Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2022.04.010
M. Dettori , N. Riccardi , D. Canetti , R.M. Antonello , A.F. Piana , A. Palmieri , P. Castiglia , A.A. Azara , M.D. Masia , A. Porcu , G.C. Ginesu , M.L. Cossu , M. Conti , P. Pirina , A. Fois , I. Maida , G. Madeddu , S. Babudieri , L. Saderi , G. Sotgiu
Lung transplantation can improve the survival of patients with severe chronic pulmonary disorders. However, the short- and long-term risk of infections can increase morbidity and mortality rates.
A non-systematic review was performed to provide the most updated information on pathogen, host, and environment-related factors associated with the occurrence of bacterial, fungal, and viral infections as well as the most appropriate therapeutic options.
Bacterial infections account for about 50% of all infectious diseases in lung transplanted patients, while viruses represent the second cause of infection accounting for one third of all infections.
Almost 10% of patients develop invasive fungal infections during the first year after lung transplant. Pre-transplantation comorbidities, disruption of physical barriers during the surgery, and exposure to nosocomial pathogens during the hospital stay are directly associated with the occurrence of life-threatening infections.
Empiric antimicrobial treatment after the assessment of individual risk factors, local epidemiology of drug-resistant pathogens and possible drug-drug interactions can improve the clinical outcomes.
{"title":"Infections in lung transplanted patients: A review","authors":"M. Dettori , N. Riccardi , D. Canetti , R.M. Antonello , A.F. Piana , A. Palmieri , P. Castiglia , A.A. Azara , M.D. Masia , A. Porcu , G.C. Ginesu , M.L. Cossu , M. Conti , P. Pirina , A. Fois , I. Maida , G. Madeddu , S. Babudieri , L. Saderi , G. Sotgiu","doi":"10.1016/j.pulmoe.2022.04.010","DOIUrl":"10.1016/j.pulmoe.2022.04.010","url":null,"abstract":"<div><p>Lung transplantation can improve the survival of patients with severe chronic pulmonary disorders. However, the short- and long-term risk of infections can increase morbidity and mortality rates.</p><p>A non-systematic review was performed to provide the most updated information on pathogen, host, and environment-related factors associated with the occurrence of bacterial, fungal, and viral infections as well as the most appropriate therapeutic options.</p><p>Bacterial infections account for about 50% of all infectious diseases in lung transplanted patients, while viruses represent the second cause of infection accounting for one third of all infections.</p><p>Almost 10% of patients develop invasive fungal infections during the first year after lung transplant. Pre-transplantation comorbidities, disruption of physical barriers during the surgery, and exposure to nosocomial pathogens during the hospital stay are directly associated with the occurrence of life-threatening infections.</p><p>Empiric antimicrobial treatment after the assessment of individual risk factors, local epidemiology of drug-resistant pathogens and possible drug-drug interactions can improve the clinical outcomes.</p></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 287-304"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2531043722001180/pdfft?md5=3e964f561e772a66bc30323b785dbdee&pid=1-s2.0-S2531043722001180-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86194654","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2023.08.004
A. Gama da Silva , C. Constant , S. Madeira , A.R. Sousa , T. Bandeira
{"title":"A contribution towards a world without tobacco – The TabacoPed study","authors":"A. Gama da Silva , C. Constant , S. Madeira , A.R. Sousa , T. Bandeira","doi":"10.1016/j.pulmoe.2023.08.004","DOIUrl":"10.1016/j.pulmoe.2023.08.004","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 307-309"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2531043723001575/pdfft?md5=d6f4dc98df146a1c845a9201c6421aea&pid=1-s2.0-S2531043723001575-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165352","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2021.12.006
C. Aguirre-Franco , CA. Torres-Duque , G. Salazar , A. Casas , C. Jaramillo , M. Gonzalez-Garcia
Background
Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA).
Objectives
To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m).
Methods
Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted).
Results
We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients.
Conclusions
The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.
{"title":"Prevalence of pulmonary hypertension in COPD patients living at high altitude","authors":"C. Aguirre-Franco , CA. Torres-Duque , G. Salazar , A. Casas , C. Jaramillo , M. Gonzalez-Garcia","doi":"10.1016/j.pulmoe.2021.12.006","DOIUrl":"10.1016/j.pulmoe.2021.12.006","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA).</p></div><div><h3>Objectives</h3><p>To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m).</p></div><div><h3>Methods</h3><p>Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV<sub>1</sub>/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV<sub>1</sub> > 50% predicted).</p></div><div><h3>Results</h3><p>We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (<em>p</em> = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients.</p></div><div><h3>Conclusions</h3><p>The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.</p></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 247-253"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2531043722000046/pdfft?md5=685dbc48802c7fba0677dc8269435514&pid=1-s2.0-S2531043722000046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39609294","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2021.12.009
R. Mustafaoglu , A. Gorek Dilektaslı , R. Demir , E. Zirek , T. Birinci , E. Kaya Mutlu , C. Evren , A. Razak Ozdincler
Background
Substance use disorder (SUD) causes conditions such as cognitive and behavioral disorders, anxiety, depression, and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics. The current study aimed to investigate the lung function, respiratory muscle strength, and exercise capacity in patients with SUD.
