D. Ionescu, Tracy L. Stockley, Shantanu Banerji, Christian Couture, Cheryl A. Mather, Zhaolin Xu, Normand Blais, Parneet K. Cheema, Q. Chu, Barbara Melosky, Natasha B. Leighl
Ein nicht kleinzelliges Lungenkarzinom (NSCLC) wird seit jeher mit einer schlechten Prognose und einer geringen Überlebensrate von bis zu 5 Jahren in Verbindung gebracht, aber der Einsatz zielgerichteter Therapien beim NSCLC hat die Behandlungsergebnisse für die Patienten in den letzten 10 Jahren verbessert. Die Entwicklung neuer zielgerichteter Therapien beschleunigt sich und damit auch der Bedarf an molekularen Tests für neue Mutationen, die als Ziele geeignet sind. Da die Komplexität der Biomarkertests beim NSCLC zunimmt, besteht ein Bedarf an Leitlinien für den Umgang mit dem im Fluss befindlichen Behandlungsstandard beim NSCLC, für pragmatische molekulare Testbedingungen und für die Optimierung des Ergebnisberichts. Eine multidisziplinäre Expertengruppe mit Vertretern aus der medizinischen Onkologie, der Pathologie und der klinischen Genetik kam über virtuelle Treffen zusammen, um Konsensusempfehlungen für Tests auf neue geeignete Zielmutationen beim NSCLC zu erarbeiten. Die Arbeitsgruppe betonte, wie wichtig es ist, alle potenziellen Zielmutationen genau und rechtzeitig zu testen, um die Behandlung der Krankheit mit gezielten Therapien zu optimieren. Daher empfiehlt das Expertengremium, dass alle möglichen Zielmutationen routinemäßig bei der Diagnose von NSCLC als Teil eines umfassenden Panels getestet werden, wobei Methoden verwendet werden sollten, die alle relevanten mutierten Zielgene erkennen können. Darüber hinaus sollten auf Wunsch des behandelnden Arztes umfassende Biomarkertests durchgeführt werden, wenn sich eine Resistenz gegen eine zielgerichtete Therapie entwickelt. Die multidisziplinäre Expertenarbeitsgruppe gab auch Empfehlungen für die Berichterstattung ab, um die nötige Klarheit und einfache Interpretation der Ergebnisse durch die behandelnden Ärzte zu gewährleisten und der raschen Entwicklung der klinischen Anwendbarkeit dieser Mutationen Rechnung zu tragen. Molekulare Tests auf alle geeigneten Zielmutationen beim NSCLC sind der Schlüssel für die Behandlungsentscheidung und den Zugang zu neuen Therapien. Diese Konsensusempfehlungen sind als Leitfaden für die weitere Optimierung der molekularen Tests auf neue geeignete Zielmutationen gedacht.
{"title":"Konsensusempfehlungen zur Optimierung von Tests auf neue geeignete Zielmutationen bei nicht kleinzelligem Lungenkrebs","authors":"D. Ionescu, Tracy L. Stockley, Shantanu Banerji, Christian Couture, Cheryl A. Mather, Zhaolin Xu, Normand Blais, Parneet K. Cheema, Q. Chu, Barbara Melosky, Natasha B. Leighl","doi":"10.1159/000526948","DOIUrl":"https://doi.org/10.1159/000526948","url":null,"abstract":"Ein nicht kleinzelliges Lungenkarzinom (NSCLC) wird seit jeher mit einer schlechten Prognose und einer geringen Überlebensrate von bis zu 5 Jahren in Verbindung gebracht, aber der Einsatz zielgerichteter Therapien beim NSCLC hat die Behandlungsergebnisse für die Patienten in den letzten 10 Jahren verbessert. Die Entwicklung neuer zielgerichteter Therapien beschleunigt sich und damit auch der Bedarf an molekularen Tests für neue Mutationen, die als Ziele geeignet sind. Da die Komplexität der Biomarkertests beim NSCLC zunimmt, besteht ein Bedarf an Leitlinien für den Umgang mit dem im Fluss befindlichen Behandlungsstandard beim NSCLC, für pragmatische molekulare Testbedingungen und für die Optimierung des Ergebnisberichts. Eine multidisziplinäre Expertengruppe mit Vertretern aus der medizinischen Onkologie, der Pathologie und der klinischen Genetik kam über virtuelle Treffen zusammen, um Konsensusempfehlungen für Tests auf neue geeignete Zielmutationen beim NSCLC zu erarbeiten. Die Arbeitsgruppe betonte, wie wichtig es ist, alle potenziellen Zielmutationen genau und rechtzeitig zu testen, um die Behandlung der Krankheit mit gezielten Therapien zu optimieren. Daher empfiehlt das Expertengremium, dass alle möglichen Zielmutationen routinemäßig bei der Diagnose von NSCLC als Teil eines umfassenden Panels getestet werden, wobei Methoden verwendet werden sollten, die alle relevanten