301
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Ben Saad H. Review of the current use of global lung function initiative norms for spirometry (GLI-2012) and static lung volumes (GLI-2021) in Great Arab Maghreb (GAM) countries and steps required to improve their utilization. Libyan J Med 2022; 17:2031596. [PMID: 35080480 PMCID: PMC8794060 DOI: 10.1080/19932820.2022.2031596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Helmi Ben Saad
- Faculty of Medicine of Sousse, Farhat Hached Hospital, Research Laboratory "Heart Failure, LR12SP09", University of Sousse, Sousse, Tunisia
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302
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Schallerer AE, Duke JW, Speros JP, Mangum TS, Norris HC, Beasley KM, Laurie SS, Elliott JE, Davis JT, Lovering AT. Lower transfer factor of the lung for carbon monoxide in women with a patent foramen ovale. Exp Physiol 2022; 107:243-252. [DOI: 10.1113/ep090176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | - Joseph W. Duke
- Department of Biological Sciences Northern Arizona University Flagstaff AZ USA
| | - Julia P. Speros
- Department of Human Physiology University of Oregon Eugene OR USA
| | - Tyler S. Mangum
- Department of Human Physiology University of Oregon Eugene OR USA
| | | | - Kara M. Beasley
- Department of Human Physiology University of Oregon Eugene OR USA
| | - Steven S. Laurie
- KBR, Cardiovascular and Vision Laboratory NASA Johnson Space Center Houston TX USA
| | - Jonathan E. Elliott
- VA Portland Health Care System Portland OR USA
- Department of Neurology Oregon Health & Science University Portland OR USA
| | - James T. Davis
- Department of Kinesiology Recreation, and Sport Indiana State University Terre Haute IN USA
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303
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Grafino M, Todo-Bom F, Lutas AC, Cabral J, Pereira M, Valença J, Furtado ST. Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria. J Bras Pneumol 2022; 47:e20210124. [PMID: 35019054 PMCID: PMC8836624 DOI: 10.36416/1806-3756/e20210124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/19/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion. METHODS This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD-, respectively) and according to the LLN criterion (LLN+ and LLN-, respectively). We also evaluated the level of agreement between the two criteria. RESULTS A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN- category (p = 0.03), as was the median DLCO (p = 0.04). CONCLUSIONS The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.
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Affiliation(s)
- Monica Grafino
- . Departamento de Pneumologia, Hospital da Luz Lisboa, Lisboa, Portugal
| | - Filipa Todo-Bom
- . Departamento de Pneumologia, Hospital da Luz Lisboa, Lisboa, Portugal
| | | | - Jorge Cabral
- . Departamento de Matemática, Universidade de Aveiro, Aveiro, Portugal
| | - Marco Pereira
- . Departamento de Pneumologia, Hospital da Luz Lisboa, Lisboa, Portugal
| | - João Valença
- . Departamento de Pneumologia, Hospital da Luz Lisboa, Lisboa, Portugal
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304
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Jung H, Kimball JP, Receveur T, Gazi AH, Agdeppa ED, Inan OT. Estimation of Tidal Volume Using Load Cells on a Hospital Bed. IEEE J Biomed Health Inform 2022; 26:3330-3341. [PMID: 34995200 DOI: 10.1109/jbhi.2022.3141209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although respiratory failure is one of the primary causes of admission to intensive care, the importance placed on measurement of respiratory parameters is commonly overshadowed compared to cardiac parameters. With the increased demand for unobtrusive yet quantifi- able respiratory monitoring, many technologies have been proposed recently. However, there are challenges to be addressed for such technologies to enable widespread use. In this work, we explore the feasibility of using load cell sensors embedded on a hospital bed for monitoring respi- ratory rate (RR) and tidal volume (TV). We propose a globalized machine learning (ML)-based algorithm for estimating TV without the requirement of subject-specific calibration or training. In a study of 15 healthy subjects performing respiratory tasks in four different postures, the outputs from four load cell channels and the reference spirometer were recorded simultaneously. A signal processing pipeline was implemented to extract features that capture respira- tory movement and the respiratory effects on the cardiac (i.e., ballistocardiogram, BCG) signals. The proposed RR estimation algorithm achieved a root mean square error (RMSE) of 0.6 breaths per minute (brpm) against the ground truth RR from the spirometer. The TV estimation results demonstrated that combining all three axes of the low- frequency force signals and the BCG heartbeat features best quantifies the respiratory effects of TV. The model resulted in a correlation and RMSE between the estimated and true TV values of 0.85 and 0.23 L, respectively, in the posture independent model without electrocardiogram (ECG) signals. This study suggests that load cell sensors already existing in certain hospital beds can be used for convenient and continuous respiratory monitoring in general care settings.
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305
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Air Trapping versus Atelectasis in Obesity: Relationship to Late-Onset Nonallergic Asthma and Aging. Ann Am Thorac Soc 2022; 19:135-139. [PMID: 34343031 PMCID: PMC8787791 DOI: 10.1513/annalsats.202010-1317rl] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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306
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Pietton R, Bouloussa H, Langlais T, Taytard J, Beydon N, Skalli W, Vergari C, Vialle R. Estimating pulmonary function after surgery for adolescent idiopathic scoliosis using biplanar radiographs of the chest with 3D reconstruction. Bone Joint J 2022; 104-B:112-119. [PMID: 34969276 DOI: 10.1302/0301-620x.104b1.bjj-2021-0337.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction? METHODS A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. RESULTS All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. CONCLUSION 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112-119.
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Affiliation(s)
- Raphaël Pietton
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France.,Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Houssam Bouloussa
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| | - Tristan Langlais
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| | - Jessica Taytard
- Department of Pediatric Pulmonology, Sorbonne Université, Armand Trousseau Hospital, Paris, France
| | - Nicole Beydon
- Department of Pulmonary Function Test and Sleep Center, Sorbonne Université, Armand Trousseau Hospital, Paris, France
| | - Wafa Skalli
- Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Claudio Vergari
- Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Raphaël Vialle
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
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307
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Choi MG, Choi SM, Lee JH, Kim JY, Song JW. Blood Krebs von den Lungen-6 levels predict treatment response to antifibrotic therapy in patients with idiopathic pulmonary fibrosis. Respir Res 2022; 23:334. [PMID: 36494685 PMCID: PMC9733030 DOI: 10.1186/s12931-022-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antifibrotic therapy can slow disease progression (DP) in patients with idiopathic pulmonary fibrosis (IPF). However, the prognostic biomarkers for DP in patients with IPF receiving antifibrotic therapy have not been identified. Therefore, we aimed to evaluate the prognostic efficacy of serum Krebs von den Lungen-6 (KL-6) for DP in patients with IPF receiving antifibrotic therapy. METHODS The clinical data of 188 patients with IPF who initiated antifibrotic therapy at three tertiary hospitals was retrospectively analyzed. DP was defined as a relative decline in forced vital capacity (FVC) ≥ 10%, diffusing capacity for carbon monoxide ≥ 15%, acute exacerbation, or deaths during 6 months after antifibrotic therapy. RESULTS The mean age of patients was 68.9 years, 77.7% were male, and DP occurred in 43 patients (22.9%) during follow-up (median, 7.6 months; interquartile range, 6.2-9.8 months). There was no difference in baseline KL-6 levels between the DP and no-DP groups; however, among patients with high baseline KL-6 levels (≥ 500 U/mL), changes in KL-6 levels over 1 month were higher in the DP group than those in the non-DP group, and higher relative changes in KL-6 over 1 month were independently associated with DP (odds ratio, 1.043; 95% confidence interval 1.005-1.084) in the multivariable logistic analysis adjusted for age and FVC. In the receiver operating characteristic curve analysis, the 1-month change in KL-6 was also useful for predicting DP (area under the curve = 0.707; P < 0.012). CONCLUSIONS Our data suggest that the relative change in KL-6 over 1 month might be useful for predicting DP in patients with IPF receiving antifibrotic therapy when baseline KL6 is high.
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Affiliation(s)
- Myeong Geun Choi
- grid.267370.70000 0004 0533 4667Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea ,grid.255649.90000 0001 2171 7754Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sun Mi Choi
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Ha Lee
- grid.411631.00000 0004 0492 1384Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Joong-Yub Kim
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Woo Song
- grid.267370.70000 0004 0533 4667Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
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308
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Gartman EJ, McCool FD. Pulmonary function testing in neuromuscular disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:3-13. [PMID: 36031311 DOI: 10.1016/b978-0-323-91532-8.00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neuromuscular disorders frequently compromize pulmonary function and effective ventilation, and a thorough respiratory evaluation often can assist in diagnosis, risk assessment, and prognostication. Since many of these disorders can be progressive, serial assessments may be necessary to best define a trajectory of impairment or improvement with therapy. Patients with neuromuscular diseases may have few respiratory symptoms and limited signs of skeletal muscle weakness, but can have significant respiratory muscle weakness. A single testing modality may fail to elucidate true respiratory compromise, and often a combination of tests is recommended to fully evaluate these patients. Common tests performed in this population include measurement of flow rates, lung volumes, maximal pressures, and airways resistance. This review covers the major respiratory testing modalities available in the evaluation of these patients, emphasizing both the benefits and shortcomings of each approach. The majority of parameters are available in a standard pulmonary laboratory (flows, volumes, static pressures), although referral to a specialized center may be necessary to conclusively evaluate a given patient.
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Affiliation(s)
- Eric J Gartman
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - F Dennis McCool
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
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309
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Si-Mohamed SA, Nasser M, Colevray M, Nempont O, Lartaud PJ, Vlachomitrou A, Broussaud T, Ahmad K, Traclet J, Cottin V, Boussel L. Automatic quantitative computed tomography measurement of longitudinal lung volume loss in interstitial lung diseases. Eur Radiol 2022; 32:4292-4303. [PMID: 35029730 PMCID: PMC9123030 DOI: 10.1007/s00330-021-08482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the lung CT volume (CTvol) and pulmonary function tests in an interstitial lung disease (ILD) population. Then to evaluate the CTvol loss between idiopathic pulmonary fibrosis (IPF) and non-IPF and explore a prognostic value of annual CTvol loss in IPF. METHODS We conducted in an expert center a retrospective study between 2005 and 2018 on consecutive patients with ILD. CTvol was measured automatically using commercial software based on a deep learning algorithm. In the first group, Spearman correlation coefficients (r) between forced vital capacity (FVC), total lung capacity (TLC), and CTvol were calculated. In a second group, annual CTvol loss was calculated using linear regression analysis and compared with the Mann-Whitney test. In a last group of IPF patients, annual CTvol loss was calculated between baseline and 1-year CTs for investigating with the Youden index a prognostic value of major adverse event at 3 years. Univariate and log-rank tests were calculated. RESULTS In total, 560 patients (4610 CTs) were analyzed. For 1171 CTs, CTvol was correlated with FVC (r: 0.86) and TLC (r: 0.84) (p < 0.0001). In 408 patients (3332 CT), median annual CTvol loss was 155.7 mL in IPF versus 50.7 mL in non-IPF (p < 0.0001) over 5.03 years. In 73 IPF patients, a relative annual CTvol loss of 7.9% was associated with major adverse events (log-rank, p < 0.0001) in univariate analysis (p < 0.001). CONCLUSIONS Automated lung CT volume may be an alternative or a complementary biomarker to pulmonary function tests for the assessment of lung volume loss in ILD. KEY POINTS • There is a good correlation between lung CT volume and forced vital capacity, as well as for with total lung capacity measurements (r of 0.86 and 0.84 respectively, p < 0.0001). • Median annual CT volume loss is significantly higher in patients with idiopathic pulmonary fibrosis than in patients with other fibrotic interstitial lung diseases (155.7 versus 50.7 mL, p < 0.0001). • In idiopathic pulmonary fibrosis, a relative annual CT volume loss higher than 9.4% is associated with a significantly reduced mean survival time at 2.0 years versus 2.8 years (log-rank, p < 0.0001).
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Affiliation(s)
- Salim A. Si-Mohamed
- Radiology Department, Department of Cardiovascular and Thoracic Radiology, CHU Cardiologique Louis Pradel, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France ,University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Mouhamad Nasser
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Marion Colevray
- Radiology Department, Hôpital de La Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| | | | - Pierre-Jean Lartaud
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | | | - Thomas Broussaud
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Kais Ahmad
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Julie Traclet
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Loic Boussel
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France ,Radiology Department, Hôpital de La Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
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310
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Ghosh S. Breathing disorders in neurodegenerative diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:223-239. [PMID: 36031306 DOI: 10.1016/b978-0-323-91532-8.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative disorders are a diverse group of conditions caused by progressive degeneration of neurons resulting in cognitive, motor, sensory, and autonomic dysfunction, leading to severe disability and death. Pulmonary dysfunction is relatively common in these conditions, may be present early in the disease, and is less well recognized and treated than other symptoms. There are variable disorders of upper and lower airways, central control of ventilation, strength of respiratory muscles, and breathing during sleep which further impact daily activities and quality of life and have the potential to injure vulnerable neurons. Laryngopharyngeal dysfunction affects speech, swallowing, and clearance of secretions, increases the risk of aspiration pneumonia, and can cause stridor and sudden death. In Parkinson's disease, L-Dopa benefits some pulmonary symptoms but there are limited pharmacological treatment options for pulmonary dysfunction. Targeted treatments include strengthening of respiratory muscles, positive airway pressure in sleep and techniques to improve cough efficacy. Well-designed clinical trials are needed to evaluate the long-term benefits of these interventions. Challenges for the future include earlier identification of pulmonary dysfunction in the clinic, institution of the most effective treatments (based on clinical trials that measure long-term meaningful outcomes) and the development of neuroprotective treatment.
