Pulmonology最新文献

英文中文

Unraveling the resurgence of pertussis: Insights into epidemiology and global health strategies 揭示百日咳卷土重来的原因：流行病学和全球健康战略的启示。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.009

引用次数: 0

Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals – EvaluateCOPDpt, a multicentre, observational, prospective study 葡萄牙医院对慢性阻塞性肺疾病加重的管理 - EvaluateCOPDpt，一项多中心、观察性、前瞻性研究。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.07.007

Introduction and Objectives

In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals.

Materials and Methods

Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview.

Results

196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised.

Conclusions

The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.

导言和目标：为了提高慢性阻塞性肺病（COPD）患者的治疗质量，需要更好地了解临床实践以及与患者治疗效果相关的因素。本研究旨在评估葡萄牙医院的临床实践与慢性阻塞性肺病加重患者的治疗效果之间的关系：观察性、多中心、前瞻性研究，随访期60天，在11家医院进行，包括年龄≥30岁、因慢性阻塞性肺疾病急性加重住院至少24小时的患者。研究人员收集了人口统计学和临床数据，包括性别、年龄、吸烟习惯、住院情况、肺功能、合并症、慢性阻塞性肺病症状和治疗情况。出院 60 天后，通过结构化电话随访对慢性阻塞性肺疾病加重的管理、结果测量和再入院数据进行评估：共纳入了 196 名患者（85.7% 为男性，平均年龄 71.2 岁），其中大部分患者是通过急诊服务入院的。曾经吸烟者和目前吸烟者分别占 51% 和 36%。入院时，72.4%的患者使用LAMA，54.6%使用LABA，45.5%使用LABA/LAMA。37.3%的患者使用吸入性皮质类固醇（ICS），10.3%的患者使用全身性类固醇（SCS）。35.7%的患者在过去一年中至少出现过一次病情加重并住院治疗。23.2%的患者没有肺活量数据。住院期间，98.5% 的患者接受了氧气治疗，38.3% 接受了无创通气治疗。此外，93.4%的患者使用了SCS，60.2%的患者使用了ICS。85.2%的患者使用了抗生素。95.4%的患者出院；9人死亡，其中5人死于慢性阻塞性肺病。出院患者的中位住院时间为 12 天，死亡患者的中位住院时间为 33 天。出院时，79.1%的患者接受了LAMA治疗，63.6%接受了SCS治疗，61.5%接受了LABA治疗，55.6%接受了LAMA+LABA治疗。26.2%的患者接受了 ICS+LABA+LAMA 治疗。在随访中，44.4%的患者在出院后60天内进行了预约就诊，28.3%的患者后来因病情加重再次入院，其中52.8%的患者住院治疗：结论：慢性阻塞性肺病的严重程度，尤其是病情加重的程度，与肺功能受损、生活质量下降、死亡率和医疗系统的重大成本直接相关。了解葡萄牙急性入院患者慢性阻塞性肺疾病加重的管理情况有助于促进全国性讨论和对现有数据的审查，让临床医生、政策制定者、管理者和患者参与进来，提高对慢性阻塞性肺疾病的认识并促进相关行动。

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引用次数: 0

Reliability and validity of the Chester step test in patients with interstitial lung disease 间质性肺病患者切斯特台阶试验的可靠性和有效性。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.10.009

Background

The Chester Step Test (CST) is a simple and inexpensive field test, which requires minimal physical space to assess exercise capacity. Such characteristics make the CST suitable to be used in different settings, however, its measurement properties in patients with interstitial lung diseases (ILD) are unknown.

Methods

A cross-sectional study was conducted in patients with ILD. First, a CST-1 and a 6-minute walk test (6MWT) were performed. After 48-72 hours, a CST-2 was repeated. A 2nd rater was present in one of the sessions. Relative reliability was measured using intraclass correlation coefficient (ICC_1,1 and ICC_2,1). Absolute reliability was determined using standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC₉₅) and the Bland-Altman method. The values of SEM and MDC₉₅ were also expressed as a percentage of the mean. Construct validity was explored using Spearman correlation coefficient (r_s) between the number of steps taken in the best CST and the distance performed in the 6MWT.

Results

Sixty-six patients with ILD (65.5±12.9 years; 48.5%men; FVC 79.4±18.8pp; DL_CO 49.0±18.3pp) participated in the study. Relative (ICC 0.95-1.0) and absolute reliability were excellent without evidence of systematic bias. The SEM and MDC₉₅ were 11.8 (14.7%) and 32.6 steps (40.7%), respectively. The correlation between CST and 6MWT was significant, positive, and high (r_s=0.85, p=0.001).

Conclusion

The CST is a reliable and valid test and might be especially useful to assess exercise capacity in patients with ILD in limited space environments.

