Pub Date : 2025-02-07DOI: 10.1016/j.resmer.2025.101162
Hendrik Kever , Giuseppe Liistro , Dominique Butenda Babapu , Gregory Reychler
Background
Sitting to supine fall in vital capacity (∆VC) is commonly used to screen for diaphragmatic dysfunction (DD), but the predictive threshold value varies.
This systematic review aimed to compare the position-dependent change in vital capacity (VC) in patients with objectively confirmed DD.
Research question
What is the optimal predictive value of ∆VC to diagnose DD.
Study design and methods
We searched Medline/PubMed, Embase and Scopus, including backward citations, for studies from database inception to December 5, 2023. Included trials measured position change in VC in adult patients with DD, confirmed independently by a parameter other than ∆VC. Risk of bias was assessed using the Downs and Black checklist.
Results
Of 497 records identified, 10 studies were included, totalling 393 adults, of which 284 had DD. In patients with confirmed unilateral diaphragmatic paralysis, mean change in VC ranged from 7 to 23%, and in those with bilateral diaphragmatic paralysis, from 19 to 37%. In studies providing only values for DD without specifying unilateral or bilateral involvement, it ranged from 31 to 42%. In control groups, it ranged from 3 to 9%.
Interpretation
The change in VC appears to be a valid test for confirming DD when using a cut-off value of 20%, though this approach results in very low sensitivity.
A cut-off value of 15% should be used in a screening setting as an initial approach of a multimodal strategy, without being sensible enough to exclude milder forms of DD.
{"title":"The positional change in vital capacity as a tool to identify diaphragm dysfunction: A qualitative systematic review","authors":"Hendrik Kever , Giuseppe Liistro , Dominique Butenda Babapu , Gregory Reychler","doi":"10.1016/j.resmer.2025.101162","DOIUrl":"10.1016/j.resmer.2025.101162","url":null,"abstract":"<div><h3>Background</h3><div>Sitting to supine fall in vital capacity (∆VC) is commonly used to screen for diaphragmatic dysfunction (DD), but the predictive threshold value varies.</div><div>This systematic review aimed to compare the position-dependent change in vital capacity (VC) in patients with objectively confirmed DD.</div></div><div><h3>Research question</h3><div>What is the optimal predictive value of ∆VC to diagnose DD.</div></div><div><h3>Study design and methods</h3><div>We searched Medline/PubMed, Embase and Scopus, including backward citations, for studies from database inception to December 5, 2023. Included trials measured position change in VC in adult patients with DD, confirmed independently by a parameter other than ∆VC. Risk of bias was assessed using the Downs and Black checklist.</div></div><div><h3>Results</h3><div>Of 497 records identified, 10 studies were included, totalling 393 adults, of which 284 had DD. In patients with confirmed unilateral diaphragmatic paralysis, mean change in VC ranged from 7 to 23%, and in those with bilateral diaphragmatic paralysis, from 19 to 37%. In studies providing only values for DD without specifying unilateral or bilateral involvement, it ranged from 31 to 42%. In control groups, it ranged from 3 to 9%.</div></div><div><h3>Interpretation</h3><div>The change in VC appears to be a valid test for confirming DD when using a cut-off value of 20%, though this approach results in very low sensitivity.</div><div>A cut-off value of 15% should be used in a screening setting as an initial approach of a multimodal strategy, without being sensible enough to exclude milder forms of DD.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101162"},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of long-acting muscarinic antagonists (LAMA) in asthma is supported by their mechanism of action and evidence of drug synergy with inhaled corticosteroids ± long-acting β-agonists. This review discusses the scientific rationale, clinical data, and recommendations for the use of LAMA in the asthma therapeutic strategy. Adding a LAMA to a dual therapy with an inhaled corticosteroid and long-acting β-agonist has been shown to reduce exacerbations, increase asthma control, and improve quality of life, with a good safety profile. In addition, using a single inhaler device containing multiple drugs enhances patients’ adherence to therapy. Some predictive factors of the efficacy of this triple therapy have been suggested in the literature: patients with a history of at least one exacerbation within the past 12 months, male patients, those younger than 65 years, and non-smokers have been reported to have a greater improvement from baseline forced expiratory volume in 1 second (FEV1) compared with patients without these characteristics, while patients with high bronchial hyperresponsiveness and persistent airway limitations (PAL) seem to show better gains in the exacerbation rate. However, eosinophil levels do not seem to predict the efficacy of LAMA. The role and long-term benefits of LAMA combined with biologic therapy in severe asthma remain uncertain, with more clinical data needed.
