Canadian respiratory journal最新文献

Systemic sclerosis (SSc) is predominantly characterized by an array of cutaneous manifestations including Raynaud's phenomenon, calcinosis, telangiectasias, and skin fibrosis contributing toward substantial morbidity and diminished quality of life. The monumental impact of the disease regarding mortality is due to its pulmonary involvement known as SSc-associated interstitial lung disease (SSc-ILD). Currently, treatment is chiefly directed toward impeding disease progression with the mainstay treatment approaches involving the utilization of cyclophosphamide, mycophenolate mofetil, rituximab, and tocilizumab. Recently, a tyrosine kinase inhibitor, nintedanib, has been approved for the treatment of SSc-ILD and thus became the first medication to be fully licensed for SSc-ILD. A systematic review based on the Preferred Reporting Items of Systematic Review with Meta-analysis (PRISMA) was conducted after successful registration in PROSPERO to evaluate the efficacy and safety of nintedanib in SSc-ILD. We searched PubMed, Scopus, and CENTRAL up to the first of September 2023 utilizing the following keywords: ((Diffuse Parenchymal Lung Disease) OR (Diffuse Parenchymal Lung Diseases) OR (Interstitial Lung Disease) OR (Interstitial Lung Diseases) OR (Interstitial Pneumonia) OR (Interstitial Pneumonitis) OR (Pulmonary Fibrosis)) AND ((Systemic Scleroderma) OR (Systemic Scleroderma)) AND ((BIBF 1120) OR (BIBF-1120) OR (BIBF1120) OR (Nintedanib esylate) OR (Ofev) OR (Vargatef)). The clinical safety profile of nintedanib was deemed more favorable than other therapeutic regimens currently utilized, in addition to adequate clinical efficacy toward SSc-ILD.

Introduction: Kallistatin is an enzyme with antioxidative and anti-inflammatory properties and has been shown to provide protection against pneumosepsis, acute respiratory distress syndrome (ARDS), and lung fibrosis. This study revealed the use of kallistatin in the clinical management of COPD. Materials and Methods: Forty-eight COPD patients were evaluated during both exacerbation and stable periods. A control group of 30 healthy individuals was also included. In addition to kallistatin, serum levels of TAS, TOS, OSI, VEGF, and TNF-α were measured. Data were statistically analyzed for the exacerbation and stable periods of COPD patients, as well as the control group. Correlation analysis of serum parameters was conducted, and regression analysis was performed on those with significant results. Results: Serum kallistatin levels were significantly lower in COPD patients compared to the normal population (p < 0.001). Additionally, kallistatin levels were lower during COPD exacerbations compared to the stable period (p < 0.001). Kallistatin levels measured during exacerbations were positively correlated with OSI and VEGF (r = 0.333, p=0.021; r = 0.301, p=0.037, respectively). The relationship between kallistatin and OSI was strongly supported by regression analysis (p=0.049, CI 16.889). Conclusion: Kallistatin is a promising biomarker for distinguishing COPD patients from the normal population and for identifying disease exacerbations.

[This corrects the article DOI: 10.1155/2021/4835536.].

Chronic obstructive pulmonary disease (COPD) is a lung condition characterized by persistent airway obstruction and is associated with various phenotypes and endotypes. While eosinophilic inflammation is typically seen in asthma, it also occurs in COPD, with known increases in eosinophil counts during exacerbations. However, the impact of cumulative tobacco exposure on eosinophil counts is not well understood. This study aims to investigate this relationship. Data for this prospective study were collected from three centers, involving patients diagnosed with COPD. Patients' demographic data and eosinophil levels were documented. They were categorized according to GOLD Stages A, B, and E, and each group was analyzed relative to the amount of cigarette smoking. The study enrolled 227 COPD patients, predominantly male (92.5%) with an average age of 64.6 years. Of the study population, 39.8% (n: 90) were current smokers, and 86.9% had a smoking history of more than 20 packs/year. The average smoking history of our patients was 52.38 ± 30.69 (mean ± SD) pack/year. Our patients had an average smoking history of 39.49 ± 12.56 years. No statistically significant results were found between the amount of cigarettes smoked and eosinophil counts. However, in the correlation between smoking history and eosinophil counts, higher eosinophil counts were found in those who had former smoking compared to current smokers or never smokers. While the number of pack-years and the duration of smoking increased from Stage A to Stage E, daily cigarette consumption remained constant, and eosinophil counts did not show a significant correlation with the quantity of tobacco. Eosinophil counts in COPD patients did not vary significantly with either the amount of tobacco exposure or the severity of COPD as categorized by GOLD stages. These findings suggest that factors other than tobacco exposure may influence eosinophil levels in COPD patients.

