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Morgan C, Higbee D. An attack of asthma is not an attack of the heart: clarifying causal links between asthma and incident coronary heart disease. Eur Respir J 2023; 62:2302009. [PMID: 38035696 DOI: 10.1183/13993003.02009-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Caitlin Morgan
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Daniel Higbee
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Cazzola M, Rogliani P, Ora J, Calzetta L, Lauro D, Matera MG. Hyperglycaemia and Chronic Obstructive Pulmonary Disease. Diagnostics (Basel) 2023; 13:3362. [PMID: 37958258 PMCID: PMC10650064 DOI: 10.3390/diagnostics13213362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of lung function. The mechanistic relationships between these two diseases are complicated, multifaceted, and little understood, yet they can impact treatment strategy. The potential risks and benefits for patients with T2DM treated with pulmonary drugs and the potential pulmonary risks and benefits for patients with COPD when taking antidiabetic drugs should always be considered. The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle; however, several strategies may help to break this circle. The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM). In any case, it is always crucial to establish glycaemic management since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD. In this article, we examine possible connections between COPD and T2DM as well as pharmacological strategies that could focus on these connections.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome ‘Tor Vergata’, 00133 Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome ‘Tor Vergata’, 00133 Rome, Italy
- Division of Respiratory Medicine, University Hospital Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Davide Lauro
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, University of Rome ‘Tor Vergata’, 00173 Rome, Italy
- Division of Endocrinology and Diabetes, University Hospital Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, 81138 Naples, Italy
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Benslimane A, Garcia-Larsen V, El Kinany K, Alaoui Chrifi A, Hatime Z, Benjelloun MC, El Biaze M, Nejjari C, El Rhazi K. Association between obesity and chronic obstructive pulmonary disease in Moroccan adults: Evidence from the BOLD study. SAGE Open Med 2021; 9:20503121211031428. [PMID: 34349996 PMCID: PMC8287346 DOI: 10.1177/20503121211031428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 06/22/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: The Moroccan cross-sectional study aimed to investigate obesity in
association to chronic obstructive pulmonary disease in Fez city. Methods: A cross-sectional survey was carried out in Moroccan adults. Anthropometric
and spirometry measurements were performed using standardized
guidelines. Results: Among the 744 participants, 53.9% of were women, with a mean age of 55.27
years (SD = 10.29). Nearly all women declared themselves to be never
smokers, while 21% of men were current smokers. Overall, chronic obstructive
pulmonary disease prevalence decreased with body mass index
(p = 0.01) and waist circumference (p
< 0.001). The same trends were also observed in women. The adjusted
regression analysis showed a significant independent association between
chronic obstructive pulmonary disease and decreasing overweight
(ORa: 0.66; CI95% (0.40–0.98)), obesity
(ORa: 0.66 CI95%: (0.36–0.89)), and a decreasing
waist circumference-abdominal obesity (ORa: 0.58
CI95%: (0.34–0.99)) in the whole population. The same association
remains significant in women for overweight (ORa: 0.18
CI95%: (0.06–0.54)) and for waist circumference-abdominal
obesity (ORa: 0.40 CI95%: (0.19–0.85)). All these
associations disappeared for men. Conclusion: Chronic obstructive pulmonary disease decreases with the increase in body
mass index and waist circumference. The effect of waist circumference on the
chronic obstructive pulmonary disease was greater among women, regardless of
the tobacco factor. A multicenter study would help to confirm the accuracy
of these findings in a larger sample of the Moroccan population. Developed
lifestyle programs in patients with chronic obstructive pulmonary disease
should be considered.
