Pub Date : 2024-07-04DOI: 10.1183/23120541.00386-2024
K. Yaacoby-Bianu, M. Heching, Mordechai R Kramer, Einat Shmueli, Dario Prais, François Vermeulen, A. Ramalho, Raya Cohen, G. Livnat, M. Shteinberg
{"title":"Treatment effects of CFTR modulators on people with Cystic Fibrosis carrying the Q359K/T360K variant","authors":"K. Yaacoby-Bianu, M. Heching, Mordechai R Kramer, Einat Shmueli, Dario Prais, François Vermeulen, A. Ramalho, Raya Cohen, G. Livnat, M. Shteinberg","doi":"10.1183/23120541.00386-2024","DOIUrl":"https://doi.org/10.1183/23120541.00386-2024","url":null,"abstract":"","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141678007","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.01027-2023
F. Steinbeis, C. Kedor, Hans-Jakob Meyer, C. Thibeault, M. Mittermaier, P. Knape, K. Ahrens, G. Rotter, B. Temmesfeld-Wollbrück, Leif Erik Sander, F. Kurth, M. Witzenrath, C. Scheibenbogen, T. Zoller
Patients with post COVID-19 condition frequently suffer from chronic dyspnoea. The causes and mechanism for dyspnoea in these patients without evidence of structural lung disease are unclear.Patients treated for COVID-19 at Charité University hospital in Berlin received pulmonary function testing including respiratory muscle strength tests and completed health related quality of life questionnaires during follow-up. Patients with post COVID-19 condition during outpatient follow-up with fatigue and exertional intolerance (PCF) were compared to patients with post COVID-19 condition with evidence of chronic pulmonary sequelae (PCR) as well as to patients without post COVID-19 condition (NCF).A total of 170 patients presented for follow-up. 36 participants met criteria for PCF, 28 for PCR and 24 for NCF. PCF patients reported dyspnoea in 63.8%. Percent predicted value (ppv) of respiratory muscle strength (median (IQR)) was reduced in PCF (55.8 (41.5–75.9)) compared to NCF and PCR (70.6 (66.3–88.9); 76.8 (63.6–102.2); p=0.011). A pattern of reduced forced vital capacity (FVC), but normal total lung capacity (TLC), termed complex ventilatory dysfunction defined as TLC-FVC>10% (of ppv) was observed and occurred more frequently in PCF (88.9%) compared to NCF and PCR (29.1% and 25.0%; p<0.001).Dyspnoea in PCF is characterized by reduced respiratory muscle strength and complex ventilatory dysfunction indicating neuromuscular disturbance as a distinct phenotype among patients with post COVID-19 condition. These observations could be a starting point for developing personalized rehabilitation concepts.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and resulting coronavirus disease 2019 (COVID-19) has caused serious morbidity and mortality worldwide [1]. Acute, subacute and long-term effects of COVID-19 can involve multiple organ systems including vascular endothelial cells, lung, heart, brain, kidney, intestine, liver, pharynx and other tissues, potentially through direct organ damage [2, 3]. New and persisting symptoms for more than three months after SARS-CoV-2 infection which cannot be explained by an alternative diagnosis are commonly referred to as long-COVID, and different terms have been introduced by multiple institutions such as post COVID-19 condition [4] or post COVID-19 syndrome [5]. An estimated 6% of COVID-19 survivors reported ongoing respiratory problems, cognitive sequelae or fatigue after three months of infection [6]. However, all current definitions of post COVID-19 condition are based on broadly defined symptoms and symptom complexes, and their underlying pathophysiology is still not fully understood [7].