{"title":"Long-acting muscarinic antagonists (LAMA) in asthma: What is the best strategy?","authors":"Guillaume Mahay , Maeva Zysman , Nicolas Guibert , Cindy Barnig , Laurent Guilleminault , Clairelyne Dupin","doi":"10.1016/j.resmer.2025.101157","DOIUrl":"10.1016/j.resmer.2025.101157","url":null,"abstract":"<div><div>The use of long-acting muscarinic antagonists (LAMA) in asthma is supported by their mechanism of action and evidence of drug synergy with inhaled corticosteroids ± long-acting β-agonists. This review discusses the scientific rationale, clinical data, and recommendations for the use of LAMA in the asthma therapeutic strategy. Adding a LAMA to a dual therapy with an inhaled corticosteroid and long-acting β-agonist has been shown to reduce exacerbations, increase asthma control, and improve quality of life, with a good safety profile. In addition, using a single inhaler device containing multiple drugs enhances patients’ adherence to therapy. Some predictive factors of the efficacy of this triple therapy have been suggested in the literature: patients with a history of at least one exacerbation within the past 12 months, male patients, those younger than 65 years, and non-smokers have been reported to have a greater improvement from baseline forced expiratory volume in 1 second (FEV1) compared with patients without these characteristics, while patients with high bronchial hyperresponsiveness and persistent airway limitations (PAL) seem to show better gains in the exacerbation rate. However, eosinophil levels do not seem to predict the efficacy of LAMA. The role and long-term benefits of LAMA combined with biologic therapy in severe asthma remain uncertain, with more clinical data needed.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101157"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.resmer.2025.101159
Luc Haudebourg , Morgane Faure , Martin Dres , Nicolas Roche , Nicolas Terzi , Elise Morawiec , Julie Delemazure , Armand Mekontso-Dessap , Thomas Similowski , Maxens Decavèle , Alexandre Demoule
Background
Severe exacerbations of chronic obstructive pulmonary disease (ECOPD) require hospitalization in intensive care unit (ICU) in 10 % of cases. This study aims to describe current practices for the management of severe ECOPD in the ICU and to evaluate adherence to the 2017 French guidelines.
Methods
From March to May 2019, we conducted a cross-sectional multicenter survey across 80 ICUs in France. A 9-item questionnaire exploring physicians practices in terms of diagnostic workup and management of severe ECOPD was sent to participating centers.
Results
Four hundred and thirty-eight physicians responded to the survey, 75 % were senior physicians, 39 % were certified medical intensivists and 67 % worked in a medical or respiratory ICU. Nebulized short-acting beta agonists prescription was mostly driven by the presence of wheezing, silent chest or respiratory failure, even though guidelines recommend them systematically for ECOPD (moderate adhesion to guidelines). Antibiotic prescription was mostly driven by increased sputum purulence and volume, fever, signs of respiratory distress or the severity of the underlying COPD, but was not deemed systematic in case of severity signs (poor adhesion to guidelines). Regarding the use of biomarkers for antibiotics prescription, adhesion to guidelines was moderate. The prescription of systemic corticosteroids was not deemed systematic but was rather considered if no improvement was observed 72 h after admission (good adhesion to guidelines).
Conclusion
Reported management of severe ECOPD does not follow all guidelines. Future works should focus on understanding barriers to clinical practice guidelines implementation.
