Pulmonary hypertension (PH) is the abnormal elevation of pressure in the pulmonary vascular system, with various underlying causes. A specific type of PH is pulmonary arterial hypertension (PAH), a severe condition characterized by high pulmonary arterial pressure resulting from structural changes in distal pulmonary vessels, altered arterial tone, and inflammation. This leads to right ventricular hypertrophy and heart failure. The molecular mechanisms behind PAH are not well understood. This manuscript aims to elucidate these mechanisms using the genetic tool, aiding in diagnosis and treatment selection.
Method
In our present study, we have obtained blood samples from both patients with pulmonary arterial hypertension (PAH) and healthy individuals. We conducted a comparative transcriptome analysis to identify genes that are either upregulated or downregulated in PAH patients when compared to the control group. Subsequently, we carried out a validation study focusing on the log2-fold downregulated genes in PAH, employing Quantitative Real-Time PCR for confirmation. Additionally, we quantified the proteins encoded by the validated genes using the ELISA technique.
Results
The results of the transcriptome analysis revealed that 97 genes were significantly upregulated, and 6 genes were significantly downregulated. Among these, we chose to focus on and validate only four of the downregulated genes, as they were directly or indirectly associated with the hypertension pathway. We also conducted validation studies for the proteins encoded by these genes, and the results were consistent with those obtained in the transcriptome analysis.
Conclusion
In conclusion, the findings of this study indicate that the four validated genes identified in the context of PAH can be further explored as potential targets for both diagnostic and therapeutic applications.
{"title":"Unraveling the genetic landscape of pulmonary arterial hypertension in Indian patients: A transcriptome study","authors":"Kirti Chauhan , M.H. Yashavarddhan , Atul Gogia , Vivek Ranjan , Ujjawal Parakh , Aman Makhija , Vishal Nanavaty , Nirmal Kumar Ganguly , Rashmi Rana","doi":"10.1016/j.rmed.2024.107716","DOIUrl":"10.1016/j.rmed.2024.107716","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary hypertension (PH) is the abnormal elevation of pressure in the pulmonary vascular system, with various underlying causes. A specific type of PH is pulmonary arterial hypertension (PAH), a severe condition characterized by high pulmonary arterial pressure resulting from structural changes in distal pulmonary vessels, altered arterial tone, and inflammation. This leads to right ventricular hypertrophy and heart failure. The molecular mechanisms behind PAH are not well understood. This manuscript aims to elucidate these mechanisms using the genetic tool, aiding in diagnosis and treatment selection.</p></div><div><h3>Method</h3><p>In our present study, we have obtained blood samples from both patients with pulmonary arterial hypertension (PAH) and healthy individuals. We conducted a comparative transcriptome analysis to identify genes that are either upregulated or downregulated in PAH patients when compared to the control group. Subsequently, we carried out a validation study focusing on the log2-fold downregulated genes in PAH, employing Quantitative Real-Time PCR for confirmation. Additionally, we quantified the proteins encoded by the validated genes using the ELISA technique.</p></div><div><h3>Results</h3><p>The results of the transcriptome analysis revealed that 97 genes were significantly upregulated, and 6 genes were significantly downregulated. Among these, we chose to focus on and validate only four of the downregulated genes, as they were directly or indirectly associated with the hypertension pathway. We also conducted validation studies for the proteins encoded by these genes, and the results were consistent with those obtained in the transcriptome analysis.</p></div><div><h3>Conclusion</h3><p>In conclusion, the findings of this study indicate that the four validated genes identified in the context of PAH can be further explored as potential targets for both diagnostic and therapeutic applications.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1016/j.rmed.2024.107717
María Cayeiro-Marín , Javier Merino-Andrés , Álvaro Hidalgo-Robles , Arturo Ladriñán-Maestro , Alberto Sánchez-Sierra
Introduction
Enhancing lung function can significantly improve daily life functionality for children with cerebral palsy, leading to increased interest in respiratory physiotherapy training devices in clinical practice. This study aims to evaluate the efficacy of devices (inspiratory muscle training and feedback devices) for improving pulmonary function through various respiratory parameters.
Methods
A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias (RoB2).
Results
Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size −0.604; confidence interval −1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size −0.500; confidence interval −1.259 to 0.259), the Tiffeneau index, and quality of life.
Conclusion
Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter.
