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Miravitlles M, Matsunaga K, Dreher M. Stepwise management of COPD: What is next after bronchodilation? Ther Adv Respir Dis 2023; 17:17534666231208630. [PMID: 37936381 PMCID: PMC10631322 DOI: 10.1177/17534666231208630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/29/2023] [Indexed: 11/09/2023] Open
Abstract
Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination is currently the mainstay of treatment for chronic obstructive pulmonary disease (COPD). Treatment guidelines recommend the addition of inhaled corticosteroids (ICS) to LABA/LAMA only in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma. Despite this, real-world data suggest that clinicians are not adhering to this guidance and that ICS are frequently overused. This is possibly due to the incorrect assumption that when LABA/LAMA therapy is not sufficient, adding an ICS to the treatment regimen is the logical next step. In this narrative review, we describe global and country-specific guideline recommendations from Germany, Spain, and Japan and compare these with real-world data on LABA/LAMA and ICS use in clinical practice. We also provide a clinical guide to the use of add-on therapies with LABA/LAMA for different patient phenotypes, including (1) patients still symptomatic (but not exacerbating) despite LABA/LAMA treatment; (2) patients still exacerbating despite LABA/LAMA treatment who have high blood eosinophil counts; and (3) patients still exacerbating despite LABA/LAMA treatment who do not have high blood eosinophils or concomitant asthma.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, University Hospital Vall d′Hebron/Vall d’Hebron Research Institute (VHIR, Vall d’Hebron Barcelona Hospital Campus; CIBER de Enfermedades Respiratorias [CIBERES]), P. Vall d’Hebron 119–129, Barcelona 08035, Spain
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
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Monteagudo M, Nuñez A, Barrecheguren M, Miravitlles M. Effectiveness of treatment with dual bronchodilation (LABA/LAMA) compared with combination therapy (LABA/ICS) for patients with COPD: A population-based study. Arch Bronconeumol 2022; 58:699-707. [DOI: 10.1016/j.arbres.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
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Martinez-Garcia MA, Miravitlles M. The Impact of Chronic Bronchial Infection in COPD: A Proposal for Management. Int J Chron Obstruct Pulmon Dis 2022; 17:621-630. [PMID: 35355582 PMCID: PMC8958724 DOI: 10.2147/copd.s357491] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Up to 50% of patients with chronic obstructive pulmonary disease (COPD) in stable state may carry potentially pathogenic microorganisms (PPMs) in their airways. The presence of PPMs has been associated with increased symptoms, increased risk and severity of exacerbations, a faster decline in lung function and impairment in quality of life. Although some clinical trials have demonstrated a reduction in exacerbations in patients chronically treated with systemic antibiotics, particularly macrolides, the selection of patients was based on the previous frequency of exacerbations and not on the presence of PPMs in their airways. Therefore, unlike in bronchiectasis, there is a lack of evidence-based recommendations for assessment and treatment of the presence of PPMs in either single or repeated isolations in COPD. In this article, we propose that chronic bronchial infection (CBI) in COPD be defined as the isolation of the same PPM in at least three sputum samples separated by more than one month; we review the impact of CBI on the natural course of COPD and suggest a course of action in patients with a single isolation of a PPM or suspected CBI. Antibiotic treatment in stable COPD should be recommended based on four main criteria: a) the presence of comorbid bronchiectasis, b) the demonstration of a single or multiple isolation of the same PPM, c) the clinical impact of CBI on the patients, and d) the type of PPM, either Pseudomonas aeruginosa or non-pseudomonal PPM. These recommendations are derived from evidence generated in patients with bronchiectasis and, until new evidence specifically obtained in COPD is available, they may help in the management of these challenging patients with COPD. Existing evidence suggests that inhaled therapy is insufficient to manage patients with moderate-to-severe COPD, frequent exacerbations, and CBI. New studies must be conducted in this particularly demanding population.