mutierten Zielgene erkennen können. Darüber hinaus sollten auf Wunsch des behandelnden Arztes umfassende Biomarkertests durchgeführt werden, wenn sich eine Resistenz gegen eine zielgerichtete Therapie entwickelt. Die multidisziplinäre Expertenarbeitsgruppe gab auch Empfehlungen für die Berichterstattung ab, um die nötige Klarheit und einfache Interpretation der Ergebnisse durch die behandelnden Ärzte zu gewährleisten und der raschen Entwicklung der klinischen Anwendbarkeit dieser Mutationen Rechnung zu tragen. Molekulare Tests auf alle geeigneten Zielmutationen beim NSCLC sind der Schlüssel für die Behandlungsentscheidung und den Zugang zu neuen Therapien. Diese Konsensusempfehlungen sind als Leitfaden für die weitere Optimierung der molekularen Tests auf neue geeignete Zielmutationen gedacht.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126730047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren’s syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren’s demonstrate pulmonary involvement with higher mortality and lower quality of life. Research question: Clinical practice guidelines for pulmonary manifestations of Sjögren’s were developed by the Sjögren’s Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care. Study design: and methods: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. Results: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren’s patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease. Interpretation: Clinical practice guidelines for pulmonary manifestations in Sjögren’s will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.
{"title":"Leitlinie zu Evaluation und Management von pulmonalen Manifestationen bei Sjögren-Syndrom","authors":"N. Kahn","doi":"10.1159/000527281","DOIUrl":"https://doi.org/10.1159/000527281","url":null,"abstract":"Background: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren’s syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren’s demonstrate pulmonary involvement with higher mortality and lower quality of life. Research question: Clinical practice guidelines for pulmonary manifestations of Sjögren’s were developed by the Sjögren’s Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care. Study design: and methods: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. Results: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren’s patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease. Interpretation: Clinical practice guidelines for pulmonary manifestations in Sjögren’s will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131410104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Percutaneous needle biopsy (PNB) and bronchoscopic biopsy (BB) are widely used in the preoperative diagnosis of pulmonary nodules, but whether PNB or BB may cause tumor spread through air spaces (STAS) has not been reported. Methods: 433 postoperative patients with pathological stage I non-small cell lung cancer (NSCLC) from January 2015 to December 2018 at our hospital were enrolled and divided into PNB group (n = 40), BB group (n = 48) and non-biopsy group (n = 345). The PNB and BB groups were matched using propensity score matched (PSM) separately from the non-biopsy group, after which the effects of PNB and BB on STAS, recurrence-free survival (RFS) and overall survival (OS) were assessed. Results: After PSM for 9 confounding factors (gender, age, smoking history, tumor site, scope of surgery, pathology type, stage, maximum tumor diameter and postoperative treatment), 38 cases in the PNB group were successfully matched with 38 cases in the non-biopsy group and 28 cases in the BB group were successfully matched with 28 cases in the non-biopsy group. After PSM, there was no significant difference in the incidence of STAS between the PNB and non-biopsy groups (42.1% vs. 34.2%, P > 0.05) and between the BB and non-biopsy groups (42.9% vs. 46.4%, P > 0.05). The results after PSM showed no significant effect of both PNB and BB on RFS and OS after radical surgery (P > 0.05). Conclusion: Preoperative biopsy in patients with stage I NSCLC has not been shown to increase the occurrence of STAS, nor postoperative recurrence and death.