{"title":"A new phenotype of patients with post COVID-19 condition is characterized by a pattern of complex ventilatory dysfunction, neuromuscular disturbance and fatigue symptoms","authors":"F. Steinbeis, C. Kedor, Hans-Jakob Meyer, C. Thibeault, M. Mittermaier, P. Knape, K. Ahrens, G. Rotter, B. Temmesfeld-Wollbrück, Leif Erik Sander, F. Kurth, M. Witzenrath, C. Scheibenbogen, T. Zoller","doi":"10.1183/23120541.01027-2023","DOIUrl":"https://doi.org/10.1183/23120541.01027-2023","url":null,"abstract":"Patients with post COVID-19 condition frequently suffer from chronic dyspnoea. The causes and mechanism for dyspnoea in these patients without evidence of structural lung disease are unclear.Patients treated for COVID-19 at Charité University hospital in Berlin received pulmonary function testing including respiratory muscle strength tests and completed health related quality of life questionnaires during follow-up. Patients with post COVID-19 condition during outpatient follow-up with fatigue and exertional intolerance (PCF) were compared to patients with post COVID-19 condition with evidence of chronic pulmonary sequelae (PCR) as well as to patients without post COVID-19 condition (NCF).A total of 170 patients presented for follow-up. 36 participants met criteria for PCF, 28 for PCR and 24 for NCF. PCF patients reported dyspnoea in 63.8%. Percent predicted value (ppv) of respiratory muscle strength (median (IQR)) was reduced in PCF (55.8 (41.5–75.9)) compared to NCF and PCR (70.6 (66.3–88.9); 76.8 (63.6–102.2); p=0.011). A pattern of reduced forced vital capacity (FVC), but normal total lung capacity (TLC), termed complex ventilatory dysfunction defined as TLC-FVC>10% (of ppv) was observed and occurred more frequently in PCF (88.9%) compared to NCF and PCR (29.1% and 25.0%; p<0.001).Dyspnoea in PCF is characterized by reduced respiratory muscle strength and complex ventilatory dysfunction indicating neuromuscular disturbance as a distinct phenotype among patients with post COVID-19 condition. These observations could be a starting point for developing personalized rehabilitation concepts.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and resulting coronavirus disease 2019 (COVID-19) has caused serious morbidity and mortality worldwide [1]. Acute, subacute and long-term effects of COVID-19 can involve multiple organ systems including vascular endothelial cells, lung, heart, brain, kidney, intestine, liver, pharynx and other tissues, potentially through direct organ damage [2, 3]. New and persisting symptoms for more than three months after SARS-CoV-2 infection which cannot be explained by an alternative diagnosis are commonly referred to as long-COVID, and different terms have been introduced by multiple institutions such as post COVID-19 condition [4] or post COVID-19 syndrome [5]. An estimated 6% of COVID-19 survivors reported ongoing respiratory problems, cognitive sequelae or fatigue after three months of infection [6]. However, all current definitions of post COVID-19 condition are based on broadly defined symptoms and symptom complexes, and their underlying pathophysiology is still not fully understood [7].","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677146","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00180-2024
S. Vanni, P. Bartalucci, Lorenzo Pelagatti, Ginevra Fabiani, Elena Guglielmini, Gianfranco Giannasi, G. Ruggiano, E. de Curtis, A. Coppa, G. Pepe, S. Magazzini, A. Voza, Fulvio Morello, P. Nazerian, S. Grifoni
To determine the prevalence and characteristics of pulmonary embolism (PE) in patients presenting with hemoptysis. Additionally, we assessed the efficiency and failure rates of different clinical diagnostic algorithms for PE in this patient population.We enrolled consecutive adult patients who presented to nine Italian Emergency Departments (ED) with hemoptysis as the primary complaint. PE diagnosis was ruled out in patients with a low pretest probability in combination with a negative age-adjusted D-dimer (referred to as the “age-adjusted” D-dimer strategy), a negative computed tomography pulmonary angiography, or when a clear alternative source of bleeding was identified, along with negative findings for venous thromboembolism during a 30-day follow-up.A total of 546 patients were included in the study. The prevalence of PE, including the 30-day follow-up, was 4.2% (95% confidence interval, CI, 2.7–6.3%). The majority of these cases (78%) exhibited distal (segmental or subsegmental) emboli, and there were no PE-related fatalities. The “age-adjusted” D-dimer strategy initially excluded PE in 24% of patients (95% CI, 21–28%), with a failure rate of 0.8% (95% CI, 0.0–4.1%). Retrospectively applied, the “clinical probability-adjusted” D-dimer strategies, specifically the YEARS and PEGeD algorithms, excluded PE in a significantly higher proportion (30% and 32%, respectively) compared to the “age-adjusted” D-dimer strategy (p<0.05 for both), with similar failure rates.Pulmonary embolism is infrequent among patients presenting with hemoptysis, showing segmental or subsegmental emboli distribution. The “clinical probability-adjusted” D-dimer strategies seem to have significantly higher efficiency compared to the “age-adjusted” strategy.
