51
|
Quantitative Evaluation of Chronic Obstructive Pulmonary Disease and Risk Prediction of Acute Exacerbation by High-Resolution Computed Tomography. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6015766. [PMID: 35865341 PMCID: PMC9296276 DOI: 10.1155/2022/6015766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Objective It is imperative to popularize the tertiary prevention of chronic obstructive pulmonary disease (COPD) and to improve the diagnosis and treatment. Methods COPD patients were divided into mild (n = 18), moderate (n = 20), severe (n = 24), and extremely severe (n = 22) groups for performing high-resolution computed tomography (HRCT) and pulmonary function test. Serum procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) were detected, and the occurrence rate of acute exacerbation COPD (AECOPD) was recorded during a 12-months follow-up period. Results With an increase in the severity grade, the HRCT indexes, including emphysema index (EI), 1st and 15th percentile of inspiratory attenuation distribution (Perc1 and Perc15), ratio of expiratory/inspiratory mean lung density (MLDex/in) and lung volume (LVex/in), and ratio of the wall thickness to the outer diameter of the lumen (TDR), as well as percentage of the wall area to the total cross-sectional area (WA%) were increased with a decreased change in relative lung volume with attenuation values between −860 and −950 HU (RVC−860to −950) and lumen area (Ai). These were correlated with the ratio of forced expiratory volume in 1 sec (FEV1) over forced vital capacity (FVC) (FEV1/FVC), the percentage of FEV1 the predicted value (FEV1%), and ratio of residual volume to total lung volume (RV/TLC). Body mass index, MLDex/in, FEV1%, FEV1/FVC, and PCT had a predictive value to AECOPD, with the combined AUC of 0.812. Conclusions HRCT imaging effectively classifies the severity of COPD, which combined with BMI, PFT, and serum PCT can predict the risk of AECOPD.
Collapse
|
52
|
Kaminsky DA, Irvin CG. The Physiology of Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:575-589. [DOI: 10.1016/j.iac.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
53
|
Xiong XF, Zhu M, Wu HX, Fan LL, Cheng DY. Immunophenotype in acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study. Respir Res 2022; 23:137. [PMID: 35643501 PMCID: PMC9145461 DOI: 10.1186/s12931-022-02058-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/20/2022] [Indexed: 02/18/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease, and the immune inflammatory response is thought to play an important role in pathogenesis. However, the immunophenotype of patients with COPD is unknown. Herein, we evaluated the immunophenotype of patients with acute exacerbation of COPD (AECOPD). Methods A cross-sectional study was conducted in West China Hospital from September 2018 to October 2019. The proportion of CD4 + T lymphocyte subtypes (Th1, Th2, Th17 and Treg) and levels of serum cytokines in the peripheral blood of patients with AECOPD, stable COPD (SCOPD), healthy smokers (HSs)and healthy controls (HCs) were evaluated. Results A total of 15 HCs, 19 HSs, 42 patients with SCOPD, and 55 patients with AECOPD were included. Compared to patients with SCOPD, Th1 cells, Th17 cells, Treg cell ratio, Th1/Th2 cell ratio, and the levels of C-reactive protein, interleukin (IL)-6, and IL-10 were significantly increased in patients with AECOPD (P < 0.001), while the proportion of Th2 cells was significantly reduced (P < 0.01). The proportion of Th17 cells was positively correlated with COPD Assessment Test score (r = 0.266, P = 0.009), modified Medical Research Council dyspnea score (r = 0.858, P < 0.0001), and Th1 cell ratio (r = 0.403, P < 0.0001) and negatively correlated with forced vital capacity (r = − 0.367, P = 0.009) and proportion of Th2 cells (r = − 0.655, P < 0.0001). Conclusions The immunophenotype of patients with AECOPD shows abnormal activation of Th1, Th17, and Treg cells. There is a correlation between the proportion of Th17 cells and the severity of COPD; therefore, this may represent a novel index for the evaluation of COPD severity. Trial registration: China Clinical Trials Registry, ChiCTR1800018452, registered 19 September 2018, https://www.chictr.org.cn/index.aspx. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02058-x.
Collapse
|
54
|
Cohen J, Shekarnabi M, Destors M, Tamisier R, Bouzon S, Orkisz M, Ferretti GR, Pépin JL, Bayat S. Computed Tomography Registration-Derived Regional Ventilation Indices Compared to Global Lung Function Parameters in Patients With COPD. Front Physiol 2022; 13:862186. [PMID: 35721545 PMCID: PMC9202420 DOI: 10.3389/fphys.2022.862186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
CT registration-derived indices provide data on regional lung functional changes in COPD. However, because unlike spirometry which involves dynamic maximal breathing maneuvers, CT-based functional parameters are assessed between two static breath-holds, it is not clear how regional and global lung function parameters relate to each other. We assessed the relationship between CT-density change (dHU), specific volume change (dsV), and regional lung tissue deformation (J) with global spirometric and plethysmographic parameters, gas exchange, exercise capacity, dyspnoea, and disease stage in a prospective cohort study in 102 COPD patients. There were positive correlations of dHU, dsV, and J with spirometric variables, DLCO and gas exchange, 6-min walking distance, and negative correlations with plethysmographic lung volumes and indices of trapping and lung distension as well as GOLD stage. Stepwise regression identified FEV1/FVC (standardized β = 0.429, p < 0.0001), RV/TLC (β = −0.37, p < 0.0001), and BMI (β = 0.27, p=<0.001) as the strongest predictors of CT intensity-based metrics dHU, with similar findings for dsV, while FEV1/FVC (β = 0.32, p=<0.001) and RV/TLC (β = −0.48, p=<0.0001) were identified as those for J. These data suggest that regional lung function is related to two major pathophysiological processes involved in global lung function deterioration in COPD: chronic airflow obstruction and gas trapping, with an additional contribution of nutritional status, which in turn determines respiratory muscle strength. Our data confirm previous findings in the literature, suggesting the potential of CT image-based regional lung function metrics as the biomarkers of disease severity and provide mechanistic insight into the interpretation of regional lung function indices in patients with COPD.
Collapse
Affiliation(s)
- Julien Cohen
- Department of Radiology, Grenoble University Hospital, Grenoble, France
- Department of Imaging, Neuchatel Hospital Network (RHNE), Neuchatel, Switzerland
- *Correspondence: Julien Cohen, ; Mehdi Shekarnabi,
| | - Mehdi Shekarnabi
- Inserm UA07 STROBE Laboratory, Université Grenoble Alpes, Grenoble, France
- INSA-Lyon, CNRS, Inserm, CREATIS UMR 5220, University Lyon, Université Claude Bernard Lyon 1, Lyon, France
- *Correspondence: Julien Cohen, ; Mehdi Shekarnabi,
| | - Marie Destors
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France
- Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France
- Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France
| | - Sandrine Bouzon
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France
| | - Maciej Orkisz
- INSA-Lyon, CNRS, Inserm, CREATIS UMR 5220, University Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, Université Grenoble Alpes, Grenoble, France
- Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France
| | - Sam Bayat
- Inserm UA07 STROBE Laboratory, Université Grenoble Alpes, Grenoble, France
- Department of Pulmonology and Physiology, Grenoble University Hospital, Grenoble, France
| |
Collapse
|
55
|
Arellano-Orden E, Calero-Acuña C, Sanchez-Lopez V, Carrasco-Hernandez L, Márquez-Martín E, Ortega-Ruiz F, Otero-Candelera R, Marín-Hinojosa C, López-Campos JL. Inflammatory response in human lung cells stimulated with plasma from COPD patients. Multidiscip Respir Med 2022; 17:817. [PMID: 35692377 PMCID: PMC9179873 DOI: 10.4081/mrm.2022.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a condition resulting from a persistent inflammatory state in the airways even after smoking cessation. Intriguingly, the reasons behind this persistence of the inflammatory influx without smoking exposure have not been fully unraveled. We aimed to explore the hypothesis that systemic inflammation in COPD patients influences lung cell inflammatory response.
Methods: We cultured human lung fibroblast and human airway epithelial cell lines with plasma from COPD patients (four emphysematous-COPD, four asthma-COPD overlap, four chronic bronchitis-COPD, and four bronchiectasis-COPD), and four smokers or ex-smokers without COPD as controls. We measured Interleukine-8 (IL-8), C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9) in plasma and culture supernatants by ELISA.
Results: Cells stimulated with plasma from COPD patients and control subjects produced higher CRP, IL-8 and MMP-9 levels, an increase for COPD in CRP(p=0.039) in epithelial cells and IL-8(p=0.039) in fibroblasts and decrease for MMP-9(p=0.039) in fibroblasts. The response was higher in epithelial cells for IL-8(p=0.003) and in fibroblasts for MMP-9(p=0.063). The plasma from chronic bronchitis and bronchiectasis phenotypes induced higher IL-8 in fibroblasts.
Conclusions: Plasma from COPD patients increases the inflammatory response in lung epithelial cells and lung fibroblasts, with a different response depending on the cell type and clinical phenotype.
Collapse
|
56
|
Lundh L, Larsson K, Lindén A, Montgomery S, Palmberg L, Sandelowsky H. Biomarkers, Clinical Course, and Individual Needs in COPD Patients in Primary Care: The Study Protocol of the Stockholm COPD Inflammation Cohort (SCOPIC). Int J Chron Obstruct Pulmon Dis 2022; 17:993-1004. [PMID: 35528148 PMCID: PMC9075012 DOI: 10.2147/copd.s358056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/11/2022] [Indexed: 01/09/2023] Open
Abstract
Background To facilitate effective personalized medicine, primary health care needs better methods of assessing and monitoring chronic obstructive pulmonary disease (COPD). Aim This cohort study aims to investigate how biomarkers relate to clinical characteristics and COPD patients' subjective needs over time. Methods Patients (n=750) in different COPD severity according to the GOLD criteria and age- and sex-matched controls (n=750) will be recruited over a period of 5 years from 15 primary health care centers in Region Stockholm, Sweden, and followed for 10 years in the first instance. Data on patients' subjective needs will be collected via telephone/email, data on clinical/physiological variables (eg, symptoms, exacerbations, comorbidities, medications, smoking habits, lung function) from existing databases that are based on medical records, and data on biomarkers via repeated blood sampling. Quantitative and qualitative methods will be used. Initial results are expected after 2 years (feasibility test), and a larger body of evidence after 5 years. Discussion The study is expected to provide definitive and clinically useful scientific evidence about how biomarkers relate to clinical variables and patients' subjective needs. This new evidence will facilitate accurate, and personalized COPD management by the use of valid biomarkers. It will provide useful tools for primary care professionals and may facilitate optimal self-management.
Collapse
Affiliation(s)
- Lena Lundh
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Kjell Larsson
- Division of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Lindén
- Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Karolinska Severe COPD Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Epidemiology and Public Health, University College London, London, UK
| | - Lena Palmberg
- Division of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sandelowsky
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Correspondence: Hanna Sandelowsky, Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, Stockholm, SE-171 76, Sweden, Tel +46738902565, Email
| |
Collapse
|
57
|
Caspersen NF, Søyseth V, Lyngbakken MN, Berge T, Ariansen I, Tveit A, Røsjø H, Einvik G. Treatable Traits in Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the Akershus Cardiac Examination 1950 Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:165-180. [PMID: 35158418 PMCID: PMC9166336 DOI: 10.15326/jcopdf.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is often misdiagnosed. We aimed to estimate the prevalence of misdiagnosed COPD in middle-aged Norwegians, and to assess potentially treatable clinical traits in over- and undiagnosed individuals. METHODS AND FINDINGS The Akershus Cardiac Examination (ACE) 1950 Study is a population-based study of the 1950 birth cohort of Akershus county including 3706 participants aged 62-65 years at baseline. COPD was defined as a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio < lower limit of normal (LLN). Misdiagnosed COPD was defined according to self-reported COPD. A total of 259 (7.1%) participants had spirometry confirmed COPD. Of these, only 72 (28%) reported having COPD, thus 187 (72%) were undiagnosed. A total of 92 (2.5%) of the 164 particpants who reported having COPD had an FEV1/FVC ratio ≥ LLN and were overdiagnosed. They had lower lung function, and more respiratory symptoms, self-reported asthma, eosinophils, and sleep apnea than other non-COPD participants . The main predictor of being overdiagnosed was overweight. Spirometry in participants reporting wheezing or cough and current smokers or participants with ≥20 tobacco pack-year history would have identified 85% of the undiagnosed cases. CONCLUSION Both over- and underdiagnosis of COPD is frequent. Undiagnosed individuals have better lung function and less symptoms, but similar prevalence of comorbidities and systemic inflammation. Overdiagnosed individuals have treatable traits including asthma, eosinophilic inflammation, and sleep apnea. The main predictor of being overdiagnosed was being overweight.
