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Koinis-Mitchell D, Kopel SJ, Dunsiger S, McQuaid EL, Miranda LG, Mitchell P, Vehse N, Jelalian E. Asthma and Physical Activity in Urban Children. J Pediatr Psychol 2021; 46:970-979. [PMID: 33749790 DOI: 10.1093/jpepsy/jsab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Asthma and obesity disproportionately affect urban minority children. Avoidance of physical activity contributes to obesity, and urban children with asthma are at risk for lower levels of physical activity. We examined associations between lung function and moderate to vigorous physical activity (MVPA) and moderators of this association in a diverse sample of children with asthma. METHODS Urban children (N = 142) ages 7-9 with persistent asthma and their caregivers completed a study of asthma and physical activity. Longitudinal mixed effects models examining daily-level asthma and physical activity evaluated the association between asthma and MVPA, and the moderating effect of weight, and cultural/contextual factors on this association. RESULTS Average daily MVPA was below recommended guidelines. Differences in MVPA were found by racial/ethnic group (p = .04) and weight (p = .001). Poorer asthma status was associated with lower MVPA in Latino and Black participants (p's < .05), and in normal weight youth (p = .01). Body mass index (BMI) moderated the association between asthma and MVPA. Those with lower BMI had more optimal asthma status and higher MVPA levels, whereas associations attenuated for participants with higher BMI (p = .04). Caregivers' perceptions of neighborhood safety and fear of asthma were marginally associated with children's symptoms and MVPA: as perceptions of safety decreased and fear increased, associations between asthma and MVPA weakened (p's = .09 and .07, respectively). CONCLUSIONS Suboptimal asthma status is associated with less MVPA in urban children. Weight status and cultural/contextual factors play a role in the association and are worthy targets for future research and intervention.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital.,Warren Alpert Medical School of Brown University
| | - Sheryl J Kopel
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital.,Warren Alpert Medical School of Brown University
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Brown University School of Public Health
| | - Elizabeth L McQuaid
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital.,Warren Alpert Medical School of Brown University
| | - Luis Gonzalez Miranda
- Bradley-Hasbro Research Center and the Department of Pediatrics, Rhode Island Hospital
| | | | - Nico Vehse
- Warren Alpert Medical School of Brown University
| | - Elissa Jelalian
- Warren Alpert Medical School of Brown University.,Diabetes and Weight Control Research Center, The Miriam Hospital
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Cifarelli V, Beeman SC, Smith GI, Yoshino J, Morozov D, Beals JW, Kayser BD, Watrous JD, Jain M, Patterson BW, Klein S. Decreased adipose tissue oxygenation associates with insulin resistance in individuals with obesity. J Clin Invest 2021; 130:6688-6699. [PMID: 33164985 DOI: 10.1172/jci141828] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDData from studies conducted in rodent models have shown that decreased adipose tissue (AT) oxygenation is involved in the pathogenesis of obesity-induced insulin resistance. Here, we evaluated the potential influence of AT oxygenation on AT biology and insulin sensitivity in people.METHODSWe evaluated subcutaneous AT oxygen partial pressure (pO2); liver and whole-body insulin sensitivity; AT expression of genes and pathways involved in inflammation, fibrosis, and branched-chain amino acid (BCAA) catabolism; systemic markers of inflammation; and plasma BCAA concentrations, in 3 groups of participants that were rigorously stratified by adiposity and insulin sensitivity: metabolically healthy lean (MHL; n = 11), metabolically healthy obese (MHO; n = 15), and metabolically unhealthy obese (MUO; n = 20).RESULTSAT pO2 progressively declined from the MHL to the MHO to the MUO group, and was positively associated with hepatic and whole-body insulin sensitivity. AT pO2 was positively associated with the expression of genes involved in BCAA catabolism, in conjunction with an inverse relationship between AT pO2 and plasma BCAA concentrations. AT pO2 was negatively associated with AT gene expression of markers of inflammation and fibrosis. Plasma PAI-1 increased from the MHL to the MHO to the MUO group and was negatively correlated with AT pO2, whereas the plasma concentrations of other cytokines and chemokines were not different among the MHL and MUO groups.CONCLUSIONThese results support the notion that reduced AT oxygenation in individuals with obesity contributes to insulin resistance by increasing plasma PAI-1 concentrations and decreasing AT BCAA catabolism and thereby increasing plasma BCAA concentrations.TRIAL REGISTRATIONClinicalTrials.gov NCT02706262.FUNDINGThis study was supported by NIH grants K01DK109119, T32HL130357, K01DK116917, R01ES027595, P42ES010337, DK56341 (Nutrition Obesity Research Center), DK20579 (Diabetes Research Center), DK052574 (Digestive Disease Research Center), and UL1TR002345 (Clinical and Translational Science Award); NIH Shared Instrumentation Grants S10RR0227552, S10OD020025, and S10OD026929; and the Foundation for Barnes-Jewish Hospital.
