Respiratory medicine最新文献_第9页

The risk factors for chronic cough in children: A meta-analysis covering five continents 儿童慢性咳嗽的风险因素：涵盖五大洲的荟萃分析。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-31 DOI: 10.1016/j.rmed.2024.107752

Background

This study aimed to explore the risk factors for chronic cough in children and provide a reference for prevention and healthcare measures.

Methods

PubMed, Web of Science, Cochrane, and EMBASE were searched for observational studies published up to April 2024. Outcome included risk factors associated with chronic cough in children. Two investigators independently searched and screened the literature, evaluated the qualities and extracted baseline datas. Results were analyzed using random-effects models with odds ratios and their 95 % confidence intervals to address heterogeneity. Subgroup analyses, sensitivity analyses and assessment of publication bias were performed. Stata17 and GRADEwas used for the meta-analysis.

Results

18 studies including 97,462 children were reviewed. Asthma(OR = 4.06, 95%CI: 2.37–6.96, P＜0.01), NO₂(OR = 1.19, 95%CI: 1.01–1.39, P = 0.031), Home remodeling history (OR = 1.82,95 % CI: 1.61–2.05, P＜0.01), Environment Tobacco Smoke(OR = 1.41, 95 % CI: 1.15–1.73, P = 0.001), Pet exposure (OR = 1.56, 95%CI: 1.25–1.95, P＜0.01), Mould (OR = 1.64,95%CI: 1.45–1.85, P＜0.01), Age＜1 year(OR = 3.19, 95 % CI: 1.8–5.63, P＜0.01) were reported as risk factors for chronic cough in children, these results were discussed qualitatively in the study.

Conclusion

Asthma, NO₂, Home remodeling history, Environment Tobacco Smoke(ETS), Pet exposure, Mould, and Age＜1 year are risk factors for chronic coughing in children. Due to the few studies and insufficient evidence, other potential risk factors need to be robustly confirmed by subsequent large-sample and multicenter trials.

背景：本研究旨在探讨儿童慢性咳嗽的风险因素，并为预防和保健措施提供参考：本研究旨在探讨儿童慢性咳嗽的风险因素，为预防和保健措施提供参考：方法：检索PubMed、Web of Science、Cochrane和EMBASE上截至2024年4月发表的观察性研究。结果包括与儿童慢性咳嗽相关的风险因素。两名研究人员独立检索和筛选文献，评估文献质量并提取基线数据。使用随机效应模型分析结果，并使用几率比及其 95% 的置信区间来解决异质性问题。还进行了分组分析、敏感性分析和发表偏倚评估。荟萃分析使用了 Stata17 和 GRADE：对包括 97 462 名儿童在内的 18 项研究进行了审查。哮喘（OR= 4.06，95%CI：2.37-6.96，P＜0.01）、NO2（OR= 1.19，95%CI：1.01-1.39，P= 0.031）、家庭改造史（OR= 1.82，95%CI：1.61-2.05，P＜0.01）、环境烟草烟雾（OR= 1.41，95%CI：1.15-1.73，P=0.001）、宠物接触（OR= 1.56，95%CI：1.OR=1.41，95%CI：1.15-1.73，P=0.001）、宠物接触（OR=1.56，95%CI：1.25-1.95，P＜0.01）、霉菌（OR=1.64，95%CI：1.45-1.85，P＜0.01）、年龄＜1岁（OR=3.19，95%CI：1.8-5.63，P＜0.01）被报告为儿童慢性咳嗽的危险因素，研究对这些结果进行了定性讨论：结论：哮喘、二氧化氮、家庭改造史、环境烟草烟雾（ETS）、宠物接触、霉菌和年龄＜1 岁是儿童慢性咳嗽的危险因素。由于研究较少且证据不足，其他潜在的危险因素还需要通过后续的大样本和多中心试验加以证实。

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引用次数: 0

Respiratory physiological mechanism of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease 两种等强度吸气肌训练在慢性阻塞性肺病稳定期患者中的呼吸生理机制。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-31 DOI: 10.1016/j.rmed.2024.107747

Purpose

This study aimed to investigate the respiratory physiological changes resulting from short-term inspiratory resistance training (R-IMT) and inspiratory threshold training (T-IMT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the mechanisms of the two training methods.