背景:经皮穿刺活检(PNB)和支气管镜活检(BB)被广泛用于肺结节的术前诊断，但PNB或BB是否会导致肿瘤通过空气间隙扩散(STAS)尚未见报道。方法:选取2015年1月至2018年12月我院收治的病理期非小细胞肺癌(NSCLC)术后患者433例，分为PNB组(n = 40)、BB组(n = 48)和非活检组(n = 345)。将PNB和BB组与非活检组分别使用倾向评分匹配(PSM)进行匹配，然后评估PNB和BB对STAS、无复发生存期(RFS)和总生存期(OS)的影响。结果:经9个混杂因素(性别、年龄、吸烟史、肿瘤部位、手术范围、病理类型、分期、最大肿瘤直径、术后治疗)PSM后，PNB组38例与非活检组38例匹配成功，BB组28例与非活检组28例匹配成功。PSM术后，PNB组与非活检组STAS发生率(42.1% vs. 34.2%， P > 0.05)、BB组与非活检组STAS发生率(42.9% vs. 46.4%， P > 0.05)差异无统计学意义。PSM后的结果显示，PNB和BB对根治性术后RFS和OS均无显著影响(P > 0.05)。结论:未发现I期NSCLC患者术前活检会增加STAS的发生，也不会增加术后复发和死亡。
{"title":"STAS beim NSCLC: Risikomarker für Rezidiv und Prognose?","authors":"C. Schumann","doi":"10.1159/000527610","DOIUrl":"https://doi.org/10.1159/000527610","url":null,"abstract":"Background: Percutaneous needle biopsy (PNB) and bronchoscopic biopsy (BB) are widely used in the preoperative diagnosis of pulmonary nodules, but whether PNB or BB may cause tumor spread through air spaces (STAS) has not been reported. Methods: 433 postoperative patients with pathological stage I non-small cell lung cancer (NSCLC) from January 2015 to December 2018 at our hospital were enrolled and divided into PNB group (n = 40), BB group (n = 48) and non-biopsy group (n = 345). The PNB and BB groups were matched using propensity score matched (PSM) separately from the non-biopsy group, after which the effects of PNB and BB on STAS, recurrence-free survival (RFS) and overall survival (OS) were assessed. Results: After PSM for 9 confounding factors (gender, age, smoking history, tumor site, scope of surgery, pathology type, stage, maximum tumor diameter and postoperative treatment), 38 cases in the PNB group were successfully matched with 38 cases in the non-biopsy group and 28 cases in the BB group were successfully matched with 28 cases in the non-biopsy group. After PSM, there was no significant difference in the incidence of STAS between the PNB and non-biopsy groups (42.1% vs. 34.2%, P > 0.05) and between the BB and non-biopsy groups (42.9% vs. 46.4%, P > 0.05). The results after PSM showed no significant effect of both PNB and BB on RFS and OS after radical surgery (P > 0.05). Conclusion: Preoperative biopsy in patients with stage I NSCLC has not been shown to increase the occurrence of STAS, nor postoperative recurrence and death.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114701651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Advanced pulmonary sarcoidosis causes significant morbidity and can lead to death. Large trials demonstrated efficacy of antifibrotics in patients with progressive fibrosing interstitial lung diseases (PF-ILD), including a few with sarcoidosis. To date, little is known about this progressive fibrosing phenotype in sarcoidosis. Diffusion capacity of carbon monoxide (DLCO) may be a useful functional marker to screen for advanced pulmonary sarcoidosis. In this study, we describe a cohort with advanced pulmonary sarcoidosis and we gain insights in the progressive fibrosing phenotype in sarcoidosis. Methods: Patients with sarcoidosis and a DLCO < 50% predicted were included in this retrospective cohort study. First measurement of DLCO < 50% predicted was the baseline. Lung function data, HRCT, pulmonary hypertension (PH) and mortality were collected. Patients with > 10% fibrosis on HRCT meeting the criteria for ILD-progression within 24 months were labelled as PF-ILD. With Cox-regression analysis predictors of mortality were established. Results: 106 patients with a DLCO < 50% predicted were included. Evolution of forced vital capacity (FVC) varied widely between patients from -34% to +45% after 2 years follow-up, whereas change in DLCO varied between -11% and +26%. Fourteen patients (15%) met the PF-ILD criteria, of whom 6 (43%) died within 10 years versus 10 (13%) in the non PF-ILD group (p = 0.006). PH was present 12 (11%), 56 (53%) demonstrated > 10% fibrosis on HRCT. Independent predictors of mortality and lung transplantation in the whole cohort are PH, PF-ILD and UIP-like pattern. Conclusion: In conclusion, within this group with advanced pulmonary sarcoidosis disease course varied widely from great functional improvement to death. PF-ILD patients had higher mortality rate than the mortality in the overall pulmonary sarcoidosis group. Future research should focus on the addition of antifibrotics in these patients. Trial registration retrospectively registered