{"title":"Management of severe exacerbations of COPD by French intensivists and adherence to guidelines","authors":"Luc Haudebourg , Morgane Faure , Martin Dres , Nicolas Roche , Nicolas Terzi , Elise Morawiec , Julie Delemazure , Armand Mekontso-Dessap , Thomas Similowski , Maxens Decavèle , Alexandre Demoule","doi":"10.1016/j.resmer.2025.101159","DOIUrl":"10.1016/j.resmer.2025.101159","url":null,"abstract":"<div><h3>Background</h3><div>Severe exacerbations of chronic obstructive pulmonary disease (ECOPD) require hospitalization in intensive care unit (ICU) in 10 % of cases. This study aims to describe current practices for the management of severe ECOPD in the ICU and to evaluate adherence to the 2017 French guidelines.</div></div><div><h3>Methods</h3><div>From March to May 2019, we conducted a cross-sectional multicenter survey across 80 ICUs in France. A 9-item questionnaire exploring physicians practices in terms of diagnostic workup and management of severe ECOPD was sent to participating centers.</div></div><div><h3>Results</h3><div>Four hundred and thirty-eight physicians responded to the survey, 75 % were senior physicians, 39 % were certified medical intensivists and 67 % worked in a medical or respiratory ICU. Nebulized short-acting beta agonists prescription was mostly driven by the presence of wheezing, silent chest or respiratory failure, even though guidelines recommend them systematically for ECOPD (moderate adhesion to guidelines). Antibiotic prescription was mostly driven by increased sputum purulence and volume, fever, signs of respiratory distress or the severity of the underlying COPD, but was not deemed systematic in case of severity signs (poor adhesion to guidelines). Regarding the use of biomarkers for antibiotics prescription, adhesion to guidelines was moderate. The prescription of systemic corticosteroids was not deemed systematic but was rather considered if no improvement was observed 72 h after admission (good adhesion to guidelines).</div></div><div><h3>Conclusion</h3><div>Reported management of severe ECOPD does not follow all guidelines. Future works should focus on understanding barriers to clinical practice guidelines implementation.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101159"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-25DOI: 10.1016/j.resmer.2025.101158
Manon Levêque , Julien Bermudez , Ana Nieves , Florence Daviet , Antoine Roux , Xavier Demant , Benjamin Renaud-Picard , Jérôme Le Pavec , Hervé Mal , Thomas Villeneuve , Jean-François Mornex , Loïc Falque , Véronique Boussaud , Christiane Knoop , Adrien Tissot , Martine Reynaud-Gaubert , Benjamin Coiffard , the COLT consortium
Background
The ISHLT guidelines recommend early referral to a lung transplantation (LTx) center for patients with interstitial lung disease (ILD) due to the unpredictable course. To our knowledge, no study has assessed the impact of forced vital capacity (FVC) reduction severity on LTx outcomes in ILD. This study aims to determine whether the severity of FVC reduction is associated with post-transplant outcomes in ILD.
Methods and Results
Recipients from the French multicentric COLT cohort who underwent lung transplantation for ILD were included in this study. FVC was assessed to determine if the severity of its reduction is associated with post-transplant outcomes. 311 recipients were included in the study. FVC was identified as a significant risk factor for mortality at one year in multivariate analysis (p = 0.003). The ROC curve for FVC estimated the probability of death at one year with an area under the curve of 64 % (95 % confidence interval 57–71 %) and defined an optimal FVC threshold of 46 %. Recipients with an FVC ≤46 % were more likely to be listed as emergency cases, had lower FVC at one year, and exhibited reduced short- and long-term survival.
Conclusions
The severity of pre-transplant FVC reduction is a risk factor for poorer post-transplant outcomes. The findings should stimulate discussion about benefits of LTx for patients with lower FVC. An FVC threshold of ≤46 % should be considered in discussions about lung transplantation indications, decisions regarding single lung transplantation, and the selection of smaller donor lungs. Respirologists managing patients with ILD should consider early referral to a LTx center.
{"title":"Forced vital capacity reduction severity in pulmonary fibrosis and post-lung transplantation outcomes","authors":"Manon Levêque , Julien Bermudez , Ana Nieves , Florence Daviet , Antoine Roux , Xavier Demant , Benjamin Renaud-Picard , Jérôme Le Pavec , Hervé Mal , Thomas Villeneuve , Jean-François Mornex , Loïc Falque , Véronique Boussaud , Christiane Knoop , Adrien Tissot , Martine Reynaud-Gaubert , Benjamin Coiffard , the COLT consortium","doi":"10.1016/j.resmer.2025.101158","DOIUrl":"10.1016/j.resmer.2025.101158","url":null,"abstract":"<div><h3>Background</h3><div>The ISHLT guidelines recommend early referral to a lung transplantation (LTx) center for patients with interstitial lung disease (ILD) due to the unpredictable course. To our knowledge, no study has assessed the impact of forced vital capacity (FVC) reduction severity on LTx outcomes in ILD. This study aims to determine whether the severity of FVC reduction is associated with post-transplant outcomes in ILD.</div></div><div><h3>Methods and Results</h3><div>Recipients from the French multicentric COLT cohort who underwent lung transplantation for ILD were included in this study. FVC was assessed to determine if the severity of its reduction is associated with post-transplant outcomes. 