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Affiliation(s)
- Miguel Angel Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Correspondence: Marc Miravitlles, Pneumology Department, Vall d’Hebron Barcelona Hospital Campus, P. Vall d’Hebron 119-129, Barcelona, 08035, Spain, Tel +34932746083, Email
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Wan C, Yang Z, Zhao Z, Quan P, Wu B, Yang Y. Development and preliminary validation of the chronic obstructive pulmonary disease scale quality of life instruments for chronic diseases-chronic obstructive pulmonary disease based on classical test theory and generalizability theory. Chron Respir Dis 2022; 19:14799731221104099. [PMID: 36000309 PMCID: PMC9421010 DOI: 10.1177/14799731221104099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Quality of life (QOL) in patients with Chronic obstructive pulmonary disease (COPD) is a major global concern in respiratory care with the specific instruments used rarely being developed using a modular approach. This paper is aimed to develop the COPD scale of the system of QOL Instruments for Chronic Diseases (QLICD-COPD) by the modular approach based on Classical Test Theory and Generalizability Theory (GT). 114 inpatients with COPD were used to provide the data measuring QOL three times before and after treatments. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation analysis, factor analyses, multi-trait scaling analysis, and also GT analysis. The Results showed that Multi-trait scaling analysis, correlation and factor analyses confirmed good construct validity and criterion-related validity with almost all correlation coefficients or factor loadings being above 0.40. The internal consistency α and test-retest reliability coefficients (Pearson r and Intra-class correlations ICC) for all domains except for the social domain were larger than 0.70, ranging between 0.70–0.86 with r = 0.85 for the overall. The overall score and scores for physical and the specific domains had statistically significant changes after treatments with moderate effect size SRM (standardized response mean) ranging from 0.32 to 0.44. All G-coefficients and index of dependability were all greater than 0.80 exception of social domain (0.546 and 0.500 respectively), confirming the reliability of the scale further. It concluded that the QLICD-COPD has good validity, reliability, and moderate responsiveness, and can be used as the QOL instrument for patients with COPD.
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Affiliation(s)
- Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological assessment and Intervention, Guangdong Medical University, Dongguan, China
| | - Zheng Yang
- School of Public Health, Guangdong Medical University, Dongguan, China
| | - Zhihuan Zhao
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Peng Quan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological assessment and Intervention, Guangdong Medical University, Dongguan, China
| | - Bin Wu
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yunbin Yang
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological assessment and Intervention, Guangdong Medical University, Dongguan, China
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Miravitlles M, García-Rivero JL, Ribera X, Galera J, García A, Palomino R, Pomares X. Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis. Respir Res 2022; 23:347. [PMID: 36522735 PMCID: PMC9753337 DOI: 10.1186/s12931-022-02268-3] [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: 05/26/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persistent airflow limitation and dyspnoea may reduce chronic obstructive pulmonary disease (COPD) patients exercise capacity and physical activity, undermining their physical status and quality of life. Long-acting muscarinic antagonists and long-acting beta-2 agonists (LAMA/LABA) combinations are amongst moderate-to-severe COPD recommended treatments. This article analyses LAMA/LABA combinations effect on COPD patients exercise capacity and physical activity outcomes. METHODS A systematic review and meta-analysis of double-blind randomized controlled trials comparing LAMA/LABA combinations against monotherapy or placebo was conducted. RESULTS Seventeen articles were identified (N = 4041 patients). In endurance shuttle walk test and constant work rate cycle ergometry, LAMA/LABA combinations obtained better results than placebo, but not monotherapy, whereas in 6-min walking test, results favoured LAMA/LABA over monotherapy (four studies), but not over placebo (one study). Moreover, LAMA/LABA combinations obtained better results than placebo in number of steps per day, reduction in percentage of inactive patients and daily activity-related energy expenditure, and better than monotherapy when measuring time spent on ≥ 1.0-1.5, ≥ 2.0 and ≥ 3.0 metabolic equivalents of task activities. CONCLUSIONS LAMA/LABA combinations in COPD patients provided better results than monotherapy or placebo in most exercise capacity and physical activity outcomes.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’HebronVall d’Hebron Institut de Recerca, Vall d’Hebron Barcelona Hospital Campus, Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Juan Luís García-Rivero
- grid.411325.00000 0001 0627 4262Pneumology Department, President of ACINAR, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Xavier Ribera
- grid.488221.50000 0004 0544 6204Boehringer Ingelheim España S.A., Barcelona, Spain
| | | | | | | | - Xavier Pomares
