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The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation. Transplantation 2018; 102:318-325. [PMID: 28825952 DOI: 10.1097/tp.0000000000001919] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in body mass index (BMI) during the waiting period for LTx on early postoperative outcomes. METHODS Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-candidate BMI, less than 18.5 or 18.5 to 29.9 and transplant BMI, less than 18.5; B-candidate BMI, less than 18.5 and transplant BMI, 18.5 to 29.9; C-candidate BMI, 18.5 to 29.9 and transplant BMI, 18.5 to 29.9; D-candidate BMI, 30 or greater and transplant BMI, 18.5 to 29.9; and E-candidate BMI, 30 or greater or 18.5 to 29.9 and transplant BMI, 30 or greater. Our primary outcome was in-hospital mortality and secondary outcomes were length of mechanical ventilation, intensive care unit length of stay (LOS), hospital LOS and postoperative complications. RESULTS BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of mechanical ventilation (21 days vs 9 days; P = 0.018), intensive care unit LOS (26 days vs 15 days; P = 0.035), and rates of surgical complications (76% vs 44%; P = 0.018) were significantly worse in patients of group E versus group D. Obese candidates who failed to decrease BMI less than 30 by transplant exhibited an increased risk of postoperative mortality (odds ratio, 2.62; 95% confidence interval, 1.01-6.48) compared with patients in group C. Pre-LTx BMI evolution had no impact on postoperative morbidity and mortality in underweight patients. CONCLUSIONS Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.
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Metabolic Syndrome and Pulmonary Function Indices. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: Metabolic syndrome (MetS) is a collection of metabolic risk factors including increased waist circumference (WC), elevated blood pressure (BP), increased triglyceride (TG), decreased high density lipoprotein (HDL-C) and increased fasting blood sugar (FBS). We aimed to examine the relevance between the MetS and its components with reduced lung functions in adult men.
Material and method: A total of 3899 adult men underwent screening examination between 2015-2016 in a cross-sectional survey.
Results: The mean (± SD) age of our population was 37.25 (± 4.9) years. The overall prevalence of MetS was 7.6%. The total prevalence of reduced lung function in men with MetS was 13.8%. The most common type of reduced lung function was the restrictive pattern (7.1%). The forced expiratory volume of first second (FEV1) and forced vital capacity (FVC) values were significantly lower in men with MetS (both p<0.001). Also these values were significantly lower in diabetic men compared to non-diabetics and those with impaired fasting glucose (IFG). WC and HDL were the most potent predictors of reduced FEV1 and FVC.
Conclusions: We obtained a positive independent association between MetS and reduced lung function in adult men which may be related mainly due to increased WC and decreased HDL.
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Factors Associated With Mechanical Ventilation Use in Children With Sickle Cell Disease and Acute Chest Syndrome. Pediatr Crit Care Med 2018; 19:801-809. [PMID: 29923940 DOI: 10.1097/pcc.0000000000001643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Acute chest syndrome is the leading cause of death in children with sickle cell disease and is generally due to respiratory failure. Epidemiologic factors for a need for mechanical ventilation in children with acute chest syndrome require further clarification. DESIGN Retrospective observational study. SETTING Nationally representative pediatric inpatient records in the United States by using the Kids' Inpatient Database for the years 2003, 2006, 2009, and 2012. PATIENTS Patients age less than 20 years old with a discharge diagnosis of acute chest syndrome. MEASUREMENTS AND MARIN RESULTS Data were weighted to estimate annual hospitalizations according to hospital characteristics in the United States. Multivariable logistic regression was conducted to ascertain factors associated with use of mechanical ventilation, after adjusting for patient and hospital characteristics. Total hospitalizations for acute chest syndrome were 5,018 in 2003, 6,058 in 2006, 6,072 in 2009, and 6,360 in 2012. Mechanical ventilation use was associated with comorbidities of obesity (odds ratio, 3.35; 95% CI, 1.94-5.78), obstructive sleep apnea (odds ratio, 3.72; 95% CI, 2.23-6.20), and heart disease (odds ratio, 2.19; 95% CI, 1.47-3.27). In addition, nonblack compared with black children (odds ratio, 1.53; 95% CI, 1.02-2.31) and the fall season (p = 0.018) were associated with mechanical ventilation use. CONCLUSIONS Comorbidity of obesity, obstructive sleep apnea, or heart disease could be potentially associated with mechanical ventilation use during an episode of acute chest syndrome. Prospective observational studies would be required to confirm these findings and infer potential interventions for preventing illness severity.
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Framnes SN, Arble DM. The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease. Front Endocrinol (Lausanne) 2018; 9:440. [PMID: 30127766 PMCID: PMC6087747 DOI: 10.3389/fendo.2018.00440] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder, effecting 17% of the total population and 40-70% of the obese population (1, 2). Multiple studies have identified OSA as a critical risk factor for the development of obesity, diabetes, and cardiovascular diseases (3-5). Moreover, emerging evidence indicates that metabolic disorders can exacerbate OSA, creating a bidirectional relationship between OSA and metabolic physiology. In this review, we explore the relationship between glycemic control, insulin, and leptin as both contributing factors and products of OSA. We conclude that while insulin and leptin action may contribute to the development of OSA, further research is required to determine the mechanistic actions and relative contributions independent of body weight. In addition to increasing our understanding of the etiology, further research into the physiological mechanisms underlying OSA can lead to the development of improved treatment options for individuals with OSA.
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Affiliation(s)
| | - Deanna M. Arble
- Department of Biological Sciences, Marquette University, Milwaukee, WI, United States
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205
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Andolfi C, Fisichella PM. Epidemiology of Obesity and Associated Comorbidities. J Laparoendosc Adv Surg Tech A 2018; 28:919-924. [DOI: 10.1089/lap.2018.0380] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ciro Andolfi
- Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - P. Marco Fisichella
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital and Boston VA Healthcare System, Boston, Massachusetts
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206
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Metabolic Dysregulation, Systemic Inflammation, and Pediatric Obesity-related Asthma. Ann Am Thorac Soc 2018; 14:S363-S367. [PMID: 29161075 DOI: 10.1513/annalsats.201703-231aw] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obesity-related asthma is a distinct pediatric asthma phenotype. It is associated with higher disease burden, lower pulmonary function, and suboptimal response to current asthma medications. Recent studies have made inroads into elucidating its pathophysiology. Systemic immune responses in obese children with asthma are skewed to a nonatopic T-helper cell type 1 (Th1) pattern that correlates with pulmonary function deficits. The prevalence of metabolic dysregulation is also higher among obese children with asthma than among normal-weight children with asthma. Insulin resistance and dyslipidemia, particularly low levels of high-density lipoprotein (HDL), are associated with lower airway obstruction and low expiratory reserve volume. These associations are independent of truncal and general adiposity and thereby suggest a direct association between metabolic abnormalities and pulmonary function. Furthermore, insulin resistance is associated with Th1 polarization, whereas low HDL is associated with monocyte activation. Although insulin resistance mediates the association of Th1 polarization with pulmonary function, HDL does not have a similar influence on the association of monocyte activation with pulmonary function. Together, these recent studies have paved the way to the understanding of obesity-related asthma as a distinct asthma phenotype and have begun to identify the complex relationships between metabolic dysregulation, systemic inflammation, and pulmonary function deficits in obese children with asthma. Studies are now needed to elucidate the mechanisms that link metabolic dysregulation and systemic immune responses to pulmonary function.
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207
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Carvalho TMDCS, Soares AF, Climaco DCS, Secundo IV, Lima AMJD. Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome. ACTA ACUST UNITED AC 2018; 44:279-284. [PMID: 29947714 DOI: 10.1590/s1806-37562017000000031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 12/07/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate lung function and inspiratory muscle strength, correlating them with exercise tolerance, in obese individuals with obstructive sleep apnea syndrome (OSAS). METHODS The sample comprised 31 adult subjects with moderate-to-severe OSAS diagnosed by polysomnography. We used spirometry to measure FVC, FEV1, and FVC/FEV1 ratio, using pressure manometry to measure MIP and MEP. The incremental shuttle walk test (ISWT) and the six-minute walk test (6MWT) were used in order to determine functional exercise capacity. RESULTS In this sample, the mean values for FVC (% of predicted), FEV1 (% of predicted): MIP, and MEP were 76.4 ± 12.3%, 80.1 ± 6.3%, 60.0 ± 21.9 cmH2O, and 81.3 ± 22.2 cmH2O, respectively. The mean distances covered on the ISWT and 6MWT were 221 ± 97 m and 480.8 ± 67.3 m, respectively. The ISWT distance showed moderate positive correlations with FVC (r = 0.658; p = 0.001) and FEV1 (r = 0.522; p = 0.003). CONCLUSIONS In this sample of obese subjects with untreated OSAS, lung function, inspiratory muscle strength, and exercise tolerance were all below normal. In addition, we found that a decline in lung function, but not in respiratory muscle strength, was associated with exercise tolerance in these patients.