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Affiliation(s)
- Abdelilah Benslimane
- Department of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khaoula El Kinany
- Department of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Amina Alaoui Chrifi
- Department of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Zineb Hatime
- Department of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | | | - Mohammed El Biaze
- Respiratory Department, Hassan II University Hospital Center of Fez, Fez, Morocco
| | - Chakib Nejjari
- Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Karima El Rhazi
- Department of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Abstract
PURPOSE OF REVIEW Severe asthma is often associated with numerous comorbidities that complicate disease management and affect patient's outcomes. They contribute to poor disease control and mimic asthma symptoms. Although some comorbidities such as obstructive sleep apnea, bronchiectasis, and chronic obstructive pulmonary disease are generally well recognized, many other may remain undiagnosed but may be detected in an expert specialist setting. The management of comorbidities seems to improve asthma outcomes, and optimizes therapy by avoiding overtreatment. The present review provides recent knowledge regarding the most common comorbidities which are associated with severe asthma. RECENT FINDINGS Comorbidities are more prevalent in severe asthma than in mild-to-moderate disease or in the general population. They can be grouped into two large domains: the pulmonary domain and the extrapulmonary domain. Pulmonary comorbidities include upper respiratory tract disorders (obstructive sleep apnea, allergic and nonallergic rhinitis, chronic rhinosinusitis, nasal polyposis) and middle/lower respiratory tract disorders (chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis and fungal sensitization, bronchiectasis, dysfunctional breathing). Extrapulmonary comorbidities include anxiety, depression, gastro-esophageal reflux disease, obesity, cardiovascular, and metabolic diseases. SUMMARY The identification of comorbidities via multidimensional approach is needed to initiate appropriate multidisciplinary management of patients with severe asthma.
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5
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Hakola R, Leino T, Luukkonen R, Kauppi P. Occupational health check-ups and health-promoting programs and asthma. BMC Public Health 2020; 20:1313. [PMID: 32867741 PMCID: PMC7457532 DOI: 10.1186/s12889-020-09403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background The focus in occupational health check-ups is in work and health, but they offer also a possibility to assess health behavior and give guidance e.g. on weight control. We wanted to study whether having occupational health checks-up, receiving physicians’ advice to change health behavior or participation in health promotion programs had an effect on obesity in a five-year follow-up from 1998 to 2003 in asthmatic and non-asthmatic workers. Methods Altogether 23,220 individuals aged 20–54 years were picked up from a randomized Finnish population sample. Univariate and multivariate logistic regression analysis was used to calculate the risk for obesity in 2003. The variables used in the modelling were gender, age, smoking, asthma, depression, and physical workload. Results Both asthmatic and non-asthmatic workers gained weight during the follow-up. Of the asthmatics 48 and 47% of the non-asthmatics had occupational health-check-up in the last 5 years. Of the asthmatics 18 and 14% of the non-asthmatics had received physician’s advice to change their health behavior (p < 0.001). Associated factors for obesity (BMI > 30) in 2003 were gender (men OR 1.19), older age (OR 1.25), smoking (OR 1.07) or depression (OR 1.44). Conclusions Results show that having occupational health checks-up or receiving physicians’ advice to change health behavior or participation in health promotion programs did not stop gain of weight during a five-year follow-up. Asthmatic workers did not differ from non-asthmatics. Male gender, older age, smoking, and depression were associated with obesity but not the physical workload.
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Affiliation(s)
- Riina Hakola
- Department of Public Health, University of Helsinki, PO Box 40, 00014, Helsinki, Finland.
| | - Timo Leino
- The Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ritva Luukkonen
- The Finnish Institute of Occupational Health, Helsinki, Finland
| | - Paula Kauppi
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
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Brandts L, van den Brandt PA. Body size, non-occupational physical activity and the chance of reaching longevity in men and women: findings from the Netherlands Cohort Study. J Epidemiol Community Health 2019; 73:239-249. [PMID: 30665909 DOI: 10.1136/jech-2018-211410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The rising number of obese and/or physically inactive individuals might negatively impact human lifespan. This study assessed the association between height, body mass index (BMI) and non-occupational physical activity and the likelihood of reaching 90 years of age, in both sexes separately. METHODS Analyses were conducted using data from the Netherlands Cohort Study. Participants born in 1916-1917 (n=7807) completed a questionnaire in 1986 (at age 68-70 years) and were followed up for vital status information until the age of 90 years (2006-2007). Cox regression analyses were based on 5479 participants with complete data to calculate risk ratios (RRs) of reaching longevity (age 90 years). RESULTS In women, we observed significant associations between reaching longevity and height (RR: 1.05 per 5 cm increment; 95% CI 1.00 to 1.09), BMI at baseline (≥30vs18.5-<25 kg/m2; RR: 0.68; 95% CI 0.54 to 0.86) and BMI change since age 20 years (≥8vs0-<4 kg/m2; RR: 0.81; 95% CI 0.66 to 0.98). In men, height and BMI were not associated with reaching longevity. In women, non-occupational physical activity showed an inverse U-shaped association with reaching longevity, with the highest RR around 60 min of physical activity per day. In men, a positive linear association was observed between physical activity and reaching longevity. CONCLUSION This study indicates that body size and physical activity are related to the likelihood of reaching 90 years of age and that these associations differ by sex.