Collapse
Affiliation(s)
- Nina Faksvåg Caspersen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vidar Søyseth
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Inger Ariansen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division for Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Gunnar Einvik
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
58
|
Baba RY, Zhang Y, Shao Y, Berger KI, Goldring RM, Liu M, Kazeros A, Rosen R, Reibman J. COPD in Smoking and Non-Smoking Community Members Exposed to the World Trade Center Dust and Fumes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074249. [PMID: 35409931 PMCID: PMC8999000 DOI: 10.3390/ijerph19074249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023]
Abstract
Background: The characteristics of community members exposed to World Trade Center (WTC) dust and fumes with Chronic Obstructive Pulmonary Disease (COPD) can provide insight into mechanisms of airflow obstruction in response to an environmental insult, with potential implications for interventions. Methods: We performed a baseline assessment of respiratory symptoms, spirometry, small airway lung function measures using respiratory impulse oscillometry (IOS), and blood biomarkers. COPD was defined by the 2019 GOLD criteria for COPD. Patients in the WTC Environmental Health Center with <5 or ≥5 pack year smoking history were classified as nonsmoker-COPD (ns-COPD) or smoker-COPD (sm-COPD), respectively. Main Results: Between August 2005 and March 2018, 467 of the 3430 evaluated patients (13.6%) fit criteria for COPD. Among patients with COPD, 248 (53.1%) were ns-COPD. Patients with ns-COPD had measures of large airway function (FEV1) and small airway measures (R5−20, AX) that were less abnormal than those with sm-COPD. More ns-COPD compared to sm-COPD had a bronchodilator (BD) response measured by spirometry (24 vs. 14%, p = 0.008) or by IOS (36 vs. 21%, p = 0.002). Blood eosinophils did not differ between ns-COPD and sm-COPD, but blood neutrophils were higher in sm-COPD compared to ns-COPD (p < 0.001). Those with sm-COPD were more likely to be WTC local residents than ns-COPD (p = 0.007). Conclusions: Spirometry findings and small airway measures, as well as inflammatory markers, differed between patients with ns-COPD and sm-COPD. These findings suggest potential for differing mechanisms of airway injury in patients with WTC environmental exposures and have potential therapeutic implications.
Collapse
Affiliation(s)
- Ridhwan Y. Baba
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (Y.Z.); (Y.S.); (M.L.)
| | - Yongzhao Shao
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (Y.Z.); (Y.S.); (M.L.)
| | - Kenneth I. Berger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Roberta M. Goldring
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health and Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (Y.Z.); (Y.S.); (M.L.)
| | - Angeliki Kazeros
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
| | - Rebecca Rosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - Joan Reibman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (R.Y.B.); (K.I.B.); (R.M.G.); (A.K.)
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
- Correspondence:
| |
Collapse
|
59
|
García Castillo E, Vargas G, García Guerra JA, López-Giraldo A, Alonso Pérez T. [Chronic Obstructive Pulmonary Disease]. OPEN RESPIRATORY ARCHIVES 2022; 4:100171. [PMID: 37497315 PMCID: PMC10369568 DOI: 10.1016/j.opresp.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is related to smoking as the main etiological agent although there are other risk factors that can interact influencing the development of the disease. The definition of COPD is based on three points: the presence of persistent respiratory symptoms, exposure to risk agents, and a non-reversible obstructive spirometric ratio. Forced spirometry with a bronchodilator test is necessary to confirm the diagnosis of COPD, however, attempts are being made to develop alternative methods for screening given the current significant underdiagnosis of this pathology.In order to advance in a more personalized medicine for the patient, classification tools have been adopted such as clinical phenotypes and treatable traits, allowing treatments to be adapted according to the characteristics of the patients. Non-pharmacological treatment (smoking cessation, vaccination, physical exercise...) are essential for the management of the disease, as well as pharmacological treatment based on clinical phenotypes. Eosinophils have become a key marker when establishing treatment with inhaled glucocorticoids.In the follow-up of the disease, it is very relevant to evaluate the degree of control being a fundamental element the absence of exacerbations given their implications in mortality, morbidity and quality of life of patients. More studies are needed to better define the phenotypes of exacerbations and their biomarkers.
Collapse
Affiliation(s)
- Elena García Castillo
- Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, España. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Gianna Vargas
- Servicio de Neumología, Hospital Universitario Clínico San Carlos, Madrid, España
| | | | | | - Tamara Alonso Pérez
- Servicio de Neumología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, España. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| |
Collapse
|
60
|
Li FJ, Surolia R, Singh P, Dsouza KG, Stephens CT, Wang Z, Liu RM, Bae S, Kim YI, Athar M, Dransfield MT, Antony VB. Fibrinogen mediates cadmium-induced macrophage activation and serves as a predictor of cadmium exposure in chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol 2022; 322:L593-L606. [PMID: 35200041 PMCID: PMC8993524 DOI: 10.1152/ajplung.00475.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/27/2022] [Accepted: 02/20/2022] [Indexed: 11/22/2022] Open
Abstract
The etiologies of chronic obstructive pulmonary disease (COPD) remain unclear. Cadmium (Cd) causes both pulmonary fibrosis and emphysema; however, the predictors for Cd exposure and the mechanisms by which Cd causes COPD remain unknown. We demonstrated that Cd burden was increased in lung tissue from subjects with COPD and this was associated with cigarette smoking. Fibrinogen levels increased markedly in lung tissue of patients with smoked COPD compared with never-smokers and control subjects. Fibrinogen concentration also correlated positively with lung Cd load, but inversely with the predicted % of FEV1 and FEV1/FVC. Cd enhanced the secretion of fibrinogen in a cdc2-dependent manner, whereas fibrinogen further mediated Cd-induced peptidylarginine deiminase 2 (PAD2)-dependent macrophage activation. Using lung fibroblasts from CdCl2-treated Toll-like receptor 4 (TLR4) wild-type and mutant mice, we demonstrated that fibrinogen enhanced Cd-induced TLR4-dependent collagen synthesis and cytokine/chemokine production. We further showed that fibrinogen complexed with connective tissue growth factor (CTGF), which in turn promoted the synthesis of plasminogen activator inhibitor-2 (PAI-2) and fibrinogen and inhibited fibrinolysis in Cd-treated mice. The amounts of fibrinogen were increased in the bronchoalveolar lavage fluid (BALF) of Cd-exposed mice. Positive correlations were observed between fibrinogen with hydroxyproline. Our data suggest that fibrinogen is involved in Cd-induced macrophage activation and increases in fibrinogen in patients with COPD may be used as a marker of Cd exposure and predict disease progression.
Collapse
Affiliation(s)
- Fu Jun Li
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ranu Surolia
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pooja Singh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin G Dsouza
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Crystal T Stephens
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zheng Wang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rui-Ming Liu
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Young-Il Kim
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohammad Athar
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Veena B Antony
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
61
|
Si J, Choi Y, Raes J, Ko G, You HJ. Sputum Bacterial Metacommunities in Distinguishing Heterogeneity in Respiratory Health and Disease. Front Microbiol 2022; 13:719541. [PMID: 35432240 PMCID: PMC9008356 DOI: 10.3389/fmicb.2022.719541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objective Cluster-based analysis, or community typing, has been attempted as a method for studying the human microbiome in various body niches with the aim of reducing variations in the bacterial composition and linking the defined communities to host health and disease. In this study, we have presented the bacterial subcommunities in the healthy and the diseased population cohorts and have assessed whether these subcommunities can distinguish different host health conditions. Methods We performed community typing analysis on the sputum microbiome dataset obtained from a healthy Korean twin-family cohort (n = 202) and an external chronic obstructive pulmonary disease (COPD) cohort (n = 324) and implemented a networks analysis to investigate the associations of bacterial metacommunities with host health parameters and microbial interactions in disease. Results The analysis of the sputum microbiome of a healthy Korean cohort revealed high levels of interindividual variation, which was driven by two dominant bacteria: Neisseria and Prevotella. Community typing of the cohort samples identified three metacommunities, namely, Neisseria 1 (N1), Neisseria 2 (N2), and Prevotella (P), each of which showed different functional potential and links to host traits (e.g., triglyceride levels, waist circumference, and levels of high-sensitivity C-reactive protein). In particular, the Prevotella-dominant metacommunity showed a low-community diversity, which implies an adverse health association. Network analysis of the healthy twin cohort illustrated co-occurrence of Prevotella with pathogenic anaerobic bacteria; this bacterial cluster was negatively associated with high-density lipoproteins but positively correlated with waist circumference, blood pressure, and pack-years. Community typing of the external COPD cohort identified three sub-metacommunities: one exclusively comprising healthy subjects (HSs) and the other two (CS1 and CS2) comprising patients. The two COPD metacommunities, CS1 and CS2, showed different abundances of specific pathogens, such as Serratia and Moraxella, as well as differing functional potential and community diversity. Network analysis of the COPD cohort showed enhanced bacterial coexclusions in the CS metacommunities when compared with HS metacommunity. Conclusion Overall, our findings point to a potential association between pulmonary Prevotella and host health and disease, making it possible to implement community typing for the diagnosis of heterogenic respiratory disease.