311 recipients were included in the study. FVC was identified as a significant risk factor for mortality at one year in multivariate analysis (<em>p</em> = 0.003). The ROC curve for FVC estimated the probability of death at one year with an area under the curve of 64 % (95 % confidence interval 57–71 %) and defined an optimal FVC threshold of 46 %. Recipients with an FVC ≤46 % were more likely to be listed as emergency cases, had lower FVC at one year, and exhibited reduced short- and long-term survival.</div></div><div><h3>Conclusions</h3><div>The severity of pre-transplant FVC reduction is a risk factor for poorer post-transplant outcomes. The findings should stimulate discussion about benefits of LTx for patients with lower FVC. An FVC threshold of ≤46 % should be considered in discussions about lung transplantation indications, decisions regarding single lung transplantation, and the selection of smaller donor lungs. Respirologists managing patients with ILD should consider early referral to a LTx center.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101158"},"PeriodicalIF":2.2,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-24DOI: 10.1016/j.resmer.2025.101156
Asma Tariq , Maher Ghamloush , Greg Schumaker , Anthony Faugno , Lori Lyn Price , Leslie Lussier , Anjan Devaraj , Amrita Karambelkar , Beverly Wong , Elizabeth Han , Lydia Ran , Edward Shi , Alison Travers , Suma Gondi , Derek Lejeune , Gizem Koybasi , Nicholas S. Hill
Background
The use of high flow nasal oxygen therapy (HFNO) may improve clinical outcomes in acute hypoxemic respiratory failure (AHRF) compared to conventional oxygen. However, whether the use of HFNO improves clinical outcomes in COVID-19 pneumonia remains unclear. In this study, we describe the use of HFNO, as compared to conventional oxygen therapy (COT), in moderate to severe COVID-19 pneumonia.
Methods
This is a retrospective cohort study conducted at one academic medical center and one community hospital between March 1, 2020 and July 14, 2020. The primary purpose of the study was to determine the success of HFNO in preventing the composite outcome of invasive mechanical ventilation (IMV) or in-hospital death compared to COT. Secondary objectives included determining the predictors of this composite outcome, rate of endotracheal intubation, hospital mortality and outcomes of early versus late HFNO failure. Logistic and quantile regression were used to test for associations.
Results
A total of 197 patients were included, 166 in the HFNO and 31 in the COT group. There was no significant difference between the groups in the composite outcome of IMV or death, odds ratio (OR) = 0.36, p = 0.08. Use of HFNO as opposed to COT was associated with a significant reduction in the rate of IMV (64 % versus 87 %, p = 0.03). Older age and coronary artery disease were associated with HFNO failure. There was no significant mortality difference between early and late IMV.
Conclusion
In our study, HFNO did not reduce our primary composite outcome of IMV or death in moderate to severe AHRF, although we found that HFNO was associated with lower rate of intubation compared to COT. We detected no benefit of early vs late IMV. Utilizing HFNO in COVID-19 patients with AHRF may be a reasonable initial respiratory support strategy with close monitoring. Additional studies are needed to determine subset(s) of such patients that would benefit the most from HFNO use.
{"title":"The role of high flow nasal oxygen therapy in acute hypoxemic respiratory failure due to COVID-19 pneumonia","authors":"Asma Tariq , Maher Ghamloush , Greg Schumaker , Anthony Faugno , Lori Lyn Price , Leslie Lussier , Anjan Devaraj , Amrita Karambelkar , Beverly Wong , Elizabeth Han , Lydia Ran , Edward Shi , Alison Travers , Suma Gondi , Derek Lejeune , Gizem Koybasi , Nicholas S. Hill","doi":"10.1016/j.resmer.2025.101156","DOIUrl":"10.1016/j.resmer.2025.101156","url":null,"abstract":"<div><h3>Background</h3><div>The use of high flow nasal oxygen therapy (HFNO) may improve clinical outcomes in acute hypoxemic respiratory failure (AHRF) compared to conventional oxygen. However, whether the use of HFNO improves clinical outcomes in COVID-19 pneumonia remains unclear. In this study, we describe the use of HFNO, as compared to conventional oxygen therapy (COT), in moderate to severe COVID-19 pneumonia.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study conducted at one academic medical center and one community hospital between March 1, 2020 and July 14, 2020. The primary purpose of the study was to determine the success of HFNO in preventing the composite outcome of invasive mechanical ventilation (IMV) or in-hospital death compared to COT. Secondary objectives included determining the predictors of this composite outcome, rate of endotracheal intubation, hospital mortality and outcomes of early versus late HFNO failure. Logistic and quantile regression were used to test for associations.</div></div><div><h3>Results</h3><div>A total of 197 patients were included<strong>,</strong> 166 in the HFNO and 31 in the COT group. There was no significant difference between the groups in the composite outcome of IMV or death, odds ratio (OR) = 0.36, <em>p</em> = 0.08. Use of HFNO as opposed to COT was associated with a significant reduction in the rate of IMV (64 % versus 87 %, <em>p</em> = 0.03). Older age and coronary artery disease were associated with HFNO failure. There was no significant mortality difference between early and late IMV.</div></div><div><h3>Conclusion</h3><div>In our study, HFNO did not reduce our primary composite outcome of IMV or death in moderate to severe AHRF, although we found that HFNO was associated with lower rate of intubation compared to COT. We detected no benefit of early vs late IMV. Utilizing HFNO in COVID-19 patients with AHRF may be a reasonable initial respiratory support strategy with close monitoring. Additional studies are needed to determine subset(s) of such patients that would benefit the most from HFNO use.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101156"},"PeriodicalIF":2.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.resmer.2025.101155
