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Zhao M, Wu Y, Li Y, Zhang X, Xia S, Xu J, Chen R, Liang Z, Qi S. Learning and depicting lobe-based radiomics feature for COPD Severity staging in low-dose CT images. BMC Pulm Med 2024; 24:294. [PMID: 38915049 PMCID: PMC11197240 DOI: 10.1186/s12890-024-03109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating respiratory condition that imposes a significant healthcare burden worldwide. Accurate staging of COPD severity is crucial for patient management and treatment planning. METHODS The retrospective study included 530 hospital patients. A lobe-based radiomics method was proposed to classify COPD severity using computed tomography (CT) images. First, we segmented the lung lobes with a convolutional neural network model. Secondly, the radiomic features of each lung lobe are extracted from CT images, the features of the five lung lobes are merged, and the selection of features is accomplished through the utilization of a variance threshold, t-Test, least absolute shrinkage and selection operator (LASSO). Finally, the COPD severity was classified by a support vector machine (SVM) classifier. RESULTS 104 features were selected for staging COPD according to the Global initiative for chronic Obstructive Lung Disease (GOLD). The SVM classifier showed remarkable performance with an accuracy of 0.63. Moreover, an additional set of 132 features were selected to distinguish between milder (GOLD I + GOLD II) and more severe instances (GOLD III + GOLD IV) of COPD. The accuracy for SVM stood at 0.87. CONCLUSIONS The proposed method proved that the novel lobe-based radiomics method can significantly contribute to the refinement of COPD severity staging. By combining radiomic features from each lung lobe, it can obtain a more comprehensive and rich set of features and better capture the CT radiomic features of the lung than simply observing the lung as a whole.
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Affiliation(s)
- Meng Zhao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Yanan Wu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yifu Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Xiaoyu Zhang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shuyue Xia
- Respiratory Department, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China
| | - Jiaxuan Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, China
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
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Fröhlich AK, Porthun J, Talha KM, Lena A, Hadzibegovic S, Wilkenshoff U, Sonntag F, Nikolski A, Ramer LV, Zeller T, Keller U, Bullinger L, Anker SD, Haverkamp W, von Haehling S, Doehner W, Rauch U, Skurk C, Cleland JGF, Butler J, Coats AJS, Landmesser U, Karakas M, Anker MS. Association of an impaired GH-IGF-I axis with cardiac wasting in patients with advanced cancer. Clin Res Cardiol 2024:10.1007/s00392-024-02400-x. [PMID: 38587563 DOI: 10.1007/s00392-024-02400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Growth hormone (GH) resistance is characterized by high GH levels but low levels of insulin-like growth factor-I (IGF-I) and growth hormone binding protein (GHBP) and, for patients with chronic disease, is associated with the development of cachexia. OBJECTIVES We investigated whether GH resistance is associated with changes in left ventricular (LV) mass (cardiac wasting) in patients with cancer. METHODS We measured plasma IGF-I, GH, and GHBP in 159 women and 148 men with cancer (83% stage III/IV). Patients were grouped by tertile of echocardiographic LVmass/height2 (women, < 50, 50-61, > 61 g/m2; men, < 60, 60-74, > 74 g/m2) and by presence of wasting syndrome with unintentional weight loss (BMI < 24 kg/m2 and weight loss ≥ 5% in the prior 12 months). Repeat echocardiograms were obtained usually within 3-6 months for 85 patients. RESULTS Patients in the lowest LVmass/height2 tertile had higher plasma GH (median (IQR) for 1st, 2nd, and 3rd tertile women, 1.8 (0.9-4.2), 0.8 (0.2-2.2), 0.5 (0.3-1.6) ng/mL, p = 0.029; men, 2.1 (0.8-3.2), 0.6 (0.1-1.7), 0.7 (0.2-1.9) ng/mL, p = 0.003). Among women, lower LVmass was associated with higher plasma IGF-I (68 (48-116), 72 (48-95), 49 (35-76) ng/mL, p = 0.007), whereas such association did not exist for men. Patients with lower LVmass had lower log IGF-I/GH ratio (women, 1.60 ± 0.09, 2.02 ± 0.09, 1.88 ± 0.09, p = 0.004; men, 1.64 ± 0.09, 2.14 ± 0.11, 2.04 ± 0.11, p = 0.002). GHBP was not associated with LVmass. Patients with wasting syndrome with unintentional weight loss had higher plasma GH and GHBP, lower log IGF-I/GH ratio, and similar IGF-I. Overall, GHBP correlated inversely with log IGF-I/GH ratio (women, r = - 0.591, p < 0.001; men, r = - 0.575, p < 0.001). Additionally, higher baseline IGF-I was associated with a decline in LVmass during follow-up (r = - 0.318, p = 0.003). CONCLUSION In advanced cancer, reduced LVmass is associated with increased plasma GH and reduced IGF-I/GH ratio, suggesting increasing GH resistance, especially for patients with wasting syndrome with unintentional weight loss. Higher baseline IGF-I was associated with a decrease in relative LVmass during follow-up.