{"title":"Effects of pulmonary function improvement devices in the pediatric population with cerebral palsy: Systematic review and meta-analysis of randomized clinical trials","authors":"María Cayeiro-Marín , Javier Merino-Andrés , Álvaro Hidalgo-Robles , Arturo Ladriñán-Maestro , Alberto Sánchez-Sierra","doi":"10.1016/j.rmed.2024.107717","DOIUrl":"https://doi.org/10.1016/j.rmed.2024.107717","url":null,"abstract":"<div><h3>Introduction</h3><p>Enhancing lung function can significantly improve daily life functionality for children with cerebral palsy, leading to increased interest in respiratory physiotherapy training devices in clinical practice. This study aims to evaluate the efficacy of devices (inspiratory muscle training and feedback devices) for improving pulmonary function through various respiratory parameters.</p></div><div><h3>Methods</h3><p>A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias (RoB2).</p></div><div><h3>Results</h3><p>Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size −0.604; confidence interval −1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size −0.500; confidence interval −1.259 to 0.259), the Tiffeneau index, and quality of life.</p></div><div><h3>Conclusion</h3><p>Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141438416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1016/j.rmed.2024.107719
Natalia Smirnova , Sarah H. Cross , Amanda Light , Dio Kavalieratos
{"title":"Racial differences in palliative care and hospice among adults with chronic obstructive pulmonary disease","authors":"Natalia Smirnova , Sarah H. Cross , Amanda Light , Dio Kavalieratos","doi":"10.1016/j.rmed.2024.107719","DOIUrl":"10.1016/j.rmed.2024.107719","url":null,"abstract":"","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440841","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}
Clofazimine (CFZ) has shown promising effects against Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD) and Mycobacterium abscessus species pulmonary disease (MABS-PD). However, the optimal CFZ dose remains unknown. We aimed to explore the relationship between steady-state CFZ concentration and its safety and efficacy in MAC-PD and MABS-PD.
Methods
This prospective observational study focused on patients with MAC-PD and MABS-PD treated with CFZ (UMIN 000041053). To understand the safety and efficacy profile of CFZ and elucidate its optimal concentration, we analyzed CFZ-induced pigmentation grade, QTc interval, and culture conversion outcomes in relation to serum CFZ concentration using Student's t-test, a concentration-QTc model, and multivariable logistic regression analysis, respectively. In total, 64 patients (34 with MAC-PD; 30 with MABS-PD) were included.
Results
The steady-state concentration of CFZ was higher in the moderate-to-severe pigmentation group than in the none-to-light pigmentation group (P < 0.001). At a CFZ concentration of 1 mg/L, the QTc interval was prolonged by 17.3 ms (95 % confidence interval [CI], 3.9–25.4) from baseline. Culture conversion was achieved in 33 (51.6 %) patients. The only significant predictor of culture conversion was surgery (adjusted odds ratio, 5.4; 95 % CI, 1.3–38.0). CFZ concentration and MIC of CFZ less than 0.25 mg/L were not associated with culture conversion in this study.
Conclusion
CFZ-induced pigmentation and QT interval prolongation are associated with serum CFZ concentrations. CFZ dosage may be optimized by monitoring serum CFZ concentration.