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Affiliation(s)
- Vincenza Cifarelli
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
| | - Scott C Beeman
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gordon I Smith
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
| | - Jun Yoshino
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
| | - Darya Morozov
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph W Beals
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
| | - Brandon D Kayser
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
| | - Jeramie D Watrous
- Departments of Medicine and Pharmacology, University of California, San Diego, La Jolla, California, USA
| | - Mohit Jain
- Departments of Medicine and Pharmacology, University of California, San Diego, La Jolla, California, USA
| | - Bruce W Patterson
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
| | - Samuel Klein
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, and
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Kooistra EJ, de Nooijer AH, Claassen WJ, Grondman I, Janssen NAF, Netea MG, van de Veerdonk FL, van der Hoeven JG, Kox M, Pickkers P. A higher BMI is not associated with a different immune response and disease course in critically ill COVID-19 patients. Int J Obes (Lond) 2021; 45:687-694. [PMID: 33495522 PMCID: PMC7829495 DOI: 10.1038/s41366-021-00747-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/02/2020] [Accepted: 01/04/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity appears to be an independent risk factor for ICU admission and a severe disease course in COVID-19 patients. An aberrant inflammatory response and impaired respiratory function have been suggested as underlying mechanisms. We investigated whether obesity is associated with differences in inflammatory, respiratory, and clinical outcome parameters in critically ill COVID-19 patients. SUBJECTS/METHODS Sixty-seven COVID-19 ICU patients were divided into obese (BMI ≥ 30 kg/m2, n = 18, 72% class I obesity, 28% class II obesity) and non-obese (BMI < 30 kg/m2, n = 49) groups. Concentrations of circulating interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), interferon gamma-induced protein (IP)-10, monocyte chemoattractant protein (MCP)-1, and IL-1 receptor antagonist (RA) were determined from ICU admission until 10 days afterward, and routine laboratory and clinical parameters were collected. RESULTS BMI was 32.6 [31.2-34.5] and 26.0 [24.4-27.7] kg/m2 in the obese and non-obese group, respectively. Apart from temperature, which was significantly lower in obese patients (38.1 [36.9-38.9] vs. 38.7 [38.0 -39.5] °C, p = 0.02), there were no between-group differences on ICU admission. Plasma cytokine concentrations declined over time (p < 0.05 for all), but no differences between obese and non-obese patients were observed. Also, BMI did not correlate with the cytokine response (IL-6 r = 0.09, p = 0.61, TNF-α r = 0.03, p = 0.99, IP-10 r = 0.28, p = 0.11). The kinetics of clinical inflammatory parameters and respiratory mechanics were also similar in both groups. Finally, no differences in time on ventilator, ICU length of stay or 40-day mortality between obese and non-obese patients were apparent. CONCLUSIONS In COVID-19 patients requiring mechanical ventilation in the ICU, a higher BMI is not related to a different immunological response, unfavorable respiratory mechanics, or impaired outcome.
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Affiliation(s)
- Emma J. Kooistra
- grid.10417.330000 0004 0444 9382Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Aline H. de Nooijer
- grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Internal Medicine, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Wout J. Claassen
- grid.10417.330000 0004 0444 9382Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Inge Grondman
- grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Internal Medicine, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Nico A. F. Janssen
- grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Internal Medicine, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Mihai G. Netea
- grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Internal Medicine, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Frank L. van de Veerdonk
- grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Internal Medicine, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Johannes G. van der Hoeven
- grid.10417.330000 0004 0444 9382Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Matthijs Kox
- grid.10417.330000 0004 0444 9382Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
| | - Peter Pickkers
- grid.10417.330000 0004 0444 9382Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
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Brock JM, Billeter A, Müller-Stich BP, Herth F. Obesity and the Lung: What We Know Today. Respiration 2020; 99:856-866. [PMID: 33242862 DOI: 10.1159/000509735] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Obesity is becoming more and more prevalent especially in Western industrial nations. The understanding of adipose tissue as an endocrine organ as well as the detection of adipocytokines - hormones that are secreted from the adipose tissue - gave reason to examine the interactions between adipose tissue and target organs. These efforts have been intensified especially in the context of bariatric surgery as promising weight loss therapy. Interactions between the lung and adipose tissue have rarely been investigated and are not well understood. There are obvious mechanical effects of obesity on lung function explaining the associations between obesity and lung diseases, in particular obesity hypoventilation syndrome, obstructive sleep apnea syndrome, asthma, and chronic obstructive pulmonary disease. The rise in the prevalence of obesity affects the epidemiology of pulmonary diseases as well. The aim of this review is to summarize the current knowledge on interactions, associations, and consequences of obesity and weight loss on lung function and lung diseases. Based on these data, areas for future research are identified.