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Affiliation(s)
- Soumya Ghosh
- Perron Institute for Neurological and Translational Science, University of Western Australia and Department of Neurology, Sir Charles Gairdner and Perth Children's Hospitals, Nedlands, WA, Australia.
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311
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de Roos MP, Siegerink S, Dijkstra NG, Broekman BFP, Brinkman K, Jonkman NH, Bresser P. Pulmonary function and Quality of Life in a prospective cohort of (non-) hospitalized COVID-19 pneumonia survivors up to six months. Chron Respir Dis 2022; 19:14799731221114271. [PMID: 36367295 PMCID: PMC9659768 DOI: 10.1177/14799731221114271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/27/2022] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES A decrease of both diffusion capacity (DLCO) and Quality of Life (QoL) was reported after discharge in hospitalized COVID-19 pneumonia survivors. We studied three and 6 month outcomes in hospitalized and non-hospitalized patients. METHODS COVID-19 pneumonia survivors (n = 317) were categorized into non-hospitalized "moderate" cases (n = 59), hospitalized "severe" cases (n = 180) and ICU-admitted "critical" cases (n = 39). We studied DLCO and QoL (Short Form SF-36 health survey) 3 and 6 months after discharge. Data were analyzed using (repeated measures) ANOVA, Kruskal-Wallis or Chi-square test (p < .05). RESULTS At 3 months DLCO was decreased in 44% of moderate-, 56% of severe- and 82% of critical cases (p < .003). Mean DLCO in critical cases (64±14%) was lower compared to severe (76 ± 17%) and moderate (81±15%) cases (p < .001). A total of 159/278 patients had a decreased DLCO (<80%), of whom the DLCO improved after 6 months in 45% (71/159). However the DLCO did not normalize in the majority (89%) of the cases (63 ± 10% vs 68±10%; p < .001). At 3 months, compared to critical cases, moderate cases scored lower on SF-36 domain "general health" (p < .05); both moderate and severe cases scored lower on the domain of "health change" (p < .05). At 6 months, there were no differences in SF-36 between the subgroups. Compared to 3 months, in all groups "physical functioning" improved; in contrast all groups scored significantly lower on "non-physical" SF-36 domains. CONCLUSION Three months after COVID-19 pneumonia, DLCO was still decreased in the more severely affected patients, with an incomplete recovery after 6 months. At 3 months QoL was impaired. At 6 months, while "physical functioning" improved, a decrease in "non-physical" QoL was observed but did not differ between the moderate and severely affected patients.
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Affiliation(s)
- Marlise P de Roos
- Department of Respiratory Medicine, OLVG, Amsterdam, The Netherlands
| | - Sebastiaan Siegerink
- Department of Medical Psychiatry, Amsterdam UMC and OLVG, Amsterdam, The Netherlands
| | - Nynke G Dijkstra
- Department of Respiratory Medicine, OLVG, Amsterdam, The Netherlands
| | - Birit FP Broekman
- Department of Medical Psychiatry, Amsterdam UMC and OLVG, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine and Infectious diseases, OLVG, Amsterdam, The Netherlands
| | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | - Paul Bresser
- Department of Respiratory Medicine, OLVG, Amsterdam, The Netherlands
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312
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Quadflieg K, Machado A, Haesevoets S, Daenen M, Thomeer M, Ruttens D, Spruit MA, Burtin C. Physical Tests Are Poorly Related to Patient-Reported Outcome Measures during Severe Acute Exacerbations of COPD. J Clin Med 2021; 11:150. [PMID: 35011892 PMCID: PMC8745821 DOI: 10.3390/jcm11010150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on patients' health status, including physical function and patient-reported outcomes. We aimed to explore the associations between physical tests and patient-reported outcome measures (PROMs) in hospitalised patients for an AECOPD. Patients were assessed on the day of discharge. Quadriceps force, handgrip strength, short physical performance battery (SPPB), five-repetition sit-to-stand test (5STS), four-meter gait speed test (4MGS), balance test, six-minute walk test (6MWT), COPD Assessment Test (CAT), London Chest Activity of Daily Living scale (LCADL), modified Medical Research Council (mMRC) dyspnea scale, Checklist of Individual Strength (CIS)-fatigue subscale, and Patient Health Questionnaire (PHQ-9) were collected. Sixty-nine patients with an AECOPD were included (54% female; age 69 ± 9 years; FEV1 39.2 (28.6-49.1%) predicted). Six-minute walk distance was strongly correlated with mMRC (ρ: -0.64, p < 0.0001) and moderately correlated with LCADL total score, subscales self-care and household activities (ρ ranging from -0.40 to -0.58, p < 0.01). Moreover, 4MGS was moderately correlated with mMRC (ρ: -0.49, p < 0.0001). Other correlations were weak or non-significant. During a severe AECOPD, physical tests are generally poorly related to PROMs. Therefore, a comprehensive assessment combining both physical tests and PROMs needs to be conducted in these patients to understand their health status.
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Affiliation(s)
- Kirsten Quadflieg
- REVAL–Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (K.Q.); (A.M.); (S.H.)
- BIOMED–Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Ana Machado
- REVAL–Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (K.Q.); (A.M.); (S.H.)
- BIOMED–Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Sarah Haesevoets
- REVAL–Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (K.Q.); (A.M.); (S.H.)
- BIOMED–Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Marc Daenen
- Department Respiratory Medicine, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium; (M.D.); (M.T.); (D.R.)
| | - Michiel Thomeer
- Department Respiratory Medicine, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium; (M.D.); (M.T.); (D.R.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - David Ruttens
- Department Respiratory Medicine, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium; (M.D.); (M.T.); (D.R.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Martijn A. Spruit
- CIRO, Center of Expertise for Chronic Organ Failure, Department of Research and Education, 6085 NM Horn, The Netherlands;
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Chris Burtin
- REVAL–Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (K.Q.); (A.M.); (S.H.)
- BIOMED–Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
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313
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Gottlieb J, Verleden GM, Perchl M, Valtin C, Vallee A, Brugière O, Bravo C. Disease progression in patients with the restrictive and mixed phenotype of Chronic Lung Allograft dysfunction-A retrospective analysis in five European centers to assess the feasibility of a therapeutic trial. PLoS One 2021; 16:e0260881. [PMID: 34941934 PMCID: PMC8700042 DOI: 10.1371/journal.pone.0260881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic Lung Allograft Dysfunction (CLAD) is a major obstacle for long term survival after lung transplantation (LTx). Besides Bronchiolitis Obliterans Syndrome, two other phenotypes of CLAD, restrictive allograft syndrome (RAS) and mixed phenotype, have been described. Trials to test in these conditions are desperately needed and analyzing natural outcome to plan such trials is essential. METHODS We performed a retrospective analysis of functional outcome in bilateral LTx recipients with RAS and mixed phenotype, transplanted between 2009 and 2018 in five large European centers with follow- up spirometry up to 12 months after diagnosis. Based on these data, sample size and power calculations for randomized therapeutic trial was estimated using two imputation methods for missing values. RESULTS Seventy patients were included (39 RAS and 31 mixed phenotype), median 3.1 years after LTx when CLAD was diagnosed. Eight, 13 and 25 patients died within 6, 9 and 12 months after diagnosis and a two patients underwent re-transplantation within 12 months leading to a graft survival of 89, 79 and 61% six, nine and 12 months after diagnosis, respectively. Observed FEV1 decline was 451 ml at 6 months and stabilized at 9 and 12 months, while FVC showed continuous decline. Using two methods of imputation, a progressive further decline after 6 months for FEV1 was noted. CONCLUSION The poor outcome of these two specific CLAD phenotypes suggests the urgent need for future therapeutic randomized trials. The number of missing values in a potential trial seems to be high and most frequently attributed to death. Survival may be used as an endpoint in clinical trials in these distinct phenotypes and imputation techniques are relevant if graft function is used as a surrogate of disease progression in future trials.
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Affiliation(s)
- Jens Gottlieb
- Dept. of Respir. Medicine OE 6870, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- * E-mail:
| | - Geert M. Verleden
- Dept Respir. Med, Lung Transplant Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | - Michael Perchl
- Department of Cardiology, Section for Lung transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Valtin
- Dept. of Respir. Medicine OE 6870, Hannover Medical School, Hannover, Germany
| | - Alexander Vallee
- Délégation à la Recherche Clinique et à l’Innovation, Hôpital Foch, Suresnes, France
| | - Olivier Brugière
- Service de Transplantation Pulmonaire et Centre de compétence de la Mucoviscidose, Hôpital Foch, Suresnes, France
| | - Carlos Bravo
- Servei de Pneumologia, Hospital Universitari Val d’Hebron, Barcelona, Spain
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314
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Adams CJ, Shapera S, Ryerson CJ, Assayag D, Johannson KA, Fell CD, Morisset J, Manganas H, Kolb M, Hambly N, Cox G, Khalil N, Marcoux V, Wilcox PG, To T, Sadatsafavi M, Halayko AJ, Gershon A, Garlick K, Fisher JH. Effect of continued antifibrotic therapy after forced vital capacity decline in patients with idiopathic pulmonary fibrosis; a real world multicenter cohort study. Respir Med 2021; 191:106722. [PMID: 34959146 DOI: 10.1016/j.rmed.2021.106722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
RATIONALE Longitudinal data on the impact of continued, switched or discontinued antifibrotic therapy in patients with idiopathic pulmonary fibrosis (IPF) who have disease progression is needed. OBJECTIVE We hypothesized that ongoing antifibrotic use (versus discontinuation) in the setting of forced vital capacity (FVC) decline would be associated with less future decline and lower likelihood of a composite outcome of FVC decline, lung transplant, or death. METHODS We performed a multicenter cohort study using data from the Canadian Registry for Pulmonary Fibrosis in patients with IPF with FVC decline ≥10% over 6 months on antifibrotic therapy. The association of continued, switched or discontinued therapy with (1) further change in FVC and (2) a composite of FVC decline ≥10%, transplant, or death, in the subsequent 6 months, was assessed using adjusted linear and logistic regression modelling, respectively. Generalized estimating equations accounted for repeated observations per patient. RESULTS 165 patients had a decline in FVC ≥10% over 6 months while receiving antifibrotic therapy. Compared to continued use, antifibrotic discontinuation after FVC decline was associated with greater additional FVC decline (-207 mL 95%CI -353 to -62, p = 0.005) and higher odds of FVC decline ≥10%, transplant, or death (odds ratio 12.2 95%CI 1.2 to 130.5, p = 0.04). There was no difference between continued versus switched antifibrotic therapy. CONCLUSIONS Ongoing antifibrotic therapy in the setting of FVC decline is associated with less future FVC decline and lower odds of FVC decline ≥10%, transplant, or death in a real-world cohort of IPF.
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Affiliation(s)
- Colin J Adams
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Charlene D Fell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Hélène Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nathan Hambly
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gerard Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J Halayko
- Departments of Internal Medicine and Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
| | - Andrea Gershon
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Ducharme JB, Hsiao YY, Gibson AL, Mermier CM. Predictive model specific to young adults for estimating thoracic gas volume for air-displacement plethysmography. Clin Physiol Funct Imaging 2021; 42:96-103. [PMID: 34931438 DOI: 10.1111/cpf.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thoracic gas volume either measured (mTGV) or predicted by the BodPod® (bpTGV) is used during air-displacement plethysmography to obtain a better estimate of percent body fat. Evidence suggests that bpTGV underestimates mTGV for young adults and this is especially evident for young males. AIMS We developed, validated, and cross-validated a TGV prediction model (pTGV) for males and females 18-30 years of age to address this underestimation. MATERIALS & METHODS Participants (N = 181; 18-30 years) that had their body composition assessed with the BodPod® were retrospectively randomly assigned to one of two independent subgroups, a validation (n = 145) or cross-validation (n = 36) sample. Ten iterations of the k-fold validation procedure were performed to assess the internal replicability of pTGV within the validation sample. External replicability of pTGV was evaluated by assessing the difference and standard error of the estimate (SEE) compared to mTGV in the cross-validation group. RESULTS The model using height, sex and body mass yielded the highest adjusted R2 (0.627) and the lowest SEE (0.56 L): pTGV = 0.615338 × Sex (0 = Female, 1 = Male) + 0.056267 × Height (cm) - 0.011006 × Body Mass (kg) - 5.358839. R2 remained stable across 10 iterations of the k-fold procedure (average R2 = 0.64). Differences between pTGV and mTGV were not significantly different than zero for the total cross-validation sample (-0.06 ± 0.7 L; SEE = 3.0%), for males (-0.11 ± 0.7 L; SEE = 3.7%), or for females (-0.02 ± 0.7 L; SEE = 5.3%). CONCLUSION We recommend that when it is impractical to obtain mTGV, the strong internal and external replicability of the new prediction model supports its use for males and females ages 18-30 years old during air-displacement plethysmography.