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Affiliation(s)
| | - Anísio Francisco Soares
- . Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco - UFRPE - Recife (PE) Brasil
| | | | | | - Anna Myrna Jaguaribe de Lima
- . Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco - UFRPE - Recife (PE) Brasil
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208
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Zhao Y, Li Z, Yang T, Wang M, Xi X. Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. PLoS One 2018; 13:e0198669. [PMID: 29883469 PMCID: PMC5993298 DOI: 10.1371/journal.pone.0198669] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Obesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains controversial. METHODS MEDLINE, EMBASE, China Biology Medicine disc (CBM) and CINAHL electronic databases were searched from the earliest available date to July 2017, using the following search terms: "body weight", "body mass index", "overweight" or "obesity" and "ventilator", "mechanically ventilated", "mechanical ventilation", without language restriction. Subjects were divided into the following categories based on BMI (kg/m2): underweight, < 18.5 kg/m2; normal, 18.5-24.9 kg/m2; overweight, BMI 25-29.9 kg/m2; obese, 30-39.9 kg/m2; and severely obese > 40 kg/m2. The primary outcome was mortality, and included ICU mortality, hospital mortality, short-term mortality (<6 months), and long-term mortality (6 months or beyond). Secondary outcomes included duration of mechanical ventilation, length of stay (LOS) in ICU and hospital. A random-effects model was used for data analyses. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale. RESULTS A total of 15,729 articles were screened. The final analysis included 23 articles (199,421 subjects). In comparison to non-obese patients, obese patients had lower ICU mortality (odds ratio (OR) 0.88, 95% CI 0.0.84-0.92, I2 = 0%), hospital mortality (OR 0.83, 95% CI 0.74-0.93, I2 = 52%), short-term mortality (OR 0.81, 95% CI 0.74-0.88, I2 = 0%) as well as long-term mortality (OR 0.69, 95% CI 0.60-0.79, I2 = 0%). In comparison to subjects with normal BMI, obese patients had lower ICU mortality (OR 0.88, 95% CI 0.82-0.93, I2 = 5%). Hospital mortality was lower in severely obese and obese subjects (OR 0.71, 95% CI 0.53-0.94, I2 = 74%, and OR 0.80, 95% CI 0.73-0.89, I2 = 30%). Short-term mortality was lower in overweight and obese subjects (OR 0.82, 95% CI 0.75-0.90, I2 = 0%, and, OR 0.75, 95% CI 0.66-0.84, I2 = 8%, respectively). Long-term mortality was lower in severely obese, obese and overweight subjects (OR 0.39, 95% CI 0.18-0.83, and OR 0.63, 95% CI 0.46-0.86, I2 = 56%, and OR 0.66, 95% CI 0.57-0.77, I2 = 0%). All 4 mortality measures were higher in underweight subjects than in subjects with normal BMI. Obese subjects had significantly longer duration on mechanical ventilation than non-obese group (mean difference (MD) 0.48, 95% CI 0.16-0.80, I2 = 37%), In comparison to subjects with normal BMI, severely obese BMI had significantly longer time in mechanical ventilation (MD 1.10, 95% CI 0.38-1.83, I2 = 47%). Hospital LOS did not differ between obese and non-obese patients (MD 0.05, 95% CI -0.52 to 0.50, I2 = 80%). Obese patients had longer ICU LOS than non-obese patients (MD 0.38, 95% CI 0.17-0.59, I2 = 70%). Hospital LOS and ICU LOS did not differ significantly in subjects with different BMI status. CONCLUSIONS In ICU patients receiving mechanical ventilation, higher BMI is associated with lower mortality and longer duration on mechanical ventilation.
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Affiliation(s)
- Yonghua Zhao
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Langfang People’s Hospital, Langfang, China
| | - Zhiqiang Li
- Department of Critical Care Medicine, Hebei United University Affiliated Hospital, Tangshan, China
| | - Tao Yang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Meiping Wang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Talaminos Barroso A, Márquez Martín E, Roa Romero LM, Ortega Ruiz F. Factors Affecting Lung Function: A Review of the Literature. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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210
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211
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Golparvar M, Mofrad SZ, Mahmoodieh M, Kalidarei B. Comparative Evaluation of the Effects of Three Different Recruitment Maneuvers during Laparoscopic Bariatric Surgeries of Morbid Obese Patients on Cardiopulmonary Indices. Adv Biomed Res 2018; 7:89. [PMID: 29930929 PMCID: PMC5991281 DOI: 10.4103/abr.abr_75_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Laparoscopic bariatric surgeries in morbid obese patients may be associated with atelectasis, hypercapnia, and hypoxemia, intra and postoperatively. Several strategies are used for the prevention of these consequences. This study aimed to examine the effects of three different recruitment maneuvers comparatively during surgery and the influence of the maneuvers on some cardiopulmonary indices. Materials and Methods: In a clinical trial, ninety participants of laparoscopic surgery with body mass index higher than 40 were randomly divided into three equal groups. The first group was subject to 10 cmH2O positive end-expiratory pressure (PEEP) during surgery, the second group, after venting the pneumoperitoneum, had 5 deep breaths with a positive pressure of 40 cmH2O, and the third group was subject to both. Some pulmonary and hemodynamic parameters were measured every 15 min and compared between three groups. Results: The average of peak airway pressure, plateau airway pressure, and SpO2 static and dynamic compliance between the three groups had no meaningful differences (P > 0.05), but PaCO2in the second group was statistically higher than the other two groups (P < 0.05). Conclusion: Multiple deep breaths alone are not as effective as PEEP or PEEP plus MDB in preventing adverse pulmonary effects in laparoscopic bariatric surgeries of morbid obese patients.
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Affiliation(s)
- Mohammad Golparvar
- Department of Anesthesia, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simaa Zangouei Mofrad
- Department of Anesthesia, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mahmoodieh
- Department of Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Kalidarei
- Department of Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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212
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Effect of obesity on biodistribution of nanoparticles. J Control Release 2018; 281:11-18. [PMID: 29753960 DOI: 10.1016/j.jconrel.2018.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/21/2018] [Accepted: 05/04/2018] [Indexed: 12/15/2022]
Abstract
Nanoparticles have specific features (lipophilicity, surface charge, composition and size). Studies regarding the biological behavior of nanoparticles in diseases such diabetics and obesity are scarce. Here, we evaluated two nanoparticles: magnetic core mesoporous silica (MSN) (58 nm) and polycaprolactone (PCL) nanoparticle (280 nm) in obese mice. Changes in the biodistribution were observed, especially considering the mononuclear phagocyte system (MPS), and the visceral fat tissue. Nonetheless, our data corroborates the influence of size in the biodistribution in obese animals, supporting that smaller nanoparticles, may show a higher tissue deposition at spleen, due the associated splenomegaly and the complications arising from this state. Finally, our study demonstrated that, in obesity, probably due the low-grade inflammatory state associated with metabolic syndrome a difference in accumulation of nanoparticles was found, with profound impact in the tissue deposition of nanoparticles.
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213
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Narewski ER, Blackford AL, Lammi MR, Fuhlbrigge AL, Soler X, Albert R, Criner GJ. Clinical Differences in COPD Patients with Variable Patterns of Hypoxemia. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2018; 5:167-176. [PMID: 30584580 DOI: 10.15326/jcopdf.5.3.2017.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Chronic obstructive pulmonary disease (COPD) patients enrolled into the Long-term Oxygen Treatment Trial had hypoxemia at rest, hypoxemia on exertion, or hypoxemia both at rest and on exertion. We hypothesized that patients with different patterns of hypoxemia may have significant differences in clinical features. Methods: All patients had COPD and oxygen saturation measured by pulse oximetry (blood oxygenation [SpO2]) at rest and during the 6-minute walk test (6MWT). Hypoxemia at rest was defined as resting SpO2 between 89-93%. SpO2 < 90% for at least 10 seconds and ³ 80% for at least 5 minutes during ambulation characterized hypoxemia on exertion. Severe exercise hypoxemia (< 80% for > 1 minute) was exclusionary. Results: Of 738 patients studied, 133 (18.0%) had mild-moderate hypoxemia at rest only, 319 (43.2%) had hypoxemia on exertion only, and 286 (38.8%) had hypoxemia at both rest and exertion. Patients with hypoxemia at rest only were more likely to be current smokers, had higher body mass index (BMI) and a higher incidence of self-reported diabetes. Patients with hypoxemia on exertion only were more severely obstructed compared to the other groups. General and disease-specific quality of life scores were similarly impaired in all groups. Quality of well-being scores were more impaired in those with hypoxemia at rest only. Conclusions: COPD patients with mild-moderate hypoxemia have distinct clinical characteristics based on the pattern of oxygen desaturation at rest and with exertion.
