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Muršić D, Glunčić TJ, Ostojić J, Škrinjarić-Cincar S, Kardum LB, Dokoza M, Lazarušić NK, Bešić E, Samaržija M, Dugac AV. Body composition, pulmonary function tests, exercise capacity, and quality of life in chronic obstructive pulmonary disease patients with obesity. Postgrad Med J 2024; 100:469-474. [PMID: 38377471 DOI: 10.1093/postmj/qgae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE OF THE STUDY Larger proportions of chronic obstructive pulmonary disease (COPD) patients are currently overweight or with obesity than underweight, and the combination of COPD and obesity is increasing. The purpose of this study was to investigate differences in the body composition, pulmonary function tests, exercise capacity, and health-related quality of life among normal weight, overweight, and obese patients with COPD. STUDY DESIGN A total of 514 patients with COPD were included in the study. According to the World Health Organization criteria for body mass index, the patients were classified as normal weight, overweight, and obese. Evaluations included fat-free mass, fat-free mass index, phase angle, pulmonary function tests, and 6-minute walk test. Dyspnea was assessed using the modified Medical Research Council dyspnea scale, and the health-related quality of life was evaluated using COPD Assessment Test and St. George's Respiratory Questionnaire. Values were compared among the three groups. RESULTS There were 315 male and 199 female patients, with a mean age of 66.7 ± 8.4 years. Fat-free mass, fat-free mass index, and phase angle values were significantly higher in COPD patients with obesity than in other patients (P < .001, P < .001, P < .001). Forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, and diffusing capacity of lung for carbon monoxide value in pulmonary function tests were significantly higher in COPD patients with obesity than in other patients (P = .046, P < .001, P < .001), while the forced vital capacity values were similar in all groups. Exercise capacity (6-min walk test distance), dyspnea symptoms (modified Medical Research Council scale), and health-related quality of life (COPD Assessment Test and St. George's Respiratory Questionnaire) did not differ significantly between groups. CONCLUSIONS According to our study, obesity has no negative effect on pulmonary function tests, dyspnea perception, exercise capacity, and health-related quality of life.
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Affiliation(s)
- Davorka Muršić
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Tajana Jalušić Glunčić
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Jelena Ostojić
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Sanda Škrinjarić-Cincar
- Department of Internal Medicine and History of Medicine, Faculty of Medicine, University of Osijek, 31000 Osijek, Croatia
| | | | - Martina Dokoza
- Department of Internal Medicine, Zadar General Hospital, 23000 Zadar, Croatia
| | | | - Erim Bešić
- Department of Biophysics, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Miroslav Samaržija
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Andrea Vukić Dugac
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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2
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Müller A, Wouters EF, Koul P, Welte T, Harrabi I, Rashid A, Loh LC, Al Ghobain M, Elsony A, Ahmed R, Potts J, Mortimer K, Rodrigues F, Paraguas SN, Juvekar S, Agarwal D, Obaseki D, Gislason T, Seemungal T, Nafees AA, Jenkins C, Dias HB, Franssen FME, Studnicka M, Janson C, Cherkaski HH, El Biaze M, Mahesh PA, Cardoso J, Burney P, Hartl S, Janssen DJA, Amaral AFS. Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study. Pulmonology 2024:S2531-0437(24)00044-8. [PMID: 38614859 DOI: 10.1016/j.pulmoe.2024.03.005] [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: 01/17/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC CONCLUSION The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.
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Affiliation(s)
- A Müller
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - E F Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - T Welte
- Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
| | - I Harrabi
- Faculté de Médecine, Sousse, Tunisia
| | - A Rashid
- RCSI and UCD Malaysia Campus, Penang, Malaysia
| | | | - M Al Ghobain
- King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - A Elsony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - J Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Rodrigues
- Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
| | - S N Paraguas
- Philippine College of Chest Physicians, Manila, Philippines
| | - S Juvekar
- KEM Hospital Research Centre, Pune, India
| | - D Agarwal
- KEM Hospital Research Centre, Pune, India
| | - D Obaseki
- Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
| | - T Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Seemungal
- Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
| | | | - C Jenkins
- Woolcock Institute of Medical Research, Sydney, Australia
| | - H B Dias
- Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
| | - F M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - M Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - H H Cherkaski
- Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
| | - M El Biaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
| | - P A Mahesh
- Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - D J A Janssen
- Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
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3
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Hwang IC, Lee CW, Lee YJ, Ahn HY. Association between neck circumference and pulmonary function in Korean adults. Medicine (Baltimore) 2024; 103:e37864. [PMID: 38608059 PMCID: PMC11018241 DOI: 10.1097/md.0000000000037864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Neck circumference (NC) is associated with various diseases. However, its association with pulmonary diseases remains unclear. This study aimed to investigate the association between NC and pulmonary function in Korean adults. Data from the 2019 Korean National Health and Nutrition Examination Survey were used, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). A total of 3818 adults aged 40 to 79 years were included in the analysis. Multivariable logistic regression models were used to examine factors associated with low pulmonary function (<80% of the predicted value) and calculate odds ratios (ORs) and 95% confidence intervals (CIs) for decreased lung function per 1-cm increase in NC. A negative correlation was observed between the NC and pulmonary function in both sexes. In multivariate logistic regression analyses, in contrast to men, women exhibited a notable relationship between increased NC and impaired pulmonary function, with a more pronounced effect observed in FVC (OR, 1.14; 95% CI, 1.05-1.24). Central obesity may play a role in pulmonary function decline. Understanding this relationship can inform preventive strategies and interventions to improve the respiratory health of individuals with central obesity.