Damien Basille , Bénédicte Toublanc , Géraldine François , Isabelle Mayeux , Claire Poulet , Lola Soriot , Mélanie Drucbert , Nour Ahmad , Claire Andrejak , Daniel Rodenstein , Yazine Mahjoub , Vincent Jounieaux
Background
SARS-CoV-2 virus which targets the lung vasculature is supposed to affect both pulmonary and bronchial arteries. This study evaluated the tracheobronchial vascularization density observed with narrow band imaging (NBI) in patients hospitalized for COVID-19 pneumonia. To determine if the observed changes were specific of COVID-19 patients, the procedure was also performed in non-COVID-19 patients.
Methods
Thirty patients included in this monocentric, prospective study underwent videobronchoscopy using both white light and NBI: 10 with a COVID-19 infection, 10 with a non-COVID-19 pulmonary infection and 10 with a peripheral pulmonary nodule. The tracheobronchial vascular density observed through NBI was rated by two blinded pneumologists at three levels (carina, right main bronchus and left main bronchus).
Results
When compared to the two other groups, a significant increase of the tracheobronchial vascularization was found in COVID-19 patients. The median tracheobronchial vascularization global score obtained with NBI (out of 15 points) was: 10 [9 – 13] in the COVID-19 group, 5 [4 – 10] in the non-COVID-19 group (p < 0.001) and 6 in the Nodule group [4 – 9] (p = 0.002). Using a weighted Cohen's Kappa coefficient, we observed a good agreement between the two raters for the evaluation of the tracheobronchial vascularization score (κ = 0.75 [0.65–0.83]); p < 0.001).
Conclusion
Videobronchoscopy with NBI in COVID-19 patients showed diffuse changes in tracheobronchial vascularization. We suggest that such bronchial hypervascularisation with dilated vessels contributes, at least in part, to the intrapulmonary right to left shunt that characterized the COVID-19 related Acute Vascular Distress Syndrome (AVDS).
{"title":"Role of narrow band imaging in assessing bronchial mucosal hypervascularization in COVID-19 patients","authors":"Damien Basille , Bénédicte Toublanc , Géraldine François , Isabelle Mayeux , Claire Poulet , Lola Soriot , Mélanie Drucbert , Nour Ahmad , Claire Andrejak , Daniel Rodenstein , Yazine Mahjoub , Vincent Jounieaux","doi":"10.1016/j.resmer.2025.101155","DOIUrl":"10.1016/j.resmer.2025.101155","url":null,"abstract":"<div><h3>Background</h3><div>SARS-CoV-2 virus which targets the lung vasculature is supposed to affect both pulmonary and bronchial arteries. This study evaluated the tracheobronchial vascularization density observed with narrow band imaging (NBI) in patients hospitalized for COVID-19 pneumonia. To determine if the observed changes were specific of COVID-19 patients, the procedure was also performed in non-COVID-19 patients.</div></div><div><h3>Methods</h3><div>Thirty patients included in this monocentric, prospective study underwent videobronchoscopy using both white light and NBI: 10 with a COVID-19 infection, 10 with a non-COVID-19 pulmonary infection and 10 with a peripheral pulmonary nodule. The tracheobronchial vascular density observed through NBI was rated by two blinded pneumologists at three levels (carina, right main bronchus and left main bronchus).</div></div><div><h3>Results</h3><div>When compared to the two other groups, a significant increase of the tracheobronchial vascularization was found in COVID-19 patients. The median tracheobronchial vascularization global score obtained with NBI (out of 15 points) was: 10 [9 – 13] in the COVID-19 group, 5 [4 – 10] in the non-COVID-19 group (<em>p</em> < 0.001) and 6 in the Nodule group [4 – 9] (<em>p</em> = 0.002). Using a weighted Cohen's Kappa coefficient, we observed a good agreement between the two raters for the evaluation of the tracheobronchial vascularization score (κ = 0.75 [0.65–0.83]); <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Videobronchoscopy with NBI in COVID-19 patients showed diffuse changes in tracheobronchial vascularization. We suggest that such bronchial hypervascularisation with dilated vessels contributes, at least in part, to the intrapulmonary right to left shunt that characterized the COVID-19 related Acute Vascular Distress Syndrome (AVDS).</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101155"},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-invasive ventilation (NIV) is the reference treatment for chronic respiratory failure (CRF) due to impairment of the ventilatory system. Home initiation is increasingly practiced. To better support this ambulatory shift, we aimed to assess the implementation constraints and short-term efficacy according to different aetiologies of CRF.