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Affiliation(s)
- Jeremy B Ducharme
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yu-Yu Hsiao
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ann L Gibson
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christine M Mermier
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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316
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Bernhardt V, Stickford JL, Bhammar DM, Balmain BN, Babb TG. Repeatability of dyspnea measurements during exercise in women with obesity. Respir Physiol Neurobiol 2021; 297:103831. [PMID: 34922000 DOI: 10.1016/j.resp.2021.103831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/10/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
While the 0-10 Borg scale to rate perceived breathlessness (RPB) is widely used to assess dyspnea on exertion, the repeatability of RPB in women with obesity is unknown. We examined the repeatability of RPB in women with obesity during submaximal constant-load cycling following at least 10 weeks of normal daily life. Seventeen women (37 ± 7 yr; 34.6 ± 4.5 kg/m2) who rated their breathlessness as 3 on the Borg scale (i.e., "moderate") during 60 W submaximal cycling repeated the same test following 19 ± 9 weeks of normal living. Mean body weight (93.8 ± 16.1 vs. 93.6 ± 116.8 kg, p = 0.94) and RPB (3.0 ± 0.0 vs. 3.1 ± 1.4, p = 0.80) did not differ between pre- and post-normal living periods. We demonstrate that subjective ratings of breathlessness are repeatable for the majority of subjects and can be used to accurately assess DOE during submaximal constant-load cycling in women with obesity.
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Affiliation(s)
| | | | | | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.
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317
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Bakker JT, Klooster K, Bouwman J, Pelgrim GJ, Vliegenthart R, Slebos DJ. Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients. ERJ Open Res 2021; 8:00492-2021. [PMID: 35083322 PMCID: PMC8784891 DOI: 10.1183/23120541.00492-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
Abstract
IntroductionIn emphysema patient being evaluated for bronchoscopic lung volume reduction (BLVR), accurate measurement of lung volumes is important. Total lung capacity (TLC) and residual volume (RV) are commonly measured by body plethysmography but can also be derived from chest computed tomography (CT). Spirometry-gated CT scanning potentially improves the agreement of CT and body plethysmography. The aim of this study was to compare lung volumes derived from spirometry-gated CT and “breath-hold-coached” CT to the reference standard: body plethysmography.MethodsIn this single-centre retrospective cohort study, emphysema patients being evaluated for BLVR underwent body plethysmography, inspiration (TLC) and expiration (RV) CT scan with spirometer guidance (“gated group”) or with breath-hold-coaching (“non-gated group”). Quantitative analysis was used to calculate lung volumes from the CT.Results200 patients were included in the study (mean±sd age 62±8 years, forced expiratory flow in 1 s 29.2±8.7%, TLC 7.50±1.46 L, RV 4.54±1.07 L). The mean±sd CT-derived TLC was 280±340 mL lower compared to body plethysmography in the gated group (n=100), and 590±430 mL lower for the non-gated group (n=100) (both p<0.001). The mean±sd CT-derived RV was 300±470 mL higher in the gated group and 700±720 mL higher in the non-gated group (both p<0.001). Pearson correlation factors were 0.947 for TLC gated, 0.917 for TLC non-gated, 0.823 for RV gated, 0.693 for RV non-gated, 0.539 for %RV/TLC gated and 0.204 for %RV/TLC non-gated. The differences between the gated and non-gated CT results for TLC and RV were significant for all measurements (p<0.001).ConclusionIn severe COPD patients with emphysema, CT-derived lung volumes are strongly correlated to body plethysmography lung volumes, and especially for RV, more accurate when using spirometry gating.
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318
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Silva H, Mantoani LC, Zamboti CL, Aguiar WF, Ries AL, Gonçalves AFL, da Silva TG, Ribeiro M, Pitta F, Camillo CA. Validation of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire in patients with interstitial lung disease. J Bras Pneumol 2021; 47:e20210172. [PMID: 34932719 PMCID: PMC8836616 DOI: 10.36416/1806-3756/e20210172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ) in patients with interstitial lung disease (ILD). METHODS Patients with ILD completed the questionnaire at three different time points, one week apart, with the assistance of two independent assessors. Intra- and inter-rater reliability were analysed via the intraclass correlation coefficient (ICC). Internal consistency was assessed with the Cronbach's alpha coefficient. For the validity analysis, associations between variables were assessed with Spearman's or Pearson's correlation coefficient. RESULTS Thirty patients with ILD (idiopathic pulmonary fibrosis, connective tissue disease-associated pulmonary fibrosis, sarcoidosis, asbestosis or non-specific interstitial pneumonia) were included (15 men; mean age, 59 ± 10 years; DLCO: 46 [33-64] % predicted). UCSD SOBQ scores showed excellent agreement and internal consistency in the intra-rater analysis (ICC: 0.93 [0.85-0.97]; Cronbach alpha: 0.95) and in the inter-rater analysis (ICC: 0.95 [0.89-0.97]; Cronbach alpha: 0.95), as well as correlating significantly with dyspnoea (as assessed by the Medical Research Council scale; r = 0.56); Medical Outcomes Study 36-item Short-Form Health Survey domains bodily pain, general health, vitality and physical functioning (-0.40 ≤ r ≤ -0.74); six-minute walk distance (r = -0.38); and quadriceps muscle strength (r = -0.41). CONCLUSIONS The Brazilian Portuguese version of the UCSD SOBQ is valid, is reliable and has internal consistency in patients with ILD in Brazil.
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Affiliation(s)
- Humberto Silva
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Leandro Cruz Mantoani
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Camile Ludovico Zamboti
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Wagner Florentin Aguiar
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Andrew L. Ries
- . School of Medicine, University of California San Diego, San Diego (CA) USA
| | - Aline Ferreira Lima Gonçalves
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Thatielle Garcia da Silva
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Marcos Ribeiro
- . Departamento de Pneumologia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Fabio Pitta
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
| | - Carlos Augusto Camillo
- . Laboratório de Pesquisa em Fisioterapia Pulmonar - LFIP - Departamento de Fisioterapia, Universidade Estadual de Londrina - UEL - Londrina (PR) Brasil
- . Departamento de Ciências da Reabilitação, Universidade Pitágoras-Universidade Norte do Paraná - UNOPAR - Londrina (PR) Brasil
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319
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DiMarco KG, Beasley KM, Shah K, Speros JP, Elliott JE, Laurie SS, Duke JW, Goodman RD, Futral JE, Hawn JA, Roach RC, Lovering AT. No effect of patent foramen ovale on acute mountain sickness and pulmonary pressure in normobaric hypoxia. Exp Physiol 2021; 107:122-132. [PMID: 34907608 DOI: 10.1113/ep089948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
Abstract
What is the central question to this study? Is there a relationship between a patent foramen ovale and the development of acute mountain sickness and an exaggerated increase in pulmonary pressure in response to 7-10 hours of normobaric hypoxia? What is the main finding and its importance? Patent foramen ovale presence did not increase susceptibility to acute mountain sickness or result in an exaggerated increase in pulmonary artery systolic pressure with normobaric hypoxia. This data suggest hypobaric hypoxia is integral to the increased susceptibility to acute mountain sickness previously reported in those with patent foramen ovale, and patent foramen ovale presence alone does not contribute to the hypoxic pulmonary pressor response. ABSTRACT: Acute mountain sickness (AMS) develops following rapid ascent to altitude, but its exact causes remain unknown. A patent foramen ovale (PFO) is a right-to-left intracardiac shunt present in ∼30% of the population that has been shown to increase AMS susceptibility with high altitude hypoxia. Additionally, high altitude pulmonary edema (HAPE), is a severe type of altitude illness characterized by an exaggerated pulmonary pressure response, and there is a greater prevalence of PFO in those with a history of HAPE. However, whether hypoxia, per se, is causing the increased incidence of AMS in those with a PFO and whether a PFO is associated with an exaggerated increase in pulmonary pressure in those without a history of HAPE is unknown. Participants (n = 36) matched for biological sex (18 female) and the presence or absence of a PFO (18 PFO+) were exposed to 7-10 hours of normobaric hypoxia equivalent to 4755 m. Presence and severity of AMS was determined using the Lake Louise AMS scoring system. Pulmonary artery systolic pressure, cardiac output, and total pulmonary resistance were measured using ultrasound. We found no significant association of PFO with incidence or severity of AMS and no association of PFO with arterial oxygen saturation. Additionally, there was no effect of a PFO on pulmonary pressure, cardiac output, or total pulmonary resistance. These data suggest that hypobaric hypoxia is necessary for those with a PFO to have increased incidence of AMS and that presence of PFO is not associated with an exaggerated pulmonary pressor response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kaitlyn G DiMarco
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Kara M Beasley
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Karina Shah
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Julia P Speros
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Jonathan E Elliott
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Department of Neurology, Portland, OR, USA
| | - Steven S Laurie
- KBR, Cardiovascular and Vision Laboratory, NASA Johnson Space Center, Houston, TX, USA
| | - Joseph W Duke
- Northern Arizona University, Department of Biological Sciences, Flagstaff, AZ, USA
| | | | | | - Jerold A Hawn
- Oregon Heart and Vascular Institute, Springfield, OR, USA
| | - Robert C Roach
- University of Colorado Anschutz Medical Campus, Altitude Research Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Aurora, CO, USA
| | - Andrew T Lovering
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
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320
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Jõgi NO, Kitaba N, Storaas T, Schlünssen V, Triebner K, Holloway JW, Horsnell WGC, Svanes C, Bertelsen RJ. Ascaris exposure and its association with lung function, asthma, and DNA methylation in Northern Europe. J Allergy Clin Immunol 2021; 149:1960-1969. [PMID: 34996616 DOI: 10.1016/j.jaci.2021.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ascaris infections, with a worldwide prevalence above 10%, can cause respiratory pathology. However, long-term effects on lung function in humans are largely unknown. OBJECTIVE We investigated the associations of Ascaris exposure with lung function, asthma, and DNA methylation. METHODS Serum Ascaris IgG antibodies were measured in 671 adults aged 18 to 47 years (46% women) from Aarhus, Bergen, and Tartu RHINESSA study centers. Seropositivity was defined as IgG above the 90th percentile. Linear and logistic regressions were used to analyze Ascaris seropositivity as associated with lung function and asthma, adjusted for age, height, and smoking and clustered by center. DNA methylation in blood was profiled by a commercial methylation assay. RESULTS Ascaris seropositivity was associated with lower FEV1 (-247 mL; 95% CI, -460, -34) and higher odds for asthma (adjusted odds ratio, 5.84; 95% CI, 1.67, 20.37) among men but not women, also after further adjusting for house dust mite sensitivity, consistent across study centers. At a genome-wide level, Ascaris exposure was associated with 23 differentially methylated sites in men and 3 in women. We identified hypermethylation of the MYBPC1 gene, which can regulate airway muscle contraction. We also identified genes linked to asthma pathogenesis such as CRHR1 and GRK1, as well as a differentially methylated region in the PRSS22 gene linked to nematode infection. CONCLUSION Ascaris exposure was associated with substantially lower lung function and increased asthma risk among men. Seropositive participants had sex-specific differences in DNA methylation compared to the unexposed, thus suggesting that exposure may lead to sex-specific epigenetic changes associated with lung pathology.
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Affiliation(s)
- Nils O Jõgi
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Negusse Kitaba
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Torgeir Storaas
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Environmental Occupation, and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway; Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - William G C Horsnell
- Institute of Infectious Disease and Molecular Medicine/Division of Immunology, University of Cape Town, Cape Town, South Africa; Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom; Laboratory of Molecular and Experimental Immunology and Neurogenetics, CNRS-University of Orléans and Le Studium Institute for Advanced Studies, Orléans, France.
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, University of Bergen, Bergen, Norway
| | - Randi J Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Manzetti GM, Hosein K, Cecchini MJ, Kwan K, Abdelrazek M, Zompatori M, Rogliani P, Mura M. Validation of the risk stratification score in idiopathic pulmonary fibrosis: study protocol of a prospective, multi-centre, observational, 3-year clinical trial. BMC Pulm Med 2021; 21:396. [PMID: 34863146 PMCID: PMC8645123 DOI: 10.1186/s12890-021-01753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is characterized by a poor prognosis, with a progressive decline in lung function and considerable variability in the disease's natural history. Besides lung transplantation (LTx), the only available treatments are anti-fibrosing drugs, which have shown to slow down the disease course. Therefore, predicting the prognosis is of pivotal importance to avoid treatment delays, which may be fatal for patients with a high risk of progression. Previous studies showed that a multi-dimensional approach is practical and effective in the development of a reliable prognostic score for IPF. In the RIsk Stratification scorE (RISE), physiological parameters, an objective measure of patient-reported dyspnea and exercise capacity are combined to capture different domains of the complex pathophysiology of IPF. METHODS This is an observational, multi-centre, prospective cohort study, designed to reflect common clinical practice in IPF. A development cohort and a validation cohort will be included. Patients newly diagnosed with IPF based on the ATS/ERS criteria and multi-disciplinary discussion will be included in the study. A panel of chest radiologists and lung pathologists will further assess eligibility. At the first visit (time of diagnosis), and every 4-months, MRC dyspnea score, pulmonary function tests (FEV1, FVC and DLCO), and 6-min walking distance will be recorded. Patients will be prospectively followed for 3 years. Comorbidities will be considered. The radiographic extent of fibrosis on HRCT will be recalculated at a 2-year interval. RISE, Gender-Age-Physiology, CPI and Mortality Risk Scoring System will be calculated at 4-month intervals. Longitudinal changes of each variable considered will be assessed. The primary endpoint is 3-year LTx-free survival from the time of diagnosis. Secondary endpoints include several, clinically-relevant information to ensure reproducibility of results across a wide range of disease severity and in concomitance of associated pulmonary hypertension or emphysema. DISCUSSION The objective of this study is to validate RISE as a simple, straightforward, inexpensive and reproducible tool to guide clinical decision making in IPF, and potentially as an endpoint for future clinical trials. TRIAL REGISTRATION U.S National Library of Medicine Clinicaltrials.gov, trial n. NCT02632123 "Validation of the risk stratification score in idiopathic pulmonary fibrosis". Date of registration: December 16th, 2015.
