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Jathal I, Wang Y, Binongo JNG, Cobb C, Hunt WR, Khan FN, Tangpricha V. Testosterone concentrations and associated predictors in men with cystic fibrosis: a retrospective, single-center study. Am J Med Sci 2024:S0002-9629(24)01346-6. [PMID: 38997066 DOI: 10.1016/j.amjms.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Men with cystic fibrosis (CF) have sexual health concerns such as delayed puberty, infertility, and hypogonadism. The causes and prevalence of hypogonadism have not been well studied. The purpose of this study was to determine the prevalence of a low testosterone concentration in men with CF. METHODS This retrospective study was approved by the Emory University Institutional Review Board (IRB). Data were extracted from the electronic medical records of adult men with CF receiving care at the Emory Cystic Fibrosis Center. A total of 129 men with CF were followed at our center from 2016 to 2023. Of these individuals, 76 men with CF (58.9%) had at least one serum total testosterone measurement. Seven individuals were excluded from this study since they were currently receiving testosterone therapy, leaving a final sample size of 69 individuals for the analysis. Demographic data, serum testosterone concentrations, and other factors associated with low testosterone concentrations were collected. Low testosterone was defined as a value below 300 ng/dL. Regression analyses were used to determine factors associated with low testosterone levels. RESULTS The mean (± SD) age of the 69 eligible participants was 33.34 ± 10.98 years. The mean testosterone concentration was 421 ± 158.5 ng/dL with 27.54 percent of men with a testosterone value below 300 ng/dL. The mean hemoglobin level was 14.23 ± 2.18 g/dL. Testosterone levels were positively related to hemoglobin levels. Time of day of measurement and age were not associated with testosterone levels. CONCLUSION Roughly a quarter of men with CF demonstrated low testosterone in our sample. Low hemoglobin was associated with low testosterone levels in men with CF. Neither time of day nor age influenced testosterone concentrations in this sample.
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Affiliation(s)
| | - Yanhua Wang
- Renal Division, Department of Medicine, Emory University
| | - José Nilo G Binongo
- Department of Biostatics and Bioinformatics, Rollins School of Public Health
| | - Crystal Cobb
- Division of Endocrinology, Department of Medicine, Emory School of Medicine
| | - William R Hunt
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University
| | - Farah N Khan
- Division of Metabolism, Endocrinology and Nutrition, University of Washington
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University; Atlanta VA Medical Center, Decatur, GA.
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Abelenda VLB, da Costa CH, Firmida MDC, Lopes AJ. Evaluating the contribution of the Glittre-ADL test in adults with cystic fibrosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2087. [PMID: 38551092 DOI: 10.1002/pri.2087] [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: 07/03/2023] [Revised: 01/15/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Cardiopulmonary and skeletal muscle impairment and poor physical activity are potential contributors to reduced functional capacity in cystic fibrosis (CF). The Glittre-ADL test (TGlittre) has great potential for clinical use in adult CF adults, as it meets the need for a comprehensive assessment of physical function using tasks similar to activities of daily living. This study aimed to evaluate the performance of TGlittre in CF adults compared to the 6-min walk test (6MWT) and, secondarily, to quantify the associations of their results with pulmonary function, muscle strength, and health-related quality of life (HRQoL). METHODS This cross-sectional study evaluated 34 CF adults and compared them with 34 subjects from a control group. The participants underwent the following assessments: functional capacity using TGlittre and 6MWT; spirometry; respiratory muscle strength; handgrip strength (HGS); and HRQoL using the Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS While CF patients showed a longer time to perform TGlittre compared to controls (134 (119-150) versus 107 (95-126) % of the predicted time p = 0.0002), no difference between these groups was observed in the 6MWT. When the second TGlittre was compared to the first TGlittre, there was a significant decrease in total time for both CF patients (p < 0.0001) and controls (p = 0.0001). TGlittre time correlated with 6MWT distance (6MWD) (rs = -0.641, p < 0.0001), HGS (rs = -0.364, p = 0.034), peripheral oxygen saturation at the end of the test (rs = -0.463, p = 0.006) and the "digestive symptoms" domain of CFQ-R (rs = 0.376, p = 0.028). TGlittre time was shorter in patients who engaged in regular physical activity (3.10 (2.49-3.39) min versus 3.28 (2.95-3.53) min, p = 0.016). CONCLUSIONS TGlittre is more effective than the 6MWT in detecting limitations during exercise. There is an important learning effect of TGlittre in adult CF patients. TGlittre time was correlated with 6MWD, HGS, oxygen saturation level, and the patient's level of physical activity.
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Affiliation(s)
- Vera Lucia Barros Abelenda
- Post-Graduation Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Cláudia Henrique da Costa
- Post-Graduation Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Department of Pulmonology, Piquet Carneiro Polyclinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Mônica de Cássia Firmida
- Department of Pulmonology, Piquet Carneiro Polyclinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Post-Graduation Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Department of Pulmonology, Piquet Carneiro Polyclinic, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
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Schenesse D, Mouillot P, Rabec C, Barnestein R, Tankere P, Giboulot M, Bonniaud P, Georges M. [Diaphragmatic ultrasonography for the pulmonologist: Technique and clinical use]. Rev Mal Respir 2024; 41:1-17. [PMID: 37980184 DOI: 10.1016/j.rmr.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/29/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Ultrasonography is an emerging tool that helps to assess diaphragmatic function. It is now widely used in ICUs to predict weaning from mechanical ventilation. Ultrasonography is readily available, harmless (no radiation), and repeatable with good interoperator reproducibility. Over the past few years, ultrasonography has seen increasing use in patients with chronic pulmonary pathologies. STATE OF THE ART The aim of this review is (1) to describe the ultrasound techniques used to assess diaphragmatic excursion and thickening, (2) to indicate the expected, normal values in healthy patients, and (3) to summarize the main findings and clinical applications in treatment of chronic respiratory disorders. CONCLUSIONS Chronic pulmonary diseases are associated with diaphragmatic dysfunction that can be assessed with ultrasound. Diaphragmatic dysfunction is primary in neuromuscular disorders and secondary to respiratory disease in other chronic pulmonary conditions (COPD, ILD). Ultrasound is correlated with the severity of the underlying disease (functional and clinical parameters). PERSPECTIVES The prognostic interest of diaphragm ultrasonography remains to be established, after which its utilization should become routine.
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Affiliation(s)
- D Schenesse
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Mouillot
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C Rabec
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - R Barnestein
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Tankere
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - M Giboulot
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm, LNC UMR 1231, LipSTIC LabEx Team, Dijon, France
| | - M Georges
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; UMR 6265 CNRS 1234 INRA, centre des sciences du goût et de l'alimentation, université Bourgogne-Franche-Comté, Dijon, France.
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Ostadan F, Donovan AA, Matouk E, David FG, Marchand D, Reinhold C, Nguyen D, Goldberg P, Benedetti A, Smith BM, Petrof BJ. Computed tomography reveals hypertrophic remodelling of the diaphragm in cystic fibrosis but not in COPD. ERJ Open Res 2023; 9:00282-2023. [PMID: 37753287 PMCID: PMC10518894 DOI: 10.1183/23120541.00282-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 09/28/2023] Open
Abstract
Background Computed tomography (CT) is increasingly used for assessing skeletal muscle characteristics. In cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD), reduced limb muscle mass predicts poor clinical outcomes. However, the degree to which quantity or quality of respiratory and nonrespiratory muscles is affected by these diseases remains controversial. Methods Thoracic CT images of 29 CF, 21 COPD and 20 normal spirometry control subjects were analysed to measure indices of muscle quantity (volume or cross-sectional area) and quality (radiodensity) in respiratory (diaphragm, abdominal) and nonrespiratory (pectoralis, lumbar paraspinal) muscles. Multivariable linear regression assessed relationships of CT measurements with body mass index (BMI), forced expiratory volume in 1 s (FEV1) % pred, inflammation and infection biomarkers, nutritional status and CF genotype. Results Diaphragm volume in CF was significantly higher than in COPD (by 154%) or controls (by 140%). Abdominal muscle area in CF was also greater than in COPD (by 130%). Nonrespiratory muscles in COPD had more low radiodensity muscle (marker of lipid content) compared to CF and controls. In CF but not COPD, higher BMI and FEV1 % pred were independently associated with higher diaphragm and/or abdominal muscle quantity indices. Serum creatinine also predicted respiratory and nonrespiratory muscle quantity in CF, whereas other biomarkers including genotype correlated poorly with muscle CT parameters. Conclusions Our data suggest that the CF diaphragm undergoes hypertrophic remodelling, whereas in COPD the nonrespiratory muscles show altered muscle quality consistent with greater lipid content. Thoracic CT can thus identify distinctive respiratory and nonrespiratory muscle remodelling signatures associated with different chronic lung diseases.
