Background and aims: The recurrence of obstructive sleep apnoea (OSA) after positive airway pressure (PAP) therapy termination has physiological consequences that may increase cardiovascular (CV) risk. We aimed to determine whether PAP termination is associated with an increased incidence of major adverse CV events (MACE) compared with adherent PAP continuation.
Methods: Data from the Pays de la Loire Sleep Cohort were linked to the French national health insurance database to identify incident MACE (composite outcome of mortality, stroke and cardiac diseases), and CV active drug (lipid-lowering, antihypertensive and antiplatelet drugs, beta-blockers) adherence (medication possession ratio ≥80%). The association of PAP termination with MACE was evaluated using a time-dependent survival Cox model, with adjustment for confounders including CV active drug status.
Results: After a median follow-up of 8 years, 969 of 4188 included patients (median age 58 years, 69.6% men) experienced MACE, 1485 had terminated PAP while 2703 continued PAP with at least 4 hours/night use. 38% of patients were adherent to all CV drugs in the PAP continuation group versus 28% in the PAP termination group (p<0.0001). After adjustment for confounders, PAP termination was associated with an increased risk of MACE (HR (95% CI): 1.39 (1.20 to 1.62); p<0.0001). PAP termination was not associated with incident heart failure and coronary artery disease.
Conclusions: In this multicentre clinical-based cohort involving 4188 patients with OSA, PAP termination compared with adherent PAP continuation was associated with an increased risk of MACE. More research is needed to determine whether support programmes on PAP adherence could improve CV outcomes.
背景和目的：气道正压疗法（PAP）终止后阻塞性睡眠呼吸暂停（OSA）的复发会产生生理后果，可能会增加心血管（CV）风险。我们的目的是确定，与继续坚持正压治疗相比，终止正压治疗是否会增加主要不良心血管事件（MACE）的发生率：将卢瓦尔河地区睡眠队列的数据与法国国家医疗保险数据库相连接，以确定MACE事件（死亡率、中风和心脏病的综合结果）和CV活性药物（降脂药、降压药和抗血小板药、β-受体阻滞剂）的依从性（药物持有率≥80%）。采用时间依赖性生存考克斯模型评估了PAP终止与MACE的关系，并对包括CV活性药物状态在内的混杂因素进行了调整：中位随访 8 年后，4188 名纳入患者中有 969 人（中位年龄 58 岁，69.6% 为男性）发生了 MACE，1485 人终止了 PAP，2703 人继续使用 PAP，至少每晚使用 4 小时。继续使用 PAP 组中有 38% 的患者坚持服用所有 CV 药物，而终止使用 PAP 组中只有 28% 的患者坚持服用所有 CV 药物（p 结论：在这个多中心临床队列中，共有 4188 名 OSA 患者，与坚持使用 PAP 相比，终止使用 PAP 与 MACE 风险增加有关。还需要进行更多的研究，以确定坚持 PAP 的支持计划是否能改善 CV 结果。
{"title":"Association of positive airway pressure termination with mortality and non-fatal cardiovascular events in patients with obstructive sleep apnoea.","authors":"AbdelKebir Sabil, Claire Launois, Wojchiech Trzepizur, François Goupil, Thierry Pigeanne, Sandrine Launois, Laurène Leclair-Visonneau, Philippe Masson, Acya Bizieux-Thaminy, Sandrine Kerbat, Sebastien Bailly, Frédéric Gagnadoux","doi":"10.1136/thorax-2024-221689","DOIUrl":"10.1136/thorax-2024-221689","url":null,"abstract":"<p><strong>Background and aims: </strong>The recurrence of obstructive sleep apnoea (OSA) after positive airway pressure (PAP) therapy termination has physiological consequences that may increase cardiovascular (CV) risk. We aimed to determine whether PAP termination is associated with an increased incidence of major adverse CV events (MACE) compared with adherent PAP continuation.</p><p><strong>Methods: </strong>Data from the Pays de la Loire Sleep Cohort were linked to the French national health insurance database to identify incident MACE (composite outcome of mortality, stroke and cardiac diseases), and CV active drug (lipid-lowering, antihypertensive and antiplatelet drugs, beta-blockers) adherence (medication possession ratio ≥80%). The association of PAP termination with MACE was evaluated using a time-dependent survival Cox model, with adjustment for confounders including CV active drug status.</p><p><strong>Results: </strong>After a median follow-up of 8 years, 969 of 4188 included patients (median age 58 years, 69.6% men) experienced MACE, 1485 had terminated PAP while 2703 continued PAP with at least 4 hours/night use. 38% of patients were adherent to all CV drugs in the PAP continuation group versus 28% in the PAP termination group (p<0.0001). After adjustment for confounders, PAP termination was associated with an increased risk of MACE (HR (95% CI): 1.39 (1.20 to 1.62); p<0.0001). PAP termination was not associated with incident heart failure and coronary artery disease.