{"title":"Diagnosis of Pulmonary Embolism in patients with Hemoptysis: the POPEIHE study","authors":"S. Vanni, P. Bartalucci, Lorenzo Pelagatti, Ginevra Fabiani, Elena Guglielmini, Gianfranco Giannasi, G. Ruggiano, E. de Curtis, A. Coppa, G. Pepe, S. Magazzini, A. Voza, Fulvio Morello, P. Nazerian, S. Grifoni","doi":"10.1183/23120541.00180-2024","DOIUrl":"https://doi.org/10.1183/23120541.00180-2024","url":null,"abstract":"To determine the prevalence and characteristics of pulmonary embolism (PE) in patients presenting with hemoptysis. Additionally, we assessed the efficiency and failure rates of different clinical diagnostic algorithms for PE in this patient population.We enrolled consecutive adult patients who presented to nine Italian Emergency Departments (ED) with hemoptysis as the primary complaint. PE diagnosis was ruled out in patients with a low pretest probability in combination with a negative age-adjusted D-dimer (referred to as the “age-adjusted” D-dimer strategy), a negative computed tomography pulmonary angiography, or when a clear alternative source of bleeding was identified, along with negative findings for venous thromboembolism during a 30-day follow-up.A total of 546 patients were included in the study. The prevalence of PE, including the 30-day follow-up, was 4.2% (95% confidence interval, CI, 2.7–6.3%). The majority of these cases (78%) exhibited distal (segmental or subsegmental) emboli, and there were no PE-related fatalities. The “age-adjusted” D-dimer strategy initially excluded PE in 24% of patients (95% CI, 21–28%), with a failure rate of 0.8% (95% CI, 0.0–4.1%). Retrospectively applied, the “clinical probability-adjusted” D-dimer strategies, specifically the YEARS and PEGeD algorithms, excluded PE in a significantly higher proportion (30% and 32%, respectively) compared to the “age-adjusted” D-dimer strategy (p<0.05 for both), with similar failure rates.Pulmonary embolism is infrequent among patients presenting with hemoptysis, showing segmental or subsegmental emboli distribution. The “clinical probability-adjusted” D-dimer strategies seem to have significantly higher efficiency compared to the “age-adjusted” strategy.","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677836","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00241-2024
Hisham Abubakar-Waziri, David A. Edwards, Deen Bhandu Bhatta, James H. Hull, Matthew Rudd, Peter Small, K. Fan Chung
Treatment of chronic cough remains a challenge. We hypothesized that inhaled alkaline hypertonic divalent salts (alkaline HDS) might provide relief for refractory chronic cough by laryngeal and tracheal hydration.We conducted an exploratory, single-blinded, nasal-saline-controlled study in 12 refractory chronic cough patients to examine cough-suppression efficacy of an alkaline HDS composition (SC001) at pH 8 or pH 9 administered by nasal inhalation. As control, we used nasal saline with the same hand-held pump spray aerosol device. Each subject was monitored continuously using a digital cough monitor watch for one week of baseline, one week of control treatment, and one week of active treatment.Baseline daily cough rates ranged from 4 to 34 coughs/hour with mean visual analog score 65±17 pre- and post-baseline testing. Control-adjusted efficacy of cough rate reduction ranged from 15% (p=0.015) (from Day 1) to 23% (p=0.002) (from Day 3). Control-adjusted efficacy was highest with SC001 pH 9 (n=5), ranging from 25% (p=0.03) (from Day 1) to 35% (p=0.02) (from Day 3), and lowest for SC001 pH 8 (n=7), ranging from 9% (p=0.08) (from Day 1) to 16% (p=0.02) (from Day 3). Hourly cough counts and VAS correlated for baseline (r=0.254, p-value=0.02) and control (r=0.299, p-value=0.007) monitoring weeks. Treatment improved this correlation (r=0.434, p-value=0.00006). No adverse events were reported.Alkaline (pH 9) HDS aerosol is a promising treatment for refractory chronic cough and should be further evaluated.