Methods
This retrospective study with cross-sectional and longitudinal analysis included patients initiated with NIV at Angers University Hospital. Patients were separated according to the following aetiologies: obesity hypoventilation syndrome (OHS), chronic obstruction pulmonary disease (COPD), amyotrophic lateral sclerosis (ALS), myopathy and chest wall disease. Implementation constraints were assessed by analysing the variability of NIV settings, the number of masks tried and the duration of hospitalisation. NIV effectiveness was assessed by measuring residual PaCO2 (arterial pressure in CO2), apnoea hypopnea index (AHIflow) and tidal volume (VT) (as displayed by the NIV software).
Results
Between October 2020 and May 2022, 102 patients were started with NIV, including a majority of ALS patients. We found a moderate variability in NIV settings (pressure, slope, triggers, etc.) within the different etiological groups, particularly in ALS. On the other hand, ALS patients required more interface trials than other groups and often had unmet efficacy criteria at hospital discharge. Interestingly, longitudinal follow-up showed a progressive improvement in efficacy criteria, particularly in patients who were initially inadequately ventilated.
Conclusion
Each aetiological group has specific constraints in the initiation of NIV that should be considered when initiating NIV in the outpatient setting.
{"title":"Constraints to the initiation of home non-invasive ventilation and short-term efficacy in different diagnostic groups (as a prelude to an ambulatory shift)","authors":"Claire Drouet , Pascaline Priou , Frédéric Gagnadoux , Wojciech Trzepizur","doi":"10.1016/j.resmer.2025.101154","DOIUrl":"10.1016/j.resmer.2025.101154","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-invasive ventilation (NIV) is the reference treatment for chronic respiratory failure (CRF) due to impairment of the ventilatory system. Home initiation is increasingly practiced. To better support this ambulatory shift, we aimed to assess the implementation constraints and short-term efficacy according to different aetiologies of CRF.</div></div><div><h3>Methods</h3><div>This retrospective study with cross-sectional and longitudinal analysis included patients initiated with NIV at Angers University Hospital. Patients were separated according to the following aetiologies: obesity hypoventilation syndrome (OHS), chronic obstruction pulmonary disease (COPD), amyotrophic lateral sclerosis (ALS), myopathy and chest wall disease. Implementation constraints were assessed by analysing the variability of NIV settings, the number of masks tried and the duration of hospitalisation. NIV effectiveness was assessed by measuring residual PaCO2 (arterial pressure in CO2), apnoea hypopnea index (AHI<sub>flow</sub>) and tidal volume (V<sub>T</sub>) (as displayed by the NIV software).</div></div><div><h3>Results</h3><div>Between October 2020 and May 2022, 102 patients were started with NIV, including a majority of ALS patients. We found a moderate variability in NIV settings (pressure, slope, triggers, etc.) within the different etiological groups, particularly in ALS. On the other hand, ALS patients required more interface trials than other groups and often had unmet efficacy criteria at hospital discharge. Interestingly, longitudinal follow-up showed a progressive improvement in efficacy criteria, particularly in patients who were initially inadequately ventilated.</div></div><div><h3>Conclusion</h3><div>Each aetiological group has specific constraints in the initiation of NIV that should be considered when initiating NIV in the outpatient setting.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101154"},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1016/j.resmer.2024.101153
Claire Farkouh , Ari Chaouat , Anne Guillaumot , Bruno Ribeiro Baptista , François Chabot , Simon Valentin
Background
Pulmonary hypertension (PH) is common during chronic obstructive pulmonary disease (COPD), particularly in patients with severe COPD. These patients can be classified into different PH groups due to frequent comorbidities. Emphysema is often associated with COPD and is responsible for lung hyperinflation, which may contribute to the development of PH. The treatment of PH in COPD is not well defined, and the response to treatment is variable depending on the phenotype of the patients. The aim of this study was to determine whether pulmonary hyperinflation in COPD patients predicts response to treatment.
