Pub Date : 2023-12-01DOI: 10.1016/j.chpulm.2023.100020
Andrew J. Synn MD, MPH , Eileen M. Harder MD , Pietro Nardelli PhD , James C. Ross PhD , Bradley A. Maron MD , Jane A. Leopold MD , Aaron B. Waxman MD, PhD , Raúl San José Estépar PhD , George R. Washko MD , Farbod N. Rahaghi MD, PhD
{"title":"Automated CT-Based Quantification of Pulmonary Veins Shows Greater Central Venous Dilation in Group 2 Pulmonary Hypertension Compared With Group 1 Pulmonary Arterial Hypertension and Control Subjects","authors":"Andrew J. Synn MD, MPH , Eileen M. Harder MD , Pietro Nardelli PhD , James C. Ross PhD , Bradley A. Maron MD , Jane A. Leopold MD , Aaron B. Waxman MD, PhD , Raúl San José Estépar PhD , George R. Washko MD , Farbod N. Rahaghi MD, PhD","doi":"10.1016/j.chpulm.2023.100020","DOIUrl":"10.1016/j.chpulm.2023.100020","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100020"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978922300020X/pdfft?md5=497aafb64ae474e014b4245ec18837d0&pid=1-s2.0-S294978922300020X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135249305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.chpulm.2023.100022
Lorraine Mascarenhas DO , Megan Campbell MPH , Hildi Hagedorn PhD , Steven S. Fu MD, MSCE , Anne C. Melzer MD, MS
{"title":"Experiences With Tobacco Dependence Treatment Training Among Respiratory Care Clinicians","authors":"Lorraine Mascarenhas DO , Megan Campbell MPH , Hildi Hagedorn PhD , Steven S. Fu MD, MSCE , Anne C. Melzer MD, MS","doi":"10.1016/j.chpulm.2023.100022","DOIUrl":"10.1016/j.chpulm.2023.100022","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100022"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000223/pdfft?md5=1f17aed2212a2b1dab5bfc5f0ae53c7f&pid=1-s2.0-S2949789223000223-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135389287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-23DOI: 10.1016/j.chpulm.2023.100031
Adam Edward Lang PharmD , Tiffany Lee PhD, MPH , Mark Eatherly BS , Urvashi Patel PharmD , Chester B. Good MD, MPH
{"title":"Changes in National Prescribing Trends of Pharmacotherapy to Treat Tobacco and Nicotine Dependence in Relationship to the COVID-19 Pandemic","authors":"Adam Edward Lang PharmD , Tiffany Lee PhD, MPH , Mark Eatherly BS , Urvashi Patel PharmD , Chester B. Good MD, MPH","doi":"10.1016/j.chpulm.2023.100031","DOIUrl":"https://doi.org/10.1016/j.chpulm.2023.100031","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000314/pdfft?md5=51398079a8c86c45016ba254bd6f0565&pid=1-s2.0-S2949789223000314-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-07DOI: 10.1016/j.chpulm.2023.100026
Ingmar Fortmann , Marie-Theres Dammann , Alexander Humberg , Hannah Kraft , Alexander Herz , Kathrin Hanke , Kirstin Faust , Isabell Ricklefs , Michael Zemlin , Johannes Liese , Geraldine Engels , Christoph Härtel , Carsten Fortmann-Grote , Matthias Volkmar Kopp , Folke Brinkmann , Egbert Herting , Wolfgang Göpel , Guido Stichtenoth , for the German Neonatal Network
Background
Prematurity and infection with respiratory syncytial virus (RSV) are major risk factors for impaired lung function beyond the neonatal period.
Research Question
What are the long-term effects of palivizumab immunoprophylaxis in the first year of life on lung function and frequency of bronchitis episodes in 5- to 6-year-old preterm infants?
Study Design and Methods
Preterm infants with a birth weight < 1,500 g (very low-birth weight infants [VLBWIs]) were enrolled in a German Neonatal Network cohort study between 2009 and 2016. Children were examined by a single follow-up team at 5 to 6 years of age. VLBWIs who received at least five doses of palivizumab were compared with children who never received palivizumab. Analyses were stratified by bronchopulmonary dysplasia (BPD) and gestational age. We analyzed FVC, FEV1, FEV1 to FVC ratio, and the risk of respiratory tract infections at 5 to 6 years of age via univariate analyses and linear and logistic regression models.