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Affiliation(s)
- Fatemeh Ostadan
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Adamo A. Donovan
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Elias Matouk
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Francois Gabriel David
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Critical Care, McGill University, Montreal, QC, Canada
| | - Dylan Marchand
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Dao Nguyen
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Peter Goldberg
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Critical Care, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Benjamin M. Smith
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Basil J. Petrof
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
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Tran JK, Ooi CY, Blazek K, Katz T. Body composition and body mass index measures from 8 to 18 years old in children with cystic fibrosis. J Cyst Fibros 2023; 22:851-856. [PMID: 37365079 DOI: 10.1016/j.jcf.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/21/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Historically, body mass index (BMI) >50th percentile has represented optimal nutritional status in children with cystic fibrosis (CF) due to its positive association with lung function. Body composition parameters including fat-free mass index (FFMI) have been suggested as a more physiological nutrition benchmark. AIMS (1) describe changes in body composition with age and gender; (2) assess the correlation between measures of nutritional status (FFMI-z, FMI-z, BMI-z) and lung function (forced expiratory volume in one second predicted; FEV1pp). METHODS This retrospective, mixed cross-sectional and serial measures study consisted of children with CF (8 to 18 years) attending Sydney Children's Hospital (2007-2020). FFMI and fat mass index (FMI) were taken from biennial dual energy x-ray absorptiometry (DXA) scans. Z-scores were derived using Well's reference population [1]. Repeated measures correlation analyses assessed correlations between FFMI-z, FMI-z, and BMI-z with FEV1pp. RESULTS 339 DXA reports were analysed from 137 patients. There were slight downwards trends in BMI-z and FMI-z, and an upwards trend in FFMI-z with increasing age and across both genders. Females had higher FMI-z and FFMI-z than males from 12.5 years. There was a weak, positive correlation between FEV1pp and BMI-z (r = 0.14, p = 0.04), and FFMI-z (r = 0.25, p<0.001). FMI-z had no correlation with FEV1pp (r=-0.06, p = 0.41). CONCLUSION Deficits in FFMI exist despite increasing trends with age. FFMI-z and BMI-z had a weak, positive correlation with FEV1pp. In contemporary cohorts, nutritional status (reflected by surrogate markers such as FFMI and BMI) may be less influential upon lung function than in previous decades. [1]: Wells, J.C., et al. Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am. J. Clin. Nutr.96, 1316-1326 (2012).
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Affiliation(s)
- Jade K Tran
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Gastroenterology, Sydney Children's Hospital Randwick, New South Wales, Australia
| | - Katrina Blazek
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Tamarah Katz
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Nutrition and Dietetics, Sydney Children's Hospital Randwick, New South Wales, Australia
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Holmes CJ, Racette SB, Symonds L, Arbeláez AM, Cao C, Granados A. Comparison of Bioelectrical Impedance Analysis with DXA in Adolescents with Cystic Fibrosis before and after a Resistance Training Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074037. [PMID: 35409718 PMCID: PMC8997924 DOI: 10.3390/ijerph19074037] [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] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this pilot study was to compare body composition metrics obtained by two portable bioelectrical impedance analysis (BIA) devices with dual-energy X-ray absorptiometry (DXA) among adolescents with cystic fibrosis (CF) before and after a resistance exercise training program. Methods: Participants with CF were assessed using DXA, single-frequency BIA (SFBIA), and multiple-frequency BIA (MFBIA) to quantify percent body fat (%Fat), fat mass (FM), and fat-free mass (FFM) at baseline and after a home-based resistance training intervention comprised of 36, 1 h sessions completed in 12–14 weeks. Repeated measures analysis of variance, paired samples t-tests, Cohen’s d effect sizes, and Pearson’s correlations were used to compare differences between and within methods at baseline and post-intervention. Results: Ten participants (15.8 ± 2.2 yr, 60.1 ± 15.1 kg) completed the assessments. At baseline, both SFBIA and MFBIA scales significantly underestimated %Fat and FM and overestimated FFM, with small to moderate effect sizes. Post-intervention, small, non-significant differences were found between DXA and both BIA scales for all body composition metrics. Significant changes in %Fat and FFM were observed with DXA. MFBIA displayed less constant error than SFBIA when compared to DXA for pre- and post-intervention assessments for %Fat (MFBIA: pre and post −2.8 and −0.8 vs. SFBIA: −4.6 and −2.0), FM (−0.4 and −0.4 vs. −3.0 and −1.1), and FFM (+0.8 and +0.6 vs. +3.1 and +1.3). Near-perfect correlations were observed at both time points between DXA and each BIA scale. Conclusions: Portable BIA results should be interpreted with caution, and further validation studies in CF patients are needed prior to clinical use.
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Affiliation(s)
- Clifton J. Holmes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.B.R.); (C.C.)
- Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA
- Correspondence: ; Tel.: +1-314-392-2016
| | - Susan B. Racette
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.B.R.); (C.C.)
- Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Leslie Symonds
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63108, USA; (L.S.); (A.M.A.)
| | - Ana Maria Arbeláez
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63108, USA; (L.S.); (A.M.A.)
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA; (S.B.R.); (C.C.)
| | - Andrea Granados
- Nicklaus Children’s Hospital, Division of Pediatric Endocrinology and Metabolism, Miami, FL 33155, USA;
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Holmes CJ, Racette SB, Symonds L, Arbeláez AM, Cao C, Granados A. Feasibility and Efficacy of Telehealth-Based Resistance Exercise Training in Adolescents with Cystic Fibrosis and Glucose Intolerance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3297. [PMID: 35328985 PMCID: PMC8950531 DOI: 10.3390/ijerph19063297] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023]
Abstract
The aims of this study were to (1) determine the feasibility of a home-based resistance exercise training (RET) program in patients with cystic fibrosis and impaired glucose tolerance using virtual personal training and (2) observe the effects completion of the RET program had on glucose metabolism, pulmonary function, body composition, and physical fitness. The feasibility of the program was defined as 80% compliance. Ten participants (15.80 ± 2.20 yr, 25.1 ± 7.4 kg/m2) began a home-based resistance training program consisting of 36 sessions supervised via online videoconferencing. Compliance scores of 78.9% (all participants) and 81.8% (without one outlier) were observed. A significant increase was observed in 2-h C-peptide levels (2.1 ng/mL; p = 0.04), with a moderate decrease in fasting glucose (-5.2 mg/dL; p = 0.11) and a moderate increase in 2-h insulin (35.0 U/mL; p = 0.10). A small decrease in the fat percentage (-1.3%; p = 0.03) was observed in addition to increases in fat-free mass (1.5 kg; p = 0.01) and the fat-free mass index (0.4; p = 0.01). Small, yet statistically significant increases were observed in V̇O2peak (0.1 L/min p = 0.01), V̇CO2peak (0.1 L/min; p = 0.01), and ventilation (5.3 L/min; p = 0.04). Telehealth-based RET is feasible in adolescents with CF and impaired glucose tolerance and elicits small yet favorable changes in insulin secretion, body composition, and exercise capacity.
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Affiliation(s)
- Clifton J. Holmes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.B.R.); (C.C.)
- Department of Medicine, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Susan B. Racette
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.B.R.); (C.C.)
- Department of Medicine, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Leslie Symonds
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA; (L.S.); (A.M.A.)
| | - Ana Maria Arbeláez
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA; (L.S.); (A.M.A.)
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.B.R.); (C.C.)
| | - Andrea Granados
- Department of Pediatrics, Division of Endocrinology and Metabolism, Nicklaus Children’s Hospital, Miami, FL 33155, USA;
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Bagci R, Vardar-Yagli N, Saglam M, Calik Kutukcu E, Inal-Ince D, Sener F, Damadoglu E. Body functions and structure, activity, and participation limitations of adult cystic fibrosis patients under the international classification of functioning, disability, and health framework. Physiother Theory Pract 2022:1-11. [PMID: 35192420 DOI: 10.1080/09593985.2022.2041780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: There is no study in the literature evaluating impairments and functional limitations in adults with cystic fibrosis (CF) under the framework of the International Classification of Functioning, Disability, and Health (ICF). To evaluate the adults with CF using ICF model. Methods: Twenty-three adults with CF and 23 age-sex matched healthy individuals included in this cross-sectional study. The participants evaluated according to the selected items for domain b, domain s, and domain d from the Obstructive Pulmonary Diseases (OPD) Comprehensive Core Set. The body composition, pulmonary functions, respiratory and peripheral muscle strength/endurance tests and anxiety/depression level were evaluated for domain b and s. For domain d, the Incremental Shuttle Walk Test (ISWT) and Short Form-36 (SF-36) Health Survey were used. Results: The fat-free mass (p = .044), pulmonary functions (p < .05), respiratory muscle endurance (p = .010), absolute and %quadriceps muscle strength (p = .001, p = .025, respectively), number of sit-ups (p = .020), walking speed (p = .035), ISWT and ISWT% distance (p < .001) and peak oxygen consumption (p < .001) were significantly lower in adults with CF compared to healthy individuals (p < .05). There were only significant differences in SF-36 physical functioning and role physical subdimension scores between groups (p = .009, p = .045 respectively). Conclusions: The ICF framework is applicable to comprehensively evaluate limitations of adults with CF among rehabilitation professionals. Especially age, respiratory function, respiratory muscle strength and endurance, dyspnea perception, peripheral muscle endurance were related to activity and participation limitation.