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Affiliation(s)
- In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chung-Woo Lee
- Department of Family Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Yoo Jeong Lee
- Palliative Care Center and Department of Family Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hong Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Republic of Korea
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Aron J, Baldomero AK, Rau A, Fiecas MB, Wendt CH, Berman JD. Individual Risk Factors of PM 2.5 Associated With Wintertime Mortality in Urban Patients With COPD. Chest 2024; 165:825-835. [PMID: 37858719 PMCID: PMC11026168 DOI: 10.1016/j.chest.2023.10.016] [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: 07/05/2023] [Revised: 09/19/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Air pollution contributes to premature mortality, but potential impacts differ in populations with existing disease, particularly for individuals with multiple risk factors. Although COPD increases vulnerability to air pollution, individuals with COPD and other individual risk factors are at the intersection of multiple risks and may be especially susceptible to the effect of acute outdoor air pollution. RESEARCH QUESTION What is the association between wintertime air pollution and mortality in patients with COPD and the modifying role of individual risk factors? STUDY DESIGN AND METHODS This study evaluated 19,243 deceased veterans with prior COPD diagnosis who had resided in 25 US metropolitan regions (2016-2019). Electronic health records included patient demographic characteristics; smoking status; and comorbidities such as asthma, coronary artery disease (CAD), obesity, and diabetes. Using geocoded addresses, individuals were assigned wintertime fine particulate matter (particulate matter smaller than 2.5 μg in diameter [PM2.5]) and nitrogen dioxide air pollution exposures. Associations between acute air pollution and mortality were estimated by using a time-stratified case-crossover design with a conditional logistic model, and individual risk differences were assessed according to stratified analysis. RESULTS A 1.05 (95% CI, 1.02-1.09) mortality risk was estimated for each 10 μg/m3 increase in daily wintertime PM2.5). Older patients and Black individuals displayed elevated risk. Obesity was a substantial air pollution-related mortality risk factor (OR, 1.11; 95% CI, 1.01-1.23), and the estimated risk for individuals with obesity plus CAD or obesity plus diabetes was 16% higher. INTERPRETATION Wintertime PM2.5 exposure was associated with elevated mortality risk in people with COPD, but individuals with multiple comorbidities, notably obesity, had high vulnerability. Our study suggests that obesity, CAD, and diabetes are understudied modifiers of air pollution-related risks for people with existing COPD.
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Affiliation(s)
- Jordan Aron
- Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Arianne K Baldomero
- Pulmonary, Allergy, Critical Care and Sleep Medicine, Medical School, University of Minnesota, Minneapolis, MN; Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | - Austin Rau
- Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Mark B Fiecas
- Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Christine H Wendt
- Pulmonary, Allergy, Critical Care and Sleep Medicine, Medical School, University of Minnesota, Minneapolis, MN; Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN
| | - Jesse D Berman
- Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN
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Pankoke S, Schweitzer T, Bikker R, Pich A, Pfarrer C, Mühlfeld C, Schipke J. Obesity impacts hypoxia adaptation of the lung. Am J Physiol Lung Cell Mol Physiol 2023; 325:L352-L359. [PMID: 37461840 DOI: 10.1152/ajplung.00125.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 08/19/2023] Open
Abstract
Obesity is mostly associated with adverse health consequences, but may also elicit favorable effects under chronic conditions. This "obesity paradox" is under debate for pulmonary diseases. As confounding factors complicate conclusions from human studies, this study used a controlled animal model combining diet-induced obesity and chronic hypoxia as a model for pulmonary hypertension and chronic obstructive pulmonary disease. Male C57BL/6 mice were fed control or high-fat diet for 30 wk, and half of the animals were exposed to chronic hypoxia (13% O2) for 3 wk. Hypoxia induced right ventricular hypertrophy, thickening of pulmonary arterial and capillary walls, higher lung volumes, and increased hemoglobin concentrations irrespective of the body weight. In contrast, lung proteomes differed substantially between lean- and obese-hypoxic mice. Many of the observed changes were linked to vascular and extracellular matrix (ECM) proteins. In lean-hypoxic animals, circulating platelets were reduced and abundances of various clotting-related proteins were altered, indicating a hypercoagulable phenotype. Moreover, the septal ECM composition was changed, and airspaces were significantly distended pointing to lung hyperinflation. These differences were mostly absent in the obese-hypoxic group. However, the obesity-hypoxia combination induced the lowest blood CO2 concentrations, indicating hyperventilation for sufficient oxygen supply. Moreover, endothelial surface areas were increased in obese-hypoxic mice. Thus, obesity exerts differential effects on lung adaptation to hypoxia, which paradoxically include not only adverse but also rather protective changes. These differences have a molecular basis in the lung proteome and may influence the pathogenesis of lung diseases. This should be taken into account for future individualized prevention and therapy.NEW & NOTEWORTHY An "obesity paradox" is discussed for pulmonary diseases. By linking lung proteome analyses to pulmonary structure and function, we demonstrate that diet-induced obesity affects lung adaptation to chronic hypoxia in various ways. The observed changes include not only adverse but also protective effects and are associated with altered abundances of vascular and extracellular matrix proteins. These results highlight the existence of relevant differences in individuals with obesity that may influence the pathogenesis of lung diseases.
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Affiliation(s)
- Sophia Pankoke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Theresa Schweitzer
- Institute of Toxicology, Hannover Medical School, Hannover, Germany
- Core Facility Proteomics, Hannover Medical School, Hannover, Germany
| | - Rolf Bikker
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Andreas Pich
- Institute of Toxicology, Hannover Medical School, Hannover, Germany
- Core Facility Proteomics, Hannover Medical School, Hannover, Germany
| | - Christiane Pfarrer
- Institute of Anatomy, University of Veterinary Medicine, Foundation, Hannover, Germany
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Julia Schipke
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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6
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Hagmann M, Baty F, Rassouli F, Maeder MT, Brutsche MH. Gender-specific disease trajectories prior to the onset of COPD allow individualized screening and early intervention. PLoS One 2023; 18:e0288237. [PMID: 37418429 DOI: 10.1371/journal.pone.0288237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/21/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Nation-wide hospitalization databases include diagnostic information at the level of an entire population over an extended period of time. Comorbidity network and early disease development can be unveiled. Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition for which it is crucial to identify early disease indicators. The identification of gender-specific conditions preceding the onset of COPD may reveal disease progression patterns allowing for early diagnosis and intervention. The objective of the study was to investigate the antecedent hospitalization history of patients newly diagnosed with COPD and to retrace a gender-specific trajectory of coded entities prior to the onset of COPD. MATERIAL AND METHODS A population-wide hospitalization database including information about all hospitalizations in Switzerland between 2002 and 2018 was used. COPD cases were extracted from the database and comorbidities occurring prior to the onset of COPD identified. Comorbidities significantly over-represented in COPD compared with a 1:1, age- and sex-matched control population were identified and their longitudinal evolution was analyzed. RESULTS Between 2002 and 2018, 697,714 hospitalizations with coded COPD were recorded in Switzerland. Sixty-two diagnoses were significantly over-represented before onset of COPD. These preceding comorbidities included both well-established conditions and novel links to COPD. Early pre-conditions included nicotine and alcohol abuse, obesity and cardiovascular diseases. Later comorbidities included atrial fibrillation, diseases of the genitourinary system and pneumonia. Atherosclerotic heart diseases were more prevalent in males, whereas hypothyroidism, varicose and intestinal disorders were more frequent in females. Disease trajectories were validated using an independent data set. CONCLUSIONS Gender-specific disease trajectories highlight early indicators and pathogenetic links between COPD and antecedent diseases and could allow for early detection and intervention.