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Affiliation(s)
- Lloyd Brandts
- Department of Epidemiology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of Epidemiology, Maastricht University Medical Centre, CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands
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7
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Faeh D, Kaufmann M, Haile SR, Bopp M. BMI-mortality association: shape independent of smoking status but different for chronic lung disease and lung cancer. Int J Chron Obstruct Pulmon Dis 2018; 13:1851-1855. [PMID: 29922051 PMCID: PMC5995287 DOI: 10.2147/copd.s157629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Besides smoking, low or high body mass index (BMI) is associated with chronic lung disease (CLD). It is unclear how CLD is associated with BMI, whether smoking interacts with this association, and how the associations differ from the patterns known for lung cancer. Population and Methods Our population comprised 35,212 individuals aged 14–99, who participated in population-based surveys conducted in 1977–1993 in Switzerland (mortality follow-up until 2014). We categorized smokers into never, former, light, and heavy; and BMI into underweight, normal weight, overweight, and obese. Hazard ratios (HRs) were obtained with multivariable Cox proportional hazards models. Results CLD mortality was strongly associated with being underweight. This was mainly due to the effect in men (HR 5.04 [2.63–9.66]) and also prevailed in never smokers (HR 1.81 [1.11–3.00]). Obesity was also associated with CLD mortality (HR men: 1.37 [1.01–1.86], women: 1.39 [0.90–2.17]), but not with lung cancer mortality. In line with lung cancer, for CLD, the BMI–mortality association followed the same shape in all smoking categories, suggesting that this association was largely independent of smoking status. Conclusion The shape of the BMI–mortality association was inversely linear for lung cancer but followed a U-shape for CLD. Further research should examine the potentially protective effect of obesity on lung cancer occurrence and the possibly hazardous impact of underweight on CLD development.
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Affiliation(s)
- David Faeh
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.,Health Department - Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
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Pinto P, Rothnie KJ, Lui K, Timmis A, Smeeth L, Quint JK. Presentation, management and mortality after a first MI in people with and without asthma: A study using UK MINAP data. Chron Respir Dis 2018; 15:60-70. [PMID: 28393591 PMCID: PMC5802653 DOI: 10.1177/1479972317702140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/10/2017] [Accepted: 02/23/2017] [Indexed: 01/07/2023] Open
Abstract
Asthma has been associated with a higher incidence of myocardial infarction (MI), higher prevalence of MI risk factors and higher burden of cardiovascular diseases. However, detailed associations between the presentation and initial management at the time of MI and post-MI outcomes in people with asthma compared to the general population have not been studied. A total of 300,161 people were identified with a first MI over the period 2003-2013 in the Myocardial Ischaemia National Audit Project database, of whom 8922 (3%) had asthma. Logistic regression was used to compare presentation, in-hospital care, in-hospital and 180-day post-discharge all-cause mortality in people with and without asthma adjusting for demographics and comorbidities, diagnosis on arrival and secondary prevention. People with asthma were more likely to have a delay in their MI diagnosis following an STEMI (ST-elevation myocardial infarction; odds ratio (OR) 1.38, confidence interval CI 1.06-1.79) but not an nSTEMI (non-ST-elevation myocardial infarction; OR 1.04, CI 0.92-1.17) compared to people without asthma and a delay in reperfusion (OR 1.19, CI 1.09-1.30) following an STEMI. They were much less likely to be discharged on a beta blocker following an STEMI or nSTEMI (OR 0.24, CI 0.21-0.28 and OR 0.27, CI 0.24-0.30, respectively). There was no difference in in-hospital or 180-day mortality (OR 0.98, CI 0.59-1.62 and OR 0.99, CI 0.72-1.36) following an STEMI or nSTEMI (OR 0.89, CI 0.47-1.68 and OR 1.05, CI 0.85-1.28). Although people with asthma were more likely to have a delay in diagnosis following an STEMI but not an nSTEMI compared to the general population, were more likely to have a delay in reperfusion therapy and were much less likely to receive beta blockers following an STEMI or nSTEMI, there was no difference in the prescriptions of other secondary prevention medications. None of the differences in presentation or management were associated with an increase in all-cause in-hospital or 180-day mortality in people with asthma compared to the general population.