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Affiliation(s)
- Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany,
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
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Xiao D, Chen Z, Wu S, Huang K, Xu J, Yang L, Xu Y, Zhang X, Bai C, Kang J, Ran P, Shen H, Wen F, Yao W, Sun T, Shan G, Yang T, Lin Y, Zhu J, Wang R, Shi Z, Zhao J, Ye X, Song Y, Wang Q, Hou G, Zhou Y, Li W, Ding L, Wang H, Chen Y, Guo Y, Xiao F, Lu Y, Peng X, Zhang B, Wang Z, Zhang H, Bu X, Zhang X, An L, Zhang S, Cao Z, Zhan Q, Yang Y, Liang L, Liu Z, Zhang X, Cheng A, Cao B, Dai H, Chung KF, He J, Wang C. Prevalence and risk factors of small airway dysfunction, and association with smoking, in China: findings from a national cross-sectional study. THE LANCET. RESPIRATORY MEDICINE 2020; 8:1081-1093. [PMID: 32598906 DOI: 10.1016/s2213-2600(20)30155-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. METHODS From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV1 and FEV1/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV1 and FEV1/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. FINDINGS Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 μm (PM2·5) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m2. The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM2·5, and increase of BMI by 5 kg/m2 were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. INTERPRETATION In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM2·5 exposure and increase of BMI by 5 kg/m2. Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. FUNDING Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China.
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Affiliation(s)
- Dan Xiao
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sinan Wu
- Data and Project Management Unit, China-Japan Friendship Hospital, Beijing, China; Center of Respiratory Medicine, and Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Kewu Huang
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Jianying Xu
- Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Lan Yang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yongjian Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyan Zhang
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huahao Shen
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Fuqiang Wen
- State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wanzhen Yao
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Tieying Sun
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China; National Center of Gerontology, Beijing, China
| | - Guangliang Shan
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yingxiang Lin
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Jianguo Zhu
- National Center of Gerontology, Beijing, China
| | - Ruiying Wang
- Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Zhihong Shi
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianping Zhao
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianwei Ye
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiuyue Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wen Li
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Liren Ding
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Hao Wang
- State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yanfei Guo
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China; National Center of Gerontology, Beijing, China
| | - Fei Xiao
- National Center of Gerontology, Beijing, China
| | - Yong Lu
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Xiaoxia Peng
- Clinical Epidemiology and Evidence-based Medicine, Capital Medical University, Beijing, China; Beijing Children's Hospital, National Center for Children's Health, Beijing, China
| | - Biao Zhang
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zuomin Wang
- Department of Stomatology, Capital Medical University, Beijing, China
| | - Hong Zhang
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Xiaoning Bu
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Xiaolei Zhang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Li An
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Shu Zhang
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Zhixin Cao
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yuanhua Yang
- Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Lirong Liang
- Department of Epidemiology, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China
| | - Zhao Liu
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinran Zhang
- Data and Project Management Unit, China-Japan Friendship Hospital, Beijing, China; Center of Respiratory Medicine, and Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Anqi Cheng
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Huaping Dai
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China.
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Marillier M, Bernard AC, Reimao G, Castelli G, Alqurashi H, O'Donnell DE, Neder JA. Breathing at Extremes. Chest 2020; 158:1576-1585. [DOI: 10.1016/j.chest.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
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Rychter AM, Zawada A, Ratajczak AE, Dobrowolska A, Krela‐Kaźmierczak I. Should patients with obesity be more afraid of COVID-19? Obes Rev 2020; 21:e13083. [PMID: 32583537 PMCID: PMC7362042 DOI: 10.1111/obr.13083] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 crisis has lasted since the late 2019 to the present day. The severity of the disease is positively correlated with several factors, such as age and coexisting diseases. Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID-19 infection. On the basis of current research, in our nonsystematic review, we have investigated the extent to which obesity can affect the SARS-CoV-2 course and identify the potential mechanisms of the disease. We have also described the role of proper nutrition, physical activity and other aspects relevant to the management of obesity.