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Affiliation(s)
- Michelle Hagmann
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Micha T Maeder
- Department of Cardiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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7
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Bhide P, Bapaye J, Mohan G, Ghose M, Ravilla J, Yarrarapu SNS, Du D. Impact of Obesity on In-Hospital Morbidity and Mortality Among Patients Admitted for Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD). Cureus 2023; 15:e35138. [PMID: 36949996 PMCID: PMC10026755 DOI: 10.7759/cureus.35138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
Background Obesity has been considered to be a risk factor for increased morbidity and mortality among patients with cardiopulmonary diseases. The burden of chronic obstructive pulmonary disease (COPD) and obesity is very high in the United States. We aimed to use the National Inpatient Sample (NIS) to evaluate the impact of obesity on the outcomes of patients hospitalized with COPD exacerbation. Materials & Methods This is a retrospective cohort study from the NIS database involving adult patients hospitalized for COPD exacerbation in the year 2019 obtained using the international classification of diseases, 10th revision coding system (ICD-10). Obese and morbidly obese subgroups were identified. Statistical analyses were done using the Stata software, and regression analysis was performed to calculate odds ratios. Adjusted odds ratios (aOR) were calculated after adjusting for potential confounders. Results Among patients hospitalized for COPD exacerbations, mortality rates were lower among obese and morbidly obese patients; aOR 0.72 [0.65, 0.80] and aOR 0.88 [0.77-0.99], respectively. Obese and morbidly obese were more likely to require non-invasive ventilation aOR 1.63 [1.55, 1.7] and aOR 1.93 [1.85-2.05], respectively, and were more likely to require mechanical ventilation aOR 1.25 [1.19, 1.31], and aOR 1.53 [1.44-1.62], respectively. The tracheostomy rate was 1.17%, 0.83%, and 0.38% among patients with morbid obesity, obesity, and nonobese patients, respectively. Obese (aOR 1.11 [1.07-1.14]) and morbidly obese patients (aOR 1.21 [1.16-1.26]) had higher odds of being discharged on home oxygen and to a skilled nursing facility (SNF), aOR 1.32[1.27-1.38] and aOR 1.37 [1.3-1.43], respectively. Average hospital charges and length of hospitalization were significantly higher for morbidly obese and obese patients as compared to non-obese patients (p < 0.01). Conclusions Among admissions for COPD exacerbation, the rates of non-invasive ventilation, mechanical ventilation, tracheostomy, discharge with supplemental oxygen, length of hospitalization, hospitalization charges, and discharge to an SNF were higher among obese patients representing a higher morbidity and healthcare utilization in this group. This, however, did not translate into increased mortality among obese patients admitted with COPD exacerbations, and further randomized controlled trials are required to confirm our findings.
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Affiliation(s)
- Poorva Bhide
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Jay Bapaye
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Gaurav Mohan
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Medha Ghose
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | | | - Doantrang Du
- Internal Medicine, RWJBarnabas Health, Long Branch, USA
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8
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Kogo M, Sato S, Muro S, Matsumoto H, Nomura N, Tashima N, Oguma T, Sunadome H, Nagasaki T, Murase K, Kawaguchi T, Tabara Y, Matsuda F, Chin K, Hirai T. Development of airflow limitation, dyspnoea, and both in the general population: the Nagahama study. Sci Rep 2022; 12:20060. [PMID: 36414653 PMCID: PMC9681883 DOI: 10.1038/s41598-022-24657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Subjects with subclinical respiratory dysfunction who do not meet the chronic obstructive pulmonary disease (COPD) criteria have attracted attention with regard to early COPD intervention. Our aim was to longitudinally investigate the risks for the development of airflow limitation (AFL) and dyspnoea, the main characteristics of COPD, in a large-scale community-based general population study. The Nagahama study included 9789 inhabitants, and a follow-up evaluation was conducted after 5 years. AFL was diagnosed using a fixed ratio (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) < 0.7). We enrolled normal subjects aged 40-75 years with no AFL, dyspnoea or prior diagnosis of asthma or COPD at baseline. In total, 5865 subjects were analysed, 310 subjects had subclinical respiratory dysfunction (FEV1/FVC < the lower limit of normal; n = 57, and FEV1 < 80% of the predicted value (preserved ratio impaired spirometry); n = 256). A total of 5086 subjects attended the follow-up assessment, and 449 and 1021 subjects developed AFL and dyspnoea, respectively. Of these, 100 subjects developed AFL with dyspnoea. Baseline subclinical respiratory dysfunction was independently and significantly associated with AFL with dyspnoea development within 5 years. Subjects with subclinical respiratory dysfunction are at risk of developing COPD-like features and require careful monitoring.