Results
Of 1,986 VLBWIs with follow-up at 5 to 6 years of age, 951 infants (48%) received immunoprophylaxis with palivizumab. Children with BPD (n = 1,019) showed a much lower FEV1 than children without BPD (median FEV1z score, –1.51 vs –1.09; P < .001). However, FEV1 in children with BPD was not altered by palivizumab (median FEV1z score in 698 children with BPD who received palivizumab, –1.57 [interquartile range, –0.75 to –2.43] vs in 320 children with BPD who did not receive palivizumab, –1.37 [interquartile range, –0.69 to –2.25]; P = .1). As for FEV1, we did not find any protective effects of palivizumab for other end points or in other risk groups.
Interpretation
Palivizumab immunoprophylaxis in VLBWIs is not associated with improved lung function or lower rates of respiratory tract infections in early school-age infants.
研究背景早产和感染呼吸道合胞病毒(RSV)是新生儿期后肺功能受损的主要风险因素。研究问题帕利珠单抗免疫预防在出生后第一年对 5-6 岁早产儿肺功能和支气管炎发作频率的长期影响如何?研究设计与方法2009年至2016年间,一项德国新生儿网络队列研究对出生体重为1500克的早产儿(极低出生体重儿[VLBWIs])进行了登记。儿童在5至6岁时由一个随访小组进行检查。接受过至少五次帕利珠单抗治疗的超低体重儿与从未接受过帕利珠单抗治疗的儿童进行了比较。根据支气管肺发育不良(BPD)和胎龄进行分层分析。我们通过单变量分析、线性回归模型和逻辑回归模型分析了 5-6 岁时的 FVC、FEV1、FEV1 与 FVC 比值以及呼吸道感染风险。患有 BPD 的儿童(n = 1,019)的 FEV1 远低于未患 BPD 的儿童(FEV1 z 评分中位数,-1.51 vs -1.09; P <.001)。然而,帕利珠单抗并未改变BPD患儿的FEV1(接受帕利珠单抗治疗的698名BPD患儿的FEV1 z评分中位数为-1.57[四分位距范围为-0.75至-2.43],而未接受帕利珠单抗治疗的320名BPD患儿的FEV1 z评分中位数为-1.37[四分位距范围为-0.69至-2.25];P = .1)。至于 FEV1,我们没有发现帕利珠单抗对其他终点或其他风险组有任何保护作用。
{"title":"Respiratory Syncytial Virus Prophylaxis With Palivizumab Is Not Associated With Improved Lung Function in Infants of Very Low Birth Weight at Early School Age","authors":"Ingmar Fortmann , Marie-Theres Dammann , Alexander Humberg , Hannah Kraft , Alexander Herz , Kathrin Hanke , Kirstin Faust , Isabell Ricklefs , Michael Zemlin , Johannes Liese , Geraldine Engels , Christoph Härtel , Carsten Fortmann-Grote , Matthias Volkmar Kopp , Folke Brinkmann , Egbert Herting , Wolfgang Göpel , Guido Stichtenoth , for the German Neonatal Network","doi":"10.1016/j.chpulm.2023.100026","DOIUrl":"10.1016/j.chpulm.2023.100026","url":null,"abstract":"<div><h3>Background</h3><p>Prematurity and infection with respiratory syncytial virus (RSV) are major risk factors for impaired lung function beyond the neonatal period.</p></div><div><h3>Research Question</h3><p>What are the long-term effects of palivizumab immunoprophylaxis in the first year of life on lung function and frequency of bronchitis episodes in 5- to 6-year-old preterm infants?</p></div><div><h3>Study Design and Methods</h3><p>Preterm infants with a birth weight < 1,500 g (very low-birth weight infants [VLBWIs]) were enrolled in a German Neonatal Network cohort study between 2009 and 2016. Children were examined by a single follow-up team at 5 to 6 years of age. VLBWIs who received at least five doses of palivizumab were compared with children who never received palivizumab. Analyses were stratified by bronchopulmonary dysplasia (BPD) and gestational age. We analyzed FVC, FEV<sub>1</sub>, FEV<sub>1</sub> to FVC ratio, and the risk of respiratory tract infections at 5 to 6 years of age via univariate analyses and linear and logistic regression models.</p></div><div><h3>Results</h3><p>Of 1,986 VLBWIs with follow-up at 5 to 6 years of age, 951 infants (48%) received immunoprophylaxis with palivizumab. Children with BPD (n = 1,019) showed a much lower FEV<sub>1</sub> than children without BPD (median FEV<sub>1</sub> <em>z</em> score, –1.51 vs –1.09; <em>P</em> < .001). However, FEV<sub>1</sub> in children with BPD was not altered by palivizumab (median FEV<sub>1</sub> <em>z</em> score in 698 children with BPD who received palivizumab, –1.57 [interquartile range, –0.75 to –2.43] vs in 320 children with BPD who did not receive palivizumab, –1.37 [interquartile range, –0.69 to –2.25]; <em>P</em> = .1). As for FEV<sub>1</sub>, we did not find any protective effects of palivizumab for other end points or in other risk groups.