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Affiliation(s)
- Erin R Narewski
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Bloomberg School of Health, Johns Hopkins University, Baltimore, Maryland
| | - Matthew R Lammi
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Louisiana State University, New Orleans
| | - Anne L Fuhlbrigge
- Channing Laboratory, Brigham and Women's Hospital and Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Boston, Massachusetts
| | - Xavier Soler
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California- San Diego
| | - Richard Albert
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Colorado, Denver
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Smith JR, Cross TJ, Van Iterson EH, Johnson BD, Olson TP. Resistive and elastic work of breathing in older and younger adults during exercise. J Appl Physiol (1985) 2018; 125:190-197. [PMID: 29672228 DOI: 10.1152/japplphysiol.01105.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is unknown whether the greater total work of breathing (WOB) with aging is due to greater elastic and/or resistive WOB. We hypothesized that older compared with younger adults would exhibit a greater total WOB at matched ventilations (V̇e) during graded exercise, secondary to greater inspiratory resistive and elastic as well as expiratory resistive WOB. Older (OA: 60 ± 8 yr; n = 9) and younger (YA: 38 ± 7 yr; n = 9) adults performed an incremental cycling test to volitional fatigue. Esophageal pressure, inspiratory (IRV) and expiratory reserve volumes (ERV), expiratory flow limitation (EFL), and ventilatory variables were measured at matched V̇e (i.e., 25, 50, and 75 l/min) during exercise. The inspiratory resistive and elastic as well as expiratory resistive WOB were quantified using the Otis method. At V̇e of 75 l/min, older adults had greater %EFL and larger tidal volumes to inspiratory capacity but smaller relative IRV ( P ≤ 0.03) than younger adults. Older compared with younger adults had greater total WOB at V̇E of 50 and 75 l/min (OA: 90 ± 43 vs. YA: 49 ± 21 J/min; P < 0.04 for both). At V̇e of 75 l/min, older adults had greater inspiratory elastic and resistive WOB (OA: 44 ± 27 vs. YA: 24 ± 22 and OA: 23 ± 15 vs. YA: 11 ± 3 J/min, respectively, P < 0.03 for both) and expiratory resistive WOB (OA: 23 ± 19 vs. YA: 14 ± 9 J/min, P = 0.02) than younger adults. These data demonstrate that aging-induced pulmonary alterations result in greater inspiratory elastic and resistive as well as expiratory resistive WOB, which may have implications for the integrated response during exercise. NEW & NOTEWORTHY Aging-induced changes to the pulmonary system result in increased work of breathing (WOB) during exercise. However, it is not known whether this higher WOB with aging is due to differences in elastic and/or resistive WOB. Herein, we demonstrate that older adults exhibited greater inspiratory elastic and resistive as well as expiratory resistive WOB during exercise.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Troy J Cross
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Erik H Van Iterson
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Bruce D Johnson
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
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Associations of obesity with tracheal intubation success on first attempt and adverse events in the emergency department: An analysis of the multicenter prospective observational study in Japan. PLoS One 2018; 13:e0195938. [PMID: 29672600 PMCID: PMC5908180 DOI: 10.1371/journal.pone.0195938] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/03/2018] [Indexed: 11/20/2022] Open
Abstract
Obesity is deemed to increase the risk of difficult tracheal intubation. However, there is a dearth of research that examines the relationship of obesity with intubation success and adverse events in the emergency department (ED). We analyzed the data from a prospective, observational, multicenter study—the Japanese Emergency Airway Network (JEAN) 2 study from 2012 through 2016. We included all adults (aged ≥18 years) who underwent tracheal intubation in the ED. Patients were categorized into three groups according to their body mass index (BMI): lean (<25.0 kg/m²), overweight (25.0–29.9 kg/m²), and obesity (≥30.0 kg/m²). Outcomes of interest were intubation success on the first attempt and intubation-related adverse events. Of 6,889 patients who are eligible for the analysis, 5,370 patients (77%) were lean, 1,177 (17%) were overweight, and 342 (4%) were obese. Compared to the lean patients, the intubation success rates were significantly lower in the overweight and obese patients (70.9% in lean, 66.4% in overweight, and 59.3% in obese patients; P<0.001). In the multivariable analysis, compared to the lean patients, overweight (adjusted odds ratio [OR], 0.85; 95%CI, 0.74–0.98) and obese (adjusted OR, 0.62; 95%CI, 0.49–0.79) patients had a significantly lower success rate on the first attempt. Additionally, obesity was significantly associated with a higher risk of adverse events (adjusted OR, 1.62; 95%CI, 1.23–2.13). Based on the data from a multicenter prospectively study, obesity was associated with a lower success rate on the first intubation attempt and a higher risk of adverse event in the ED.
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Baur X, Terracini B, Belpoggi F, Budnik LT, Woitowitz HJ, Soskolne CL. Commentary to the article lung function not affected by asbestos exposure in workers with normal Computed Tomography scan, by Schikowsky, Felten, et al., 2017. Am J Ind Med 2018. [PMID: 29542198 DOI: 10.1002/ajim.22772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Xaver Baur
- European Society for Environmental and Occupational Medicine; Berlin Germany
| | - Benedetto Terracini
- Unit of Cancer Epidemiology; CPO Piemonte and University of Turin; Turin Italy
| | - Fiorella Belpoggi
- Ramazzini Institute, Cesare Maltoni Cancer Research Centre; Bentivoglio, Bologna Italy
| | - Lygia T Budnik
- University of Hamburg, Hamburg and European Society for Environmental and Occupational Medicine; Berlin Germany
| | | | - Colin L. Soskolne
- University of Alberta; Edmonton Canada
- Health Research Institute, University of Canberra; Canberra Australia
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Koman PD, Hogan KA, Sampson N, Mandell R, Coombe CM, Tetteh MM, Hill-Ashford YR, Wilkins D, Zlatnik MG, Loch-Caruso R, Schulz AJ, Woodruff TJ. Examining Joint Effects of Air Pollution Exposure and Social Determinants of Health in Defining "At-Risk" Populations Under the Clean Air Act: Susceptibility of Pregnant Women to Hypertensive Disorders of Pregnancy. WORLD MEDICAL & HEALTH POLICY 2018; 10:7-54. [PMID: 30197817 PMCID: PMC6126379 DOI: 10.1002/wmh3.257] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pregnant women are uniquely susceptible to adverse effects of air pollution exposure due to vulnerabilities and health consequences during pregnancy (e.g., hypertensive disorders of pregnancy [HDP]) compared to the general population. Because the Clean Air Act (CAA) creates a duty to protect at-risk groups, the regulatory assessment of at-risk populations has both policy and scientific foundations. Previously, pregnant women have not been specially protected in establishing the margin of safety for the ozone and particulate matter (PM) standards. Due to physiological changes, pregnant women can be at greater risk of adverse effects of air pollution and should be considered an at-risk population. Women with preexisting conditions, women experiencing poverty, and groups that suffer systematic discrimination may be particularly susceptible to cardiac effects of air pollutants during pregnancy. We rigorously reviewed 11 studies of over 1.3 million pregnant women in the United States to characterize the relationship between ozone or PM exposure and HDP. Findings were generally mixed, with a few studies reporting a joint association between ozone or PM and social determinants or pre-existing chronic health conditions related to HDP. Adequate evidence associates exposure to PM with an adverse effect of HDP among pregnant women not evident among non-gravid populations.
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Affiliation(s)
- Patricia D Koman
- University of Michigan School of Public Health, Environmental Health Sciences Department in Ann Arbor, Michigan
| | - Kelly A Hogan
- University of Michigan School of Public Health, Environmental Health Sciences Department in Ann Arbor, Michigan, and presently a research fellow in the Department of Biochemistry and Molecular Biology and the Robert and Arlene Kogod Center on Aging at Mayo Clinic, Rochester, Minnesota
| | - Natalie Sampson
- University of Michigan-Dearborn, Department of Health & Human Services in Dearborn, Michigan
| | - Rebecca Mandell
- Arbor Research Collaborative for Health in Ann Arbor, Michigan
| | - Chris M Coombe
- University of Michigan School of Public Health, Department of Health Behavior & Health Education in Ann Arbor, Michigan
| | - Myra M Tetteh
- University of Michigan School of Public Health, Department of Health Behavior & Health Education in Ann Arbor, Michigan
| | | | | | - Marya G Zlatnik
- University of California San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences in San Francisco, California
| | - Rita Loch-Caruso
- University of Michigan School of Public Health, Environmental Health Sciences Department and director of the Michigan Center on Lifestage Environmental Exposures and Disease and director of the Environmental Toxicology and Epidemiology Program in Ann Arbor, Michigan
| | - Amy J Schulz
- Department of Health Behavior and Health Education, associate director for the Center for Research on Ethnicity, Culture and Health, and co-lead for the Community Engagement Core for the Michigan Center on Lifestage Environmental Exposures and Disease at the University of Michigan School of Public Health
| | - Tracey J Woodruff
- University of California, San Francisco in the Department of Obstetrics, Gynecology, and Reproductive Sciences and Philip R. Lee Institute for Health Policy Studies and the director of the Program on Reproductive Health and the Environment in San Francisco, California
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218
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Morgan JW, Ferrazzani E, Taylor JA, Vivodtzev I. Augmenting exercise capacity with noninvasive ventilation in high-level spinal cord injury. J Appl Physiol (1985) 2018; 124:1294-1296. [PMID: 29494290 DOI: 10.1152/japplphysiol.01028.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High-level spinal cord injury (SCI) results in a very limited innervated skeletal muscle mass that strongly reduces exercise capacity. Our recent work showed that when adding functional electrical stimulation (FES) of the paralyzed legs (hybrid FES-exercise) to produce higher exercise capacity, peak ventilation became a limiting factor to training-induced improvement in aerobic capacity. Our assumption was that the systemic adaptations to exercise training are delimited by the maximal ventilation that can be achieved. However, herein, we present a case showing an acute increase in aerobic capacity when using noninvasive ventilatory support (NIV) during FES-rowing test in an individual who had previously experimented a plateau in his aerobic capacity for 18 mo. An 18-yr-old man with C5 SCI trained with arms-only rowing for 6 mo and subsequently trained with hybrid FES-rowing for 18 mo. Peak minute ventilation (V̇epeak) and peak oxygen consumption (V̇o2peak) were increased after arms-only training and increased further with 6 mo of hybrid FES-row training. Despite continued intense and frequent, hybrid FES-row training, neither V̇epeak nor V̇o2peak increased further over the next year (1.94 and 66.0 l/min). However, when this individual performed a FES-rowing V̇o2peak test with the addition of NIV, V̇epeak increased by 5 l/min, resulting in an improved V̇o2peak (2.23 l/min, +12%). This case demonstrates that noninvasive ventilation can overcome limitations to ventilation in high-level SCI and improve aerobic capacity during hybrid FES-exercise to a level not otherwise achievable. In addition, it broadly illustrates the intimate role of pulmonary function in determining the capacity to perform exercise.