</p><p><strong>Conclusions: </strong>In this multicentre clinical-based cohort involving 4188 patients with OSA, PAP termination compared with adherent PAP continuation was associated with an increased risk of MACE. More research is needed to determine whether support programmes on PAP adherence could improve CV outcomes.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1077-1085"},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1136/thorax-2024-221844
Suat Yee Lee, Juo-Hau Su, Chia-Chen Chang, Fatt Yang Chew
{"title":"Unusual cause of trepopnea.","authors":"Suat Yee Lee, Juo-Hau Su, Chia-Chen Chang, Fatt Yang Chew","doi":"10.1136/thorax-2024-221844","DOIUrl":"10.1136/thorax-2024-221844","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1091-1092"},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1136/thorax-2024-221802
Chiqing Ying, Lvjun Zhang, Xuehang Jin, Hui Chen, Dan Zhu
A 38-year-old woman was admitted for uterine fibroid surgery. A routine preoperative CT chest scan identified bilateral patchy, high-density shadows, with unclear boundaries, more evident in the upper lobes (figure 1A). She had no respiratory symptoms, such as coughing or expectoration, and was an office worker with allergies to seafood and mango. She denied having comorbidities including diabetes, renal disease, liver disease, malignancy or HIV. In March 2023, she received cefuroxime anti-infective treatment during her hospitalisation for gynaecological surgery and did not continue antibiotics after discharge. Six months later, in November 2023, a follow-up CT chest revealed radiographic progression of bilateral upper lobe changes (figure 1B). Despite being asymptomatic, she was prescribed moxifloxacin at the outpatient clinic for presumed bilateral bacterial pneumonia. A subsequent CT chest a week later showed no noticeable improvement in her lung condition. Therefore, she was hospitalised for further examination to determine the cause of the lung infection. During her hospitalisation, the results of her …
{"title":"Pulmonary infection caused by Talaromyces amestolkiae","authors":"Chiqing Ying, Lvjun Zhang, Xuehang Jin, Hui Chen, Dan Zhu","doi":"10.1136/thorax-2024-221802","DOIUrl":"https://doi.org/10.1136/thorax-2024-221802","url":null,"abstract":"A 38-year-old woman was admitted for uterine fibroid surgery. A routine preoperative CT chest scan identified bilateral patchy, high-density shadows, with unclear boundaries, more evident in the upper lobes (figure 1A). She had no respiratory symptoms, such as coughing or expectoration, and was an office worker with allergies to seafood and mango. She denied having comorbidities including diabetes, renal disease, liver disease, malignancy or HIV. In March 2023, she received cefuroxime anti-infective treatment during her hospitalisation for gynaecological surgery and did not continue antibiotics after discharge. Six months later, in November 2023, a follow-up CT chest revealed radiographic progression of bilateral upper lobe changes (figure 1B). Despite being asymptomatic, she was prescribed moxifloxacin at the outpatient clinic for presumed bilateral bacterial pneumonia. A subsequent CT chest a week later showed no noticeable improvement in her lung condition. Therefore, she was hospitalised for further examination to determine the cause of the lung infection. During her hospitalisation, the results of her …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"44 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1136/thorax-2023-221210
David Lo, Claire Lawson, Clare Gillies, Sharmin Shabnam, Erol A Gaillard, Hilary Pinnock, Jennifer K Quint
Background: Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds.