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Affiliation(s)
- Mariko Kogo
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Susumu Sato
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan ,grid.258799.80000 0004 0372 2033Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Muro
- grid.410814.80000 0004 0372 782XDepartment of Respiratory Medicine, Nara Medical University, Kashihara, Nara Japan
| | - Hisako Matsumoto
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan ,grid.258622.90000 0004 1936 9967Department of Respiratory Medicine and Allergology, Kindai University, Osakasayama, Osaka Japan
| | - Natsuko Nomura
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Noriyuki Tashima
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Tsuyoshi Oguma
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Hironobu Sunadome
- grid.258799.80000 0004 0372 2033Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Nagasaki
- grid.258799.80000 0004 0372 2033Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- grid.258799.80000 0004 0372 2033Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Kawaguchi
- grid.258799.80000 0004 0372 2033Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- grid.258799.80000 0004 0372 2033Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan ,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Fumihiko Matsuda
- grid.258799.80000 0004 0372 2033Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- grid.258799.80000 0004 0372 2033Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan ,grid.260969.20000 0001 2149 8846Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Department of Internal Medicine, Nihon University of Medicine, Tokyo, Japan
| | - Toyohiro Hirai
- grid.258799.80000 0004 0372 2033Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
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9
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Nicholson JM, Orsso CE, Nourouzpour S, Elangeswaran B, Chohan K, Orchanian-Cheff A, Fidler L, Mathur S, Rozenberg D. Computed tomography-based body composition measures in COPD and their association with clinical outcomes: A systematic review. Chron Respir Dis 2022; 19:14799731221133387. [PMID: 36223552 PMCID: PMC9561670 DOI: 10.1177/14799731221133387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) is commonly utilized in chronic obstructive
pulmonary disease (COPD) for lung cancer screening and emphysema
characterization. Computed tomography-morphometric analysis of body
composition (muscle mass and adiposity) has gained increased recognition as
a marker of disease severity and prognosis. This systematic review aimed to
describe the CT-methodology used to assess body composition and identify the
association of body composition measures and disease severity,
health-related quality of life (HRQL), cardiometabolic risk factors,
respiratory exacerbations, and survival in patients with COPD. Methods Six databases were searched (inception-September 2021) for studies evaluating
adult COPD patients using thoracic or abdominal CT-muscle or adiposity body
composition measures. The systematic review was conducted in accordance with
the PRISMA guidelines. Results Twenty eight articles were included with 15,431 COPD patients, across all
GOLD stages with 77% males, age range (mean/median 59–78 years), and BMI
range 19.8–29.3 kg/m2. There was heterogeneity in assessment of
muscle mass and adiposity using thoracic (n = 22) and
abdominal (n = 8) CT-scans, capturing different muscle
groups, anatomic locations, and adiposity compartments (visceral,
subcutaneous, and epicardial). Low muscle mass and increased adiposity were
associated with increased COPD severity measures (lung function, exercise
capacity, dyspnea) and lower HRQL, but were not consistent across studies.
Increased visceral adiposity (n = 6) was associated with
cardiovascular disease or risk factors (hypertension, hyperlipidemia, and
diabetes). Low muscle CSA was prognostic of respiratory exacerbations or
mortality in three of six studies, whereas the relationship with increased
intermuscular adiposity and greater mortality was only observed in one of
three studies. Conclusion There was significant variability in CT-body composition measures. In several
studies, low muscle mass was associated with increased disease severity and
lower HRQL, whereas adiposity with cardiovascular disease/risk factors.
Given the heterogeneity in body composition measures and clinical outcomes,
the prognostic utility of CT-body composition in COPD requires further
study.
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Affiliation(s)
- John M Nicholson
- Department of Medicine,
Respirology, London
Health Science Center, London, ON,
Canada
| | - Camila E Orsso
- Department of Agricultural, Food
and Nutritional Science, University of
Alberta, Edmonton, AB, Canada
| | - Sahar Nourouzpour
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Brenawen Elangeswaran
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Karan Chohan
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Ani Orchanian-Cheff
- Library and Information Services,
University
Health Network, Toronto, ON,
Canada
| | - Lee Fidler
- Department of Medicine,
Respirology, University
Health Network, Toronto, Canada,Respirology,
Sunnybrook
Health Sciences Centre, Toronto, ON,
Canada
| | - Sunita Mathur
- Deparment of Physical Therapy,
University
of Toronto, Toronto, ON, Canada,School of Rehabilitation Therapy,
Queen’s
University, Kingston, ON, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada,Dmitry Rozenberg, Temerty Faculty of
Medicine, Respirology, Lung Transplant Program, Toronto General Hospital
Research Institute, University Health Network, 200 Elizabeth Street, 13-EN 229,
Toronto ON M5G 2C4, Canada.
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10
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Zhang H, Sun L, Yu Y, Xin H, Wu L, Yang F, Liu J, Zhang Z. The associations between body composition and vital capacity index of medical students in Shenyang of China: a cross-sectional survey. BMC Pulm Med 2022; 22:373. [PMID: 36184644 PMCID: PMC9526916 DOI: 10.1186/s12890-022-02176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aimed to examine the associations between body composition and vital capacity index (VCI) among medical students of Shenyang, China.
Study design The design of this study is a cross-sectional study. Methods Participants were 2063 individuals (17–25 years) from a medical college in Shenyang, who participated in this survey from April to May 2017. Height, weight, fat mass (FM), fat free mass (FFM), protein mass (PM), total body water (TBW), mineral mass (MM), vital capacity were measured, then BMI and VCI were calculated. Stepwise multiple linear regression analysis was used to evaluate the effect of body composition on VCI of participants in different genders. In addition, subgroup analysis was carried out according to BMI levels. Results Male students showed significantly higher height, weight, BMI, FFM, PM, TBW, MM, VC, and VCI, but lower FM in comparison with female students. Stepwise multiple linear regression analysis showed that in both sexes FM was negatively correlated with VCI which represents pulmonary function (r < 0; P < 0.001). After dividing the whole participants by BMI, further correlation analysis showed FM was positively correlated with VCI only for male subgroups with BMI < 18.5 (r > 0; P = 0.050). Conclusion Overall, FM is highly negatively correlated with the VCI of Chinese medical students of both genders. However, there was a positive correlation between FM and VCI among low-weight male students.
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Affiliation(s)
- Han Zhang
- School of Public Health, Shenyang Medical College, Shenyang, 110034, China
| | - Lu Sun
- Radiation Health Center, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, 110015, China
| | - Ye Yu
- School of Public Health, Shenyang Medical College, Shenyang, 110034, China
| | - Hong Xin
- Physical Education Department, Shenyang Medical College, Shenyang, 110034, China
| | - Li Wu
- School of Public Health, Shenyang Medical College, Shenyang, 110034, China
| | - Fengmei Yang
- School of Public Health, Shenyang Medical College, Shenyang, 110034, China
| | - Jie Liu
- School of Public Health, Shenyang Medical College, Shenyang, 110034, China
| | - Zhuo Zhang
- School of Public Health, Shenyang Medical College, Shenyang, 110034, China.