Collapse
Affiliation(s)
- Jiyeon Si
- Medical Science Research Institute, School of Medicine, Sungkyunkwan University (SKKU), Suwon, South Korea
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Center for Human and Environmental Microbiome, Seoul National University, Seoul, South Korea
| | - Yongbin Choi
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Center for Human and Environmental Microbiome, Seoul National University, Seoul, South Korea
| | - Jeroen Raes
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Leuven, Belgium
- VIB-KU Leuven Center for Microbiology, Leuven, Belgium
| | - Gwangpyo Ko
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Center for Human and Environmental Microbiome, Seoul National University, Seoul, South Korea
- Bio-MAX/N-Bio, Seoul National University, Seoul, South Korea
- KobioLabs, Seoul, South Korea
- *Correspondence: Gwangpyo Ko,
| | - Hyun Ju You
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Center for Human and Environmental Microbiome, Seoul National University, Seoul, South Korea
- Bio-MAX/N-Bio, Seoul National University, Seoul, South Korea
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
- Hyun Ju You,
| |
Collapse
|
62
|
Inflammatory Endotype-Associated Airway Resistome in Chronic Obstructive Pulmonary Disease. Microbiol Spectr 2022; 10:e0259321. [PMID: 35311590 PMCID: PMC9045194 DOI: 10.1128/spectrum.02593-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Antimicrobial resistance is a global concern in chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD). The collection of antibiotic resistance genes or resistome in human airways may underlie the resistance. COPD is heterogeneous, and understanding the airway resistome in relation to patient phenotype and endotype may inform precision antibiotic therapy. Here, we characterized the airway resistome for 94 COPD participants at stable disease. Among all demographic and clinical factors, patient inflammatory endotype was associated with the airway resistome. There were distinct resistome profiles between patients with neutrophilic or eosinophilic inflammation, two primary inflammatory endotypes in COPD. For neutrophil-predominant COPD, the resistome was dominated by multidrug resistance genes. For eosinophil-predominant COPD, the resistome was diverse, with an increased portion of patients showing a macrolide-high resistome. The differential antimicrobial resistance pattern was validated by sputum culture and in vitro antimicrobial susceptibility testing. Ralstonia and Pseudomonas were the top contributors to the neutrophil-associated resistome, whereas Campylobacter and Aggregatibacter contributed most to the eosinophil-associated resistome. Multiomic analyses revealed specific host pathways and inflammatory mediators associated with the resistome. The arachidonic acid metabolic pathway and matrix metallopeptidase 8 (MMP-8) exhibited the strongest associations with the neutrophil-associated resistome, whereas the eosinophil chemotaxis pathway and interleukin-13 (IL-13) showed the greatest associations with the eosinophil-associated resistome. These results highlight a previously unrecognized link between inflammation and the airway resistome and suggest the need for considering patient inflammatory subtype in decision-making about antibiotic use in COPD and broader chronic respiratory diseases. IMPORTANCE Antibiotics are commonly prescribed for both acute and long-term prophylactic treatment in chronic airway disorders, such as chronic obstructive pulmonary disease (COPD), and the rapid growth of antibiotic resistance is alarming globally. The airway harbors a diverse collection of microorganisms known as microbiota, which serve as a reservoir for antibiotic resistance genes or the resistome. A comprehensive understanding of the airway resistome in relation to patient clinical and biological factors may help inform decisions to select appropriate antibiotics for clinical therapies. By deep multiomic profiling and in vitro phenotypic testing, we showed that inflammatory endotype, the underlying pattern of airway inflammation, was most strongly associated with the airway resistome in COPD patients. There were distinct resistome profiles between neutrophil-predominant and eosinophil-predominant COPD that were associated with different bacterial species, host pathways, and inflammatory markers, highlighting the need of considering patient inflammatory status in COPD antibiotic management.
Collapse
|
63
|
Martinez-Garcia MA, Miravitlles M. The Impact of Chronic Bronchial Infection in COPD: A Proposal for Management. Int J Chron Obstruct Pulmon Dis 2022; 17:621-630. [PMID: 35355582 PMCID: PMC8958724 DOI: 10.2147/copd.s357491] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Up to 50% of patients with chronic obstructive pulmonary disease (COPD) in stable state may carry potentially pathogenic microorganisms (PPMs) in their airways. The presence of PPMs has been associated with increased symptoms, increased risk and severity of exacerbations, a faster decline in lung function and impairment in quality of life. Although some clinical trials have demonstrated a reduction in exacerbations in patients chronically treated with systemic antibiotics, particularly macrolides, the selection of patients was based on the previous frequency of exacerbations and not on the presence of PPMs in their airways. Therefore, unlike in bronchiectasis, there is a lack of evidence-based recommendations for assessment and treatment of the presence of PPMs in either single or repeated isolations in COPD. In this article, we propose that chronic bronchial infection (CBI) in COPD be defined as the isolation of the same PPM in at least three sputum samples separated by more than one month; we review the impact of CBI on the natural course of COPD and suggest a course of action in patients with a single isolation of a PPM or suspected CBI. Antibiotic treatment in stable COPD should be recommended based on four main criteria: a) the presence of comorbid bronchiectasis, b) the demonstration of a single or multiple isolation of the same PPM, c) the clinical impact of CBI on the patients, and d) the type of PPM, either Pseudomonas aeruginosa or non-pseudomonal PPM. These recommendations are derived from evidence generated in patients with bronchiectasis and, until new evidence specifically obtained in COPD is available, they may help in the management of these challenging patients with COPD. Existing evidence suggests that inhaled therapy is insufficient to manage patients with moderate-to-severe COPD, frequent exacerbations, and CBI. New studies must be conducted in this particularly demanding population.
Collapse
Affiliation(s)
- Miguel Angel Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Correspondence: Marc Miravitlles, Pneumology Department, Vall d’Hebron Barcelona Hospital Campus, P. Vall d’Hebron 119-129, Barcelona, 08035, Spain, Tel +34932746083, Email
| |
Collapse
|
64
|
París JM, Sardón AS. Papel de GesEPOC en Atención Primaria. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497313 PMCID: PMC10369602 DOI: 10.1016/j.opresp.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
65
|
Pompe E, Mohamed Hoesein FAA. Role of visual assessment of chronic obstructive pulmonary disease on chest CT: beauty is in the eye of the beholder. J Thorac Dis 2022; 13:6936-6939. [PMID: 35070377 PMCID: PMC8743402 DOI: 10.21037/jtd-21-1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
66
|
Medina-Mirapeix F, Bernabeu-Mora R, Gacto-Sánchez M, Montilla-Herrador J, Escolar-Reina P, Sánchez-Martínez MP. The prognosis of pre-frail chronic obstructive pulmonary disease patients for hospitalizations and mortality depends on their level of functional physical performance. Chron Respir Dis 2022; 19:14799731221119810. [PMID: 36071021 PMCID: PMC9459488 DOI: 10.1177/14799731221119810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To determine if pre-frail Chronic obstructive pulmonary disease (COPD)
patients with poor and non-poor performance in the five-repetition
sit-to-stand test (5-STS) had a worse prognosis for hospitalization and
mortality at 2 years and for mortality at 5 years than non-frail
patients. Methods We prospectively included patients with stable COPD, between 40 and 80 years,
from a hospital in Spain. Patients were classified according their
performance on the 5-STS test and level of frailty. Timing, number of
hospitalizations, length of stay, and timing and rate of mortality were
outcome measures. Patients were followed for 2 years for exacerbations and
for 5 years for mortality. Kaplan-Meier curves and univariate and
multivariate Cox proportional-hazard analyses, ANOVA tests and univariate
and multivariate linear and logistic regression models were used. Results Of the 125 patients included, 25.6% were pre-frail with poor performance, 57%
pre-frail with non-poor performance, and 17.4% non-frail with non-poor
performance. Pre-frail patients with poor performance had a higher number of
hospitalizations (adjusted beta: 0.49; 95% CI: 0.01–0.96), mortality rates
(odds ratio: 11.33; 95% CI: 1.15–110.81), and risk at 5 years (adjusted
hazard ratio: 8.77; 95% CI: 1.02–75.51) than non-frail patients. Pre-frail
patients with poor performance also had worse prognoses than non-frail
patients with respect to length of hospital stays (increased by 4.16 days)
and timing to first hospitalization (HR: 6.01) in unadjusted models, but not
when adjusted. Conclusion The COPD prognosis of pre-frail patients with respect to the number of
exacerbations with hospitalization and the timing and rate of mortality is
dependent of functional performance.
Collapse
Affiliation(s)
- Francesc Medina-Mirapeix
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Roberto Bernabeu-Mora
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain.,Department of Pneumology, 16270Hospital General Universitario Morales Meseguer, Murcia, Spain.,Department of Internal Medicine, 16751University of Murcia, Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - María Piedad Sánchez-Martínez
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| |
Collapse
|
67
|
Carrasco Hernández L, Caballero Eraso C, Ruiz-Duque B, Abad Arranz M, Márquez Martín E, Calero Acuña C, Lopez-Campos JL. [Translated article] Deconstructing phenotypes in COPD: An analysis of the TRACE cohort. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2020.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
68
|
Stratification of COPD patients towards personalized medicine: reproduction and formation of clusters. Respir Res 2022; 23:336. [PMID: 36494786 PMCID: PMC9733189 DOI: 10.1186/s12931-022-02256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The global initiative for chronic obstructive lung disease (GOLD) 2020 emphasizes that there is only a weak correlation between FEV1, symptoms and impairment of the health status of patients with chronic obstructive pulmonary disease (COPD). Various studies aimed to identify COPD phenotypes by cluster analyses, but behavioral aspects besides smoking were rarely included. METHODS The aims of the study were to investigate whether (i) clustering analyses are in line with the classification into GOLD ABCD groups; (ii) clustering according to Burgel et al. (Eur Respir J. 36(3):531-9, 2010) can be reproduced in a real-world COPD cohort; and (iii) addition of new behavioral variables alters the clustering outcome. Principal component and hierarchical cluster analyses were applied to real-world clinical data of COPD patients newly referred to secondary care (n = 155). We investigated if the obtained clusters paralleled GOLD ABCD subgroups and determined the impact of adding several variables, including quality of life (QOL), fatigue, satisfaction relationship, air trapping, steps per day and activities of daily living, on clustering. RESULTS Using the appropriate corresponding variables, we identified clusters that largely reflected the GOLD ABCD groups, but we could not reproduce Burgel's clinical phenotypes. Adding six new variables resulted in the formation of four new clusters that mainly differed from each other in the following parameters: number of steps per day, activities of daily living and QOL. CONCLUSIONS We could not reproduce previously identified clinical COPD phenotypes in an independent population of COPD patients. Our findings therefore indicate that COPD phenotypes based on cluster analysis may not be a suitable basis for treatment strategies for individual patients.
Collapse
|
69
|
Martínez-García MÁ, Labarca G. Sleep apnea phenotypes: do not forget the external validation. Sleep 2021; 44:6357666. [PMID: 34432066 DOI: 10.1093/sleep/zsab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBEres de enfermedades respiratorias, ISCIII, Madrid, Spain
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
70
|
Cardoso J, Ferreira AJ, Guimarães M, Oliveira AS, Simão P, Sucena M. Treatable Traits in COPD - A Proposed Approach. Int J Chron Obstruct Pulmon Dis 2021; 16:3167-3182. [PMID: 34824530 PMCID: PMC8609199 DOI: 10.2147/copd.s330817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/03/2021] [Indexed: 12/20/2022] Open
Abstract
The well-recognized individual heterogeneity within COPD patients has led to a growing interest in greater personalization in the approach of these patients. Thus, the treatable traits strategy has been proposed as a further step towards precision medicine in the management of chronic airway disease, both in stable phase and acute exacerbations. The aim of this paper is to perform a critical review on the treatable traits strategy and propose a guide to approach COPD patients in the light of this new concept. An innovative stepwise approach is proposed - a multidisciplinary model based on two distinct phases, with the potential to be implemented in both primary care and hospital settings. The first phase is the initial and focused assessment of a selected subset of treatable traits, which should be addressed in all COPD patients in both settings (primary care and hospital). As some patients may present with advanced disease at diagnosis or may progress despite this initial treatment requiring a more specialized assessment, they should progress to a second phase, in which a broader approach is recommended. Beyond stable COPD, we explore how the treatable traits strategy may be applied to reduce the risk of future exacerbations and improve the management of COPD exacerbations. Since many treatable traits have already been related to exacerbation risk, the strategy proposed here represents an opportunity to be proactive. Although it still lacks prospective validation, we believe this is the way forward for the future of the COPD approach.