{"title":"Inhaled alkaline hypertonic divalent salts reduce refractory chronic cough frequency","authors":"Hisham Abubakar-Waziri, David A. Edwards, Deen Bhandu Bhatta, James H. Hull, Matthew Rudd, Peter Small, K. Fan Chung","doi":"10.1183/23120541.00241-2024","DOIUrl":"https://doi.org/10.1183/23120541.00241-2024","url":null,"abstract":"Treatment of chronic cough remains a challenge. We hypothesized that inhaled alkaline hypertonic divalent salts (alkaline HDS) might provide relief for refractory chronic cough by laryngeal and tracheal hydration.We conducted an exploratory, single-blinded, nasal-saline-controlled study in 12 refractory chronic cough patients to examine cough-suppression efficacy of an alkaline HDS composition (SC001) at pH 8 or pH 9 administered by nasal inhalation. As control, we used nasal saline with the same hand-held pump spray aerosol device. Each subject was monitored continuously using a digital cough monitor watch for one week of baseline, one week of control treatment, and one week of active treatment.Baseline daily cough rates ranged from 4 to 34 coughs/hour with mean visual analog score 65±17 pre- and post-baseline testing. Control-adjusted efficacy of cough rate reduction ranged from 15% (p=0.015) (from Day 1) to 23% (p=0.002) (from Day 3). Control-adjusted efficacy was highest with SC001 pH 9 (n=5), ranging from 25% (p=0.03) (from Day 1) to 35% (p=0.02) (from Day 3), and lowest for SC001 pH 8 (n=7), ranging from 9% (p=0.08) (from Day 1) to 16% (p=0.02) (from Day 3). Hourly cough counts and VAS correlated for baseline (r=0.254, p-value=0.02) and control (r=0.299, p-value=0.007) monitoring weeks. Treatment improved this correlation (r=0.434, p-value=0.00006). No adverse events were reported.Alkaline (pH 9) HDS aerosol is a promising treatment for refractory chronic cough and should be further evaluated.","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677403","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00529-2024
K. Holt, Joanne Mitchell, R. Dockry, Shilpi Sen, Jacky Smith
{"title":"Comparison of different nebulisation systems for capsaicin cough challenge testing","authors":"K. Holt, Joanne Mitchell, R. Dockry, Shilpi Sen, Jacky Smith","doi":"10.1183/23120541.00529-2024","DOIUrl":"https://doi.org/10.1183/23120541.00529-2024","url":null,"abstract":"","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141678153","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00459-2024
Richard Turner, Surinder Birring
Chronic cough is a frequent reason for medical consultation and has significant impact on quality of life. Due to the limited effectiveness of currently available treatments, and delays in accessing care, patients are often inadequately managed. There also remains an overreliance by clinicians on outdated management algorithms, addressing chronic cough only as symptom of other medical conditions, and advocating investigation and trials of treatment of diseases which are often not present. This may lead to unnecessary cost, frustration, and potential harm. Newer clinical guidelines in essence consider chronic cough as a disease in itself, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. Secondary factors which aggravate chronic cough (smoking, asthma, gastroesophageal reflux, etc), are better considered as treatable traits associated with the primary disease process rather than direct “causes” of cough.Explicitly approaching chronic cough as a discrete entity is consistent with the way in which “diseases” are generally characterised, and has advantages. The patient should be better able to understand their condition, and may have better confidence in attempts at management. The clinician should have better focus and avoid unfruitful treatments and investigation. In general, considering chronic cough as a disease should also help to raise the profile of the condition, improve organisation of health service pathways, increase attention for research, and further the development of new treatments.