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11
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Liu S, Fu Y, Ziebolz D, Li S, Schmalz G, Li F. Transcriptomic analysis reveals pathophysiological relationship between chronic obstructive pulmonary disease (COPD) and periodontitis. BMC Med Genomics 2022; 15:130. [PMID: 35676670 PMCID: PMC9175353 DOI: 10.1186/s12920-022-01278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to detect potential crosstalk genes, pathways and immune cells between periodontitis and chronic obstructive pulmonary disease (COPD). Methods Chronic periodontitis (CP, GSE156993) and COPD (GSE42057, GSE94916) datasets were downloaded. Differential expressed genes (DEGs; p < 0.05) were assessed and screened for overlapping results, following functional pathway enrichment analyses (p < 0.05). The xCell method was used to assess immune cell infiltration relationship between CP and COPD. Features of the detected cross-talk genes were revealed using conventional Recursive Feature Elimination (RFE) algorithm in R project. Receiver-operating characteristic curves were applied to evaluate the predictive value of the genes. Furthermore, Pearson correlation analysis was performed on crosstalk markers and infiltrating immune cells in CP and COPD, respectively. Results A total of 904 DEGs of COPD and 763 DEGs of CP were acquired, showing 22 overlapping DEGs between the two diseases. Thereby 825 nodes and 923 edges were found in the related protein–protein-interaction network. Eight immune cell pairs were found to be highly correlated to both CP and COPD (|correlation coefficients |> 0.5 and p-value < 0.05). Most immune cells were differently expressed between COPD and CP. RFE identified three crosstalk genes, i.e. EPB41L4A-AS1, INSR and R3HDM1. In correlation analysis, INSR was positively correlated with Hepatocytes in CP (r = 0.6714, p = 0.01679) and COPD (r = 0.5209, p < 0.001). R3HDM was positively correlated with Th1 cells in CP (r = 0.6783, p = 0.0153) and COPD (r = 0.4120, p < 0.01). Conclusion EPB41L4A-AS1, INSR and R3HDM1 are potential crosstalk genes between COPD and periodontitis. R3HDM was positively correlated with Th1 cells in both diseases, while INSR was positively correlated with Hepatocytes in periodontitis and COPD, supporting a potential pathophysiological relationship between periodontitis and COPD.
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Affiliation(s)
- Shuqin Liu
- Department of Stomatology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Aiguo Road No. 152, Nanchang, 330006, Jiangxi Province, China
| | - Yun Fu
- Department of General Practice, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Aiguo Road No. 152, Nanchang, 330006, Jiangxi Province, China
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Simin Li
- Stomatological Hospital, Southern Medical University, Guangzhou, 510280, Guangdong Province, China
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Fan Li
- Department of Pulmonary and Critical Care Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Aiguo Road No. 152, Nanchang, 330006, Jiangxi Province, China.
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12
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Han SH, Choi MS, Kim YM, Kim DM, Park HE, Hong JW, Kim SH, Shin YB, Lee BJ. Is Age-Predicted Maximal Heart Rate Applicable in Patients With Heart or Lung Disease? Ann Rehabil Med 2022; 46:133-141. [PMID: 35793902 PMCID: PMC9263326 DOI: 10.5535/arm.21181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/02/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET). Methods We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution’s cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing— reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m2, normal, and high ≥25 kg/m2), and risk classification. Results There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group). Conclusion Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.
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Affiliation(s)
- Sang Hun Han
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Min Soo Choi
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young Mo Kim
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Min Kim
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ho Eun Park
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Won Hong
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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13
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Al Chikhanie Y, Bailly S, Amroussa I, Veale D, Hérengt F, Verges S. Clustering of COPD patients and their response to pulmonary rehabilitation. Respir Med 2022; 198:106861. [DOI: 10.1016/j.rmed.2022.106861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
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Smoking Cessation Among U.S. Adult Smokers With and Without Chronic Obstructive Pulmonary Disease, 2018. Am J Prev Med 2022; 62:492-502. [PMID: 35120768 PMCID: PMC8996345 DOI: 10.1016/j.amepre.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION More than 3 of 5 U.S. adults who have ever smoked cigarettes have quit. This study assesses the latest estimates of smoking cessation among U.S. adults with and without chronic obstructive pulmonary disease who have ever smoked cigarettes (ever smokers). METHODS Data from 161,233 ever smokers (12.8% with chronic obstructive pulmonary disease) in the 2018 Behavioral Risk Factor Surveillance System were analyzed in 2020. Weighted percentages of quit ratios (percentage of ever smokers who quit smoking), past-year quit attempts (≥1 day), and recent successful cessation (quit ≥6 months ago) by self-reported physician-diagnosed chronic obstructive pulmonary disease status were obtained from multivariable logistic regression analyses, with adjustment for sociodemographic characteristics, health risk behaviors, depression, and asthma. RESULTS Adults with chronic obstructive pulmonary disease who smoked had greater age-adjusted past-year quit attempts (68.8% vs 64.3%) but lower recent successful cessation (4.5% vs 5.8%) and quit ratio (53.2% vs 63.9%) than those without chronic obstructive pulmonary disease. After adjusting for covariates, adults with chronic obstructive pulmonary disease who smoked had a significantly higher percentage of past-year quit attempts but similar recent successful cessation and a significantly lower lifetime quit ratio than their counterparts without chronic obstructive pulmonary disease. CONCLUSIONS These findings suggest that individuals with chronic obstructive pulmonary disease who try to quit smoking may be less likely to succeed than those without chronic obstructive pulmonary disease. Evidence-based treatments for smoking cessation remain an important component of a comprehensive approach to helping all adults to quit and are a particularly important element of chronic obstructive pulmonary disease management and care.
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15
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Shchepikhin EI, Shmelev EI, Zaytseva AS. Respiratory diseases and obesity: special phenotype or independent events: Review. TERAPEVT ARKH 2022; 94:442-447. [DOI: 10.26442/00403660.2022.03.201412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/18/2022] [Indexed: 11/22/2022]
Abstract
A combination of factors, including Western European eating habits, physical inactivity and genetic predisposition, lead to a dramatic increase in adipose tissue mass. A special place is occupied by abdominal obesity, in which there is an accumulation of adipose tissue in the mesentery of the small intestine and the omentum. Developing in conditions of visceral obesity, insulin resistance, dyslipidemia and systemic inflammation are one of the key components of the pathogenesis of type 2 diabetes mellitus, cardiovascular diseases, non-alcoholic fatty liver and pancreas disease, polycystic ovary disease, some forms of cancer (breast cancer, endometrial cancer, colonic and direct intestines). At the same time, the pathogenetic role of adipose tissue is not limited to its participation in the formation of the cardiometabolic continuum and oncogenesis. The most important role of metabolically active fat in the pathogenesis of many respiratory diseases is known, including bronchial asthma, obstructive sleep apnea and pulmonary hypertension. This paper presents an overview of current data on immunological, pathophysiological and clinical features of the phenotype of the combination of respiratory diseases with overweight and obesity.