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Affiliation(s)
- Ann-Kathrin Fröhlich
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Jan Porthun
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
- Norwegian University of Science and Technology, Campus Gjøvik, Gjøvik, Norway
| | - Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alessia Lena
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Sara Hadzibegovic
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Ursula Wilkenshoff
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
- Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Frederike Sonntag
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Anja Nikolski
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Luisa Valentina Ramer
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Clinic for Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site HH/Kiel/HL, Hamburg, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, a partnership between DKFZ and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center, Berlin, Germany
| | - Lars Bullinger
- German Cancer Consortium (DKTK), Partner Site Berlin, a partnership between DKFZ and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Stefan D Anker
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology Campus, Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Wilhelm Haverkamp
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology Campus, Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
- Centre for Stroke Research, Berlin, Charité-Universitätsmedizin, Berlin, Germany
| | - Ursula Rauch
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Carsten Skurk
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Ulf Landmesser
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
- Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Mahir Karakas
- German Centre for Cardiovascular Research, Partner Site HH/Kiel/HL, Hamburg, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus S Anker
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany.
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Mapelli M, Salvioni E, Bonomi A, Paneroni M, Raimondo R, Gugliandolo P, Mattavelli I, Bidoglio J, Mirza KK, La Rovere MT, Gustafsson F, Agostoni P. Taking a walk on the heart failure side: comparison of metabolic variables during walking and maximal exertion. ESC Heart Fail 2024; 11:1269-1274. [PMID: 38287881 DOI: 10.1002/ehf2.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024] Open
Abstract
AIMS Although cardiopulmonary exercise testing (CPET) is the gold standard to assess exercise capacity, simpler tests (i.e., 6-min walk test, 6MWT) are also commonly used. The aim of this study was to evaluate the relationship between cardiorespiratory parameters during CPET and 6MWT in a large, multicentre, heterogeneous population. METHODS We included athletes, healthy subjects, and heart failure (HF) patients of different severity, including left ventricular assist device (LVAD) carriers, who underwent both CPET and 6MWT with oxygen consumption measurement. RESULTS We enrolled 186 subjects (16 athletes, 40 healthy, 115 non-LVAD HF patients, and 15 LVAD carriers). CPET-peakV̇O2 was 41.0 [35.0-45.8], 26.2 [23.1-31.0], 12.8 [11.1-15.3], and 15.2 [13.6-15.6] ml/Kg/min in athletes, healthy, HF patients, and LVAD carriers, respectively (P < 0.001). During 6MWT they used 63.5 [56.3-76.8], 72.0 [57.8-81.0], 95.5 [80.3-109], and 95.0 [92.0-99.0] % of their peakV̇O2, respectively. None of the athletes, 1 healthy (2.5%), 30 HF patients (26.1%), and 1 LVAD carrier (6.7%), reached a 6MWT-V̇O2 higher than their CPET-peakV̇O2. Both 6MWT-V̇O2 and walked distance were significantly associated with CPET-peakV̇O2 in the whole population (R2 = 0.637 and R2 = 0.533, P ≤ 0.001) but not in the sub-groups. This was confirmed after adjustment for groups. CONCLUSIONS The 6MWT can be a maximal effort especially in most severe HF patients and suggest that, in absence of prognostic studies related to 6MWT metabolic values, CPET should remain the first method of choice in the functional assessment of patients with HF as well as in sport medicine.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Mara Paneroni
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Italy
| | - Rosa Raimondo
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Kiran K Mirza
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - Finn Gustafsson