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Affiliation(s)
- Gian Marco Manzetti
- Malattie Apparato Respiratorio, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Karishma Hosein
- Division of Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | | | - Maurizio Zompatori
- Radiologia, MultiMedica Group, I.R.C.C.S. San Giuseppe Hospital, Milan, Italy
| | - Paola Rogliani
- Malattie Apparato Respiratorio, Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Mura
- Division of Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Marczak H, Peradzyńska J, Seidl E, Griese M, Urbankowski T, Lange J, Bogusławski S, Krenke K. The improved clinical course of persistent tachypnea of infancy with inhaled bronchodilators and corticosteroids. Pediatr Pulmonol 2021; 56:3952-3959. [PMID: 34520130 DOI: 10.1002/ppul.25674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/31/2021] [Accepted: 09/11/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Persistent tachypnea of infancy (PTI) is the most common interstitial lung disease in young children. As no standardized therapeutic guidelines exist, different pharmaceuticals are used to treat PTI; inhaled corticosteroids (ICS) and bronchodilators being mostly used. This observation assessed the effectiveness of bronchodilators and ICS in children with PTI enrolled in the children's interstitial lung diseases (chILD)-EU Register. METHODS Symptomatic children with PTI were observed according to a predetermined stepwise protocol including bronchodilators as the first choice treatment (6 weeks). In patients with incomplete response, additionally, ICS was given (12 weeks). Signs, symptoms, and pulmonary function were evaluated at three time points: at baseline, 6 (±1) weeks after initiation of bronchodilators, and 12 (±1) weeks after bronchodilators/ICS. RESULTS Thirty-one children (median age: 44 months, interquartile range [IQR]: 15-67) were included. The therapy was associated with a significant reduction of tachypnea (53.3% of patients, p = 0.02), exercise intolerance (52.2% of patients, p < 0.001), chest retractions (43.8% of patients, p = 0.04), and crackles (29.2% of patients, p = 0.02). Also, a significant improvement in forced expiratory volume in 1 s (FEV1 ) (median z score: -2.21 vs. -0.47, p = 0.03), residual volume (RV) (median z score 5.28 vs. 1.07, p = 0.007), RV% total lung capacity (TLC) (median z score: 6.05 vs. 1.48, p = 0.01), sRaw (median z score: 6.6 vs. 4.64, p = 0.01), R5 (median z score: 1.27 vs. 0.31, p = 0.009), and R5-R20 (median: 0.58 vs. 0.26 kPa/(l/s), p = 0.002) was demonstrated. CONCLUSIONS Inhaled bronchodilators and ICS may exert a positive effect on the severity of symptoms and pulmonary function test (PFT) in symptomatic children with PTI. However, a randomized control trial should be conducted to confirm their effectiveness.
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Affiliation(s)
- Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Elias Seidl
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Matthias Griese
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | | | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Bogusławski
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Siler TM, Hohenwarter C, Xiong K, Sciarappa K, Sanjar S, Sharma S. Efficacy of Nebulized Glycopyrrolate on Lung Hyperinflation in Patients with COPD. Pulm Ther 2021; 7:503-516. [PMID: 34232493 PMCID: PMC8260570 DOI: 10.1007/s41030-021-00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Lung hyperinflation in chronic obstructive pulmonary disease (COPD) is associated with activity limitation, impaired cardiac output, and mortality. Several studies have demonstrated that long-acting muscarinic antagonists (LAMAs) delivered by dry powder inhalers can promote lung deflation; however, the potential of nebulized LAMAs on improving hyperinflation in COPD is currently unknown. METHODS This single-center, randomized, double-blind, two-way crossover study (NCT04155047) evaluated the efficacy of a single dose of nebulized LAMA [glycopyrrolate (GLY) 25 µg] versus placebo in patients with COPD and lung hyperinflation. Patients with moderate-to-severe COPD and a residual volume (RV) ≥ 130% of predicted normal were included. The primary endpoint was changed from baseline in RV at 6 h post-treatment. Other endpoints included changes from baseline in spirometric and plethysmographic measures up to 6 h post-treatment. RESULTS A total of 22 patients (mean pre-bronchodilator RV, 153.7% of predicted normal) were included. The primary objective of the study was not met; the placebo-adjusted least squares (LS) mean [95% confidence interval (CI) change from baseline in RV with GLY at 6 h post-treatment was - 0.323 l (- 0.711 to 0.066); p = 0.0987]. A post hoc evaluation of the primary analysis was conducted after excluding a single statistical outlier; substantial improvements in RV with GLY compared with placebo was observed after exclusion of this outlier [placebo-adjusted LS mean change from baseline (95% CI) in RV was - 0.446 l (- 0.741 to - 0.150)]. Improvements from baseline were also observed with GLY compared with placebo in spirometric and plethysmographic measures up to 6 h post-treatment. GLY was generally safe, and no new safety signals were detected. CONCLUSIONS This is the first study to evaluate the effect of nebulized GLY on lung deflation. Nebulized GLY resulted in marked improvements in RV up to 6 h post-treatment, compared with placebo. Improvements were also observed with GLY in spirometric and plethysmographic parameters of lung function. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04155047.
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Affiliation(s)
| | | | | | | | | | - Sanjay Sharma
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
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Martinez-Navarro I, Collado E, Hernando B, Hernando C. Pulmonary and Inspiratory Muscle Function Response to a Mountain Ultramarathon. J Sports Sci Med 2021; 20:706-713. [PMID: 35321133 PMCID: PMC8488829 DOI: 10.52082/jssm.2021.706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
The study aimed to provide within-race data on the time course of pulmonary function during a mountain ultramarathon (MUM). Additionally, we wanted to assess possible sex differences regarding pre- to post-race change in pulmonary and inspiratory muscle function. Lastly, we were interested in evaluating whether changes in respiratory function were associated with relative running speed and due to general or specific fatigue. 47 athletes (29 males and 18 females; 41 ± 5 years) were submitted to a cardiopulmonary exercise test (CPET) before a 107-km MUM. Spirometric variables: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC and peak expiratory flow (PEF); maximal inspiratory pressure (MIP); squat jump (SJ) and handgrip strength (HG) were assessed before and after the race. Additionally PEF was measured at three aid stations (33rd, 66th and 84th km) during the race. PEF declined from the 33rd to the 66th km (p = 0.004; d = 0.72) and from the 84th km to the finish line (p = 0.003; d = 0.90), while relative running speed dropped from the first (0-33 km) to the second (33-66 km) race section (p < 0.001; d = 1.81) and from the third (66-84 km) to the last race section (p < 0.001; d = 1.61). Post-race, a moderate reduction was noted in FVC (-13%; p < 0.001; d = 0.52), FEV1 (-19.5%; p < 0.001; d = 0.65), FEV1/FVC (-8.4%; p = 0.030; d = 0.59), PEF (-20.3%; p < 0.001; d = 0.58), MIP (-25.3%; p < 0.001; d = 0.79) and SJ (-31.6%; p < 0.001; d = 1.42). Conversely, HG did not change from pre- to post-race (-1.4%; p = 0.56; d = 0.05). PEF declined during the race in parallel with running speed drop. No sex differences were noted regarding post-race respiratory function, except that FEV1/FVC decay was significantly greater among women. The magnitude of pre- to post-race respiratory function decline was uncorrelated with relative running speed.
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Affiliation(s)
- Ignacio Martinez-Navarro
- Physical Education and Sports Department, University of Valencia, Valencia, Spain
- Sports Health Unit, Vithas 9 de Octubre Hospital, Valencia, Spain
| | - Eladio Collado
- Faculty of Health Sciences, Jaume I University, Castellon, Spain
| | | | - Carlos Hernando
- Sport Service, Jaume I University, Castellon, Spain
- Department of Education and Specific Didactics, Jaume I University, Castellon, Spain
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325
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Phillips DB, Neder JA, Elbehairy AF, Milne KM, James MD, Vincent SG, Day AG, DE-Torres JP, Webb KA, O'Donnell DE. Qualitative Components of Dyspnea during Incremental Exercise across the COPD Continuum. Med Sci Sports Exerc 2021; 53:2467-2476. [PMID: 34649264 DOI: 10.1249/mss.0000000000002741] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Evaluation of the intensity and quality of activity-related dyspnea is potentially useful in people with chronic obstructive pulmonary disease (COPD). The present study sought to examine associations between qualitative dyspnea descriptors, dyspnea intensity ratings, dynamic respiratory mechanics, and exercise capacity during cardiopulmonary exercise testing (CPET) in COPD and healthy controls. METHODS In this cross-sectional study, 261 patients with mild-to-very severe COPD (forced expiratory volume in 1 s, 62 ± 25%pred) and 94 age-matched controls (forced expiratory volume in 1 s, 114 ± 14%pred) completed an incremental cycle CPET to determine peak oxygen uptake (V˙O2peak). Throughout exercise, expired gases, operating lung volumes, and dyspnea intensity were assessed. At peak exercise, dyspnea quality was assessed using a modified 15-item questionnaire. RESULTS Logistic regression analysis revealed that among 15 dyspnea descriptors, only those alluding to the cluster "unsatisfied inspiration" were consistently associated with an increased likelihood for both critical inspiratory mechanical constraint (end-inspiratory lung volume/total lung capacity ratio ≥0.9) during exercise and reduced exercise capacity (V˙O2peak < lower limit of normal) in COPD (odds ratio (95% confidence interval), 3.26 (1.40-7.60) and 3.04 (1.24-7.45), respectively; both, P < 0.05). Thus, patients reporting "unsatisfied inspiration" (n = 177 (68%)) had an increased relative frequency of critical inspiratory mechanical constraint and low exercise capacity compared with those who did not select this descriptor, regardless of COPD severity or peak dyspnea intensity scores. CONCLUSIONS In patients with COPD, regardless of disease severity, reporting descriptors in the unsatisfied inspiration cluster complemented traditional assessments of dyspnea during CPET and helped identify patients with critical mechanical abnormalities germane to exercise intolerance.
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Affiliation(s)
- Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
| | | | | | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
| | - Andrew G Day
- Kingston General Hospital Health Research Institute, Kingston, Ontario, CANADA
| | - Juan P DE-Torres
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
| | - Katherine A Webb
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, CANADA
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326
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Mohammad M, Viuff SL, Munch MW, Berg RMG. Peer instruction versus conventional group work-based teaching in a laboratory exercise on respiratory physiology: a randomized study. ADVANCES IN PHYSIOLOGY EDUCATION 2021; 45:694-701. [PMID: 34498941 DOI: 10.1152/advan.00045.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Collaborative teaching strategies such as peer instruction and conventional group work have previously been shown to enhance meaningful learning, but they have not previously been compared. In this present study, we compared the impact of solving quizzes with peer instruction and conventional group work on immediate learning in a laboratory exercise. A total of 186 second-year medical students were randomized to solve two quizzes by either a peer instruction strategy (n = 93) or conventional group work (n = 93) during a mandatory laboratory exercise on respiratory physiology, after which all students completed an individual test. There was no difference in total test scores between groups, but students randomized to peer instruction obtained the highest test scores in solving simple integrated questions. Conversely, students randomized to conventional group work provided the best evaluations of the overall assessment of the laboratory exercise. In conclusion, different collaborative teaching strategies implemented during a laboratory exercise appear to affect immediate learning and student satisfaction differently.