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Affiliation(s)
- Anna Maria Rychter
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
| | - Agnieszka Zawada
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
| | - Alicja Ewa Ratajczak
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
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Zhu C, Yao JW, An LX, Bai YF, Li WJ. Effects of intraoperative individualized PEEP on postoperative atelectasis in obese patients: study protocol for a prospective randomized controlled trial. Trials 2020; 21:618. [PMID: 32631414 PMCID: PMC7338115 DOI: 10.1186/s13063-020-04565-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Obese patients undergoing general anesthesia and mechanical ventilation during laparoscopic abdominal surgery commonly have a higher incidence of postoperative pulmonary complications (PPCs), due to factors such as decreasing oxygen reserve, declining functional residual capacity, and reducing lung compliance. Pulmonary atelectasis caused by pneumoperitoneum and mechanical ventilation is further aggravated in obese patients. Recent studies demonstrated that individualized positive end-expiratory pressure (iPEEP) was one of effective lung-protective ventilation strategies. However, there is still no exact method to determine the best iPEEP, especially for obese patients. Here, we will use the best static lung compliance (Cstat) method to determine iPEEP, compared with regular PEEP, by observing the atelectasis area measured by electrical impedance tomography (EIT), and try to prove a better iPEEP setting method for obese patients. Methods This study is a single-center, two-arm, prospective, randomized control trial. A total number of 80 obese patients with body mass index ≥ 32.5 kg/m2 scheduled for laparoscopic gastric volume reduction and at medium to high risk for PPCs will be enrolled. They will be randomly assigned to control group (PEEP5 group) and iPEEP group. A PEEP of 5 cmH2O will be used in PEEP5 group, whereas an individualized PEEP value determined by a Cstat-directed PEEP titration procedure will be applied in the iPEEP group. Standard lung-protective ventilation methods such as low tidal volumes (7 ml/kg, predicted body weight, PBW), a fraction of inspired oxygen ≥ 0.5, and recruitment maneuvers (RM) will be applied during and after operation in both groups. Primary endpoints will be postoperative atelectasis measured by chest electrical impedance tomography (EIT) and intraoperative oxygen index. Secondary endpoints will be serum IL-6, TNF-α, procalcitonin (PCT) kinetics during and after surgery, incidence of PPCs, organ dysfunction, length of in-hospital stay, and hospital expense. Discussion Although there are several studies about the effect of iPEEP titration on perioperative PPCs in obese patients recently, the iPEEP setting method they used was complex and was not always feasible in routine clinical practice. This trial will assess a possible simple method to determine individualized optimal PEEP in obese patients and try to demonstrate that individualized PEEP with lung-protective ventilation methods is necessary for obese patients undergoing general surgery. The results of this trial will support anesthesiologist a feasible Cstat-directed PEEP titration method during anesthesia for obese patients in attempt to prevent PPCs. Trial registration www.chictr.org.cn ChiCTR1900026466. Registered on 11 October 2019
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Affiliation(s)
- Chen Zhu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Jing-Wen Yao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Li-Xin An
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China.
| | - Ya-Fan Bai
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Wen-Jing Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
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Dixon AE, Peters U, Walsh R, Daphtary N, MacLean ES, Hodgdon K, Kaminsky DA, Bates JH. Physiological signature of late-onset nonallergic asthma of obesity. ERJ Open Res 2020; 6:00049-2020. [PMID: 32832525 PMCID: PMC7430141 DOI: 10.1183/23120541.00049-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Obesity can lead to a late-onset nonallergic (LONA) form of asthma for reasons that are not understood. We sought to determine whether this form of asthma is characterised by any unique physiological features. METHODS Spirometry, body plethysmography, multiple breath nitrogen washout (MBNW) and methacholine challenge were performed in four subject groups: Lean Control (n=11), Lean Asthma (n=11), Obese Control (n=11) and LONA Obese Asthma (n=10). The MBNW data were fitted with a novel computational model that estimates functional residual capacity (FRC), dead space volume (VD), the coefficient of variation of regional specific ventilation (CV,V'E) and a measure of structural asymmetry at the level of the acinus (sacin). RESULTS Body mass index and waist circumference values were similar in both obese groups, and significantly greater than in lean asthmatic individuals and controls. Forced vital capacity was significantly lower in the LONA Asthma group compared with the other groups (p<0.001). Both asthma groups exhibited similar hyperresponsiveness to methacholine. FRC was reduced in the Obese LONA Asthma group as measured by MBNW, but not in obese controls, whereas FRC was reduced in both obese groups as measured by plethysmography. VD, CV,V'E and sacin were not different between groups. CONCLUSIONS Chronic lung compression characterises all obese subjects, as reflected by reduced plethysmographic FRC. Obese LONA asthma is characterised by a reduced ability to recruit closed lung units, as seen by reduced MBNW FRC, and an increased tendency for airway closure as seen by a reduced forced vital capacity.
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Affiliation(s)
- Anne E. Dixon
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Ubong Peters
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Ryan Walsh
- Dept of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Nirav Daphtary
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Erick S. MacLean
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Kevin Hodgdon
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - David A. Kaminsky
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jason H.T. Bates
- Dept of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Smith GI, Mittendorfer B, Klein S. Metabolically healthy obesity: facts and fantasies. J Clin Invest 2020; 129:3978-3989. [PMID: 31524630 DOI: 10.1172/jci129186] [Citation(s) in RCA: 326] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although obesity is typically associated with metabolic dysfunction and cardiometabolic diseases, some people with obesity are protected from many of the adverse metabolic effects of excess body fat and are considered "metabolically healthy." However, there is no universally accepted definition of metabolically healthy obesity (MHO). Most studies define MHO as having either 0, 1, or 2 metabolic syndrome components, whereas many others define MHO using the homeostasis model assessment of insulin resistance (HOMA-IR). Therefore, numerous people reported as having MHO are not metabolically healthy, but simply have fewer metabolic abnormalities than those with metabolically unhealthy obesity (MUO). Nonetheless, a small subset of people with obesity have a normal HOMA-IR and no metabolic syndrome components. The mechanism(s) responsible for the divergent effects of obesity on metabolic health is not clear, but studies conducted in rodent models suggest that differences in adipose tissue biology in response to weight gain can cause or prevent systemic metabolic dysfunction. In this article, we review the definition, stability over time, and clinical outcomes of MHO, and discuss the potential factors that could explain differences in metabolic health in people with MHO and MUO - specifically, modifiable lifestyle factors and adipose tissue biology. Better understanding of the factors that distinguish people with MHO and MUO can produce new insights into mechanism(s) responsible for obesity-related metabolic dysfunction and disease.