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Song B, Li H, Zhang H, Jiao L, Wu S. Impact of electronic cigarette usage on the onset of respiratory symptoms and COPD among Chinese adults. Sci Rep 2024; 14:5598. [PMID: 38454045 PMCID: PMC10920732 DOI: 10.1038/s41598-024-56368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/05/2024] [Indexed: 03/09/2024] Open
Abstract
The prevalence of dual usage and the relatively low cessation rate among e-cigarette (EC) users suggest that ECs have not demonstrated significant effectiveness as a smoking cessation tool. Furthermore, there has been a substantial increase in the prevalence of EC usage in recent years. Therefore, the objective of this study is to investigate the association between EC use and the incidence of respiratory symptoms and chronic obstructive pulmonary disease (COPD). A total of 10,326 participants aged between 20 and 55 years, without any respiratory diseases or COPD, were recruited for the study. These individuals attended employee physical examinations conducted at 16 public hospitals in Hebei province, China from 2015 to 2020. Logistic regression models were utilized to assess the association between EC use and the risk of respiratory symptoms and COPD using risk ratios along with their corresponding 95% confidence intervals. Restricted cubic spline functions were employed to investigate the dose-response non-linear relationship. The robustness of the logistic regression models was evaluated through subgroup analyses, and sensitivity analyses. During the 5-year follow-up period, a total of 1071 incident cases of respiratory symptoms and 146 incident cases of COPD were identified in this cohort study. After adjusting for relevant confounding factors, EC users demonstrated a respective increase in the risk of reporting respiratory symptoms and COPD by 28% and 8%. Furthermore, dual users who used both ECs and combustible cigarettes exhibited an elevated risk of incident respiratory symptoms and COPD by 41% and 18%, respectively, compared to those who had never used non-users of any cigarette products. The association between daily EC consumption and the development of respiratory symptoms, as well as COPD, demonstrated a significant J-shaped pattern. The potential adverse association between the consumption of ECs, particularly when used in combination with combustible cigarettes, and the development of respiratory symptoms and COPD necessitates careful consideration. Policymakers should approach ECs cautiously as a prospective smoking cessation tool.
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Affiliation(s)
- Beibei Song
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University/Hebei Key Laboratory of Respiratory Critical Care/Hebei Institute of Respiratory Diseases, No. 215 Heping West Road, Shijiazhuang, 050000, China
| | - Honglin Li
- The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University/Hebei Key Laboratory of Respiratory Critical Care/Hebei Institute of Respiratory Diseases, No. 215 Heping West Road, Shijiazhuang, 050000, China
| | - Huiran Zhang
- Department of Biological Pharmacy, Hebei Medical University, Shijiazhuang, 050000, China
| | - Libin Jiao
- Hebei Far East Communication System Engineering Company, Shijiazhuang, 050000, China
| | - Siyu Wu
- The Third Department of Respiratory and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Chen Y, Li J, Zhu Z, Lyu G. Lung Ultrasound Assessment of Lung Hyperinflation in Patients with Stable COPD: An Effective Diagnostic Tool. Int J Chron Obstruct Pulmon Dis 2024; 19:319-330. [PMID: 38298918 PMCID: PMC10829508 DOI: 10.2147/copd.s441374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose To evaluate the degree of lung hyperinflation (LH) in patients with stable chronic obstructive pulmonary disease (COPD) by lung ultrasound score (LUS) and assess its value. Patients and Methods We conducted a study of 149 patients with stable COPD and 100 healthy controls recruited by the Second Affiliated Hospital of Fujian Medical University. The pleural sliding displacement (PSD) was measured, the sliding of the pleura in different areas was observed, and LUS was calculated from both of them. The diaphragm excursion (DE), residual capacity (RV), total lung capacity (TLC), inspiratory capacity (IC) and functional residual capacity (FRC) were measured. We described the