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Affiliation(s)
- James W Morgan
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital , Cambridge, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
| | - Eric Ferrazzani
- Exercise for Persons with Disabilities Program, Spaulding Hospital Cambridge, Cambridge, Massachusetts
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital , Cambridge, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
| | - Isabelle Vivodtzev
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital , Cambridge, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts
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219
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Forno E, Han YY, Mullen J, Celedón JC. Overweight, Obesity, and Lung Function in Children and Adults-A Meta-analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:570-581.e10. [PMID: 28967546 PMCID: PMC5845780 DOI: 10.1016/j.jaip.2017.07.010] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is conflicting evidence on the effect of obesity on lung function in adults and children with and without asthma. We aimed to evaluate the relation between overweight or obesity and lung function, and whether such relationship varies by age, sex, or asthma status. METHODS We searched PubMed, Scopus, CINAHL, Cochrane, and EMBASE for all studies (in English) reporting on obesity status (by body mass index) and lung function, from 2005 to 2017. Main outcomes were forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow between 25th and 75th percentile of the forced vital capacity (FEF25-75), total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC). Random-effects models were used to calculate the pooled risk estimates; each study was weighed by the inverse effect size variance. For each outcome, we compared overweight or obese ("obese") subjects with those of normal weight. RESULTS All measures of lung function were decreased among obese subjects. Obese adults showed a pattern (lower FEV1, FVC, TLC, and RV) different from obese children (more pronounced FEV1/FVC deficit with unchanged FEV1 or FVC). There were also seemingly different patterns by asthma status, in that subjects without asthma had more marked decreases in FEV1, TLC, RV, and FRC than subjects with asthma. Subjects who were obese (as compared with overweight) had even further decreased FEV1, FVC, TLC, RV, and FRC. CONCLUSIONS Obesity is detrimental to lung function, but specific patterns differ between children and adults. Physicians should be aware of adverse effects of obesity on lung function, and weight control should be considered in the management of airway disease among the obese.
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Affiliation(s)
- Erick Forno
- Division of Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa.
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
| | - James Mullen
- College of Science, University of Notre Dame, Notre Dame, Ind
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pa
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220
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Talaminos Barroso A, Márquez Martín E, Roa Romero LM, Ortega Ruiz F. Factors Affecting Lung Function: A Review of the Literature. Arch Bronconeumol 2018; 54:327-332. [PMID: 29496283 DOI: 10.1016/j.arbres.2018.01.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
Lung function reference values are traditionally based on anthropometric factors, such as weight, height, sex, and age. FVC and FEV1 decline with age, while volumes and capacities, such as RV and FRC, increase. TLC, VC, RV, FVC and FEV1 are affected by height, since they are proportional to body size. This means that a tall individual will experience greater decrease in lung volumes as they get older. Some variables, such as FRC and ERV, decline exponentially with an increase in weight, to the extent that tidal volume in morbidly obese patients can be close to that of RV. Men have longer airways than women, causing greater specific resistance in the respiratory tract. The increased work of breathing to increase ventilation among women means that their consumption of oxygen is higher than men under similar conditions of physical intensity. Lung volumes are higher when the subject is standing than in other positions. DLCO is significantly higher in supine positions than in sitting or standing positions, but the difference between sitting and standing positions is not significant. Anthropometric characteristics are insufficient to explain differences in lung function between different ethnic groups, underlining the importance of considering other factors in addition to the conventional anthropometric measurements.
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Affiliation(s)
| | - Eduardo Márquez Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Laura María Roa Romero
- Departamento de Ingeniería Biomédica, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, España
| | - Francisco Ortega Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, España.
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221
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Spelta F, Fratta Pasini AM, Cazzoletti L, Ferrari M. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord 2018; 23:15-22. [PMID: 29110280 DOI: 10.1007/s40519-017-0456-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/22/2017] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the "obesity paradox". In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the "paradox" is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild-moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties-related to increased fat mass-obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese "blue bloaters" a low-grade emphysema in opposition to lean "pink puffers"; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue. LEVEL OF EVIDENCE Level V: Narrative Review.
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Affiliation(s)
- Francesco Spelta
- Section of Internal Medicine, University of Verona, Policlinico G.B. Rossi, P.le Scuro, 10, 37134, Verona, Italy.
| | - A M Fratta Pasini
- Section of Internal Medicine, University of Verona, Policlinico G.B. Rossi, P.le Scuro, 10, 37134, Verona, Italy
| | - L Cazzoletti
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - M Ferrari
- Section of Respiratory Disease, Department of Medicine, University of Verona, Verona, Italy
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222
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Yan J, Grantham M, Pantelic J, Bueno de Mesquita PJ, Albert B, Liu F, Ehrman S, Milton DK. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci U S A 2018; 115:1081-1086. [PMID: 29348203 PMCID: PMC5798362 DOI: 10.1073/pnas.1716561115] [Citation(s) in RCA: 331] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Little is known about the amount and infectiousness of influenza virus shed into exhaled breath. This contributes to uncertainty about the importance of airborne influenza transmission. We screened 355 symptomatic volunteers with acute respiratory illness and report 142 cases with confirmed influenza infection who provided 218 paired nasopharyngeal (NP) and 30-minute breath samples (coarse >5-µm and fine ≤5-µm fractions) on days 1-3 after symptom onset. We assessed viral RNA copy number for all samples and cultured NP swabs and fine aerosols. We recovered infectious virus from 52 (39%) of the fine aerosols and 150 (89%) of the NP swabs with valid cultures. The geometric mean RNA copy numbers were 3.8 × 104/30-minutes fine-, 1.2 × 104/30-minutes coarse-aerosol sample, and 8.2 × 108 per NP swab. Fine- and coarse-aerosol viral RNA were positively associated with body mass index and number of coughs and negatively associated with increasing days since symptom onset in adjusted models. Fine-aerosol viral RNA was also positively associated with having influenza vaccination for both the current and prior season. NP swab viral RNA was positively associated with upper respiratory symptoms and negatively associated with age but was not significantly associated with fine- or coarse-aerosol viral RNA or their predictors. Sneezing was rare, and sneezing and coughing were not necessary for infectious aerosol generation. Our observations suggest that influenza infection in the upper and lower airways are compartmentalized and independent.
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Affiliation(s)
- Jing Yan
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
- Department of Chemical and Biomolecular Engineering, Clark School of Engineering, University of Maryland, College Park, MD 20742
| | - Michael Grantham
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Jovan Pantelic
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - P Jacob Bueno de Mesquita
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Barbara Albert
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Fengjie Liu
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742
| | - Sheryl Ehrman
- Department of Chemical and Biomolecular Engineering, Clark School of Engineering, University of Maryland, College Park, MD 20742
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742;
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223
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Fuertes E, Carsin AE, Antó JM, Bono R, Corsico AG, Demoly P, Gislason T, Gullón JA, Janson C, Jarvis D, Heinrich J, Holm M, Leynaert B, Marcon A, Martinez-Moratalla J, Nowak D, Pascual Erquicia S, Probst-Hensch NM, Raherison C, Raza W, Gómez Real F, Russell M, Sánchez-Ramos JL, Weyler J, Garcia Aymerich J. Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study. Thorax 2018; 73:376-384. [PMID: 29306902 PMCID: PMC5870462 DOI: 10.1136/thoraxjnl-2017-210947] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/09/2017] [Accepted: 12/04/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort. METHODS FEV1 and FVC were measured in 3912 participants at 27-57 years and 39-67 years (mean time between examinations=11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity ≥2 times and ≥1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC. RESULTS Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline. CONCLUSION Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.
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Affiliation(s)
- Elaine Fuertes
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Anne-Elie Carsin
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Josep M Antó
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Pascal Demoly
- Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.,UMR-S 1136 INSERM, IPLESP, UPMC, Sorbonne Universités, Paris, France
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Deborah Jarvis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,Department of Population Health and Occupational Diseases, National Heart and Lung Institute, Imperial College London, London, UK
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bénédicte Leynaert
- Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France.,UMR 1152, University Paris Diderot Paris, Paris, France
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Martinez-Moratalla
- Servicio de Neumología del Complejo, Servicio de Salud de Castilla - La Mancha (SESCAM), Hospitalario Universitario de Albacete, Albacete, Spain.,Facultad de Medicina de Albacete, Universidad de Castilla - La Mancha, Albacete, Spain
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | | | - Nicole M Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland
| | | | - Wasif Raza
- Department of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Melissa Russell
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - Joost Weyler
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Judith Garcia Aymerich
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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224
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Miyazaki S, Matsui T, Inoue M, Ikeda T. Negative-pressure pulmonary oedema following choking on a rice ball. BMJ Case Rep 2018; 2018:bcr-2017-222520. [DOI: 10.1136/bcr-2017-222520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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225
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Carvalho TMDCS, Soares AF, Climaco DCS, Secundo IV, de Lima AMJ. Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome. J Bras Pneumol 2018; 44. [PMID: 29947714 PMCID: PMC6326717 DOI: 10.1590/s1806-375644-04-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate lung function and inspiratory muscle strength, correlating them with exercise tolerance, in obese individuals with obstructive sleep apnea syndrome (OSAS). METHODS The sample comprised 31 adult subjects with moderate-to-severe OSAS diagnosed by polysomnography. We used spirometry to measure FVC, FEV1, and FVC/FEV1 ratio, using pressure manometry to measure MIP and MEP. The incremental shuttle walk test (ISWT) and the six-minute walk test (6MWT) were used in order to determine functional exercise capacity. RESULTS In this sample, the mean values for FVC (% of predicted), FEV1 (% of predicted): MIP, and MEP were 76.4 ± 12.3%, 80.1 ± 6.3%, 60.0 ± 21.9 cmH2O, and 81.3 ± 22.2 cmH2O, respectively. The mean distances covered on the ISWT and 6MWT were 221 ± 97 m and 480.8 ± 67.3 m, respectively. The ISWT distance showed moderate positive correlations with FVC (r = 0.658; p = 0.001) and FEV1 (r = 0.522; p = 0.003). CONCLUSIONS In this sample of obese subjects with untreated OSAS, lung function, inspiratory muscle strength, and exercise tolerance were all below normal. In addition, we found that a decline in lung function, but not in respiratory muscle strength, was associated with exercise tolerance in these patients.
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Affiliation(s)
| | - Anísio Francisco Soares
- . Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco - UFRPE - Recife (PE) Brasil
| | | | | | - Anna Myrna Jaguaribe de Lima
- . Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco - UFRPE - Recife (PE) Brasil
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226
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Zhang ZJ, Zheng ML, Nie Y, Niu ZQ. Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with left-sided double-lumen endobronchial tube in one-lung ventilation in thoracic surgery in the morbidly obese. ACTA ACUST UNITED AC 2017; 51:e6825. [PMID: 29267506 PMCID: PMC5734186 DOI: 10.1590/1414-431x20176825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.
