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Spirometric Transition of at Risk Individuals and Risks for Progression to Chronic Obstructive Pulmonary Disease in General Population 高危人群的肺活量变化和普通人群发展为慢性阻塞性肺病的风险
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.033

Introduction

Chronic obstructive pulmonary disease (COPD) is a dynamic disease with a high socioeconomic burden. Using data collected prospectively from the general population, we examined factors related to the transition of at-risk individuals to COPD.

Methods

We used the Korean Genome Epidemiology Study (KoGES) database, defining pre-COPD based on respiratory symptoms and radiological abnormalities suggestive of COPD; the preserved ratio impaired spirometry (PRISm) was defined as a forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio  70% and FEV1 < 80%, as predicted by spirometry. We determined group differences in the rate of lung function decline, risk of future airflow obstruction (AFO).

Results

The study included 4762 individuals, and longitudinal analysis revealed distinct trends in pulmonary function indicators. Compared to the normal group, the pre-COPD group showed a more rapid decline in lung function, while the PRISm group showed a slower decline. In the pre-COPD and PRISm groups, 4.4% and 3.5%, and 13.6% and 10.8%, respectively, of patients had progressed to COPD at the first and second visits. Pre-COPD and PRISm contributed to an earlier time to first AFO, but consideration of comorbid cardiovascular disease weakened this relationship in the PRISm group. Multivariate logistic regression showed that pre-COPD and PRISm are significant risk factors for future development of COPD (OR 1.80, p < 0.001; OR 4.26, p < 0.001, respectively).

Conclusion

Pre-COPD and PRISm patients showed different trends in lung function changes over time and both were significant risk factors for future development of COPD.
导言 慢性阻塞性肺疾病(COPD)是一种具有高度社会经济负担的动态疾病。方法 我们使用韩国基因组流行病学研究(KoGES)数据库,根据呼吸系统症状和提示慢性阻塞性肺病的放射学异常来定义慢性阻塞性肺病前期;肺活量保留比值受损(PRISm)定义为 1 秒用力呼气容积(FEV1)/用力肺活量比值≥ 70% 和肺活量预测值 FEV1 < 80%。我们确定了肺功能下降率、未来气流阻塞(AFO)风险的组间差异。结果研究共纳入 4762 人,纵向分析显示肺功能指标有明显的变化趋势。与正常组相比,慢性阻塞性肺病前期组的肺功能下降更快,而 PRISm 组则下降较慢。在慢性阻塞性肺病前期组和 PRISm 组中,分别有 4.4% 和 3.5%、13.6% 和 10.8% 的患者在第一次和第二次就诊时发展为慢性阻塞性肺病。COPD前期和PRISm导致首次AFO时间提前,但在PRISm组中,合并心血管疾病削弱了这种关系。多变量逻辑回归显示,COPD前期和PRISm是未来发展为慢性阻塞性肺病的重要风险因素(OR分别为1.80,p <0.001;OR为4.26,p <0.001)。
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引用次数: 0
Time Dependence Between Tobacco Consumption and Lung Cancer Mortality in Spain 西班牙烟草消费与肺癌死亡率之间的时间依赖性。
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.028

Objectives

Lung cancer is the leading cause of cancer death and the second most common cancer in both sexes worldwide, with tobacco being its main risk factor. The aim of this study is to establish the temporal relationship between smoking prevalence and lung cancer mortality in Spain.

Methods

To model the time dependence between smoking prevalence and lung cancer mortality, a distributed lag non-linear model was applied adjusting for sex, age, year of mortality and population at risk. Smoking prevalence data from 1991-2020 were used. Considering a maximum lag of 25 years, mortality data from 2016-2020 were included. The effect of prevalence on mortality for each lag is presented in terms of relative risk (RR). To identify the lag at which smoking prevalence has the greatest effect on mortality, the RR of the different lags were compared.

Results

The optimal lag observed between smoking prevalence and lung cancer mortality in Spain was 15 years. The maximum RR was 2.9 (95%CI: 2.0-4.3) for a prevalence of 71% and a 15-year lag. The RR was 1.8 for a prevalence of 33%, an approximate median value between 1991-2020, and a 15-year lag.