correlation between ultrasound indicators and pulmonary function indicators reflecting LH. Multiple linear regression analysis was used. The ROC curves of LUS and DE were drawn to evaluate their diagnostic efficacy, and De Long method was used for comparison. Results (1) The LUS of patients with stable COPD were positively correlated with RV, TLC, RV/TLC and FRC and negatively correlated with IC and IC/TLC (r1=0.72, r2=0.41, r3=0.72, r4=0.70, r5=-0.56, r6=-0.65, P < 0.001). The correlation was stronger than that between DE at maximal deep inspiration and the corresponding pulmonary function indices (r1=-0.41, r2=-0.26, r3=-0.40, r4=-0.43, r5=0.30, r6=0.37, P < 0.001). (2) Multiple linear regression analysis showed that LUS were significantly correlated with IC/TLC and RV/TLC. (3) With IC/TLC<25% and RV/TLC>60% as the diagnostic criterion of severe LH, the areas under the ROC curves of LUS and DE at maximal deep inspiration for diagnosing severe LH were 0.914 and 0.385, 0.845 and 0.543, respectively (P < 0.001). Conclusion The lung ultrasound score is an important parameter for evaluating LH. LUS is better than DE at maximal deep inspiration for diagnosing severe LH and is expected to become an effective auxiliary tool for evaluating LH.
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Affiliation(s)
- Yongjian Chen
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
| | - Jingyun Li
- School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, People’s Republic of China
| | - Zhixing Zhu
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
| | - Guorong Lyu
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
- School of Medicine, Quanzhou Medical College, Quanzhou, Fujian, People’s Republic of China
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Cui Y, Ma Y, Dai Z, Long Y, Chen Y. Does the 2017 global initiative for chronic obstructive lung disease revision really improve the assessment of Chinese chronic obstructive pulmonary disease patients? A multicenter prospective study for more than 5 years. Chin Med J (Engl) 2023; 136:2587-2595. [PMID: 37367695 PMCID: PMC10617920 DOI: 10.1097/cm9.0000000000002487] [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: 02/27/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 proposed a new classification that reclassified many chronic obstructive pulmonary disease (COPD) patients from group D to B. However, there is a paucity of data related to the comparison between reclassified and non-reclassified COPD patients in terms of long-term prognosis. This study aimed to investigate long-term outcomes of them and determine whether the GOLD 2017 revision improved the assessment of COPD patients. METHODS This observational, multicenter, prospective study recruited outpatients at 12 tertiary hospitals in China from November 2016 to February 2018 and followed them up until February 2022. All enrolled patients were classified into groups A to D based on GOLD 2017, and the subjects in group B included patients reclassified from group D to B (group DB) and those remaining in group B (group BB). Incidence rates and hazard ratios (HRs) were calculated for the exacerbation of COPD and hospitalization in each group. RESULTS We included and followed up 845 patients. During the first year of follow-up, the GOLD 2017 classification had a better discrimination ability for different risks of COPD exacerbation and hospitalization than GOLD 2013. Group DB was associated with a higher risk of moderate-to-severe exacerbation (HR = 1.88, 95% confidence interval [CI] = 1.37-2.59, P <0.001) and hospitalization for COPD exacerbation (HR = 2.23, 95% CI = 1.29-3.85, P = 0.004) than group BB. However, during the last year of follow-up, the differences in the risks of frequent exacerbations and hospitalizations between group DB and BB were not statistically significant (frequent exacerbations: HR = 1.02, 95% CI = 0.51-2.03, P = 0.955; frequent hospitalizations: HR = 1.66, 95% CI = 0.58-4.78, P = 0.348). The mortality rates of the two groups were both approximately 9.0% during the entire follow-up period. CONCLUSIONS The long-term prognosis of patients reclassified into group B and of those remaining in group B was similar, although patients reclassified from group D to group B had worse short-term outcomes. The GOLD 2017 revision could improve the assessment of Chinese COPD patients in terms of long-term prognosis.
