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Ruiz-Rull C, Jaén-Moreno MJ, Del Pozo GI, Camacho-Rodríguez C, Rodríguez-López M, Rico-Villademoros F, Otero-Ferrer JL, Feu N, Reyes-López M, Fiestas RM, Laguna-Muñoz D, Jiménez-Peinado A, Mannino D, Vieta E, Sarramea F. Lung function decline in people with serious mental illness: A call to action. Eur Neuropsychopharmacol 2024; 89:41-46. [PMID: 39332148 DOI: 10.1016/j.euroneuro.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/29/2024]
Abstract
This prospective observational study aimed to evaluate the rate of change in forced expiratory volume in the first second (FEV1) and to explore the factors associated with changes in FEV1 in people with serious mental illness (SMI). Sixty subjects diagnosed with schizophrenia or bipolar disorder who were smokers and without history of respiratory illness agreed to participate. The mean (range) follow-up period was 3.54 (3.00-4.98) years. The mean (standard deviation) annual rate of change in FEV1 decreased by 39.1 (105.2) mL/year. Thirty-one (51.7 %) patients experienced a decrease in the FEV1 ≥40 mL/year (i.e. a rapid decline). The factors associated with the absolute change in FEV1 were the baseline International Physical Activity Questionnaire activity score in metabolic equivalents of tasks (β 0.145, 95 % confidence interval [CI] 0.043 to 0.246; p = 0.005), baseline FEV1 (β -0.025, 95 % CI -0.076 to 0.027; p = 0.352), and the interaction term of both variables (β -3.172e-05, 95 % CI -6.025e-05 to -0.319e-05; p = 0.029). The factors associated with rapid FEV1 decline were income (odds ratio [OR] 0.999, 95 % CI 0.995 to 1.003; p = 0.572), the rate of change in abdominal circumference (OR 0.000, 95 % CI 0.000 to 0.890; p = 0.081), and the interaction term of both variables (OR 1.038, 95 % CI 1.010 to 1.082; p = 0.026). In conclusion, a substantial proportion of people with SMI experienced a rapid decrease in FEV1. If our results are confirmed in larger samples, the routine evaluation of lung function in people with SMI would be an opportunity to identify individuals at greater risk of morbidity and mortality.
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Affiliation(s)
- Cristina Ruiz-Rull
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain
| | - María José Jaén-Moreno
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain; University of Cordoba, Departament of Morphological and Sociosanitary Science, Córdoba, Spain.
| | - Gloria Isabel Del Pozo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain
| | - Cristina Camacho-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain
| | - Marta Rodríguez-López
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | | | - José Luis Otero-Ferrer
- Biostatech, Advice, Training and Innovation in Biostatistics (Ltd.), Santiago de Compostela, Spain
| | - Nuria Feu
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain
| | - Micaela Reyes-López
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain
| | - Rosa M Fiestas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain
| | - David Laguna-Muñoz
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain
| | - Ana Jiménez-Peinado
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain
| | - David Mannino
- University of Kentucky, Chief Medical Officer, COPD Foundation, Lexington, KY, United States
| | - Eduard Vieta
- Department of Medicine, School of Medicine & Health Sciences, University of Barcelona (UB), 143 Casanova st., 08036 Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic, 170 Villarroel st., 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 170 Villarroel st., 08036 Barcelona, Catalonia, Spain; Institute of Neurosciences (UBNeuro), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Sarramea
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avenida Menéndez Pidal, 14004 Córdoba, Spain; Reina Sofia University Hospital, Avenida Menéndez Pidal 7, 14004 Córdoba, Spain; University of Cordoba, Departament of Morphological and Sociosanitary Science, Córdoba, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Kühnisch J, Zhao T, Bertelsen RJ, Jörres RA, Nowak D, Heinrich J. The impact of gingivitis reduction on lung function: a randomized trial under intensified oral hygiene. Trials 2023; 24:139. [PMID: 36823669 PMCID: PMC9949689 DOI: 10.1186/s13063-023-07135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Periodontal disease and lung function impairment were found to be associated with low-grade systemic or local inflammation, and it might be that gingival/periodontal inflammation triggers lung function due to systemic inflammation or the transfer of oral bacteria or its components to the lung. A recent observational study in non-smoking subjects showed that lung volumes and flow rates were significantly reduced by 71-185 ml for severe gingivitis regardless of the adjustment for potential confounders. The result did