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Affiliation(s)
- Z J Zhang
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - M L Zheng
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Y Nie
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Z Q Niu
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
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228
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Zewari S, Vos P, van den Elshout F, Dekhuijzen R, Heijdra Y. Obesity in COPD: Revealed and Unrevealed Issues. COPD 2017; 14:663-673. [DOI: 10.1080/15412555.2017.1383978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- S. Zewari
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - P. Vos
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - F. van den Elshout
- Department of Pulmonary Disease, Rijnstate hospital, Arnhem, The Netherlands
| | - R. Dekhuijzen
- Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Y. Heijdra
- Department of Pulmonary Disease, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Moualla M, Qualls C, Arynchyn A, Thyagarajan B, Kalhan R, Smith LJ, Carr JJ, Jacobs DR, Sood A. Rapid decline in lung function is temporally associated with greater metabolically active adiposity in a longitudinal study of healthy adults. Thorax 2017; 72:1113-1120. [PMID: 28729298 PMCID: PMC6158777 DOI: 10.1136/thoraxjnl-2016-209125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 05/06/2017] [Accepted: 05/22/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE Adiposity is associated with low lung function, but the longitudinal relationship between lung function and adiposity is inadequately studied. OBJECTIVE To examine the bidirectional longitudinal associations between rapid decline in lung function and adiposity phenotypes in healthy adults. METHODS This secondary analysis used a 25-year longitudinal dataset from the Coronary Artery Risk Development in Young Adults (CARDIA) study that enrolled 5115 participants. MEASUREMENTS In the first analysis, metabolic syndrome at or before CARDIA year (Y) 10 (Y10) was the predictor, and subsequent rapid decline in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1) between Y10 and Y20 was the outcome. In the second analysis, rapid decline was the predictor, and incident metabolic syndrome at Y20 and/or Y25 was the outcome. In the third analysis, rapid decline was the predictor, and subsequent CT-assessed regional fat depots at Y25 were the outcome. RESULTS Metabolic syndrome at or before Y10 is temporally associated with rapid decline in FVC between Y10 and Y20 (adjusted p=0.04), but this association was explained by body mass index (BMI) at Y10. Rapid decline in FVC or FEV1 is temporally associated with greater incident metabolic syndrome at Y20 and/or Y25 (adjusted OR 2.10 (1.69, 2.61); p<0.001, and 1.56 (1.26, 1.94); p<0.001, respectively) and greater CT-assessed intrathoracic visceral adiposity at Y25 (adjusted standardised β 0.09; p<0.001 for both analyses). These associations were not explained by BMI levels prior to the outcome measurement. CONCLUSIONS Healthy adults with rapid decline in lung function are at risk for developing metabolic syndrome and for disproportionate accumulation of intrathoracic visceral fat. Metabolic abnormalities may be an early extrapulmonary manifestation of lung impairment that may be preventable by improving lung health.
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Affiliation(s)
- Maan Moualla
- Department of Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Clifford Qualls
- Office of Research, Clinical Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alexander Arynchyn
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bharat Thyagarajan
- University of Minnesota, Department of Laboratory Medicine and Pathology, Minneapolis, Minnesota, USA
| | - Ravi Kalhan
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lewis J Smith
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John J Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Akshay Sood
- Department of Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Negm MF, Essawy TS, Mohammad OI, Gouda TM, EL-Badawy AM, Shahoot AG. The impact of metabolic syndrome on ventilatory pulmonary Functions. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_82_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cvijetić S, Pipinić IS, Varnai VM, Macan J. Relationship between ultrasound bone parameters, lung function, and body mass index in healthy student population. Arh Hig Rada Toksikol 2017; 68:53-58. [PMID: 28365676 DOI: 10.1515/aiht-2017-68-2869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/01/2016] [Indexed: 12/13/2022] Open
Abstract
Low bone mineral density has been reported in paediatric and adult patients with different lung diseases, but limited data are available on the association between lung function and bone density in a healthy young population. We explored the predictors of association between bone mass and pulmonary function in healthy first-year university students, focusing on body mass index (BMI). In this cross-sectional study we measured bone density with ultrasound and lung function with spirometry in 370 university students (271 girls and 99 boys). Information on lifestyle habits, such as physical activity, smoking, and alcohol consumption were obtained with a questionnaire. All lung function and bone parameters were significantly higher in boys than in girls (P<0.001). Underweight students had a significantly lower forced vital capacity (FVC%) (P=0.001 girls; P=0.012 boys), while overweight students had a significantly higher FVC% than normal weight students (P=0.024 girls; P=0.001 boys). BMI significantly correlated with FVC% (P=0.001) and forced expiratory volume in 1 second (FEV1 %) in both genders (P=0.001 girls; P=0.018 boys) and with broadband ultrasound attenuation (BUA) in boys. There were no significant associations between any of the bone and lung function parameters either in boys or girls. The most important determinant of lung function and ultrasound bone parameters in our study population was body mass index, with no direct association between bone density and lung function.
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Affiliation(s)
- Selma Cvijetić
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10000 Zagreb
| | | | | | - Jelena Macan
- Institute for Medical Research and Occupational Health, Zagreb
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Abston E, Comellas A, Reed RM, Kim V, Wise RA, Brower R, Fortis S, Beichel R, Bhatt S, Zabner J, Newell J, Hoffman EA, Eberlein M. Higher BMI is associated with higher expiratory airflow normalised for lung volume (FEF25-75/FVC) in COPD. BMJ Open Respir Res 2017; 4:e000231. [PMID: 29071083 PMCID: PMC5652498 DOI: 10.1136/bmjresp-2017-000231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/04/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The obesity paradox in chronic obstructive pulmonary disease (COPD), whereby patients with higher body mass index (BMI) fare better, is poorly understood. Higher BMIs are associated with lower lung volumes and greater lung elastic recoil, a key determinant of expiratory airflow. The forced expiratory flow (25-75) (FEF25-75)/forced vital capacity (FVC) ratio reflects effort-independent expiratory airflow in the context of lung volume and could be modulated by BMI. METHODS We analysed data from the COPDGene study, an observational study of 10 192 subjects, with at least a 10 pack-year smoking history. Data were limited to subjects with BMI 20-40 kg/m2 (n=9222). Subjects were stratified according to forced expiratory volume in 1 s (FEV1) (%predicted)-quintiles. In regression analyses and Cox proportional hazard models, we analysed the association between BMI, the FEF25-75/FVC ratio, the imaging phenotype, COPD exacerbations, hospitalisations and death. RESULTS There was no correlation between BMI and FEV1(%predicted). However, a higher BMI is correlated with a higher FEF25-75/FVC ratio. In CT scans, a higher BMI was associated with less emphysema and less air trapping. In risk-adjusted models, the quintile with the highest FEF25-75/FVC ratio was associated with a 46% lower risk of COPD exacerbations (OR 0.54, p<0.001) and a 40% lower risk of death (HR 0.60, p=0.02), compared with the lowest quintile. BMI was not independently associated with these outcomes. CONCLUSIONS A higher BMI is associated with lower lung volumes and higher expiratory airflows when normalised for lung volume, as quantified by the FEF25-75/FVC ratio. A higher FEF25-75/FVC ratio is associated with a lower risk of COPD exacerbations and death and might quantify functional aspects of the paradoxical effect of higher BMIs on COPD.
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Affiliation(s)
- Eric Abston
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro Comellas
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Robert Michael Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Temple University, School of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roy Brower
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Spyridon Fortis
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Reinhard Beichel
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
| | - Surya Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Joseph Zabner
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - John Newell
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa, USA
| | - Eric A Hoffman
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa, USA
| | - Michael Eberlein
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
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Pan J, Xu L, Lam TH, Jiang CQ, Zhang WS, Jin YL, Zhu F, Zhu T, Thomas GN, Cheng KK, Adab P. Association of adiposity with pulmonary function in older Chinese: Guangzhou Biobank Cohort Study. Respir Med 2017; 132:102-108. [PMID: 29229080 DOI: 10.1016/j.rmed.2017.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/10/2017] [Accepted: 10/07/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We examined the association between different adiposity indices and pulmonary function in Chinese adults in the Guangzhou Biobank Cohort Study (GBCS). METHODS Participants with body mass index (BMI) < 18.5 (underweight) were excluded. Adiposity indices including BMI, waist circumference (WC), waist hip ratio, waist height ratio and body fat percentage were measured. Lung function was assessed by spirometry using a turbine flowmeter. We analyzed percent predicted for forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC %) and restrictive respiratory defect (FEV1/FVC ratio > low limits of normal and FVC % <0.80). RESULTS Of 16186 participants (mean age 61.4 ± 7.2 years; 74.0% women), 116 (0.7%) had only general obesity (BMI ≥28 kg/m2), 4079 (25.2%) had only central obesity (WC: ≥90 cm in men, ≥80 cm in women) and 1591 (9.8%) had both central obesity and general obesity. Comparing to those with neither central nor general obesity, those with only central adiposity and with both central and general obesity had lower pulmonary function (adjusted β range from -2.85 to -6.02 for FEV1% and FVC%, adjusted OR range from 1.14 to 1.70, all P < 0.05). But those with only general obesity had better but non-significant pulmonary function. (Crude β range from 1.46 to 2.92 for FEV1% and FVC%, crude OR range from 0.68 to 0.93, all P > 0.05). Both FEV1% and FVC% decreased per standard deviation increase in obesity indices (adjusted β from -0.46 to -3.17, all P < 0.002). A positive association of central or general obesity with restrictive respiratory defect was observed (adjusted odds ratio (AOR) from 1.50 to 2.04, all P < 0.002). Further adjustment for WC reversed the inverse association between BMI and pulmonary function (adjusted β from 1.93 to 6.22, all P < 0.001) and restrictive respiratory defect (adjusted AOR from 0.72 to 0.80, all P < 0.001). CONCLUSION Central adiposity and its indices, but not general adiposity and BMI, were independently associated with lower pulmonary function and higher risk of restrictive respiratory defect in older Chinese.