- grid.7080.f0000 0001 2296 0625Pneumology Department, Hospital de Sabadell, Hospital Universitari Parc TaulíInstitut Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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Matera MG, Page CP, Calzetta L, Rogliani P, Cazzola M. Pharmacology and Therapeutics of Bronchodilators Revisited. Pharmacol Rev 2020; 72:218-252. [PMID: 31848208 DOI: 10.1124/pr.119.018150] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bronchodilators remain the cornerstone of the treatment of airway disorders such as asthma and chronic obstructive pulmonary disease (COPD). There is therefore considerable interest in understanding how to optimize the use of our existing classes of bronchodilator and in identifying novel classes of bronchodilator drugs. However, new classes of bronchodilator have proved challenging to develop because many of these have no better efficacy than existing classes of bronchodilator and often have unacceptable safety profiles. Recent research has shown that optimization of bronchodilation occurs when both arms of the autonomic nervous system are affected through antagonism of muscarinic receptors to reduce the influence of parasympathetic innervation of the lung and through stimulation of β 2-adrenoceptors (β 2-ARs) on airway smooth muscle with β 2-AR-selective agonists to mimic the sympathetic influence on the lung. This is currently achieved by use of fixed-dose combinations of inhaled long-acting β 2-adrenoceptor agonists (LABAs) and long-acting muscarinic acetylcholine receptor antagonists (LAMAs). Due to the distinct mechanisms of action of LAMAs and LABAs, the additive/synergistic effects of using these drug classes together has been extensively investigated. More recently, so-called "triple inhalers" containing fixed-dose combinations of both classes of bronchodilator (dual bronchodilation) and an inhaled corticosteroid in the same inhaler have been developed. Furthermore, a number of so-called "bifunctional drugs" having two different primary pharmacological actions in the same molecule are under development. This review discusses recent advancements in knowledge on bronchodilators and bifunctional drugs for the treatment of asthma and COPD. SIGNIFICANCE STATEMENT: Since our last review in 2012, there has been considerable research to identify novel classes of bronchodilator drugs, to further understand how to optimize the use of the existing classes of bronchodilator, and to better understand the role of bifunctional drugs in the treatment of asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- M G Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - C P Page
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - L Calzetta
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - P Rogliani
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - M Cazzola
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
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Barrecheguren M, Miravitlles M. COUNTERPOINT: Should LAMA/LABA Combination Therapy Be Used as Initial Maintenance Treatment for COPD? No. Chest 2019; 154:749-751. [PMID: 30290926 DOI: 10.1016/j.chest.2018.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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COPD overdiagnosis in primary care: a UK observational study of consistency of airflow obstruction. NPJ Prim Care Respir Med 2019; 29:33. [PMID: 31417094 PMCID: PMC6695394 DOI: 10.1038/s41533-019-0145-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/10/2019] [Indexed: 02/08/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is heterogeneous, but persistent airflow obstruction (AFO) is fundamental to diagnosis. We studied AFO consistency from initial diagnosis and explored factors associated with absent or inconsistent AFO. This was a retrospective observational study using patient-anonymised routine individual data in Care and Health Information Analytics (CHIA) database. Identifying a prevalent COPD cohort based on diagnostic codes in primary care records, we used serial ratios of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC%) from time of initial COPD diagnosis to assign patients to one of three AFO categories, according to whether all (persistent), some (variable) or none (absent) were <70%. We described respiratory prescriptions over 3 years (2011-2013) and used multivariable logistic regression to estimate odds of absent or variable AFO and potential predictors. We identified 14,378 patients with diagnosed COPD (mean ± SD age 68.8 ± 10.7 years), median (IQR) COPD duration of 60 (25,103) months. FEV1/FVC% was recorded in 12,491 (86.9%) patients: median (IQR) 5 (3, 7) measurements. Six thousand five hundred and fifty (52.4%) had persistent AFO, 4507 (36.1%) variable AFO and 1434 (11.5%) absent AFO. Being female, never smoking, having higher BMI or more comorbidities significantly predicted absent and variable AFO. Despite absent AFO, 57% received long-acting bronchodilators and 60% inhaled corticosteroids (50% and 49%, respectively, in those without asthma). In all, 13.1% of patients diagnosed with COPD had unrecorded FEV1/FVC%; 11.5% had absent AFO on repeated measurements, yet many received inhalers likely to be ineffective. Such prescribing is not evidence based and the true cause of symptoms may have been missed.
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Triple inhaled therapy in COPD patients: determinants of prescription in primary care. Respir Med 2019; 154:12-17. [DOI: 10.1016/j.rmed.2019.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
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Li Z, Huang J, Hu Z. Screening and Diagnosis of Chronic Pharyngitis Based on Deep Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101688. [PMID: 31091759 PMCID: PMC6572379 DOI: 10.3390/ijerph16101688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 12/13/2022]
Abstract
Chronic pharyngitis is a common disease, which has a long duration and a wide range of onset. It is easy to misdiagnose by mistaking it with other diseases, such as chronic tonsillitis, by using common diagnostic methods. In order to reduce costs and avoid misdiagnosis, the search for an affordable and rapid diagnostic method is becoming more and more important for chronic pharyngitis research. Speech disorder is one of the typical symptoms of patients with chronic pharyngitis. This paper introduces a convolutional neural network model for diagnosis based on the typical symptom of speech disorder. First of all, the voice data is converted into a speech spectrogram, which can better output the speech characteristic information and lay a foundation for computer diagnosis and discrimination. Second, we construct a deep convolutional neural network for the diagnosis of chronic pharyngitis through the design of the structure, the design of the network layer, and the description of the function. Finally, we perform a parameter optimization experiment on the convolutional neural network and judge the recognition efficiency of chronic pharyngitis. The results show that the convolutional neural network has a high recognition rate for patients with chronic pharyngitis and has a good diagnostic effect.