Methods
This observational, retrospective, single-center study included COPD patients diagnosed with PH, treated with PH treatments. Patient were divided into two groups according to lung hyperinflation, judged on the ratio of residual volume to total lung capacity. Response to treatment was defined by an improvement of at least 30 m in the 6-minute walk test or a one-point improvement in World Health Organization functional class at the first reassessment performed at least three months after treatment initiation.
Results
Of the 47 patients included, 30 (63.8 %) were responders to PH treatments, with no significant difference between patients in the “lung hyperinflation” (HI) group and those in the “no lung hyperinflation” (NoHI) group (64.3 % vs. 63.2 %, p = 0.937). However, response to treatment was significantly lower in the most distended patients when compared to non-distended patients (p = 0.033). Mean overall survival was 59.1 months (95 % CI [47.4–70.7]) and was significantly better in responders, with a mean survival of 71.5 months (95 % CI [58.6–84.5]) vs. 35.4 months (95 % CI [17.3–53.4], p = 0.001). Mean survival did not differ according to lung hyperinflation, with a mean survival of 50.3 months (95 % CI [35.2–65.3]) for patients with HI, and 70.4 months (95 % CI [54.3–86.5], p = 0.105) for NoHI patients.
Conclusions
In COPD and PH patients eligible for PH treatments, the presence of lung hyperinflation did not predict response to treatment. However, patients with high degree of lung hyperinflation had a significantly poorer response to PAH treatment than patients without lung hyperinflation. Further studies are needed to confirm these results and to investigate other determinants of response in this population.
Clinical Trial Registration
The study design has been registered on ClinicalTrials (NCT06613321).
{"title":"Pulmonary hypertension in patients with chronic obstructive pulmonary disease: Impact of lung hyperinflation on the response to pulmonary hypertension treatment","authors":"Claire Farkouh , Ari Chaouat , Anne Guillaumot , Bruno Ribeiro Baptista , François Chabot , Simon Valentin","doi":"10.1016/j.resmer.2024.101153","DOIUrl":"10.1016/j.resmer.2024.101153","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary hypertension (PH) is common during chronic obstructive pulmonary disease (COPD), particularly in patients with severe COPD. These patients can be classified into different PH groups due to frequent comorbidities. Emphysema is often associated with COPD and is responsible for lung hyperinflation, which may contribute to the development of PH. The treatment of PH in COPD is not well defined, and the response to treatment is variable depending on the phenotype of the patients. The aim of this study was to determine whether pulmonary hyperinflation in COPD patients predicts response to treatment.</div></div><div><h3>Methods</h3><div>This observational, retrospective, single-center study included COPD patients diagnosed with PH, treated with PH treatments. Patient were divided into two groups according to lung hyperinflation, judged on the ratio of residual volume to total lung capacity. Response to treatment was defined by an improvement of at least 30 m in the 6-minute walk test or a one-point improvement in World Health Organization functional class at the first reassessment performed at least three months after treatment initiation.</div></div><div><h3>Results</h3><div>Of the 47 patients included, 30 (63.8 %) were responders to PH treatments, with no significant difference between patients in the “lung hyperinflation” (HI) group and those in the “no lung hyperinflation” (NoHI) group (64.3 % vs. 63.2 %, <em>p</em> = 0.937). However, response to treatment was significantly lower in the most distended patients when compared to non-distended patients (<em>p</em> = 0.033). Mean overall survival was 59.1 months (95 % CI [47.4–70.7]) and was significantly better in responders, with a mean survival of 71.5 months (95 % CI [58.6–84.5]) vs. 35.4 months (95 % CI [17.3–53.4], <em>p</em> = 0.001). Mean survival did not differ according to lung hyperinflation, with a mean survival of 50.3 months (95 % CI [35.2–65.3]) for patients with HI, and 70.4 months (95 % CI [54.3–86.5], <em>p</em> = 0.105) for NoHI patients.</div></div><div><h3>Conclusions</h3><div>In COPD and PH patients eligible for PH treatments, the presence of lung hyperinflation did not predict response to treatment. However, patients with high degree of lung hyperinflation had a significantly poorer response to PAH treatment than patients without lung hyperinflation. Further studies are needed to confirm these results and to investigate other determinants of response in this population.</div></div><div><h3>Clinical Trial Registration</h3><div>The study design has been registered on ClinicalTrials (NCT06613321).</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101153"},"PeriodicalIF":2.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-12DOI: 10.1016/j.resmer.2024.101150
Julie Tronchetti , Paul Habert , Thibault Agripnidis , Katia Chaumoitre , Noémie Resseguier , Anh Thu Nguyen , Jean-Yves Gaubert , Hervé Dutau , Philippe Astoul , Julien Guinde
Background
CT-guided trans-thoracic lung biopsy (CT-TTLB) is efficient and widely used to diagnose pulmonary nodules. After pneumothorax, the second most frequent complication is hemoptysis, which can be life-threatening. These patients often have comorbidities and are on acetylsalicylic-acid (ASA) therapy. The aim of this study was to assess ASA as a risk factor for hemoptysis or severe hemoptysis following CT-TTLB.