背景：切斯特台阶试验（CST）是一种简单而廉价的现场试验，只需最小的物理空间即可评估运动能力。这些特点使切斯特台阶试验适合在不同环境中使用，但其在间质性肺病（ILD）患者中的测量特性尚不清楚：方法：对 ILD 患者进行了一项横断面研究。首先，进行 CST-1 和 6 分钟步行测试（6MWT）。48-72 小时后，重复 CST-2。在其中一次测试中，有第二位评分者在场。相对可靠性采用类内相关系数（ICC1,1 和 ICC2,1）进行测量。绝对信度采用标准测量误差（SEM）、95% 置信区间（MDC95）的最小可检测变化和布兰德-阿尔特曼法确定。SEM 和 MDC95 的值也以平均值的百分比表示。使用最佳 CST 的步数与 6MWT 的距离之间的斯皮尔曼相关系数（rs）探讨了结构有效性：66名 ILD 患者（65.5±12.9 岁；48.5% 男性；FVC 79.4±18.8pp；DLCO 49.0±18.3pp）参加了研究。相对信度（ICC 0.95-1.0）和绝对信度都非常好，没有系统性偏差的证据。SEM和MDC95分别为11.8步（14.7%）和32.6步（40.7%）。CST与6MWT之间的相关性显著、正且高（rs=0.85，P=0.001）：CST是一项可靠有效的测试，尤其适用于评估ILD患者在有限空间环境中的运动能力。

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引用次数: 0

Chronic cough in patients with obstructive sleep apnoea: A prospective cohort study 阻塞性睡眠呼吸暂停患者的慢性咳嗽：前瞻性队列研究

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.04.010

引用次数: 0

Issue 2 - “Update on adverse respiratory effects of indoor air pollution”. Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries 第 2 期--"室内空气污染对呼吸系统不良影响的最新情况"。第 2 部分）：室内空气污染与呼吸系统疾病：意大利和其他一些 GARD 国家的观点。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2023.03.007

Objective

to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution.

Results

Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan.

Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education.

Conclusions

in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions.

Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of “a world where all people breathe freely” and encourage policy makers to increase their engagement in advocacy for clean air.

目的：综合意大利流行病学对室内污染对呼吸系统影响的贡献，分析一些 GARD 国家对室内空气污染对健康影响的看法：结果：意大利流行病学分析研究证实，室内空气污染与普通人群的健康关系密切。环境烟草烟雾、用于烹饪/取暖的生物质（木材/煤炭）燃料和室内过敏原（室内尘螨、猫和狗的皮屑、霉菌/潮气）是最相关的室内污染源，与意大利以及墨西哥、巴西、越南、印度、尼泊尔和吉尔吉斯斯坦等其他 GARD 国家的呼吸道和过敏症状/疾病有关。结论：在过去的三十年中，有关室内空气污染对呼吸系统健康影响的科学证据已经非常广泛，但为了实施有效的干预措施，必须增强科学界和地方管理部门之间的协同作用，这仍然是一个需要应对的挑战。基于室内污染对健康影响的大量证据，世卫组织、科学协会、患者组织和卫生界其他成员应共同努力，追求 "一个人人自由呼吸的世界 "的 GARD 愿景，并鼓励决策者更多地参与倡导清洁空气。

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引用次数: 0

Evaluation of maximal exercise capacity through the incremental shuttle walking test in lymphangioleiomyomatosis 通过增量穿梭步行测试评估淋巴管瘤病的最大运动能力。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2022.04.009

Background

The cardiopulmonary exercise test (CPET) is the gold standard for assessing aerobic fitness; however, it is expensive, not widely available, and requires specialized equipment and staff. The incremental shuttle walking test (ISWT) is an exercise field test used to evaluate exercise capacity and may be an alternative to CPET in patients with lymphangioleiomyomatosis (LAM).

Objective

To investigate whether the ISWT can be used to assess maximal aerobic capacity in patients with LAM.

Methods

Forty-five women were evaluated on two days, and they randomly performed the CPET and ISWT. The maximum oxygen uptake (peak VO₂) was evaluated using gas analyzers in both tests. The carbon dioxide production (VCO₂), respiratory exchange ratio (RER), and heart rate (HR) were compared during peak exercise. Pearson's correlation and Bland-Altman assessed the association and agreement, respectively. The intraclass correlation coefficient (ICC) was used to assess the reliability of the data.

Results

All patients (46.1 ± 10.2 years) presented similar peak VO₂, RER, and peak HR during the CPET and ISWT (15.6 ± 4.6 vs. 15.7 ± 4.4 ml·kg⁻¹·min⁻¹; 1.15±0.09 vs. 1.17±0.12; and 142.2 ± 18.6 vs. 141.5 ± 22.2 bpm, respectively; p>0.05). A good linear correlation (r = 0.79; p<0.001) and ICC (0.86; 95%CI 0.74−0.93) were observed between the peak VO₂ in both tests. Predictive peak VO₂ equations based on the ISWT performance are also presented.