Patients and methods

A total of 75 stable patients with COPD combined with inspiratory muscle weakness were randomly allocated to three groups: R-IMT (n = 26), T-IMT (n = 24), and control (n = 25). Before and after 8 weeks of inspiratory muscle training(IMT), cardiopulmonary exercise tests were conducted to assess respiratory patterns, respiratory central drive, exercise tolerance, and ventilation efficiency.

Results

After 8 weeks of IMT, Inspiratory muscle strength, represented by MIP (maximum inspiratory mouth pressure) and exercise capacity increased during exercise in both IMT groups (P < 0.05). In the R-IMT group, inspiratory time (Ti) prolonged (P < 0.05), tidal volume (Vt) increased (P < 0.05), ventilation efficiency (represented by ventilation-center coupling) increased (P < 0.05) during exercise. Conversely, the T-IMT group did not exhibit any of these changes after IMT (P > 0.05).

Conclusion

In summary, the improvement in exercise tolerance was associated with an increase in inspiratory muscle reserve in both R-IMT and T-IMT. However, only R-IMT was associated with deeper and slower breathing, as well as improved ventilation efficiency.

目的：本研究旨在探讨短期吸气阻力训练（R-IMT）和吸气阈值训练（T-IMT）在慢性阻塞性肺疾病（COPD）患者中引起的呼吸生理变化，并比较两种训练方法的机制：将 75 名慢性阻塞性肺病合并吸气肌无力的稳定期患者随机分配到三组：R-IMT组（26人）、T-IMT组（24人）和对照组（25人）。在吸气肌训练（IMT）8周前后，进行心肺运动测试以评估呼吸模式、呼吸中枢驱动力、运动耐量和通气效率：结果：经过 8 周的吸气肌训练后，两组吸气肌训练者的吸气肌力（以 MIP（最大吸气口压）表示）和运动耐量均有所提高（P0.05）：总之，在 R-IMT 和 T-IMT 组中，运动耐量的提高与吸气肌肉储备的增加有关。然而，只有 R-IMT 组的呼吸更深更慢，通气效率也有所提高。

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引用次数: 0

Diagnostic yield and safety of repeat bronchoscopy in pulmonary disease: A five-year retrospective analysis 肺部疾病重复支气管镜检查的诊断率和安全性：五年回顾性分析

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-31 DOI: 10.1016/j.rmed.2024.107759

Aim

In this study, we aim to analyze the frequency and indications of repeat bronchoscopic procedures performed at our hospital over a five-year period.

Methods

This retrospective study was conducted at the Department of Pulmonary Diseases, Akdeniz University, and included patients who underwent bronchoscopy between January 1, 2018, and May 31, 2024. Patients who required a repeat bronchoscopy were identified. Inclusion criteria for the repeat bronchoscopy group were non-diagnostic initial bronchoscopy or the need for additional samples for molecular testing in lung cancer patients. Exclusion criteria included patients with incomplete medical records or those who did not provide informed consent for the repeat procedure.

Findings

A total of 3877 patients underwent bronchoscopy in this time periods. Among these, 69 patients (1.8 %) required a repeat bronchoscopy. The mean age of these patients was 61.3 ± 11.7 years, with 54 (78 %) being male. The most common reason for the repeat procedure was the non-diagnostic outcome of the initial bronchoscopy (n = 53, 77 %), followed by cases where the initial bronchoscopy was diagnostic for lung cancer but insufficient for molecular testing (n = 16, 23 %). Among the 16 patients who underwent molecular testing, sufficient samples for molecular tests were obtained in 12 patients (75 %) following the second bronchoscopy. Molecular tests were negative for driver mutations in 6 patients, while 6 patients tested positive (PD-L1, n = 5; EGFR, n = 1). In 4 patients (25 %), the sample was reported as insufficient for molecular testing. Patients who underwent repeat bronchoscopy had the second procedure an average of 38.5 ± 59.7 days after the initial procedure. No complications developed in patients undergoing repeat bronchoscopy, except for bleeding not requiring intervention related to the bronchoscopy procedure.