</p></div><div><h3>Interpretation</h3><p>Palivizumab immunoprophylaxis in VLBWIs is not associated with improved lung function or lower rates of respiratory tract infections in early school-age infants.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000260/pdfft?md5=6bd3d313db74a7149105b66f5c8408f9&pid=1-s2.0-S2949789223000260-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.1016/j.chpulm.2023.100021
Erika Becerra-Ashby MD , Tiffany Gardner MD , Kelli Robertson MD , Katie E. Raffel MD , Peter Hountras MD
Case Presentation
A 29-year-old man with a history of mood disorder was admitted with acute encephalopathy after friends had requested a welfare check. He initially was disoriented, with poor recall and reporting delusions of alien interaction. During interview, he was falling asleep intermittently but was able to be aroused. He denied any new symptoms except discomfort with eating because of insects inside his body. His friend reported the patient used alcohol 1 to 2 drinks weekly, and LSD and marijuana use the weekend prior. He also has a remote history of recreational cocaine use in college that stopped because of nosebleeds. The patient reported a daily medication for anxiety, but he was unable to recall the name.
{"title":"A 29-Year-Old With Iron Deficiency and Multifocal Cerebral Infarcts","authors":"Erika Becerra-Ashby MD , Tiffany Gardner MD , Kelli Robertson MD , Katie E. Raffel MD , Peter Hountras MD","doi":"10.1016/j.chpulm.2023.100021","DOIUrl":"https://doi.org/10.1016/j.chpulm.2023.100021","url":null,"abstract":"<div><h3>Case Presentation</h3><p>A 29-year-old man with a history of mood disorder was admitted with acute encephalopathy after friends had requested a welfare check. He initially was disoriented, with poor recall and reporting delusions of alien interaction. During interview, he was falling asleep intermittently but was able to be aroused. He denied any new symptoms except discomfort with eating because of insects inside his body. His friend reported the patient used alcohol 1 to 2 drinks weekly, and LSD and marijuana use the weekend prior. He also has a remote history of recreational cocaine use in college that stopped because of nosebleeds. The patient reported a daily medication for anxiety, but he was unable to recall the name.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000211/pdfft?md5=64a039724afceb8feddf888f8fdbd37d&pid=1-s2.0-S2949789223000211-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134656692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1016/j.chpulm.2023.100016
Jonathan Angotti MD , Charlene Pope PhD , Nichole T. Tanner MD
Background
Lung cancer screening (LCS) with low-dose CT scan has been shown to reduce mortality from lung cancer, the deadliest cancer killer. More than one-half of incident lung cancers detected in the National Lung Screening Trial were identified after the first year of screening, which highlights the importance of annual adherence to achieve mortality benefit from LCS. Although National Lung Screening Trial adherence across three rounds of screening was 95%, adherence in the community is lower and highly variable even within the same health system.
Research Question
What are patient and LCS coordinator perspectives on barriers and potential solutions to ensuring adherence to annual LCS?