Collapse
Affiliation(s)
- João Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.,NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - António Jorge Ferreira
- Pulmonology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Guimarães
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
| | - Ana Sofia Oliveira
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Lisboa, Portugal
| | - Paula Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Maria Sucena
- Pulmonology Department, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal.,Lung Function and Ventilation Unit, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| |
Collapse
|
71
|
Zhang C, Wang Y, Zhang M, Su X, Lei T, Yu H, Liu J. Monoclonal Antibodies Targeting IL-5 or IL-5Rα in Eosinophilic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:754268. [PMID: 34795588 PMCID: PMC8594629 DOI: 10.3389/fphar.2021.754268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although the predominant airway inflammation in chronic obstructive pulmonary disease (COPD) is neutrophilic, approximately 20-40% of COPD patients present with eosinophilic airway inflammation. Compared with non-eosinophilic COPD patients, eosinophilic COPD patients are characterized by a greater number of total exacerbations and higher hospitalization rates. Furthermore, anti-interleukin-5 (IL-5) therapy, consisting of monoclonal antibodies (mAbs) targeting IL-5 or IL-5 receptor α (IL-5Rα), has been proven to be effective in severe eosinophilic asthma. This meta-analysis aimed to determine the efficacy and safety of anti-IL-5 therapy in eosinophilic COPD. Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to August 2020 (updated in June 2021) to identify studies comparing anti-IL-5 therapy (including mepolizumab, benralizumab, and reslizumab) with placebo in eosinophilic COPD patients. Results: Anti-IL-5 therapy was associated with a decrease in acute exacerbation rate (RR 0.89; 95% CI 0.84 to 0.95, I 2 = 0%) and the severe adverse events (RR 0.90; 95% CI 0.84 to 0.97, I 2 = 0%). However, no significant improvement was observed in pre-bronchodilator forced expiratory volume in 1 s (FEV1) (WMD 0.01; 95% CI -0.01 to 0.03, I 2 = 25.9%), SGRQ score (WMD -1.17; 95% CI -2.05 to -0.29, I 2 = 0%), and hospital admission rate (RR 0.91; 95% CI 0.78 to 1.07, I 2 = 20.8%). Conclusion: Anti-IL-5 therapy significantly reduced the annual acute exacerbation rate and severe adverse events in eosinophilic COPD patients. However, it did not improve lung function, quality of life, and hospitalization rate.
Collapse
Affiliation(s)
- Chuchu Zhang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Yalei Wang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Meng Zhang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Xiaojie Su
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Ting Lei
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Haichuan Yu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Jian Liu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lanzhou, China
| |
Collapse
|
72
|
Hussain MS, Sharma P, Dhanjal DS, Khurana N, Vyas M, Sharma N, Mehta M, Tambuwala MM, Satija S, Sohal SS, Oliver BGG, Sharma HS. Nanotechnology based advanced therapeutic strategies for targeting interleukins in chronic respiratory diseases. Chem Biol Interact 2021; 348:109637. [PMID: 34506765 DOI: 10.1016/j.cbi.2021.109637] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
Both communicable and non-communicable chronic respiratory conditions have accorded for suffering of millions of people of all ages and stated to be leading cause of death, morbidity, economic and social pressures, and disability-adjusted life-years (DALYs) worldwide. These illnesses impair patient's health and negatively impacts families and society, particularly in low and middle-income countries. Chronic respiratory diseases (CRDs) affect different organs of respiratory system, involving airways, parenchyma, and pulmonary vasculature. As the number of respiratory diseases are exponentially escalating but still the stakeholders are not paying attention towards its serious complications. Currently, the treatment being used primarily focusses only on alleviating symptoms of these illness rather delivering the therapeutic agent at target site for optimal care and/or prevention. Lately, extensive research is being conducted on airways and systemic inflammation, oxidative stress, airway, or parenchymal rehabilitation. From which macrophages, neutrophils, and T cells, as well as structural cells as fibroblasts, epithelial, endothelial, and smooth muscle cells have been found to be active participants that are involved in these chronic respiratory diseases. The pathogenesis of all these chronic respiratory diseases gets caused differently via mediators and proteins, including cytokines, chemokines, growth factors and oxidants. Presently, the target of prescription therapies is to reduce the inflammation of airways and relieve the airway contraction. In all studies, cytokines have been found to play an imperative role in fostering chronic airway inflammation and remodelling. Owing to the limitations of conventional treatments, the current review aims to summarize the current knowledge about the chronic respiratory disease and discuss further about the various conventional methods that can be used for treating this ailment. Additionally, it also highlights and discusses about the advanced drug delivery system that are being used for targeting the interleukins for the treatment of CRDs.
Collapse
Affiliation(s)
- Md Sadique Hussain
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Parvarish Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Daljeet Singh Dhanjal
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Manish Vyas
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Neha Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Meenu Mehta
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Murtaza M Tambuwala
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Londonderry, BT52 1SA, United Kingdom
| | - Saurabh Satija
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, 7248, Australia
| | - Brian G G Oliver
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, 2007, Australia; Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Hari S Sharma
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| |
Collapse
|
73
|
Cheng SL, Lin CH, Chu KA, Chiu KL, Lin SH, Lin HC, Ko HK, Chen YC, Chen CH, Sheu CC, Huang WC, Yang TM, Wei YF, Chien JY, Wang HC, Lin MC. Update on guidelines for the treatment of COPD in Taiwan using evidence and GRADE system-based recommendations. J Formos Med Assoc 2021; 120:1821-1844. [PMID: 34210585 DOI: 10.1016/j.jfma.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/14/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has significant contributions to morbidity and mortality world-wide. Early symptoms of COPD are not readily distinguishable, resulting in a low rate of diagnosis and intervention. Different guidelines and recommendatations for the diagnosis and treatment of COPD exist globally. The first edition of clinical practice guidelines for COPD was published in 2016 by the Ministry of Health and Welfare in Taiwan in collaboration with the Taiwan evidence-based medicine association and Cochrane Taiwan, and was revised in 2019 in order to update recent diagnostic and therapeutic modalities for COPD and its acute exacerbation. This revised guideline covered a range of topics highlighted in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, including strategies for the diagnosis, assessment, monitoring, and management of stable COPD and exacerbations, with particular focus on evidence from Taiwan. The recommendations included in the revised guideline were formed based on a comprehensive systematic review or meta-analysis of specific clinical issues identified by an expert panel that surveyed relevant scientific evidence in the literature and guidelines published by the clinical communities and organizations nationally and internationally. The guidelines and recommendations are applicable to the clinical settings in Taiwan. We expect this revised guideline to facilitate the diagnosis, treatment and management of patients with COPD by physicians and health care professionals in Taiwan. Adaptations of the materials included herein for educational and training purposes is encouraged.
Collapse
Affiliation(s)
- Shih-Lung Cheng
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Kuo-An Chu
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-baccalaureate Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Horng-Chyuan Lin
- Lin-Kou Medical Center of Chang Gung Memorial Hospital, Kwei-San, Tao-Yan, Taiwan
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Che Chen
- Kaohsiung Chang Gung MemoriaI Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Hung Chen
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chang Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsung-Ming Yang
- Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Feng Wei
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Meng-Chih Lin
- Kaohsiung Chang Gung MemoriaI Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
74
|
Marcos PJ, Otero González I, Pernas Ónega Y, Delgado-Roel M, Montero-Martínez C. Prevalence of Clinical COPD Phenotypes in Patients Who Are Candidates for Lung Transplantation, Complications and Post-Transplant Survival. OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496834 PMCID: PMC10369550 DOI: 10.1016/j.opresp.2021.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Introduction The prevalence of COPD phenotypes that are referred for assessment for lung transplantation is unknown, as well as whether specific phenotype influences post-transplant evolution in those patients who receive it. Material and methods Ambispective observational study without intervention. The main objective was to know the prevalence of the different COPD phenotypes of the patients referred for the evaluation of a lung transplant. Secondary objective were to compare their clinical characteristics, to perform an analysis of post-transplant survival or complications according to their phenotype. Results 502 patients were evaluated for lung transplantation, of which 173 met the study criteria. 31.21% of the patients were discarded for transplantation on a first visit. The final cohort of potential transplant candidates who completed the pre-transplant study was 119 (69%) and 47 finally received a lung transplant (39.5%). The most frequent COPD phenotype evaluated for lung transplantation was the exacerbator (59%), followed by the non-exacerbator (38%) and the Asthma COPD Overlap [ACO] (3%). 59.8% of the exacerbator-phenotype patients assessed did not complete the pre-transplant study. Exacerbator-phenotype patients have a lower post-transplant survival (1115.1 days [standard deviation-DE-587]) vs. ACO: 1432 days [DE 507.5] and Non-exacerbators: 1317.8 days [DE 544.7] p = 0.16), although this difference has not been statistically significant. Conclusions The most frequent COPD phenotype assessed for lung transplantation is the exacerbator, although more than half of these patients fail to complete the pre-transplant study.
Collapse
|
75
|
Souweine JS, Pasquier G, Kuster N, Rodriguez A, Patrier L, Morena M, Badia E, Raynaud F, Chalabi L, Raynal N, Ohresser I, Hayot M, Mercier J, Quintrec ML, Gouzi F, Cristol JP. Dynapaenia and sarcopaenia in chronic haemodialysis patients: do muscle weakness and atrophy similarly influence poor outcome? Nephrol Dial Transplant 2021; 36:1908-1918. [PMID: 33306128 DOI: 10.1093/ndt/gfaa353] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sarcopaenia, defined as a decline in both muscle mass and function, has been recognized as a major determinant of poor outcome in haemodialysis (HD) patients. It is generally assumed that sarcopaenia is driven by muscle atrophy related to protein-energy wasting. However, dynapaenia, defined as weakness without atrophy, has been characterized by a different disease phenotype from sarcopaenia. The aim of this study was to compare the characteristics and prognosis of sarcopaenic and dynapaenic patients among a prospective cohort of chronic HD (CHD) patients. METHODS Two hundred and thirty-two CHD patients were enrolled from January to July 2016 and then followed prospectively until December 2018. At inclusion, weakness and atrophy were, respectively, evaluated by maximal voluntary force (MVF) and creatinine index (CI). Sarcopaenia was defined as the association of weakness and atrophy (MVF and CI below the median) while dynapaenia was defined as weakness not related to atrophy (MVF below the median, and CI above the median). RESULTS From a total of 187 prevalent CHD patients [65% of men, age 65.3 (49.7-82.0) years], 44 died during the follow-up period of 23.7 (12.4-34.9) months. Sarcopaenia and dynapaenia were observed in 33.7 and 16% of the patients, respectively. Compared with patients with sarcopaenia, patients with dynapaenia were younger and with a lower Charlson score. In contrast, mortality rate was similar in both groups (38 and 27%, respectively). After adjustment for age, sex, lean tissue index, serum albumin, high-sensitivity C-reactive protein (hs-CRP), haemoglobin (Hb), normalized protein catabolic rate (nPCR), dialysis vintage and Charlson score, only patients with dynapaenia were at increased risk of death [hazard ratio (HR) = 2.99, confidence interval 1.18-7.61; P = 0.02]. CONCLUSIONS Screening for muscle functionality is highly warranted to identify patients with muscle functional impairment without muscle atrophy. In contrast to sarcopaenia, dynapaenia should appear as a phenotype induced by uraemic milieu, characterized by young patients with low Charlson score and poor prognosis outcome independently of serum albumin, hs-CRP, Hb, nPCR and dialysis vintage.
Collapse
Affiliation(s)
- Jean-Sébastien Souweine
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Grégoire Pasquier
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Nils Kuster
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | | | | | - Marion Morena
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Eric Badia
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Fabrice Raynaud
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | | | | | | | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Department of Physiology, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Jacques Mercier
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Department of Physiology, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Fares Gouzi
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Department of Physiology, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, University of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| |
Collapse
|
76
|
Inhaled Corticosteroids and the Lung Microbiome in COPD. Biomedicines 2021; 9:biomedicines9101312. [PMID: 34680429 PMCID: PMC8533282 DOI: 10.3390/biomedicines9101312] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
The Global Initiative for Chronic Obstructive Lung Disease 2021 Report recommends inhaled corticosteroid (ICS)-containing regimens as part of pharmacological treatment in patients with chronic obstructive lung disease (COPD) and frequent exacerbations, particularly with eosinophilic inflammation. However, real-world studies reveal overprescription of ICS in COPD, irrespective of disease presentation and inflammatory endotype, leading to increased risk of side effects, mainly respiratory infections. The optimal use of ICS in COPD therefore remains an area of intensive research, and additional biomarkers of benefit and risk are needed. Although the interplay between inflammation and infection in COPD is widely acknowledged, the role of the microbiome in shaping lower airway inflammation has only recently been explored. Next-generation sequencing has revealed that COPD disease progression and exacerbation frequency are associated with changes in the composition of the lung microbiome, and that the immunosuppressive effects of ICS can contribute to potentially deleterious airway microbiota changes by increasing bacterial load and the abundance of potentially pathogenic taxa such as Streptococcus and Haemophilus. Here, we explore the relationship between microbiome, inflammation, ICS use and disease phenotype. This relationship may inform the benefit:risk assessment of ICS use in patients with COPD and lead to more personalised pharmacological management.
