Pulmonology最新文献

英文中文

Physiotherapists in intensive care units: Where are we? 重症监护室的物理治疗师：我们在哪里？

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2024.02.004

F. Ramalho , A. Oliveira , A. Machado , V. Azevedo , M.R. Gonçalves , G. Ntoumenopoulos , A. Marques

引用次数: 0

Clinical usefulness of serum angiotensin converting enzyme in silicosis 血清血管紧张素转换酶在矽肺病中的临床应用。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2022.06.002

J. Blanco-Pérez , Á. Salgado-Barreira , S. Blanco-Dorado , M.E. González Bello , A.C. Caldera Díaz , A. Pérez-Gonzalez , A. Pallarés Sanmartín , A. Fernández Villar , F.J. Gonzalez-Barcala

Introduction

Silicosis is an irreversible and incurable disease. Preventive measures to eliminate exposure are the only effective way to reduce morbidity and mortality. In such situations, having a biomarker for early diagnosis or to predict evolution would be very useful in order to improve control of the disease. The elevation of serum angiotensin-converting enzyme (sACE) in silicosis has been described in previous studies, although its relationship with severity and prognosis is not clear.

Aims

To determine the levels of sACE in a cohort of patients with exposure to silica dust with and without silicosis, and to assess their impact on the prognosis of the aforementioned patients.

Method

Prospective observational study on patients treated in a silicosis clinic from 2009 to 2018. sACE levels and pulmonary function tests were performed. Radiological progression was assessed in patients who had already had 2 X-rays of the thorax and / or two CT scans with at least a 1-year interval, from the time of inclusion in the study.

Results

A total of 413 cases of silicosis were confirmed, as well as 73 with exposure to silica dust but without silicosis. The mean sACE level for healthy subjects was 27.5±7.3U/L, for exposed patients without silicosis it was 49.6±24.2U/L, for simple silicosis it was 57.8±31,3U/L and for complicated silicosis it was 74.5±38.6U/L. Patients with a higher sACE generally progressed radiologically during follow-up (73.3±38.0 vs. 60.4±33.7; p<.001) and so the category of silicosis changed (73,9±38.1 vs. 62.5±34.6; p<.021).

Conclusions

sACE was elevated in patients with silicosis, and the greater its severity, the higher it was, which is associated with disease progression measured radiologically or as a category change of silicosis.

导言矽肺病是一种不可逆转、无法治愈的疾病。消除接触的预防措施是降低发病率和死亡率的唯一有效方法。在这种情况下，如果能有一种生物标志物用于早期诊断或预测病情发展，将对改善疾病控制非常有用。目的：确定暴露于二氧化硅粉尘并患有和未患有矽肺病的一组患者的血清血管紧张素转换酶（sACE）水平，并评估其对上述患者预后的影响：对 2009 年至 2018 年期间在矽肺诊所接受治疗的患者进行前瞻性观察研究。自纳入研究时起，对已进行过 2 次胸部 X 光检查和/或 2 次 CT 扫描且间隔至少 1 年的患者进行放射学进展评估：共有 413 例矽肺患者得到确诊，另有 73 例患者接触过矽尘但未患矽肺。健康受试者的平均 sACE 水平为（27.5±7.3）U/L，无矽肺的暴露患者的平均 sACE 水平为（49.6±24.2）U/L，单纯性矽肺患者的平均 sACE 水平为（57.8±31.3）U/L，复杂性矽肺患者的平均 sACE 水平为（74.5±38.6）U/L。在随访期间，sACE 较高的患者一般在放射学上有所进展（73.3±38.0 vs. 60.4±33.7；p 结论：矽肺患者的 sACE 升高，且严重程度越高，sACE 越高，这与放射学上测量的疾病进展或矽肺类别变化有关。

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引用次数: 0

Are we overlooking the lung function in the definition of severe asthma remission? 我们在定义严重哮喘缓解时是否忽略了肺功能？

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2023.11.004

S. Nolasco , R. Campisi , N. Crimi , C. Crimi

引用次数: 0

Reproducibility, validity, and reliability of the incremental step test for subjects with moderate to severe asthma 针对中重度哮喘患者的增量台阶试验的再现性、有效性和可靠性。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2022.02.002

R.C.C. Barbosa , R.A. Silva , A.C. Lunardi , S.T.C. Silva , S.D. Corso , A.J. Fonseca , R. Stelmach , C.R.F. Carvalho

Objective

We investigated the measurement properties of the incremental step test in subjects with moderate to severe asthma.