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Affiliation(s)
- Rabia Bagci
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Ebru Calik Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Fatma Sener
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Samanpazari, Turkey
| | - Ebru Damadoglu
- Faculty of Medicine, Department of Chest Diseases, Hacettepe University, Sıhhiye, Turkey
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9
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Gabrysz-Forget F, Maynard-Paquette AC, Kharat A, Tremblay F, Silviet-Carricart M, Lavoie A, Girard M, Dubé BP. Ultrasound-Derived Diaphragm Contractile Reserve as a Marker of Clinical Status in Patients With Cystic Fibrosis. Front Physiol 2022; 12:808770. [PMID: 35082696 PMCID: PMC8784523 DOI: 10.3389/fphys.2021.808770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In patients with cystic fibrosis (CF), the monitoring of respiratory muscle activity using electromyography can provide information on the demand-to-capacity ratio of the respiratory system and act as a clinical marker of disease activity, but this technique is not adapted to routine clinical care. Ultrasonography of the diaphragm could provide an alternative, simpler and more widely available alternative allowing the real-time assessment of the diaphragm contractile reserve (DCR), but its relationship with recognized markers of disease severity and clinical outcomes are currently unknown. Methods: Stable patients with CF were prospectively recruited. Diaphragm ultrasound was performed and compared to forced expiratory volume in 1 s (FEV1), residual volume (RV), handgrip strength, fat-free mass index (FFMI), serum vitamin levels, dyspnea levels and rate of acute exacerbation (AE). Diaphragm activity was reported as DCR (the ratio of tidal-to-maximal thickening fractions, representing the remaining diaphragm contractility available after tidal inspiration) and TFmax (representing maximal diaphragm contractile strength). Inter-observer reliability of the measurement of DCR was evaluated using intra-class correlation analysis. Results: 110 patients were included [61 males, median (interquartile range), age 31 (27–38) years, FEV1 66 (46–82)% predicted]. DCR was significantly correlated to FEV1 (rho = 0.46, p < 0.001), RV (rho = −0.46, p < 0.001), FFMI (rho = 0.41, p < 0.001), and handgrip strength (rho = 0.22, p = 0.02), but TFmax was not. In a multiple linear regression analysis, both RV and FFMI were independent predictors of DCR. DCR, but not TFmax, was statistically lower in patients with > 2 exacerbations/year (56 ± 25 vs. 71 ± 17%, p = 0.001) and significantly lower with higher dyspnea levels. A ROC analysis showed that DCR performed better than FEV1 (mean difference in AUROC 0.09, p = 0.04), RV (mean difference in AUROC 0.11, p = 0.03), and TFmax at identifying patients with an mMRC score > 2. Inter-observer reliability of DCR was high (ICC = 0.89, 95% CI 0.84–0.92, p < 0.001). Conclusion: In patients with CF, DCR is a reliable and non-invasive marker of disease severity that is related to respiratory and extra-pulmonary manifestations of the disease and to clinical outcomes. Future studies investigating the use of DCR as a longitudinal marker of disease progression, response to interventions or target for therapy would further validate its translation into clinical practice.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | | | - Aileen Kharat
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - François Tremblay
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Maité Silviet-Carricart
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Annick Lavoie
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Martin Girard
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Département d'Anesthésiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Bruno-Pierre Dubé
- Département de Médecine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Carrefour de l'Innovation et de l'Évaluation en Santé, Montréal, QC, Canada
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10
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FitzMaurice TS, McCann C, Nazareth D, Shaw M, McNamara PS, Walshaw MJ. Measuring the effect of elexacaftor/tezacaftor/ivacaftor combination therapy on the respiratory pump in people with CF using dynamic chest radiography. J Cyst Fibros 2022; 21:1036-1041. [DOI: 10.1016/j.jcf.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
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11
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Soltman S, Hicks RA, Naz Khan F, Kelly A. Body composition in individuals with cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100272. [PMID: 34804808 PMCID: PMC8586800 DOI: 10.1016/j.jcte.2021.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
BMI is used to characterize nutritional status but may not accurately depict body composition in CF. DXA and bioelectrical impedance are the most commonly used methods for assessing BC. Lower fat-free mass associates with worse pulmonary function and greater CF disease severity. Fat-free mass associates with greater bone mineral density in individuals with CF.
Because nutritional status is intimately linked with pulmonary function and survival, nutrition has been at the mainstay of cystic fibrosis (CF) care. Body Mass Index (BMI) is traditionally used to define nutritional status because of the ease with which it can be calculated, but it has a number of limitations including its inability to differentiate fat mass (FM) from lean body mass (LBM), the latter thought to confer health advantage. A number of tools are available to quantify body composition including dual-energy x-ray absorptiometry (DXA), bioelectrical impedance, MRI, CT, air displacement plethysmography, and stable isotopes, and these have been used to varying degrees in studies of CF. In CF, LBM tends to be lower for a given BMI, particularly at lower BMI. In adults, lower fat-free mass (FFM) correlates with greater CF disease severity, lower pulmonary function and higher inflammatory markers. FFM is also positively associated with greater bone mineral density, while greater FM is associated with greater loss of lumbar spine bone mineral density over 2 years. In youth, LBM is positively associated with pulmonary function. The predictive value of body composition for functional and clinical outcomes and the role of improving LBM on these outcomes remain undefined. With improvements in BMI accompanying highly-effective modulator therapy, closer evaluations of body composition may inform risk for more traditional, non-CF adult outcomes in CF.
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12
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Granados A, Beach EA, Christiansen AJ, Patterson BW, Wallendorf M, Arbeláez AM. The association between body composition, leptin levels and glucose dysregulation in youth with cystic fibrosis. J Cyst Fibros 2021; 20:796-802. [PMID: 34183284 PMCID: PMC8552309 DOI: 10.1016/j.jcf.2021.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Optimization of nutritional status is recommended in patients with cystic fibrosis (CF) given the association between lower body mass index (BMI) and poor clinical outcomes. However, higher BMI and body fat correlate with glucose impairment and higher leptin levels in the general population. Differences in body composition and leptin levels between the categories of glucose tolerance were assessed in youth with CF and healthy controls. METHODS In a cross-sectional study, 59 adolescents and young adults with CF and 15 healthy controls matched by age and gender, underwent body composition analysis using dual energy X-ray absorptiometry (DXA) and a 2-hour oral glucose tolerance test (OGTT). Measures of insulin sensitivity, β-cell insulin secretion and fasting leptin levels were obtained. RESULTS Of the participants with CF, 62% were classified as abnormal glucose tolerant and 22% with cystic fibrosis related diabetes (CFRD). Patients with CFRD had a lower fat mass index (FMI) z-score, wt z-score and leptin levels compared to the control group (-1.86 vs. - 0.59, p=0.01; -1.86 vs 0.44, p=<0.001 and 7.9 vs vs. 27.7 µg/L, p=0.01). Leptin correlated positively with FMI z-score, BMI, weight z-score and indices of insulin secretion. FMI z-score correlated positively with higher insulin resistance (HOMA-IR), and lower insulin sensitivity (Matsuda index) (r=0.31; p =0.01 and r=-0.29; p=0.02, respectively) in the CF group. CONCLUSIONS This study shows that despite new therapeutic strategies, youth with CF have lower body fat, weight z-score and leptin levels, particularly in subjects with early onset CFRD.
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Affiliation(s)
- Andrea Granados
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA.
| | - Elizabeth A Beach
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA
| | - Andrew J Christiansen
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA
| | - Bruce W Patterson
- University of Nebraska Medical Center, Department of Surgery, Omaha, NE. USA
| | - Michael Wallendorf
- Washington University School of Medicine, Department of Medicine, St. Louis, MO. USA; Washington University School of Medicine, Division of Biostatistics, St. Louis, MO. USA
| | - Ana María Arbeláez
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO. USA
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13
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Shiraishi M, Higashimoto Y, Sugiya R, Mizusawa H, Takeda Y, Fujita S, Nishiyama O, Kudo S, Kimura T, Chiba Y, Fukuda K, Tohda Y. Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients. ERJ Open Res 2020; 6:00589-2020. [PMID: 33447614 PMCID: PMC7792831 DOI: 10.1183/23120541.00589-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD. Methods Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DEmax). Ventilation parameters, including the change in inspiratory capacity (ΔIC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DEmax and the ventilation parameters. Results The DEmax of patients with COPD was significantly lower than that of the controls (45.0±12.8 mm versus 64.6±6.3 mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DEmax in patients with COPD. During CPET, oxygen uptake/weight (V′O2/W) and minute ventilation (V′E) were significantly positively correlated with DEmax, while V′E/V′O2 and V′E/carbon dioxide output (V′CO2) were significantly negatively correlated with DEmax in patients with COPD. DEmax was also significantly positively correlated with ΔIC, reflecting DLH, and with V′O2/W, reflecting exercise capacity. Conclusion Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients. Reduced diaphragmatic excursion, as measured on ultrasound images, might predict decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patientshttps://bit.ly/3jkERxZ
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Affiliation(s)
- Masashi Shiraishi
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan.,Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Yuji Higashimoto
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Ryuji Sugiya
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Hiroki Mizusawa
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yu Takeda
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Shuhei Fujita
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Osamu Nishiyama
- Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Health Sciences, Osaka, Japan
| | - Tamotsu Kimura
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kindai University School of Medicine, Osaka, Japan
| | - Kanji Fukuda
- Dept of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Yuji Tohda
- Dept of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
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14
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Owen E, Williams JE, Davies G, Wallis C, Grant RL, Fewtrell MS. Growth, Body Composition, and Lung Function in Prepubertal Children with Cystic Fibrosis Diagnosed by Newborn Screening. Nutr Clin Pract 2020; 36:1240-1246. [PMID: 33301217 DOI: 10.1002/ncp.10604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Children with cystic fibrosis (CF) are at risk of altered body composition (BC). Newborn screening (NBS) may lead to improved BC outcomes. We investigated BC and its relationship with lung function in prepubertal children diagnosed with CF by NBS. Secondary aims explored predictors of fat-free mass (FFM) and lung function. METHODS Thirty-seven screened (non-meconium ileus) children with CF (20 boys) born 2007-2012 had a dual-energy x-ray absorptiometry scan at 5-8 years to determine whole-body (WB) and appendicular BC. Anthropometry was performed and routine spirometry recorded. Results were converted to z-scores, height-adjusted (fat mass index [FMI] and FFM index [FFMI]) and compared with population mean values. Predictors of forced expiratory volume in 1 second (FEV1 ) were assessed using linear regression. RESULTS Height, body mass index (BMI), and FEV1 were within normal limits, however, weight and BC were significantly low compared with reference data (weight, P = .03; WB FMI, P = .001; WB FFMI, P = .009). Gender differences were detected, with lower appendicular BC in boys and lower weight, BMI, and BC in girls. The association between FEV1 and WB FFMI (r = 0.38; P = .02) was stronger than with BMI (r = 0.29; P = .08). WB FFMI was the only significant predictor of FEV1 in a multivariable model (95% CI, 0.11-0.99; P = .016). CONCLUSION In this NBS CF population, gender differences in growth and BC were apparent despite preserved lung function. These results support BC assessment in prepubertal children, particularly girls, with an opportunity to direct interventions to optimize FFM.