{"title":"Clofazimine serum concentration and safety/efficacy in nontuberculous mycobacterial pulmonary disease treatment","authors":"Fumiya Watanabe , Keiji Fujiwara , Koji Furuuchi , Masashi Ito , Kazuhiko Hanada , Tatsuya Kodama , Akio Aono , Satoshi Mitarai , Takashi Yoshiyama , Atsuyuki Kurashima , Ken Ohta , Kozo Morimoto","doi":"10.1016/j.rmed.2024.107718","DOIUrl":"10.1016/j.rmed.2024.107718","url":null,"abstract":"<div><h3>Background</h3><p>Clofazimine (CFZ) has shown promising effects against <em>Mycobacterium avium</em>-<em>intracellulare</em> complex pulmonary disease (MAC-PD) and <em>Mycobacterium abscessus</em> species pulmonary disease (MABS-PD). However, the optimal CFZ dose remains unknown. We aimed to explore the relationship between steady-state CFZ concentration and its safety and efficacy in MAC-PD and MABS-PD.</p></div><div><h3>Methods</h3><p>This prospective observational study focused on patients with MAC-PD and MABS-PD treated with CFZ (UMIN 000041053). To understand the safety and efficacy profile of CFZ and elucidate its optimal concentration, we analyzed CFZ-induced pigmentation grade, QTc interval, and culture conversion outcomes in relation to serum CFZ concentration using Student's <em>t</em>-test, a concentration-QTc model, and multivariable logistic regression analysis, respectively. In total, 64 patients (34 with MAC-PD; 30 with MABS-PD) were included.</p></div><div><h3>Results</h3><p>The steady-state concentration of CFZ was higher in the moderate-to-severe pigmentation group than in the none-to-light pigmentation group (<em>P</em> < 0.001). At a CFZ concentration of 1 mg/L, the QTc interval was prolonged by 17.3 ms (95 % confidence interval [CI], 3.9–25.4) from baseline. Culture conversion was achieved in 33 (51.6 %) patients. The only significant predictor of culture conversion was surgery (adjusted odds ratio, 5.4; 95 % CI, 1.3–38.0). CFZ concentration and MIC of CFZ less than 0.25 mg/L were not associated with culture conversion in this study.</p></div><div><h3>Conclusion</h3><p>CFZ-induced pigmentation and QT interval prolongation are associated with serum CFZ concentrations. CFZ dosage may be optimized by monitoring serum CFZ concentration.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-15DOI: 10.1016/j.rmed.2024.107714
Sylvia Packham , Maria Ödling , Apostolos Bossios , Jon R. Konradsen , Caroline Stridsman
Background
Patients with uncontrolled asthma should be evaluated for medication adherence. This study aimed to identify characteristics associated with poor adherence to inhaled corticosteroids (ICS) and to explore adherence prior to treatment escalation.
Methods
This nationwide longitudinal cohort study included adult asthma patients (n = 30880) with a healthcare visit including Asthma Control Test (ACT) and registered in the Swedish National Airway Register between 1 July 2017 and 28 February 2019 (index date). Patient data was crosslinked to other national registers. Treatment steps two years pre- and one year post-index, were identified by prescribed drugs. Poor adherence was defined as Medication Possession Ratio <80 %.
Results
Poor adherence was identified in 73 % of patients in treatment steps 2–5, where of 35 % had uncontrolled asthma (ACT≤19). In adjusted models, poor adherence was associated with better disease control; ACT≤19 (OR 0.78, 95 % CI 0.71–0.84), short-acting β2-agonist (SABA) overuse (0.69, 0.61–0.79) and exacerbations (0.79, 0.70–0.89) in steps 2–3. Among patients with uncontrolled asthma, poor adherence was associated with SABA overuse (1.71, 1.50–1.95), exacerbations (1.29, 1.15–1.46), current smoking (1.38, 1.21–1.57) and inversely associated with asthma management education (0.85, 0.78–0.93. Similar results were observed in steps 4–5. When investigating post-index treatment, 53 % remained stationary, 30 % stepped down and 17 % escalated treatment. Prior to escalation, 49 % had poor adherence.
Conclusions
Poor ICS adherence was associated with better asthma control. Among uncontrolled patients, poor adherence was associated with SABA overuse and exacerbations. Our result highlights the importance of asthma management education to improve adherence in uncontrolled patients.