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Affiliation(s)
- Yanan Cui
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Zhongshang Dai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Yingjiao Long
- Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
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7
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Evertz R, Diehl C, Gödde K, Valentova M, Garfias-Veitl T, Overbeck TR, Braulke F, Lena A, Hadzibegovic S, Bleckmann A, Keller U, Landmesser U, König AO, Hasenfuss G, Schuster A, Anker MS, von Haehling S. Predictors of lower exercise capacity in patients with cancer. Sci Rep 2023; 13:14861. [PMID: 37684302 PMCID: PMC10491652 DOI: 10.1038/s41598-023-41390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Maintaining cancer patients' exercise capacity and therefore patients' ability to live a self-determined life is of huge importance, but little is known about major determinants. We sought to identify determinants of exercise capacity in patients with a broad spectrum of cancer types, who were already receiving cancer treatment or about to commence such therapy. Exercise capacity was assessed in 253 consecutive patients mostly suffering from advanced cancer using the 6-min walk test (6-MWT). All patients underwent echocardiography, physical examination, resting electrocardiogram, hand grip strength (HGS) measurement, and laboratory assessments. Patients were divided into two groups according to the median distance in the 6-MWT (459 m). Patients with lower exercise capacity were older, had significantly lower HGS and haemoglobin and higher values of high sensitive (hs) Troponin T and NT-proBNP (all p < 0.05). Whilst the co-morbidity burden was significantly higher in this group, no differences were detected for sex, body mass index, tumor type, or cachexia (all p > 0.2). Using multivariable logistic regression, we found that the presence of anaemia (odds ratio (OR) 6.172, 95% confidence interval (CI) 1.401-27.201, p = 0.016) as well as an increase in hs Troponin T (OR 3.077, 95% CI 1.202-5.301, p = 0.019) remained independent predictors of impaired exercise capacity. Increasing HGS was associated with a reduced risk of a lower exercise capacity (OR 0.896, 95% CI 0.813-0.987, p = 0.026). Screening patients for elevated hs troponin levels as well as reduced HGS may help to identify patients at risk of lower exercise capacity during cancer treatment.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Christine Diehl
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- Department of Paediatrics, University of Göttingen Medical Center (UMG), 37075, Göttingen, Germany
| | - Katharina Gödde
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias-Veitl
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tobias R Overbeck
- Department of Haematology and Medical Oncology, University of Göttingen Medical Center (UMG), 37075, Göttingen, Germany
- Comprehensive Cancer Center G-CCC, Medical Center (UMG), University of Göttingen, 37075, Göttingen, Germany
| | - Friederike Braulke
- Comprehensive Cancer Center G-CCC, Medical Center (UMG), University of Göttingen, 37075, Göttingen, Germany
| | - Alessia Lena
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
| | - Sara Hadzibegovic
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
| | - Annalen Bleckmann
- Department of Haematology and Medical Oncology, University of Göttingen Medical Center (UMG), 37075, Göttingen, Germany
- West German Cancer Center, University Hospital Münster, 48149, Münster, Germany
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149, Muenster, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, 12203, Berlin, Germany
- German Cancer Consortium (DKTK) & German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
- Max-Delbrück-Center for Molecular Medicine, 13125, Berlin, Germany
| | - Ulf Landmesser
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 13353, Berlin, Germany
| | - Alexander O König
- Department of Gastroenterology, University of Göttingen Medical Center (UMG), 37075, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Markus S Anker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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8
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Anker MS, Potthoff SK, Lena A, Porthun J, Hadzibegovic S, Evertz R, Denecke C, Fröhlich AK, Sonntag F, Regitz-Zagrosek V, Rosen SD, Lyon AR, Lüscher TF, Spertus JA, Anker SD, Karakas M, Bullinger L, Keller U, Landmesser U, Butler J, von Haehling S. Cardiovascular health-related quality of life in cancer: a prospective study comparing the ESC HeartQoL and EORTC QLQ-C30 questionnaire. Eur J Heart Fail 2023; 25:1635-1647. [PMID: 37369985 DOI: 10.1002/ejhf.2951] [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: 02/22/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023] Open
Abstract