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Affiliation(s)
- Elizabeth Owen
- Dietetics Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jane E Williams
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Gwyneth Davies
- Infection, Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Colin Wallis
- Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Mary S Fewtrell
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
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15
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Santana PV, Cardenas LZ, Albuquerque ALPD, Carvalho CRRD, Caruso P. Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses. J Bras Pneumol 2020; 46:e20200064. [PMID: 33237154 PMCID: PMC7909996 DOI: 10.36416/1806-3756/e20200064] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/30/2020] [Indexed: 12/12/2022] Open
Abstract
The diaphragm is the main muscle of respiration, acting continuously and uninterruptedly to sustain the task of breathing. Diaphragmatic dysfunction can occur secondary to numerous pathological conditions and is usually underdiagnosed in clinical practice because of its nonspecific presentation. Although several techniques have been used in evaluating diaphragmatic function, the diagnosis of diaphragmatic dysfunction is still problematic. Diaphragmatic ultrasound has gained importance because of its many advantages, including the fact that it is noninvasive, does not expose patients to radiation, is widely available, provides immediate results, is highly accurate, and is repeatable at the bedside. Various authors have described ultrasound techniques to assess diaphragmatic excursion and diaphragm thickening in the zone of apposition. Recent studies have proposed standardization of the methods. This article reviews the usefulness of ultrasound for the evaluation of diaphragmatic function, addressing the details of the technique, the main findings, and the clinical applications.
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Affiliation(s)
- Pauliane Vieira Santana
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Unidade de Terapia Intensiva, A.C. Camargo Cancer Center, São Paulo (SP) Brasil
| | - Leticia Zumpano Cardenas
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Unidade de Terapia Intensiva, A.C. Camargo Cancer Center, São Paulo (SP) Brasil
| | - André Luis Pereira de Albuquerque
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Carlos Roberto Ribeiro de Carvalho
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Pedro Caruso
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Unidade de Terapia Intensiva, A.C. Camargo Cancer Center, São Paulo (SP) Brasil
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16
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Combret Y, Medrinal C, Bonnevie T, Gravier FE, Le Roux P, Lamia B, Prieur G, Reychler G. Clinimetric evaluation of muscle function tests for individuals with cystic fibrosis: A systematic review. J Cyst Fibros 2020; 19:981-995. [PMID: 32534958 DOI: 10.1016/j.jcf.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022]
Abstract
Accurate testing of muscle function is essential in individuals with cystic fibrosis (CF). A literature search was conducted in MEDLINE, CENTRAL, CINAHL, PEDro, ScienceDirect and Web of Science according to PRISMA and COSMIN guidelines from inception to September 2019 to investigate the clinimetric properties of muscle tests in individuals with CF. The search identified 37 studies (1310 individuals) and 34 different muscle tests. Maximal inspiratory pressure, inspiratory work capacity and quadriceps strength measured by computerised dynamometry were identified as reliable tests of muscle function. The one-minute sit-to-stand test was found to have high reliability but its validity to measure quadriceps strength is unknown. The clinimetric properties of other routinely used tests have not been reported in people with CF. Very different measurement procedures were identified. Inspiratory muscle and quadriceps testing can be considered as reliable but high-quality studies evaluating tests of other muscles function (e.g. muscle endurance) are lacking.
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Affiliation(s)
- Yann Combret
- Physiotherapy Department, Le Havre Hospital, F-76600, Le Havre, France; Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels1200, Belgium.
| | - Clement Medrinal
- Physiotherapy Department, Le Havre Hospital, F-76600, Le Havre, France; Normandie University, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), F-76000, Rouen, France
| | - Tristan Bonnevie
- Normandie University, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), F-76000, Rouen, France; ADIR Association, Rouen University Hospital, F-76000, Rouen, France
| | - Francis-Edouard Gravier
- Normandie University, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), F-76000, Rouen, France; ADIR Association, Rouen University Hospital, F-76000, Rouen, France
| | - Pascal Le Roux
- Paediatric Department, Le Havre Hospital, F-76600, Le Havre, France
| | - Bouchra Lamia
- Normandie University, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), F-76000, Rouen, France; Pulmonology Department, Le Havre Hospital, F-76600, Le Havre, France; Intensive Care Unit, Respiratory Department, Rouen University Hospital, Rouen, France
| | - Guillaume Prieur
- Physiotherapy Department, Le Havre Hospital, F-76600, Le Havre, France; Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels1200, Belgium; Normandie University, UNIROUEN, UPRES EA3830 - GRHV, Institute for Research and Innovation in Biomedicine (IRIB), F-76000, Rouen, France
| | - Gregory Reychler
- Research and Clinical Experimentation Institute (IREC), Pulmonology, ORL and Dermatology, Louvain Catholic University, Brussels1200, Belgium; Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinics, Brussels1200, Belgium
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17
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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18
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Shelley J, Boddy LM, Knowles ZR, Stewart CE, Dawson EA. Physical activity and associations with clinical outcome measures in adults with cystic fibrosis; a systematic review. J Cyst Fibros 2019; 18:590-601. [PMID: 30926321 DOI: 10.1016/j.jcf.2019.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Physical activity (PA) is important in the management of Cystic Fibrosis (CF) and is associated with a number of beneficial effects. PA assessment is not commonplace or consistent in clinical practice, therefore understanding of PA in adults with CF remains limited. The purpose of this review was to evaluate PA levels in this population and compare PA to global recommendations and non-CF peers. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilised to inform the review process. Original research was identified and screened against inclusion/exclusion criteria. Quality was assessed, data extracted and a narrative synthesis undertaken to describe the findings. RESULTS Adults with CF did not achieve recommended PA guidelines and step count targets in 5/8 studies where assessment was possible. No significant differences in PA were found between CF and non-CF peers in 3/5 studies. Associations between PA and improved lung function were inconsistent with 4/9 studies finding a positive association. Evidence for an association between PA and higher exercise capacity was stronger with all 4 studies reviewed reporting a positive association. Quality ratings were low across all studies. CONCLUSIONS PA in adults with CF is largely comparable to their non-CF peers, despite being insufficiently active to achieve PA recommendations. Assessment tools used and outcomes reported are variable, many of which do not provide sufficient information to assess relevant components of PA. There is a requirement for high quality studies designed specifically to explore PA in adults with CF, ideally employing standardised PA assessment methods.
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Affiliation(s)
- James Shelley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
| | - Lynne M Boddy
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - Zoe R Knowles
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - Claire E Stewart
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
| | - Ellen A Dawson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, United Kingdom
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19
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Calella P, Valerio G, Brodlie M, Taylor J, Donini LM, Siervo M. Tools and Methods Used for the Assessment of Body Composition in Patients With Cystic Fibrosis: A Systematic Review. Nutr Clin Pract 2019; 34:701-714. [DOI: 10.1002/ncp.10247] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Patrizia Calella
- Department of Movement Sciences and Wellbeing; Parthenope University; Naples Italy
- Human Nutrition Research Centre; Institute of Cellular Medicine; Newcastle University; Newcastle on Tyne UK
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing; Parthenope University; Naples Italy
| | - Malcolm Brodlie
- Institute of Cellular Medicine; Newcastle University and Great North Children's Hospital; Newcastle upon Tyne UK
| | - Jake Taylor
- Institute of Cellular Medicine; Newcastle University and Great North Children's Hospital; Newcastle upon Tyne UK
| | - Lorenzo Maria Donini
- Department of Experimental Medicine-Medical Pathophysiology; Food Science and Endocrinology Section; Food Science and Human Research Unit; Sapienza University of Rome; Rome Italy
| | - Mario Siervo
- Human Nutrition Research Centre; Institute of Cellular Medicine; Newcastle University; Newcastle on Tyne UK
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Calella P, Valerio G, Brodlie M, Donini LM, Siervo M. Cystic fibrosis, body composition, and health outcomes: a systematic review. Nutrition 2018; 55-56:131-139. [DOI: 10.1016/j.nut.2018.03.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/26/2018] [Accepted: 03/22/2018] [Indexed: 12/15/2022]
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Dülger E, Bilgin S, Bulut E, İnal İnce D, Köse N, Türkmen C, Çetin H, Karakaya J. The effect of stabilization exercises on diaphragm muscle thickness and movement in women with low back pain. J Back Musculoskelet Rehabil 2018; 31:323-329. [PMID: 29278870 DOI: 10.3233/bmr-169749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diaphragm is an important component of spinal stability. In presence of low back pain, there may be some alterations in this muscle like other muscles that are responsible for lumbal stabilization. OBJECTIVE This study aims to assess the effects of stabilization exercises on diaphragm muscle thickness and motion along with lumbopelvic stability. METHODS Twenty-one women with low back pain participated in the study. Stabilization exercises including motor control training were performed on treatment group (n= 11). In control group (n= 10), strentghening exercises were peformed for back muscles, abdominal muscles and hip muscles. The patients underwent a total of 30 sessions of treatment, 3 days in a week for 10 weeks. The diaphragm muscle thickness and motion was evaluated using ultrasound (US), and lumbopelvic stability was evaluated using lumbopelvic stability tests. RESULTS After the treatment, in the treatment group, increase in diaphragm thickness and improvement in lumbopelvic stability were statically significant (p< 0.05). However, there were no significant changes in diaphragm motion in both groups (p> 0.05). CONCLUSIONS As a result, stabilization exercises increase diaphragm muscle thickness and improve lumbopelvic stability in women with low back pain. Therefore, stabilization exercises should be considered as a part of the treatment program in low back pain.