Methods: Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models.
Results: 194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children.
Conclusions: We identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma.
{"title":"Association between socioeconomic deprivation, ethnicity and health outcomes in preschool children with recurrent wheeze in England: a retrospective cohort study.","authors":"David Lo, Claire Lawson, Clare Gillies, Sharmin Shabnam, Erol A Gaillard, Hilary Pinnock, Jennifer K Quint","doi":"10.1136/thorax-2023-221210","DOIUrl":"10.1136/thorax-2023-221210","url":null,"abstract":"<p><strong>Background: </strong>Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds.</p><p><strong>Methods: </strong>Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models.</p><p><strong>Results: </strong>194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children.</p><p><strong>Conclusions: </strong>We identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1050-1059"},"PeriodicalIF":9.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1136/thorax-2024-222034
Camille Miard, Vincent Thomas de Montpreville, Jean-François Bernaudin, Julien Adam, Chakib Djediat, Francois Stephan
The mechanism of thrombocytopenia during acute pulmonary hypertension (PH) decompensation may be partly due to platelet aggregation in the lung. Platelet aggregates in explanted lung from 16 lung transplant patients during acute PH decompensation with and without thrombocytopenia were identified by immunohistochemistry. Scanning electron microscopy (SEM) was performed. 7 explant lung controls without PH and thrombocytopenia were also examined. Compared with controls, the median number of platelet aggregates was higher in patients with acute PH decompensation with thrombocytopenia (19.4 [IQR 3.4–38.3] vs 147.5 [IQR 26.5–203.2]). SEM showed capillaries filled with platelet aggregates. Our study suggests that platelets may aggregate in the lungs during acute PH decompensation.
{"title":"Platelet aggregates in lung capillaries in severely decompensated pulmonary hypertension","authors":"Camille Miard, Vincent Thomas de Montpreville, Jean-François Bernaudin, Julien Adam, Chakib Djediat, Francois Stephan","doi":"10.1136/thorax-2024-222034","DOIUrl":"https://doi.org/10.1136/thorax-2024-222034","url":null,"abstract":"The mechanism of thrombocytopenia during acute pulmonary hypertension (PH) decompensation may be partly due to platelet aggregation in the lung. Platelet aggregates in explanted lung from 16 lung transplant patients during acute PH decompensation with and without thrombocytopenia were identified by immunohistochemistry. Scanning electron microscopy (SEM) was performed. 7 explant lung controls without PH and thrombocytopenia were also examined. Compared with controls, the median number of platelet aggregates was higher in patients with acute PH decompensation with thrombocytopenia (19.4 [IQR 3.4–38.3] vs 147.5 [IQR 26.5–203.2]). SEM showed capillaries filled with platelet aggregates. Our study suggests that platelets may aggregate in the lungs during acute PH decompensation.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"14 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1136/thorax-2024-221910
Neeraj M Shah, Anne Rossel, Bawan Abdulaziz, Shauna Sheridan, Sophie Madden-Scott, Gillian Radcliffe, Rebecca D’Cruz, Eui-Sik Suh, Joerg Steier, Nicholas Hart, Patrick Brian Murphy, Michelle Ramsay, Georgios Kaltsakas
Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.