Conclusions

In Spain, lung cancer mortality is affected by smoking prevalence 15 years prior. Knowing the evolution of the smoking prevalence series in a country and establishing a lag time is essential to predict how lung cancer incidence and mortality will evolve.
目的:肺癌是导致癌症死亡的主要原因,也是全球第二大常见的男女癌症,烟草是其主要风险因素。本研究旨在确定西班牙吸烟率与肺癌死亡率之间的时间关系:为了模拟吸烟率与肺癌死亡率之间的时间依赖关系,采用了分布式滞后非线性模型,并对性别、年龄、死亡年份和高危人群进行了调整。模型使用了 1991-2020 年的吸烟率数据。考虑到最大滞后期为 25 年,因此纳入了 2016-2020 年的死亡率数据。每个滞后期吸烟率对死亡率的影响以相对风险(RR)表示。为了确定吸烟率对死亡率影响最大的滞后期,比较了不同滞后期的相对风险率:结果:在西班牙,吸烟率与肺癌死亡率之间的最佳滞后期为 15 年。吸烟率为 71%、滞后 15 年的最大死亡率为 2.9(95%CI:2.0-4.3)。吸烟率为 33%(1991-2020 年间的近似中值)且滞后 15 年的死亡率为 1.8:在西班牙,肺癌死亡率受15年前吸烟率的影响。要预测肺癌发病率和死亡率将如何演变,了解一个国家吸烟率的演变系列并确定滞后时间至关重要。
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引用次数: 0
Medium-Term Disability and Long-Term Functional Impairment Persistence in Survivors of Severe COVID-19 ARDS: Clinical and Physiological Insights 严重 COVID-19 ARDS 存活者的中期残疾和长期功能障碍:临床和生理学见解。
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.021

Background

Although the medium- and long-term sequelae of survivor of acute respiratory distress syndrome (ARDS) of any cause have been documented, little is known about the way in which COVID-19-induced ARDS affects functional disability and exercise components. Our aims were to examine the medium-term disability in severe COVID-19-associated ARDS survivors, delineate pathophysiological changes contributing to their exercise intolerance, and explore its utility in predicting long-term functional impairment persistence.

Methods

We studied 108 consecutive subjects with severe COVID-19 ARDS who remained alive 6 months after intensive care unit (ICU) discharge. Lung morphology was assessed with chest non-contrast CT scans and CT angiography. Functional evaluation included spirometry, plethysmography, muscle strength, and diffusion capacity, with assessment of gas exchange components through diffusing capacity of nitric oxide. Disability was assessed through an incremental exercise test, and measurements were repeated 12 and 24 months later in patients with functional impairments.

Results

At 6 months after ICU discharge, a notable dissociation between morphological and clinical-functional sequelae was identified. Moderate-severe disability was present in 47% of patients and these subjects had greater limitation of ventilatory mechanics and gas exchange, as well as greater symptomatic perception during exercise and a probable associated cardiac limitation. Female sex, hypothyroidism, reduced membrane diffusion component, lower functional residual capacity, and high-attenuation lung volume were independently associated with the presence of moderate-severe functional disability, which in turn was related to higher frequency and greater intensity of dyspnea and worse quality of life. Out of the 71 patients with reduced lung volumes or diffusion capacity at 6 months post-ICU discharge, only 19 maintained a restrictive disorder associated with gas exchange impairment at 24 months post-discharge. In these patients, 6-month values for diffusion membrane component, maximal oxygen uptake, ventilatory equivalent for CO2, and dead space to tidal volume ratio were identified as independent risk factors for persistence of long-term functional sequelae.