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Affiliation(s)
- Esra Dülger
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Sevil Bilgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Elif Bulut
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz İnal İnce
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Nezire Köse
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ceyhun Türkmen
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hatice Çetin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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22
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Staufer K, Halilbasic E, Hillebrand P, Harm S, Schwarz S, Jaksch P, Kivaranovic D, Klepetko W, Trauner M, Kazemi-Shirazi L. Impact of nutritional status on pulmonary function after lung transplantation for cystic fibrosis. United European Gastroenterol J 2018; 6:1049-1055. [PMID: 30228893 DOI: 10.1177/2050640618778381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/25/2018] [Indexed: 12/17/2022] Open
Abstract
Background Nutritional status is an important prognostic factor in patients with cystic fibrosis (CF) prior to lung transplantation. Objective To investigate the impact of nutritional status on pulmonary function in CF transplant recipients. Methods Adult double lung transplanted CF patients were consecutively included. The predictive value of nutritional status on lung function - measured by spirometry - was longitudinally assessed by body composition serially evaluated by a three-compartment model bioelectrical impedance analysis (BIA) in comparison to body mass index (BMI). Results Overall, 147 spirometries and 147 BIAs were performed in 58 patients (59% female, median age: 30.1 years, median BMI: 19.6 kg/m2). Malnourished patients (BMI < 18.5 kg/m2; 27.6%) had a significantly reduced lung function compared to normal/overweight patients (forced expiratory volume in 1 second in percent (FEV1%pred), 57% vs 77%; p = 0.024). BMI, as well as the BIA parameters phase angle, total body water, fat free mass, body cell mass (BCM) and extracellular mass (ECM)/BCM ratio, were univariate predictors of FEV1%pred. When included in a linear mixed model, ECM/BCM ratio remained the only significant predictor of lung function (p = 0.012). Conclusion Nutritional status assessed by BIA predicted lung function in CF transplant recipients. Serial BIA measurements to monitor patients' nutritional status might help to improve or maintain lung function.
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Affiliation(s)
- Katharina Staufer
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Emina Halilbasic
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Peter Hillebrand
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Solveig Harm
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Danijel Kivaranovic
- Section for Medical Statistics, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Lili Kazemi-Shirazi
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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23
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Fuchs G, Thevathasan T, Chretien YR, Mario J, Piriyapatsom A, Schmidt U, Eikermann M, Fintelmann FJ. Lumbar skeletal muscle index derived from routine computed tomography exams predict adverse post-extubation outcomes in critically ill patients. J Crit Care 2018; 44:117-123. [DOI: 10.1016/j.jcrc.2017.10.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/15/2017] [Accepted: 10/22/2017] [Indexed: 12/25/2022]
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24
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Richard P. [Exploring the diaphragm: Ultrasound is essential]. Rev Mal Respir 2017; 34:645-660. [PMID: 28502520 DOI: 10.1016/j.rmr.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
The diaphragm is the muscle most implicated in breathing. Its morphological exploration usually depends on pulmonary radiography, fluoroscopy, CT-scanning and MRI. Its function is evaluated by the classical respiratory functional tests, the measurement of maximum inspiratory and expiratory pressures, the transdiaphragmatic pressure and even an electromyogram. Ultrasound is a technique still insufficiently used in respiratory medicine. It offers, however, many advantages: it is easy to implement, there is no irradiation, it is usable at the bedside, particularly when the patient is immobile or in intensive care. The results of the examination are immediately available. It allows morphological and dynamic study of each hemidiaphragm as well as providing invaluable information on the thoracic and subdiaphragmatic environment. Its field of exploration is extremely wide: raised hemidiaphragm, dyspnea following a stroke or a surgical procedure (thoracic or abdominal), road accident trauma, diagnosis and follow-up of a paresis or paralysis, evaluation of diaphragmatic mobility during the course of COPD (Chronic Obstructive Pulmonary Disease) and many other pathologies. Ultrasound is insufficiently used in pleural disease and even less so in the evaluation of the morphology and function of the diaphragm.
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Affiliation(s)
- P Richard
- Service de pneumologie, centre hospitaliser de la région de Saint-Omer, route de Blendecques, BP 60357, 62570 Helfaut, France.
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25
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Kim M, Lee K, Cho J, Lee W. Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients. Med Sci Monit 2017; 23:1247-1253. [PMID: 28284044 PMCID: PMC5358861 DOI: 10.12659/msm.900529] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aims of this study are to investigate the difference between the diaphragm thickness at end expiration and the thickness at total lung capacity (TLC), and to examine differences in inspiratory muscle function between stroke patients and healthy individuals. Material/Methods Forty-five stroke patients and 49 healthy volunteers were included in this study. Diaphragm thickness was measured at end expiration and at TLC by ultrasonography. The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), vital capacity (VC), and inspiratory muscle endurance (IME) were assess to evaluate inspiratory muscle function. Results In stroke patients, the diaphragm was significantly thinner on the affected side than the less affected side at end expiration and at TLC. The change between the thickness at end expiration and at TLC were also significant on both sides. Between groups, the difference in diaphragm thickness at end expiration was not significant, but at TLC, the diaphragms were significantly thicker in healthy individuals than on either side in stroke patients, and the change in diaphragm thickness was significantly greater for healthy individuals. Inspiratory muscle functions were also significantly greater in healthy individuals. MIP, PIF, and VC were positively correlated with the change in thickness in healthy individuals, and MIP was positively correlated with the change in thickness and IME in stroke patients. Conclusions Stroke patients showed decreases in the thickening ability of the diaphragm at TLC and in inspiratory muscle function. The change between the diaphragm thickness at end expiration and at TLC was positively correlated with MIP, PIF, and VC.
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Affiliation(s)
- Minkyu Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Kyeongbong Lee
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Jieun Cho
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Wanhee Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, South Korea
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26
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Charatsi A, Dusser P, Freund R, Maruani G, Rossin H, Boulier A, Le Bourgeois M, Chedevergne F, de Blic J, Letourneur A, Casimir G, Jais J, Sermet-Gaudelus I. Bioelectrical impedance in young patients with cystic fibrosis: Validation of a specific equation and clinical relevance. J Cyst Fibros 2016; 15:825-833. [DOI: 10.1016/j.jcf.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 04/28/2016] [Accepted: 05/07/2016] [Indexed: 01/10/2023]
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27
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Inspiratory work capacity is more severely depressed than inspiratory muscle strength in patients with heart failure: Novel applications for inspiratory muscle training. Int J Cardiol 2016; 221:622-6. [DOI: 10.1016/j.ijcard.2016.07.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 11/23/2022]
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28
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Yun JK, Choi SH, Park SI. Clinical Outcomes of Heart-Lung Transplantation: Review of 10 Single-Center Consecutive Patients. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:157-64. [PMID: 27298792 PMCID: PMC4900857 DOI: 10.5090/kjtcs.2016.49.3.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. METHODS Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients' baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of 26.1±16.7 months. RESULTS Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. CONCLUSION HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine
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Hauschild DB, Barbosa E, Moreira EAM, Ludwig Neto N, Platt VB, Piacentini Filho E, Wazlawik E, Moreno YMF. Nutrition Status Parameters and Hydration Status by Bioelectrical Impedance Vector Analysis Were Associated With Lung Function Impairment in Children and Adolescents With Cystic Fibrosis. Nutr Clin Pract 2016; 31:378-86. [DOI: 10.1177/0884533615627157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Daniela Barbieri Hauschild
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eliana Barbosa
- Joana de Gusmão Children’s Hospital, Florianópolis, Brazil
| | - Emilia Addison Machado Moreira
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | | | - Elisabeth Wazlawik
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Yara Maria Franco Moreno
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
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The impact of resistance respiratory muscle training with a SpiroTiger(®) device on lung function, exercise performance, and health-related quality of life in respiratory diseases. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 12:386-90. [PMID: 26855662 PMCID: PMC4735547 DOI: 10.5114/kitp.2015.56796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
Abstract
Introduction There are studies demonstrating that respiratory muscles can be trained using proper stimulation. Positive effects have been achieved in patients with pulmonary diseases and in patients after thoracic surgery procedures using isocapnic hyperpnoea training with a SpiroTiger® device. The aim of this study was to investigate whether SpiroTiger® training has an impact on forced expiratory volume in one second (FEV1), exercise performance, respiratory muscle fitness, and health-related quality of life. Material and methods Search phrases “spirotiger” and “spiro tiger” were entered into the search engines of the following databases: Academic Search Complete, Medline, Ebscohost, and PubMed. Results One article about chronic obstructive pulmonary disease (COPD) and 4 articles about cystic fibrosis were found. Conclusions The positive effect of SpiroTiger® training on FEV1 cannot be unequivocally confirmed as it was found only in two of the five analysed studies. SpiroTiger® training has a positive impact on exercise performance measured with the six-minute walk test; it increases breathing muscle fitness in patients with COPD and in patients after thoracic surgery procedures, and it improves health-related quality of life.