not show any confounding by smoking, and the association between gingivitis and lower lung function was not modified by systemic inflammation. The designed interventional trial primarily aims to test the hypothesis that gingivitis reduction by optimized daily oral hygiene, professional tooth cleaning and antibacterial chlorhexidine (CHX)-containing mouth rinse improves lung function in terms of forced vital capacity (FVC) by at least 2%. The secondary objective will test the hypothesis that gingivitis reduction improves forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75) by at least 2%. Furthermore, the influence of the oral microbiome will be taken into account. METHODS The study has to include 120 non-smoking subjects aged between 18 and 30 years with biofilm-induced gingivitis. The chosen "waiting control group design" will compare the immediate intervention group with the delayed intervention group, which serves as a control group. Dental and gingival status, lung function and oral microbiome will be recorded. The intensified preventive intervention-professional tooth cleaning, one-stage full-mouth disinfection with CHX and safeguarding an optimal daily oral hygiene by each subject-cannot be blinded, but the outcome measurement in terms of lung function tests is blind. DISCUSSION This proposed multidisciplinary study has several strengths. Only one previous intervention study with patients with severe periodontitis (mostly smokers) has been performed. It is novel to include non-smoking subjects with mild and potentially reversible oral inflammation. Furthermore, this research is innovative, because it includes evidence-based interventions for gingivitis reduction, standardized measures of the outcome on lung function and oral microbiome and combines expertise from dentistry, lung physiology, oral microbiology and epidemiology/statistical modelling. TRIAL REGISTRATION German Clinical Trial Register DRKS00028176. Registered on February 2022.
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Affiliation(s)
- Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, Germany, Munich, Germany.
| | - Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians University Munich, Germany, Munich, Germany
| | - Randi J Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians University Munich, Germany, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians University Munich, Germany, Munich, Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians University Munich, Germany, Munich, Germany
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Blake TL, Chang AB, Marchant JM, McElrea MS. Respiratory health profile of Indigenous Australian children and young adults. J Paediatr Child Health 2020; 56:1066-1071. [PMID: 32096321 DOI: 10.1111/jpc.14817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 12/01/2022]
Abstract
AIM National data report respiratory illness to be the most common chronic illness in Australian Indigenous people aged <35 years but multi-centre data on specific diseases is sparse. Respiratory health is now known to be an independent predictor of future all-cause mortality and cardiovascular disease. We aimed to describe the respiratory health profile (clinical and spirometry data) of randomly recruited Indigenous Australian children and young adults from several sites. METHODS As part of the Indigenous Respiratory Reference Values study, 1278 Australian Indigenous children and young adults (aged 3-25 years) were recruited from nine communities (Queensland, n = 8; Northern Territory, n = 1). Self-reported and medical records were used to ascertain respiratory history. Participants were classified as 'healthy' if there was no current/previous respiratory disease history. Spirometry was performed on all participants and assessed according to forced expiratory volume at 1 s impairment. RESULTS Medical history data were available for 1245 (97.4%) and spirometry for 1106 participants (86.5%). Asthma and bronchitis were the most commonly reported respiratory conditions (city/regional 19.5% and rural/remote 16.8%, respectively). Participants with a history of any respiratory disease or those living in rural/remote communities had lower lung function compared to the 'healthy' group. Almost 52.0% of the entire cohort had mild-moderate forced expiratory volume at 1 s impairment (47.7% in 'healthy' group, 58.5% in 'respiratory history' group). CONCLUSION The high prevalence of poor respiratory health among Indigenous Australian children/young adults places them at increased risk of future all-cause mortality and cardiovascular disease. Respiratory assessments including spirometry should be part of the routine evaluation of Indigenous Australians.
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Affiliation(s)
- Tamara L Blake
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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