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16
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Pulmonary Complications Are a Strong Independent Predictor of 30-Day Mortality Following Elective Bariatric Surgery. Obes Surg 2022; 32:696-703. [PMID: 35072915 DOI: 10.1007/s11695-021-05882-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pulmonary complications in patients with obesity carry a high morbidity and mortality. An analysis of the MBSAQIP database was performed to determine the effect of post-operative pulmonary complications on patients undergoing elective bariatric surgery, with the primary outcome of 30-day mortality. METHODS We extracted data from the MBSAQIP database from 2015 to 2019 on patients who underwent elective Roux-en-Y gastric bypass or sleeve gastrectomy. Pulmonary complications were defined as prolonged ventilation, pneumonia, unplanned intubation, pulmonary embolism, and coma past 24 h (with the assumption of this being due to hypercapnia). Data on post-operative complications and 30-day mortality was extracted. To determine the effect of pulmonary complications on 30-day mortality, a multivariable logistic regression model was developed. RESULTS Pulmonary complications were associated with a near 50-fold increased odds of 30-day mortality (OR 47.1; 95%, 38.6-57.5; p < 0.0001). Pulmonary complications were also associated with higher rates of anastomotic leaks (9.5% vs. 0.3%; p < 0.0001), post-operative bleeding (13.7% vs. 0.9%; p < 0.0001), cardiac complications (6.6% vs. 0.0%; p < 0.0001), post-operative AKIs (9.6% vs. 0.1%; p < 0.0001), incidence of deep SSI (9.4% vs. 0.2%; p < 0.0001), incidence of post-operative sepsis (6.2% vs. 0.1%; p < 0.0001), and incidence of Clostridioides difficile (2.0% vs. 0.1%; p < 0.0001). CONCLUSION Pulmonary complications after elective bariatric surgery are a strong predictor of 30-day mortality. Patients who experience pulmonary complications have a higher incidence of co-morbidities and unfavorable baseline patient characteristics, and thus, likely form a unique subset of the bariatric patient population.
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17
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Gürsoy Coşkun G, Andac-Ozturk S, Arslan Ulukan Z. Comparison of constipation and nutritional status with disease-related parameters in chronic obstructive pulmonary disease patients. Int J Clin Pract 2021; 75:e14451. [PMID: 34105860 DOI: 10.1111/ijcp.14451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/06/2021] [Indexed: 11/26/2022] Open
Abstract
AIM The aim of the study was to determine the effects of constipation symptoms and nutritional status on disease-related parameters, such as disease duration, spirometry test and quality of life, of chronic obstructive pulmonary disease (COPD) patients. METHODS The research was performed with 48 COPD patients attending the centre from January 2019 to August 2019. Assessment of constipation symptoms was done by Constipation Severity Instrument (CSI), whereas for quality of life assessment, St. George's Respiratory Questionnaire (SGRQ) was used. Patient's nutritional status was determined by food frequency questionnaire. Body mass index (BMI) and fat-free mass index (FFMI) of the patients were identified with the bioelectrical impedance analysis (BIA) method. Statistical assessment of data was done with SPSS 22 program. RESULTS According to the relationship between CSI scores and COPD disease parameters, there was a weak positive correlation between the CSI obstructive defecation subscale and SGRQ activity score and weak positive correlation between CSI colonic inertia subscale and COPD duration from the diagnosis. We found a weak negative correlation between protein intake percentage and SGRQ impact score. As the disease duration increased, the total fat, polyunsaturated fatty acids and vitamin E intake of individuals were determined to reduce. CONCLUSION According to our results, there were some changes in the nutrient intake depending on the duration of COPD, and possible constipation in COPD patients may affect the quality of life.
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Affiliation(s)
- Gözde Gürsoy Coşkun
- Department of Gastronomy and Culinary Arts, Istanbul Rumeli University, Istanbul, Turkey
| | - Serap Andac-Ozturk
- Department of Nutrition and Dietetics, Istanbul Aydin University, Istanbul, Turkey
| | - Zeliha Arslan Ulukan
- Department of Pulmonary Medicine, Medicana International Istanbul Hospital, Istanbul, Turkey
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18
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Probst-Hensch N, Jeong A, Stolz D, Pons M, Soccal PM, Bettschart R, Jarvis D, Holloway JW, Kronenberg F, Imboden M, Schindler C, Lovison GF. Causal Effects of Body Mass Index on Airflow Obstruction and Forced Mid-Expiratory Flow: A Mendelian Randomization Study Taking Interactions and Age-Specific Instruments Into Consideration Toward a Life Course Perspective. Front Public Health 2021; 9:584955. [PMID: 34046380 PMCID: PMC8144328 DOI: 10.3389/fpubh.2021.584955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/01/2021] [Indexed: 11/22/2022] Open
Abstract
Obesity has complex links to respiratory health. Mendelian randomization (MR) enables assessment of causality of body mass index (BMI) effects on airflow obstruction and mid-expiratory flow. In the adult SAPALDIA cohort, recruiting 9,651 population-representative samples aged 18–60 years at baseline (female 51%), BMI and the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) as well as forced mid-expiratory flow (FEF25–75%) were measured three times over 20 follow-up years. The causal effects of BMI in childhood and adulthood on FEV1/FVC and FEF25–75% were assessed in predictive (BMI averaged over 1st and 2nd, lung function (LF) averaged over 2nd and 3rd follow-up; N = 2,850) and long-term cross-sectional models (BMI and LF averaged over all follow-ups; N = 2,728) by Mendelian Randomization analyses with the use of weighted BMI allele score as an instrument variable and two-stage least squares (2SLS) method. Three different BMI allele scores were applied to specifically capture the part of BMI in adulthood that likely reflects tracking of genetically determined BMI in childhood. The main causal effects were derived from models containing BMI (instrumented by BMI genetic score), age, sex, height, and packyears smoked as covariates. BMI interactions were instrumented by the product of the instrument (BMI genetic score) and the relevant concomitant variable. Causal effects of BMI on FEV1/FVC and FEF25–75% were observed in both the predictive and long-term cross-sectional models. The causal BMI- LF effects were negative and attenuated with increasing age, and stronger if instrumented by gene scores associated with childhood BMI. This non-standard MR approach interrogating causal effects of multiplicative interaction suggests that the genetically rooted part of BMI patterns in childhood may be of particular relevance for the level of small airway function and airflow obstruction later in life. The methodological relevance of the results is first to point to the importance of a life course perspective in studies on the etiological role of BMI in respiratory health, and second to point out novel methodological aspects to be considered in future MR studies on the causal effects of obesity related phenotypes.