{"title":"Fortgeschrittene pulmonale Sarkoidose: Auf Wirksamkeit und Zeitpunkt der antifibrotischen Therapie bei Patienten mit einem PF-ILD-Phänotyp konzentrieren","authors":"F. Drakopanagiotakis, A. Günther","doi":"10.1159/000527477","DOIUrl":"https://doi.org/10.1159/000527477","url":null,"abstract":"Background: Advanced pulmonary sarcoidosis causes significant morbidity and can lead to death. Large trials demonstrated efficacy of antifibrotics in patients with progressive fibrosing interstitial lung diseases (PF-ILD), including a few with sarcoidosis. To date, little is known about this progressive fibrosing phenotype in sarcoidosis. Diffusion capacity of carbon monoxide (DLCO) may be a useful functional marker to screen for advanced pulmonary sarcoidosis. In this study, we describe a cohort with advanced pulmonary sarcoidosis and we gain insights in the progressive fibrosing phenotype in sarcoidosis. Methods: Patients with sarcoidosis and a DLCO < 50% predicted were included in this retrospective cohort study. First measurement of DLCO < 50% predicted was the baseline. Lung function data, HRCT, pulmonary hypertension (PH) and mortality were collected. Patients with > 10% fibrosis on HRCT meeting the criteria for ILD-progression within 24 months were labelled as PF-ILD. With Cox-regression analysis predictors of mortality were established. Results: 106 patients with a DLCO < 50% predicted were included. Evolution of forced vital capacity (FVC) varied widely between patients from -34% to +45% after 2 years follow-up, whereas change in DLCO varied between -11% and +26%. Fourteen patients (15%) met the PF-ILD criteria, of whom 6 (43%) died within 10 years versus 10 (13%) in the non PF-ILD group (p = 0.006). PH was present 12 (11%), 56 (53%) demonstrated > 10% fibrosis on HRCT. Independent predictors of mortality and lung transplantation in the whole cohort are PH, PF-ILD and UIP-like pattern. Conclusion: In conclusion, within this group with advanced pulmonary sarcoidosis disease course varied widely from great functional improvement to death. PF-ILD patients had higher mortality rate than the mortality in the overall pulmonary sarcoidosis group. Future research should focus on the addition of antifibrotics in these patients. Trial registration retrospectively registered","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132460788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: N2 stage disease constitutes approximately 20%–30% of all non-small cell lung cancer (NSCLC). Concurrently, surgery remains the first-choice treatment for patients with N2 NSCLC if feasible. However, the role of pneumonectomy in N2 NSCLC has rarely been investigated and remains controversial Methods: We enrolled 26,798 patients with T1–4N2M0 NSCLC (stage IIIA/IIIB) from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. We compared the overall survival (OS) and cancer-specific survival (CSS) between patients who received pneumonectomy and those who did not receive surgery. The Kaplan–Meier method, Cox regression analyses, and propensity score matching (PSM) were applied to demonstrate the effect of pneumonectomy. Results: Patients receiving pneumonectomy had a significantly better OS and CSS than those without pneumonectomy both before [adjusted-HR (95% CI): 0.461 (0.425–0.501) for OS, 0.444 (0.406–0.485) for CSS] and after PSM [adjusted-HR (95% CI): 0.499 (0.445–0.560) for OS, 0.457 (0.405–0.517) for CSS] with all p-values <0.001. Subgroup analysis demonstrated concordant results stratified by demographic or clinicopathological variables. In sensitivity analysis, no significant difference was observed between patients receiving single pneumonectomy and chemoradiotherapy without surgery in OS and CSS both before [unadjusted-HR (95% CI): 1.016 (0.878–1.176) for OS, 0.934 (0.794–1.099) for CSS, p = 0.832] and after PSM [unadjusted-HR (95% CI): 0.988 (0.799–1.222) for OS, 0.938 (0.744–1.182) for CSS] with all p-values >0.4. Conclusions: For patients with T1–4N2M0 NSCLC (stage IIIA/IIIB), pneumonectomy is an independent protective factor of OS and should be considered when applicable.