Conclusion

In conclusion, regardless of the reason, repeated bronchoscopy in suitable patients is safe and has a high diagnostic yield.

目的：在这项研究中，我们旨在分析我院五年内重复进行支气管镜手术的频率和适应症：这项回顾性研究在阿克登尼兹大学肺病系进行，纳入了 2018 年 1 月 1 日至 2024 年 5 月 31 日期间接受支气管镜检查的患者。研究确定了需要再次接受支气管镜检查的患者。重复支气管镜检查组的纳入标准为初次支气管镜检查未确诊或需要额外样本进行分子检测的肺癌患者。排除标准包括医疗记录不完整的患者或未就重复检查提供知情同意书的患者：在此期间，共有 3877 名患者接受了支气管镜检查。其中，69 名患者（1.8%）需要再次接受支气管镜检查。这些患者的平均年龄为（61.3 ± 11.7）岁，其中 54 人（78%）为男性。重复检查最常见的原因是初次支气管镜检查未确诊（53 人，占 77%），其次是初次支气管镜检查确诊肺癌，但分子检测结果不充分（16 人，占 23%）。在接受分子检测的16名患者中，有12名患者（75%）在第二次支气管镜检查后获得了足够的分子检测样本。分子检测结果显示，6 名患者的驱动基因突变呈阴性，6 名患者呈阳性（PD-L1，5 人；表皮生长因子受体（EGFR），1 人）。4名患者（25%）的样本被报告为不足以进行分子检测。接受重复支气管镜检查的患者平均在首次检查后（38.5 ± 59.7）天进行第二次检查。除了与支气管镜检查无关的出血外，接受重复支气管镜检查的患者均未出现并发症：总之，无论出于何种原因，对合适的患者进行重复支气管镜检查都是安全的，而且诊断率高。

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引用次数: 0

Treatment intensity level as a proxy for severity of chronic obstructive pulmonary disease: A risk stratification tool 作为慢性阻塞性肺病严重程度替代物的治疗强度水平：风险分层工具。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-31 DOI: 10.1016/j.rmed.2024.107742

Background

Increasing severity of chronic obstructive pulmonary disease (COPD) is associated with increasing risk of poor outcomes. Using health registry data, we aimed to assess the association between treatment intensity levels (TIL), as a proxy for underlying COPD severity, and long-term outcomes.

Methods

Using Danish nationwide registries, we identified patients diagnosed with COPD during 2001–2016, who were alive at index date of 1 January 2017. We stratified patients into exclusive TILs from least to most severe: no use, short term therapy, mono-, dual-, triple therapy, oral corticosteroid (OCS), and long-term oxygen treatment (LTOT). Survival analyses were used to assess 5-year outcomes by TIL.

Results

We identified 53,803 patients with COPD in the study period (median age: 72 years [inter quartile range, 64–80], 48 % male). The three most severe TILs were associated with a significant incremental increase in all-cause mortality with an adjusted hazard ratio (aHR) for triple therapy, OCS and LTOT of 1.44 (95 % CI: 1.38–1.51), 1.67 (95 % CI: 1.59–1.75), and 2.91 (95 % CI: 2.76–3.07) compared with those receiving no therapy as reference. The same pattern was evident for the composite outcome of 5-year mortality or COPD-related hospitalization with an aHR for triple therapy, OCS and LTOT of 2.30 (95 % CI: 2.22–2.38), 2.85 (95 % CI: 2.74–2.96), and 4.00 (95 % CI: 3.81–4.20), respectively.

Conclusion

Increasing TILs were associated with increasing five-year mortality and risk of COPD-related hospitalization. TILs may be used as a proxy for underlying COPD severity in epidemiological studies.