Conclusion

Our results suggest that the ISWT can be used to assess maximal exercise performance in patients with LAM, and it is a valuable option to be used as an alternative to the CPET and predict maximal exercise capacity.

背景：心肺运动测试（CPET）是评估有氧体能的黄金标准；然而，它价格昂贵，并不普及，而且需要专门的设备和人员。增量穿梭步行试验（ISWT）是一种用于评估运动能力的运动场试验，可作为淋巴管瘤病患者 CPET 的替代方法：目的：研究 ISWT 是否可用于评估 LAM 患者的最大有氧能力：方法：45 名女性在两天内接受了评估，她们随机进行了 CPET 和 ISWT。两项测试均使用气体分析仪评估最大摄氧量（峰值 VO2）。比较了峰值运动时的二氧化碳产生量（VCO2）、呼吸交换比（RER）和心率（HR）。Pearson 相关性和 Bland-Altman 分别评估了相关性和一致性。类内相关系数（ICC）用于评估数据的可靠性：结果：所有患者（46.1±10.2 岁）在 CPET 和 ISWT 过程中的峰值 VO2、RER 和峰值 HR 相似（分别为 15.6±4.6 vs. 15.7±4.4 ml-kg-1-min-1；1.15±0.09 vs. 1.17±0.12；142.2±18.6 vs. 141.5±22.2 bpm；P>0.05）。两项测试的线性相关性良好（r = 0.79；p2）。结论：我们的研究结果表明，ISWT 是一种有效的运动疗法：我们的研究结果表明，ISWT 可用于评估 LAM 患者的最大运动能力，是替代 CPET 和预测最大运动能力的重要选择。

{"title":"Evaluation of maximal exercise capacity through the incremental shuttle walking test in lymphangioleiomyomatosis","authors":"","doi":"10.1016/j.pulmoe.2022.04.009","DOIUrl":"10.1016/j.pulmoe.2022.04.009","url":null,"abstract":"<div><h3>Background</h3><div>The cardiopulmonary exercise test (CPET) is the gold standard for assessing aerobic fitness; however, it is expensive, not widely available, and requires specialized equipment and staff. The incremental shuttle walking test (ISWT) is an exercise field test used to evaluate exercise capacity and may be an alternative to CPET in patients with lymphangioleiomyomatosis (LAM).</div></div><div><h3>Objective</h3><div>To investigate whether the ISWT can be used to assess maximal aerobic capacity in patients with LAM.</div></div><div><h3>Methods</h3><div>Forty-five women were evaluated on two days, and they randomly performed the CPET and ISWT. The maximum oxygen uptake (peak VO<sub>2</sub>) was evaluated using gas analyzers in both tests. The carbon dioxide production (VCO<sub>2</sub>), respiratory exchange ratio (RER), and heart rate (HR) were compared during peak exercise. Pearson's correlation and Bland-Altman assessed the association and agreement, respectively. The intraclass correlation coefficient (ICC) was used to assess the reliability of the data.</div></div><div><h3>Results</h3><div>All patients (46.1 ± 10.2 years) presented similar peak VO<sub>2</sub>, RER, and peak HR during the CPET and ISWT (15.6 ± 4.6 vs. 15.7 ± 4.4 ml·kg<sup>−1</sup>·min<sup>−1</sup>; 1.15±0.09 vs. 1.17±0.12; and 142.2 ± 18.6 vs. 141.5 ± 22.2 bpm, respectively; <em>p</em>>0.05). A good linear correlation (<em>r</em> = 0.79; <em>p</em><0.001) and ICC (0.86; 95%CI 0.74−0.93) were observed between the peak VO<sub>2</sub> in both tests. Predictive peak VO<sub>2</sub> equations based on the ISWT performance are also presented.</div></div><div><h3>Conclusion</h3><div>Our results suggest that the ISWT can be used to assess maximal exercise performance in patients with LAM, and it is a valuable option to be used as an alternative to the CPET and predict maximal exercise capacity.</div></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 6","pages":"Pages 563-569"},"PeriodicalIF":10.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Redundancy in sarcoidosis granulomas 肉样瘤肉芽肿的重复性。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.05.001

引用次数: 0

Impact of the 2022 ATS/ERS update criteria on the bronchodilator responsiveness test result 2022 年 ATS/ERS 更新标准对支气管扩张剂反应性测试结果的影响。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.06.003

B. Martins , A. Marinho , P. Amorim

引用次数: 0

Sclerosing pneumocytoma with rosette structure mimicking carcinoid: A diagnostic pitfall of intraoperative consultation 具有模仿类癌花纹结构的硬化性肺细胞瘤：术中会诊的诊断陷阱。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2024.03.006

引用次数: 0

Associations and relative risks of pulmonary hypertension and lung diseases in individuals with methamphetamine use disorder 甲基苯丙胺使用障碍患者肺动脉高压和肺部疾病的相关性和相对风险。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-11-01 DOI: 10.1016/j.pulmoe.2023.01.003

Objective

Methamphetamine causes considerable short- and long-term adverse health effects. Our aim was to assess the effects of methamphetamine use on pulmonary hypertension and lung diseases at the population level.