嗅鼻吸气压力（SNIP）用于评估肌萎缩性脊髓侧索硬化症（ALS）等神经肌肉疾病的呼吸肌强度。目前还不清楚对侧鼻孔闭塞和口腔密封对 SNIP 测量的影响。该研究共纳入了 81 名参与者（16 名健康人、39 名肢端型 ALS 患者和 26 名球部型 ALS 患者）。SNIP测量采用张口/封口和对侧鼻孔张开/闭合的组合方式。闭合对侧鼻孔（嘴闭合）可使健康参与者的SNIP增加12 cmH2O（95% CI 4, 20; p=0.003），使肢体发病组群的SNIP增加9 cmH2O（95% CI 5, 12; p<0.001），使躯干发病组群的SNIP增加10 cmH2O（95% CI 5, 14; p<0.001）。健康参与者张开嘴后，SNIP 下降了 19 cmH2O (95% CI 5, 34; p<0.009)，肢端发病者下降了 8 cmH2O (95% CI 4, 13; p<0.001)，球部发病者下降了 13 cmH2O (95% CI 7, 19; p<0.001)。如果对侧鼻孔闭塞，符合无创通气条件的患者将减少 11%。总之，与标准技术相比，对侧鼻孔闭塞会增加 SNIP，这可能反映了真正的强度。张开嘴巴会降低 SNIP，这强调了良好的口腔密封的必要性。记录 SNIP 技术对于纵向评估和临床决策非常重要。
{"title":"Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure","authors":"Neeraj M Shah, Anne Rossel, Bawan Abdulaziz, Shauna Sheridan, Sophie Madden-Scott, Gillian Radcliffe, Rebecca D’Cruz, Eui-Sik Suh, Joerg Steier, Nicholas Hart, Patrick Brian Murphy, Michelle Ramsay, Georgios Kaltsakas","doi":"10.1136/thorax-2024-221910","DOIUrl":"https://doi.org/10.1136/thorax-2024-221910","url":null,"abstract":"Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"41 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-07DOI: 10.1136/thorax-2024-221874
Dimitris Evangelopoulos, Hanbin Zhang, Lia Chatzidiakou, Heather Walton, Klea Katsouyanni, Roderic L Jones, Jennifer K Quint, Benjamin Barratt
Introduction While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated health effects by source. Aim To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms. Methods We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF. Results Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%–45%), 19% (12%–18%) and 12% (5%–20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter2.5 with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF. Conclusions Indoor-generated and outdoor-generated pollution can deteriorate COPD patients’ health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation. No data are available. The datasets used for this manuscript contain personal data and cannot be shared.
{"title":"Air pollution and respiratory health in patients with COPD: should we focus on indoor or outdoor sources?","authors":"Dimitris Evangelopoulos, Hanbin Zhang, Lia Chatzidiakou, Heather Walton, Klea Katsouyanni, Roderic L Jones, Jennifer K Quint, Benjamin Barratt","doi":"10.1136/thorax-2024-221874","DOIUrl":"https://doi.org/10.1136/thorax-2024-221874","url":null,"abstract":"Introduction While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated health effects by source. Aim To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms. Methods We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF. Results Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%–45%), 19% (12%–18%) and 12% (5%–20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter2.5 with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF. Conclusions Indoor-generated and outdoor-generated pollution can deteriorate COPD patients’ health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation. No data are available. The datasets used for this manuscript contain personal data and cannot be shared.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"51 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary outcomes and mortality between GLP-1 RA use and no use in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). Methods The study identified 8060 matched GLP-1 RA users and non-users from Taiwan’s National Health Insurance Research Database from 1 January 2008 to 31 December 2019. Cox proportional hazards models were used to determine the risk of cardiopulmonary outcomes between GLP-1 RA users and non-users. Results The mean follow-up time was 2.51 and 2.46 years for GLP-1 RA users and non-users, respectively. In the matched cohorts, GLP-1 RA users had a significantly lower risk of mortality (adjusted HR (aHR) 0.46, 95% CI 0.38 to 0.56), cardiovascular events (aHR 0.73, 95% CI 0.65 to 0.82), non-invasive positive pressure ventilation (aHR 0.66, 95% CI 0.47 to 0.93), invasive mechanical ventilation (aHR 0.64, 95% CI 0.51 to 0.8) and bacterial pneumonia (aHR 0.76, 95% CI 0.65 to 0.88) than GLP-1 RA non-users. The subsequent analyses for various subgroup and medication duration also showed that GLP-1 RA was associated with a significantly lower risk of mortality, cardiovascular events, ventilation support and bacterial pneumonia than non-GLP-1 RA. Conclusion This nationwide cohort study showed that GLP-1 RA had a lower risk of cardiopulmonary outcomes and all-cause mortality than non-GLP-1 RA in patients with T2D and COPD. GLP-1 RA may help manage diabetes in people with COPD. No data are available. Data of this study are available from the National Health Insurance Research Database (NHIRD) published by Taiwan National Health Insurance (NHI) Administration. The data used in this study cannot be made available in the paper, the supplemental files or in a public repository due to the ‘Personal Information Protection Act’ executed by Taiwan government starting from 2012. Requests for data can be sent as a formal proposal to the NHIRD office () or by email to stsung@mohw.gov.tw.
