Chest最新文献

Background: Obesity-associated asthma results in increased morbidity and mortality. We report one-year asthma outcomes with the Counterweight-Plus weight management programme (CWP) compared to usual care (UC) in a single-centre, randomised, controlled trial in patients with difficult-to-treat asthma and obesity.

Research question: Can CWP use result in improved asthma control and quality of life compared to UC at one-year in patients with difficult-to-treat asthma and obesity?

Study design and methods: We randomised (1:1 CWP:UC) adults with difficult-to-treat asthma and body mass index ≥30kg/m². CWP with dietitian support: 12-week total diet replacement phase (850kcal/day low-energy formula); food reintroduction and maintenance phases up to one-year. Outcomes include Asthma Control Questionnaire (ACQ-6), Asthma Quality of Life Questionnaire (AQLQ) and healthcare usage. Minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ.

Results: Of 36 recruited, 29 attended at 52-weeks: 13 CWP, 16 UC. CWP resulted in greater weight change (median -14kg [IQR -15, -9]) compared to UC (2kg [-7, 8]; p=0.015) at 52-weeks. A greater proportion achieved MCID with CWP vs UC in AQLQ (71% vs 6% respectively; p<0.001). No between-group differences were observed in ACQ-6. Median exacerbation frequency reduced over 52-weeks with CWP from 4 (IQR 2, 5) to 0 (0, 2) (p<0.001), though no between-group difference was observed. 70% of the CWP group lost ≥10% body weight and had improvement in ACQ-6 (mean difference -1.1, 95%CI -1.9, -0.3; p=0.018) and AQLQ (1.2, 95%CI 0.4, 2.1; p=0.011) across 52-weeks.

Interpretation: Use of a dietitian-supported weight management programme results in sustained weight-loss and is a potential treatment for obesity in asthma. CWP resulted in a higher proportion achieving MCID improvement in AQLQ compared to UC. Within group differences in AQLQ and exacerbation frequency suggest potential with CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.

Background: Critical illness can render patients at heightened risk of anonymity, loss of dignity and dehumanization. As dehumanization results in significant patient distress, it is imperative to find ways to humanize care in the ICU. A Get to Know Me Board (GTKMB) is a personal patient profile designed to bring the patient from anonymity, yet its widespread adoption has been challenging.

Research question: Identify perspectives of ICU clinicians on the value of the GTKMB in caring for ICU patients.

Study design and methods: This qualitative study used focus groups conducted via videoconference. We recruited stakeholders from multiprofessional teams across different ICU settings at a large U.S. quaternary care center. Thematic content analysis approach was performed to identify key themes and concepts.

Results: We interviewed 38 participants in 6 focus groups including 10 nurses, 7 physicians, 6 advanced practice providers, 5 rehabilitation therapists, a respiratory therapist, and a social worker. Themes highlighted the role of the GTKMB in multiple domains including a) humanizing care of the critically ill, b) fostering communication, c) connecting with families and d) guiding and facilitating care processes. Several sub- themes were identified for each category.

Interpretation: The GTKMB was considered important in fostering humanized caring in the ICU by diverse members of an interprofessional ICU team, helping to facilitate communication, establish family connection, and guide care.

Background: Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD).

Study question: What is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting?

Study design and methods: Medical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR).

Results: A total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen's κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (β=0.154; P=0.004).

Interpretation: STAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.