Methods

This population-based retrospective study used data from the Taiwan National Health Insurance Research Database between 2000 and 2018 that included 18,118 individuals with methamphetamine use disorder (MUD) and 90,590 matched participants of the same age and sex without substance use disorder as the non-exposed group. A conditional logistic regression model was used to estimate associations of methamphetamine use with pulmonary hypertension and lung diseases such as lung abscess, empyema, pneumonia, emphysema, pleurisy, pneumothorax, or pulmonary hemorrhage. Incidence rate ratios (IRRs) of pulmonary hypertension and hospitalization due to lung diseases were determined between the methamphetamine group and non-methamphetamine group using negative binomial regression models.

Results

During an 8-year observation period, 32 (0.2%) individuals with MUD and 66 (0.1%) non-methamphetamine participants suffered from pulmonary hypertension, and 2652 (14.6%) individuals with MUD and 6157 (6.8%) non-methamphetamine participants suffered from lung diseases. After adjusting for demographic characteristics and comorbidities, individuals with MUD were 1.78 times (95% confidence interval (CI) = 1.07–2.95) more likely to have pulmonary hypertension and 1.98 times (95% CI = 1.88–2.08) more likely to have a lung disease, especially emphysema, lung abscess, and pneumonia in descending order. Furthermore, compared to the non-methamphetamine group, the methamphetamine group was associated with higher risks of hospitalization caused by pulmonary hypertension and lung diseases. The respective IRRs were 2.79 and 1.67. Individuals with polysubstance use disorder were associated with higher risks of empyema, lung abscess, and pneumonia compared to individuals with MUD alone, with respective adjusted odds ratios of 2.96, 2.21, and 1.67. However, pulmonary hypertension and emphysema did not differ significantly between MUD individuals with or without polysubstance use disorder.

Conclusions

Individuals with MUD were associated with higher risks of pulmonary hypertension and lung diseases. Clinicians need to ensure that a methamphetamine exposure history is obtained as part of the workup for these pulmonary diseases and provide timely management for this contributing factor.

目的：甲基苯丙胺会对健康造成很大的短期和长期不利影响。我们的目的是在人群水平上评估吸食甲基苯丙胺对肺动脉高压和肺部疾病的影响：这项基于人群的回顾性研究使用了台湾国民健康保险研究数据库 2000 年至 2018 年间的数据，其中包括 18 118 名甲基苯丙胺使用障碍（MUD）患者和 90 590 名年龄和性别相同、无药物使用障碍的非暴露组匹配参与者。该研究采用条件逻辑回归模型来估算吸食甲基苯丙胺与肺动脉高压和肺部疾病（如肺脓肿、肺水肿、肺炎、肺气肿、胸膜炎、气胸或肺出血）之间的关系。使用负二项回归模型确定了甲基苯丙胺组和非甲基苯丙胺组之间肺动脉高压和肺部疾病住院的发病率比（IRRs）：在8年的观察期内，32名（0.2%）甲基苯丙胺感染者和66名（0.1%）非甲基苯丙胺感染者患有肺动脉高压，2652名（14.6%）甲基苯丙胺感染者和6157名（6.8%）非甲基苯丙胺感染者患有肺部疾病。在对人口统计学特征和合并症进行调整后，MUD 患者罹患肺动脉高压的几率是非 MUD 患者的 1.78 倍（95% 置信区间 (CI) = 1.07-2.95），罹患肺部疾病的几率是非 MUD 患者的 1.98 倍（95% 置信区间 (CI) = 1.88-2.08），尤其是肺气肿、肺脓肿和肺炎的几率依次递增。此外，与非甲基苯丙胺组相比，甲基苯丙胺组因肺动脉高压和肺部疾病住院的风险更高。其内部相关系数分别为 2.79 和 1.67。与只吸食甲基苯丙胺的人相比，有多种物质使用障碍的人患肺水肿、肺脓肿和肺炎的风险更高，调整后的几率比分别为 2.96、2.21 和 1.67。然而，肺动脉高压和肺气肿在有或没有多种药物使用障碍的 MUD 患者之间没有显著差异：结论：MUD 患者罹患肺动脉高压和肺部疾病的风险较高。临床医生需要确保获得甲基苯丙胺接触史，作为这些肺部疾病检查的一部分，并对这一诱因进行及时处理。

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