AIMS Health-related quality of life (HRQoL) is highly relevant in cancer and often assessed with the EORTC QLQ-C30. Cardiovascular HRQoL in cancer can be measured with the ESC HeartQoL questionnaire. We compared these instruments and examined their prognostic value. METHODS AND RESULTS Summary scores for EORTC QLQ-C30 (0-100 points) and ESC HeartQoL (0-3 points) questionnaires were prospectively assessed in 290 patients with mostly advanced cancer (stage 3/4: 81%, 1-year mortality: 36%) and 50 healthy controls (similar age and sex). Additionally, physical function and activity assessments were performed. Both questionnaires demonstrated reduced HRQoL in patients with cancer versus controls (EORTC QLQ-C30: 67 ± 20 vs. 91 ± 11, p < 0.001; ESC HeartQoL: 1.8 ± 0.8 vs. 2.7 ± 0.4, p < 0.001). The instruments were strongly correlated with each other (summary scores [r = 0.76], physical [r = 0.81], and emotional subscales [r = 0.75, all p < 0.001]) and independently associated with all-cause mortality (best cut-offs: EORTC QLQ-C30 <82.69: hazard ratio [HR] 2.33, p = 0.004; ESC HeartQoL <1.50: HR 1.85, p = 0.004 - adjusted for sex, age, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T, cancer stage/type), with no differences in the strength of the association by sex (p-interaction > 0.9). Combining both questionnaires identified three risk groups with highest mortality in patients below both cut-offs (vs. patients above both cut-offs: HR 3.60, p < 0.001). Patients with results below both cut-offs, showed higher NT-proBNP and reduced physical function and activity. CONCLUSIONS The EORTC QLQ-C30 and ESC HeartQoL - assessing cancer and cardiovascular HRQoL - are both associated with increased mortality in cancer patients, with even greater stratification by combing both. Reduced HRQoL scores were associated with elevated cardiovascular biomarkers and decreased functional status.
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Affiliation(s)
- Markus S Anker
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Sophia K Potthoff
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany
| | - Alessia Lena
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Jan Porthun
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Sara Hadzibegovic
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Corinna Denecke
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany
| | - Ann-Kathrin Fröhlich
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany
| | - Frederike Sonntag
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany
| | - Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Charité University Medicine Berlin, Berlin, Germany
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stuart D Rosen
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
- Heart Division, Royal Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Thomas F Lüscher
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
- Heart Division, Royal Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - John A Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MI, USA
| | - Stefan D Anker
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany
| | - Mahir Karakas
- German Centre for Cardiovascular Research (DZHK), partner site HH/Kiel/HL, Hamburg, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Bullinger
- German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
- Department of Hematology, Oncology, and Tumor Immunology CVK, Charité-University Medicine Berlin corporate member of Free University Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Ulrich Keller
- German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
- Department of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Berlin, Germany
- Max Delbrück Center, Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany
- Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité Berlin, Universitätsmedizin Berlin, Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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9
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Nguyen-Nhu V, Nguyen LP, Duong-Quy S, Le An P, Bui-Minh T. Classification of COPD as ABCD according to GOLD 2011 and 2017 versions in COPD patients at University Medical Center in Ho Chi Minh City, Vietnam. Monaldi Arch Chest Dis 2023. [PMID: 37522870 DOI: 10.4081/monaldi.2023.2619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
In 2017, Global Initiative for Chronic Lung Disease (GOLD) made substantial changes to its ABCD group categorization. Although several studies had been conducted to assess the impact of the new GOLD category, there was no research on the change of the GOLD classification in Vietnam. This retrospective analysis was conducted at Asthma and COPD clinic at the University Medical Center in Ho Chi Minh City, Vietnam. Our study population comprised patients visiting Medical Center from January 2018 to January 2020. We categorized patients' demographic, clinical characteristics and pharmacotherapy based on GOLD 2011 and 2017 guidelines. A comparison between the two versions was also determined. A total of 457 patients were included in this study. The percentage of groups A, B, C and D according to GOLD 2011 was 5%, 20.8%, 13.1% and 61.1%; and according to GOLD 2017 was 6.1%, 34.1%, 12% and 47.8%, respectively. In terms of gender, male patients constituted nearly 95% of the study's population (433/457 patients). Regarding pharmacotherapy, approximately 20% of the low-risk group (group A-B) was overtreated with ICS components: LABA+ICS (15.8%) and LAMA+LABA+ICS (3.8%). There were 13.3% and 1.1% of patients transferred from D to B and from C to A, respectively. All of them had lower FVC% pred, FEV1% pred and FEV1/FVC than the patients remained in group B or A (p<0.005). This is the first research in Vietnam to show the distribution of COPD patients using both the GOLD 2011 and GOLD 2017 criteria. There was 14% of patients reclassified from high-risk groups to low-risk groups when changing from 2011 to 2017 version and discordance of medications between guidelines and real-life practice. Therefore, clinicians should use their clinical competence to consider patients' conditions before deciding the appropriate therapeutic approach. Consequently, further studies were required to evaluate the effect of the change in GOLD classification.