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Affiliation(s)
- Milan Mohammad
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Lundgaard Viuff
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Psychiatry Region Zealand, Roskilde, Denmark
| | - Marie Warrer Munch
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Ronan M G Berg
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
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327
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Freeman A, Cellura D, Minnion M, Fernandez BO, Spalluto CM, Levett D, Bates A, Wallis T, Watson A, Jack S, Staples KJ, Grocott MPW, Feelisch M, Wilkinson TMA. Exercise Training Induces a Shift in Extracellular Redox Status with Alterations in the Pulmonary and Systemic Redox Landscape in Asthma. Antioxidants (Basel) 2021; 10:antiox10121926. [PMID: 34943027 PMCID: PMC8750917 DOI: 10.3390/antiox10121926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/25/2022] Open
Abstract
Redox dysregulation and oxidative stress have been implicated in asthma pathogenesis. Exercise interventions improve symptoms and reduce inflammation in asthma patients, but the underlying mechanisms remain unclear. We hypothesized that a personalised exercise intervention would improve asthma control by reducing lung inflammation through modulation of local and systemic reactive species interactions, thereby increasing antioxidant capacity. We combined deep redox metabolomic profiling with clinical assessment in an exploratory cohort of six female patients with symptomatic asthma and studied their responses to a metabolically targeted exercise intervention over 12 weeks. Plasma antioxidant capacity and circulating nitrite levels increased following the intervention (p = 0.028) and lowered the ratio of reduced to oxidised glutathione (p = 0.029); this was accompanied by improvements in physical fitness (p = 0.046), symptoms scores (p = 0.020), quality of life (p = 0.046), lung function (p = 0.028), airway hyperreactivity (p = 0.043), and eosinophilic inflammation (p = 0.007). Increased physical fitness correlated with improved plasma antioxidant capacity (p = 0.019), peak oxygen uptake and nitrite changes (p = 0.005), the latter also associated with reductions in peripheral blood eosinophil counts (p = 0.038). Thus, increases in “redox resilience” may underpin the clinical benefits of exercise in asthma. An improved understanding of exercise-induced alterations in redox regulation offers opportunities for greater treatment personalisation and identification of new treatment targets.
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Affiliation(s)
- Anna Freeman
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
- Correspondence:
| | - Doriana Cellura
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Magdalena Minnion
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Bernadette O. Fernandez
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Cosma Mirella Spalluto
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Denny Levett
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Andrew Bates
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Timothy Wallis
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Alastair Watson
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Sandy Jack
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Karl J. Staples
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Michael P. W. Grocott
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Martin Feelisch
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
| | - Tom M. A. Wilkinson
- Clinical and Experimental Sciences and Southampton Centre for Biomedical Research, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (D.C.); (M.M.); (B.O.F.); (C.M.S.); (D.L.); (A.B.); (T.W.); (A.W.); (S.J.); (K.J.S.); (M.P.W.G.); (M.F.); (T.M.A.W.)
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
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Longitudinal Assessment of Health and Quality of Life of COVID-19 Patients Requiring Intensive Care-An Observational Study. J Clin Med 2021; 10:jcm10235469. [PMID: 34884172 PMCID: PMC8658191 DOI: 10.3390/jcm10235469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/30/2022] Open
Abstract
Long-term health consequences in survivors of severe COVID-19 remain unclear. Eighteen COVID-19 patients admitted to the intensive care unit at the University Hospital Rechts der Isar, Munich, Germany, between 14 March and 23 June 2020, were prospectively followed-up at a median of 36, 75.5, 122 and 222 days after discharge. The health-related quality of life (HrQoL) (36-item Short Form Health Survey and St. George’s Respiratory Questionnaire, SGRQ), cardiopulmonary function, laboratory parameters and chest imaging were assessed longitudinally. The HrQoL assessment revealed a reduced physical functioning, as well as increased SGRQ impact and symptoms scores that all improved over time but remained markedly impaired compared to the reference groups. The median radiological severity scores significantly declined; persistent abnormalities were found in 33.3% of the patients on follow-up. A reduced diffusion capacity was the most common abnormal pulmonary function parameter. The length of hospitalization correlated with role limitations due to physical problems, the SGRQ symptom and the impact score. In conclusion, in survivors of severe COVID-19, the pulmonary function and symptoms improve over time, but impairments in their physical function and diffusion capacity can persist over months. Longer follow-up studies with larger cohorts will be necessary to comprehensively characterize long-term sequelae upon severe COVID-19 and to identify patients at risk.
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329
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Rasmussen IE, Foged F, Bjørn Budde J, Rasmussen RS, Rasmussen V, Lyngbæk M, Jønck S, Krogh-Madsen R, Lindegaard B, Ried-Larsen M, Jørgensen PG, Lund MAV, Køber L, Vejlstrup N, Pedersen BK, Berg RMG, Christensen RH. Protective potential of high-intensity interval training on cardiac structure and function after COVID-19: protocol and statistical analysis plan for an investigator-blinded randomised controlled trial. BMJ Open 2021; 11:e048281. [PMID: 34794987 PMCID: PMC8602927 DOI: 10.1136/bmjopen-2020-048281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION COVID-19 is associated with a marked systemic inflammatory response with concomitant cardiac injury and remodelling, but it is currently unknown whether the latter is reversible. Given that high-intensity interval training (HIIT) is a powerful stimulus to improve cardiorespiratory fitness while also eliciting marked anti-inflammatory effects, it may be an important countermeasure of reducing cardiopulmonary morbidity following COVID-19. METHODS AND ANALYSIS 40 COVID-19 survivors who have been discharged from hospital will be included in this investigator-blinded randomised study with a 12-week HIIT intervention. Patients will be 1:1 block-randomised by sex to either a supervised HIIT exercise group or standard care (control group). The main hypothesis is that a 12-week HIIT scheme is a safe way to improve loss of cardiac mass and associated cardiorespiratory fitness, despite hypothesised limited HIIT-induced changes in conventional lung function indices per se. Ultimately, we hypothesise that the HIIT scheme will reduce post-COVID-19 symptoms and improve quality of life. ETHICS AND DISSEMINATION This study is approved by the Scientific Ethical Committee at the Capital Region of Denmark (H-20033733, including amendments 75068 and 75799) and registered at ClinicalTrials.gov (NCT04647734, pre-results). The findings will be published in a peer-reviewed journal, including cases of positive, negative and inconclusive results.Trial registration number NCT04549337.
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Affiliation(s)
- Iben Elmerdahl Rasmussen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Frederik Foged
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Josephine Bjørn Budde
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Syberg Rasmussen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Villads Rasmussen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mark Lyngbæk
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Simon Jønck
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital - Hvidovre Hospital, Hvidovre, Denmark
| | - Birgitte Lindegaard
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand Hospital, Hillerød, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Morten Asp Vonsild Lund
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ronan M G Berg
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
- Department of Clinical Physiology and Nuclear Medicine, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Regitse Højgaard Christensen
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, University Hospital Copenhagen - Rigshospitalet, Copenhagen, Denmark
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330
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Thoreau B, Eustache M, Fievet A, Lasfargues G, Plantier L, Diot E. Independent association between occupational exposure and decline of forced vital capacity in systemic sclerosis (SSc): a multicenter recruitment retrospective cohort study. Chest 2021; 161:1011-1021. [PMID: 34793760 DOI: 10.1016/j.chest.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/22/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although male sex is associated with poor prognosis in Systemic Sclerosis (SSc), it is unclear whether this association is independent of confounding factors such as occupational exposure to toxicants. RESEARCH QUESTION What is the respective impact of sex and occupational exposure on SSc patients' characteristics with a focus on lung function decline? STUDY DESIGN AND METHODS Patients with SSc (n=210, 55 males) underwent standardized quantitative assessment of occupational exposure through a cumulative exposure score (CES) in a multicenter recruitment retrospective cohort. Association of the CES with patients' characteristics was assessed. Mixed linear, logistic and Cox regression models were used to identify predictors of time variation of forced vital capacity (FVC) and the hemoglobin-corrected transfer coefficient for carbon monoxide in the lung (DLCOc). RESULTS Male sex was strongly associated with occupational exposure (OR=10.3, p<.0001). The CES was inversely correlated (r= -.20) and independently associated with decline in FVC over time and with occurrence of FVC decline ≥10% from baseline (p<.05). By contrast, the CES was not associated with decline in DLCOc or DLCOc decline ≥15%. There was no independent association between sex and decline in FVC or DLCOc. The prevalence of interstitial lung disease was similar across sex or occupational exposure. INTERPRETATION Occupational exposure to toxicants appears to independently predict decline of FVC in SSc patients, regardless of sex. Assessment of occupational exposure may be useful for SSc prognostication.
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Affiliation(s)
- Benjamin Thoreau
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, CHRU Tours, 2 Boulevard Tonnellé, Tours, France.
| | - Marine Eustache
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, CHRU Tours, 2 Boulevard Tonnellé, Tours, France
| | - Adèle Fievet
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 boulevard Béranger, Tours, France
| | - Gérard Lasfargues
- Institut santé travail Paris-Est, Université Paris-Est Créteil, 61 avenue du Général de Gaulle, Créteil, France
| | - Laurent Plantier
- CEPR/INSERM UMR1100, Department of Pulmonology and Pulmonary Function Testing, CHRU Tours, Tours University, Tours, France
| | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, CHRU Tours, 2 Boulevard Tonnellé, Tours, France
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331
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Short-Term Acute Exposure to Wildfire Smoke and Lung Function among Royal Canadian Mounted Police (RCMP) Officers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211787. [PMID: 34831540 PMCID: PMC8618710 DOI: 10.3390/ijerph182211787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
The increasing incidence of extreme wildfire is becoming a concern for public health. Although long-term exposure to wildfire smoke is associated with respiratory illnesses, reports on the association between short-term occupational exposure to wildfire smoke and lung function remain scarce. In this cross-sectional study, we analyzed data from 218 Royal Canadian Mounted Police officers (mean age: 38 ± 9 years) deployed at the Fort McMurray wildfires in 2016. Individual exposure to air pollutants was calculated by integrating the duration of exposure with the air quality parameters obtained from the nearest air quality monitoring station during the phase of deployment. Lung function was measured using spirometry and body plethysmography. Association between exposure and lung function was examined using principal component linear regression analysis, adjusting for potential confounders. In our findings, the participants were predominantly male (71%). Mean forced expiratory volume in 1 s (FEV1), and residual volume (RV) were 76.5 ± 5.9 and 80.1 ± 19.5 (% predicted). A marginal association was observed between air pollution and higher RV [β: 1.55; 95% CI: -0.28 to 3.37 per interquartile change of air pollution index], but not with other lung function indices. The association between air pollution index and RV was significantly higher in participants who were screened within the first three months of deployment (2.80; 0.91 to 4.70) than those screened later (-0.28; -2.58 to 2.03), indicating a stronger effect of air pollution on peripheral airways. Acute short-term exposure to wildfire-associated air pollutants may impose subtle but clinically important deleterious respiratory effects, particularly in the peripheral airways.
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332
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Baranauskas MN, Carter SJ. Evidence for impaired chronotropic responses to and recovery from 6-minute walk test in women with post-acute COVID-19 syndrome. Exp Physiol 2021; 107:722-732. [PMID: 34761446 PMCID: PMC8667649 DOI: 10.1113/ep089965] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023]
Abstract
NEW FINDINGS What is the central question of this study? Are chronotropic responses to a 6-minute walk test different in women with post-acute coronavirus disease 2019 (COVID-19) syndrome compared with control subjects? What is the main finding and its importance? Compared with control subjects, the increase in heart rate was attenuated and recovery delayed after a 6-minute walk test in participants after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Women reporting specific symptoms at time of testing had greater impairments compared with control subjects and SARS-CoV-2 participants not actively experiencing these symptoms. Such alterations have potential to constrain not only exercise tolerance but also participation in free-living physical activity in women during post-acute recovery from COVID-19. ABSTRACT The short-term cardiopulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well defined. However, the implications of cardiopulmonary sequelae, persisting beyond acute illness, on physical function are largely unknown. Herein, we characterized heart rate responses to and recovery from a 6-minute walk test (6MWT) in women ∼3 months after mild-to-moderate SARS-CoV-2 infection compared with non-infected control subjects. Forty-five women (n = 29 SARS-CoV-2; n = 16 controls; age = 56 ± 11 years; body mass index = 25.8 ± 6.0 kg/m2 ) completed pulmonary function testing and a 6MWT. The SARS-CoV-2 participants demonstrated reduced total lung capacity (84 ± 8 vs. 93 ± 13%; P = 0.006), vital capacity (87 ± 10 vs. 93 ± 10%; P = 0.040), functional residual capacity (75 ± 16 vs. 88 ± 16%; P = 0.006) and residual volume (76 ± 18 vs. 93 ± 22%; P = 0.001) compared with control subjects. No between-group differences were observed in 6MWT distance (P = 0.194); however, the increase in heart rate with exertion was attenuated among SARS-CoV-2 participants compared with control subjects (+52 ± 20 vs. +65 ± 18 beats/min; P = 0.029). The decrease in heart rate was also delayed for minutes 1-5 of recovery among SARS-CoV-2 participants (all P < 0.05). Women reporting specific symptoms at the time of testing had greater impairments compared with control subjects and SARS-CoV-2 participants not actively experiencing these symptoms. Our findings provide evidence for marked differences in chronotropic responses to and recovery from a 6MWT in women several months after acute SARS-CoV-2 infection.