{"title":"Die Pneumektomie ist berechtigt zur radikalen Resektion eines NSCLC – auch bei mediastinalem Lymphknotenbefall","authors":"T. Lesser","doi":"10.1159/000527280","DOIUrl":"https://doi.org/10.1159/000527280","url":null,"abstract":"Background: N2 stage disease constitutes approximately 20%–30% of all non-small cell lung cancer (NSCLC). Concurrently, surgery remains the first-choice treatment for patients with N2 NSCLC if feasible. However, the role of pneumonectomy in N2 NSCLC has rarely been investigated and remains controversial Methods: We enrolled 26,798 patients with T1–4N2M0 NSCLC (stage IIIA/IIIB) from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. We compared the overall survival (OS) and cancer-specific survival (CSS) between patients who received pneumonectomy and those who did not receive surgery. The Kaplan–Meier method, Cox regression analyses, and propensity score matching (PSM) were applied to demonstrate the effect of pneumonectomy. Results: Patients receiving pneumonectomy had a significantly better OS and CSS than those without pneumonectomy both before [adjusted-HR (95% CI): 0.461 (0.425–0.501) for OS, 0.444 (0.406–0.485) for CSS] and after PSM [adjusted-HR (95% CI): 0.499 (0.445–0.560) for OS, 0.457 (0.405–0.517) for CSS] with all p-values <0.001. Subgroup analysis demonstrated concordant results stratified by demographic or clinicopathological variables. In sensitivity analysis, no significant difference was observed between patients receiving single pneumonectomy and chemoradiotherapy without surgery in OS and CSS both before [unadjusted-HR (95% CI): 1.016 (0.878–1.176) for OS, 0.934 (0.794–1.099) for CSS, p = 0.832] and after PSM [unadjusted-HR (95% CI): 0.988 (0.799–1.222) for OS, 0.938 (0.744–1.182) for CSS] with all p-values >0.4. Conclusions: For patients with T1–4N2M0 NSCLC (stage IIIA/IIIB), pneumonectomy is an independent protective factor of OS and should be considered when applicable.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131586758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Relationships between gut microbiomes and airway immunity have been established in murine and human studies of allergy and asthma. Early life Lactobacillus supplementation alters the composition and metabolic productivity of the gut microbiome. However, little is known of how Lactobacillus supplementation impacts the gut microbiota in children with cystic fibrosis (CF) and whether specific microbiota states that arise following gut microbiome manipulation relate to pulmonary outcomes. Methods: Stool samples were collected from CF patients enrolled in a multi-center, double-blind, randomized placebo-controlled trial of daily Lactobacillus rhamnosus strain GG (LGG) probiotic supplementation over a 12-month period. Fecal 16S rRNA biomarker sequencing was used to profile fecal bacterial microbiota and analyses were performed in QiiME. Results: Bifidobacteria-dominated fecal microbiota were more likely to arise in LGG-treated children with CF (P = 0.04). Children with Bifidobacteria-dominated gut microbiota had a reduced rate of pulmonary exacerbations (IRR = 0.55; 95% CI 0.25 to 0.82; P = 0.01), improved pulmonary function (+ 20.00% of predicted value FEV1; 95% CI 8.05 to 31.92; P = 0.001), lower intestinal inflammation (Calprotectin; Coef = − 16.53 μg g−1 feces; 95% CI − 26.80 to − 6.26; P = 0.002) and required fewer antibiotics (IRR = 0.43; 95% CI 0.22 to 0.69; P = 0.04) compared to children with Bacteroides-dominated microbiota who were less likely to have received LGG. Conclusions: The majority of pediatric CF patients in this study possessed a Bacteroides- or Bifidobacteria-dominated gut microbiota. Bifidobacteria-dominated gut microbiota were more likely to be associated with LGG-supplementation and with better clinical outcomes.