Methods
We retrospectively reviewed consecutive patients undergoing CT-TTLB from 2 centers between 01/2018 and 01/2021. Exclusion criteria were nodules with a pleural contact or a contraindication to lung puncture. Clinical and imaging data were recorded such as age, gender, comorbidities, hemoptysis (every blood spit), severe hemoptysis (>200 mL / oxygen need>10L/min / intervention or resuscitation / death), nodule size, puncture depth, emphysema, nodule location, patient position and histology. Lung parenchymal hemorrhage (LPH) was quantified in cm³ on CT after biopsy. Univariate and multivariate analysis were performed with a logistic regression model, without and with propensity match score, to identify variables associated with hemoptysis and severe hemoptysis.
Results
Four-hundred-and-one patients were analyzed, 106 and 295 in the ASA or the control group respectively. In multivariate analysis, ASA use was a risk factor for severe hemoptysis (OR=4.5; 95 %CI[1.3–15.9]) but not for hemoptysis (OR=1.7; 95 %CI[0.5–3.1]), persisting after matching. There was no difference for LPH between the ASA and the control sub-groups (median (IQR)) 5.2cm³ (15.3) vs 3.1cm³ (11.5) p = 0.2).
Conclusions
Treatment with ASA did not increase the risk of all hemoptysis occurrence after CT-TTLB but was a risk factor for severe hemoptysis.
{"title":"The effect of concurrent acetylsalicylic acid on hemorrhagic complications during percutaneous image-guided lung biopsy","authors":"Julie Tronchetti , Paul Habert , Thibault Agripnidis , Katia Chaumoitre , Noémie Resseguier , Anh Thu Nguyen , Jean-Yves Gaubert , Hervé Dutau , Philippe Astoul , Julien Guinde","doi":"10.1016/j.resmer.2024.101150","DOIUrl":"10.1016/j.resmer.2024.101150","url":null,"abstract":"<div><h3>Background</h3><div>CT-guided trans-thoracic lung biopsy (CT-TTLB) is efficient and widely used to diagnose pulmonary nodules. After pneumothorax, the second most frequent complication is hemoptysis, which can be life-threatening. These patients often have comorbidities and are on acetylsalicylic-acid (ASA) therapy. The aim of this study was to assess ASA as a risk factor for hemoptysis or severe hemoptysis following CT-TTLB.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive patients undergoing CT-TTLB from 2 centers between 01/2018 and 01/2021. Exclusion criteria were nodules with a pleural contact or a contraindication to lung puncture. Clinical and imaging data were recorded such as age, gender, comorbidities, hemoptysis (every blood spit), severe hemoptysis (>200 mL / oxygen need>10L/min / intervention or resuscitation / death), nodule size, puncture depth, emphysema, nodule location, patient position and histology. Lung parenchymal hemorrhage (LPH) was quantified in cm³ on CT after biopsy. Univariate and multivariate analysis were performed with a logistic regression model, without and with propensity match score, to identify variables associated with hemoptysis and severe hemoptysis.</div></div><div><h3>Results</h3><div>Four-hundred-and-one patients were analyzed, 106 and 295 in the ASA or the control group respectively. In multivariate analysis, ASA use was a risk factor for severe hemoptysis (OR=4.5; 95 %CI[1.3–15.9]) but not for hemoptysis (OR=1.7; 95 %CI[0.5–3.1]), persisting after matching. There was no difference for LPH between the ASA and the control sub-groups (median (IQR)) 5.2cm³ (15.3) vs 3.1cm³ (11.5) <em>p</em> = 0.2).</div></div><div><h3>Conclusions</h3><div>Treatment with ASA did not increase the risk of all hemoptysis occurrence after CT-TTLB but was a risk factor for severe hemoptysis.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101150"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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