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Affiliation(s)
- Paulo Pinto
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kieran J Rothnie
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kelvin Lui
- Faculty of Life Sciences, University College London, London, UK
| | - Adam Timmis
- Barts NIHR Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer K Quint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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9
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Cazzola M, Rogliani P, Calzetta L, Lauro D, Page C, Matera MG. Targeting Mechanisms Linking COPD to Type 2 Diabetes Mellitus. Trends Pharmacol Sci 2017; 38:940-951. [DOI: 10.1016/j.tips.2017.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 01/26/2023]
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10
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Calzetta L, Puxeddu E, Rogliani P. Gender-related Responsiveness to the Pharmacological Treatment of COPD: A First Step Towards the Personalized Medicine. EBioMedicine 2017; 19:14-15. [PMID: 28473238 PMCID: PMC5440626 DOI: 10.1016/j.ebiom.2017.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/28/2017] [Indexed: 11/26/2022] Open
Abstract
The post-hoc analysis of the data collected from the Lung Health Study supports the evolving concept that the impact of COPD may be different between men and women, and supports the hypothesis of a gender-related responsiveness to the pharmacological treatment of COPD. Specific translational studies are needed to assess the real gender-related impact of the currently available dual bronchodilation therapy on the lung function and clinical outcomes of COPD patients. This approach may represent the first affordable step towards a feasible personalized medicine.
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Affiliation(s)
- Luigino Calzetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Ermanno Puxeddu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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11
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Li X, Obeidat M, Zhou G, Leung JM, Tashkin D, Wise R, Connett J, Joubert P, Bossé Y, van den Berge M, Brandsma CA, Nickle DC, Hao K, Paré PD, Sin DD. Responsiveness to Ipratropium Bromide in Male and Female Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease. EBioMedicine 2017; 19:139-145. [PMID: 28461224 PMCID: PMC5440622 DOI: 10.1016/j.ebiom.2017.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 02/07/2023] Open
Abstract
Introduction Although the prevalence of chronic obstructive pulmonary disease (COPD) is similar between men and women, current evidence used to support bronchodilator therapy has been generated in therapeutic trials that have predominately enrolled male patients. Here, we determined whether there is any significant sex-related differences in FEV1 responses to ipratropium bromide. Methods Data from the Lung Health Study (n = 5887; 37% females) were used to determine changes in FEV1 with ipratropium or placebo in male and female subjects with mild to moderate COPD over 5 years. Lung Expression Quantitative Trait Loci (eQTL) dataset was used to determine whether there were any sex-related differences in gene expression for muscarinic (M2 and M3) receptors in lungs of male and female patients. Results After 4 months, ipratropium therapy increased FEV1 by 6.0% in female and 2.9% in male subjects from baseline values (p = 2.42 × 10− 16). This effect was modified by body mass index (BMI) such that the biggest improvements in FEV1 with ipratropium were observed in thin female subjects (p for BMI ∗ sex interaction = 0.044). The sex-related changes in FEV1 related to ipratropium persisted for 2 years (p = 0.0134). Female compared with male lungs had greater gene expression for M3 relative to M2 receptors (p = 6.86 × 10− 8). Conclusion Ipratropium induces a larger bronchodilator response in female than in male patients and the benefits are particularly notable in non-obese females. Female lungs have greater gene expression for the M3 muscarinic receptor relative to M2 receptors than male lungs. Female patients are thus more likely to benefit from ipratropium than male COPD patients. Ipratropium; a muscarinic antagonist bronchodilator is more effective in female COPD patients compared to males. The effect was modified by body mass index (BMI) such that thin female subjects respond better. Female compared with male lungs had greater gene expression for the M3/M2 ratio of muscarinic receptors.
Most evidence used to support bronchodilator therapy in COPD has been generated in therapeutic trials with predominately male patients. Here, we determined whether there are any significant sex-related differences in lung function responses to the bronchodilator ipratropium bromide. After 4 months, ipratropium therapy increased lung function in females twice as much as males. This effect was modified by body mass index (BMI) such that the biggest improvements in lung function with ipratropium were observed in thin female subjects. Female compared with male lungs had greater gene expression for ipratropium receptors. Female patients are likely to benefit more from ipratropium than male COPD patients.