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Affiliation(s)
- Marissa N Baranauskas
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA
| | - Stephen J Carter
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA.,Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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333
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Üçsular F, Karadeniz G, Polat G, Yalnız E, Ayrancı A, Çinkooğlu A, Savaş R, Solmaz H, Güldaval F, Büyükşirin M. Quantitative CT in mortality prediction in pulmonary fibrosis with or without emphysema. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021024. [PMID: 34744420 PMCID: PMC8552565 DOI: 10.36141/svdld.v38i3.11044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/11/2021] [Indexed: 11/05/2022]
Abstract
Aim: We aimed to evaluate the quantitative CT analysis of patients with CPFE in comparison with IPF and emphysema. Methods: Patients with CPFE(n:36), IPF(n:38) and emphysema(n:32) were retrospectively included in the study with the approval of the ethics committee. Results: There was a positive correlation between total lung volume and FVC%, TLCO% and 6 MWT, and negative correlation between mMRC and mortality. Negative correlation was found between right, left lung density and FVC%, TLCO% and 6 MWT, and positive correlation between mortality. Also, total lung volume, right and left lung densities were significant in predicting mortality and cut-off values are ≤3831,> -778 and> -775, respectively (p = 0.040, 0.020, 0.013). Conclusion: Quantitative CT are guiding in predicting mortality of the disease.
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Affiliation(s)
- Fatma Üçsular
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
| | - Gülistan Karadeniz
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
| | - Gülru Polat
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
| | - Enver Yalnız
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
| | - Aysu Ayrancı
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
| | - Akin Çinkooğlu
- Ege University Medical Faculty, Radiology, Izmir, Turkey
| | - Recep Savaş
- Ege University Medical Faculty, Radiology, Izmir, Turkey
| | - Hatice Solmaz
- University of Health Sciencies, Tepecik Training and Research Hospital, Cardiology, Izmir, Turkey
| | - Filiz Güldaval
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
| | - Melih Büyükşirin
- University of Health Sciences, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Pulmonary Disease, Izmir, Turkey
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334
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Yoon HY, Moon SJ, Song JW. Lung Tissue Microbiome Is Associated With Clinical Outcomes of Idiopathic Pulmonary Fibrosis. Front Med (Lausanne) 2021; 8:744523. [PMID: 34733866 PMCID: PMC8559550 DOI: 10.3389/fmed.2021.744523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Several studies using bronchoalveolar lavage fluid (BALF) reported that lung microbial communities were associated with the development and clinical outcome of idiopathic pulmonary fibrosis (IPF). However, the microbial communities in IPF lung tissues are not well known. This study is aimed to investigate bacterial microbial communities in lung tissues and determine their impact on the clinical outcomes of patients with IPF. Methods: Genomic DNA extracted from lung tissues of patients with IPF (n = 20; 10 non-survivors) and age- and sex-matched controls (n = 20) was amplified using fusion primers targeting the V3 and V4 regions of the 16S RNA genes with indexing barcodes. Results: Mean age of IPF subjects was 63.3 yr, and 65% were male. Alpha diversity indices did not significantly differ between IPF patients and controls, or between IPF non-survivors and survivors. The relative abundance of Lactobacillus, Paracoccus, and Akkermansia was increased, whereas that of Caulobacter, Azonexus, and Undibacterium decreased in patients with IPF compared with that in the controls. A decreased relative abundance of Pelomonas (odds ratio [OR], 0.352, p = 0.027) and Azonexus (OR, 0.013, p = 0.046) was associated with a diagnosis of IPF in the multivariable logistic analysis adjusted by age and gender. Multivariable Cox analysis adjusted for age and forced vital capacity (FVC) revealed that higher relative abundance of Streptococcus (hazard ratio [HR], 1.993, p = 0.044), Sphingomonas (HR, 57.590, p = 0.024), and Clostridium (HR, 37.189, p = 0.038) was independently associated with IPF mortality. The relative abundance of Curvibacter (r = 0.590) and Thioprofundum (r = 0.373) was correlated positively, whereas that of Anoxybacillus (r = -0.509) and Enterococcus (r = -0.593) was correlated inversely with FVC. In addition, the relative abundance of the Aquabacterium (r = 0.616) and Peptoniphilus (r = 0.606) genera was positively correlated, whereas that of the Fusobacterium (r = -0.464) and Phycicoccus (r = -0.495) genera was inversely correlated with distance during the 6-min walking test. Conclusions: The composition of the microbiome in lung tissues differed between patients with IPF and controls and was associated with the diagnosis, mortality, and disease severity of IPF.
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Affiliation(s)
- Hee-Young Yoon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Su-Jin Moon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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335
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Measurement of chest wall motion using a motion capture system with the one-pitch phase analysis method. Sci Rep 2021; 11:21497. [PMID: 34728740 PMCID: PMC8563798 DOI: 10.1038/s41598-021-01033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022] Open
Abstract
Spirometry is a standard method for assessing lung function. However, its use is challenging in some patients, and it has limitations such as risk of infection and inability to assess regional chest wall motion. A three-dimensional motion capture system using the one-pitch phase analysis (MCO) method can facilitate high precision measurement of moving objects in real-time in a non-contacting manner. In this study, the MCO method was applied to examine thoraco-abdominal (TA) wall motion for assessing pulmonary function. We recruited 48 male participants, and all underwent spirometry and chest wall motion measurement with the MCO method. A significant positive correlation was observed between the vital capacity (Spearman’s ρ = 0.68, p < 0.0001), forced vital capacity (Spearman’s ρ = 0.62, p < 0.0001), and tidal volume (Spearman’s ρ = 0.61, p < 0.0001) of spirometry and the counterpart parameters of MCO method. Moreover, the MCO method could detect regional rib cage and abdomen compartment contributions and could assess TA asynchrony, indicating almost complete synchronous movement (phase angle for each compartment: − 5.05° to 3.86°). These findings suggest that this technique could examine chest wall motion, and may be effective in analyzing chest wall volume changes and pulmonary function.
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336
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Willer K, Fingerle AA, Noichl W, De Marco F, Frank M, Urban T, Schick R, Gustschin A, Gleich B, Herzen J, Koehler T, Yaroshenko A, Pralow T, Zimmermann GS, Renger B, Sauter AP, Pfeiffer D, Makowski MR, Rummeny EJ, Grenier PA, Pfeiffer F. X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study. Lancet Digit Health 2021; 3:e733-e744. [PMID: 34711378 PMCID: PMC8565798 DOI: 10.1016/s2589-7500(21)00146-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD). METHODS In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)-which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmography) were performed for every patient and for a subgroup of patients the measurement of diffusion capacity was performed. Individual patient datasets were statistically evaluated using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison. FINDINGS Between October, 2018 and December, 2019 we enrolled 77 patients. Compared with CT-based parameters (quantitative emphysema ρ=-0·27, p=0·089 and visual emphysema ρ=-0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with lung diffusion capacity in the evaluated cohort. Emphysema assessment based on dark-field chest x-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance than conventional clinical tests characterising emphysema. Pair-wise comparison of corresponding test parameters between adjacent visual emphysema severity groups (CT-based, reference standard) showed higher effect sizes. The mean effect size over the group comparisons (absent-trace, trace-mild, mild-moderate, and moderate-confluent or advanced destructive visual emphysema grades) for the COPD assessment test score is 0·21, for forced expiratory volume in 1 s (FEV1)/functional vital capacity is 0·25, for FEV1% of predicted is 0·23, for residual volume % of predicted is 0·24, for CT emphysema index is 0·35, for dark-field signal homogeneity within lungs is 0·38, for dark-field signal texture within lungs is 0·38, and for dark-field-based emphysema severity is 0·42. INTERPRETATION X-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema in patients with COPD because this technique provides relevant information representing the structural condition of lung parenchyma. This technique might offer a low radiation dose alternative to CT in COPD and potentially other lung disorders. FUNDING European Research Council, Deutsche Forschungsgemeinschaft, Royal Philips, and Karlsruhe Nano Micro Facility.
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Affiliation(s)
- Konstantin Willer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang Noichl
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Manuela Frank
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Theresa Urban
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Rafael Schick
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alex Gustschin
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Thomas Koehler
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Philips Research Hamburg, Hamburg, Germany
| | | | - Thomas Pralow
- Philips Medical Systems DMC Hamburg, Hamburg, Germany
| | - Gregor S Zimmermann
- Department of Cardiology, Angiology, and Pneumology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas P Sauter
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philippe A Grenier
- Department of Clinical Research and Innovation, Hôpital Foch, Suresnes, Paris, France
| | - Franz Pfeiffer
- Department of Physics, Technical University of Munich, Garching, Germany; Munich School of BioEngineering, Technical University of Munich, Garching, Germany; Institute for Advanced Study, Technical University of Munich, Garching, Germany; Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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337
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Kwon BS, Choe J, Chae EJ, Hwang HS, Kim YG, Song JW. Progressive fibrosing interstitial lung disease: prevalence and clinical outcome. Respir Res 2021; 22:282. [PMID: 34719401 PMCID: PMC8559348 DOI: 10.1186/s12931-021-01879-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/26/2021] [Indexed: 02/15/2023] Open
Abstract
Background The progressive fibrosing (PF) phenotype of interstitial lung disease (ILD) is characterised by worsening respiratory symptoms, lung function, and extent of fibrosis on high-resolution computed tomography. We aimed to investigate the prevalence and clinical outcomes of PF-ILD in a real-world cohort and assess the prognostic significance of the PF-ILD diagnostic criteria. Methods Clinical data of patients with fibrosing ILD other than idiopathic pulmonary fibrosis (IPF) consecutively diagnosed at a single centre were retrospectively reviewed. A PF phenotype was defined based on the criteria used in the INBUILD trial. Results The median follow-up duration was 62.7 months. Of the total of 396 patients, the mean age was 58.1 years, 39.9% were men, and rheumatoid arthritis-ILD was the most common (42.4%). A PF phenotype was identified in 135 patients (34.1%). The PF-ILD group showed lower forced vital capacity and total lung capacity (TLC) than the non-PF-ILD group. The PF-ILD group also showed poorer survival (median survival, 91.2 months vs. not reached; P < 0.001) than the non-PF-ILD group. In multivariable Cox analysis adjusted for age, DLCO, HRCT pattern, and specific diagnosis, PF phenotype was independent prognostic factor (hazard ratio, 3.053; P < 0.001) in patients with fibrosing ILD. Each criterion of PF-ILD showed similar survival outcomes. Conclusions Our results showed that approximately 34% of patients with non-IPF fibrosing ILD showed a progressive phenotype and a poor outcome similar to that of IPF, regardless of the diagnostic criteria used. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01879-6.
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Affiliation(s)
- Byoung Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-S, Gyeonggi-Do, Republic of Korea
| | - Jooae Choe
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Hee Sang Hwang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Centre, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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338
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Mannée DC, de Jongh F, van Helvoort H. Telemonitoring Techniques for Lung Volume Measurement: Accuracy, Artifacts and Effort. Front Digit Health 2021; 2:559483. [PMID: 34713036 PMCID: PMC8521879 DOI: 10.3389/fdgth.2020.559483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Telemonitoring becomes more important in pulmonary research. It can be used to decrease the pressure on the health care system, to lower the costs of health care and to increase quality of life of patients. Previous studies show contradictory results regarding the effectiveness of telemonitoring. According to multiple researchers, inefficiency can be a result of poor study design, low data quality and usability issues. To counteract these issues, this review proves for an in-depth explanation of four (potential) telemonitoring systems in terms of work principle, accuracy, disturbing factors and usability. The evaluated systems are portable spirometry/breath-by-breath analyzers, respiratory inductance and magnetic plethysmography and electrical impedance tomography. These insights can be used to select the optimal technique for a specific purpose in future studies.