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Affiliation(s)
- Vinh Nguyen-Nhu
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City; Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City.
| | - Lam-Phuoc Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City.
| | - Sy Duong-Quy
- Bio-Medical Research Centre, Lam Dong Medical College, Da Lat.
| | - Pham Le An
- Faculty of Medicine and Grant Innovation Center, University of Medicine and Pharmacy, Ho Chi Minh City.
| | - Tri Bui-Minh
- Grant Innovation Center, University of Medicine and Pharmacy, Ho Chi Minh City.
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10
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Lena A, Wilkenshoff U, Hadzibegovic S, Porthun J, Rösnick L, Fröhlich AK, Zeller T, Karakas M, Keller U, Ahn J, Bullinger L, Riess H, Rosen SD, Lyon AR, Lüscher TF, Totzeck M, Rassaf T, Burkhoff D, Mehra MR, Bax JJ, Butler J, Edelmann F, Haverkamp W, Anker SD, Packer M, Coats AJS, von Haehling S, Landmesser U, Anker MS. Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer. J Am Coll Cardiol 2023; 81:1569-1586. [PMID: 37076211 DOI: 10.1016/j.jacc.2023.02.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Body wasting in patients with cancer can affect the heart. OBJECTIVES The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown. METHODS This study prospectively enrolled 300 patients with mostly advanced, active cancer but without significant cardiovascular disease or infection. These patients were compared with 60 healthy control subjects and 60 patients with chronic heart failure (ejection fraction <40%) of similar age and sex distribution. RESULTS Cancer patients presented with lower left ventricular (LV) mass than healthy control subjects or heart failure patients (assessed by transthoracic echocardiography: 177 ± 47 g vs 203 ± 64 g vs 300 ± 71 g, respectively; P < 0.001). LV mass was lowest in cancer patients with cachexia (153 ± 42 g; P < 0.001). Importantly, the presence of low LV mass was independent of previous cardiotoxic anticancer therapy. In 90 cancer patients with a second echocardiogram after 122 ± 71 days, LV mass had declined by 9.3% ± 1.4% (P < 0.001). In cancer patients with cardiac wasting during follow-up, stroke volume decreased (P < 0.001) and resting heart rate increased over time (P = 0.001). During follow-up of on average 16 months, 149 patients died (1-year all-cause mortality 43%; 95% CI: 37%-49%). LV mass and LV mass adjusted for height squared were independent prognostic markers (both P < 0.05). Adjustment of LV mass for body surface area masked the observed survival impact. LV mass below the prognostically relevant cutpoints in cancer was associated with reduced overall functional status and lower physical performance. CONCLUSIONS Low LV mass is associated with poor functional status and increased all-cause mortality in cancer. These findings provide clinical evidence of cardiac wasting-associated cardiomyopathy in cancer.
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Affiliation(s)
- Alessia Lena
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Ursula Wilkenshoff
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Sara Hadzibegovic
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Jan Porthun
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany; Norwegian University of Science and Technology, Campus Gjøvik, Gjøvik, Norway
| | - Lukas Rösnick
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Ann-Kathrin Fröhlich
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Clinic for Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, partner site HH/Kiel/HL, Hamburg, Germany
| | - Mahir Karakas
- German Centre for Cardiovascular Research, partner site HH/Kiel/HL, Hamburg, Germany; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité - University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany; German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany; Max Delbrück Center, Berlin, Germany
| | - Johann Ahn
- Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Lars Bullinger
- German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany; Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Hanno Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin, Campus CCM, Berlin, Germany
| | - Stuart D Rosen
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Heart Division, Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Thomas F Lüscher
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Heart Division, Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | | | - Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku University, Turku, Finland
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Frank Edelmann
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Wilhelm Haverkamp
- German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology Campus Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Stefan D Anker
- German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology Campus Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; German Centre for Cardiovascular Research, partner site Göttingen, Göttingen, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Markus S Anker
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.