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Affiliation(s)
- Xuan Li
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ma'en Obeidat
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Janice M Leung
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald Tashkin
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Wise
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Connett
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Philippe Joubert
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Yohan Bossé
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada; Department of Molecular Medicine, Laval University, Québec, Canada
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Corry-Anke Brandsma
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, The Netherlands
| | | | - Ke Hao
- Department of Genetics and Genomics Sciences, Mount Sinai School of Medicine, New York, NY, USA
| | - Peter D Paré
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, British Columbia, Canada.
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12
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Gini R, Schuemie MJ, Mazzaglia G, Lapi F, Francesconi P, Pasqua A, Bianchini E, Montalbano C, Roberto G, Barletta V, Cricelli I, Cricelli C, Dal Co G, Bellentani M, Sturkenboom M, Klazinga N. Automatic identification of type 2 diabetes, hypertension, ischaemic heart disease, heart failure and their levels of severity from Italian General Practitioners' electronic medical records: a validation study. BMJ Open 2016; 6:e012413. [PMID: 27940627 PMCID: PMC5168667 DOI: 10.1136/bmjopen-2016-012413] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The Italian project MATRICE aimed to assess how well cases of type 2 diabetes (T2DM), hypertension, ischaemic heart disease (IHD) and heart failure (HF) and their levels of severity can be automatically extracted from the Health Search/CSD Longitudinal Patient Database (HSD). From the medical records of the general practitioners (GP) who volunteered to participate, cases were extracted by algorithms based on diagnosis codes, keywords, drug prescriptions and results of diagnostic tests. A random sample of identified cases was validated by interviewing their GPs. SETTING HSD is a database of primary care medical records. A panel of 12 GPs participated in this validation study. PARTICIPANTS 300 patients were sampled for each disease, except for HF, where 243 patients were assessed. OUTCOME MEASURES The positive predictive value (PPV) was assessed for the presence/absence of each condition against the GP's response to the questionnaire, and Cohen's κ was calculated for agreement on the severity level. RESULTS The PPV was 100% (99% to 100%) for T2DM and hypertension, 98% (96% to 100%) for IHD and 55% (49% to 61%) for HF. Cohen's kappa for agreement on the severity level was 0.70 for T2DM and 0.69 for hypertension and IHD. CONCLUSIONS This study shows that individuals with T2DM, hypertension or IHD can be validly identified in HSD by automated identification algorithms. Automatic queries for levels of severity of the same diseases compare well with the corresponding clinical definitions, but some misclassification occurs. For HF, further research is needed to refine the current algorithm.
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Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martijn J Schuemie
- Department of EpidemiologyJanssen Research & Development, Titusville, New Jersey, USA
- Observational Health Data Sciences and Informatics (OHDSI), New York, New York, USA
| | - Giampiero Mazzaglia
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Paolo Francesconi
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Elisa Bianchini
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Valentina Barletta
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | | | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Giulia Dal Co
- Agenzia Nazionale per il Servizi Sanitari Regionali, Rome, Italy
| | | | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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13
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Rogliani P, Ora J, Puxeddu E, Cazzola M. Airflow obstruction: is it asthma or is it COPD? Int J Chron Obstruct Pulmon Dis 2016; 11:3007-3013. [PMID: 27942210 PMCID: PMC5137932 DOI: 10.2147/copd.s54927] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite the availability of guideline recommendations, diagnostic confusion between COPD and asthma appears common, and often it is very difficult to decide whether the obstruction is caused by asthma or COPD in a patient with airway obstruction. However, there are well-defined features that help in differentiating asthma from COPD in the presence of fixed airflow obstruction. Nonetheless, the presentations of asthma and COPD can converge and mimic each other, making it difficult to give these patients a diagnosis of either condition. The association of asthma and COPD in the same patient has been designated mixed asthma–COPD phenotype or overlap syndrome. However, since the absence of a clear definition and the inclusion of patients with different characteristics under this umbrella term, it may not facilitate treatment decisions, especially in the absence of clinical trials addressing this heterogeneous population. We are realizing that neither asthma nor COPD are single diseases, but rather syndromes consisting of several endotypes and phenotypes, consequently comprising a spectrum of diseases that must be recognized and adequately treated with targeted therapy. Therefore, we must treat patients by personalizing therapy on the basis of those treatable traits present in each subject.