Study Design and Methods
In this qualitative study, we conducted six veteran focus groups of 21 veterans who had undergone at least one LCS examination and individual interviews of eight LCS coordinators. Interviews and focus groups were transcribed and coded using qualitative content analysis. Codes were sorted into categories reflecting veteran perceptions, LCS ideas, observations, barriers, facilitators, preferences, recommendations, and LCS program issues. These codes were then analyzed and used to identify themes influencing adherence.
Results
The following four themes were identified from qualitative analysis: (1) direct communication about the repeat annual nature of screening was a driver for patient adherence, (2) patients recommended using other modalities including text messaging and mobile applications to improve adherence, (3) LCS coordinators reported a lack of emphasis and focus on adherence because of a lack of resources, and (4) the variability in program practices for bringing patients back every year and inability to measure adherence are barriers that need to be addressed.
Interpretation
Direct and multimodal communication may improve patient adherence to annual LCS, and system-level changes (eg, tracking dashboard and metrics) could assist LCS coordinators in addressing and focusing on LCS program adherence.
{"title":"Veteran and Lung Cancer Screening Coordinator Perspectives on Improving Adherence to Lung Cancer Screening","authors":"Jonathan Angotti MD , Charlene Pope PhD , Nichole T. Tanner MD","doi":"10.1016/j.chpulm.2023.100016","DOIUrl":"https://doi.org/10.1016/j.chpulm.2023.100016","url":null,"abstract":"<div><h3>Background</h3><p>Lung cancer screening (LCS) with low-dose CT scan has been shown to reduce mortality from lung cancer, the deadliest cancer killer. More than one-half of incident lung cancers detected in the National Lung Screening Trial were identified after the first year of screening, which highlights the importance of annual adherence to achieve mortality benefit from LCS. Although National Lung Screening Trial adherence across three rounds of screening was 95%, adherence in the community is lower and highly variable even within the same health system.</p></div><div><h3>Research Question</h3><p>What are patient and LCS coordinator perspectives on barriers and potential solutions to ensuring adherence to annual LCS?</p></div><div><h3>Study Design and Methods</h3><p>In this qualitative study, we conducted six veteran focus groups of 21 veterans who had undergone at least one LCS examination and individual interviews of eight LCS coordinators. Interviews and focus groups were transcribed and coded using qualitative content analysis. Codes were sorted into categories reflecting veteran perceptions, LCS ideas, observations, barriers, facilitators, preferences, recommendations, and LCS program issues. These codes were then analyzed and used to identify themes influencing adherence.</p></div><div><h3>Results</h3><p>The following four themes were identified from qualitative analysis: (1) direct communication about the repeat annual nature of screening was a driver for patient adherence, (2) patients recommended using other modalities including text messaging and mobile applications to improve adherence, (3) LCS coordinators reported a lack of emphasis and focus on adherence because of a lack of resources, and (4) the variability in program practices for bringing patients back every year and inability to measure adherence are barriers that need to be addressed.</p></div><div><h3>Interpretation</h3><p>Direct and multimodal communication may improve patient adherence to annual LCS, and system-level changes (eg, tracking dashboard and metrics) could assist LCS coordinators in addressing and focusing on LCS program adherence.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000168/pdfft?md5=03d6629b141da27d83cf0758bbdc4791&pid=1-s2.0-S2949789223000168-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92026089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04DOI: 10.1016/j.chpulm.2023.100017
Meredith A. Case MD, MHS , Eric P. Boorman PhD , Elizabeth Ruvalcaba MSPH , Michael T. Vest DO , Nadia N. Hansel MD, MPH , Nirupama Putcha MD, MHS , Michelle N. Eakin PhD
Background
Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD.
Research Question
To examine rates of guideline alignment and medication concordance and to identify patient-level factors that place patients at risk for these types of poor disease management outcomes.
Study Design and Methods
This study was a secondary data analysis of the Medication Adherence Research in COPD study (2017-2023). Participants were categorized into 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Medication regimens were classified as aligned or nonaligned with 2017 GOLD guidelines. Nonaligned regimens were stratified further into overuse and underuse categories. Medication concordance between provider-reported and participant-reported regimens was determined. Factors associated with guideline alignment and medication concordance were evaluated using logistic regression.