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Affiliation(s)
- Jing Pan
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China; School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China; School of Public Health, The University of Hong Kong, Hong Kong, China.
| | | | - Wei Sen Zhang
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Feng Zhu
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Tong Zhu
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Oh SS, Du R, Zeiger AM, McGarry ME, Hu D, Thakur N, Pino-Yanes M, Galanter JM, Eng C, Nishimura KK, Huntsman S, Farber HJ, Meade K, Avila P, Serebrisky D, Bibbins-Domingo K, Lenoir MA, Ford JG, Brigino-Buenaventura E, Rodriguez-Cintron W, Thyne SM, Sen S, Rodriguez-Santana JR, Williams K, Kumar R, Burchard EG. Breastfeeding associated with higher lung function in African American youths with asthma. J Asthma 2017; 54:856-865. [PMID: 27929698 PMCID: PMC6130885 DOI: 10.1080/02770903.2016.1266496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/02/2016] [Accepted: 11/26/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In the United States, Puerto Ricans and African Americans have lower prevalence of breastfeeding and worse clinical outcomes for asthma compared with other racial/ethnic groups. We hypothesize that the history of breastfeeding is associated with increased forced expiratory volume in 1 second (FEV1) % predicted and reduced asthma exacerbations in Latino and African American youths with asthma. METHODS As part of the Genes-environments & Admixture in Latino Americans (GALA II) Study and the Study of African Americans, asthma, Genes & Environments (SAGE II), we conducted case-only analyses in children and adolescents aged 8-21 years with asthma from four different racial/ethnic groups: African Americans (n = 426), Mexican Americans (n = 424), mixed/other Latinos (n = 255), and Puerto Ricans (n = 629). We investigated the association between any breastfeeding in infancy and FEV1% predicted using multivariable linear regression; Poisson regression was used to determine the association between breastfeeding and asthma exacerbations. RESULTS Prevalence of breastfeeding was lower in African Americans (59.4%) and Puerto Ricans (54.9%) compared to Mexican Americans (76.2%) and mixed/other Latinos (66.9%; p < 0.001). After adjusting for covariates, breastfeeding was associated with a 3.58% point increase in FEV1% predicted (p = 0.01) and a 21% reduction in asthma exacerbations (p = 0.03) in African Americans only. CONCLUSION Breastfeeding was associated with higher FEV1% predicted in asthma and reduced number of asthma exacerbations in African American youths, calling attention to continued support for breastfeeding.
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Affiliation(s)
- Sam S Oh
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Randal Du
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- b Department of Pharmacy , University of California San Francisco , San Francisco , CA , USA
| | - Andrew M Zeiger
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Meghan E McGarry
- c Department of Pediatrics , University of California San Francisco , San Francisco , CA , USA
| | - Donglei Hu
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Neeta Thakur
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Maria Pino-Yanes
- d Research Unit , Hospital Universitario NS de Candelaria , Santa Cruz de Tenerife , Spain
| | - Joshua M Galanter
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Bioengineering and Therapeutic Sciences , University of California San Franscisco , San Francisco , CA , USA
| | - Celeste Eng
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | | | - Scott Huntsman
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Harold J Farber
- f Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- g Department of Pulmonology , Texas Children's Hospital , Houston , TX , USA
| | - Kelley Meade
- h Department of Primary Care , UCSF Benioff Children's Hospital , San Francisco , CA , USA
| | - Pedro Avila
- i Department of Medicine , Northwestern University , Evanston , IL , USA
| | - Denise Serebrisky
- j Department of Pediatric Pulmonology , Jacobi Medical Center , Bronx , NY , USA
| | - Kirsten Bibbins-Domingo
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
| | - Michael A Lenoir
- k Department of Pediatrics , Bay Area Pediatrics , Oakland , CA , USA
| | - Jean G Ford
- l Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | | | | | - Shannon M Thyne
- o Department of Medicine , University of California Los Angeles David Geffen School of Medicine , Los Angeles , CA , USA
| | - Saunak Sen
- p Department of Epidemiology and Biostatistics , University of California San Francisco , San Francisco , CA , USA
| | - Jose R Rodriguez-Santana
- q Department of Pediatric Pulmonology and Critical Care , Centro de Neumología Pediátrica , San Juan , Puerto Rico
| | - Keoki Williams
- r Center for Health Policy and Health Services Research, Henry Ford Health System , Detroit , MI , USA
- s Department of Internal Medicine , Henry Ford Health System , Detroit , MI , USA
| | - Rajesh Kumar
- i Department of Medicine , Northwestern University , Evanston , IL , USA
| | - Esteban G Burchard
- a Department of Medicine , University of California San Francisco , San Francisco , CA , USA
- e Department of Bioengineering and Therapeutic Sciences , University of California San Franscisco , San Francisco , CA , USA
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T-cell profile and systemic cytokine levels in overweight-obese patients with moderate to very-severe COPD. Respir Physiol Neurobiol 2017; 247:74-79. [PMID: 28963085 DOI: 10.1016/j.resp.2017.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 01/12/2023]
Abstract
This study aimed to evaluate the immune profile of lean and overweight-obese COPD patients. Forty patients with moderate to very severe COPD were divided into lean group (n=20; aged 62.00±8.91years; BMI 22.26±1.65kg/m2) or overweight-obese group (n=20; aged 65.40±6.69years; BMI 29.19±3.55kg/m2). The cytokine profile (IL-2, IL-4, IL-6, IL-10, INF-γ, and TNF-α) was evaluated through the Cytometric Bead Array technique, and the expression of CD4, CD8, CD25, CD45ra, CD45ro, CD69, CD195(CCr5) and HLA-DR were evaluated in CD3+ T-cells. Overweight-obese COPD group had lower levels of IL-2 (p=0.01) and higher INF-γ levels (p=0.02) and IL-6 (p=0.003) than lean COPD. Lean COPD patients had higher CD25+ (p=0.01), CCr5 (p=0.04) and HLA-DR (p=0.007) expression on T cell surface compared to overweight-obese COPD participants. These changes are related to immune dysfunction of obesity, and excess of fat mass in COPD can be a key factor to low T-cells activation.
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Boriek AM, Lopez MA, Velasco C, Bakir AA, Frolov A, Wynd S, Babb TG, Hanania NA, Hoffman EA, Sharafkhaneh A. Obesity modulates diaphragm curvature in subjects with and without COPD. Am J Physiol Regul Integr Comp Physiol 2017; 313:R620-R629. [PMID: 28903915 DOI: 10.1152/ajpregu.00173.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/08/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
Obesity is a common comorbidity of chronic obstructive pulmonary disease (COPD) and has been associated with worse outcomes. However, it is unknown whether the interaction between obesity and COPD modulates diaphragm shape and consequently its function. The body mass index (BMI) has been used as a correlate of obesity. We tested the hypothesis that the shape of the diaphragm muscle and size of the ring of its insertion in non-COPD and COPD subjects are modulated by BMI. We recruited 48 COPD patients with postbronchiodilator forced expiratory volume in 1 s (FEV1)-to-forced vital capacity (FVC) < 0.7 and 29 age-matched smoker/exsmoker control (non-COPD) subjects, who underwent chest computed tomography (CT) at lung volumes ranging from functional residual capacity (FRC) to total lung capacity (TLC). We then computed maximum principal diaphragm curvature in the midcostal region of the left hemidiaphragm at the end of inspiration during quiet breathing (EI) and at TLC. The radius of maximum curvature of diaphragm muscle increased with BMI in both COPD and non-COPD subjects. The size of diaphragm ring of insertion on the chest wall also increased significantly with increasing BMI. Surprisingly, COPD severity did not appear to cause significant alteration in diaphragm shape except in normal-weight subjects at TLC. Our data uncovered important factors such as BMI, the size of the diaphragm ring of insertion, and disease severity that modulate the structure of the ventilatory pump in non-COPD and COPD subjects.
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Affiliation(s)
| | | | | | | | | | - Shari Wynd
- Texas Chiropractic College, Houston, Texas
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas; and
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Jain R, Osranek M, Jan MF, Kalvin LR, Olet S, Allaqaband SQ, Jahangir A, Khandheria BK, Tajik AJ. Marked respiratory-related fluctuations in left ventricular outflow tract gradients in hypertrophic obstructive cardiomyopathy: an observational study. Eur Heart J Cardiovasc Imaging 2017; 19:1126-1133. [DOI: 10.1093/ehjci/jex215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/16/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Renuka Jain
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
| | | | - M Fuad Jan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
| | - Lindsey R Kalvin
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
| | - Susan Olet
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
| | - Arshad Jahangir
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
- Center for Integrative Research on Cardiovascular Aging, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, Wisconsin, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
- Marcus Family Fund for Echocardiography (ECHO) Research and Education, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, Wisconsin, USA
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI, USA
- Center for Integrative Research on Cardiovascular Aging, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, Wisconsin, USA
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Rowe A, Hernandez P, Kuhle S, Kirkland S. The association between anthropometric measures and lung function in a population-based study of Canadian adults. Respir Med 2017; 131:199-204. [PMID: 28947030 DOI: 10.1016/j.rmed.2017.08.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decreased lung function has health impacts beyond diagnosable lung disease. It is therefore important to understand the factors that may influence even small changes in lung function including obesity, physical fitness and physical activity. The aim of this study was to determine the anthropometric measure most useful in examining the association with lung function and to determine how physical activity and physical fitness influence this association. METHODS The current study used cross-sectional data on 4662 adults aged 40-79 years from the Canadian Health Measures Survey Cycles 1 and 2. Linear regression models were used to examine the association between the anthropometric and lung function measures (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]); R2 values were compared among models. Physical fitness and physical activity terms were added to the models and potential confounding was assessed. RESULTS Models using sum of 5 skinfolds and waist circumference consistently had the highest R2 values for FEV1 and FVC, while models using body mass index consistently had among the lowest R2 values for FEV1 and FVC and for men and women. Physical activity and physical fitness were confounders of the relationships between waist circumference and the lung function measures. Waist circumference remained a significant predictor of FVC but not FEV1 after adjustment for physical activity or physical fitness. CONCLUSIONS Waist circumference is an important predictor of lung function. Physical activity and physical fitness should be considered as potential confounders of the relationship between anthropometric measures and lung function.