{"title":"Adherence to inhaled corticosteroid therapy and treatment escalation in the Swedish adult asthma population","authors":"Sylvia Packham , Maria Ödling , Apostolos Bossios , Jon R. Konradsen , Caroline Stridsman","doi":"10.1016/j.rmed.2024.107714","DOIUrl":"10.1016/j.rmed.2024.107714","url":null,"abstract":"<div><h3>Background</h3><p>Patients with uncontrolled asthma should be evaluated for medication adherence. This study aimed to identify characteristics associated with poor adherence to inhaled corticosteroids (ICS) and to explore adherence prior to treatment escalation.</p></div><div><h3>Methods</h3><p>This nationwide longitudinal cohort study included adult asthma patients (<em>n</em> = 30880) with a healthcare visit including Asthma Control Test (ACT) and registered in the Swedish National Airway Register between 1 July 2017 and 28 February 2019 (index date). Patient data was crosslinked to other national registers. Treatment steps two years pre- and one year post-index, were identified by prescribed drugs. Poor adherence was defined as Medication Possession Ratio <80 %.</p></div><div><h3>Results</h3><p>Poor adherence was identified in 73 % of patients in treatment steps 2–5, where of 35 % had uncontrolled asthma (ACT≤19). In adjusted models, poor adherence was associated with better disease control; ACT≤19 (OR 0.78, 95 % CI 0.71–0.84), short-acting β2-agonist (SABA) overuse (0.69, 0.61–0.79) and exacerbations (0.79, 0.70–0.89) in steps 2–3. Among patients with uncontrolled asthma, poor adherence was associated with SABA overuse (1.71, 1.50–1.95), exacerbations (1.29, 1.15–1.46), current smoking (1.38, 1.21–1.57) and inversely associated with asthma management education (0.85, 0.78–0.93. Similar results were observed in steps 4–5. When investigating post-index treatment, 53 % remained stationary, 30 % stepped down and 17 % escalated treatment. Prior to escalation, 49 % had poor adherence.</p></div><div><h3>Conclusions</h3><p>Poor ICS adherence was associated with better asthma control. Among uncontrolled patients, poor adherence was associated with SABA overuse and exacerbations. Our result highlights the importance of asthma management education to improve adherence in uncontrolled patients.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001896/pdfft?md5=77a4b51f70e34461f3915ae182af9268&pid=1-s2.0-S0954611124001896-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-08DOI: 10.1016/j.rmed.2024.107697
Lekhya Raavi , Shahin Isha , Sadhana Jonna , Emily C. Craver , Hrishikesh Nataraja , Anna Jenkins , Abby J. Hanson , Arvind Bala Venkataraman , Prasanth Balasubramanian , Aysun Tekin , Vikas Bansal , Sean M. Caples , Syed Anjum Khan , Nitesh K. Jain , Abigail T. LaNou , Rahul Kashyap , Rodrigo Cartin-Ceba , Bhavesh M. Patel , Ricardo Diaz Milian , Carla P. Venegas , Devang K. Sanghavi
Objective
To assess antibiotics impact on outcomes in COVID-19 pneumonia patients with varying procalcitonin (PCT) levels.
Methods
This retrospective cohort study included 3665 COVID-19 pneumonia patients hospitalized at five Mayo Clinic sites (March 2020 to June 2022). PCT levels were measured at admission. Patients’ antibiotics use and outcomes were collected via the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Patients were stratified into high and low PCT groups based on the first available PCT result. The distinction between high and low PCT was demarcated at both 0.25 ng/ml and 0.50 ng/ml.
Results
Our cohort consisted of 3665 patients admitted with COVID-19 pneumonia. The population was predominantly male, Caucasian and non-Hispanic. With the PCT cut-off of 0.25 ng/ml, 2375 (64.8 %) patients had a PCT level <0.25 ng/mL, and 1290 (35.2 %) had PCT ≥0.25 ng/ml. While when the PCT cut off of 0.50 ng/ml was used we observed 2934 (80.05 %) patients with a PCT <0.50 ng/ml while 731(19.94 %) patients had a PCT ≥0.50 ng/ml. Patients with higher PCT levels exhibited significantly higher rates of bacterial infections (0.25 ng/ml cut-off: 4.2 % vs 7.9 %; 0.50 ng/ml cut-off: 4.6 % vs 9.2 %).
Antibiotics were used in 66.0 % of the cohort. Regardless of the PCT cutoffs, the antibiotics group showed increased hospital length of stay (LOS), intensive care unit (ICU) admission rate, and mortality. However, early de-escalation (<24 h) of antibiotics correlated with reduced hospital LOS, ICU LOS, and mortality. These results were consistent even after adjusting for confounders.
Conclusion
Our study shows a substantial number of COVID-19 pneumonia patients received antibiotics despite a low incidence of bacterial infections. Therefore, antibiotics use in COVID pneumonia patients with PCT <0.5 in the absence of clinical evidence of bacterial infection has no beneficial effect.