{"title":"Lactobacillus-rhamnosus-Supplementation bei pädiatrischen Mukoviszidose-Patienten – nur das (Mikrobiom-)Ergebnis zählt?","authors":"M. Jorczyk","doi":"10.1159/000527393","DOIUrl":"https://doi.org/10.1159/000527393","url":null,"abstract":"Background: Relationships between gut microbiomes and airway immunity have been established in murine and human studies of allergy and asthma. Early life Lactobacillus supplementation alters the composition and metabolic productivity of the gut microbiome. However, little is known of how Lactobacillus supplementation impacts the gut microbiota in children with cystic fibrosis (CF) and whether specific microbiota states that arise following gut microbiome manipulation relate to pulmonary outcomes. Methods: Stool samples were collected from CF patients enrolled in a multi-center, double-blind, randomized placebo-controlled trial of daily Lactobacillus rhamnosus strain GG (LGG) probiotic supplementation over a 12-month period. Fecal 16S rRNA biomarker sequencing was used to profile fecal bacterial microbiota and analyses were performed in QiiME. Results: Bifidobacteria-dominated fecal microbiota were more likely to arise in LGG-treated children with CF (P = 0.04). Children with Bifidobacteria-dominated gut microbiota had a reduced rate of pulmonary exacerbations (IRR = 0.55; 95% CI 0.25 to 0.82; P = 0.01), improved pulmonary function (+ 20.00% of predicted value FEV1; 95% CI 8.05 to 31.92; P = 0.001), lower intestinal inflammation (Calprotectin; Coef = − 16.53 μg g−1 feces; 95% CI − 26.80 to − 6.26; P = 0.002) and required fewer antibiotics (IRR = 0.43; 95% CI 0.22 to 0.69; P = 0.04) compared to children with Bacteroides-dominated microbiota who were less likely to have received LGG. Conclusions: The majority of pediatric CF patients in this study possessed a Bacteroides- or Bifidobacteria-dominated gut microbiota. Bifidobacteria-dominated gut microbiota were more likely to be associated with LGG-supplementation and with better clinical outcomes.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115487284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
For optimal drug delivery, dry powder inhalers (DPIs) depend on the patient’s peak inspiratory flow (PIF) and the internal resistance of the device to create turbulent energy and disaggregate the powder. A suboptimal PIF may lead to ineffective drug inhalation into the lungs. Our objective was to report the prevalence of suboptimal PIF in patients with COPD hospitalized for any reason using 1 or more DPIs. In this real-world, observational, single-site, retrospective study, PIF was measured for each DPI using the In-Check™ DIAL set to match the resistance of the DPI used by each patient. PIFs <60 and <30L/min were considered suboptimal for low to medium-high- and high-resistance DPIs, respectively. At initial hospitalization, the prevalence of suboptimal PIF was 44.6% in 829 patients (mean age, 71.7 years; 56.8% female); 21.2% were measured during admission for a COPD exacerbation. Suboptimal PIF percentages were 61.0% (38.1±9.5L/min [mean±standard deviation]) across low to medium-high-resistance DPIs and 17.2% (20.7±4.2L/min) for high-resistance DPIs. Overall, 190/829 patients had 1 or more 30-day all-cause readmission with 253 corresponding PIF measurements. For readmissions, suboptimal PIFs were observed in49.5% (94/190) of patients. Suboptimal PIF percentages were 65.4% (38.4±9.2L/min) for low to medium-high-resistance DPIs and 19.8% (22.4±3.3L/min) for high-resistance DPIs. As the overall prevalence of suboptimal PIFs in hospitalized patients with COPD varied according to the specific internal resistance of the DPI, these findings may have clinical implications for inhaler selection.