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Affiliation(s)
- A Rowe
- Dept. of Community Health and Epidemiology, Dalhousie University, Canada
| | - P Hernandez
- Dept. of Medicine, Dalhousie University, Canada
| | - S Kuhle
- Dept. of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, Canada
| | - S Kirkland
- Dept. of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Room 423, 5790 University Ave, Halifax, Nova Scotia B3H 1V7, Canada.
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Garshick E, Walia P, Goldstein RL, Teylan M, Lazzari AA, Tun CG, Hart JE. Plasma Leptin and Reduced FEV 1 and FVC in Chronic Spinal Cord Injury. PM R 2017; 10:276-285. [PMID: 28827209 DOI: 10.1016/j.pmrj.2017.08.437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness. OBJECTIVE To assess the associations between leptin and adiponectin with pulmonary function in a chronic SCI cohort. DESIGN Cross-sectional study. SETTING Veterans Affairs Medical Center. PARTICIPANTS A total of 285 participants (237 men and 48 women) with chronic SCI with mean (standard deviation) injury duration 17.8 (13.2) years from the VA Boston and the community participating in an epidemiologic study assessing factors associated with respiratory health. METHODS Participants (24.6% cervical American Spinal Injury Association Impairment Scale (AIS) level A, B, and C; 33.6% other AIS A, B, and C; 41.8% AIS D) provided a blood sample, completed a respiratory health questionnaire, and underwent spirometry. Linear regression methods were used to assess cross-sectional associations between plasma leptin and adiponectin with spirometric measures of pulmonary function adjusted for age, race, gender, and height. Level and severity of SCI, mobility mode, body mass index, smoking, chronic obstructive pulmonary disease, asthma, chest injury history, laboratory batch, and other potential confounders were also considered. MAIN OUTCOME MEASUREMENTS forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS There was a statistically significant inverse relationship between plasma leptin assessed in quartiles or as a continuous covariate with FEV1 and FVC. In fully adjusted models, each interquartile range (16,214 pg/mL) increase in leptin was associated with a significant decrease in FEV1 (-93.1 mL; 95% confidence interval = -166.2, -20.0) and decrease in FVC (-130.7 mL; 95% confidence interval = -219.4, -42.0). There were no significant associations between leptin and FEV1/FVC or between plasma adiponectin with FEV1, FVC, or FEV1/FVC. CONCLUSION Plasma leptin in individuals with chronic SCI is inversely associated with FEV1 and FVC, independently of SCI level and severity and other covariates. This finding suggests that plasma leptin may contribute to reduced pulmonary function in chronic SCI. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Palak Walia
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rebekah L Goldstein
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Merilee Teylan
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonio A Lazzari
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Carlos G Tun
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaime E Hart
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; VA Boston Healthcare System, West Roxbury Campus, 1400 VFW Parkway, West Roxbury, MA 02132.,Research and Development Service, VA Boston Healthcare System, Boston, MA.,Divison of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, Boston University School of Medicine, Boston, MA.,Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
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241
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Spero K, Bayasi G, Beaudry L, Barber KR, Khorfan F. Overdiagnosis of COPD in hospitalized patients. Int J Chron Obstruct Pulmon Dis 2017; 12:2417-2423. [PMID: 28860736 PMCID: PMC5565250 DOI: 10.2147/copd.s139919] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The diagnosis of chronic obstructive pulmonary disease (COPD) is usually made based on history and physical exam alone. Symptoms of dyspnea, cough, and wheeze are nonspecific and attributable to a variety of diseases. Confirmatory testing to verify the airflow obstruction is available but rarely used, which may result in substantial misdiagnoses of COPD. The aim of this study is to evaluate the use of confirmatory testing and assess the accuracy of the diagnosis. Methods From January 2011 through December 2013, 6,018 patients with COPD as a principal or leading diagnosis were admitted at a community teaching hospital. Of those, only 504 (8.4%) patients had spirometry performed during hospitalization. The studies were reviewed by two board-certified pulmonologists to verify presence of persistent airflow obstruction. Charts of these patients were then examined to determine if the spirometry results had changed the diagnosis or the treatment plan for these patients. Results Spirometry confirmed the diagnosis of COPD in 270 patients (69.2%) treated as COPD during their hospitalization. Restrictive lung disease was found to be present in 104 patients (26.6%) and normal in 16 patients (4.2%). Factors predictive of airflow obstruction included smoking status and higher pack-year history. Negative predictive factors included higher body mass index (BMI) and other medical comorbidities. These patients were significantly more likely to be misdiagnosed and mistreated as COPD. Conclusion Up to a third of patients diagnosed and treated as COPD in the hospital may be inaccurately diagnosed as COPD based on confirmatory spirometry testing. Factors contributing to the inaccuracy of diagnosis include less smoking history, high BMI, and associated comorbidities.
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Affiliation(s)
- Kerry Spero
- Department of Medical Education, Genesys Regional Medical Center, Grand Blanc
| | - Ghiath Bayasi
- Department of Pulmonary and Critical Care Medicine, Michigan State University, East Lansing
| | | | - Kimberly R Barber
- Department of Research, Genesys Regional Medical Center, Grand Blanc, MI, USA
| | - Fahim Khorfan
- Department of Pulmonary and Critical Care Medicine, Michigan State University, East Lansing
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242
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Hancox RJ, Gray AR, Poulton R, Sears MR. The Effect of Cigarette Smoking on Lung Function in Young Adults with Asthma. Am J Respir Crit Care Med 2017; 194:276-84. [PMID: 26866532 DOI: 10.1164/rccm.201512-2492oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Life-course persistent asthma and tobacco smoking are risk factors for irreversible airflow obstruction. It is often assumed that smoking and asthma have additive or multiplicative effects on the risk for airflow obstruction, but this has not been demonstrated in prospective studies of children with persistent asthma. OBJECTIVES To investigate the effects of smoking and asthma on the development of airflow obstruction in a population-based birth cohort followed to age 38 years. METHODS Reports of childhood asthma from ages 9, 11, and 13 and self-reports of adult asthma at ages 32 and 38 years were used to define childhood-onset persistent asthma (n = 91), late-onset asthma (n = 93), asthma in remission (n = 85), and nonasthmatic (n = 572) phenotypes. Cumulative tobacco smoking histories and spirometry were obtained at ages 18, 21, 26, 32, and 38 years. Analyses were by generalized estimating equations adjusting for childhood spirometry, body mass index, age, and sex. MEASUREMENTS AND MAIN RESULTS Smoking history and childhood-onset persistent asthma were both associated with lower FEV1/FVC ratios. Associations between smoking and FEV1/FVC ratios were different between asthma phenotypes (interaction P < 0.001). Smoking was associated with lower prebronchodilator and post-bronchodilator FEV1/FVC ratios among subjects without asthma and those with late-onset or remittent asthma, but smoking was not associated with lower FEV1/FVC ratios among those with childhood-onset persistent asthma. CONCLUSIONS Childhood-onset persistent asthma is associated with airflow obstruction by mid-adult life, but this does not seem to be made worse by tobacco smoking. We found no evidence that smoking and childhood-persistent asthma have additive or multiplicative effects on airflow obstruction.
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Affiliation(s)
- Robert J Hancox
- 1 Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R Gray
- 1 Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- 2 Department of Psychology, University of Otago, Dunedin, New Zealand; and
| | - Malcolm R Sears
- 3 Firestone Institute for Respiratory Health, Michael de Groote School of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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243
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Koman PD, Mancuso P. Ozone Exposure, Cardiopulmonary Health, and Obesity: A Substantive Review. Chem Res Toxicol 2017; 30:1384-1395. [PMID: 28574698 DOI: 10.1021/acs.chemrestox.7b00077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
From 1999-2014, obesity prevalence increased among adults and youth. Obese individuals may be uniquely susceptible to the proinflammatory effects of ozone because obese humans and animals have been shown to experience a greater decline in lung function than normal-weight subjects. Obesity is independently associated with limitations in lung mechanics with increased ozone dose. However, few epidemiologic studies have examined the interaction between excess weight and ozone exposure among adults. Using PubMed keyword searches and reference lists, we reviewed epidemiologic evidence to identify potential response-modifying factors and determine if obese or overweight adults are at increased risk of ozone-related health effects. We initially identified 170 studies, of which seven studies met the criteria of examining the interaction of excess weight and ozone exposure on cardiopulmonary outcomes in adults, including four short-term ozone exposure studies in controlled laboratory settings and three community epidemiologic studies. In the studies identified, obesity was associated with decreased lung function and increased inflammatory mediators. Results were inconclusive about the effect modification when data were stratified by sex. Obese and overweight populations should be considered as candidate at-risk groups for epidemiologic studies of cardiopulmonary health related to air pollution exposures. Air pollution is a modifiable risk factor that may decrease lung function among obese individuals with implications for environmental and occupational health policy.