Methods

Subjects with moderate to severe persistent asthma were recruited from a tertiary university hospital specializing in treating severe asthma. All subjects performed one cardiopulmonary exercise test (CPET) and two incremental step tests (IST) in random sequences. Pulmonary gas exchange was measured during all exercise tests. The measurement properties investigated were reliability by intraclass correlation coefficient (ICC), measurement error by the standard error of measurement and minimum detectable difference, construct validity by Pearson's correlation, and interpretability by the ceiling and floor effects.

Results

Fifty subjects (38 females, mean [SD], age 43.7 [11.6] yr, % FEV₁ 70 [14.3], BMI 28.5 [5.3] kg/m²) completed the study. The peak oxygen uptake (peak VO₂) for the CPET was 27.6 [±6.8] ml/kg/min, for the first IST was 22.3 [±5.3] ml/kg/min and for the second IST was 23.3 [±5.3] ml/kg/min. The IST presented excellent reliability (ICC=0.93, CI95% 0.88-0.96), very good measurement error (2.5%), and construct validity for peak VO₂ measurement compared to the CPET (r = 0.85; p < 0.001) to assess exercise capacity in subjects with moderate to severe asthma, with appropriate ceiling (10%) and floor (0%) effects.

Conclusion

The IST presented excellent reliability and very good measurement error and validity to assess exercise capacity in subjects with moderate to severe asthma, without ceiling or floor effects.

目的我们研究了中度至重度哮喘患者增量台阶试验的测量特性：方法：我们从一家专门治疗重症哮喘的三级甲等大学医院招募了患有中重度持续性哮喘的受试者。所有受试者以随机顺序进行了一次心肺运动测试（CPET）和两次增量阶梯测试（IST）。在所有运动测试中都测量了肺气体交换。研究的测量特性包括：用类内相关系数（ICC）表示的可靠性、用测量标准误差和最小可检测差异表示的测量误差、用皮尔逊相关性表示的结构效度以及用上限和下限效应表示的可解释性：50 名受试者（38 名女性，平均[标码]，年龄 43.7 [11.6] 岁，FEV1 70 [14.3] %，体重指数 28.5 [5.3] kg/m2）完成了研究。CPET 的峰值摄氧量（峰值 VO2）为 27.6 [±6.8] 毫升/千克/分钟，第一次 IST 为 22.3 [±5.3] 毫升/千克/分钟，第二次 IST 为 23.3 [±5.3] 毫升/千克/分钟。与 CPET 相比，IST 具有极佳的可靠性（ICC=0.93，CI95% 0.88-0.96）、极好的测量误差（2.5%）和峰值 VO2 测量的构造效度（r = 0.85；p 结论：IST 具有极佳的可靠性和极好的构造效度：IST 在评估中重度哮喘患者的运动能力方面具有极佳的可靠性、极好的测量误差和有效性，且无上限或下限效应。

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引用次数: 0

Mould exposure and COPD outcomes: Association or causation? 霉菌暴露与慢性阻塞性肺病结局:相关性还是因果关系?

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2023.10.001

Hiroshi Ito

引用次数: 0

Issue 2 - “Update on adverse respiratory effects of indoor air pollution” Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective 第 2 期--"室内空气污染对呼吸系统不良影响的最新情况"（第 1 部分）：室内空气污染与呼吸系统疾病：总体更新和葡萄牙的观点

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2023.03.006

J.C. Rufo , I. Annesi-Maesano , P. Carreiro-Martins , A. Moreira , A.C. Sousa , M.R. Pastorinho , N. Neuparth , L. Taborda-Barata

Objective

To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population.

Results

Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances.

Conclusions

Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.

结果世界范围内的多项系统综述和荟萃分析（MA）表明，室内空气质量对呼吸系统健康有影响，其中室内颗粒物和气体对呼吸道有显著影响。挥发性有机化合物（VOC）与哮喘和肺癌有关。然而，只有对生物质的使用进行荟萃分析，才能记录对呼吸系统的长期影响。早期有关葡萄牙人群的出版物主要关注室内环境烟草烟雾暴露，后来的研究则将注意力转移到相关的暴露环境，如日托建筑、学校、住宅和养老院。结论尽管在 2008 年公共建筑室内禁烟令实施后，室内空气污染的影响显著减少，但研究表明，葡萄牙的一些室内空气参数仍然与呼吸系统健康密切相关。葡萄牙与世界其他国家一样，需要实现方法和背景数据的标准化，以扩大家庭空气污染流行病学研究的覆盖范围，从而对旨在降低相关呼吸系统发病率的干预措施和政策进行加权评估。

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引用次数: 0

Effect of 5 weeks of oral acetazolamide on patients with pulmonary vascular disease: A randomized, double-blind, cross-over trial 口服乙酰唑胺 5 周对肺血管疾病患者的影响：随机、双盲、交叉试验。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2022.11.004

M. Lichtblau , S. Saxer , J. Müller , P. Appenzeller , C. Berlier , S.R. Schneider , L. Mayer , M. Furian , E.I. Schwarz , E.R. Swenson , K.E. Bloch , S. Ulrich

Background

The carbonic anhydrase inhibitor acetazolamide stimulates ventilation through metabolic acidosis mediated by renal bicarbonate excretion. In animal models, acetazolamide attenuates acute hypoxia-induced pulmonary hypertension (PH), but its efficacy in treating patients with PH due to pulmonary vascular disease (PVD) is unknown.