背景 临床研究表明，胰高血糖素样肽-1 受体激动剂（GLP-1 RA）可对心肺功能产生有益影响。我们进行了这项纵向队列研究，以比较 2 型糖尿病（T2D）和慢性阻塞性肺病（COPD）患者使用和不使用 GLP-1 RA 的心肺功能风险和死亡率。方法 该研究从2008年1月1日至2019年12月31日期间的台湾国民健康保险研究数据库中确定了8060名匹配的GLP-1 RA使用者和非使用者。采用Cox比例危害模型确定GLP-1 RA使用者和非使用者之间的心肺结局风险。结果 GLP-1 RA使用者和非使用者的平均随访时间分别为2.51年和2.46年。在匹配队列中，GLP-1 RA 使用者的死亡率（调整 HR (aHR) 0.46，95% CI 0.38 至 0.56）、心血管事件（aHR 0.73，95% CI 0.65 至 0.82）、无创正压通气（aHR 0.66，95% CI 0.47 至 0.93）、有创机械通气（aHR 0.64，95% CI 0.51 至 0.8）和细菌性肺炎（aHR 0.76，95% CI 0.65 至 0.88）。随后对不同亚组和用药时间的分析也显示，GLP-1 RA 与死亡率、心血管事件、通气支持和细菌性肺炎的相关风险显著低于非 GLP-1 RA。结论 这项全国性队列研究表明，与非 GLP-1 RA 相比，GLP-1 RA 可降低 T2D 和慢性阻塞性肺病患者的心肺预后风险和全因死亡率。GLP-1 RA 可帮助慢性阻塞性肺病患者控制糖尿病。暂无数据。本研究的数据来自台湾国民健康保险管理局（NHI）发布的国民健康保险研究数据库（NHIRD）。由于台湾政府自 2012 年起实施 "个人信息保护法"，本研究中使用的数据无法在论文、补充文件或公共资料库中提供。如需索取数据，可向国家健康保险研究所办公室（）提出正式申请，或发送电子邮件至 stsung@mohw.gov.tw。
{"title":"Glucagon-like peptide-1 receptor agonists may benefit cardiopulmonary outcomes in patients with COPD","authors":"Fu-Shun Yen, Chih-Cheng Hsu, James Cheng-Chung Wei, Fuu-Jen Tsai, Yuhan Huang, Teng-Shun Yu, Chii-Min Hwu","doi":"10.1136/thorax-2023-221040","DOIUrl":"https://doi.org/10.1136/thorax-2023-221040","url":null,"abstract":"Background Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary outcomes and mortality between GLP-1 RA use and no use in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). Methods The study identified 8060 matched GLP-1 RA users and non-users from Taiwan’s National Health Insurance Research Database from 1 January 2008 to 31 December 2019. Cox proportional hazards models were used to determine the risk of cardiopulmonary outcomes between GLP-1 RA users and non-users. Results The mean follow-up time was 2.51 and 2.46 years for GLP-1 RA users and non-users, respectively. In the matched cohorts, GLP-1 RA users had a significantly lower risk of mortality (adjusted HR (aHR) 0.46, 95% CI 0.38 to 0.56), cardiovascular events (aHR 0.73, 95% CI 0.65 to 0.82), non-invasive positive pressure ventilation (aHR 0.66, 95% CI 0.47 to 0.93), invasive mechanical ventilation (aHR 0.64, 95% CI 0.51 to 0.8) and bacterial pneumonia (aHR 0.76, 95% CI 0.65 to 0.88) than GLP-1 RA non-users. The subsequent analyses for various subgroup and medication duration also showed that GLP-1 RA was associated with a significantly lower risk of mortality, cardiovascular events, ventilation support and bacterial pneumonia than non-GLP-1 RA. Conclusion This nationwide cohort study showed that GLP-1 RA had a lower risk of cardiopulmonary outcomes and all-cause mortality than non-GLP-1 RA in patients with T2D and COPD. GLP-1 RA may help manage diabetes in people with COPD. No data are available. Data of this study are available from the National Health Insurance Research Database (NHIRD) published by Taiwan National Health Insurance (NHI) Administration. The data used in this study cannot be made available in the paper, the supplemental files or in a public repository due to the ‘Personal Information Protection Act’ executed by Taiwan government starting from 2012. Requests for data can be sent as a formal proposal to the NHIRD office (<https://dep.mohw.gov.tw/DOS/cp-2516-3591-113.html>) or by email to stsung@mohw.gov.tw.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"23 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1136/thorax-2024-222174