Collapse
|
77
|
Naval E, González MC, Giraldós S, Calatayud J, Jornet M, Lluch I, Meseguer M, Cubillan JJR, Viña J, Tarazona-Santabalbina FJ. Frailty Assessment in a Stable COPD Cohort: Is There a COPD-Frail Phenotype? COPD 2021; 18:525-532. [PMID: 34503389 DOI: 10.1080/15412555.2021.1975670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The frailty syndrome increases the morbidity/mortality in older adults, and several studies have shown a higher prevalence of this syndrome in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to identify the characteristics of frail patients with COPD to define a new phenotype called "COPD-frail." We conducted a cross-sectional study in a cohort of patients with stable COPD, classified as either frail, pre-frail, or non-frail. Sociodemographic, clinical, and biochemical variables were compared between the three groups of patients. The study included 127 patients, of which 31 were frail, 64 were pre-frail, and 32 non-frail. All subjects had FEV1/FVC below the lower limit of normal (range Z-score: -1.66 and -5.32). Patients in the frail group showed significantly higher scores in the mMRC (modified Medical Research Council) scale, the CAT (COPD Assessment Test), and the BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index. They also showed differences in symptoms according to GOLD (Global Initiative for Chronic Obstructive Lung Disease), as well as more COPD exacerbations, less physical activity, more anxiety and depression symptoms based on HADS (Hospital Anxiety and Depression Scale), and lower hemoglobin, hematocrit, and 25-hydroxycholecalciferol levels. Variables with independent association with frailty included the mMRC score, the HAD index for depression and age. In summary, differential characteristics of frail patients with COPD encourage the definition of a "COPD-frail" phenotype that-if identified early-would allow performing interventions to prevent a negative impact on the morbidity/mortality of these patients.
Collapse
Affiliation(s)
- Elsa Naval
- Department of Pneumology, Hospital Universitari La Ribera, Alzira, Valencia, Spain
| | | | - Sonia Giraldós
- Department of Pneumology, Hospital Universitari La Ribera, Alzira, Valencia, Spain
| | - Julia Calatayud
- Departament de Matemàtiques, Universitat Jaume I Castelló, Valencia, Spain
| | - Marc Jornet
- Departament de Matemàtiques, Universitat Jaume I Castelló, Valencia, Spain
| | - Inmaculada Lluch
- Department of Pneumology, Hospital Universitari La Ribera, Alzira, Valencia, Spain
| | - Maria Meseguer
- Department of Pneumology, Hospital Universitari La Ribera, Alzira, Valencia, Spain
| | | | - José Viña
- Departament de Fisiología, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, CIBERFES, Madrid, Spain
| | - Francisco José Tarazona-Santabalbina
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, CIBERFES, Madrid, Spain.,Department of Geriatric Medicine, Hospital Universitari La Ribera, Alzira, Valencia, Spain
| |
Collapse
|
78
|
Yang M, Yang T, Li X, Li D, Liao Z, Shen Y, Xu D, Chen L, Wen F. Clinical Predictors of High Blood Eosinophils in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:2467-2474. [PMID: 34483658 PMCID: PMC8409512 DOI: 10.2147/copd.s324511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Elevated blood eosinophils have been implicated in chronic obstructive pulmonary disease (COPD) progression and exacerbation. We aim to investigate clinical predictors of high blood eosinophils in a Chinese COPD cohort. Patients and Methods We conducted a retrospective cohort study in Sichuan province, a Southwest province with high prevalence of COPD in China. All patients in this cohort were extracted from the Chinese Pulmonary Health study, a large cross-sectional study on COPD epidemiology in China. Demographics, personal and family history, living condition, spirometry and blood eosinophil counts were obtained. Univariate and multiple linear regression analyses were performed to determine predictors of high blood eosinophils. Results A total of 375 COPD patients were included in this cohort. The median absolute blood eosinophil count was 138.8 cells/μL, and the prevalence of COPD with high blood eosinophils was 66.7% and 14.7% when using the thresholds of 100 cells/μL and 300 cells/μL, respectively. Univariate analyses indicated that male gender, lower body mass index, high-density lipoprotein (HDL), lower family income, raising pets and biomass use were significantly associated with high blood eosinophils (p < 0.05). Multiple linear regression model further revealed male gender (unstandardized coefficient (B)=66.125, 95% confidence intervals (CI) 16.350 to 115.900, p=0.009), age (B=2.819, 95% CI 0.639 to 5.000, p=0.012) predicted high blood eosinophil level, whereas HDL (B=−64.682, 95% CI −123.451 to −5.914, p=0.031) was a negative predictor for high blood eosinophils. Conclusion This retrospective cohort study suggests male gender, oldness and lower HDL could be clinical predictors of high blood eosinophils in Chinese COPD patients.
Collapse
Affiliation(s)
- Mei Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Ting Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xiaoou Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Diandian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Zenglin Liao
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Dan Xu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Fuqiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| |
Collapse
|
79
|
Fujita Y, Yamauchi M, Yoshikawa M, Yamamoto Y, Sakaguchi K, Fujioka N, Ibaraki T, Muro S. Resting Breathing Instability During Wakefulness as a Predictor of Clinical Outcome in COPD. Respir Care 2021; 66:1477-1484. [PMID: 34408081 PMCID: PMC9993881 DOI: 10.4187/respcare.08877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Dyspnea is a common symptom in patients with COPD. It causes physical inactivity and impaired health-related quality of life. Although optimal breathing methods alleviate dyspnea, it is unclear whether breathing instability has a clinical impact on patients with COPD. This study aimed to investigate whether resting breathing instability during wakefulness was associated with dyspnea assessed by the modified Medical Research Council (mMRC) dsypnea scale and whether breathing instability can be a novel predictor of clinical outcomes. METHODS Forty-four subjects with stable COPD were enrolled (mean age, 71.0 y). Resting breathing was monitored for 15 min by using respiratory inductance plethysmography. Breathing instability was evaluated with the coefficient of variation for breath-by-breath respiratory duration and tidal volume ([Formula: see text]) by using an artifact-free respiratory signal for 5 min. Pulmonary function testing and blood gas analysis were performed (mean FEV1 percent of predicted, 68.5%). Questionnaires with regard to dyspnea and health-related quality of life were also completed. Exacerbations were recorded prospectively for 1 year after the initial assessment. RESULTS The coefficients of variation for [Formula: see text] were significantly higher in the subjects with an mMRC dyspnea scale score ≥ 2 versus those with an mMRC dyspnea scale score < 2 (26.4 ± 7.4% vs 20.3 ± 6.4%, P = .006) . The coefficients of variation for respiratory duration and VT were not associated with age, body mass index, and pulmonary function variables. In multivariate analysis, FEV1 percent of predicted and coefficient of variation for [Formula: see text] remained significant predictors for an mMRC dyspnea scale score ≥ 2 (P = .004 and P = .01, respectively). Coefficient of variation values were also correlated with several health-related quality of life domains. The exacerbation frequency was associated with the coefficient of variation for [Formula: see text]. CONCLUSIONS Resting breathing pattern during wakefulness is a novel assessment tool for severity of dyspnea, which can be one of the predictors for exacerbation in patients with COPD.
Collapse
Affiliation(s)
- Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan.
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Masanori Yoshikawa
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshifumi Yamamoto
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuhiro Sakaguchi
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Nobuhiro Fujioka
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Takahiro Ibaraki
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| |
Collapse
|
80
|
Clinical form of asthma and vaccine immunity in preschoolers. Postepy Dermatol Alergol 2021; 38:123-130. [PMID: 34408578 PMCID: PMC8362791 DOI: 10.5114/ada.2021.104287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/09/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction Asthma is the most common chronic disease in children. Its exacerbation results from allergic and infectious diseases. Aim To assess the influence of a clinical form of asthma on preschoolers’ vaccine immunity following 3 years after the completion of the mandatory vaccination programme. Material and methods The study encompassed 172 preschool children with asthma being newly diagnosed, including 140 patients with mild asthma and 32 with moderate asthma, whose vaccine immunity (level of IgG-specific antibodies) was assessed after the mandatory early vaccines had been administered in the early childhood. Monovalent vaccines (HBV + IPV + Hib) along with a three-component combined vaccine (DTwP) and MMR were given to 86 children while a six-component combined vaccine (DTaP + IPV + Hib + HBV) along with a three-component MMR vaccine were administered to the remaining 86 children. The immunity class for particular vaccinations was assessed according to the manufacturers’ instructions. Results Children suffering from mild asthma had considerably more frequently vaccinations administered on time (p < 0.001) and the type of vaccines (monovalent or highly-combined) administered did not have a significant influence on the clinical form of asthma in the children examined (p = 0.6951). Apart from the vaccines against hepatitis B and rubella where considerably more frequently a high level of antibodies occurred in children with mild asthma, the antibody levels to other vaccines, namely diphtheria, tetanus, pertussis, Hib and mumps, were not associated with the severity of asthma. Conclusions Moderate asthma may have a negative impact on remote vaccine immunity to HBV and rubella.
Collapse
|
81
|
Beaulieu D, Attwe A, Breau M, Lipskaia L, Marcos E, Born E, Huang J, Abid S, Derumeaux G, Houssaini A, Maitre B, Lefevre M, Vienney N, Bertolino P, Jaber S, Noureddine H, Goehrig D, Vindrieux D, Bernard D, Adnot S. Phospholipase A2 receptor 1 promotes lung cell senescence and emphysema in obstructive lung disease. Eur Respir J 2021; 58:13993003.00752-2020. [PMID: 33509955 DOI: 10.1183/13993003.00752-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cell senescence is a key process in age-associated dysfunction and diseases, notably chronic obstructive pulmonary disease (COPD). We previously identified phospholipase A2 receptor 1 (PLA2R1) as a positive regulator of cell senescence acting via Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling. Its role in pathology, however, remains unknown. Here, we assessed PLA2R1-induced senescence in COPD and lung emphysema pathogenesis. METHODS We assessed cell senescence in lungs and cultured lung cells from patients with COPD and controls subjected to PLA2R1 knockdown, PLA2R1 gene transduction and treatment with the JAK1/2 inhibitor ruxolitinib. To assess whether PLA2R1 upregulation caused lung lesions, we developed transgenic mice overexpressing PLA2R1 (PLA2R1-TG) and intratracheally injected wild-type mice with a lentiviral vector carrying the Pla2r1 gene (LV-PLA2R1 mice). RESULTS We found that PLA2R1 was overexpressed in various cell types exhibiting senescence characteristics in COPD lungs. PLA2R1 knockdown extended the population doubling capacity of these cells and inhibited their pro-inflammatory senescence-associated secretory phenotype (SASP). PLA2R1-mediated cell senescence in COPD was largely reversed by treatment with the potent JAK1/2 inhibitor ruxolitinib. Five-month-old PLA2R1-TG mice exhibited lung cell senescence, and developed lung emphysema and lung fibrosis together with pulmonary hypertension. Treatment with ruxolitinib induced reversal of lung emphysema and fibrosis. LV-PLA2R1-treated mice developed lung emphysema within 4 weeks and this was markedly attenuated by concomitant ruxolitinib treatment. CONCLUSIONS Our data support a major role for PLA2R1 activation in driving lung cell senescence and lung alterations in COPD. Targeting JAK1/2 may represent a promising therapeutic approach for COPD.