{"title":"Chronic cough as a disease","authors":"Richard Turner, Surinder Birring","doi":"10.1183/23120541.00459-2024","DOIUrl":"https://doi.org/10.1183/23120541.00459-2024","url":null,"abstract":"Chronic cough is a frequent reason for medical consultation and has significant impact on quality of life. Due to the limited effectiveness of currently available treatments, and delays in accessing care, patients are often inadequately managed. There also remains an overreliance by clinicians on outdated management algorithms, addressing chronic cough only as symptom of other medical conditions, and advocating investigation and trials of treatment of diseases which are often not present. This may lead to unnecessary cost, frustration, and potential harm. Newer clinical guidelines in essence consider chronic cough as a disease in itself, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. Secondary factors which aggravate chronic cough (smoking, asthma, gastroesophageal reflux, etc), are better considered as treatable traits associated with the primary disease process rather than direct “causes” of cough.Explicitly approaching chronic cough as a discrete entity is consistent with the way in which “diseases” are generally characterised, and has advantages. The patient should be better able to understand their condition, and may have better confidence in attempts at management. The clinician should have better focus and avoid unfruitful treatments and investigation. In general, considering chronic cough as a disease should also help to raise the profile of the condition, improve organisation of health service pathways, increase attention for research, and further the development of new treatments.","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141679435","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00468-2024
B. Hirons, P. Cho, Chris Krägeloh, Richard J. Siegert, Richard Turner, K. Rhatigan, Harini Kesavan, E. Mackay, Ha-Kyeong Won, Ju-Young Kim, Woo-Jung Song, S. Birring
Chronic cough is considered a disorder of neuronal hypersensitivity in which patients frequently report abnormal laryngeal and chest sensations, and excessive triggers. To facilitate clinical assessment we developed the Cough Hypersensitivity Questionnaire (CHQ).Candidate questionnaire items were developed following interviews with patients with refractory chronic cough (n=10, United Kingdom), and review by a multidisciplinary team. The CHQ was evaluated in individuals with chronic cough (n=535, UK/South Korea), for uni-dimensionality and differential item functioning (with Rasch Analysis), internal consistency, concurrent validity (against cough severity visual analogue scale (VAS) and Leicester Cough Questionnaire (LCQ) scores), and content validity (cognitive debriefing interviews, n=13).Concept elicitation created a pool of 34 items. Eleven were removed following multidisciplinary team review of patient interviews. Rasch analysis confirmed the CHQ total score to be a unidimensional scale; one item was removed due to differential item functioning. The final 22 binary-item CHQ comprises 6 sensation-related and 16 trigger-related items.Median (IQR) total CHQ scores were 9 (6–12); sensations 4 (2–5), triggers 5 (3–8). Internal consistency was good (person separation index 0.74). The CHQ total score was moderately associated with cough severity VAS (0.42, p=0.005) and LCQ total score (ρ=−0.52, p<0.001). In cognitive debriefing, patients found the CHQ relevant to their condition and simple to complete.The CHQ is simple to use and has validity for assessing cough triggers and sensations in patients with chronic cough. Further studies are needed to assess its repeatability, responsiveness, and clinical utility.