{"title":"Bei stationärer Aufnahme korrekte Inhalationstechnik prüfen – unabhängig von der Art des verwendeten Systems","authors":"P. Haidl","doi":"10.1159/000527243","DOIUrl":"https://doi.org/10.1159/000527243","url":null,"abstract":"For optimal drug delivery, dry powder inhalers (DPIs) depend on the patient’s peak inspiratory flow (PIF) and the internal resistance of the device to create turbulent energy and disaggregate the powder. A suboptimal PIF may lead to ineffective drug inhalation into the lungs. Our objective was to report the prevalence of suboptimal PIF in patients with COPD hospitalized for any reason using 1 or more DPIs. In this real-world, observational, single-site, retrospective study, PIF was measured for each DPI using the In-Check™ DIAL set to match the resistance of the DPI used by each patient. PIFs <60 and <30L/min were considered suboptimal for low to medium-high- and high-resistance DPIs, respectively. At initial hospitalization, the prevalence of suboptimal PIF was 44.6% in 829 patients (mean age, 71.7 years; 56.8% female); 21.2% were measured during admission for a COPD exacerbation. Suboptimal PIF percentages were 61.0% (38.1±9.5L/min [mean±standard deviation]) across low to medium-high-resistance DPIs and 17.2% (20.7±4.2L/min) for high-resistance DPIs. Overall, 190/829 patients had 1 or more 30-day all-cause readmission with 253 corresponding PIF measurements. For readmissions, suboptimal PIFs were observed in49.5% (94/190) of patients. Suboptimal PIF percentages were 65.4% (38.4±9.2L/min) for low to medium-high-resistance DPIs and 19.8% (22.4±3.3L/min) for high-resistance DPIs. As the overall prevalence of suboptimal PIFs in hospitalized patients with COPD varied according to the specific internal resistance of the DPI, these findings may have clinical implications for inhaler selection.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"280 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121136718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Endobronchial administration of voriconazole is a potential therapeutic option for inoperable aspergilloma. Objective: This study aimed to assess the efficacy of endobronchial instillation of voriconazole for inoperable pulmonary aspergilloma. Method: Patients with mild to moderate hemoptysis, due to inoperable aspergilloma, were randomized to receive either medical therapy (MT) alone or bronchoscopic instillation of voriconazole with MT and followed up till 3 months. The primary objective of this study was to compare the percentage of patients achieving reduction in the severity of hemoptysis assessed on visual analogue scale (VAS) in intervention and control arm at 3 months. Results: This study included 60 patients (female = 47) with mean (SD) age of 40.6 (13.2) years who were randomized to receive either bronchoscopic instillation of voriconazole (n = 30) or MT alone (n = 30). At 3-month follow-up, the primary objective was achieved in 26/30 (86.7%) patients in intervention group as compared to 11/30 (36.7%) in the control group (p value <0.0001). The VAS score at 3 months was significantly lower in voriconazole group 13.9 (9.3) mm as compared to MT alone group 22.3 (11.5) mm, p value of 0.003. Bronchoscopic instillation of voriconazole was also associated with reduction in cough severity and size of the aspergilloma; however, there was no benefit of this therapy in terms of requirement of hospitalization and BAE. Conclusions: Our study shows that for nonoperable aspergilloma, bronchoscopic instillation of voriconazole is associated with reduction in the severity of hemoptysis. This therapy should be evaluated in large multi-center trials.
{"title":"Lokale Antimykotikumgabe bei inoperablen pulmonalen Aspergillomen","authors":"M. Wagner","doi":"10.1159/000527216","DOIUrl":"https://doi.org/10.1159/000527216","url":null,"abstract":"Background: Endobronchial administration of voriconazole is a potential therapeutic option for inoperable aspergilloma. Objective: This study aimed to assess the efficacy of endobronchial instillation of voriconazole for inoperable pulmonary aspergilloma. Method: Patients with mild to moderate hemoptysis, due to inoperable aspergilloma, were randomized to receive either medical therapy (MT) alone or bronchoscopic instillation of voriconazole with MT and followed up till 3 months. The primary objective of this study was to compare the percentage of patients achieving reduction in the severity of hemoptysis assessed on visual analogue scale (VAS) in intervention and control arm at 3 months. Results: This study included 60 patients (female = 47) with mean (SD) age of 40.6 (13.2) years who were randomized to receive either bronchoscopic instillation of voriconazole (n = 30) or MT alone (n = 30). At 3-month follow-up, the primary objective was achieved in 26/30 (86.7%) patients in intervention group as compared to 11/30 (36.7%) in the control group (p value <0.0001). The VAS score at 3 months was significantly lower in voriconazole group 13.9 (9.3) mm as compared to MT alone group 22.3 (11.5) mm, p value of 0.003. Bronchoscopic instillation of voriconazole was also associated with reduction in cough severity and size of the aspergilloma; however, there was no benefit of this therapy in terms of requirement of hospitalization and BAE. Conclusions: Our study shows that for nonoperable aspergilloma, bronchoscopic instillation of voriconazole is associated with reduction in the severity of hemoptysis. This therapy should be evaluated in large multi-center trials.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129992820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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