Results
Of 191 participants, 51% of provider-reported regimens were guideline aligned, with 86% of nonaligned regimens reflecting overuse with an inhaled corticosteroid (ICS). Thirty-eight percent of participants reported different regimens than their providers, of which > 80% reflected participants not reporting medications their providers reported prescribing. Participants did not report long-acting muscarinic antagonists and long-acting beta-agonists at similar rates as ICSs. Greater symptom burden and absence of a pulmonologist on the care team were associated with both guideline misalignment and medication discordance. Cognitive impairment and Black race additionally were associated with medication discordance.
Interpretation
Guideline misalignment and medication discordance were common and were driven by overuse of ICSs and unreported medications, respectively. The patient-level factors associated with medication discordance highlight the importance of improving patient-provider communication to improve clinical management in COPD.
{"title":"Guideline Alignment and Medication Concordance in COPD","authors":"Meredith A. Case MD, MHS , Eric P. Boorman PhD , Elizabeth Ruvalcaba MSPH , Michael T. Vest DO , Nadia N. Hansel MD, MPH , Nirupama Putcha MD, MHS , Michelle N. Eakin PhD","doi":"10.1016/j.chpulm.2023.100017","DOIUrl":"10.1016/j.chpulm.2023.100017","url":null,"abstract":"<div><h3>Background</h3><p>Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD.</p></div><div><h3>Research Question</h3><p>To examine rates of guideline alignment and medication concordance and to identify patient-level factors that place patients at risk for these types of poor disease management outcomes.</p></div><div><h3>Study Design and Methods</h3><p>This study was a secondary data analysis of the Medication Adherence Research in COPD study (2017-2023). Participants were categorized into 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Medication regimens were classified as aligned or nonaligned with 2017 GOLD guidelines. Nonaligned regimens were stratified further into overuse and underuse categories. Medication concordance between provider-reported and participant-reported regimens was determined. Factors associated with guideline alignment and medication concordance were evaluated using logistic regression.</p></div><div><h3>Results</h3><p>Of 191 participants, 51% of provider-reported regimens were guideline aligned, with 86% of nonaligned regimens reflecting overuse with an inhaled corticosteroid (ICS). Thirty-eight percent of participants reported different regimens than their providers, of which > 80% reflected participants not reporting medications their providers reported prescribing. Participants did not report long-acting muscarinic antagonists and long-acting beta-agonists at similar rates as ICSs. Greater symptom burden and absence of a pulmonologist on the care team were associated with both guideline misalignment and medication discordance. Cognitive impairment and Black race additionally were associated with medication discordance.</p></div><div><h3>Interpretation</h3><p>Guideline misalignment and medication discordance were common and were driven by overuse of ICSs and unreported medications, respectively. The patient-level factors associated with medication discordance highlight the importance of improving patient-provider communication to improve clinical management in COPD.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 1","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978922300017X/pdfft?md5=28678bcf29fd4fa96c270a415bf9106b&pid=1-s2.0-S294978922300017X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91551452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Existing reports show a bidirectional association between type 2 diabetes (T2D) and pulmonary dysfunction. Obesity, which is causally related to both T2D and pulmonary dysfunction, could play an important role in this association. However, this has not been reported.
Research Question
What are the associations of measures of obesity with pulmonary function in T2D?
Study Design and Methods
This was a cross-sectional study among 464 adults with T2D. Spirometry was performed according to the American Thoracic Society/European Respiratory Society guidelines. The predicted values of the spirometric indices were determined using the Global Lung Function Initiative 2012 equations. The values of FEV1/FVC and FVC were used to categorize pulmonary function patterns as normal, obstructive, restrictive, or mixed. Waist circumference (WC) was measured at the midpoint between the lower margin of the lowest palpable rib and the top of the iliac crest.