Objectives: Excess adipose tissue induces low-intensity inflammation, which is an important pathogenetic factor adversely affecting the course of bronchial asthma (BA) in overweight/obese patients. The key effector cells of this inflammation are monocytes and macrophages. However, there are currently no studies characterising the effect of body mass index (BMI) on peripheral blood monocyte levels in children and adolescents with BA and their relationship with spirometric parameters reflecting bronchial patency. The aim of this study was to investigate the effect of BMI on peripheral blood monocyte and eosinophil levels and their relationship with spirometric parameters in children and adolescents with asthma. Methods: A single-centre, observational cross-sectional study was conducted. A total of 212 patients with asthma aged 7-17 years were studied. Anthropometric and spirometric parameters and the cellular composition of peripheral blood were evaluated. The children were divided into two groups: Group 1: with normal body weight (BW) and Group 2: with overweight/obesity. Results: In overweight/obesity patients, the number of peripheral blood monocytes (0.62 ± 0.19) was significantly higher compared to the group of normal weight patients (0.54 ± 0.15, p < 0.001). In contrast, eosinophil levels were statistically lower in the overweight/obesity group (0.22 [0.12; 0.42]) than in the normal weight patients (0.30 [0.14; 0.56], p = 0.039). A statistically significant negative correlation was found between the absolute number of monocytes and z FEV1/FVC, z MMEF_25-75 in the overweight/obesity group (R = -0.32, p = 0.005, R = -0.30, p = 0.007, respectively) and a statistically significant negative correlation between eosinophil count and z FEV1/FVC, z MMEF25-75 in normal weight patients (R = -0.20, p = 0.021, R = -0.22, p = 0.010, respectively). Conclusions: The results obtained may indicate a modifying effect of overweight/obesity on inflammation endotypes in children and adolescents with BA.

Objectives: Recommendations for programmatic components for lung cancer screening programs (LCSPs) have been published; however, adoption within LCSPs has not been mandated and implementation requires resources. We aimed to determine the presence of recommended structural and quality elements within LCSPs and determine barriers to performing LCS within a community-based, multistate healthcare network. Methods: We conducted a cross-sectional study using two structured interviews within a community-based healthcare network between 1 June 2018 and 31 July 2020. Two separate interviews were created, one delivered to LCSP navigators to determine the presence of recommended structural and quality elements within LCSPs and one delivered to imaging center administrators to determine barriers to LCS implementation. Results: Of the 22 LCSPs, 20 (91%) were decentralized and 2 (9%) centralized. Three (14%) utilized standardized shared decision-making tools and 13 (59%) a multidisciplinary nodule review. Of the 21 (95%) LCSPs who collected information for external purposes, 9 (43%) collected it manually. Ten (45%) utilized a standard procedure for smoking cessation, and 5 (23%) had Certified Tobacco Treatment Specialists. Of the 31 affiliated imaging sites not associated with a LCSP, 8 (26%) were performing LCS. While 19 (61%) sites had the resources to fulfill or maintain an increase in LCS orders, lack of resources was the predominant (11, 35%) barrier to implementing a LCSP. Conclusions: A wide variation in the structure, quality, and resource allocation was identified within the network of LCSPs. Further research identifying the implications this variation has on outcomes, operational cost, and experience may shed light on whether stringent program quality control is needed.

Background: Populations residing at high altitudes display distinct physiological adaptations that are essential for understanding respiratory diseases. However, there is limited research on how these adaptations affect the assessment and prognosis of community-acquired pneumonia (CAP). Methods: A prognostic validation nested within a retrospective cohort was conducted on subjects with pneumonia admitted to two high-complexity institutions in Colombia at different altitudes above sea level. The receiver operating characteristic (ROC) curves were calculated for SaO₂, PaO₂, SpO₂, A-a O₂ gradient, a-A index, PaO₂/FiO₂, SpO₂/FiO₂, and the CURB-65 score to predict 30-day mortality, requirement for invasive mechanical ventilation (IMV), and need for vasopressor support. Results: 3467 were selected for analysis, with 73.7% (2557/3467) residing at high altitudes and 26.2% (910/3467) at low altitudes. The CURB-65 score  ≥ 2 showed a performance in predicting mortality of 0.707 (95% CI: 0.653-0.761; p < 0.001) at low altitudes and 0.737 (95% CI: 0.709-0.765; p < 0.001) at high altitudes. The PaO₂/FiO₂ ≤ 300 showed a performance in predicting the need for IMV and vasopressor support of 0.734 (95% CI: 0.685-0.783; p < 0.001) and 0.724 (0.674-0.775; p < 0.001) at high altitudes, respectively. The SpO₂/FiO₂ ≤ 350 showed a performance in predicting the need for IMV of 0.679 (0.507-0.85; p < 0.001) at low altitudes. The A-a O₂ gradient ≥ 10 showed a performance in predicting the need for vasopressor support of 0.686 (95% CI: 0.537-0.835; p=0.06) at low altitudes. Conclusion: In patients with CAP at altitudes above 2500 m above sea level, PaO₂/FiO₂, SpO₂/FiO₂, and the A-a O₂ gradient show a greater predictive capacity for 30-day mortality, need for IMV, and vasopressor requirements. The CURB-65 score showed a good predictive performance.