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Affiliation(s)
- Zhichao Li
- School of Political Science and Public Administration, East China University of Political Science and Law, Shanghai 201620, China.
| | - Jilin Huang
- College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China.
| | - Zhiping Hu
- School of Political Science and Public Administration, East China University of Political Science and Law, Shanghai 201620, China.
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Phillips I, Ezhil V, Hussein M, South C, Nisbet A, Alobaidli S, Prakash V, Ajaz M, Wang H, Evans P. Textural analysis and lung function study: Predicting lung fitness for radiotherapy from a CT scan. BJR Open 2019; 1:20180001. [PMID: 33178905 PMCID: PMC7592404 DOI: 10.1259/bjro.20180001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study tested the hypothesis that shows advanced image analysis can differentiate fit and unfit patients for radical radiotherapy from standard radiotherapy planning imaging, when compared to formal lung function tests, FEV1 (forced expiratory volume in 1 s) and TLCO (transfer factor of carbon monoxide). METHODS An apical region of interest (ROI) of lung parenchyma was extracted from a standard radiotherapy planning CT scan. Software using a grey level co-occurrence matrix (GLCM) assigned an entropy score to each voxel, based on its similarity to the voxels around it. RESULTS Density and entropy scores were compared between a cohort of 29 fit patients (defined as FEV1 and TLCO above 50 % predicted value) and 32 unfit patients (FEV1 or TLCO below 50% predicted). Mean and median density and median entropy were significantly different between fit and unfit patients (p = 0.005, 0.0008 and 0.0418 respectively; two-sided Mann-Whitney test). CONCLUSION Density and entropy assessment can differentiate between fit and unfit patients for radical radiotherapy, using standard CT imaging. ADVANCES IN KNOWLEDGE This study shows that a novel assessment can generate further data from standard CT imaging. These data could be combined with existing studies to form a multiorgan patient fitness assessment from a single CT scan.
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Affiliation(s)
| | - Veni Ezhil
- Royal Surrey County Hospital, Guildford, UK
| | | | | | | | | | | | - Mazhar Ajaz
- University of Surrey & Royal Surrey County Hospital, Guildford, UK
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He S, Chen D, Hu M, Zhang L, Liu C, Traini D, Grau GE, Zeng Z, Lu J, Zhou G, Xie L, Sun S. Bronchial epithelial cell extracellular vesicles ameliorate epithelial-mesenchymal transition in COPD pathogenesis by alleviating M2 macrophage polarization. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 18:259-271. [PMID: 30981817 DOI: 10.1016/j.nano.2019.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/08/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is partly characterized as epithelial-mesenchymal transition (EMT)-related airflow limitation. Extracellular vesicles (EVs) play crucial roles in the crosstalk between cells, affecting many diseases including COPD. Up to now, the roles of EVs in COPD are still debated. As we found in this investigation, COPD patients have higher miR-21 level in total serum EVs. EMT occurs in lungs of COPD mice. Furthermore, bronchial epithelial cells (BEAS-2B) could generate EVs with less miR-21 when treated with cigarette smoke extract (CSE), impacting less on the M2-directed macrophage polarization than the control-EVs (PBS-treated) according to EVs miR-21 level. Furthermore, the EMT processes in BEAS-2B cells were enhanced with the M2 macrophages proportion when co-cultured. Collectively, these results demonstrate that CSE-treated BEAS-2B cells could alleviate M2 macrophages polarization by modulated EVs, and eventually relieve the EMT process of BEAS-2B cells themselves under COPD pathogenesis, revealing a novel compensatory role of them in COPD.