Conclusions

Less than half of survivors of COVID-19 ARDS have moderate-severe disability in the medium term, identifying several risk factors. In turn, diffusion membrane component and exercise tolerance at 6-month ICU discharge are independently associated with the persistence of long-term functional sequelae.
背景:虽然任何原因引起的急性呼吸窘迫综合征(ARDS)幸存者的中长期后遗症都有记录,但人们对 COVID-19 引起的 ARDS 如何影响功能障碍和运动成分知之甚少。我们的目的是研究与 COVID-19 相关的严重 ARDS 存活者的中期残疾情况,明确导致其运动不耐受的病理生理学变化,并探索其在预测长期功能障碍持续性方面的效用:我们连续研究了 108 名重症监护病房(ICU)出院后 6 个月仍存活的重症 COVID-19 型 ARDS 患者。通过胸部非对比 CT 扫描和 CT 血管造影评估肺部形态。功能评估包括肺活量、胸透、肌力和弥散能力,并通过一氧化氮的弥散能力评估气体交换成分。通过增量运动测试评估残疾情况,并在 12 个月和 24 个月后对有功能障碍的患者进行重复测量:结果:重症监护室出院 6 个月后,发现形态学后遗症和临床功能后遗症之间存在明显差异。47%的患者存在中度-重度残疾,这些受试者的通气力学和气体交换受限程度更高,运动时的症状感更强,可能伴有心脏功能受限。女性性别、甲状腺机能减退、膜弥散成分减少、功能残余能力降低和高衰减肺活量与中度-重度功能障碍存在独立关联,而中度-重度功能障碍又与更高频率、更剧烈的呼吸困难和更差的生活质量有关。在重症监护室出院后 6 个月肺容量或弥散能力下降的 71 名患者中,只有 19 人在出院后 24 个月仍存在与气体交换障碍相关的限制性失调。在这些患者中,6个月的扩散膜成分、最大摄氧量、二氧化碳通气当量和死腔与潮气量比值被确定为长期功能性后遗症持续存在的独立风险因素:结论:不到一半的 COVID-19 ARDS 存活者在中期内会出现中度-重度残疾,这其中有几个风险因素。反过来,ICU 6 个月出院时的弥散膜成分和运动耐量与长期功能后遗症的持续存在有独立关联。
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引用次数: 0
Questionnaires May Help Pulmonologists for Referral of Patients With IPF to a Holistic Approach 调查问卷可帮助肺科医生采用综合方法转诊 IPF 患者
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.003
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引用次数: 0
CO1 CO1
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-10-01 DOI: 10.1016/S0300-2896(24)00396-X
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引用次数: 0
The In-between: Time to Talk About Bronchiectasis in Adolescents and Their Transition to Adult Care. 两者之间:是时候谈谈青少年支气管扩张症及其向成人护理的过渡了。
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-24 DOI: 10.1016/j.arbres.2024.09.001
Letizia Traversi, Laura Garriga-Grimau, Antonio Moreno-Galdó, Eva Polverino

Paediatric and adult bronchiectasis patients have been addressed in the literature as two different populations due to several differences, but there is insufficient evidence to understand how and when disease characteristics really change along patients' lifespan. This lack of knowledge is evident in all aspects of the transition: insufficient data is available about radiology, lung function, microbiology and treatment, and only limited information is currently available about changes in clinical presentation and psychosocial aspects. For instance, symptoms seem to improve during the third and fourth decades of life, a period sometimes referred to as the "honeymoon phase". However, adolescents with bronchiectasis have poorer quality of life than healthy peers, suggesting, therefore, potential disease underestimation at this age. This scarcity of data most likely hinders the design of appropriate evidence-based transition protocols, ultimately limiting our ability to understand the factors driving disease progression and how to prevent it. Nowadays it is crucial to raise awareness about this neglected aspect of bronchiectasis care, and fill this cultural and scientific gap by joining forces between pediatricians and adult physicians, to understand and stop disease progression and, lastly, to provide the best possible care to our patients in all phases of their lives.

由于儿童支气管扩张症和成人支气管扩张症患者存在一些差异,因此在文献中将其作为两个不同的人群来研究,但目前还没有足够的证据来了解疾病特征在患者生命周期中如何以及何时发生真正的变化。这种知识的匮乏体现在疾病转变的各个方面:放射学、肺功能、微生物学和治疗方面的数据不足,目前关于临床表现和社会心理方面变化的信息也很有限。例如,在生命的第三和第四个十年,症状似乎有所改善,这一时期有时被称为 "蜜月期"。然而,患有支气管扩张症的青少年的生活质量比健康的同龄人要差,这表明在这个年龄段可能存在疾病低估的情况。数据的匮乏很可能会阻碍设计适当的循证过渡方案,最终限制我们了解疾病进展的驱动因素以及如何预防疾病的能力。如今,至关重要的是要提高人们对支气管扩张症护理中这一被忽视的方面的认识,并通过儿科医生和成人医生之间的合作来填补这一文化和科学空白,从而了解并阻止疾病进展,最后在患者生命的各个阶段为其提供尽可能最好的护理。
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引用次数: 0
Airway Remodeling in Asthma: Mechanisms, Diagnosis, Treatment, and Future Directions. 哮喘的气道重塑:哮喘的气道重塑:机制、诊断、治疗和未来方向。
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-24 DOI: 10.1016/j.arbres.2024.09.007
Angelica Tiotiu Cepuc, Paschalis Steiropoulos, Silviya Novakova, Denislava Nedeva, Plamena Novakova, Herberto Chong-Neto, Guillermo Guidos Fogelbach, Krzysztof Kowal