Methods

28 PVD patients (15 pulmonary arterial hypertension, 13 distal chronic thromboembolic PH), 13 women, mean±SD age 61.6±15.0 years stable on PVD medications, were randomised in a double-blind crossover protocol to 5 weeks acetazolamide (250mg b.i.d) or placebo separated by a ≥2 week washout period. Primary endpoint was the change in 6-minute walk distance (6MWD) at 5 weeks. Additional endpoints included safety, tolerability, WHO functional class, quality of life, arterial blood gases, and hemodynamics (by echocardiography).

Results

Acetazolamide had no effect on 6MWD compared to placebo (treatment effect: mean change [95%CI] -18 [-40 to 4]m, p=0.102) but increased arterial blood oxygenation through hyperventilation induced by metabolic acidosis. Other measures including pulmonary hemodynamics were unchanged. No severe adverse effects occurred, side effects that occurred significantly more frequently with acetazolamide vs. placebo were change in taste (22/0%), paraesthesia (37/4%) and mild dyspnea (26/4%).

Conclusions

In patients with PVD, acetazolamide did not change 6MWD compared to placebo despite improved blood oxygenation. Some patients reported a tolerable increase in dyspnoea during acetazolamide treatment, related to hyperventilation, induced by the mild drug-induced metabolic acidosis. Our findings do not support the use of acetazolamide to improve exercise in patients with PVD at this dosing.

ClinicalTrials.gov Identifier

NCT02755298

背景：碳酸酐酶抑制剂乙酰唑胺通过肾脏碳酸氢盐排泄介导的代谢性酸中毒刺激通气。在动物模型中，乙酰唑胺可减轻急性缺氧诱发的肺动脉高压（PH），但其对因肺血管疾病（PVD）导致的肺动脉高压患者的治疗效果尚不清楚。方法：28名PVD患者（15名肺动脉高压患者，13名远端慢性血栓栓塞性PH患者），13名女性，平均（±SD）年龄为61.6±15.0岁，稳定服用PVD药物，在双盲交叉方案中随机接受为期5周的乙酰唑胺（250毫克，b.i.d）或安慰剂治疗，中间有≥2周的冲洗期。主要终点是5周时6分钟步行距离（6MWD）的变化。其他终点包括安全性、耐受性、WHO功能分级、生活质量、动脉血气和血液动力学（通过超声心动图）：与安慰剂相比，乙酰唑胺对6MWD没有影响（治疗效果：平均变化[95%CI] -18 [-40 to 4]米，P=0.102），但通过代谢性酸中毒引起的过度通气增加了动脉血氧饱和度。包括肺血液动力学在内的其他指标均无变化。与安慰剂相比，乙酰唑胺无严重不良反应，但出现频率明显高于安慰剂的副作用有味觉改变（22/0%）、麻痹（37/4%）和轻度呼吸困难（26/4%）：尽管改善了血氧饱和度，但与安慰剂相比，乙酰脞胺并未改变心血管疾病患者的6MWD。一些患者表示，在乙酰唑胺治疗期间，呼吸困难的增加是可以忍受的，这与药物引起的轻度代谢性酸中毒导致的过度换气有关。我们的研究结果不支持在此剂量下使用乙酰唑胺来改善心血管疾病患者的运动状况：Gov 标识符：NCT02755298。

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Comparison of thoracic surgery training in the Iberian Peninsula: A call for European uniformity 伊比利亚半岛胸外科培训比较：呼吁欧洲统一。

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-07-01 DOI: 10.1016/j.pulmoe.2024.01.004

Álvaro Fuentes-Martín , Luís Lourenço Graça

引用次数: 0

Rehabilitation and physiotherapists in the critical care medicine. 重症监护医学中的康复和理疗师。

IF 11.7 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-06-01 DOI: 10.1016/j.pulmoe.2024.04.006

E Clini, S Costi, M Girardis

引用次数: 0

Posters 海报

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM

Pulmonology

Pub Date : 2024-06-01 DOI: 10.1016/S2531-0437(24)00118-1

引用次数: 0

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