We present the findings from an evaluation of 144 survivors who experienced post-COVID-19 complications or reinfection. The assessment was conducted at 1, 3, and 6 months following their discharge from an intensive post-COVID care center. The evaluation encompassed a comprehensive analysis of clinical life-critical indicators and mental health states. Based on lung CT scans, pneumonia was identified in 73% of the patients, categorized into four severity groups according to their health conditions: mild (26%), moderate (57%), severe (14%), and extremely severe (3%). Among the extremely severe cases, two patients succumbed to the illness. Self-reported fatigue during the acute phase was prevalent among 79% of participants, which increased to 91% at 1 month, decreased to 64% at 3 months, and further decreased to 56% at 6 months. The vital signs of patients, including systolic and diastolic blood pressure, oxygen saturation, body temperature, respiratory rate, and heart rate, gradually normalized over time. Anxiety and depression symptoms persisted in 17% and 21% of patients, respectively, up to the 6-month mark; even though during the acute phase, these figures were 15% and 13%. The limitations of this study include issues related to sample representation and the exclusion of hypertension data, which affect the overall balance of its findings. Trial Registration: ClinicalTrials.gov identifier: NCT04987853.

Background: Pulmonary hypertension (PH) in patients undergoing lung transplantation (LT) for pulmonary fibrosis can impair lung function, reduce physical activity, and decrease survival. However, data on outcomes at 1 and 5 years of follow-up remain limited. Methods: In this prospective cohort study, pulmonary function, the 6-min walk test (6MWT), and the St. George's Respiratory Questionnaire (SGRQ) were assessed pretransplant, at hospital discharge, and at 3, 6, and 12 months posttransplant. Additionally, minimal clinically important differences (MCIDs) between patients with and without PH were evaluated. Survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Results: The study included 39 patients undergoing LT for pulmonary fibrosis. Of these, 82% (32/39) had PH, with a median age of 52.6 years (SD: 10.2). In both the PH and non-PH groups, lung function, 6MWD, and SGRQ total scores showed progressive improvement from pre-LT to 1 year posttransplant. Patients without PH demonstrated MCID in 6MWT and SGRQ total scores from pre-LT through the 6- and 12-month follow-up. The overall 1-year survival rate was 84.6%, with an average survival of 10.51 months (95% CI: 9.29-11.73). The 5-year overall survival rate was 61.5%, with an average survival of 44.89 months (95% CI: 37.62-52.16). No statistically significant differences in survival were found based on sex (p=0.322 and 0.206), mean pulmonary artery pressure (mPAP) (p=0.232 and 0.486), age (p=0.375 and 0.959), or body mass index (BMI) (p=0.884 and 0.594) at 1 and 5 years. Conclusion: Survival at 1 and 5 years was lower in patients with PH. However, no significant differences in survival were observed based on sex, mPAP, age, or BMI. Statistically significant improvements in FVC, FEV1, 6MWT, and SGRQ total scores were observed both before and after LT, continuing through 1 year of follow-up. The 6MWT and SGRQ showed MCID both prior to surgery and during follow-up at 6 and 12 months, in both PH and non-PH patients.

Background: Patients with esophageal cancer (EC) who have undergone esophagectomy are at risk of developing hypoxemia and encountering postoperative complications. It is essential to ascertain whether the high-flow nasal cannula (HFNC) therapy offers superior clinical efficacy compared to conventional oxygen therapy (COT). Methods: Clinical data from 80 patients who experienced hypoxemia subsequent to radical esophagectomy were retrospectively collected at our institution spanning January 2020 to December 2022. The whole cohort was divided into two groups: the HFNC group and the COT group. Following oxygen administration, we evaluated the variations in arterial blood gas parameters and infection indices within each group, in addition to scrutinizing the occurrence of postoperative pulmonary complications. Results: The HFNC group was associated with a better oxygenation index (F _group=41.779, p < 0.001) and partial pressure of carbon dioxide (F _group=16.760, p < 0.001) compared with the COT group. Moreover, there were statistically significant differences in the reduction of C-reactive protein (F _group = 17.603, p < 0.001) and neutrophil count (F _group = 4.395, p=0.039) in the HFNC group compared with the COT group after 3 days of oxygen therapy. Notably, patients treated with HFNC exhibited a markedly reduced risk of developing postoperative complications, especially pneumonia (p=0.039). Conclusion: HFNC outperformed COT in enhancing oxygenation and reducing carbon dioxide levels and infection indices among patients with hypoxemia after radical resection of EC and also lowered the risk of postoperative pneumonia.