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31
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Alicandro G, Battezzati A, Bianchi ML, Loi S, Speziali C, Bisogno A, Colombo C. Estimating body composition from skinfold thicknesses and bioelectrical impedance analysis in cystic fibrosis patients. J Cyst Fibros 2015; 14:784-91. [DOI: 10.1016/j.jcf.2015.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 01/10/2023]
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32
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Bradley J, O'Neill B, Kent L, Hulzebos EH, Arets B, Hebestreit H, Alison J, Arets B, Boas S, Bradley J, Button B, Bye P, Cerny F, Cooper D, Downs A, Dwyer T, Forster E, Gallagher C, Gruber W, Hebestreit A, Hebestreit H, Huber M, Hulzebos E, Johnstone Z, Lands L, Lannefors L, Lessine F, Lindblad A, Lowman J, Mandrusiak A, Martensson M, McIlwaine M, Möller A, Molloy M, Montgomery G, Morrison L, Murray J, Nippins M, Orenstein D, Prasaad A, Renner S, Salhberg M, Schneiderman J, Swisher A, Urquhart D, Zeitoun M. Physical activity assessment in cystic fibrosis: A position statement. J Cyst Fibros 2015. [DOI: 10.1016/j.jcf.2015.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Arikan H, Yatar İ, Calik-Kutukcu E, Aribas Z, Saglam M, Vardar-Yagli N, Savci S, Inal-Ince D, Ozcelik U, Kiper N. A comparison of respiratory and peripheral muscle strength, functional exercise capacity, activities of daily living and physical fitness in patients with cystic fibrosis and healthy subjects. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 45-46:147-156. [PMID: 26241869 DOI: 10.1016/j.ridd.2015.07.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/29/2015] [Accepted: 07/20/2015] [Indexed: 06/04/2023]
Abstract
There are limited reports that compare muscle strength, functional exercise capacity, activities of daily living (ADL) and parameters of physical fitness of cystic fibrosis (CF) patients with healthy peers in the literature. The purpose of this study was to assess and compare respiratory and peripheral muscle strength, functional exercise capacity, ADL and physical fitness in patients with CF and healthy subjects. Nineteen patients with CF (mean forced expiratory volume in one second-FEV1: 86.56±18.36%) and 20 healthy subjects were included in this study. Respiratory (maximal inspiratory pressure-MIP and maximal expiratory pressure-MEP) and peripheral muscle strength (quadriceps, shoulder abductors and hand grip strength) were evaluated. Functional exercise capacity was determined with 6min walk test (6MWT). ADL was assessed with Glittre ADL test and physical fitness was assessed with Munich fitness test (MFT). There were not any statistically significant difference in MIP, %MIP, MEP and %MEP values between two groups (p>0.05). %Peripheral muscle strength (% quadriceps and shoulder abductors strength), 6MWT distance and %6MWT distance were significantly lower in patients with CF than those of healthy subjects (p<0.05). Glittre ADL-test time was significantly longer in patients with CF than healthy subjects (p<0.05). According to Munich fitness test, the number of bouncing a ball, hanging score, distance of standing vertical jumping and standing vertical jumping score were significantly lower in patients with CF than those of healthy subjects (p<0.05). Peripheral muscle strength, functional exercise capacity, ADL performance and speed, coordination, endurance and power components of physical fitness are adversely affected in mild-severe patients with CF compared to healthy peers. Evaluations must be done in comprehensive manner in patients with CF with all stages.
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Affiliation(s)
- Hulya Arikan
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazari, Ankara, Turkey
| | - İlker Yatar
- Dogu Akdeniz University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazimagusa, Cyprus
| | - Ebru Calik-Kutukcu
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazari, Ankara, Turkey.
| | - Zeynep Aribas
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Besevler, Ankara, Turkey
| | - Melda Saglam
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazari, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazari, Ankara, Turkey
| | - Sema Savci
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, 35340 Inciralti, Izmir, Turkey
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100 Samanpazari, Ankara, Turkey
| | - Ugur Ozcelik
- Hacettepe University, Faculty of Medicine, Department of Child Health and Diseases, Unit of Chest Diseases, 06230 Sihhiye, Ankara, Turkey
| | - Nural Kiper
- Hacettepe University, Faculty of Medicine, Department of Child Health and Diseases, Unit of Chest Diseases, 06230 Sihhiye, Ankara, Turkey
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Dekerlegand RL, Hadjiliadis D, Swisher AK, Parrott JS, Heuer AJ, Myslinski MJ. Inspiratory muscle strength relative to disease severity in adults with stable cystic fibrosis. J Cyst Fibros 2015; 14:639-45. [PMID: 26005006 DOI: 10.1016/j.jcf.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Due to heterogeneity in pulmonary disease, current literature may misrepresent inspiratory muscle involvement in cystic fibrosis (CF). This study investigated inspiratory muscle strength (IMS) relative to disease severity in adults with CF. METHODS Maximal inspiratory pressure (MIP) was assessed in 58 adults with stable CF grouped by disease severity (20 mild, 20 moderate, 18 severe) and compared to 20 controls. Relationships between MIP, lung function, dyspnea and anthropometrics were evaluated using multivariable linear models. RESULTS MIP in cmH2O and %-predicted was decreased in advanced CF lung disease as compared to mild disease and healthy controls (p<0.05). Disease severity accounted for 24% of the variance in IMS after controlling for confounding variables (p<0.001). CONCLUSIONS IMS is decreased in some adults with stable CF with moderate and severe pulmonary disease, and is related to dyspnea. Future studies should determine if decreased IMS contributes inefficient breathing patterns, respiratory pump dysfunction, and/or exercise intolerance in advanced CF.
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Affiliation(s)
- Robert L Dekerlegand
- Rutgers, The State University of New Jersey, School of Health Related Professions, Doctor of Physical Therapy Program - South, 40 East Laurel Road, Stratford, NJ 08084, USA.
| | - Denis Hadjiliadis
- University of Pennsylvania, Adult Cystic Fibrosis Program, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 1st Floor West, Philadelphia, PA 19104, USA.
| | - Anne K Swisher
- West Virginia University, Division of Physical Therapy, Room 8314, PO Box 9226, Morgantown, WV 26506, USA.
| | - J Scott Parrott
- Rutgers, The State University of New Jersey, School of Health Related Professions, Interdisciplinary Studies, 65 Bergen Street, Rm. 353A, Newark, NJ 07101, USA; Rutgers, The State University of New Jersey, School of Public Health, Quantitative Methods, 65 Bergen Street, Rm. 353A, Newark, NJ 07101, USA.
| | - Albert J Heuer
- Rutgers, The State University of New Jersey, School of Health Related Professions, Respiratory Therapy, 65 Bergen Street, Rm. 358, Newark, NJ 07101, USA.
| | - Mary Jane Myslinski
- Rutgers, The State University of New Jersey, School of Health Related Professions, Doctor of Physical Therapy Program - North, 65 Bergen Street, Rm. 721, Newark, NJ 07101, USA.