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Affiliation(s)
- Paola Rogliani
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Josuel Ora
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ermanno Puxeddu
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Mario Cazzola
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
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14
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Pandolfi P, Zanasi A, Musti MA, Stivanello E, Pisani L, Angelini S, Maffei F, Hrelia S, Angeloni C, Zenesini C, Hrelia P. Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients. PLoS One 2015; 10:e0135116. [PMID: 26252571 PMCID: PMC4529271 DOI: 10.1371/journal.pone.0135116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 07/19/2015] [Indexed: 11/30/2022] Open
Abstract
Background Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients. Methods Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant’Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines. Results 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01–16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52–8.83), belonging to moderate (HR = 3.50; 95% CI 1.01–12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35–28.85). Conclusions Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.
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Affiliation(s)
- Paolo Pandolfi
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
- * E-mail:
| | | | | | - Elisa Stivanello
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - Lara Pisani
- Department of Clinical, Integrated and Experimental Medicine, Respiratory and Clinical Care Unit, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - Sabrina Angelini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Maffei
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy
| | - Silvana Hrelia
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy
| | - Cristina Angeloni
- Department for Life Quality Studies, Alma Mater Studiorum, University of Bologna, Rimini, Italy
| | - Corrado Zenesini
- Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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15
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McCormack MC, Belli AJ, Kaji DA, Matsui EC, Brigham EP, Peng RD, Sellers C, Williams DL, Diette GB, Breysse PN, Hansel NN. Obesity as a susceptibility factor to indoor particulate matter health effects in COPD. Eur Respir J 2015; 45:1248-57. [PMID: 25573407 DOI: 10.1183/09031936.00081414] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/02/2014] [Indexed: 11/05/2022]
Abstract
Our goal was to investigate whether obesity increases susceptibility to the adverse effects of indoor particulate matter on respiratory morbidity among individuals with chronic obstructive pulmonary disease (COPD). Participants with COPD were studied at baseline, 3 and 6 months. Obesity was defined as a body mass index ≥30 kg·m(-2). At each time point, indoor air was sampled for 5-7 days and particulate matter (PM) with an aerodynamic size ≤2.5 μm (PM2.5) and 2.5-10 μm (PM2.5-10) was measured. Respiratory symptoms, health status, rescue medication use, exacerbations, blood biomarkers and exhaled nitric oxide were assessed simultaneously. Of the 84 participants enrolled, 56% were obese and all were former smokers with moderate-to-severe COPD. Obese participants tended to have less severe disease as assessed by Global Initiative for Chronic Obstructive Pulmonary Disease stage and fewer pack-years of smoking. There was evidence that obesity modified the effects of indoor PM on COPD respiratory outcomes. Increases in PM2.5 and PM2.5-10 were associated with greater increases in nocturnal symptoms, dyspnoea and rescue medication use among obese versus non-obese participants. The impact of indoor PM on exacerbations, respiratory status and wheeze also tended to be greater among obese versus non-obese participants, as were differences in airway and systemic inflammatory responses to indoor PM. We found evidence that obesity was associated with exaggerated responses to indoor fine and coarse PM exposure among individuals with COPD.