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Affiliation(s)
| | - Frans de Jongh
- Pulmonary Department, Medisch Spectrum Twente, Enschede, Netherlands
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339
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Kirby M, Smith BM, Tanabe N, Hogg JC, Coxson HO, Sin DD, Bourbeau J, Tan WC. Computed tomography total airway count predicts progression to COPD in at-risk smokers. ERJ Open Res 2021; 7:00307-2021. [PMID: 34708120 PMCID: PMC8542990 DOI: 10.1183/23120541.00307-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited understanding of how to identify people at high risk of developing COPD. Our objective was to investigate the association between computed tomography (CT) total airway count (TAC) and incident COPD over 3 years among ever-smokers from the population-based Canadian Cohort Obstructive Lung Disease (CanCOLD) study. CT and spirometry were acquired in ever-smokers at baseline; spirometry was repeated at 3-year follow-up. CT TAC was generated by summing all airway segments in the segmented airway tree (VIDA Diagnostics, Inc.). CT airway wall area, wall thickness for a theoretical airway with 10 mm perimeter (Pi10), and low attenuation areas below −856 HU (LAA856) were also measured. Logistic and mixed effects regression models were constructed to determine the association for CT measurements with development of COPD and forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decline, respectively. Among 316 at-risk participants evaluated at baseline (65±9 years, 40% female, 18±19 pack-years), incident COPD was detected in 56 participants (18%) over a median 3.1±0.6 years of follow-up. Among CT measurements, only TAC was associated with incident COPD (p=0.03), where a 1-sd decrement in TAC increased the odds ratio for incident COPD by a factor of two. In a multivariable linear regression model, reduced TAC was significantly associated with greater longitudinal FEV1/FVC decline (p=0.03), but no other measurements were significant. CT TAC predicts incident COPD in at-risk smokers, indicating that smokers exhibit early structural changes associated with COPD prior to abnormal spirometry. Computed tomography (CT) total airway count (TAC) predicts incident COPD in at-risk smokers, indicating that smokers exhibit early airway remodelling prior to abnormal spirometry and that CT TAC is a potential tool to help identify smokers at increased risk of COPDhttps://bit.ly/2UTw3I4
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Affiliation(s)
- Miranda Kirby
- Dept of Physics, Ryerson University, Toronto, ON, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Benjamin M Smith
- Dept of Medicine, McGill University, Montreal, QC, Canada.,Dept of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Dept of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Naoya Tanabe
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - James C Hogg
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Harvey O Coxson
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Wan C Tan
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
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340
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Niederseer D, Walser R, Schmied C, Dela F, Gräni C, Bohm P, Müller E, Niebauer J. Effects of a 12-Week Recreational Skiing Program on Cardio-Pulmonary Fitness in the Elderly: Results from the Salzburg Skiing in the Elderly Study (SASES). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111378. [PMID: 34769896 PMCID: PMC8583387 DOI: 10.3390/ijerph182111378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate whether recreational alpine skiing in the elderly can improve cardio-pulmonary fitness. DESIGN Randomized controlled study with pre-post repeated measurements. METHODS A total of 48 elderly participants (60-76 years) were randomly assigned to either participate in a 12-week guided recreational skiing program (intervention group, IG, average of 28.5 ± 2.6 skiing days) or to continue a sedentary ski-free lifestyle (control group, CG). Cardio-pulmonary exercise testing (CPET) and pulmonary function testing were performed in both groups before (PRE) and after (POST) the intervention/control period to compare parameters PRE vs. POST CPET. RESULTS At baseline, IG and CG did not differ significantly with respect to CPET and pulmonary function parameters. At POST, several measures of maximal exercise capacity and breathing economy were significantly improved in IG as compared to CG: maximal oxygen capacity (IG: 33.8 ± 7.9; CG: 28.7 ± 5.9 mL/min/kg; p = 0.030), maximal carbon dioxide production (IG: 36.2 ± 7.7; CG: 31.8 ± 6.5 mL/min/kg; p = 0.05), maximal oxygen pulse (IG: 16.8 ± 4.2; CG: 13.2 ± 4 mL/heart beat; p = 0.010), maximal minute ventilation (IG: 96.8 ± 17.8; CG: 81.3 ± 21.9 l/min; p = 0.025), and maximal metabolic equivalent of task (METs, IG: 9.65 ± 2.26; CG: 8.19 ± 1.68 METs; p = 0.029). Except for oxygen pulse, these significant changes could also be observed at the anaerobic threshold. Maximal heart rate and pulmonary function parameters remained essentially unchanged. CONCLUSION Regular recreational skiing improves cardio-pulmonary fitness along with breathing economy and thus can contribute to a heart-healthy lifestyle for the elderly.
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Affiliation(s)
- David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
- Correspondence: ; Tel.: +41-(0)44-253-94-71; Fax: +41-(0)44-255-44-01
| | - Roman Walser
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
| | - Christian Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
| | - Flemming Dela
- Department of Geriatrics, Bispebjerg-Frederiksberg University Hospital, DK-2400NV Copenhagen, Denmark;
- Xlab, Department of Biomedicine, University of Copenhagen, DK-2200N Copenhagen, Denmark
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland;
| | - Philipp Bohm
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
| | - Erich Müller
- Department of Sport Science and Kinesiology, University of Salzburg, 5020 Salzburg, Austria;
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
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341
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Yoon HY, Lee SH, Ha S, Ryu JS, Song JW. The Value of 18F-FDG PET/CT in Evaluating Disease Severity and Prognosis in Idiopathic Pulmonary Fibrosis Patients. J Korean Med Sci 2021; 36:e257. [PMID: 34697928 PMCID: PMC8546311 DOI: 10.3346/jkms.2021.36.e257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several parameters are useful for assessing disease severity in idiopathic pulmonary fibrosis (IPF); however, the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is not well-defined. We aimed to evaluate the value of 18F-FDG PET/CT for assessing disease severity and prognosis in IPF patients. METHODS Clinical data of 89 IPF patients (mean age: 68.1 years, male: 94%) who underwent 18F-FDG PET/CT for evaluation of lung nodules or cancer staging were retrospectively reviewed. Mean and maximal standardized uptake values (SUVmean, SUVmax, respectively) were measured in the fibrotic area. Adjusted SUV, including SUV ratio (SUVR, defined as SUVmax-to-liver SUVmean ratio), tissue fraction-corrected SUVmean (SUVmeanTF), and SUVR (SUVRTF), and tissue-to-blood ratio (SUVmax/SUVmean venous; TBRblood) were obtained. Death was defined as the primary outcome, and associations between other clinical parameters (lung function, exercise capacity, C-reactive protein [CRP] level) were also investigated. RESULTS All SUV parameters were inversely correlated with the forced vital capacity, diffusing capacity for carbon monoxide, and positively correlated with CRP level and the gender-age-physiology index. The SUVmean, SUVmax, and SUVmeanTF were associated with changes in lung function at six months. The SUVR (hazard ratio [HR], 1.738; 95% confidence interval [CI], 1.011-2.991), SUVRTF (HR, 1.441; 95% CI, 1.000-2.098), and TBRblood (HR, 1.377; 95% CI, 1.038-1.827) were significant predictors for mortality in patients with IPF in the univariate analysis, but not in the multivariate analysis. CONCLUSION 18F-FDG PET/CT may provide additional information on the disease severity and prognosis in IPF patients, and the SUVR may be superior to other SUV parameters.
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Affiliation(s)
- Hee-Young Yoon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Hyun Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Nuclear Medicine, Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sejin Ha
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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342
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Hanna G, Bankler S, Schandl A, Roël M, Hedman A, Andersson Franko M, Lyngå P, Geborek A, Joelsson-Alm E, Söderberg M, Darlington P. The role of ventilatory support for long-term outcomes after critical infection with COVID-19: A prospective cohort study. CLINICAL RESPIRATORY JOURNAL 2021; 16:63-71. [PMID: 34665518 PMCID: PMC8652938 DOI: 10.1111/crj.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Objectives The full range of long‐term health consequences in intensive care unit (ICU) survivors with COVID‐19 is unclear. This study aims to investigate the role of ventilatory support for long‐term pulmonary impairment in critically ill patients and further to identify risk factors for prolonged radiological recovery. Methods A prospective observational study from a single general hospital, including all with COVID‐19 admitted to ICU between March and August 2020, investigating the association between ventilatory support and the extent of residual parenchymal changes on chest computed tomography (CT) scan and measurement of lung volumes at follow‐up comparing high‐flow nasal oxygen (HFNO) or non‐invasive ventilation (NIV) with invasive ventilation. A semi‐quantitative score (CT involvement score) based on lobar involvement and a total score for all five lobes was used to estimate residual parenchymal changes. The association was calculated with logistic regression and adjusted for age, sex, smoking, and severity of illness. Results Among the 187 eligible, 86 had a chest CT scan and 76 a pulmonary function test at the follow‐up with a median time of 6 months after ICU discharge. Residual lung changes were seen in 74%. The extent of pulmonary changes was similar regardless of ventilatory support, but patients with invasive ventilation had a lower total lung capacity 84% versus 92% of predicted (p < 0.001). Conclusions The majority of ICU‐treated patients with COVID‐19 had residual lung changes at 6 months of follow‐up regardless of ventilator support or not, but the total lung capacity was lower in those treated with invasive ventilation.
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Affiliation(s)
- Gabriel Hanna
- Department of Radiology, Södersjukhuset, Stockholm, Sweden
| | - Sara Bankler
- Department of Radiology, Södersjukhuset, Stockholm, Sweden
| | - Anna Schandl
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mari Roël
- Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Anders Hedman
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Anne Geborek
- Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mårten Söderberg
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Pernilla Darlington
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
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343
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Karanikas I, Karayiannis D, Karachaliou A, Papanikolaou A, Chourdakis M, Kakavas S. Body composition parameters and functional status test in predicting future acute exacerbation risk among hospitalized patients with chronic obstructive pulmonary disease. Clin Nutr 2021; 40:5605-5614. [PMID: 34656957 DOI: 10.1016/j.clnu.2021.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Nutritional and functional status derangement is a commonly seen in COPD patients, and this is associated with a higher disease severity and mortality. To assess body composition analysis - measured by segmental multi-frequency bioelectrical impedance analysis (BIA)- and functional status and investigate their relationship with the COPD acute exacerbation risk. METHODS Eighty COPD patients admitted to hospital for COPD acute exacerbation were prospectively followed-up for one year after discharge, focusing on a new incidence of COPD acute exacerbation. Following discharge, participants' body composition was assessed with the use of segmental multi-frequency BIA, whereas physical function by performing 5-repetitions and 30 s sit-to-stand (STS) tests. Unadjusted and multivariate logistic regression analyses were performed to evaluate the ability of the various measures to predict incidence of future COPD acute exacerbation in one-year period. RESULTS Seventy-six out of 80 participants completed the study and were analyzed. Fifty-one [24 male (47.1%)] out of 76 participants (67.1%), mean aged of 69.3 ± 8.9 years, developed at least one new COPD acute exacerbation during the one year follow-up. The probability of COPD acute exacerbation in one year was significantly related to BMI (OR = 0.75, 95% CI; 0.61-0.91, p = 0.004) and Fat Free Mass (OR = 0.88, 95% CI; 0.79-0.97, p = 0.012) after adjustment for sex, age and smoking index (pack × years). Both 5-repetitions and 30 s STS tests had a good predictive ability for the incidence of COPD acute exacerbation in one year (AUC = 0.80, 95% CI; 0.65-0.95, p = 0.009 and AUC = 0.83, 95% CI; 0.70-0.96, p = 0.004, respectively). CONCLUSION In an observational study among patients admitted with COPD acute exacerbation, body composition analysis parameters and functional status are related to acute exacerbation risk incidence.
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Affiliation(s)
- Ioannis Karanikas
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Dimitrios Karayiannis
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Alexandra Karachaliou
- Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Aggeliki Papanikolaou
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, GR 54124, Greece.
| | - Sotirios Kakavas
- 1st Pulmonary Department, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece.
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Bhatawadekar SA, Dixon AE, Peters U, Daphtary N, Hodgdon K, Kaminsky DA, Bates JHT. Positive Expiratory Pressure: A Potential Therapy to Mitigate Acute Bronchoconstriction in the Asthma of Obesity. J Appl Physiol (1985) 2021; 131:1663-1670. [PMID: 34647827 DOI: 10.1152/japplphysiol.00399.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Late-onset non-allergic (LONA) asthma in obesity is characterized by increased peripheral airway closure secondary to abnormally collapsible airways. We hypothesized that positive expiratory pressure (PEP) would mitigate the tendency to airway closure during bronchoconstriction, potentially serving as rescue therapy for LONA asthma of obesity. The PC20 dose of methacholine was determined in 18 obese participants with LONA asthma. At each of 4 subsequent visits, we used oscillometry to measure input respiratory impedance (Zrs) over 8 minutes; participants received their PC20 concentration of methacholine aerosol during the first 4.5 minutes. PEP combinations of either 0 or 10 cmH2O either during and/or after the methacholine delivery were applied, randomized between visits. Parameters characterizing respiratory system mechanics were extracted from the Zrs spectra. In 18 LONA asthma patients (14 females, BMI: 39.6±3.4 kg/m2), 10 cmH2O PEP during methacholine reduced elevations in the central airway resistance, peripheral airway resistance and elastance, and breathing frequency was also reduced. During the 3.5 min following methacholine delivery, PEP of 10 cmH2O reduced Ax and peripheral elastance compared to no PEP. PEP mitigates the onset of airway narrowing brought on by methacholine challenge, and airway closure once it is established. PEP thus might serve as a non-pharmacologic therapy to manage acute airway narrowing for obese LONA asthma.