背景：慢性阻塞性肺病（COPD）严重程度的增加与不良预后风险的增加有关。我们利用健康登记数据，旨在评估治疗强度水平（TIL）作为慢性阻塞性肺病严重程度的替代指标与长期预后之间的关系：我们利用丹麦全国范围内的登记数据，确定了 2001-2016 年间被诊断为慢性阻塞性肺病的患者，这些患者在 2017 年 1 月 1 日指数日时仍然存活。我们将患者分为从最轻到最重的专属 TIL：不使用、短期治疗、单一治疗、双重治疗、三重治疗、口服皮质类固醇（OCS）和长期氧治疗（LTOT）。采用生存分析评估 TIL 的 5 年疗效：在研究期间，我们共发现了 53803 名慢性阻塞性肺病患者（中位年龄：72 岁[四分位间范围：64-80 岁]，48% 为男性）。与不接受治疗的患者相比，三种最严重的 TIL 与全因死亡率的显著增加有关，三联疗法、OCS 和 LTOT 的调整后危险比 (aHR) 分别为 1.44（95% CI：1.38-1.51）、1.67（95% CI：1.59-1.75）和 2.91（95% CI：2.76-3.07）。对于5年死亡率或慢性阻塞性肺病相关住院治疗的综合结果，三联疗法、OCS和LTOT的aHR分别为2.30（95% CI：2.22-2.38）、2.85（95% CI：2.74-2.96）和4.00（95% CI：3.81-4.20）：结论：TILs的增加与五年死亡率和慢性阻塞性肺疾病相关住院风险的增加有关。在流行病学研究中，TILs可作为慢性阻塞性肺病潜在严重程度的替代指标。

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引用次数: 0

Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea 阻塞性睡眠呼吸暂停的舌下神经刺激和自动调整气道正压疗法的多导睡眠图和患者报告结果的真实世界数据。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-30 DOI: 10.1016/j.rmed.2024.107750

Background

Few data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups.

Methods

20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting.

Results

Propensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01).

Conclusion

These are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.

背景：将阻塞性睡眠呼吸暂停（OSA）的一线气道正压（PAP）疗法（尤其是自动调节气道正压（aPAP））与二线舌下神经刺激（HGNS）疗法进行比较的数据很少。本研究的目的是通过标准多导睡眠图（PSG）相关参数和患者报告结果，直接比较可比组中的这些治疗方案。方法：20 名患者（年龄为 57.30 ± 8.56 岁；6 名女性）被纳入 HGNS 组，35 名患者（年龄为 56.83 ± 9.20 岁；9 名女性）被纳入 aPAP 组。两组患者都必须符合现行的 HGNS 治疗指南标准。采用逆倾向得分加权法进行协方差分析（ANCOVA），对各组进行比较：结果：各组的倾向得分没有差异。治疗前 AHI（HGNS：40.22 ± 12.78 /h；aPAP：39.23± 12.33/h）和 ODI（HGNS：37.9± 14.7/h；aPAP：34.58± 14.74/h）在各组之间具有可比性。治疗 413.6 ± 116.66 天（HGNS 组）和 162.09 ± 140.58 天（aPAP 组）后，AHI（HGNS 组：30.22± 17.65/h，aPAP 组：4.71± 3.42/h4.71±3.42/小时；p结论：这些都是新颖的真实世界数据。需要对 HGNS 神经刺激参数调整的关键参数以及影响 HGNS 依从性的因素的影响进行更多研究。

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引用次数: 0

Association of naples prognostic score and lung health: A population-based study 那不勒斯预后评分与肺部健康的关系：基于人群的研究

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-30 DOI: 10.1016/j.rmed.2024.107751

Background

The Naples Prognostic Score (NPS) is a novel indicator of inflammatory and nutritional status, but its relationship to lung health is unknown.

Objective

To evaluate the relationship of NPS to lung health problems.

Methods

A total of 15,600 participants aged 20 years or older with an available assessment of chronic lung diseases were enrolled from the National Health and Nutrition Examination Survey 2007–2012. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Associations of NPS with chronic lung disease (diagnosed asthma, chronic bronchitis, and emphysema), respiratory symptoms (cough, phlegm production, wheeze, and exertional dyspnea), and spirometric measurements (FEV₁, FVC, and obstructive or restrictive spirometry pattern) were evaluated. Kaplan-Meier survival analysis and multiple Cox regressions were used to assess the significance of NPS in relation to all-cause mortality and chronic lower respiratory diseases mortality in participants. Furthermore, to comprehensively assess the association between NSP and chronic lower respiratory diseases mortality, Fine-Gray subdistribution hazards model was performed to analyze non-chronic lower respiratory diseases mortality as a competitive risk.