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Affiliation(s)
- Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland
| | - Ayoung Jeong
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Marco Pons
- Division of Pulmonary Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | - Paola M Soccal
- Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Deborah Jarvis
- Medical Research Council-Public Health England, Centre for Environment and Health, Imperial College London, London, United Kingdom.,Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland
| | - Gianfranco F Lovison
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland.,Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
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19
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Neder JA, de Torres JP, O'Donnell DE. Recent Advances in the Physiological Assessment of Dyspneic Patients with Mild COPD. COPD 2021; 18:374-384. [PMID: 33902376 DOI: 10.1080/15412555.2021.1913110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is growing recognition that a sizable fraction of COPD patients with forced expiratory volume in one second (FEV1)/forced vital capacity ratio below the lower limit of normal but preserved FEV1 reports out-of-proportion dyspnea relative to the severity of airflow limitation. Most physicians, however, assume that patients' breathlessness is unlikely to reflect the negative physiological consequences of COPD vis-à-vis FEV1 normalcy. This concise review integrates the findings of recent studies which uncovered the key pathophysiological features shared by these patients: poor pulmonary gas exchange efficiency (increased "wasted" ventilation) and gas trapping. These abnormalities are associated with two well-known causes of exertional dyspnea: heightened ventilation relative to metabolic demand and critically low inspiratory reserves, respectively. From a clinical standpoint, a low diffusion capacity associated with increased residual volume (RV) and/or RV/total lung capacity ratio might uncover these disturbances, identifying the subset of patients in whom exertional dyspnea is causally related to "mild" COPD.
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Affiliation(s)
- J Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - Juan P de Torres
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, ON, Canada
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Ategbole M, Su BB, Wang N, Loudermilk E, Xie X, Acevedo P, Ozuna K, Xu C, Liu Y, Wang K. Gender differences in the associations of early onset poly tobacco and drug use prior to age 18 with the prevalence of adult bronchitis in the United States. J Addict Dis 2021; 39:189-198. [PMID: 33215555 PMCID: PMC8366588 DOI: 10.1080/10550887.2020.1847992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated the associations of early onset polysubstance use prior to age 18 with the prevalence of bronchitis among U.S. adults and tested whether the associations differ by gender. METHODS A total of 77,950 adults, of them 2,653 with bronchitis in the past year, were from the combined 2013 and 2014 National Survey on Drug Use and Health data. The variable cluster analysis was used to classify nine variables about substance use prior to age 18 (cigarettes, cigars, smokeless tobacco, marijuana, cocaine, heroin, methamphetamines, ecstasy, and phencyclidine). Weighted multivariate logistic regression analysis (MLR) was used to examine the associations with bronchitis. RESULTS Nine variables were divided into two clusters: early onset poly tobacco use (three tobacco use variables) and early onset poly drug use (six drug use variables). The overall prevalence of bronchitis was 3.8% (5.1% for females and 2.3% for males). MLR analysis showed that being female, elderly (ages 65 and above), obese, and early onset poly tobacco use were associated with increased odds of bronchitis (p < 0.05). Gender-stratified analyses showed that early-onset poly tobacco use was significantly associated with bronchitis only in males, whereas early onset poly drug use was associated with bronchitis only in females. Moreover, obesity and tobacco use in the past year revealed associations with bronchitis regardless of gender. CONCLUSIONS Obesity, early onset poly tobacco use prior to age 18, and tobacco use in the past year were positively associated with bronchitis; furthermore, the associations of early onset polysubstance use with bronchitis differed by gender, which indicated that gender differences should be considered in developing effective prevention strategies.
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Affiliation(s)
- Muyiwa Ategbole
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Brenda Bin Su
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, TX, USA
| | - Nianyang Wang
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA
| | - Elaine Loudermilk
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Xin Xie
- Department of Economics and Finance, College of Business and Technology, East Tennessee State University, Johnson City, TN, USA
| | - Priscila Acevedo
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, TX, USA
| | - Kaysie Ozuna
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, TX, USA
| | - Chun Xu
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, TX, USA
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
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21
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Argano C, Scichilone N, Natoli G, Nobili A, Corazza GR, Mannucci PM, Perticone F, Corrao S. Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry. Intern Emerg Med 2021; 16:389-400. [PMID: 32720248 PMCID: PMC7384278 DOI: 10.1007/s11739-020-02412-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards.
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Affiliation(s)
- Christiano Argano
- Internal Medicine Department, UOC Medicina Interna iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy
| | - Nicola Scichilone
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Natoli
- Internal Medicine Department, UOC Medicina Interna iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, University of Pavia and San Matteo Hospital, Pavia, Italy
| | | | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Salvatore Corrao
- Internal Medicine Department, UOC Medicina Interna iGR, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy.
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro, University of Palermo, Palermo, Italy.
