Respirology最新文献

Special Series: Leading Women in Respiratory Clinical Sciences. Series Editors: Anne-Marie Russell and Kathleen O Lindell.

Background and objective: Digital technologies offer opportunities for remote monitoring, increased patient engagement and incorporation of patient-reported outcome measures (PROMs) into interstitial lung disease (ILD) care and research. This study evaluated the usability and patient experience of the RE-BUILD (Registry for Better Understanding of ILD) application, an ILD-specific smartphone app.

Methods: Patients with ILD aged ≥18 years were recruited from three tertiary ILD centres to use the RE-BUILD app for 6 months. The mHealth App Usability Questionnaire (MAUQ) was evaluated at 1, 3 and 6 months and patients received monthly prompts to enter clinical and PROM data. Qualitative interviews regarding patient experience were performed in a subset of 10.

Results: Fifty patients, with mean age 66.9 ± 10.3 years, 25 (50%) female were included. Participants used the app for a median of 48 (IQR 21-178.3) sessions, equivalent to 8 sessions (IQR 3.5-29.71) per month. Median number of days that the app was accessed was 37 (IQR 14-96.8), with 13 (26%) patients using the app >30 times per month. The most accessed app feature was physical activity, followed by 'air quality'. Participants agreed or strongly agreed that the app was easy to use (76.0%) easy to learn to use (79.8%) and well-organized with accessible information (74.8%). The median overall MAUQ score for usability was 5.69 (IQR 5.03-6.19). There was also a high rate of engagement with app functionalities.

Conclusion: RE-BUILD is a usable and intuitive platform for self-monitoring and data collection in ILD. Patients report a high degree of satisfaction and have provided valuable feedback for its further development.

Globally, more than 1.2 billion inhalers are purchased for asthma and chronic obstructive pulmonary disease (COPD) annually. In Australia and New Zealand, pressurized metered dose inhalers (pMDIs) are the leading delivery device prescribed and pMDI salbutamol can be purchased over the counter in Australia. These inhalers are a major contributor to healthcare related greenhouse gases. This is due to the propellants that they currently contain which have extremely high global warming potential (GWP). In this position paper, we report the findings of a Thoracic Society of Australia and New Zealand (TSANZ) working group on the environmental impact of inhaled respiratory medicines. We reviewed the use of inhaled medicines in Australia and New Zealand and their contribution to climate change and other environmental degradation. We propose strategies for health professionals and consumers to reduce environmental impact in the management of airway diseases. These include accurate diagnosis to avoid unnecessary treatment, better disease control to minimize the need for reliever therapy and actively choosing inhaler devices with lower environmental impacts when clinically appropriate. Inhaler selection should be tailored to the individual, aiming to achieve the best possible clinical outcome. Choosing an appropriate inhaler for an individual involves consideration of factors such as dexterity, inspiratory capacity and cost. In our current climate emergency and with the availability of lower carbon alternatives, health professionals should also consider environmental impact.

Background and objective: Acute exacerbation (AE) is often the fatal complication of idiopathic pulmonary fibrosis (IPF). Emerging evidence indicates that metabolic reprogramming and dysregulation of lipid metabolism are distinctive characteristics of IPF. However, the lipid metabolic mechanisms that underlie the pathophysiology of AE-IPF remain elusive.

Methods: Serum samples for pilot study were collected from 34 Controls, 37 stable IPF (S-IPF) cases and 41 AE-IPF patients. UHPLC-MS/MS was utilized to investigate metabolic variations and identify lipid biomarkers in serum. ELISA, quantitative PCR and western blot were employed to validate the identified biomarkers.

Results: There were 32 lipid metabolites and 5 lipid metabolism pathways enriched in all IPF patients compared to Controls. In AE-IPF versus S-IPF, 19 lipid metabolites and 12 pathways were identified, with 5-hydroxyeicosatetraenoic Acid (5-HETE) significantly elevated in AE-IPF. Both in internal and external validation cohorts, the serum levels of 5-HETE were significantly elevated in AE-IPF patients compared to S-IPF subjects. Consequently, the indicators related to 5-HETE in lipid metabolic pathway were significantly changed in AE-IPF patients compared with S-IPF cases in the lung tissues. The serum level of 5-HETE was significantly correlated with the disease severity (CT score and PaO₂/FiO₂ ratio) and survival time. Importantly, the receiver operating characteristic (ROC) curve, Kaplan-Meier analysis and Multivariate Cox regression analysis demonstrated that 5-HETE represents a promising lipid biomarker for the diagnosis and prognosis of AE-IPF.

Conclusion: Our study highlights lipid reprogramming as a novel therapeutic approach for IPF, and 5-HETE may be a potential biomarker of AE-IPF patients.

Background and objective: Chronic obstructive pulmonary disease (COPD) exhibits diverse patterns of disease progression, due to underlying disease activity. We hypothesized that changes in static hyperinflation or KCO % predicted would reveal subgroups with disease progression unidentified by preestablished markers (FEV₁, SGRQ, exacerbation history) and associated with unique baseline biomarker profiles. We explored 18-month measures of disease progression associated with 18-54-month mortality, including changes in hyperinflation parameters and transfer factor, in a large German COPD cohort.

Methods: Analysing data of 1364 patients from the German observational COSYCONET-cohort, disease progression and improvement patterns were assessed for their impact on mortality via Cox hazard regression models. Association of biomarkers and COPD Assessment test items with phenotypes of disease progression or improvement were evaluated using logistic regression and random forest models.

Results: Increased risk of 18-54-month mortality was linked to decrease in KCO % predicted (7.5% increments) and FEV₁ (20 mL increments), increase in RV/TLC (2% increments) and SGRQ (≥6 points), and an exacerbation grade of 2 at 18 months. Decrease in KCO % predicted ≥7.5% and an increase of RV/TLC ≥2% were the most frequent measures of 18-month disease progression occurring in ~52% and ~46% of patients, respectively. IL-6 and CRP thresholds exhibited significant associations with medium- and long-term disease measures.

Conclusion: In a multicentric cohort of COPD, new markers of current disease activity predicted mid-term mortality and could not be anticipated by baseline biomarkers.