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Neder JA, Berton DC, O'Donnell DE. The Lung Function Laboratory to Assist Clinical Decision-making in Pulmonology: Evolving Challenges to an Old Issue. Chest 2020; 158:1629-1643. [PMID: 32428514 DOI: 10.1016/j.chest.2020.04.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
The lung function laboratory frequently provides relevant information to the practice of pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has been complicated more recently by temporal changes in demographic characteristics (higher life expectancy), anthropometric attributes (increased obesity prevalence), and the surge of polypharmacy in a sedentary population with multiple chronic degenerative diseases. In this narrative review, we concisely discuss some key challenges to test interpretation that have been affected by these epidemiologic shifts: (a) the confounding effects of advanced age and severe obesity, (b) the contemporary controversies in the diagnosis of obstruction (including asthma and/or COPD), (c) the importance of considering the diffusing capacity of the lung for carbon monoxide (Dlco)/"accessible" alveolar volume (carbon monoxide transfer coefficient) in association with Dlco to uncover the causes of impaired gas exchange, and (d) the modern role of the pulmonary function laboratory (including cardiopulmonary exercise testing) in the investigation of undetermined dyspnea. Following a Bayesian perspective, we suggest interpretative algorithms that consider the pretest probability of abnormalities as indicated by additional clinical information. We, therefore, adopt a pragmatic approach to help the practicing pulmonologist to apply the information provided by the lung function laboratory to the care of individual patients.
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Affiliation(s)
- J Alberto Neder
- Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada.
| | - Danilo C Berton
- Division of Respirology, Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denis E O'Donnell
- Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
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A retrospective analysis of associations between BMI and days spent on mechanical ventilation in a level 1 trauma facility. Heart Lung 2020; 49:605-609. [PMID: 32241562 DOI: 10.1016/j.hrtlng.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine whether BMI impacts the outcomes of mechanically ventilated patients. METHODS Data was collected retrospectively among patients involved in motor vehicle accidents in intensive care at a major trauma center in Atlanta, GA. Patients were categorized into five BMI groups: underweight (BMI < 18.5), normal weight (BMI of 18.5-24.9), overweight (BMI of 25-29.9), obese (BMI of 30-39.9), and morbidly obese (BMI of >40). RESULTS Among all patients (n=2,802), 3% of patients were underweight, 34% were of normal weight, 30% were overweight, 27% were obese, and 6% were morbidly obese. The mean number of ventilator days for normal weight patients was 4.6, whereas the mean number of ventilator days for underweight and morbidly obese patients were higher (10.3 and 7.4, respectively). CONCLUSIONS Underweight and morbidly obese populations may require additional interventions during their ICU stays to address the challenges presented by having an unhealthy BMI.
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Rutting S, Mahadev S, Tonga KO, Bailey DL, Dame Carroll JR, Farrow CE, Thamrin C, Chapman DG, King GG. Obesity alters the topographical distribution of ventilation and the regional response to bronchoconstriction. J Appl Physiol (1985) 2020; 128:168-177. [DOI: 10.1152/japplphysiol.00482.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity is associated with reduced operating lung volumes that may contribute to increased airway closure during tidal breathing and abnormalities in ventilation distribution. We investigated the effect of obesity on the topographical distribution of ventilation before and after methacholine-induced bronchoconstriction using single-photon emission computed tomography (SPECT)-computed tomography (CT) in healthy subjects. Subjects with obesity ( n = 9) and subjects without obesity ( n = 10) underwent baseline and postbronchoprovocation SPECT-CT imaging, in which Technegas was inhaled upright and followed by supine scanning. Lung regions that were nonventilated (Ventnon), low ventilated (Ventlow), or well ventilated (Ventwell) were calculated using an adaptive threshold method and were expressed as a percentage of total lung volume. To determine regional ventilation, lungs were divided into upper, middle, and lower thirds of axial length, derived from CT. At baseline, Ventnon and Ventlow for the entire lung were similar in subjects with and without obesity. However, in the upper lung zone, Ventnon (17.5 ± 10.6% vs. 34.7 ± 7.8%, P < 0.001) and Ventlow (25.7 ± 6.3% vs. 33.6 ± 5.1%, P < 0.05) were decreased in subjects with obesity, with a consequent increase in Ventwell (56.8 ± 9.2% vs. 31.7 ± 10.1%, P < 0.001). The greater diversion of ventilation to the upper zone was correlated with body mass index ( rs = 0.74, P < 0.001), respiratory system resistance ( rs = 0.72, P < 0.001), and respiratory system reactance ( rs = −0.64, P = 0.003) but not with lung volumes or basal airway closure. Following bronchoprovocation, overall Ventnon increased similarly in both groups; however, in subjects without obesity, Ventnon only increased in the lower zone, whereas in subjects with obesity, Ventnon increased more evenly across all lung zones. In conclusion, obesity is associated with altered ventilation distribution during baseline and following bronchoprovocation, independent of reduced lung volumes. NEW & NOTEWORTHY Using ventilation SPECT-computed tomography imaging in healthy subjects, we demonstrate that ventilation in obesity is diverted to the upper lung zone and that this is strongly correlated with body mass index but is independent of operating lung volumes and of airway closure. Furthermore, methacholine-induced bronchoconstriction only occurred in the lower lung zone in individuals who were not obese, whereas in subjects who were obese, it occurred more evenly across all lung zones. These findings show that obesity-associated factors alter the topographical distribution of ventilation.