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Alicandro G, Bisogno A, Battezzati A, Bianchi ML, Corti F, Colombo C. Recurrent pulmonary exacerbations are associated with low fat free mass and low bone mineral density in young adults with cystic fibrosis. J Cyst Fibros 2014; 13:328-34. [DOI: 10.1016/j.jcf.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/30/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
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Smargiassi A, Inchingolo R, Tagliaboschi L, Di Marco Berardino A, Valente S, Corbo GM. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration 2014; 87:364-71. [PMID: 24732295 DOI: 10.1159/000358564] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skeletal muscle weakness with loss of fat-free mass (FFM) is one of the main systemic effects of chronic obstructive pulmonary disease (COPD). The diaphragm is also involved, leading to disadvantageous conditions and poor contractile capacities. OBJECTIVES We measured the thickness of the diaphragm (TD) by ultrasonography to evaluate the relationships between echographic measurements, parameters of respiratory function and body composition data. METHODS Thirty-two patients (23 males) underwent (1) pulmonary function tests, (2) echographic assessment of TD in the zone of apposition at various lung volumes, i.e. TD at residual volume (TDRV), TD at functional residual capacity (TDFRC) and TD at total lung capacity (TDTLC), and (3) bioelectrical body impedance analysis. The BMI and the BODE (BMI-Obstruction-Dyspnea-Exercise) index values were reported. RESULTS TDRV, TDFRC and TDTLC measured 3.3, 3.6 and 6 mm, respectively, with good intraobserver reproducibility (0.97, 0.97 and 0.96, respectively). All the TDs were found to be related to FFM, with the relationship being greater for TDFRC (r(2) = 0.39 and p = 0.0002). With regard to lung volumes, inspiratory capacity (IC) was found to be closely related to TDTLC (r(2) = 0.42 and p = 0.0001). The difference between TDTLC and TDRV, as a thickening value (TDTLCRV), was closely related to FVC (r(2) = 0.34 and p = 0.0004) and to air-trapping indices (RV/TLC, FRC/TLC and IC/TLC): the degree of lung hyperinflation was greater and the TDTLCRV was less. Finally, we found a progressive reduction of both thicknesses and thickenings as the severity of IC/TLC increased, with a significant p value for the trend in both analyses (p = 0.02). CONCLUSIONS Ultrasonographic assessment of the diaphragm could be a useful tool for studying disease progression in COPD patients, in terms of lung hyperinflation and the loss of FFM. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Andrea Smargiassi
- Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Rome, Italy
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Impact of extracorporeal membrane oxygenation or mechanical ventilation as bridge to combined heart-lung transplantation on short-term and long-term survival. Transplantation 2014; 97:111-5. [PMID: 24056630 DOI: 10.1097/tp.0b013e3182a860b8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV) can be used as a bridge to heart-lung transplantation (HLT). The goal of this study was to determine if pretransplantation ECMO or MV affects survival in HLT. METHODS The United Network for Organ Sharing database was reviewed for all adult patients receiving HLT from 1995 to 2011. The primary outcome measured was risk-adjusted all cause mortality. RESULTS There were 542 adult patients received HLT during the study period. Of these, 15 (2.8%) required ECMO and 22 (4.1%) required MV as a bridge to transplantation. The groups were evenly matched with regards to recipient age, recipient gender, ischemic time, donor age, and donor gender. The ECMO cohort had worse survival than the control group at 30 days (20.0% vs. 83.5%) and 5 years (20.0% vs. 47.4%; P<0.001). When compared with control, patients requiring MV had worse survival at 1 month (77.3% vs. 83.5%) and 5 years (26.5% vs. 47.4%; P<0.001). The use of ECMO (hazard ratio [HR]=3.820, 95% confidence interval [CI]=1.600-9.116; P=0.003) or MV (HR=2.011, 95% CI=1.069-3.784; P=0.030) as a bridge to transplantation was independently associated with mortality on multivariate analysis. Recipient female gender was associated with survival (HR=0.754, 95% CI=0.570-0.998; P=0.048). CONCLUSIONS HLT recipients bridged by MV or ECMO have increased short-term and long-term mortality. Further studies are needed to optimize survival in these high-risk patients.
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Sheikh S, Zemel BS, Stallings VA, Rubenstein RC, Kelly A. Body composition and pulmonary function in cystic fibrosis. Front Pediatr 2014; 2:33. [PMID: 24783186 PMCID: PMC3995066 DOI: 10.3389/fped.2014.00033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/02/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lower body mass index (BMI) is associated with worse pulmonary function in cystic fibrosis (CF). HYPOTHESIS lean body mass (LBM) is more strongly associated with pulmonary function than BMI is. METHODS Anthropometrics, body composition by dual x-ray absorptiometry, and pulmonary function were determined in pancreatic insufficient CF (PI-CF) youth. Sex and age-adjusted Z-scores (BMI-Z, LBMI-Z, FMI-Z) were generated for CF and controls. (1) Associations of BMI-Z with LBMI-Z and FMI-Z and (2) age-adjusted associations of BMI-Z, LBMI-Z, and FMI-Z with FEV1%-predicted were tested. RESULTS Two hundred eight PI-CF subjects had lower BMI-Z, LBMI-Z, and FMI-Z compared to 390 controls. BMI-Z was associated with lower LBMI-Z (p < 0.0001) in PI-CF. In females, LBMI-Z and BMI-Z were positively associated with FEV1%-predicted; this relationship did not persist for FMI-Z after adjustment for LBMI-Z. In males, only LBMI-Z and BMI-Z were associated with FEV1%-predicted. CONCLUSION In PI-CF youth, deficits in LBM were apparent. At lower BMI percentiles, BMI may not accurately depict LBM in PI-CF. In under-nourished PI-CF youth, this preservation of FM in preference to LBM is relevant since LBMI-Z, but not FMI-Z, is positively associated with FEV1%-predicted. Lean body mass index is more strongly associated with lung function compared to BMI, especially in the under-nourished child and adolescent with PI-CF.
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Affiliation(s)
- Saba Sheikh
- Division of Pulmonary Medicine, Cystic Fibrosis Center, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA ; Division of Gastroenterology, Hepatology and Nutrition, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA
| | - Virginia A Stallings
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA ; Division of Gastroenterology, Hepatology and Nutrition, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA
| | - Ronald C Rubenstein
- Division of Pulmonary Medicine, Cystic Fibrosis Center, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA
| | - Andrea Kelly
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA , USA ; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia , Philadelphia, PA , USA
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Smargiassi A, Inchingolo R, Faita F, Tagliaboschi L, Di Marco Berardino A, Valente S, Corbo GM. Authors' Reply. Respiration 2014; 88:519-20. [DOI: 10.1159/000367870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Forrester DL, Knox AJ, Smyth AR, Fogarty AW. Measures of body habitus are associated with lung function in adults with cystic fibrosis: a population-based study. J Cyst Fibros 2012; 12:284-9. [PMID: 22958983 PMCID: PMC3655260 DOI: 10.1016/j.jcf.2012.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/24/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Body habitus differences may explain some of the variation in lung function between individuals with cystic fibrosis (CF). We tested the hypothesis that measures of lean muscle mass and obesity are independently associated with lung function in CF. METHODS Cross-sectional study design using UK CF registry data from 2096 clinically stable adults. RESULTS Serum creatinine and BMI were positively and independently associated with FEV1 and FVC. One standard deviation increment in serum creatinine was associated with an FEV1 increase of 171ml (95% confidence intervals CI: +116 to +227ml) in males and 90ml (95% CI: +46 to +133ml) in females. Compared to the reference group of 20-24.9kg/m(2), those with a BMI<20kg/m(2) had lower FEV1 with values of -642ml (95%CI: -784 to -500ml) for males and -468ml (95%CI: -564 to -372ml) for females. CONCLUSIONS Prospective studies and controlled trials are required to ascertain if these associations have therapeutic potential in modifying disease progression.
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Affiliation(s)
- Doug L Forrester
- Nottingham Biomedical Research Unit, Department of Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK
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Stalvey MS, Anbar RD, Konstan MW, Jacobs JR, Bakker B, Lippe B, Geller DE. A multi-center controlled trial of growth hormone treatment in children with cystic fibrosis. Pediatr Pulmonol 2012; 47:252-63. [PMID: 21905270 PMCID: PMC4166490 DOI: 10.1002/ppul.21546] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 08/08/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We evaluated safety and efficacy of recombinant human growth hormone (rhGH) for improving growth, lean body mass (LBM), pulmonary function, and exercise tolerance in children with cystic fibrosis (CF) and growth restriction. STUDY DESIGN Multicenter, open-label, controlled clinical trial comparing outcomes in prepubertal children <14 years with CF, randomized in a 1:1 ratio to receive daily rhGH (Nutropin AQ) or no treatment (control) for 12 months, followed by a 6-month observation (month 18). Safety was monitored at each visit, including assessments of glucose tolerance. RESULTS Sixty-eight subjects were randomized (control n = 32; rhGH n = 36). Mean height standard deviation score (SDS) in the rhGH group increased by 0.5 ± 0.4 at 12 months (mean ± SD, P < 0.001); the control group height SDS remained unchanged. Weight increased by 3.8 ± 1.8 versus 2.8 ± 1.5 kg, (mean ± SD, P = 0.0356) and LBM increased by 3.8 ± 1.8 versus 2.1 ± 1.4 kg (P = 0.0002) in the rhGH group versus controls, respectively. Forced vital capacity increased by 325 ± 319 in the rhGH group compared with 178 ± 152 ml in controls (mean ± SD, P = 0.032). Forced expiratory volume in 1 sec improved in both groups with a significant difference between groups after adjustment for baseline severity (LS mean ± SE: rhGH, 224 ± 37, vs. controls, 108 ± 40 ml; P = 0.04). There was no difference between groups in exercise tolerance (6-min walk distance) at 1 year. Changes in glucose tolerance for the two groups were similar over the 12-month study period, with three subjects developing IGT and one CFRD in each group. One rhGH-treated patient developed increased intracranial pressure. CONCLUSIONS Treatment with rhGH in prepubertal children with CF was effective in promoting growth, weight, LBM, lung volume, and lung flows, and had an acceptable safety profile.