{"title":"Association of antibiotics with the outcomes in COVID-19 pneumonia patients with elevated PCT levels","authors":"Lekhya Raavi , Shahin Isha , Sadhana Jonna , Emily C. Craver , Hrishikesh Nataraja , Anna Jenkins , Abby J. Hanson , Arvind Bala Venkataraman , Prasanth Balasubramanian , Aysun Tekin , Vikas Bansal , Sean M. Caples , Syed Anjum Khan , Nitesh K. Jain , Abigail T. LaNou , Rahul Kashyap , Rodrigo Cartin-Ceba , Bhavesh M. Patel , Ricardo Diaz Milian , Carla P. Venegas , Devang K. Sanghavi","doi":"10.1016/j.rmed.2024.107697","DOIUrl":"10.1016/j.rmed.2024.107697","url":null,"abstract":"<div><h3>Objective</h3><p>To assess antibiotics impact on outcomes in COVID-19 pneumonia patients with varying procalcitonin (PCT) levels.</p></div><div><h3>Methods</h3><p>This retrospective cohort study included 3665 COVID-19 pneumonia patients hospitalized at five Mayo Clinic sites (March 2020 to June 2022). PCT levels were measured at admission. Patients’ antibiotics use and outcomes were collected via the Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry. Patients were stratified into high and low PCT groups based on the first available PCT result. The distinction between high and low PCT was demarcated at both 0.25 ng/ml and 0.50 ng/ml.</p></div><div><h3>Results</h3><p>Our cohort consisted of 3665 patients admitted with COVID-19 pneumonia. The population was predominantly male, Caucasian and non-Hispanic. With the PCT cut-off of 0.25 ng/ml, 2375 (64.8 %) patients had a PCT level <0.25 ng/mL, and 1290 (35.2 %) had PCT ≥0.25 ng/ml. While when the PCT cut off of 0.50 ng/ml was used we observed 2934 (80.05 %) patients with a PCT <0.50 ng/ml while 731(19.94 %) patients had a PCT ≥0.50 ng/ml. Patients with higher PCT levels exhibited significantly higher rates of bacterial infections (0.25 ng/ml cut-off: 4.2 % vs 7.9 %; 0.50 ng/ml cut-off: 4.6 % vs 9.2 %).</p><p>Antibiotics were used in 66.0 % of the cohort. Regardless of the PCT cutoffs, the antibiotics group showed increased hospital length of stay (LOS), intensive care unit (ICU) admission rate, and mortality. However, early de-escalation (<24 h) of antibiotics correlated with reduced hospital LOS, ICU LOS, and mortality. These results were consistent even after adjusting for confounders.</p></div><div><h3>Conclusion</h3><p>Our study shows a substantial number of COVID-19 pneumonia patients received antibiotics despite a low incidence of bacterial infections. Therefore, antibiotics use in COVID pneumonia patients with PCT <0.5 in the absence of clinical evidence of bacterial infection has no beneficial effect.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301510","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}
Pulmonary rehabilitation (PR) is an effective treatment method for chronic obstructive pulmonary disease (COPD). However, individuals with chronic diseases that require lifelong treatment and experience exacerbations need motivational methods.
Objectives
The aim of this study was to examine the effects of virtual reality on symptoms, daily living activity, functional capacity, anxiety and depression levels in COPD exacerbation.
Methods
Fifty patients hospitalized for COPD exacerbation were included in the study. They were randomly assigned to two groups. Twenty-five patients participated in a traditional PR (once-daily until discharge), including pedaling exercises. The second/25 patients followed the same protocol but experienced cycling simulation in the forest via virtual reality (VR + PR). All patients were evaluated using 1-minute/Sit-to-Stand test (STST), modified-Medical Research Council (mMRC) scale, COPD Assessment test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activities of Daily Living (LCADL) before and after the treatment.
Results
The STST showed an increase in both groups post-treatment, notably higher in the VR + PR (p = 0.037). Dyspnea levels and CAT scores decreased in all patients, but the decrease was greater in the PR + VR group for both parameters (p = 0.062, p = 0.003; respectively). Both groups experienced a reduction in the HADS scores compared to the pre-treatment, with a more significant decrease in depression and the total score in the VR + PR (p < 0.05). LCADL's sub-parameters and total score, excluding household, decreased in both groups after treatment (p < 0.05). The improvement was more substantial in the VR + PR.
Conclusions
Virtual reality provides benefits in the management of COPD exacerbations and can be used safely.
Clinical trial registiration
Registered at clinicaltrials.gov, registration ID: NCT05687396, URL: www.clinicaltrials.gov.