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Affiliation(s)
- S. Rutting
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - S. Mahadev
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - K. O. Tonga
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- Department of Thoracic and Transplant Medicine, St. Vincent's Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
| | - D. L. Bailey
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - J. R. Dame Carroll
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - C. E. Farrow
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
- Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - C. Thamrin
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - D. G. Chapman
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - G. G. King
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights, NSW, Australia
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Vivodtzev I, Picard G, Cepeda FX, Taylor JA. Acute Ventilatory Support During Whole-Body Hybrid Rowing in Patients With High-Level Spinal Cord Injury: A Randomized Controlled Crossover Trial. Chest 2019; 157:1230-1240. [PMID: 31738927 DOI: 10.1016/j.chest.2019.10.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/27/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND High-level spinal cord injury (SCI) results in profound spinal and supraspinal deficits, leading to substantial ventilatory limitations during whole-body hybrid functional electrical stimulation (FES)-rowing, a form of exercise that markedly increases the active muscle mass via electrically induced leg contractions. This study tested the effect of noninvasive ventilation (NIV) on ventilatory and aerobic capacities in SCI. METHODS This blinded, randomized crossover study enrolled 19 patients with SCI (level of injury ranging from C4 to T8). All patients were familiar with FES-rowing and had plateaued in their training-related increases in aerobic capacity. Patients performed two FES-rowing peak exercise tests with NIV or without NIV (sham). RESULTS NIV increased exercise tidal volume (peak, 1.50 ± 0.31 L vs 1.36 ± 0.34 L; P < .05) and reduced breathing frequency (peak, 35 ± 7 beats/min vs 38 ± 6 beats/min; P < .05) compared with the sham test, leading to no change in alveolar ventilation but a trend toward increased oxygen uptake efficiency (P = .06). In those who reached peak oxygen consumption (Vo2peak) criteria (n = 13), NIV failed to significantly increase Vo2peak (1.73 ± 0.66 L/min vs 1.78 ± 0.59 L/min); however, the range of responses revealed a correlation between changes in peak alveolar ventilation and Vo2peak (r = 0.89; P < .05). Furthermore, those with higher level injuries and shorter time since injury exhibited the greatest increases in Vo2peak. CONCLUSIONS Acute NIV can successfully improve ventilatory efficiency during FES exercise in SCI but may not improve Vo2peak in all patients. Those who benefit most seem to be patients with cervical SCI within a shorter time since injury. TRIAL REGISTRY ClinicalTrials.gov; Nos.: NCT02865343 and NCT03267212; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA; Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA.
