56例（13%）。所有四种HPCF在HP中比在非HP ILD中更为普遍(结论：HRCT中HPCF的存在和数量预测了现实生活中HP的诊断。虽然目前的HP放射学标准显示出良好的诊断性能，但我们的研究结果强调了未来改进的领域。

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引用次数: 0