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Affiliation(s)
- Meredith C McCormack
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew J Belli
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deepak A Kaji
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Matsui
- Dept of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily P Brigham
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger D Peng
- Dept of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cortlandt Sellers
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D'Ann L Williams
- Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory B Diette
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patrick N Breysse
- Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nadia N Hansel
- Dept of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Rogliani P, Calzetta L, Segreti A, Barrile A, Cazzola M. Diabetes mellitus among outpatients with COPD attending a university hospital. Acta Diabetol 2014; 51:933-40. [PMID: 24728837 DOI: 10.1007/s00592-014-0584-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/24/2014] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes mellitus is a common comorbidity of COPD, but there are still many doubts about the relation among diabetes and COPD. We retrospectively collected data from patients afferent to our Respiratory Diseases outpatient clinic at the Tor Vergata University Hospital between 2010 and 2012. The study population was analyzed by clusters of age, gender, body mass index (BMI), smoking status, lung function, concomitant pharmacologic therapies and comorbidities. The values of the association between variables were expressed as odds ratio. Data were adjusted for gender, age and possible confounding variables by Mantel-Haenszel method. We identified 493 patients with COPD. Ninety-two (18.7 %) patients were affected by type 2 diabetes mellitus, with no significant gender differences. The prevalence distribution was similar among the different age clusters, but the association was stronger in patients younger than 65 years. The association was present only in obese subjects in whom it was significant only in patients with moderate-to-severe COPD, but not mild COPD. The presence of cardiovascular diseases was significantly associated with diabetes mellitus in patients with COPD. There was a slight association of inhaled corticosteroid (ICS) use with the presence of diabetes mellitus in COPD, but the combination of an ICS with a β2-agonist apparently reduced this association. The association with type 2 diabetes mellitus was greater in patients with COPD respect to general population, and correlated with the increase in BMI and the presence of other comorbidities, suggesting that both diseases may be targets of systemic inflammation.
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Affiliation(s)
- Paola Rogliani
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
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17
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Mathews JA, Williams AS, Brand JD, Wurmbrand AP, Chen L, Ninin FMC, Si H, Kasahara DI, Shore SA. γδ T cells are required for pulmonary IL-17A expression after ozone exposure in mice: role of TNFα. PLoS One 2014; 9:e97707. [PMID: 24823369 PMCID: PMC4019643 DOI: 10.1371/journal.pone.0097707] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/22/2014] [Indexed: 11/21/2022] Open
Abstract
Ozone is an air pollutant that causes pulmonary symptoms. In mice, ozone exposure causes pulmonary injury and increases bronchoalveolar lavage macrophages and neutrophils. We have shown that IL-17A is important in the recruitment of neutrophils after subacute ozone exposure (0.3 ppm for 24–72 h). We hypothesized that γδ T cells are the main producers of IL-17A after subacute ozone. To explore this hypothesis we exposed wildtype mice and mice deficient in γδ T cells (TCRδ−/−) to ozone or room air. Ozone-induced increases in BAL macrophages and neutrophils were attenuated in TCRδ−/− mice. Ozone increased the number of γδ T cells in the lungs and increased pulmonary Il17a mRNA expression and the number of IL-17A+ CD45+ cells in the lungs and these effects were abolished in TCRδ−/− mice. Ozone-induced increases in factors downstream of IL-17A signaling, including G-CSF, IL-6, IP-10 and KC were also decreased in TCRδ−/− versus wildtype mice. Neutralization of IL-17A during ozone exposure in wildtype mice mimicked the effects of γδ T cell deficiency. TNFR2 deficiency and etanercept, a TNFα antagonist, also reduced ozone-induced increases in Il17a mRNA, IL-17A+ CD45+ cells and BAL G-CSF as well as BAL neutrophils. TNFR2 deficient mice also had decreased ozone-induced increases in Ccl20, a chemoattractant for IL-17A+ γδ T cells. Il17a mRNA and IL-17A+ γδ T cells were also lower in obese Cpefat versus lean WT mice exposed to subacute ozone, consistent with the reduced neutrophil recruitment observed in the obese mice. Taken together, our data indicate that pulmonary inflammation induced by subacute ozone requires γδ T cells and TNFα-dependent recruitment of IL-17A+ γδ T cells to the lung.
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MESH Headings
- Analysis of Variance
- Animals
- Bronchoalveolar Lavage
- DNA Primers/genetics
- Etanercept
- Flow Cytometry
- Immunoglobulin G
- Interleukin-17/metabolism
- Lung/drug effects
- Lung/immunology
- Macrophages/immunology
- Mice
- Mice, Knockout
- Neutrophils/immunology
- Ozone/toxicity
- Pneumonia/chemically induced
- Pneumonia/immunology
- Real-Time Polymerase Chain Reaction
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Receptors, Tumor Necrosis Factor
- Receptors, Tumor Necrosis Factor, Type II
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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Affiliation(s)
- Joel A. Mathews
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Alison S. Williams
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Jeffrey D. Brand
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Allison P. Wurmbrand
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Lucas Chen
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Fernanda MC. Ninin
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Huiqing Si
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - David I. Kasahara
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Stephanie A. Shore
- Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
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