| | - Glen Picard
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA
| | | | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA; Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, MA
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Cortese G, Brazzi L. Do we need a strategy to reduce postoperative hypoxemia in morbidity obese patients? Minerva Anestesiol 2019; 85:1044-1046. [PMID: 31592625 DOI: 10.23736/s0375-9393.19.13881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gerardo Cortese
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, Turin, Italy -
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
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Association between underweight and pulmonary function in 282,135 healthy adults: A cross-sectional study in Korean population. Sci Rep 2019; 9:14308. [PMID: 31586079 PMCID: PMC6778122 DOI: 10.1038/s41598-019-50488-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/12/2019] [Indexed: 01/24/2023] Open
Abstract
In contrast to obesity, studies on the relationship between underweight and pulmonary function are still sparse. Thus, the objective of this study was to investigate the effect of being underweight on pulmonary function in a general population without apparent lung disease. A total of 282,135 retrospective cohort subjects between January 2012 and December 2014 in Korea were included. Using multivariate-adjusted analysis, the relationship between body mass index (BMI) and pulmonary function were assessed. Underweight individuals represented 5.5% of the total study population (n = 282,135), with most (87.9%) of them being females. Compare to normal weight and obese, underweight was associated with decreased pulmonary function. Forced expiratory volume in first second (FEV1), predicted FEV1 (%), forced vital capacity (FVC), predicted FVC (%), and peak expiratory flow (PEF) were lower in the underweight group than those in other groups after adjusting for age, sex, height, status of smoking, frequency of vigorous exercise, diabetes, and high-sensitivity C-reactive protein (hsCRP) (P < 0.001). Lower BMI tended to decrease pulmonary function parameters such as FEV1 (L), predicted FEV1 (%), FVC (L), predicted FVC (%), and PEF (L/sec) (P for trend <0.001). After adjusting for possible confounders, odds ratios (ORs; 95% confidence interval) for subjects with predicted FEV1% < 80% in underweight and normal weight groups compared to obese group (reference) were 2.10 (1.98–2.21), and 0.93 (0.90–0.97), respectively. ORs for subjects with predicted FVC% < 80% in underweight and normal weight groups compared to obese group (reference) were 4.90 (4.62–5.18) and 1.32 (1.27–1.38), respectively. This study demonstrated a proportional relationship between pulmonary function and the degree of BMI. We found that underweight status was independently associated with decreased pulmonary function in Korean population.
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Choosing an Adequate Test to Determine Fitness for Air Travel in Obese Individuals. Chest 2019; 156:926-932. [PMID: 31419402 DOI: 10.1016/j.chest.2019.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/03/2019] [Accepted: 07/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Air travel is physically demanding and, because obesity is rising, physicians increasingly need to assess whether such patients can fly safely. Our aim was to compare the diagnostic accuracy of two routinely used exercise tests, 50-m walk test and 6-min walk test, and hypoxic challenge testing (HCT) in obese individuals. We further explored the diagnostic potential of perceived dyspnea as measured with the Borg scale because this is often recorded subsequent to walking tests. METHODS In this prospective study, we examined 21 obese participants (10 women, age 51 ± 15 [mean ± SD], BMI 36 ± 5 kg/m2). The most prevalent comorbidity was COPD (n = 11). The reference standard for in-flight hypoxia, defined as oxygen saturation below 90%, was established in an altitude chamber. Diagnostic accuracy of each index test was estimated by area under the receiver operating characteristic curve (AUC). RESULTS Of the 21 participants, 13 (9 with COPD) were identified with in-flight hypoxia. HCT was the only test separating the reference groups significantly with AUC 0.87 (95% CI, 0.62-0.96). Neither of the walking tests predicted noticeably above chance level: 50 m walk test had an AUC of 0.63 (0.36-0.84) and 6MWT had an AUC of 0.64 (0.35-0.86). We further observed good prognostic ability of subjective dyspnea assessment when recorded after 6MWT with an AUC of 0.80 (0.55-0.93). CONCLUSIONS In-flight hypoxia in obese individuals can be predicted by HCT but not by simple walking tests.
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Hoffmeister AD, Lima KSD, Cavalli NP, Callegaro CC. Metaborreflexo inspiratório eleva a pressão arterial em indivíduos obesos e eutróficos. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.0032.ao42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: O metaborreflexo, ativado pelo acúmulo de metabólitos durante o exercício, ocasiona vasoconstrição periférica, resultando em elevação da pressão arterial. Indivíduos obesos apresentam redução da endurance muscular inspiratória, sugerindo um acúmulo precoce de metabólitos e, consequentemente, alterações no metaborreflexo inspiratório. Objetivo: Comparar as respostas hemodinâmicas mediadas pelo metaborreflexo inspiratório em indivíduos obesos e em eutróficos. Método: Participaram do estudo vinte indivíduos obesos (31 ± 6 anos, dez homens, 37,5 ± 4,7 kg/m 2 ) e vinte eutróficos (29 ± 8 anos, dez homens, 23,2 ± 1,5 kg/m 2 ) submetidos a avaliação da força muscular respiratória através de manovacuometria. O metaborreflexo inspiratório foi induzido através de exercício resistido a 60% da pressão inspiratória máxima mantido até a exaustão. O protocolo controle consistiu na respiração sem resistência inspiratória (zero cmH 2 O) mantida durante 30 minutos. A pressão arterial e a frequência cardíaca foram mensuradas ao longo dos protocolos, realizados em dias distintos e em ordem randomizada. Resultados: O protocolo de indução do metaborreflexo inspiratório induziu aumento das pressões arteriais sistólica, diastólica e média, bem como da frequência cardíaca semelhante em indivíduos obesos e eutróficos. Conforme esperado, no protocolo controle as variáveis hemodinâmicas permaneceram inalteradas. Conclusão: A força muscular inspiratória não variou (p = 0,814) entre indivíduos obesos e eutróficos. Este estudo sugere que indivíduos obesos apresentam respostas hemodinâmicas, induzidas pelo metaborreflexo inspiratório, semelhantes aos indivíduos eutróficos.