{"title":"Virtual reality for COPD exacerbation: A randomized controlled trial","authors":"Erhan Kizmaz , Orçin Telli Atalay , Nazlı Çetin , Erhan Uğurlu","doi":"10.1016/j.rmed.2024.107696","DOIUrl":"10.1016/j.rmed.2024.107696","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary rehabilitation (PR) is an effective treatment method for chronic obstructive pulmonary disease (COPD). However, individuals with chronic diseases that require lifelong treatment and experience exacerbations need motivational methods.</p></div><div><h3>Objectives</h3><p>The aim of this study was to examine the effects of virtual reality on symptoms, daily living activity, functional capacity, anxiety and depression levels in COPD exacerbation.</p></div><div><h3>Methods</h3><p>Fifty patients hospitalized for COPD exacerbation were included in the study. They were randomly assigned to two groups. Twenty-five patients participated in a traditional PR (once-daily until discharge), including pedaling exercises. The second/25 patients followed the same protocol but experienced cycling simulation in the forest via virtual reality (VR + PR). All patients were evaluated using 1-minute/Sit-to-Stand test (STST), modified-Medical Research Council (mMRC) scale, COPD Assessment test (CAT), Hospital Anxiety and Depression Scale (HADS), and London Chest Activities of Daily Living (LCADL) before and after the treatment.</p></div><div><h3>Results</h3><p>The STST showed an increase in both groups post-treatment, notably higher in the VR + PR (p = 0.037). Dyspnea levels and CAT scores decreased in all patients, but the decrease was greater in the PR + VR group for both parameters (p = 0.062, p = 0.003; respectively). Both groups experienced a reduction in the HADS scores compared to the pre-treatment, with a more significant decrease in depression and the total score in the VR + PR (p < 0.05). LCADL's sub-parameters and total score, excluding household, decreased in both groups after treatment (p < 0.05). The improvement was more substantial in the VR + PR.</p></div><div><h3>Conclusions</h3><p>Virtual reality provides benefits in the management of COPD exacerbations and can be used safely.</p></div><div><h3>Clinical trial registiration</h3><p>Registered at <span>clinicaltrials.gov</span><svg><path></path></svg>, registration ID: NCT05687396, URL: <span>www.clinicaltrials.gov</span><svg><path></path></svg>.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-07DOI: 10.1016/j.rmed.2024.107692
Zhen-feng He , Sheng-zhu Lin , Cui-xia Pan , Zhao-ming Chen , Lai-jian Cen , Xiao-xian Zhang , Yan Huang , Chun-lan Chen , Shan-shan Zha , Hui-min Li , Zhen-hong Lin , Ming-xin Shi , Nan-shan Zhong , Wei-jie Guan
Background
Exacerbations are implicated in bronchiectasis and COPD, which frequently co-exist [COPD-Bronchiectasis association (CBA)]. We aimed to determine the bacterial and viral spectrum at stable-state and exacerbation onset of CBA, and their association with exacerbations and clinical outcomes of CBA as compared with bronchiectasis.
Methods
We prospectively collected spontaneous sputum from adults with CBA, bronchiectasis with (BO) and without airflow obstruction (BNO) for bacterial culture and viral detection at stable-state and exacerbations.
Results
We enrolled 76 patients with CBA, 58 with BO, and 138 with BNO (711 stable and 207 exacerbation visits). Bacterial detection rate increased from BNO, CBA to BO at steady-state (P = 0.02), but not at AE onset (P = 0.91). No significant differences in viral detection rate were found among BNO, CBA and BO. Compared with steady-state, viral isolations occurred more frequently at exacerbation in BNO (15.8 % vs 32.1 %, P = 0.001) and CBA (19.5 % vs 30.6 %, P = 0.036) only. In CBA, isolation of viruses, human metapneumovirus and bacteria plus viruses was associated with exacerbation. Repeated detection of Pseudomonas aeruginosa (PA) correlated with higher modified Reiff score (P = 0.032) in CBA but not in BO (P = 0.178). Repeated detection of PA yielded a shorter time to the first exacerbation in CBA [median: 4.3 vs 11.1 months, P = 0.006] but not in BO (median: 8.4 vs 7.6 months, P = 0.47).
Conclusions
Isolation of any viruses, human metapneumovirus and bacterialplus viruses was associated with CBA exacerbations. Repeated detection of PA confers greater impact of future exacerbations on CBA than on BO.