Collapse
Affiliation(s)
- Delphine Beaulieu
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France.,These two authors contributed equally
| | - Aya Attwe
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France.,Environmental Health Research Laboratory (EHRL), Faculty of Sciences V, Lebanese University, Nabatieh, Lebanon.,These two authors contributed equally
| | - Marielle Breau
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Larissa Lipskaia
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Elisabeth Marcos
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Emmanuelle Born
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Jin Huang
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Shariq Abid
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Geneviève Derumeaux
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Amal Houssaini
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Bernard Maitre
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Marine Lefevre
- Département Anatomopathologie, Institut Mutualiste Montsouris, Paris, France
| | - Nora Vienney
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Philippe Bertolino
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM U1052/CNRS 5286, Université de Lyon, Centre Léon Bérard, Lyon, France
| | - Sara Jaber
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM U1052/CNRS 5286, Université de Lyon, Centre Léon Bérard, Lyon, France
| | - Hiba Noureddine
- Environmental Health Research Laboratory (EHRL), Faculty of Sciences V, Lebanese University, Nabatieh, Lebanon
| | - Delphine Goehrig
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM U1052/CNRS 5286, Université de Lyon, Centre Léon Bérard, Lyon, France
| | - David Vindrieux
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM U1052/CNRS 5286, Université de Lyon, Centre Léon Bérard, Lyon, France
| | - David Bernard
- Centre de Recherche en Cancérologie de Lyon, UMR INSERM U1052/CNRS 5286, Université de Lyon, Centre Léon Bérard, Lyon, France.,These two authors are joint senior authors
| | - Serge Adnot
- INSERM U955, Département de Physiologie-Explorations Fonctionnelles and DHU A-TVB Hôpital Henri Mondor, AP-HP, Créteil, France .,Institute for Lung Health, University of Giessen, Giessen, Germany.,These two authors are joint senior authors
| |
Collapse
|
82
|
Eymir M, Yakut H, Özalevli S, Alpaydın AÖ. Static and dynamic balance impairment and relationship with disease-related factors in patients with chronic obstructive pulmonary disease : A cross-sectional study. Wien Klin Wochenschr 2021; 133:1186-1194. [PMID: 34351502 DOI: 10.1007/s00508-021-01918-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Disease and aging-related factors may predispose chronic obstructive pulmonary disease (COPD) patients to impaired balance, although the underlying determinants of impaired balance in COPD patients are still unknown. The purpose of this study was to identify the determinants of impaired balance in COPD patients. Also, we aimed to determine which balance measures (clinical or laboratory tests) are more indicative in determining balance impairment in these patients. METHODS This cross-sectional study recruited 24 patients with moderate to severe COPD and 24 age-matched healthy subjects. Participants were evaluated regarding demographic and clinical data, previous falls history, lower limb muscle strength, exercise capacity, physical activity and balance level. RESULTS COPD patients exhibited significantly a longer test duration on timed up and go test, a higher sway index on the postural stability and lower directional control score on the limit of stability of Biodex balance system (all, p < 0.001) compared to healthy controls, whereas there was no difference in Berg balance scale score between groups (p > 0.05). Balance impairment of the patient group was significantly associated with nonpulmonary conditions, such as physical activity level, exercise capacity, lower limb muscle strength, and with fall history. Also, COPD patients represented significantly lower physical activity level and exercise capacity, weaker lower limb muscle strength than healthy controls (all, p < 0.001). CONCLUSIONS Patients with moderate to severe COPD exhibit apparently important reductions in balance control that is directly associated with nonpulmonary consequences and fall history. These results may be extremely important to fall prevention and to guide the development of interventions for this population.
Collapse
Affiliation(s)
- Musa Eymir
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balcova-Izmir, Turkey.
| | - Hazal Yakut
- Eskişehir Osmangazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskişehir, Turkey
| | - Sevgi Özalevli
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balcova-Izmir, Turkey
| | - Aylin Ö Alpaydın
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
83
|
Cen LJ, Zhang XX, Guan WJ. Phenotyping acute exacerbation of COPD: what more can we do for hospitalised patients? ERJ Open Res 2021; 7:00362-2021. [PMID: 34350289 PMCID: PMC8326715 DOI: 10.1183/23120541.00362-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
Hospitalised #AECOPD are characterised by multiple facets of aetiology. The clinical interpretation of the composite phenotypes of AECOPD and the robustness of the AECOPD phenotype need to be discussed further. https://bit.ly/3grzQEO.
Collapse
Affiliation(s)
- Lai-Jian Cen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors contributed equally
| | - Xiao-Xian Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors contributed equally
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
84
|
Ribeiro C, Vieira AL, Pamplona P, Drummond M, Seabra B, Ferreira D, Liberato H, Carreiro A, Vicente I, Castro L, Costa P, Carriço F, Martin T, Cravo J, Teixeira N, Grafino M, Conde S, Windisch W, Nunes R. Current Practices in Home Mechanical Ventilation for Chronic Obstructive Pulmonary Disease: A Real-Life Cross-Sectional Multicentric Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2217-2226. [PMID: 34349507 PMCID: PMC8328383 DOI: 10.2147/copd.s314826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.
Collapse
Affiliation(s)
- Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Paula Pamplona
- Pulmonology Department, Centro Hospitalar Universitário Lisboa Norte - Hospital Pulido Valente, Lisboa, Portugal
| | - Marta Drummond
- Centro de Responsabilidade Integrado Sono e VNI do Centro Hospitalar e Universitário São João, Porto, Portugal.,Faculty of Medicine, Porto University, Porto, Portugal
| | - Bárbara Seabra
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Diva Ferreira
- Pulmonology Department, Centro Hospitalar do Médio Ave, Famalicão, Portugal
| | - Hedi Liberato
- Pulmonology Department, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Alexandra Carreiro
- Pulmonology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
| | - Inês Vicente
- Pulmonology Department, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Luísa Castro
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Pedro Costa
- Pulmonology Functional Unit, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Filipa Carriço
- Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Teresa Martin
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Cravo
- Pulmonology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Nélson Teixeira
- Pulmonology Department, Unidade Local de Saúde do Nordeste, Bragança, Portugal
| | - Mónica Grafino
- Pulmonology Department, Hospital da Luz, Lisboa, Portugal
| | - Sara Conde
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Rui Nunes
- Faculty of Medicine, Porto University, Porto, Portugal
| |
Collapse
|
85
|
Segal LN, Huang YJ. Crossing Kingdoms: Host-Microbial Endotyping and the Quest to Understand Treatable Traits in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 203:1447-1448. [PMID: 33651664 PMCID: PMC8483227 DOI: 10.1164/rccm.202101-0169ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine New York University School of Medicine, New York New York
| | - Yvonne J Huang
- Division of Pulmonary and Critical Care Medicine University of Michigan Ann Arbor, Michigan
| |
Collapse
|
86
|
Blasi F, Antonelli Incalzi R, Canonica GW, Schino P, Cuttitta G, Zullo A, Ori A, Scichilone N. Clinical Evolution and Quality of Life in Clinically Based COPD Chronic Bronchitic and Emphysematous Phenotypes: Results from the 1-Year Follow-Up of the STORICO Italian Observational Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2133-2148. [PMID: 34345170 PMCID: PMC8325060 DOI: 10.2147/copd.s310428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Understanding clinical evolution of chronic obstructive pulmonary disease (COPD) is crucial for improving disease management. Materials and Methods STORICO (NCT03105999), an Italian, multicenter, non-interventional, observational study conducted in 40 pulmonology centers, aimed to describe the 1-year clinical evolution and health status of clinicallbased phenotypes. Baseline and follow-up data of COPD subjects with a chronic bronchitis (CB) or emphysema (EM) phenotype were collected. The frequency of COPD symptoms during the 24 hours (gathered via the night-time, morning and day-time symptoms of COPD questionnaire) and the anxiety and depression levels (via the HADS Scale) were recorded at each visit. Results A total of 261 CB and 159 EM patients were analyzed. CB patients with ≥1 night-time symptom seemed to be more frequent (51.7%, 41.8% and 41.4% at baseline, 6-month and 12-month follow-up, respectively) than EM (37.7%, 32.1% and 30.2% at study visits) even if no statistical differences were observed at time points between phenotypes (chi-square test p-values presence/absence of night-time symptoms in CB vs EM at study visits >0.0007). In the first 6 months, the frequency of patients with ≥1 night-time symptom decreased of 9.9% in CB and of 5.6% in EM. A clinically relevant decline of DLCO % predicted over 1 year in EM was observed, the mean (SD) being 61.5 (20.8) % at baseline and 59.1 (17.4) % at 12-month follow-up. EM had higher levels of anxiety and depression than CB (median (25th-75th percentile) HADS total score in CB: 7.0 (4.0–13.0) and 7.0 (3.0–12.0), in EM: 9.0 (3.0–14.0) and 9.5 (3.0–14.0) both at baseline and at 6-month follow-up, respectively), considering 1.17 as minimally clinical important difference (MCID) for the total score. Conclusion EM patients, evaluated in a real-world setting, seem to suffer from a worse clinical condition and health status compared to CB patients, appearing to have “more treatable” traits.
Collapse
Affiliation(s)
- Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, 20089, Rozzano, Milan, Italy
| | - Pietro Schino
- Miulli Hospital, Acquaviva delle Fonti, Bari, 70021, Italy
| | | | | | | | | | | |
Collapse
|
87
|
Amati F, Simonetta E, Pilocane T, Gramegna A, Goeminne P, Oriano M, Pascual-Guardia S, Mantero M, Voza A, Santambrogio M, Blasi F, Aliberti S. Diagnosis and Initial Investigation of Bronchiectasis. Semin Respir Crit Care Med 2021; 42:513-524. [PMID: 34261176 DOI: 10.1055/s-0041-1730892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bronchiectasis refers to both the name of a disease and a single radiological appearance that may, or may not, be associated with disease. As chronic respiratory disease, bronchiectasis is characterized by a variable range of signs and symptoms that may overlap with other chronic respiratory conditions. The proper identification of bronchiectasis as a disease in both primary and secondary care is of paramount importance. However, a standardized definition of radiologically and clinically significant bronchiectasis is still missing. Disease heterogeneity is a hallmark of bronchiectasis and applies not only to radiological features and clinical manifestations but also to other aspects of the disease, including the etiological and microbiological diagnosis as well as the evaluation of pulmonary function. Although the guidelines suggest a "minimum bundle" of tests, the diagnostic approach to bronchiectasis is challenging and may be driven by the "treatable traits" approach based on endotypes and biological characteristics. A broad spectrum of diagnostic tests could be used to investigate the etiology of bronchiectasis as well as other pulmonary, extrapulmonary, and environmental traits. Individualizing bronchiectasis workup according to the site of care (e.g., primary, secondary, and tertiary care) could help optimize patients' management and reduce healthcare costs.