Results
The mean age, diabetes duration, and female/male ratio of the participants were 55.09 ± 10.45 years, 10.00 ± 7.36 years, and 2:1, respectively. In a multiple linear regression model, WC was a significant predictor of FVC (P = .018) and FEV1/FVC ratio (P = .005), but not FEV1 (P = .472). BMI was a significant predictor of FEV1/FVC ratio (P = .031), but not FEV1 (P = .802) or FVC (P = .129). In a multivariable logistic regression model adjusted for age, sex, socioeconomic status, diabetes duration, glycated hemoglobin, statin use, and smoking pack-years, increasing z score WC was associated with higher odds of restrictive spirometry (OR, 1.32; 95% CI, 1.05-1.66; P = .019) but not airway obstruction (OR, 0.65; 95% CI, 0.42-1.03; P = .067). There were no significant associations of increasing z score BMI with restrictive spirometry (OR, 1.24; 95% CI, 0.98-1.58; P = .075) or airway obstruction (OR, 0.79; 95% CI, 0.51-1.24; P = .305).
Interpretation
Increasing WC is associated with restrictive spirometry, independent of conventional diabetes and pulmonary risk factors. Future research could explore the role of the reversal of central obesity on pulmonary function in T2D.
{"title":"Pulmonary Function in Adults With Type 2 Diabetes With and Without Obesity","authors":"Charles F. Hayfron-Benjamin PhD , Ruth Korkor Tei MBChB , Josephine Korang Osei-Tutu BSc , Tracy Amo-Nyarko BSc , Patience Vormatu , Joana N. Ackam BSc , Gloria Odom Asante BSc , Latif Musah MPhil , Anastasia N.K. Bruce MBChB , Kwaku Amponsah Obeng MBChB","doi":"10.1016/j.chpulm.2023.100014","DOIUrl":"10.1016/j.chpulm.2023.100014","url":null,"abstract":"<div><h3>Background</h3><p>Existing reports show a bidirectional association between type 2 diabetes (T2D) and pulmonary dysfunction. Obesity, which is causally related to both T2D and pulmonary dysfunction, could play an important role in this association. However, this has not been reported.</p></div><div><h3>Research Question</h3><p>What are the associations of measures of obesity with pulmonary function in T2D?</p></div><div><h3>Study Design and Methods</h3><p>This was a cross-sectional study among 464 adults with T2D. Spirometry was performed according to the American Thoracic Society/European Respiratory Society guidelines. The predicted values of the spirometric indices were determined using the Global Lung Function Initiative 2012 equations. The values of FEV<sub>1</sub>/FVC and FVC were used to categorize pulmonary function patterns as normal, obstructive, restrictive, or mixed. Waist circumference (WC) was measured at the midpoint between the lower margin of the lowest palpable rib and the top of the iliac crest.</p></div><div><h3>Results</h3><p>The mean age, diabetes duration, and female/male ratio of the participants were 55.09 ± 10.45 years, 10.00 ± 7.36 years, and 2:1, respectively. In a multiple linear regression model, WC was a significant predictor of FVC (<em>P</em> = .018) and FEV<sub>1</sub>/FVC ratio (<em>P</em> = .005), but not FEV<sub>1</sub> (<em>P</em> = .472). BMI was a significant predictor of FEV<sub>1</sub>/FVC ratio (<em>P</em> = .031), but not FEV<sub>1</sub> (<em>P</em> = .802) or FVC (<em>P</em> = .129). In a multivariable logistic regression model adjusted for age, sex, socioeconomic status, diabetes duration, glycated hemoglobin, statin use, and smoking pack-years, increasing <em>z</em> score WC was associated with higher odds of restrictive spirometry (OR, 1.32; 95% CI, 1.05-1.66; <em>P</em> = .019) but not airway obstruction (OR, 0.65; 95% CI, 0.42-1.03; <em>P</em> = .067). There were no significant associations of increasing <em>z</em> score BMI with restrictive spirometry (OR, 1.24; 95% CI, 0.98-1.58; <em>P</em> = .075) or airway obstruction (OR, 0.79; 95% CI, 0.51-1.24; <em>P</em> = .305).</p></div><div><h3>Interpretation</h3><p>Increasing WC is associated with restrictive spirometry, independent of conventional diabetes and pulmonary risk factors. Future research could explore the role of the reversal of central obesity on pulmonary function in T2D.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"1 3","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789223000144/pdfft?md5=f20270e7df8dd922692d55bc28f4415e&pid=1-s2.0-S2949789223000144-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76706330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}