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Affiliation(s)
- Swati A Bhatawadekar
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
| | - Anne E Dixon
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
| | - Ubong Peters
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
| | - Nirav Daphtary
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
| | - Kevin Hodgdon
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
| | - David A Kaminsky
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
| | - Jason H T Bates
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States
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Effect of nocturnal oxygen therapy on exercise performance of COPD patients at 2048 m: data from a randomized clinical trial. Sci Rep 2021; 11:20355. [PMID: 34645842 PMCID: PMC8514448 DOI: 10.1038/s41598-021-98395-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
This trial evaluates whether nocturnal oxygen therapy (NOT) during a stay at 2048 m improves altitude-induced exercise intolerance in lowlanders with chronic obstructive pulmonary disease (COPD). 32 lowlanders with moderate to severe COPD, mean ± SD forced expiratory volume in the first second of expiration (FEV1) 54 ± 13% predicted, stayed for 2 days at 2048 m twice, once with NOT, once with placebo according to a randomized, crossover trial with a 2-week washout period at < 800 m in-between. Semi-supine, constant-load cycle exercise to exhaustion at 60% of maximal work-rate was performed at 490 m and after the first night at 2048 m. Endurance time was the primary outcome. Additional outcomes were cerebral tissue oxygenation (CTO), arterial blood gases and breath-by-breath measurements (http://www.ClinicalTrials.gov NCT02150590). Mean ± SE endurance time at 490 m was 602 ± 65 s, at 2048 m after placebo 345 ± 62 s and at 2048 m after NOT 293 ± 60 s, respectively (P < 0.001 vs. 490 m). Mean difference (95%CI) NOT versus placebo was − 52 s (− 174 to 70), P = 0.401. End-exercise pulse oximetry (SpO2), CTO and minute ventilation (\documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}_{{\text{E}}}$$\end{document}V˙E) at 490 m were: SpO2 92 ± 1%, CTO 65 ± 1%, \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}_{{\text{E}}}$$\end{document}V˙E 37.7 ± 2.0 L/min; at 2048 m with placebo: SpO2 85 ± 1%, CTO 61 ± 1%, \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}_{{\text{E}}}$$\end{document}V˙E 40.6 ± 2.0 L/min and with NOT: SpO2 84 ± 1%; CTO 61 ± 1%; \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}_{{\text{E}}}$$\end{document}V˙E 40.6 ± 2.0 L/min (P < 0.05, SpO2, CTO at 2048 m with placebo vs. 490 m; P = NS, NOT vs. placebo). Altitude-related hypoxemia and cerebral hypoxia impaired exercise endurance in patients with moderate to severe COPD and were not prevented by NOT.
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Chevrier S, Abdulnour J, Saint-Pierre MD. Predictors of methacholine challenge testing results in subjects without airflow obstruction. J Asthma 2021; 59:2060-2068. [PMID: 34570662 DOI: 10.1080/02770903.2021.1986838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Methacholine challenge testing (MCT) is considered when asthma remains clinically suspected despite normal spirometry. Few studies have attempted to determine the predictive factors of MCT results. We aimed to establish which demographic data, clinical symptoms, pulmonary function testing results, and laboratory values were associated with abnormal MCT (provocation concentration causing a 20% decrease in FEV1 (PC20) ≤ 16 mg/mL) in subjects without airflow obstruction on spirometry. METHODS All patients who completed MCT at Montfort Hospital between January 1st, 2016 and December 31st, 2018 were identified. Subjects with a reduced FEV1/FVC ratio were excluded. We used Pearson's chi-squared test and point-biserial correlation method to determine which variables had a significant relationship (p < 0.05) with MCT results. RESULTS 23.3% of patients who underwent MCT had airflow limitation. In the 1126 subjects with a normal FEV1/FVC ratio, PC20 ≤ 16 mg/mL was found in 13.0%. Younger age, female gender, body mass index ≥ 40, and reported wheezing were factors associated with increased probability of airway hyper responsiveness. Lower FEV1, significant improvement of the FEV1 post-bronchodilator, reduced FEF25%-75%, greater FEF25%-75% reversibility, airway resistance measurements above the upper limit of normal, and increased blood eosinophil counts were predictive of abnormal MCT. CONCLUSIONS Only 13.0% of patients referred for MCT had a PC20 ≤ 16 mg/mL when the FEV1/FVC ratio was normal, highlighting the need to further define in which individuals this test is truly warranted. Further investigation is required to develop an easy-to-use and validated prediction model in order to better understand patients' pretest probability of abnormal MCT.
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Affiliation(s)
| | - Joseph Abdulnour
- Institut du Savoir Montfort, Ottawa, ON, Canada.,Department of Performance and Decision Support, Montfort Hospital, Ottawa, ON, Canada
| | - Mathieu D Saint-Pierre
- University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,Division of Respirology, Montfort Hospital, Ottawa, ON, Canada
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347
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Schandl A, Hedman A, Lyngå P, Fathi Tachinabad S, Svefors J, Roël M, Geborek A, Andersson Franko M, Söderberg M, Joelsson‐Alm E, Darlington P. Long-term consequences in critically ill COVID-19 patients: A prospective cohort study. Acta Anaesthesiol Scand 2021; 65:1285-1292. [PMID: 34097753 PMCID: PMC8212104 DOI: 10.1111/aas.13939] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND COVID-19 can cause severe disease with need of treatment in the intensive care unit (ICU) for several weeks. Increased knowledge is needed about the long-term consequences. METHODS This is a single-center prospective follow-up study of COVID-19 patients admitted to the ICU for respiratory organ support between March and July 2020. Patients with invasive ventilation were compared with those with high-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) regarding functional outcome and health-related qualify of life. The mean follow-up time was 5 months after ICU discharge and included clinical history, three well-validated questionnaires about health-related quality of life and psychological health, pulmonary function test, 6-minute walk test (6MWT) and work ability. Data were analyzed with multivariable general linear and logistic regression models with 95% confidence intervals. RESULTS Among 248 ICU patients, 200 patients survived. Of these, 113 patients came for follow-up. Seventy patients (62%) had received invasive ventilation. Most patients reported impaired health-related quality of life. Approximately one-third suffered from post-traumatic stress, anxiety and depression. Twenty-six percent had reduced total lung capacity, 34% had reduced 6MWT and 50% worked fulltime. The outcomes were similar regardless of ventilatory support, but invasive ventilation was associated with more bodily pain (MSD -19, 95% CI: -32 to -5) and <80% total lung capacity (OR 4.1, 95% CI: 1.3-16.5). CONCLUSION Among survivors of COVID-19 who required respiratory organ support, outcomes 5 months after discharge from ICU were largely similar among those requiring invasive compared to non-invasive ventilation.
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Affiliation(s)
- Anna Schandl
- Department of Anesthesiology and Intensive Care Södersjukhuset Stockholm Sweden
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
- Department of Molecular medicine and surgery Karolinska Institutet Stockholm Sweden
| | - Anders Hedman
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
- Department of Cardiology Södersjukhuset Stockholm Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
- Department of Cardiology Södersjukhuset Stockholm Sweden
| | | | - Jessica Svefors
- Department of Internal Medicine Södersjukhuset Stockholm Sweden
| | - Mari Roël
- Department of Internal Medicine Södersjukhuset Stockholm Sweden
| | - Anne Geborek
- Department of Internal Medicine Södersjukhuset Stockholm Sweden
| | - Mikael Andersson Franko
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
| | - Mårten Söderberg
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
- Department of Internal Medicine Södersjukhuset Stockholm Sweden
| | - Eva Joelsson‐Alm
- Department of Anesthesiology and Intensive Care Södersjukhuset Stockholm Sweden
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
| | - Pernilla Darlington
- Department of Clinical Science and Education SödersjukhusetKarolinska Institutet Stockholm Sweden
- Department of Internal Medicine Södersjukhuset Stockholm Sweden
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348
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Batajrobeh A, Ahmadi MM, Mogharnasi M. Effects of High and Moderate-Intensity Interval Training on Pulmonary and Performance Parameters in Miners Suffering From Chronic Obstructive Pulmonary Diseases. J Occup Environ Med 2021; 63:e673-e678. [PMID: 34267106 DOI: 10.1097/jom.0000000000002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the effect of 12 weeks of high and moderate-intensity interval training on pulmonary and functional parameters in miners with chronic obstructive pulmonary disease working in the polluted environment. METHODS Forty-five miners with COPD (average degree: 60 > FEV1 < 70), were randomly divided into HIIT (with 100%-125% ISWT); MIIT (with 60%-85% ISWT), and control. The study period was 12 weeks (3 sessions per week). At the beginning and end of the study, pulmonary and functional indices was evaluated. RESULTS Based on results, HIIT and MIIT significantly increased FVC, FEV1, and mean traveled distance in ISWT compared with control. Comparison of training intensities showed that HIIT led to a significant change in FVC, FEV1, and ISWT record compared to MIIT. CONCLUSION It is suggested that miners suffering from COPD, consider HIIT as part of their treatment plan.
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Affiliation(s)
- Abdolhakim Batajrobeh
- Department of Sport Sciences, University of Birjand, Birjand, 9717434765. Iran (Mr Batajrobe, Dr Ahmad, and Dr Mogharnasi)
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349
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C. Robertson L, E. Oates K, J. Fletcher A, P. Sylvester K. The association of six-minute walk work and other clinical measures to cardiopulmonary exercise test parameters in pulmonary vascular disease. Pulm Circ 2021; 11:20458940211059055. [PMID: 34917334 PMCID: PMC8670788 DOI: 10.1177/20458940211059055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In pulmonary vascular disease exercise, abnormalities can include reduced exercise capacity, reduced oxygen pulse and elevated VE/VCO2. The association of clinical measures such as six-minute walk work, haemodynamics, lung function and echocardiogram to peak VO2, O2 pulse and VE/VCO2 has not been fully investigated in pulmonary vascular disease. AIMS To determine the relationship of six-minute walk work and other clinical measures to peak VO2, peak O2 pulse and VE/VCO2. Additionally, to investigate the ability to predict peak VO2 from six-minute walk work and other clinical parameters. METHODS Clinical data was retrospectively analysed from 63 chronic thromboembolic pulmonary hypertension (CTEPH) and 54 chronic thromboembolic disease (CTED) patients. Six-minute walk test measures, haemodynamics, lung function and echocardiographic measures were correlated with peak VO2, peak O2 pulse and VE/VCO2. Predictive equations were developed to predict peak V̇O2 in both CTEPH and CTED cohorts and subsequently validated. RESULTS A number of clinical parameters correlated to peak VO2, peak O2 pulse and VE/VCO2. Six-minute walk work and transfer factor for carbon monoxide demonstrated the strongest correlation to peak VO2 and peak O2 pulse. The validation of the predictive equations showed a variable level of agreement between measured peak VO2 and calculated peak VO2 from the predictive equations. CONCLUSION Six-minute walk work and additionally a number of clinical test parameters were associated to peak VO2, peak O2 pulse and VE/VCO2. Six-minute walk work and transfer factor for carbon monoxide were particularly highly correlated to peak VO2 and similarly to peak oxygen pulse. The validation of the predictive equations showed a variable level of agreement and therefore may have limited clinical applicability.
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Affiliation(s)
- Lucy C. Robertson
- Department of Respiratory Physiology, Royal Papworth Hospital, Royal Papworth Hospital, Cambridge, UK
| | - Katrina E. Oates
- Department of Respiratory Physiology, Royal Papworth Hospital, Royal Papworth Hospital, Cambridge, UK
| | - Andy J. Fletcher
- Department of Cardiac Physiology, Royal Papworth Hospital,
Cambridge, UK
| | - Karl P. Sylvester
- Department of Respiratory Physiology, Royal Papworth Hospital, Royal Papworth Hospital, Cambridge, UK
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350
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Liu Q, Zhou L, Feng P, Liu J, Shen B, Huang L, Wang Y, Zou Y, Xia Y, Huang G. Measurement of the Total Lung Volume Using an Adjusted Single-Breath Helium Dilution Method in Patients With Obstructive Lung Disease. Front Med (Lausanne) 2021; 8:737360. [PMID: 34568392 PMCID: PMC8455942 DOI: 10.3389/fmed.2021.737360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Whole-body plethysmography (WBP) is the gold standard for measuring lung volume, but its clinical application is limited as it requires expensive equipment and is not simple to use. Studies have shown that the single-breath helium dilution (SBHD) method, which is commonly used in clinical practice, significantly underestimates lung volume in patients with obstructive lung disease (OLD). By comparing the differences in lung volume measured using SBHD and WBP, we aimed to establish a correction equation for the SBHD method to determine the total lung volume in patients with OLD of different severities. Methods: From 628 patients with OLD simultaneously subjected to SBHD and WBP, 407 patients enrolled between January 2018 and November 2019 were in the training group and 221 enrolled between December 2019 and December 2020 were in the prospective verification cohort. The multiple linear regression equation was used for data in the training group to establish a correction equation for SBHD to determine the total lung volume, and this was validated in the prospective validation cohort. Results: There was a moderate positive correlation between total lung capacity (TLC) determined using the SBHD [TLC (SBHD)] and WBP methods [TLC (WBP)] (r = 0.701; P < 0.05), and the differences between TLC (SBHD) and TLC (WBP) (ΔTLC) were related to the severity of obstruction. As the severity of obstruction increased, the TLC was underestimated by the SBHD method. We established the following correction equation: TLC (adjusted SBHD) (L) = −0.669 + 0.756*TLC(SBHD)(L) – 0.047*FEV1FVC+0.039*height (cm)–0.009*weight(kg)(r2 = 0.753 and adjusted r2 = 0.751). Next, we validated this equation in the validation cohort. With the correction equation, no statistical difference was observed between TLC (adjusted SBHD) and TLC (WBP) among the obstruction degree groups (P > 0.05). Conclusions: The SBHD method is correlated with WBP to measure the total lung volume, but the SBHD method presents limitations in determining the total lung volume in patients with obstructive lung disease. Here, we established an effective and reliable correction equation in order to accurately assess the total lung volume of patients with OLD using the SBHD method.
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Affiliation(s)
- Qing Liu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lingxiao Zhou
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Peiling Feng
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jinkai Liu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yingying Wang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yimin Zou
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Xia
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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