Airway remodeling (AR) with chronic inflammation, are key features in asthma pathogenesis. AR characterized by structural changes in the bronchial wall is associated with a specific asthma phenotype with poor clinical outcomes, impaired lung function and reduced treatment response. Most studies focus on the role of inflammation, while understanding the mechanisms driving AR is crucial for developing disease-modifying therapeutic strategies. This review paper summarizes current knowledge on the mechanisms underlying AR, diagnostic tools, and therapeutic approaches. Mechanisms explored include the role of the resident cells and the inflammatory cascade in AR. Diagnostic methods such as bronchial biopsy, lung function testing, imaging, and possible biomarkers are described. The effectiveness on AR of different treatments of asthma including corticosteroids, leukotriene modifiers, bronchodilators, macrolides, biologics, and bronchial thermoplasty is discussed, as well as other possible therapeutic options. AR poses a significant challenge in asthma management, contributing to disease severity and treatment resistance. Current therapeutic approaches target mostly airway inflammation rather than smooth muscle cell dysfunction and showed limited benefits on AR. Future research should focus more on investigating the mechanisms involved in AR to identify novel therapeutic targets and to develop new effective treatments able to prevent irreversible structural changes and improve long-term asthma outcomes.

气道重塑(AR)和慢性炎症是哮喘发病机制的关键特征。以支气管壁结构变化为特征的气道重塑与一种特殊的哮喘表型有关,这种哮喘表型具有临床疗效差、肺功能受损和治疗反应减弱等特点。大多数研究都集中在炎症的作用上,而了解 AR 的驱动机制对于开发改变疾病的治疗策略至关重要。本综述文件总结了目前有关 AR 潜在机制、诊断工具和治疗方法的知识。探讨的机制包括常驻细胞和炎症级联在 AR 中的作用。文章介绍了支气管活检、肺功能检测、成像等诊断方法以及可能的生物标记物。还讨论了皮质类固醇、白三烯调节剂、支气管扩张剂、大环内酯类药物、生物制剂和支气管热成形术等不同哮喘治疗方法对 AR 的疗效,以及其他可能的治疗方案。AR 是哮喘治疗中的一个重大挑战,它导致了疾病的严重性和治疗耐药性。目前的治疗方法主要针对气道炎症而非平滑肌细胞功能障碍,对 AR 的疗效有限。未来的研究应更多地侧重于调查 AR 的相关机制,以确定新的治疗靶点,并开发新的有效治疗方法,防止不可逆转的结构变化,改善哮喘的长期预后。
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引用次数: 0
Initiating Biological Treatment of Asthma: When is the Right Time? 启动哮喘生物治疗:何时是合适的时机?
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-24 DOI: 10.1016/j.arbres.2024.09.004
Vicente Plaza, Gabriel García, Luis Perez de Llano, Santiago Quirce
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引用次数: 0
Changes in Non-invasive Ventilation Compliance in Patients With Amyotrophic Lateral Sclerosis: A Post-hoc Analysis. 肌萎缩侧索硬化症患者无创通气顺应性的变化:事后分析
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-24 DOI: 10.1016/j.arbres.2024.09.003
Pierre Schilfarth, Thomas Réginault, Stéphane Mathis, Gwendal Le Masson, Odile Pillet, Léo Grassion
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引用次数: 0
Diagnosis and Management of Exercise-induced Laryngeal Obstruction (EILO): Initial Results of a Multidisciplinary Team. 运动诱发喉阻塞(EILO)的诊断与管理:多学科团队的初步成果。
IF 8.7 3区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2024-09-24 DOI: 10.1016/j.arbres.2024.08.007
Diego A Rodríguez-Chiaradía, Anna Rodó-Pin, Clara Espina, María Araceli Caballero-Rabasco, Pilar Ausin, Antonio Sancho Muñoz, Julia Preckler, Mireia Admetlló, Ester Marco Navarro, Jacinto García-Lorenzo
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引用次数: 0
期刊
Archivos De Bronconeumologia
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