{"title":"The development of the Cough Hypersensitivity Questionnaire (CHQ) for chronic cough","authors":"B. Hirons, P. Cho, Chris Krägeloh, Richard J. Siegert, Richard Turner, K. Rhatigan, Harini Kesavan, E. Mackay, Ha-Kyeong Won, Ju-Young Kim, Woo-Jung Song, S. Birring","doi":"10.1183/23120541.00468-2024","DOIUrl":"https://doi.org/10.1183/23120541.00468-2024","url":null,"abstract":"Chronic cough is considered a disorder of neuronal hypersensitivity in which patients frequently report abnormal laryngeal and chest sensations, and excessive triggers. To facilitate clinical assessment we developed the Cough Hypersensitivity Questionnaire (CHQ).Candidate questionnaire items were developed following interviews with patients with refractory chronic cough (n=10, United Kingdom), and review by a multidisciplinary team. The CHQ was evaluated in individuals with chronic cough (n=535, UK/South Korea), for uni-dimensionality and differential item functioning (with Rasch Analysis), internal consistency, concurrent validity (against cough severity visual analogue scale (VAS) and Leicester Cough Questionnaire (LCQ) scores), and content validity (cognitive debriefing interviews, n=13).Concept elicitation created a pool of 34 items. Eleven were removed following multidisciplinary team review of patient interviews. Rasch analysis confirmed the CHQ total score to be a unidimensional scale; one item was removed due to differential item functioning. The final 22 binary-item CHQ comprises 6 sensation-related and 16 trigger-related items.Median (IQR) total CHQ scores were 9 (6–12); sensations 4 (2–5), triggers 5 (3–8). Internal consistency was good (person separation index 0.74). The CHQ total score was moderately associated with cough severity VAS (0.42, p=0.005) and LCQ total score (ρ=−0.52, p<0.001). In cognitive debriefing, patients found the CHQ relevant to their condition and simple to complete.The CHQ is simple to use and has validity for assessing cough triggers and sensations in patients with chronic cough. Further studies are needed to assess its repeatability, responsiveness, and clinical utility.","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141678771","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00342-2024
E. Hoff, S. Musovic, A. M. Komai, D. Zou, C. Strassberger, K. Stenlöf, L. Grote, Jan Hedner
Obstructive sleep apnea (OSA) is a common disease with breathing disturbances during sleep. Sulthiame (STM), a carbonic anhydrase (CA) inhibitor, was recently shown to reduce OSA in a significant proportion of patients. CA activity and hypoxia-inducible factor 1α (HIF-1α) are two potential biomarkers reported in severe OSA and hypoxia. Both have been considered to play roles in the development of OSA comorbidities. This study investigated the effects of STM on these biomarkers in OSA.Exploratory analysis of a randomized, double-blind, placebo controlled trial of STM in OSA. Patients with moderate to severe OSA, body mass index 20–35 kg·m−2, aged 18–75 years and not accepting positive airway pressure treatment were randomized to four weeks with STM 200 mg, STM 400 mg or placebo. CA activity (n=43) and HIF-1α concentration (n=53) were determined at baseline, after four weeks of treatment and two weeks after treatment completion.In the 400 mg group, both CA activity and HIF-1α concentration were reduced (median difference −26% [95% CI −32% to −12%] and −4% [95% CI −8% to −2%], both p<0.05versusplacebo). The reductions were sustained two weeks after treatment completion. In the 200 mg group, both CA activity and HIF-1α were numerically reduced. The STM induced reductions in CA activity and HIF-1α correlated significantly (r=0.443, p=0.023).STM treatment in OSA induced a reduction of both CA activity and HIF-1α concentration. The effects remained two weeks after treatment completion, suggesting prolonged effects of STM in OSA.
阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠呼吸障碍疾病。最近的研究表明，碳酸酐酶（CA）抑制剂舒喘宁（STM）可减少相当一部分患者的 OSA。据报道，CA活性和缺氧诱导因子1α（HIF-1α）是严重OSA和缺氧的两种潜在生物标志物。两者都被认为在 OSA 并发症的发展中发挥作用。本研究调查了 STM 对 OSA 这些生物标志物的影响。STM 对 OSA 的随机、双盲、安慰剂对照试验的探索性分析。中重度 OSA 患者，体重指数 20-35 kg-m-2，年龄 18-75 岁，不接受气道正压治疗，随机接受 STM 200 毫克、STM 400 毫克或安慰剂治疗四周。在 400 毫克组中，CA 活性和 HIF-1α 浓度均有所降低（与安慰剂相比，中位差值分别为 -26% [95% CI -32% 至 -12%]和 -4% [95% CI -8% 至 -2%]，P 均<0.05）。治疗结束两周后，降幅仍在持续。在 200 毫克组中，CA 活性和 HIF-1α 在数量上都有所降低。STM诱导的CA活性和HIF-1α的降低显著相关（r=0.443，p=0.023）。STM治疗OSA可降低CA活性和HIF-1α浓度，治疗结束两周后疗效仍在，这表明STM对OSA有长期作用。
{"title":"The effect of sulthiame on potential biomarkers in moderate to severe obstructive sleep apnea","authors":"E. Hoff, S. Musovic, A. M. Komai, D. Zou, C. Strassberger, K. Stenlöf, L. Grote, Jan Hedner","doi":"10.1183/23120541.00342-2024","DOIUrl":"https://doi.org/10.1183/23120541.00342-2024","url":null,"abstract":"Obstructive sleep apnea (OSA) is a common disease with breathing disturbances during sleep. Sulthiame (STM), a carbonic anhydrase (CA) inhibitor, was recently shown to reduce OSA in a significant proportion of patients. CA activity and hypoxia-inducible factor 1α (HIF-1α) are two potential biomarkers reported in severe OSA and hypoxia. Both have been considered to play roles in the development of OSA comorbidities. This study investigated the effects of STM on these biomarkers in OSA.Exploratory analysis of a randomized, double-blind, placebo controlled trial of STM in OSA. Patients with moderate to severe OSA, body mass index 20–35 kg·m−2, aged 18–75 years and not accepting positive airway pressure treatment were randomized to four weeks with STM 200 mg, STM 400 mg or placebo. CA activity (n=43) and HIF-1α concentration (n=53) were determined at baseline, after four weeks of treatment and two weeks after treatment completion.In the 400 mg group, both CA activity and HIF-1α concentration were reduced (median difference −26% [95% CI −32% to −12%] and −4% [95% CI −8% to −2%], both p<0.05versusplacebo). The reductions were sustained two weeks after treatment completion. In the 200 mg group, both CA activity and HIF-1α were numerically reduced. The STM induced reductions in CA activity and HIF-1α correlated significantly (r=0.443, p=0.023).STM treatment in OSA induced a reduction of both CA activity and HIF-1α concentration. The effects remained two weeks after treatment completion, suggesting prolonged effects of STM in OSA.","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141679641","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}
Pub Date : 2024-07-04DOI: 10.1183/23120541.00341-2024
S. Sillanmäki, Serajeddin Ebrahimian, S. Hietakoste, David Hernando, Raquel Bailon, T. Leppänen, S. Kainulainen
Obstructive sleep apnea (OSA) imposes significant stress on the cardiovascular system and the heart. While long-term cardiac effects are understood, the immediate impact of hypoxemia on the heart’s electrophysiology lacks understanding. Our study aims to explore desaturation severity on cardiovascular repolarization.We retrospectively analyzed electrocardiograms from full diagnostic polysomnographies from 492 patients with suspected OSA. The analyses were conducted before, during, and after 9137 nocturnal apnea or hypopnea-related desaturations. The mean and standard deviation of T-wave amplitude change from the baseline level to the level during and after desaturations (ΔTamp_mean, ΔTamp_SD) was calculated. To investigate the modulatory effects of desaturation severity, the data were divided into subgroups based on the duration (10s≤Tdes<20 s, 20s≤Tdes<30 s, 30s≤Tdes<45 s, and Tdes≥45 s) and magnitude of blood oxygen saturation drop (3%≤ΔSpO2<4.5%, 4.5%≤ΔSpO2<6%, 6%≤ΔSpO2<7.5%, and ΔSpO2≥7.5%) for men and woman.Desaturations caused significant (p<0.01) changes in ΔTamp_meanduring and after desaturations. In men, the median ΔTamp_meanduring and after deep (ΔSpO2≥7.5%) desaturations were 21 µV and 24 µV, respectively. In women, the median ΔTamp_meanin deep desaturations was 15 µV during and 21 µV after desaturations. Similarly, the ΔTamp_SDincreased during and after deep desaturations. In regression analysis, the desaturation depth was an independent predictor for ventricular repolarization instability.We found an association between the severity of nocturnal desaturations and cardiac repolarization instability. These findings hold particular importance, as repolarization instability has been linked with cardiovascular morbidity and could potentially serve as a trigger for arrhythmias and sudden cardiac death.