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Affiliation(s)
- Shengyang He
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Duanni Chen
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Mengyun Hu
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Li Zhang
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Caihong Liu
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Georges E Grau
- Vascular Immunology Unit, Department of Pathology, The University of Sydney, Sydney, Australia
| | - Zhengpeng Zeng
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Junjuan Lu
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Guanzhi Zhou
- Department of Head and Neck Radiation Oncology, Hunan Cancer Hospital, Changsha, China
| | - Lihua Xie
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Shenghua Sun
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
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13
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Wang C, Chen X, Zhao R, He Z, Zhao Z, Zhan Q, Yang T, Fang Z. Predicting forced vital capacity (FVC) using support vector regression (SVR). Physiol Meas 2019; 40:025010. [PMID: 30699391 DOI: 10.1088/1361-6579/ab031c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Spirometry, as the gold standard approach in the diagnosis of chronic obstructive pulmonary disease (COPD), has strict end of test (EOT) criteria (e.g. complete exhalation), which cannot be met by patients with compromised health states. Thus, significant parameters measured by spirometry, such as forced vital capacity (FVC), have limited accuracies. To address this issue, the present study aimed to develop models based on support vector regression (SVR) to predict values of FVC under the condition that the EOT criteria were not fully met. APPROACH The prediction models for the quantification of FVC were developed based on SVR. A total of 354 subjects underwent conventional spirometry (CS), and the resulting data of forced expiratory volumes in 1 s (FEV1), peak expiratory flow (PEF), age and gender were used as input features, while the resulting values of the FVC were used as the target feature in the prediction models. Next, three prediction models (mixed model, normal model and abnormal model) were established according to the criterion in the diagnosis of COPD that a postbronchodilator shows an FEV1/FVC ratio lower than 0.70. Then, 35 subjects were recruited to be tested using both CS and a low-degree-of-EOT criteria spirometry (LDCS), which did not fully meet the EOT criteria of CS. In LDCS, subjects were allowed to terminate the procedure at their own will at any time after the technicians had assumed that both acceptable values of FEV1 and PEF had been obtained. Quantified values of FVC derived from both CS and LDCS were compared to validate the performances of the developed prediction models. MAIN RESULTS The FVC prediction performances of the normal model and abnormal model were better than that of the mixed model. The root mean squared error are lower than 0.35 l and the accuracies are higher up to 95%. One-tailed t test results demonstrate that the absolute differences in the measured and predicted values are not significantly different from 0.15 l for both the abnormal model and the normal model. SIGNIFICANCE Our study shows the possibility of predicting FVC with acceptable precision in cases where the EOT criteria of spirometry were not fully met, which can be beneficial for patients who cannot or did not achieve full exhalation in spirometry.
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Affiliation(s)
- Chenshuo Wang
- Institute of Electronics, Chinese Academy of Sciences, Beijing, People's Republic of China. University of Chinese Academy of Sciences, Beijing, People's Republic of China
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Nuñez A, Sarasate M, Loeb E, Esquinas C, Miravitlles M, Barrecheguren M. Practical Guide to the Identification and Diagnosis of Asthma-COPD Overlap (ACO). COPD 2019; 16:1-7. [PMID: 30789039 DOI: 10.1080/15412555.2019.1575802] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality around the world. COPD is characterised by a heterogeneous clinical presentation and prognosis which may vary according to the clinical phenotype. One of the phenotypes of COPD most frequently studied is the asthma-COPD overlap (ACO), however, there are no universally accepted diagnostic criteria for ACO. It is recognised that the term ACO includes patients with clinical features of both asthma and COPD, such as more intense eosinophilic bronchial inflammation, more severe respiratory symptoms and more frequent exacerbations, but in contrast, it is associated with a better prognosis compared to COPD. More importantly, ACO patients show better response to inhaled corticosteroid treatment than other COPD phenotypes. The diagnosis of ACO can be difficult in clinical practice, and the identification of these patients can be a challenge for non-specialized physicians. We describe how to recognise and diagnose ACO based on a recently proposed Spanish algorithm and by the analysis of three clinical cases of patients with COPD. The diagnosis of ACO is based on the diagnosis of COPD (chronic airflow obstruction in an adult with significant smoking exposure), in addition to a current diagnosis of asthma and/or signficant eosinophilia.
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Affiliation(s)
- Alexa Nuñez
- a Pneumology Department , University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Mikel Sarasate
- a Pneumology Department , University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Eduardo Loeb
- a Pneumology Department , University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Cristina Esquinas
- a Pneumology Department , University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
| | - Marc Miravitlles
- a Pneumology Department , University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain.,b CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | - Miriam Barrecheguren
- a Pneumology Department , University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR) , Barcelona , Spain
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Tailoring Treatment in Obstructive Lung Disease: Asthma, COPD, Asthma/COPD Overlap and Eosinophilic COPD. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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