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Affiliation(s)
- Patricia D Koman
- Department of Environmental Health Sciences, ‡Nutritional Sciences, and §Graduate Program in Immunology, School of Public Health, University of Michigan , Ann Arbor, Michigan 48109, United States
| | - Peter Mancuso
- Department of Environmental Health Sciences, ‡Nutritional Sciences, and §Graduate Program in Immunology, School of Public Health, University of Michigan , Ann Arbor, Michigan 48109, United States
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244
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Bramley AM, Reed C, Finelli L, Self WH, Ampofo K, Arnold SR, Williams DJ, Grijalva CG, Anderson EJ, Stockmann C, Trabue C, Fakhran S, Balk R, McCullers JA, Pavia AT, Edwards KM, Wunderink RG, Jain S. Relationship Between Body Mass Index and Outcomes Among Hospitalized Patients With Community-Acquired Pneumonia. J Infect Dis 2017; 215:1873-1882. [PMID: 28520948 PMCID: PMC5853774 DOI: 10.1093/infdis/jix241] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/16/2017] [Indexed: 02/06/2023] Open
Abstract
Background The effect of body mass index (BMI) on community-acquired pneumonia (CAP) severity is unclear. Methods We investigated the relationship between BMI and CAP outcomes (hospital length of stay [LOS], intensive care unit [ICU] admission, and invasive mechanical ventilation) in hospitalized CAP patients from the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, adjusting for age, demographics, underlying conditions, and smoking status (adults only). Results Compared with normal-weight children, odds of ICU admission were higher in children who were overweight (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.1-2.8) or obese (aOR, 2.1; 95% CI, 1.4-3.2), and odds of mechanical ventilation were higher in children with obesity (aOR, 2.7; 95% CI, 1.3-5.6). When stratified by asthma (presence/absence), these findings remained significant only in children with asthma. Compared with normal-weight adults, odds of LOS >3 days were higher in adults who were underweight (aOR, 1.6; 95% CI, 1.1-2.4), and odds of mechanical ventilation were lowest in adults who were overweight (aOR, 0.5; 95% CI, .3-.9). Conclusions Children who were overweight or obese, particularly those with asthma, had higher odds of ICU admission or mechanical ventilation. In contrast, adults who were underweight had longer LOS. These results underscore the complex relationship between BMI and CAP outcomes.
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Affiliation(s)
- Anna M Bramley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wesley H Self
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis
- University of Tennessee Health Science Center, Memphis
| | - Derek J Williams
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | | | | | | | - Christopher Trabue
- University of Tennessee Health Science Center/Saint Thomas Health, Nashville
| | | | - Robert Balk
- Rush University Medical Center, Chicago, Illinois
| | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis
- University of Tennessee Health Science Center, Memphis
- St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew T Pavia
- University of Utah Health Sciences Center, Salt Lake City
| | - Kathryn M Edwards
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | | | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia
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245
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Shenoy U, Jagadamba. Influence of Central Obesity Assessed by Conicity Index on Lung Age in Young Adults. J Clin Diagn Res 2017; 11:CC09-CC12. [PMID: 28571133 DOI: 10.7860/jcdr/2017/23428.9718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Central obesity is an emerging public health problem in young adults which compromises lung mechanics. Conicity Index (CI) is a simple anthropometric measure to assess central adiposity. The concept of lung age relates to a person's current lung function at which his/her lung function would be considered abnormal in relation to the present actual age. AIM To determine the effect of central obesity by CI on lung age in young adults. MATERIALS AND METHODS A total of 319 young adults in the age group 18-25 years were recruited for this cross-sectional observational study. Written informed consent and Institutional Ethical Clearance (IEC) approval were obtained. Anthropometric parameters were measured and CI was calculated using the following formula: CI = Waist Circumference (WC) (m)/ [0.109 X√ {Bodyweight (kg)/ Height (m)}] where 0.109 is a constant. Spirometry was performed and all the lung volumes and capacities were obtained. RESULTS There was a significant increase in mean values of CI in obese young adults compared to non obese (1.36±0.15 and 1.16±0.08, p<0.001). The effect of central obesity on lung age in young adults was compared using an independent t-test. Mean of lung age was significantly higher in centrally obese young adults compared to non obese 23.87±3.03 and 21.30±2.6, p<0.001) which was statistically significant. CONCLUSION Lung age is significantly increased in centrally obese young adults compared to non obese. Hence, lung age can be used as a potential psychological tool to show an individual with central obesity that there is premature aging of their lungs.
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Affiliation(s)
- Usha Shenoy
- Assistant Professor, Department of Physiology, Sri Devaraj URS Medical College, SDUAHER, Kolar, Karnataka, India
| | - Jagadamba
- Associate Professor, Department of Physiology, Sri Devaraj URS Medical College, SDUAHER, Kolar, Karnataka, India
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Abstract
Obesity has increased in incidence worldwide. Along with the increased number of obese patients, comorbid conditions are also more prevalent in this population. Obesity leads to changes in the physiology of patients along with an altered response to pharmacologic therapy. Vigilant perioperative physicians must be aware of the unique characteristics of administered agents in order to appropriately provide anesthetic care for obese patients. Because of the variability in tissue content in obese patients and changes in pharmacokinetic modeling, a one-size-fits-all approach is not justified and a more sophisticated and prudent approach is indicated.
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Affiliation(s)
- Simon Willis
- Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital/National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Gregory J Bordelon
- Department of Anesthesiology, Louisiana State University Medical Center, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA
| | - Maunak V Rana
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA.
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247
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Akın O, Arslan M, Haymana C, Karabulut E, Hacihamdioglu B, Yavuz ST. Association of neck circumference and pulmonary function in children. Ann Allergy Asthma Immunol 2017; 119:27-30. [PMID: 28527867 DOI: 10.1016/j.anai.2017.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Childhood obesity leads to many complications including impaired respiratory function. There are various anthropometric parameters related to obesity. OBJECTIVE To investigate the correlation between anthropometric indices and pulmonary function test results in children without asthma. METHODS Children without any respiratory disorders were enrolled in this study. Anthropometric measurements, such as height, weight, neck circumference (NC), and waist circumference, were obtained from the enrollees and body mass index was calculated. Afterward, pulmonary function tests were performed using spirometry. RESULTS A total of 178 children (106 boys, 59.5%) with a mean age of 9.7 years were included the study. NC was above the 90th percentile in 65 children. Importantly, pulmonary parameters, such as forced expiratory volume during the first second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC), were lower in subjects with a large NC. Similarly, waist circumference was above the 90th percentile in 67 children, and FEV1/FVC was significantly lower in children with a large waist circumference. Moreover, there was a statistically significant negative correlation among FEV1, FEV1/FVC, and body mass index SD score. Also, multivariable linear regression analysis showed that an NC above the 90th percentile was associated with lower FEV1 and FEV1/FVC values. CONCLUSION We identified NC as a novel anthropometric index that is strongly correlated with respiratory functions in children. Therefore, close monitoring of respiratory symptoms, particularly in children with obesity and a large NC, could help with early and prompt determination of respiratory complications of obesity.
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Affiliation(s)
- Onur Akın
- Department of Pediatric Endocrinology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Mutluay Arslan
- Department of Pediatrics, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cem Haymana
- Department of Endocrinology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Hacihamdioglu
- Department of Pediatric Endocrinology, GATA Military School of Medicine, Ankara, Turkey
| | - Suleyman Tolga Yavuz
- Department of Pediatric Allergy, GATA Military School of Medicine, Ankara, Turkey; Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany.
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248
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Just J, Bourgoin-Heck M, Amat F. Clinical phenotypes in asthma during childhood. Clin Exp Allergy 2017; 47:848-855. [PMID: 28422351 DOI: 10.1111/cea.12939] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Asthma is a heterogeneous disease characterized by numerous phenotypes relating to age of onset, triggers, comorbidities, severity (assessed by multiple exacerbations, lung function pattern) and finally the inflammatory cells involved in the pathophysiologic pathway. These phenotypes can vary over time in relation to changes in the principal triggers involved in the aetiology of the disease. Nevertheless, in a patient with multiple allergies and early-onset disease (defined as multiple sensitizations and allergic comorbidities), the prognosis of asthma is poor with a high risk of persistence and severity of the disease during childhood. Future research will focus on classifying phenotypes into groups based on pathophysiologic mechanisms (endotypes) and the biomarkers attached to these endotypes, which could predict prognosis and lead to targeted therapy. Currently, these biomarkers are related to inflammatory cells associated with the asthma endotype, essentially eosinophils and neutrophils (and related cytokines) attached to Th-2 and non Th-1 pathways, respectively. The most severe asthma (refractory asthma) is linked to neutrophil-derived inflammation (frequently associated with female sex, obesity and possibly disorganized airway microbiota) encountered in very young children or teenagers. Severe asthma is also linked to or a marked eosinophil inflammatory process (frequently associated with multiple atopy and, more rarely, with non-atopic hypereosinophilic asthma in children) and frequently encountered in teenagers. Severe phenotypes of asthma could also play a role in the origin of chronic obstructive pulmonary disease in adult life.
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Affiliation(s)
- J Just
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| | - M Bourgoin-Heck
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| | - F Amat
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
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249
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Complex hernias with loss of domain in morbidly obese patients: role of laparoscopic sleeve gastrectomy in a multi-step approach. Surg Obes Relat Dis 2017; 13:768-773. [DOI: 10.1016/j.soard.2017.01.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/01/2017] [Accepted: 01/20/2017] [Indexed: 11/17/2022]
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250
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Maia LDA, Silva PL, Pelosi P, Rocco PRM. Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. Expert Rev Respir Med 2017; 11:443-452. [PMID: 28436715 DOI: 10.1080/17476348.2017.1322510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m2.
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Affiliation(s)
- Lígia de Albuquerque Maia
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Pedro Leme Silva
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,b National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
| | - Paolo Pelosi
- c Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST , University of Genoa , Genoa , Italy
| | - Patricia Rieken Macedo Rocco
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,b National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
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