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Frutos AM, Sloan CD, Merrill RM. Modeling the effects of atmospheric pressure on suicide rates in the USA using geographically weighted regression. PLoS One 2018; 13:e0206992. [PMID: 30517125 PMCID: PMC6281181 DOI: 10.1371/journal.pone.0206992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/20/2018] [Indexed: 01/03/2023] Open
Abstract
Low atmospheric pressure may increase depression and suicide through inducing hypoxia. Previous studies have not evaluated the geographic variation of this relationship across the United States. Analyses were based on three groupings of age-adjusted completed suicide rates (all suicide, firearm-related suicide, non-firearm-related suicide) from 2286 counties in the United States. Multiple regression was used to determine the overall relationship between atmospheric pressure and completed suicide rates. Geographically weighted regression (GWR) models were used to obtain local coefficient estimates. A negative correlation between atmospheric pressure and completed suicide rates was observed for all three suicide groupings (p-value <0.0001). Significant, negative GWR coefficient estimates were located in the West and Northeast for the all suicides and firearm-related suicides, and in the Midwest for non-firearm-related suicides.
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Affiliation(s)
- Aaron M. Frutos
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Chantel D. Sloan
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, United States of America
| | - Ray M. Merrill
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, United States of America
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Geng W, Jia D, Wang Y, Jin S, Ren Y, Liang D, Zheng A, Tang H, Basharat Z, Zimmer V, Stock S, Zippi M, Hong W. A prediction model for hypoxemia during routine sedation for gastrointestinal endoscopy. Clinics (Sao Paulo) 2018; 73:e513. [PMID: 30462756 PMCID: PMC6218956 DOI: 10.6061/clinics/2018/e513] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/04/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The current study was designed to assess the clinical predictors of hypoxemia and to develop a multivariable, predictive model for hypoxemia during routine gastrointestinal endoscopy. METHODS In total, 308 patients were enrolled in the analysis. Demographic data, concurrent chronic disease information, anesthetic dose and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores were collected and analyzed statistically. RESULTS Multivariate logistic regression indicated that age (OR: 1.04; 95%CI 1.01-1.08), body mass index (BMI) (OR: 1.12; 95%CI: 1.02-1.21) and habitual snoring (OR: 3.71; 95%CI: 1.62-8.48) were independently associated with hypoxemia. A logistic regression function (LR model) was developed to predict hypoxemia considering the parameters of -7.73+0.04 age (years), +0.11 BMI, and +1.31 habitual snoring (yes or no). The area under the receiver operating characteristic (ROC) curve for the LR model was 0.76. CONCLUSIONS The LR model, consisting of age, BMI and habitual snoring, was a useful predictor of hypoxemia during routine sedation for gastrointestinal endoscopy.
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Affiliation(s)
- Wujun Geng
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- *Corresponding author. E-mail:
| | - Danyu Jia
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yichuan Wang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Shenhui Jin
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yelong Ren
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Dongdong Liang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Aote Zheng
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Hongli Tang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- *Corresponding author. E-mail:
| | - Zarrin Basharat
- Microbiology & Biotechnology Research Lab, Department of Environmental Sciences, Fatima Jinnah Women University, 46000 Rawalpindi, Pakistan
- *Corresponding author. E-mail:
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
| | - Simon Stock
- Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
- *Corresponding author. E-mail:
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Talaminos Barroso A, Márquez Martín E, Roa Romero LM, Ortega Ruiz F. Factors Affecting Lung Function: A Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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73
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Talaminos Barroso A, Márquez Martín E, Roa Romero LM, Ortega Ruiz F. Factors Affecting Lung Function: A Review of the Literature. Arch Bronconeumol 2018; 54:327-332. [PMID: 29496283 DOI: 10.1016/j.arbres.2018.01.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
Lung function reference values are traditionally based on anthropometric factors, such as weight, height, sex, and age. FVC and FEV1 decline with age, while volumes and capacities, such as RV and FRC, increase. TLC, VC, RV, FVC and FEV1 are affected by height, since they are proportional to body size. This means that a tall individual will experience greater decrease in lung volumes as they get older. Some variables, such as FRC and ERV, decline exponentially with an increase in weight, to the extent that tidal volume in morbidly obese patients can be close to that of RV. Men have longer airways than women, causing greater specific resistance in the respiratory tract. The increased work of breathing to increase ventilation among women means that their consumption of oxygen is higher than men under similar conditions of physical intensity. Lung volumes are higher when the subject is standing than in other positions. DLCO is significantly higher in supine positions than in sitting or standing positions, but the difference between sitting and standing positions is not significant. Anthropometric characteristics are insufficient to explain differences in lung function between different ethnic groups, underlining the importance of considering other factors in addition to the conventional anthropometric measurements.
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Affiliation(s)
| | - Eduardo Márquez Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Laura María Roa Romero
- Departamento de Ingeniería Biomédica, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, España
| | - Francisco Ortega Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, España.
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