Collapse
Affiliation(s)
- Francesco Amati
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Simonetta
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Pilocane
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Pieter Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Martina Oriano
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sergi Pascual-Guardia
- Department of Respiratory Medicine, Hospital del Mar (PSMAR)-IMIM, Barcelona, Spain.,School of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Marco Mantero
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Antonio Voza
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Martina Santambrogio
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
88
|
MacDonald MI, Osadnik CR, Bulfin L, Leahy E, Leong P, Shafuddin E, Hamza K, King PT, Bardin PG. MULTI-PHACET: multidimensional clinical phenotyping of hospitalised acute COPD exacerbations. ERJ Open Res 2021; 7:00198-2021. [PMID: 34262973 PMCID: PMC8273397 DOI: 10.1183/23120541.00198-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background The generic term “exacerbation” does not reflect the heterogeneity of acute exacerbations of COPD (AECOPD). We utilised a novel algorithmic strategy to profile exacerbation phenotypes based on underlying aetiologies. Methods Patients hospitalised for AECOPD (n=146) were investigated for aetiological contributors summarised in a mnemonic acronym ABCDEFGX (A: airway virus; B: bacterial; C: co-infection; D: depression/anxiety; E: eosinophils; F: failure (cardiac); G: general environment; X: unknown). Results from clinical investigations were combined to construct AECOPD phenotypes. Relationships to clinical outcomes were examined for both composite phenotypes and their specific aetiological components. Aetiologies identified at exacerbation were reassessed at outpatient follow-up. Results Hospitalised AECOPDs were remarkably diverse, with 26 distinct phenotypes identified. Multiple aetiologies were common (70%) and unidentifiable aetiology rare (4.1%). If viruses were detected (29.5%), patients had longer hospitalisation (7.7±5.6 versus 6.0±3.9 days, p=0.03) despite fewer “frequent exacerbators” (9.3% versus 37%, p=0.001) and lower mortality at 1 year (p=0.03). If bacterial infection was found (40.4%), patients were commonly “frequent exacerbators” (44% versus 18.4%, p=0.001). Eosinophilic exacerbations (28%) were associated with lower pH (7.32±0.06 versus 7.36±0.09, p=0.04), higher venous carbon dioxide tension (PvCO2) (53.7±10.5 versus 48.8±12.8, p=0.04), greater noninvasive ventilation (NIV) usage (34.1% versus 18.1%) but shorter hospitalisation (4 (3–5) versus 6 (4–9) days, p<0.001) and lower infection rates (41.4% versus 80.9%, p<0.0001). Cardiac dysfunction and severe anxiety/depression were common in both infective and non-infective exacerbations. Characteristics identified at exacerbation often persisted after recovery. Conclusions Hospitalised AECOPDs have numerous causes, often in combination, that converge in complex, multi-faceted phenotypes. Clinically important differences in outcomes suggest that a phenotyping strategy based on aetiologies can enhance AECOPD management. Hospitalised #AECOPD present as complex multidimensional clinical phenotypes, often comprising multiple distinct aetiologies. Profiling AECOPDs according to their multifactorial aetiological components has important prognostic and therapeutic implications.https://bit.ly/3nIHEnO
Collapse
Affiliation(s)
- Martin I MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia.,Hudson Institute, Melbourne, Australia
| | - Christian R Osadnik
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Dept of Physiotherapy, Monash University, Melbourne, Australia
| | - Lauren Bulfin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | | | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Eskandarain Shafuddin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
| | - Kais Hamza
- Statistical Services, Monash University, Melbourne, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia.,Hudson Institute, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia.,Hudson Institute, Melbourne, Australia
| |
Collapse
|
89
|
Ramírez-Venegas A, Montiel-Lopez F, Falfan-Valencia R, Pérez-Rubio G, Sansores RH. The "Slow Horse Racing Effect" on Lung Function in Adult Life in Chronic Obstructive Pulmonary Disease Associated to Biomass Exposure. Front Med (Lausanne) 2021; 8:700836. [PMID: 34307427 PMCID: PMC8295605 DOI: 10.3389/fmed.2021.700836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 01/31/2023] Open
Abstract
Although different trajectories in lung function decline have been identified in patients with COPD associated to tobacco exposure (TE-COPD), genetic, environmental, and infectious factors affecting lung function throughout life have not been fully elucidated in patients with COPD associated to biomass (BE-COPD). In this review, we present current epidemiological findings and notable advances in the natural history of lung decline in BE-COPD, as well as conditions modeling the FEV1 trajectory, such as health insults, during the first years of childhood. Evidence shows that women exposed to biomass smoke reach adult life with a lower FEV1 than expected. However, in contrast to the “horse racing effect” predicting an excessive lung-function decline in forthcoming years, as observed in smokers, this decline is slower in non-smokers, and no rapid decliners are observed. Accordingly, BE-COPD might be considered another phenotype of COPD based on assessments of lung function decline. Likewise, other functional and clinical aspects described in this review suggest that this condition might be similar to TE-COPD. More research is needed to fully characterize this subgroup of variants of COPD.
Collapse
Affiliation(s)
- Alejandra Ramírez-Venegas
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Francisco Montiel-Lopez
- Department of Tobacco Smoking and COPD Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ramces Falfan-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Raúl H Sansores
- Department of Respiratory Medicine, Medica Sur Clinic and Foundation, Mexico City, Mexico
| |
Collapse
|
90
|
Hwang HJ, Seo JB, Lee SM, Kim N, Yi J, Lee JS, Lee SW, Oh YM, Lee SD. New Method for Combined Quantitative Assessment of Air-Trapping and Emphysema on Chest Computed Tomography in Chronic Obstructive Pulmonary Disease: Comparison with Parametric Response Mapping. Korean J Radiol 2021; 22:1719-1729. [PMID: 34269529 PMCID: PMC8484152 DOI: 10.3348/kjr.2021.0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Emphysema and small-airway disease are the two major components of chronic obstructive pulmonary disease (COPD). We propose a novel method of quantitative computed tomography (CT) emphysema air-trapping composite (EAtC) mapping to assess each COPD component. We analyzed the potential use of this method for assessing lung function in patients with COPD. Materials and Methods A total of 584 patients with COPD underwent inspiration and expiration CTs. Using pairwise analysis of inspiration and expiration CTs with non-rigid registration, EAtC mapping classified lung parenchyma into three areas: Normal, functional air trapping (fAT), and emphysema (Emph). We defined fAT as the area with a density change of less than 60 Hounsfield units (HU) between inspiration and expiration CTs among areas with a density less than −856 HU on inspiration CT. The volume fraction of each area was compared with clinical parameters and pulmonary function tests (PFTs). The results were compared with those of parametric response mapping (PRM) analysis. Results The relative volumes of the EAtC classes differed according to the Global Initiative for Chronic Obstructive Lung Disease stages (p < 0.001). Each class showed moderate correlations with forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) (r = −0.659–0.674, p < 0.001). Both fAT and Emph were significant predictors of FEV1 and FEV1/FVC (R2 = 0.352 and 0.488, respectively; p < 0.001). fAT was a significant predictor of mean forced expiratory flow between 25% and 75% and residual volume/total vital capacity (R2 = 0.264 and 0.233, respectively; p < 0.001), while Emph and age were significant predictors of carbon monoxide diffusing capacity (R2 = 0.303; p < 0.001). fAT showed better correlations with PFTs than with small-airway disease on PRM. Conclusion The proposed quantitative CT EAtC mapping provides comprehensive lung functional information on each disease component of COPD, which may serve as an imaging biomarker of lung function.
Collapse
Affiliation(s)
- Hye Jeon Hwang
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Beom Seo
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sang Min Lee
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namkug Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
91
|
Szalontai K, Gémes N, Furák J, Varga T, Neuperger P, Balog JÁ, Puskás LG, Szebeni GJ. Chronic Obstructive Pulmonary Disease: Epidemiology, Biomarkers, and Paving the Way to Lung Cancer. J Clin Med 2021; 10:jcm10132889. [PMID: 34209651 PMCID: PMC8268950 DOI: 10.3390/jcm10132889] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD), the frequently fatal pathology of the respiratory tract, accounts for half a billion cases globally. COPD manifests via chronic inflammatory response to irritants, frequently to tobacco smoke. The progression of COPD from early onset to advanced disease leads to the loss of the alveolar wall, pulmonary hypertension, and fibrosis of the respiratory epithelium. Here, we focus on the epidemiology, progression, and biomarkers of COPD with a particular connection to lung cancer. Dissecting the cellular and molecular players in the progression of the disease, we aim to shed light on the role of smoking, which is responsible for the disease, or at least for the more severe symptoms and worse patient outcomes. We summarize the inflammatory conditions, as well as the role of EMT and fibroblasts in establishing a cancer-prone microenvironment, i.e., the soil for ‘COPD-derived’ lung cancer. We highlight that the major health problem of COPD can be alleviated via smoking cessation, early diagnosis, and abandonment of the usage of biomass fuels on a global basis.
Collapse
Affiliation(s)
- Klára Szalontai
- Csongrád County Hospital of Chest Diseases, Alkotmány u. 36., H6772 Deszk, Hungary;
| | - Nikolett Gémes
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- PhD School in Biology, University of Szeged, H6726 Szeged, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Semmelweis u. 8., H6725 Szeged, Hungary;
| | - Tünde Varga
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
| | - Patrícia Neuperger
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- PhD School in Biology, University of Szeged, H6726 Szeged, Hungary
| | - József Á. Balog
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- PhD School in Biology, University of Szeged, H6726 Szeged, Hungary
| | - László G. Puskás
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- Avicor Ltd. Alsó Kikötő sor 11/D, H6726 Szeged, Hungary
| | - Gábor J. Szebeni
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, H6726 Szeged, Hungary
- CS-Smartlab Devices Ltd., Ady E. u. 14., H7761 Kozármisleny, Hungary
- Correspondence:
| |
Collapse
|
92
|
Pevernagie D. Future Treatment of Sleep Disorders: Syndromic Approach Versus Management of Treatable Traits? Sleep Med Clin 2021; 16:465-473. [PMID: 34325823 DOI: 10.1016/j.jsmc.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep disorders are categorized in line with traditional taxonomy. This conventional approach allows adequate management of many patients. Failure of treatment, however, may be due to nonspecificity of symptoms, coincidental association between symptoms and pathophysiological endotype, as well as co-occurrence of different pathologic mechanisms affecting sleep. Complex phenotypes often do not respond well to standard therapeutic interventions. In these cases, the clinical workup should aim at identifying treatable traits that will likely improve under targeted therapy. The challenge for sleep medicine is to further develop this innovative approach that is driven by the principles of systems medicine.
Collapse
Affiliation(s)
- Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium.
| |
Collapse
|
93
|
Lu Y, Wang X, Zhao J. Effects of azithromycin on treating chronic obstructive pulmonary disease with acute exacerbation of chronic bronchitis in the stable phase. Am J Transl Res 2021; 13:7370-7375. [PMID: 34306507 PMCID: PMC8290734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effects of azithromycinon in treatment of chronic obstructive pulmonary disease (COPD) in patients with acute exacerbation (AE) of chronic bronchitis (CB) in the stable phase. METHODS Totally, 60 COPD patients with AE of CB were divided into control group (CG, 30 cases) and experimental group (EG, 30 cases) using the random number residue method. The CG was administered 250 mg salmeterol-fluticasone powder inhalation twice a day combined with 18 µg tiotropium bromide inhalation once a day. The EG was treated with 250 mg azithromycin tablets once a day in addition to the treatment of the CG. We compared the clinical effect, pulmonary function, and fractional exhaled nitric oxide index between two groups after treated for three-months. RESULTS Compared with the CG, the EG showed a better clinical effect with a total effective rate at 86.67% after treatment (P<0.05). The EG exhibited better FEV1 and FEV1% than the CG (P<0.05). We also observed the difference between clinically FeNO-invalid patients before and after treatment was significant (P<0.05). After treatment, this difference among groups was statistically significant (P<0.05). CONCLUSIONS Azithromycin combined with salmeterol-fluticasone powder inhalation and tiotropium bromide inhalation have good effects for treating COPD patients with AE of CB in the stable stage and can improve the pulmonary function. When COPD with AE of CB was exacerbated, the FeNO index increased significantly, indicating a potential increase in the mucosal inflammatory cells and eosinophils of the airway.