Results

People with a higher NPS score were associated with greater odds of asthma, chronic bronchitis, respiratory symptoms (including phlegm production, wheeze, and exertional dyspnea), and a greater risk of obstructive and restrictive spirometry. A higher NPS score was significantly associated with decreased FEV₁ and FVC in both overall participants and those with lung health problems. Longitudinally, we found that those in the category with highest NPS were at greater risk of all-cause mortality and chronic lower respiratory diseases mortality in those with chronic lung disease, and respiratory symptoms.

Conclusions

An elevated NPS is associated with a host of adverse pulmonary outcomes. Prospective studies to define NPS as a biomarker for impaired lung health are warranted.

背景：那不勒斯预后评分（NPS）是一种新型炎症和营养状况指标，但其与肺部健康的关系尚不清楚：那不勒斯预后评分（NPS）是衡量炎症和营养状况的新指标，但其与肺部健康的关系尚不清楚：评估那不勒斯预后评分与肺部健康问题的关系：方法：从 2007-2012 年全国健康与营养调查中选取了 15600 名年龄在 20 岁或 20 岁以上、可评估慢性肺部疾病的参与者。NPS是根据血清白蛋白、总胆固醇、中性粒细胞与淋巴细胞比率以及淋巴细胞与单核细胞比率计算得出的。研究人员评估了 NPS 与慢性肺部疾病（诊断为哮喘、慢性支气管炎和肺气肿）、呼吸道症状（咳嗽、咳痰、喘息和用力性呼吸困难）以及肺活量测量（FEV1、FVC 和阻塞性或限制性肺活量测量模式）之间的关系。采用卡普兰-梅耶生存分析和多重 Cox 回归评估了 NPS 与参与者全因死亡率和慢性下呼吸道疾病死亡率的相关性。此外，为了全面评估NSP与慢性下呼吸道疾病死亡率之间的关系，还采用了Fine-Gray亚分布危险模型来分析作为竞争风险的非慢性下呼吸道疾病死亡率：结果：NPS得分越高的人患哮喘、慢性支气管炎、呼吸道症状（包括咳痰、喘息和用力呼吸困难）的几率越大，患阻塞性和限制性肺活量的风险也越大。在总体参与者和有肺部健康问题的参与者中，较高的 NPS 分数与 FEV1 和 FVC 的下降明显相关。纵向研究发现，NPS最高的人群全因死亡率和慢性下呼吸道疾病死亡率风险更高，而患有慢性肺部疾病和呼吸道症状的人群的全因死亡率和慢性下呼吸道疾病死亡率风险更高：结论：NPS升高与一系列不良肺部结果有关。有必要开展前瞻性研究，将 NPS 界定为肺部健康受损的生物标志物。

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引用次数: 0

The 1-min sit-to-stand test as a screening tool to assess exercise-induced oxygen desaturation in normoxemic people with interstitial lung disease 将 1 分钟坐立测试作为筛查工具，以评估患有间质性肺病的正常血氧者在运动中引起的氧饱和度降低情况。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-27 DOI: 10.1016/j.rmed.2024.107748

Background

In patients with interstitial lung disease (ILD), exercise-induced desaturation during the 6-min walk test (6MWT), specifically nadir oxygen saturation (nSpO2) of ≤88 % is a negative prognostic marker. As the 6MWT is often impractical for ILD patients, the aim of this study is to compare the 1-min sit-to-stand test (1minSTS) with the 6MWT to detect exercise-induced desaturation.

Methods

Participants were recruited from a tertiary referral clinic with both tests performed on the same day. Utilising Bland-Altman analysis, the relationship between nSpO2 on 1minSTS and 6MWT was determined. An area under the receiver operating characteristic curve (AUC) determined the ability of nSpO2 on 1minSTS test to predict SpO2 ≤88 % on 6MWT.