{"title":"Hypoxemic load in sleep apnea is associated with acute changes in T-wave amplitude","authors":"S. Sillanmäki, Serajeddin Ebrahimian, S. Hietakoste, David Hernando, Raquel Bailon, T. Leppänen, S. Kainulainen","doi":"10.1183/23120541.00341-2024","DOIUrl":"https://doi.org/10.1183/23120541.00341-2024","url":null,"abstract":"Obstructive sleep apnea (OSA) imposes significant stress on the cardiovascular system and the heart. While long-term cardiac effects are understood, the immediate impact of hypoxemia on the heart’s electrophysiology lacks understanding. Our study aims to explore desaturation severity on cardiovascular repolarization.We retrospectively analyzed electrocardiograms from full diagnostic polysomnographies from 492 patients with suspected OSA. The analyses were conducted before, during, and after 9137 nocturnal apnea or hypopnea-related desaturations. The mean and standard deviation of T-wave amplitude change from the baseline level to the level during and after desaturations (ΔTamp_mean, ΔTamp_SD) was calculated. To investigate the modulatory effects of desaturation severity, the data were divided into subgroups based on the duration (10s≤Tdes<20 s, 20s≤Tdes<30 s, 30s≤Tdes<45 s, and Tdes≥45 s) and magnitude of blood oxygen saturation drop (3%≤ΔSpO2<4.5%, 4.5%≤ΔSpO2<6%, 6%≤ΔSpO2<7.5%, and ΔSpO2≥7.5%) for men and woman.Desaturations caused significant (p<0.01) changes in ΔTamp_meanduring and after desaturations. In men, the median ΔTamp_meanduring and after deep (ΔSpO2≥7.5%) desaturations were 21 µV and 24 µV, respectively. In women, the median ΔTamp_meanin deep desaturations was 15 µV during and 21 µV after desaturations. Similarly, the ΔTamp_SDincreased during and after deep desaturations. In regression analysis, the desaturation depth was an independent predictor for ventricular repolarization instability.We found an association between the severity of nocturnal desaturations and cardiac repolarization instability. These findings hold particular importance, as repolarization instability has been linked with cardiovascular morbidity and could potentially serve as a trigger for arrhythmias and sudden cardiac death.","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677842","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}
Pub Date : 2024-07-01DOI: 10.1183/23120541.00372-2024
Melissa H Ross, Shijing Jia
{"title":"Heterogeneity in non-cystic fibrosis bronchiectasis: insights from ASPEN trial participants","authors":"Melissa H Ross, Shijing Jia","doi":"10.1183/23120541.00372-2024","DOIUrl":"https://doi.org/10.1183/23120541.00372-2024","url":null,"abstract":"","PeriodicalId":504874,"journal":{"name":"ERJ Open Research","volume":"1992 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852079","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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