Collapse
Affiliation(s)
- Yangfei Lu
- Department of Respiratory Medicine, The First People's Hospital of Fuyang Hangzhou Hangzhou 311400, Zhejiang 311400, China
| | - Xiaobo Wang
- Department of Respiratory Medicine, The First People's Hospital of Fuyang Hangzhou Hangzhou 311400, Zhejiang 311400, China
| | - Jun Zhao
- Department of Respiratory Medicine, The First People's Hospital of Fuyang Hangzhou Hangzhou 311400, Zhejiang 311400, China
| |
Collapse
|
94
|
Bao H, Jia G, Cong S, Sun W, Fan J, Wang N, Feng Y, Wang B, Curtis JL, Wang L, Fang L, Chen Y. Phenotype and management of chronic obstructive pulmonary disease patients in general population in China: a nationally cross-sectional study. NPJ Prim Care Respir Med 2021; 31:32. [PMID: 34075048 PMCID: PMC8169915 DOI: 10.1038/s41533-021-00243-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/29/2021] [Indexed: 01/14/2023] Open
Abstract
This study aims to investigate the characteristics of the phenotype and management of chronic obstructive pulmonary disease (COPD) patients in the general population in China. We analyzed spirometry-confirmed COPD patients who were identified from a population-based, nationally representative sample in China. All participants were measured with airflow limitation severity based on post-bronchodilator FEV1 percent predicted, bronchodilator responsiveness, exacerbation history, and respiratory symptoms. Among a total of 9134 COPD patients, 90.3% were non-exacerbators, 2.9% were frequent exacerbators without chronic bronchitis, 2.0% were frequent exacerbators with chronic bronchitis, and 4.8% were asthma-COPD overlap. Less than 5% of non-exacerbators ever had pulmonary function testing performed. The utilization rate of inhaled medication in non-exacerbators, exacerbators without chronic bronchitis, exacerbators with chronic bronchitis, and asthma-COPD overlap was 1.4, 23.5, 29.5, and 19.4%, respectively. A comprehensive strategy for the management of COPD patients based on phenotype in primary care is urgently needed.
Collapse
Affiliation(s)
- Heling Bao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China.,Department of Maternal and Child Health, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Guohua Jia
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Shu Cong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Wanlu Sun
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Jing Fan
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Ning Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Yajing Feng
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Baohua Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Jeffrey L Curtis
- Department of Internal Medicine, University of Michigan Medical School, 150 W. Medical Center Drive, Ann Arbor, MI, USA.,Medicine Service, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, USA
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China
| | - Liwen Fang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China.
| | - Yahong Chen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China.
| |
Collapse
|
95
|
Rasch-Halvorsen Ø, Hassel E, Brumpton BM, Jenssen H, Spruit MA, Langhammer A, Steinshamn S. Lung function and peak oxygen uptake in chronic obstructive pulmonary disease phenotypes with and without emphysema. PLoS One 2021; 16:e0252386. [PMID: 34043708 PMCID: PMC8158861 DOI: 10.1371/journal.pone.0252386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Previous studies of associations of forced expiratory lung volume in one second (FEV1) with peak oxygen uptake (VO2peak) in chronic obstructive pulmonary disease (COPD) have not taken sex, age and height related variance of dynamic lung volumes into account. Nor have such demographic spread of spirometric measures been considered in studies comparing VO2peak between COPD phenotypes characterized by degree of emphysema. We aimed to assess the association of FEV1Z-score with VO2peak in COPD (n = 186) and investigate whether this association differs between emphysema (E-COPD) and non-emphysema (NE-COPD) phenotypes. Corresponding assessments using standardized percent predicted FEV1 (ppFEV1) were performed for comparison. Additionally, phenotype related differences in VO2peak were compared using FEV1Z-score and ppFEV1 as alternative expressions of FEV1. E-COPD and NE-COPD were defined by transfer factor of the lung for carbon monoxide below and above lower limits of normal (LLN), respectively. The associations were assessed in linear regression models. One unit reduction in FEV1Z-score was associated with 1.9 (95% CI 1.4, 2.5) ml/kg/min lower VO2peak. In stratified analyses, corresponding estimates were 2.2 (95% CI 1.4, 2.9) and 1.2 (95% CI 0.2, 2.2) ml/kg/min lower VO2peak in E-COPD and NE-COPD, respectively. The association did not differ statistically by COPD phenotype (p-value for interaction = 0.153). Similar estimates were obtained in analyses using standardized ppFEV1. Compared to NE-COPD, VO2peak was 2.2 (95% CI 0.8, 3.6) and 2.1 (95% CI 0.8, 3.5) ml/kg/min lower in E-COPD when adjusted for FEV1Z-score and ppFEV1, respectively. In COPD, FEV1Z-score is positively associated with VO2peak. This association was stronger in E-COPD but did not differ statistically by phenotype. Both the association of FEV1 with VO2peak and the difference in VO2peak comparing COPD phenotypes seems independent of sex, age and height related variance in FEV1. Mechanisms leading to reduction in FEV1 may contribute to lower VO2peak in E-COPD.
Collapse
Affiliation(s)
- Øystein Rasch-Halvorsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- * E-mail:
| | - Erlend Hassel
- Norwegian Armed Forces Occupational Health Service, Trondheim, Norway
| | - Ben M. Brumpton
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Martijn A. Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Steinshamn
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
96
|
von Wichert P. Bronchial Diseases are Insufficiently Defined with the Term COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:1349-1352. [PMID: 34025120 PMCID: PMC8132574 DOI: 10.2147/copd.s298210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
This paper discusses the basic thoughts behind the so-called diagnosis of COPD in relation to cause and course of the disease and questions the value of this functional defined terminology. Instead, the terminology should be based on morphology in the broadest sense including all methods suitable to describe pathological processes to understand the cause of bronchial diseases. The diagnosis COPD is only helpful in relation to therapeutic measures.
Collapse
|
97
|
Chandra D, Gupta A, Kinney GL, Fuhrman CR, Leader JK, Diaz AA, Bon J, Barr RG, Washko G, Budoff M, Hokanson J, Sciurba FC. The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers. Chest 2021; 160:858-871. [PMID: 33971144 DOI: 10.1016/j.chest.2021.04.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Smokers manifest varied phenotypes of pulmonary impairment. RESEARCH QUESTION Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers? STUDY DESIGN AND METHODS We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV1 to FVC ratio, < 0.70). RESULTS Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV1 and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts. INTERPRETATION Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV1 and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.
Collapse
Affiliation(s)
- Divay Chandra
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Aman Gupta
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Carl R Fuhrman
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Alejandro A Diaz
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jessica Bon
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - George Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Matthew Budoff
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - John Hokanson
- Department of Epidemiology, University of Colorado, Denver, CO
| | - Frank C Sciurba
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|
98
|
Ahmed AF, Sukasem C, Sabbah MA, Musa NF, Mohamed Noor DA, Daud NAA. Genetic Determinants in HLA and Cytochrome P450 Genes in the Risk of Aromatic Antiepileptic-Induced Severe Cutaneous Adverse Reactions. J Pers Med 2021; 11:383. [PMID: 34067134 PMCID: PMC8150699 DOI: 10.3390/jpm11050383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/19/2022] Open
Abstract
Adverse drug reaction (ADR) is a pressing health problem, and one of the main reasons for treatment failure with antiepileptic drugs. This has become apparent in the event of severe cutaneous adverse reactions (SCARs), which can be life-threatening. In this review, four hypotheses were identified to describe how the immune system is triggered in the development of SCARs, which predominantly involve the human leukocyte antigen (HLA) proteins. Several genetic variations in HLA genes have been shown to be strongly associated with the susceptibility to developing SCARs when prescribed carbamazepine or phenytoin. These genetic variations were also shown to be prevalent in certain populations. Apart from the HLA genes, other genes proposed to affect the risk of SCARs are genes encoding for CYP450 drug-metabolising enzymes, which are involved in the pharmacokinetics of offending drugs. Genetic variants in CYP2C9 and CYPC19 enzymes were also suggested to modulate the risk of SCARs in some populations. This review summarizes the literature on the manifestation and aetiology of antiepileptic-induced SCARs, updates on pharmacogenetic markers associated with this reaction and the implementation of pre-emptive testing as a preventive strategy for SCARs.
Collapse
Affiliation(s)
- Ali Fadhel Ahmed
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 11800, Malaysia or (A.F.A.); (D.A.M.N.)
| | - Chonlaphat Sukasem
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok 10400, Thailand
- The Thai Severe Cutaneous Adverse Drug Reaction (THAI-SCAR) Research Group, Chulalongkorn University, Bangkok 10330, Thailand
- Advanced Research and Development Laboratory, Bumrungrad International Hospital, Bangkok 10110, Thailand
| | - Majeed Arsheed Sabbah
- Forensic DNA for Research and Training Centre, Alnahrain University, Baghdad 64074, Iraq;
| | - Nur Fadhlina Musa
- Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| | - Dzul Azri Mohamed Noor
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 11800, Malaysia or (A.F.A.); (D.A.M.N.)
| | - Nur Aizati Athirah Daud
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 11800, Malaysia or (A.F.A.); (D.A.M.N.)
- Human Genome Center, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia;
| |
Collapse
|
99
|
Bai S, Zhao L. Imbalance Between Injury and Defense in the COPD Emphysematous Phenotype. Front Med (Lausanne) 2021; 8:653332. [PMID: 34026786 PMCID: PMC8131650 DOI: 10.3389/fmed.2021.653332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
The chronic obstructive pulmonary disease (COPD) emphysematous phenotype is characterized by destruction of lung tissue structure. Patients with this phenotype usually present with typical emphysema-like changes on chest computed Tomography CT, experience higher mortality and poorer prognosis, and are insensitive to routine pharmacological COPD therapy. However, the pathogenesis for the COPD emphysematous phenotype remains unclear, resulting in diagnostic and therapeutic challenges. The imbalance between injury and defense mechanisms is essential in the progression of many pulmonary diseases. Thus, in this review, we focus on the pathogenesis of the COPD emphysematous phenotype and discuss the pathophysiological processes involved in disease progression, from the perspective of injury and defense imbalance.
Collapse
Affiliation(s)
- Shuang Bai
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
100
|
Fujita Y, Kent M, Wisner E, Johnson L, Stern J, Qi L, Boone J, Yamamoto T. Combined Assessment of Pulmonary Ventilation and Perfusion with Single-Energy Computed Tomography and Image Processing. Acad Radiol 2021; 28:636-646. [PMID: 32534966 DOI: 10.1016/j.acra.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES To establish a proof-of-principle for combined assessment of pulmonary ventilation and perfusion using single-energy computed tomography (CT) and image processing/analysis (denoted as single-energy CT ventilation/perfusion imaging). MATERIALS AND METHODS Breath-hold CT scans were acquired at end-expiration and end-inspiration before injection of iodinated contrast agents, and repeated at end-inspiration after contrast injection for 17 canines (8 normal and 9 diseased lung subjects). Ventilation images were calculated with deformable image registration to map the end-expiratory and end-inspiratory CT images and quantitative analysis for regional volume changes as surrogates for ventilation. Perfusion images were calculated by subtracting the end-inspiratory precontrast CT from the deformably registered end-inspiratory postcontrast CT, yielding a map of regional Hounsfield unit enhancement as a surrogate for perfusion. Ventilation-perfusion matching, spatial heterogeneity, and gravitationally directed gradients were compared between two groups using a Wilcoxon rank-sum test. RESULTS The normal group had significantly higher Dice similarity coefficients for spatial overlap of segmented functional volumes between ventilation and perfusion (median 0.40 vs. 0.33, p = 0.05), suggesting stronger ventilation-perfusion matching. The normal group also had greater Spearman's correlation coefficients based on 16 regions of interest (median 0.58 vs. 0.40, p = 0.09). The coefficients of variation were comparable (median, ventilation 0.71 vs. 0.91, p = 0.60; perfusion 0.63 vs. 0.75, p = 0.27). The linear regression slopes of gravitationally directed gradient were also comparable for ventilation (median, ventilation -0.26 vs. -0.18, p = 0.19; perfusion -0.17 vs. -0.06, p = 0.11). CONCLUSION These findings provide proof-of-principle for single-energy CT ventilation/perfusion imaging.
Collapse
|