Ewan Christopher Mackay
Household air pollution has been estimated to be responsible for 3.2 million preventable deaths every year globally. With biomass exposure and environmental pollution linked to exacerbations of airways disease, this health impact disproportionately affects low and middle income countries. Puzzolo et al ( Lancet Resp Med 2024;12(4):281–293) undertook a systematic review and included 116 studies in the subsequent meta-analyses, to compare use of gaseous fuels in the domestic environment with more polluting fuels (wood/charcoal/kerosene) and cleaner fuels (electricity/solar) with no point of use pollution. Use of gas significantly decreased the risk of COPD (OR 0·37, 95%CI 0·23–0·60; p<0·0001), pneumonia (OR 0·54, 0·38–0·77; p=0·0008), deficits in lung function (OR 0·27, 0·17–0·44; p<0·0001), severe respiratory illness or death (OR 0·27, 0·11–0·63; p=0·0024) compared with more polluting fuels. Preterm births (OR 0·66, 0·45–0·97; p=0·033), and low birth weights were similarly reduced (OR 0·70, 0·53–0·93; p=0·015). Risk of asthma did not reach statistical significance. Gas compared with electricity did increase risk of COPD (OR 1·15, 1·06–1·25; p=0·0011) and pneumonia (OR 1·26, 1·03–1·53; p=0·025) but this was not significant in all studies. While having its own health and environmental impacts, switching to gas from more polluting fuels may reduce the burden of health risk in countries without …
{"title":"Journal club","authors":"Ewan Christopher Mackay","doi":"10.1136/thorax-2024-222174","DOIUrl":"https://doi.org/10.1136/thorax-2024-222174","url":null,"abstract":"Household air pollution has been estimated to be responsible for 3.2 million preventable deaths every year globally. With biomass exposure and environmental pollution linked to exacerbations of airways disease, this health impact disproportionately affects low and middle income countries. Puzzolo et al ( Lancet Resp Med 2024;12(4):281–293) undertook a systematic review and included 116 studies in the subsequent meta-analyses, to compare use of gaseous fuels in the domestic environment with more polluting fuels (wood/charcoal/kerosene) and cleaner fuels (electricity/solar) with no point of use pollution. Use of gas significantly decreased the risk of COPD (OR 0·37, 95%CI 0·23–0·60; p<0·0001), pneumonia (OR 0·54, 0·38–0·77; p=0·0008), deficits in lung function (OR 0·27, 0·17–0·44; p<0·0001), severe respiratory illness or death (OR 0·27, 0·11–0·63; p=0·0024) compared with more polluting fuels. Preterm births (OR 0·66, 0·45–0·97; p=0·033), and low birth weights were similarly reduced (OR 0·70, 0·53–0·93; p=0·015). Risk of asthma did not reach statistical significance. Gas compared with electricity did increase risk of COPD (OR 1·15, 1·06–1·25; p=0·0011) and pneumonia (OR 1·26, 1·03–1·53; p=0·025) but this was not significant in all studies. While having its own health and environmental impacts, switching to gas from more polluting fuels may reduce the burden of health risk in countries without …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"20 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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