Results

Fifty participants completed the study (idiopathic pulmonary fibrosis n = 24, 48 %; connective tissue disease associated ILD n = 20, 40 %; other ILD n = 6, 12 %). Mean (SD) FVC%pred was 73 ± 16 %, mean DLCO%pred 57 ± 16 % and resting SpO2 99 ± 1 %. The 1minSTS resulted in less exercise-induced oxygen desaturation, with a median IQR nSpO2 of 95 % (89–98) and 93 % (85–96) respectively (p < 0.001). Moderate agreement was determined between the nSpO2 on both tests, with a mean difference of 3.2 % [-14 to +3.0 %]. The 1minSTS test accurately identified participants with nSpO2 ≤88 % on 6MWT (AUC 0.96). Oxygen desaturation ≤94 % during the 1minSTS test provided 100 % sensitivity and 87 % specificity for oxygen desaturation ≤88 % at 6MWT.

Conclusion

This study demonstrates that exercise-induced oxygen desaturation during the 1minSTS test correlates with oxygen desaturation on 6MWT. The 1minSTS may be a practical screening tool for ILD patients who would benefit from further exercise testing.

背景：在间质性肺病（ILD）患者中，六分钟步行测试（6MWT）中运动诱发的血饱和度降低，特别是最低血氧饱和度（nSpO2）≤88%是一个负面的预后指标。由于 6MWT 对 ILD 患者来说往往不切实际，本研究旨在比较 1 分钟坐立测试（1minSTS）和 6MWT 以检测运动引起的血饱和度降低：方法：从一家三级转诊诊所招募参与者，在同一天进行这两项测试。利用布兰-阿尔特曼分析法确定了 1minSTS 和 6MWT nSpO2 之间的关系。接收器操作特征曲线下面积（AUC）确定了 1minSTS 测试 nSpO2 预测 6MWT SpO2 ≤88% 的能力：50 名参与者完成了研究（特发性肺纤维化 n=24.48%；结缔组织病相关 ILD n=20.40%；其他 ILD n=6.12%）。平均（标清）FVC%pred 为 73±16%，平均 DLCO%pred 为 57±16%，静息 SpO2 为 99±1%。1minSTS 导致的运动诱发氧饱和度降低，中位数 IQR nSpO2 分别为 95% (89-98) 和 93% (85-96)（pConclusion）：本研究表明，1minSTS 测试中运动诱发的血氧饱和度下降与 6MWT 的血氧饱和度下降相关。1minSTS 可能是一种实用的筛查工具，可用于筛查需要进行进一步运动测试的 ILD 患者。

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引用次数: 0

Prescriptions of respiratory medications in children aged 0–10 years: A longitudinal drug utilization study in the POMME database 0-10 岁儿童呼吸道用药处方：POMME 数据库中的纵向用药研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-24 DOI: 10.1016/j.rmed.2024.107741

Introduction

Respiratory tract disorders are common in children. However, there is no available data on the prescription of respiratory medications for children in France. This study aimed to provide an overview of medications for obstructive airway diseases prescriptions for children during the initial ten years of their lives within POMME, a French population-based cohort of children.

Material and methods

This longitudinal, population-based study used data from the French POMME birth cohort, comprising children born in Haute Garonne between July 2010 and June 2011. Anonymous medical information, including medication reimbursement data, was collected between ages 0 and 10 years. Exposure was defined as at least one prescription for respiratory medications (ATC code R03*), focusing on specific subclasses. Data were analyzed by age, season, and prescribing physicians' specialties.

Results

Out of 5956 children, 4951 (83.1 %) received respiratory medication prescriptions. Inhaled corticosteroids (ICSs) were the most prescribed (95.3 %), followed by short-acting β2-agonists (68.8 %). The number of prescriptions increased with age, except for ICSs alone, which peaked between 6 months and 2 years. The average number of prescriptions per child was relatively low.

Discussion

This study highlighted high prescription rates of respiratory medications in children under 10 years, with ICSs being the most prevalent. While these medications are primarily intended for asthma management, the findings suggested a significant proportion of off-label prescriptions, especially in young children. Further research and clinical guidance are warranted to ensure appropriate medication use in the pediatric population.