Methods
One hundred-eighty three patients with SUD, a total of 119 healthy controls, 54 of whom were cigarette smokers and 65 of whom were non-smokers were included in the study. Spirometric tests, respiratory muscle strength (MIP and MEP), and the 6-Minute Walk Test (6-MWT) were assessed. The III National Health and Nutrition Examination Survey were used to evaluate respiratory symptoms in patients with SUD and cigarette smokers.
Results
86.3% of the SUD patients included in the study were using heroin, 9.2% were cannabis, and 5.5% were spice. The most common symptom in both SUD patients and cigarette smokers was shortness of breath, wheezing, and sputum production. After post-hoc tests, the FVC (p = 0.002), FVC (%predicted) (p < 0.0001), FEV1 (p = 0.002), FEV1 (%predicted) (p < 0.0001), FEV1/FVC (%) (p < 0.0001), PEF (p < 0.0001) and FEF%25-75 (p < 0.0001) lung function parameters were significantly lower in SUD patients than non-smokers. In addition, it was found that MIP (p < 0.0001), MIP (%predicted) (p < 0.0001), MEP (p < 0.0001), and MEP (%predicted) (p < 0.0001) values of SUD patients were significantly lower than non-smokers.
Conclusion
The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath, wheezing, and sputum production. In addition, respiratory muscle strength and exercise capacity were decreased in SUD patients compared to non-smokers.
背景:物质使用障碍(SUD)会导致认知和行为障碍、焦虑、抑郁和社会隔离等症状,还会通过影响气道支气管动力学而引起急性气道炎症。本研究旨在调查 SUD 患者的肺功能、呼吸肌强度和运动能力:研究纳入了 183 名 SUD 患者和 119 名健康对照者,其中 54 人为吸烟者,65 人为非吸烟者。研究人员对肺活量测试、呼吸肌力量(MIP 和 MEP)以及 6 分钟步行测试(6-MWT)进行了评估。第三次全国健康与营养调查用于评估 SUD 患者和吸烟者的呼吸道症状:86.3%的 SUD 患者吸食海洛因,9.2%吸食大麻,5.5%吸食香料。吸毒成瘾患者和吸烟者最常见的症状都是气短、喘息和痰多。经过事后检验,FVC (p = 0.002)、FVC (%predicted) (p 1 (p = 0.002)、FEV1 (%predicted) (p 1/FVC (%) (p %25-75 (p 结论:研究结果表明,药物使用对肺功能有影响,最常报告的症状是气短、喘息和痰多。此外,与非吸烟者相比,吸食成瘾患者的呼吸肌强度和运动能力均有所下降。
{"title":"Exercise capacity, lung and respiratory muscle function in substance use disorders","authors":"R. Mustafaoglu , A. Gorek Dilektaslı , R. Demir , E. Zirek , T. Birinci , E. Kaya Mutlu , C. Evren , A. Razak Ozdincler","doi":"10.1016/j.pulmoe.2021.12.009","DOIUrl":"10.1016/j.pulmoe.2021.12.009","url":null,"abstract":"<div><h3>Background</h3><p>Substance use disorder (SUD) causes conditions such as cognitive and behavioral disorders, anxiety, depression, and social isolation it also causes acute airway inflammation by affecting airway bronchial dynamics. The current study aimed to investigate the lung function, respiratory muscle strength, and exercise capacity in patients with SUD.</p></div><div><h3>Methods</h3><p>One hundred-eighty three patients with SUD, a total of 119 healthy controls, 54 of whom were cigarette smokers and 65 of whom were non-smokers were included in the study. <strong>S</strong>pirometric tests, respiratory muscle strength (MIP and MEP), and the 6-Minute Walk Test (6-MWT) were assessed. The III National Health and Nutrition Examination Survey were used to evaluate respiratory symptoms in patients with SUD and cigarette smokers.</p></div><div><h3>Results</h3><p>86.3% of the SUD patients included in the study were using heroin, 9.2% were cannabis, and 5.5% were spice. The most common symptom in both SUD patients and cigarette smokers was shortness of breath, wheezing, and sputum production. After post-hoc tests, the FVC (<em>p</em> = 0.002), FVC (%predicted) (<em>p</em> < 0.0001), FEV<sub>1</sub> (<em>p =</em> 0.002), FEV1 (%predicted) (<em>p <</em> 0.0001), FEV<sub>1</sub>/FVC (%) (<em>p <</em> 0.0001), PEF (<em>p <</em> 0.0001) and FEF<sub>%25-75</sub> (<em>p <</em> 0.0001) lung function parameters were significantly lower in SUD patients than non-smokers. In addition, it was found that MIP (<em>p <</em> 0.0001), MIP (%predicted) (<em>p <</em> 0.0001), MEP (<em>p <</em> 0.0001), and MEP (%predicted) (<em>p <</em> 0.0001) values of SUD patients were significantly lower than non-smokers.</p></div><div><h3>Conclusion</h3><p>The study findings indicate that substance use has an effect on lung functions and the most commonly reported symptoms are shortness of breath, wheezing, and sputum production. In addition, respiratory muscle strength and exercise capacity were decreased in SUD patients compared to non-smokers.</p></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 254-264"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S253104372200006X/pdfft?md5=4a187dbf14500f064e3cbd9cc3870cf6&pid=1-s2.0-S253104372200006X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39885425","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2022.03.004