背景:支气管扩张症和慢性阻塞性肺病经常并存,而这两种疾病的加重与支气管扩张症有关[慢性阻塞性肺病-支气管扩张症并存(CBA)]。我们的目的是确定 CBA 稳定状态和恶化开始时的细菌和病毒谱,以及与支气管扩张症相比,病原体检测与 CBA 恶化之间的关联:我们前瞻性地收集了CBA、伴气流阻塞(BO)和不伴气流阻塞(BNO)的支气管扩张成人患者的自发痰液,用于细菌培养和病毒检测:我们共收治了 76 名 CBA 患者、58 名 BO 患者和 138 名 BNO 患者(其中稳定期 711 人次,加重期 207 人次)。从 BNO、CBA 到 BO,细菌检出率在稳定期有所上升(P=0.02),但在急性发作期没有上升(P=0.91)。BNO、CBA和BO的病毒检出率无明显差异。与稳态相比,仅在 BNO(15.8% vs 32.1%,P=0.001)和 CBA(19.5% vs 30.6%,P=0.036)中,病情加重时病毒分离率更高。在 CBA 中,病毒、人类偏肺病毒和细菌加病毒的分离与病情加重有关。在 CBA 中,重复检测到铜绿假单胞菌与较高的改良雷夫评分相关(P=0.032),但在 BO 中则不相关(P=0.178)。重复检测铜绿假单胞菌可缩短CBA患者首次病情加重的时间[中位数:4.3个月 vs 11.1个月,P=0.006],但不会缩短BO患者首次病情加重的时间(中位数:8.4个月 vs 7.6个月,P=0.47):结论:CBA 患者的疾病严重程度高于 BNO 患者。结论:CBA 患者的疾病严重程度高于 BNO 患者。虽然病毒分离与 CBA 病情加重有关,但重复检测铜绿假单胞菌对 CBA 患者未来病情加重的影响大于对 BNO 患者的影响。
{"title":"The roles of bacteria and viruses in COPD-Bronchiectasis association: A prospective cohort study","authors":"Zhen-feng He , Sheng-zhu Lin , Cui-xia Pan , Zhao-ming Chen , Lai-jian Cen , Xiao-xian Zhang , Yan Huang , Chun-lan Chen , Shan-shan Zha , Hui-min Li , Zhen-hong Lin , Ming-xin Shi , Nan-shan Zhong , Wei-jie Guan","doi":"10.1016/j.rmed.2024.107692","DOIUrl":"10.1016/j.rmed.2024.107692","url":null,"abstract":"<div><h3>Background</h3><p>Exacerbations are implicated in bronchiectasis and COPD, which frequently co-exist [COPD-Bronchiectasis association (CBA)]. We aimed to determine the bacterial and viral spectrum at stable-state and exacerbation onset of CBA, and their association with exacerbations and clinical outcomes of CBA as compared with bronchiectasis.</p></div><div><h3>Methods</h3><p>We prospectively collected spontaneous sputum from adults with CBA, bronchiectasis with (BO) and without airflow obstruction (BNO) for bacterial culture and viral detection at stable-state and exacerbations.</p></div><div><h3>Results</h3><p>We enrolled 76 patients with CBA, 58 with BO, and 138 with BNO (711 stable and 207 exacerbation visits). Bacterial detection rate increased from BNO, CBA to BO at steady-state (<em>P</em> = 0.02), but not at AE onset (<em>P</em> = 0.91). No significant differences in viral detection rate were found among BNO, CBA and BO. Compared with steady-state, viral isolations occurred more frequently at exacerbation in BNO (15.8 % vs 32.1 %, <em>P</em> = 0.001) and CBA (19.5 % vs 30.6 %, <em>P</em> = 0.036) only. In CBA, isolation of viruses, human metapneumovirus and bacteria plus viruses was associated with exacerbation. Repeated detection of <em>Pseudomonas aeruginosa</em> (PA) correlated with higher modified Reiff score (<em>P</em> = 0.032) in CBA but not in BO (<em>P</em> = 0.178). Repeated detection of PA yielded a shorter time to the first exacerbation in CBA [median: 4.3 vs 11.1 months, <em>P</em> = 0.006] but not in BO (median: 8.4 vs 7.6 months, <em>P</em> = 0.47).</p></div><div><h3>Conclusions</h3><p>Isolation of any viruses, human metapneumovirus and bacterialplus viruses was associated with CBA exacerbations. Repeated detection of PA confers greater impact of future exacerbations on CBA than on BO.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-06DOI: 10.1016/j.rmed.2024.107693
Jussi Karjalainen , Ville Vartiainen , Antti Tikkakoski , L. Pekka Malmberg , Liisa Vuotari , Satu Lähelmä , Ulla Sairanen , Mikko Vahteristo , Lauri Lehtimäki
Background
Salbutamol is a cornerstone for relieving acute asthma symptoms, typically administered through a pressurized metered-dose inhaler (pMDI). Dry powder inhalers (DPIs) offer an alternative, but concerns exist whether DPIs provide an effective relief during an obstructive event.