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22
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Brock J. Warum es sich auch in der Pneumologie lohnt, aufs Gewicht zu achten. PNEUMO NEWS 2021; 13:28-34. [PMID: 33613783 PMCID: PMC7881338 DOI: 10.1007/s15033-021-2677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Judith Brock
- Thoraxklinik Heidelberg, Röntgenstr. 1, 69126 Heidelberg, Deutschland
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23
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Brock JM, Billeter A, Müller-Stich BP, Herth F. Obesity and the Lung: What We Know Today. Respiration 2020; 99:856-866. [PMID: 33242862 DOI: 10.1159/000509735] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Obesity is becoming more and more prevalent especially in Western industrial nations. The understanding of adipose tissue as an endocrine organ as well as the detection of adipocytokines - hormones that are secreted from the adipose tissue - gave reason to examine the interactions between adipose tissue and target organs. These efforts have been intensified especially in the context of bariatric surgery as promising weight loss therapy. Interactions between the lung and adipose tissue have rarely been investigated and are not well understood. There are obvious mechanical effects of obesity on lung function explaining the associations between obesity and lung diseases, in particular obesity hypoventilation syndrome, obstructive sleep apnea syndrome, asthma, and chronic obstructive pulmonary disease. The rise in the prevalence of obesity affects the epidemiology of pulmonary diseases as well. The aim of this review is to summarize the current knowledge on interactions, associations, and consequences of obesity and weight loss on lung function and lung diseases. Based on these data, areas for future research are identified.
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Affiliation(s)
- Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany,
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
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24
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Zhu C, Yao JW, An LX, Bai YF, Li WJ. Effects of intraoperative individualized PEEP on postoperative atelectasis in obese patients: study protocol for a prospective randomized controlled trial. Trials 2020; 21:618. [PMID: 32631414 PMCID: PMC7338115 DOI: 10.1186/s13063-020-04565-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Obese patients undergoing general anesthesia and mechanical ventilation during laparoscopic abdominal surgery commonly have a higher incidence of postoperative pulmonary complications (PPCs), due to factors such as decreasing oxygen reserve, declining functional residual capacity, and reducing lung compliance. Pulmonary atelectasis caused by pneumoperitoneum and mechanical ventilation is further aggravated in obese patients. Recent studies demonstrated that individualized positive end-expiratory pressure (iPEEP) was one of effective lung-protective ventilation strategies. However, there is still no exact method to determine the best iPEEP, especially for obese patients. Here, we will use the best static lung compliance (Cstat) method to determine iPEEP, compared with regular PEEP, by observing the atelectasis area measured by electrical impedance tomography (EIT), and try to prove a better iPEEP setting method for obese patients. Methods This study is a single-center, two-arm, prospective, randomized control trial. A total number of 80 obese patients with body mass index ≥ 32.5 kg/m2 scheduled for laparoscopic gastric volume reduction and at medium to high risk for PPCs will be enrolled. They will be randomly assigned to control group (PEEP5 group) and iPEEP group. A PEEP of 5 cmH2O will be used in PEEP5 group, whereas an individualized PEEP value determined by a Cstat-directed PEEP titration procedure will be applied in the iPEEP group. Standard lung-protective ventilation methods such as low tidal volumes (7 ml/kg, predicted body weight, PBW), a fraction of inspired oxygen ≥ 0.5, and recruitment maneuvers (RM) will be applied during and after operation in both groups. Primary endpoints will be postoperative atelectasis measured by chest electrical impedance tomography (EIT) and intraoperative oxygen index. Secondary endpoints will be serum IL-6, TNF-α, procalcitonin (PCT) kinetics during and after surgery, incidence of PPCs, organ dysfunction, length of in-hospital stay, and hospital expense. Discussion Although there are several studies about the effect of iPEEP titration on perioperative PPCs in obese patients recently, the iPEEP setting method they used was complex and was not always feasible in routine clinical practice. This trial will assess a possible simple method to determine individualized optimal PEEP in obese patients and try to demonstrate that individualized PEEP with lung-protective ventilation methods is necessary for obese patients undergoing general surgery. The results of this trial will support anesthesiologist a feasible Cstat-directed PEEP titration method during anesthesia for obese patients in attempt to prevent PPCs. Trial registration www.chictr.org.cn ChiCTR1900026466. Registered on 11 October 2019
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Affiliation(s)
- Chen Zhu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Jing-Wen Yao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Li-Xin An
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China.
| | - Ya-Fan Bai
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Wen-Jing Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
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25
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Hendryx M, Luo J, Chojenta C, Byles JE. Air pollution exposures from multiple point sources and risk of incident chronic obstructive pulmonary disease (COPD) and asthma. ENVIRONMENTAL RESEARCH 2019; 179:108783. [PMID: 31590000 DOI: 10.1016/j.envres.2019.108783] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Exposure to environmental air pollutants exacerbates respiratory illness, but prospective studies of disease incidence are uncommon. Further, attempts to estimate effects from multiple point sources have rarely been undertaken. The current study examined risk of incident chronic obstructive pulmonary disease (COPD) and asthma in association with emissions of multiple air pollutants from point pollution sources in Australia. METHODS We analyzed prospective cohort data from the Australian Longitudinal Study on Women's Health. Women from three age-cohorts (N = 35,755) were followed for up to 21 years for incident COPD and asthma. Exposures were measured from the National Pollutant Inventory and included carbon monoxide, nitrogen oxides, sulfur dioxide, and particulate matter (PM2.5 and PM10). We identified inverse-distance weighted emissions in kilograms that women experienced over time from point sources within 10 km of their residences. Cox proportional hazards regression models examined risk of self-reported doctor-diagnosed COPD and asthma in association with pollutant exposures and covariates. RESULTS New COPD cases numbered 3616 (11.5%) and new asthma cases numbered 2725 (9.4%). Participants were exposed to an average of 47-59 sites with air pollution emissions within 10 km of their residences. Fossil fuel electricity generation and mining made the largest contributions to air pollution but hundreds of other types of emissions also occurred. Controlling for covariates, all five air pollutants modeled individually were significantly associated with risk of COPD. Modeled jointly, only sulfur dioxide (SO2) remained significantly associated with COPD (HR = 1.038, 95% CI = 1.010-1.067), although the five pollutants were highly correlated (r = 0.89). None of the pollutants were significantly associated with adult onset asthma. Cohort-specific analyses indicated that COPD risk was significantly associated with SO2 exposure for younger (HR = 1.021, CI = 1.001-1.047), middle-age (HR = 1.019, CI = 1.004-1.034) and older cohorts (HR = 1.025, CI = 1.004-1.047). CONCLUSIONS Multiple exposure sources and pollutants contributed to COPD risk, including electricity generation and mining but extending to many industrial processes. The results highlight the importance of policy efforts and technological improvements to reduce harmful air pollution emissions across the industrial landscape.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University. 1025 E. 7th St., Bloomington, IN, 47405, USA.
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, USA
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
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