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Affiliation(s)
- Michael S Stalvey
- University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Insulin secretion, nutritional status and respiratory function in cystic fibrosis patients with normal glucose tolerance. Clin Nutr 2012; 31:118-23. [DOI: 10.1016/j.clnu.2011.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 01/01/2023]
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Wieboldt J, Atallah L, Kelly JL, Shrikrishna D, Gyi KM, Lo B, Yang GZ, Bilton D, Polkey MI, Hopkinson NS. Effect of acute exacerbations on skeletal muscle strength and physical activity in cystic fibrosis. J Cyst Fibros 2012; 11:209-15. [PMID: 22226413 DOI: 10.1016/j.jcf.2011.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skeletal muscle weakness is an important complication of chronic respiratory disease. The effect of acute exacerbations on strength in patients with cystic fibrosis is not known. METHODS Quadriceps (QMVC) and respiratory muscle strength were measured in patients at the time of acute admission, at discharge and one month later. Patients wore an activity monitor during admission and at one month. Convalescent values were compared to the stable clinic population. RESULTS Data were available for 13 acute admissions and 25 stable CF outpatients. Strength and other parameters including daily step count did not differ significantly between the stable and one month post-admission groups. At admission, QMVC was 16.7 (8.3)% lower than at convalescence, whereas inspiratory muscle strength did not change significantly. Reduction in QMVC did not correlate with activity levels or with markers of systemic inflammation. CONCLUSION Further research is needed to identify the mechanisms responsible for the reduction in QMVC.
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Affiliation(s)
- Jason Wieboldt
- NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
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Bridge to lung transplantation using short-term ambulatory extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2010; 140:713-5. [DOI: 10.1016/j.jtcvs.2010.02.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 02/10/2010] [Accepted: 02/20/2010] [Indexed: 11/24/2022]
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Freitas Júnior IF, Rosa CSDC, Codogno JS, Bueno DR, Buonani C, Conterato I, Fernandes RA, Converso MER, Gomes JDO. [Cardiorespiratory fitness and body fat distribution in women with 50 years or more]. Rev Esc Enferm USP 2010; 44:395-400. [PMID: 20642052 DOI: 10.1590/s0080-62342010000200022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
To verify the relationship between cardiorespiratory fitness and body fat in women. Evaluations were performed on 229 women with ages ranging between 50 and 84 years. Anthropometric assessment was performed and waist/hip ratio and conicity index values were obtained. The cardiorespiratory fitness was evaluated by the six minutes walk test and one pedometer was used to evaluate the speed, length, and total number of steps. The results were distributed in quartile, and interquartil comparison was performed by means of analysis of variance with post-hoc test. The relationship between the six minutes walk test and anthropometrics was identified using the Pearson's correlation coefficient. Results showed that women with cardiorespiratory fitness in the quartile4 were younger than those in quartile1 (p < or = 0.05). The anthropometric variables values were lower (p < or = 0.05) for results in the quartiles3 and 4 compared to those in quartiles1 and 2. In conclusion, women with higher adipose tissue and central fat accumulation presented lower cardiorespiratory fitness.
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Affiliation(s)
- Ismael Forte Freitas Júnior
- Departamento de Educação Física da Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, SP, Brasil.
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Olveira G, Olveira C, Gaspar I, Cruz I, Dorado A, Pérez-Ruiz E, Porras N, Soriguer F. Validation of the Spanish Version of the Revised Cystic Fibrosis Quality of Life Questionnaire in Adolescents and Adults (CFQR 14+ Spain). ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(10)70044-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg 2010; 139:765-773.e1. [PMID: 19931096 DOI: 10.1016/j.jtcvs.2009.09.031] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 07/10/2009] [Accepted: 09/17/2009] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The study objectives were to (1) compare survival after lung transplantation in patients requiring pretransplant mechanical ventilation or extracorporeal membrane oxygenation with that of patients not requiring mechanical support and (2) identify risk factors for mortality. METHODS Data were obtained from the United Network for Organ Sharing for lung transplantation from October 1987 to January 2008. A total of 15,934 primary transplants were performed: 586 in patients on mechanical ventilation and 51 in patients on extracorporeal membrane oxygenation. Differences between nonsupport patients and those on mechanical ventilation or extracorporeal membrane oxygenation support were expressed as 2 propensity scores for use in comparing risk-adjusted survival. RESULTS Unadjusted survival at 1, 6, 12, and 24 months was 83%, 67%, 62%, and 57% for mechanical ventilation, respectively; 72%, 53%, 50%, and 45% for extracorporeal membrane oxygenation, respectively; and 93%, 85%, 79%, and 70% for unsupported patients, respectively (P < .0001). Recipients on mechanical ventilation were younger, had lower forced vital capacity, and had diagnoses other than emphysema. Recipients on extracorporeal membrane oxygenation were also younger, had higher body mass index, and had diagnoses other than cystic fibrosis/bronchiectasis. Once these variables, transplant year, and propensity for mechanical support were accounted for, survival remained worse after lung transplantation for patients on mechanical ventilation and extracorporeal membrane oxygenation. CONCLUSION Although survival after lung transplantation is markedly worse when preoperative mechanical support is necessary, it is not dismal. Thus, additional risk factors for mortality should be considered when selecting patients for lung transplantation to maximize survival. Reduced survival for this high-risk population raises the important issue of balancing maximal individual patient survival against benefit to the maximum number of patients.
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Olveira G, Olveira C, Gaspar I, Cruz I, Dorado A, Pérez-Ruiz E, Porras N, Soriguer F. [Validation of the Spanish version of the Revised Cystic Fibrosis Quality of Life Questionnaire in adolescents and adults (CFQR 14+ Spain)]. Arch Bronconeumol 2010; 46:165-75. [PMID: 20304545 DOI: 10.1016/j.arbres.2010.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/05/2010] [Accepted: 01/22/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the validity and reliability of the Spanish version of the revised disease-specific health related quality of life questionnaire for adolescents and adults with cystic fibrosis (CFQR 14+ Spain). METHODS A total of 43 cystic fibrosis (CF) patients completed the CFQR 14+ Spain. Forced expiratory volume in 1 second, in percentage of predicted - FEV(1) (%)-, number of respiratory exacerbations, 6-minute walk test, Bhalla score (based on computerized tomography of the chest), fat-free mass index, body mass index (BMI), faecal fat and St George's Respiratory Questionnaire were included as measurements of health status. RESULTS Ten out of the twelve scales had alpha coefficients above 0.70. Test-retest correlations (Spearman) ranged from 0.49 to 0.95 and they were significant in all scales. Intraclass correlations ranged from 0.47 to 0.95 (ten out of the twelve scales were >0.70) forty out of the fifty ítems have correlations between items and scale above 0.70. All the CFQR+14 scales, except the digestive symptoms scale, discriminated significantly between patients with mild, moderate and severe disease (according to FEV(1) (%)). Other respiratory parameters also discriminated significantly between patients with mild-moderate and severe disease. Only some scales discriminated significantly between nourished and malnourished patients. All of the scales met standards for floor effects (<15% of the responders with the lowest score) but not for ceiling effects (only five out of the twelve). CONCLUSION The Spanish CFQR14+ (Spain) is a reliable and valid instrument for measuring the health-related quality of life in Spanish adolescents and adults with CF, though with the exception of a few of its subscales.
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Affiliation(s)
- Gabriel Olveira
- Unidad de Fibrosis Quística, Servicio de Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
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Wells GD, Heale L, Schneiderman JE, Wilkes DL, Atenafu E, Coates AL, Ratjen F. Assessment of body composition in pediatric patients with cystic fibrosis. Pediatr Pulmonol 2008; 43:1025-32. [PMID: 18781652 DOI: 10.1002/ppul.20913] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
RATIONALE Cystic fibrosis (CF) leads to pathological changes in organs that express the cystic fibrosis transmembrane conductance regulator (CFTR), including secretory cells of the digestive tract and the pancreas. Maintaining nutritional sufficiency is challenging for CF patients and therefore accurate monitoring is important for their clinical management. PURPOSE The objectives of this study were to evaluate the effectiveness of skinfold measurements as an accurate method for determining body composition (fat mass (FM) and lean body mass (LBM)) of this population, using dual-energy X-ray absorptiometry (DEXA) as a gold standard comparison and to determine the most accurate equation for this calculation in children with CF. METHODS Fifty-five pediatric patients with CF participated in the study. FM and LBM calculated via four methods: Slaughter, Durnin, Durenberg (2-site and 4-site). The relationship between the methods and DEXA results were estimated by intraclass-correlation coefficient (ICC) and Bland and Altman analyses. RESULTS The Slaughter method was the most accurate (ICC of 0.92 for FM and 0.99 for LBM) and displayed the least bias over the range of FM and LBM in CF patients. In addition, the results of Bland Altman analyses comparing each skinfold method to DEXA, revealed that the results were evenly distributed along the range of values for the Slaughter calculation, whereas the other three methods under and over estimated % fat results at the upper and lower ends of the range respectively. CONCLUSION We therefore conclude that the Slaughter method may be used for body composition assessment of pediatric CF patients. This provides clinical teams with a simple, accurate and non-invasive method that can be used to monitor nutritional status in pediatric patients with CF.
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Affiliation(s)
- Greg D Wells
- Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Sartori R, Barbi E, Poli F, Ronfani L, Marchetti F, Amaddeo A, Ventura A. Respiratory training with a specific device in cystic fibrosis: A prospective study. J Cyst Fibros 2008; 7:313-319. [DOI: 10.1016/j.jcf.2007.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 12/04/2007] [Accepted: 12/10/2007] [Indexed: 11/30/2022]
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