S. Busani , I. Coloretti , M. Baciarello , V. Bellini , M. Sarti , E. Biagioni , R. Tonelli , A. Marchioni , E. Clini , G. Guaraldi , C. Mussini , M. Meschiari , T. Tonetti , L. Pisani , S. Nava , E. Bignami , M.V. Ranieri , M. Girardis
Aim
To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes.
Materials and methods
An observational multicentre cohort study of patients hospitalised in five COVID-19–designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO₂/FiO₂ ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission.
Measurements and main results
We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (p < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48–12.35], p = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89–39.41], p < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles.
Discussion
Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients’ need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.
{"title":"Association between respiratory distress time and invasive mechanical ventilation in COVID-19 patients: A multicentre regional cohort study","authors":"S. Busani , I. Coloretti , M. Baciarello , V. Bellini , M. Sarti , E. Biagioni , R. Tonelli , A. Marchioni , E. Clini , G. Guaraldi , C. Mussini , M. Meschiari , T. Tonetti , L. Pisani , S. Nava , E. Bignami , M.V. Ranieri , M. Girardis","doi":"10.1016/j.pulmoe.2022.03.004","DOIUrl":"10.1016/j.pulmoe.2022.03.004","url":null,"abstract":"<div><h3>Aim</h3><p>To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes.</p></div><div><h3>Materials and methods</h3><p>An observational multicentre cohort study of patients hospitalised in five COVID-19–designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO₂/FiO₂ ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission.</p></div><div><h3>Measurements and main results</h3><p>We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (<em>p</em> < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48–12.35], <em>p</em> = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89–39.41], <em>p</em> < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles.</p></div><div><h3>Discussion</h3><p>Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients’ need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.</p></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 282-286"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8958102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91191427","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2023.02.006
F. Racca , Y. Longhitano , C. Zanza , G. Draisci , P.A. Stoia , E. Gollo , M. Maio , C. Grattarola , M. Astuto , R. Vaschetto , V.A.M. Sansone , G. Conti , C. Gregoretti
{"title":"Peri-Partum respiratory management in neuro-muscular disorders (IT-NEUMA-Pregn study): A proposal by an italian panel and a call for an international collaboration","authors":"F. Racca , Y. Longhitano , C. Zanza , G. Draisci , P.A. Stoia , E. Gollo , M. Maio , C. Grattarola , M. Astuto , R. Vaschetto , V.A.M. Sansone , G. Conti , C. Gregoretti","doi":"10.1016/j.pulmoe.2023.02.006","DOIUrl":"10.1016/j.pulmoe.2023.02.006","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 210-213"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2531043723000417/pdfft?md5=710b9391eb804592f6b6af30f4d221b5&pid=1-s2.0-S2531043723000417-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9444455","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2022.01.004
R.L.M. Duarte , F.J. Magalhães-da-Silveira , D. Gozal
Objective
To evaluate possible sex-related differences in the performance of the GOAL, a 4-item obstructive sleep apnea (OSA) screening instrument in adults.
Methods
Between July 2019 and June 2021, this cross-sectional study included consecutively recruited patients from one Brazilian sleep laboratory undergoing overnight polysomnography. Individuals with GOAL scores ≥ 2 of a maximum of 4 points are classified at high risk for OSA diagnosis. Actual OSA severity was based on the apnea-hypopnea index: ≥ 5.0/h as any OSA, ≥ 15.0/h as moderate-to-severe OSA, and ≥ 30.0/h as severe OSA. Performance of the GOAL instrument in women and men was assessed by the discriminatory ability (obtained from area under the curve [AUC]-Receiver Operating Characteristic curves) and 2×2 contingency tables.