简介呼吸道疾病在儿童中很常见。然而，目前还没有关于法国儿童呼吸道疾病药物处方的数据。本研究旨在提供法国儿童人群队列（POMME）中儿童出生后最初十年的阻塞性气道疾病药物处方概况：这项基于人口的纵向研究使用了法国 POMME 出生队列的数据，该队列由 2010 年 7 月至 2011 年 6 月间在上加龙省出生的儿童组成。研究人员收集了0至10岁儿童的匿名医疗信息，包括药物报销数据。暴露定义为至少开过一次呼吸道药物处方（ATC代码R03*），重点关注特定亚类。数据按年龄、季节和处方医生的专业进行了分析：结果：在 5956 名儿童中，4951 名（83.1%）接受了呼吸道药物处方。吸入性皮质类固醇（ICS）是处方最多的药物（95.3%），其次是短效ß2-激动剂（68.8%）。除单用 ICS 外，处方数量随年龄增长而增加，在 6 个月至 2 岁期间达到高峰。每个儿童的平均处方数量相对较低。与春季过敏的预期相反，冬季的处方更频繁：本研究强调了 10 岁以下儿童呼吸道药物处方率高的问题，其中以 ICSs 最为普遍。虽然这些药物主要用于治疗哮喘，但研究结果表明，有相当一部分处方属于标签外用药，尤其是在幼儿中。有必要开展进一步研究并提供临床指导，以确保在儿童群体中合理用药。

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引用次数: 0

Evaluating the impact of short-term nitrate-rich dietary supplementation on endothelial function in COPD: A randomized crossover study 评估短期补充富含硝酸盐的膳食对慢性阻塞性肺病患者血管内皮功能的影响：一项随机交叉研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-24 DOI: 10.1016/j.rmed.2024.107745

Aim

This study aimed to investigate the acute effects of dietary nitrate ingestion through l-arginine supplementation or dehydrated beet consumption on endothelial function in chronic obstructive pulmonary disease (COPD) patients. The secondary outcome was to analyze arterial stiffness, plasma nitrate, and nitrate/protein concentration.

Methods

In this randomized crossover study, subjects with COPD underwent three series of supplementation: (1) l-arginine, (2) dehydrated beetroot, and (3) a placebo that appeared like the other supplements. Each intervention lasted 14 days, with a 7-day washout period between series. Participants underwent endothelial function assessment using flow-mediated dilatation (FMD), and plasma nitrate levels were measured at the end of each supplementation series.

Results

Seventeen subjects (twelve male) completed the study protocol. Only five subjects presented endothelial dysfunction (RHI ≤0.51) at baseline. The mean baseline characteristics included age 66.5 ± 9.4 years, BMI 27.5 ± 4.5 kg/m², FEV_1, 0.79 (0.67–1.06) L. There were no differences (p > 0.05) between the groups or from pre-to post-interventions for RHI and arterial stiffness index (AIx) values, as well as parameters of endothelium-dependent vasodilation, such as blood flow velocity (BFV), shear stress, shear rate, FMD (mm), and FMD%. There was also no differences (p > 0.05) between the groups or from pre-to post-interventions plasma nitrate levels.

Conclusions

Acute dietary supplementation with nitrates, at the doses provided, did not show a significant improvement in endothelial function assessed by FMD, EndoPAT, or plasma nitrate levels in COPD. These findings suggest that a higher dose or prolonged supplementation might be required to achieve a therapeutic effect.

目的：本研究旨在探讨通过补充左旋精氨酸或食用脱水甜菜摄入硝酸盐对慢性阻塞性肺病（COPD）患者内皮功能的急性影响。次要结果是分析动脉僵化、血浆硝酸盐和硝酸盐/蛋白质浓度：在这项随机交叉研究中，慢性阻塞性肺病患者接受了三个系列的补充剂治疗：（1）L-精氨酸；（2）脱水甜菜根；（3）与其他补充剂相似的安慰剂。每次干预持续 14 天，每个系列之间有 7 天的缓冲期。受试者通过血流介导的扩张（FMD）进行内皮功能评估，并在每个补充系列结束时测量血浆硝酸盐水平：结果：17 名受试者（12 名男性）完成了研究方案。只有五名受试者在基线时出现内皮功能障碍（RHI ≤ 0.51）。平均基线特征包括年龄 66.5 ± 9.4 岁，体重指数 27.5 ± 4.5 kg/m2，FEV1 0.79 (0.67 - 1.06) L。05）。在 RHI 和动脉僵化指数 (AIx) 值以及内皮依赖性血管舒张参数（如血流速度 (BFV)、剪应力、剪切率、FMD (mm) 和 FMD% 等）方面，各组之间或干预前与干预后之间均无差异。各组之间或干预前与干预后血浆硝酸盐水平也无差异（P > 0.05）：结论：在提供的剂量下，急性膳食补充硝酸盐并不能显著改善慢性阻塞性肺病患者的内皮功能（通过 FMD、EndoPAT 或血浆硝酸盐水平评估）。这些研究结果表明，可能需要更大剂量或更长时间的补充才能达到治疗效果。