Objective
We aimed to show non-inferiority of Salbutamol Easyhaler DPI compared to pMDI with spacer in treating methacholine-induced bronchoconstriction. Applicability of Budesonide-formoterol Easyhaler DPI as a reliever was also assessed.
Methods
This was a randomized, parallel-group trial in subjects sent to methacholine challenge (MC) test for asthma diagnostics. Participants with at least 20 % decrease in forced expiratory volume in 1 s (FEV1) were randomized to receive Salbutamol Easyhaler (2 × 200 μg), Ventoline Evohaler with spacer (4 × 100 μg) or Budesonide-formoterol Easyhaler (2 × 160/4.5 μg) as a reliever. The treatment was repeated if FEV1 did not recover to at least −10 % of baseline.
Results
180 participants (69 % females, mean age 46 yrs [range 18–80], FEV1%pred 89.5 [62–142] %) completed the trial. Salbutamol Easyhaler was non-inferior to pMDI with spacer in acute relief of bronchoconstriction showing a −0.083 (95 % LCL -0.146) L FEV1 difference after the first dose and −0.032 (−0.071) L after the last dose. The differences in FEV1 between Budesonide-formoterol Easyhaler and Salbutamol pMDI with spacer were −0.163 (−0.225) L after the first and −0.092 (−0.131) L after the last dose.
Conclusion
The study confirms non-inferiority of Salbutamol Easyhaler to Ventoline Evohaler with spacer in relieving acute bronchoconstriction, making Easyhaler a sustainable and safe reliever for MC test and supports its use during asthma attacks.
{"title":"Salbutamol Easyhaler provides non-inferior relief of methacholine induced bronchoconstriction in comparison to Ventoline Evohaler with spacer: A randomized trial","authors":"Jussi Karjalainen , Ville Vartiainen , Antti Tikkakoski , L. Pekka Malmberg , Liisa Vuotari , Satu Lähelmä , Ulla Sairanen , Mikko Vahteristo , Lauri Lehtimäki","doi":"10.1016/j.rmed.2024.107693","DOIUrl":"10.1016/j.rmed.2024.107693","url":null,"abstract":"<div><h3>Background</h3><p>Salbutamol is a cornerstone for relieving acute asthma symptoms, typically administered through a pressurized metered-dose inhaler (pMDI). Dry powder inhalers (DPIs) offer an alternative, but concerns exist whether DPIs provide an effective relief during an obstructive event.</p></div><div><h3>Objective</h3><p>We aimed to show non-inferiority of Salbutamol Easyhaler DPI compared to pMDI with spacer in treating methacholine-induced bronchoconstriction. Applicability of Budesonide-formoterol Easyhaler DPI as a reliever was also assessed.</p></div><div><h3>Methods</h3><p>This was a randomized, parallel-group trial in subjects sent to methacholine challenge (MC) test for asthma diagnostics. Participants with at least 20 % decrease in forced expiratory volume in 1 s (FEV<sub>1</sub>) were randomized to receive Salbutamol Easyhaler (2 × 200 μg), Ventoline Evohaler with spacer (4 × 100 μg) or Budesonide-formoterol Easyhaler (2 × 160/4.5 μg) as a reliever. The treatment was repeated if FEV<sub>1</sub> did not recover to at least −10 % of baseline.</p></div><div><h3>Results</h3><p>180 participants (69 % females, mean age 46 yrs [range 18–80], FEV<sub>1</sub>%pred 89.5 [62–142] %) completed the trial. Salbutamol Easyhaler was non-inferior to pMDI with spacer in acute relief of bronchoconstriction showing a −0.083 (95 % LCL -0.146) L FEV<sub>1</sub> difference after the first dose and −0.032 (−0.071) L after the last dose. The differences in FEV<sub>1</sub> between Budesonide-formoterol Easyhaler and Salbutamol pMDI with spacer were −0.163 (−0.225) L after the first and −0.092 (−0.131) L after the last dose.</p></div><div><h3>Conclusion</h3><p>The study confirms non-inferiority of Salbutamol Easyhaler to Ventoline Evohaler with spacer in relieving acute bronchoconstriction, making Easyhaler a sustainable and safe reliever for MC test and supports its use during asthma attacks.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001677/pdfft?md5=216d15549029bbef30e75fe430f550e8&pid=1-s2.0-S0954611124001677-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293670","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}