Results
A total of 2,978 subjects (55.3% males) were evaluated. The frequency of GOAL-defined OSA high-risk was statistically higher in men when compared to women (p < 0.001). The GOAL predictive parameters for screening all severity OSA levels were as follows: in females, sensitivity ranging from 58.2% to 78.3% and specificity ranging from 60.0% to 77.6%, while in males, sensitivity ranging from 90.5% to 96.9% and specificity from 20.7% to 46.8%. The GOAL questionnaire had similar discriminatory properties, assessed by AUC, in women and in men: i) any OSA: 0.741 vs. 0.771 (p = 0.204), ii) moderate-to-severe OSA: 0.727 vs. 0.737 (p = 0.595), and iii) severe OSA: 0.728 vs. 0.703 (p = 0.240); respectively.
Conclusions
The GOAL instrument emerges as a useful tool for screening adult individuals and displays similar performance in both women and men.
{"title":"Sex-dependent GOAL screening performance in adults at risk for obstructive sleep apnea","authors":"R.L.M. Duarte , F.J. Magalhães-da-Silveira , D. Gozal","doi":"10.1016/j.pulmoe.2022.01.004","DOIUrl":"10.1016/j.pulmoe.2022.01.004","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate possible sex-related differences in the performance of the GOAL, a 4-item obstructive sleep apnea (OSA) screening instrument in adults.</p></div><div><h3>Methods</h3><p>Between July 2019 and June 2021, this cross-sectional study included consecutively recruited patients from one Brazilian sleep laboratory undergoing overnight polysomnography. Individuals with GOAL scores ≥ 2 of a maximum of 4 points are classified at high risk for OSA diagnosis. Actual OSA severity was based on the apnea-hypopnea index: ≥ 5.0/h as any OSA, ≥ 15.0/h as moderate-to-severe OSA, and ≥ 30.0/h as severe OSA. Performance of the GOAL instrument in women and men was assessed by the discriminatory ability (obtained from area under the curve [AUC]-Receiver Operating Characteristic curves) and 2×2 contingency tables.</p></div><div><h3>Results</h3><p>A total of 2,978 subjects (55.3% males) were evaluated. The frequency of GOAL-defined OSA high-risk was statistically higher in men when compared to women (p < 0.001). The GOAL predictive parameters for screening all severity OSA levels were as follows: in females, sensitivity ranging from 58.2% to 78.3% and specificity ranging from 60.0% to 77.6%, while in males, sensitivity ranging from 90.5% to 96.9% and specificity from 20.7% to 46.8%. The GOAL questionnaire had similar discriminatory properties, assessed by AUC, in women and in men: i) any OSA: 0.741 vs. 0.771 (p = 0.204), ii) moderate-to-severe OSA: 0.727 vs. 0.737 (p = 0.595), and iii) severe OSA: 0.728 vs. 0.703 (p = 0.240); respectively.</p></div><div><h3>Conclusions</h3><p>The GOAL instrument emerges as a useful tool for screening adult individuals and displays similar performance in both women and men.</p></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 265-271"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2531043722000186/pdfft?md5=35ca1967e5b64307a609a9dc1de92a83&pid=1-s2.0-S2531043722000186-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39609292","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}
Pub Date : 2024-05-01DOI: 10.1016/j.pulmoe.2021.12.003
D. Polanco , J. González , E. Gracia-Lavedan , L. Pinilla , R. Plana , M. Molina , M. Pardina , F. Barbé
Introduction and objectives
Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines.
Materials and methods
Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up.
Results
A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm).
Conclusions
During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.
{"title":"Multidisciplinary virtual management of pulmonary nodules","authors":"D. Polanco , J. González , E. Gracia-Lavedan , L. Pinilla , R. Plana , M. Molina , M. Pardina , F. Barbé","doi":"10.1016/j.pulmoe.2021.12.003","DOIUrl":"10.1016/j.pulmoe.2021.12.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines.</p></div><div><h3>Materials and methods</h3><p>Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up.</p></div><div><h3>Results</h3><p>A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm).</p></div><div><h3>Conclusions</h3><p>During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.</p></div>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"30 3","pages":"Pages 239-246"},"PeriodicalIF":11.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2531043722000010/pdfft?md5=a36cd1d9941ab4bc906fd3f88feed186&pid=1-s2.0-S2531043722000010-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39885426","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}