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引用次数: 0

Five sessions of hyperbaric oxygen for critically ill patients with COVID-19-induced ARDS: A randomised, open label, phase II trial 对 COVID-19 诱导的 ARDS 重症患者进行五次高压氧治疗：随机、开放标签 II 期试验。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2024-07-24 DOI: 10.1016/j.rmed.2024.107744

Background

Few treatment options exist for patients with COVID–19–induced acute respiratory distress syndrome (ARDS). Data on the benefits and harms of hyperbaric oxygen treatment (HBOT) for this condition is limited.

Objective

To evaluate benefits and harms of HBOT in patients with COVID-19 induced ARDS.

Methods

In this open-label trial conducted at three hospitals in Sweden and Germany, patients with moderate to severe ARDS and at least two risk factors for unfavourable outcome, were randomly assigned (1:1) to medical oxygen 100 %, 2·4 Atmospheres absolute (ATA), 80 min (HBOT) adjuvant to best practice or to best practice alone (Control). Randomisation was stratified by sex and site. The primary endpoint was ICU admission by Day 30.

Results

Between June 4, 2020, and Dec 1, 2021, 34 subjects were randomised to HBOT (N = 18) or Control (N = 16). The trial was prematurely terminated for futility. There was no statistically significant difference in ICU admission, 5 (50 %) in Control vs 13 (72 %) in HBOT. OR 2·54 [95 % CI 0·62-10·39], p = 0·19.

Harms

102 adverse events (AEs) were recorded. 16 (94 %) subjects in the HBOT group and 14 (93 %) in the control group had at least one AE. Three serious adverse events (SAEs), were at least, possibly related to HBOT. All deaths were unlikely related to HBOT.

Conclusions

HBOT did not reduce ICU admission or mortality in patients with COVID–19–induced ARDS. The trial cannot conclude definitive benefits or harms. Treating COVID–19–induced ARDS with HBOT is feasible with a favourable harms profile.

背景：COVID-19诱发的急性呼吸窘迫综合征（ARDS）患者的治疗方案很少。有关高压氧治疗（HBOT）对这种疾病的益处和危害的数据十分有限：评估高压氧治疗对 COVID-19 诱导的 ARDS 患者的益处和危害：在瑞典和德国的三家医院进行的这项开放标签试验中，中度至重度 ARDS 患者且至少有两个不利预后的风险因素，被随机分配（1:1）至医用氧气 100%、2-4 个绝对大气压 (ATA)、80 分钟（HBOT），作为最佳治疗方法的辅助治疗或仅作为最佳治疗方法（对照组）。随机分组按性别和地点进行。主要终点是第30天入住ICU：2020年6月4日至2021年12月1日期间，34名受试者被随机分配到HBOT（18人）或对照组（16人）。试验因无效而提前终止。在入住重症监护室方面，对照组为 5 例（50%），而 HBOT 为 13 例（72%），两者之间的差异无统计学意义。不良反应：共记录 102 例不良反应（AEs）。HBOT组的16名受试者（94%）和对照组的14名受试者（93%）至少出现过一次AE。三起严重不良事件（SAE）至少可能与 HBOT 有关。所有死亡病例都不太可能与 HBOT 有关：HBOT并未减少COVID-19诱发的ARDS患者入住ICU的次数或死亡率。该试验无法得出明确的利弊结论。用HBOT治疗COVID-19诱发的ARDS是可行的，其危害也是有利的：瑞典研究理事会，资助编号：KBF 2019-00446。

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引用次数: 0