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Chen Y, Li J, Dong B, Zhu Z, Lyu G. Two-dimensional shear wave elastography: a new tool for evaluating respiratory muscle stiffness in chronic obstructive pulmonary disease patients. BMC Pulm Med 2022; 22:441. [PMID: 36424581 PMCID: PMC9686016 DOI: 10.1186/s12890-022-02231-4] [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: 07/02/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Impaired respiratory function caused by respiratory muscle dysfunction is one of the common consequences of chronic obstructive pulmonary disease (COPD). In this study, two-dimensional shear wave elastography (2D-SWE) was used to measure diaphragm stiffness (DS) and intercostal muscle stiffness (IMS) in patients with COPD; in addition, the value of 2D-SWE in evaluating respiratory function was determined. METHODS In total, 219 consecutive patients with COPD and 20 healthy adults were included. 2D-SWE was used to measure the DS and IMS, and lung function was also measured. The correlation between respiratory muscle stiffness and lung function and the differences in respiratory muscle stiffness in COPD patients with different severities were analysed. RESULTS 2D-SWE measurements of the DS and IMS presented with high repeatability and consistency, with ICCs of 0.756 and 0.876, respectively, and average differences between physicians of 0.10 ± 1.61 and 0.07 ± 1.65, respectively. In patients with COPD, the DS and IMS increased with disease severity (F1 = 224.50, F2 = 84.63, P < 0.001). In patients with COPD, the correlation with the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC), predicted FEV1% value, residual volume (RV), total lung capacity (TLC), RV/TLC, functional residual capacity (FRC) and inspiratory capacity (IC) of DS (r1=-0.81, r2=-0.63, r3 = 0.65, r4 = 0.54, r5 = 0.60, r6 = 0.72 and r7=-0.41, respectively; P < 0.001) was stronger than that of IMS (r1=-0.76, r2=-0.57, r3 = 0.57, r4 = 0.47, r5 = 0.48, r6 = 0.60 and r7=-0.33, respectively; P < 0.001). CONCLUSION 2D-SWE has potential for use in evaluating DS and IMS. A specific correlation was observed between respiratory muscle stiffness and lung function. With the worsening of the severity of COPD and the progression of lung function impairment, the DS and IMS gradually increased.
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Affiliation(s)
- Yongjian Chen
- grid.488542.70000 0004 1758 0435Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, 362000 Quanzhou, Fujian China
| | - Jingyun Li
- Quanzhou Medical College, No. 2 Anji Road, Luojiang District, 362000 Quanzhou, Fujian Province China
| | - Bingtian Dong
- grid.488542.70000 0004 1758 0435Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, 362000 Quanzhou, Fujian China
| | - Zhixing Zhu
- grid.488542.70000 0004 1758 0435Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, 362000 Quanzhou, Fujian China
| | - Guorong Lyu
- grid.488542.70000 0004 1758 0435Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, 362000 Quanzhou, Fujian China ,Quanzhou Medical College, No. 2 Anji Road, Luojiang District, 362000 Quanzhou, Fujian Province China
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12
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Association between waist circumference change and incident chronic obstructive pulmonary disease among Chinese adults: a 10-year cohort study. Sci Rep 2022; 12:18402. [PMID: 36319731 PMCID: PMC9626450 DOI: 10.1038/s41598-022-23248-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
The aim of our study was to investigate waist circumference (WC) change and the risk of incident chronic obstructive pulmonary disease (COPD) among Chinese adults. A total of 8164 participants aged > 18 years who attended health examinations with repeat measurements of WC and lung function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)] from 2010 to 2019 were recruited. WC change was categorized as ≤ - 2.5%, - 2.5 to 2.5%, 2.5% to 5% and > 5% according to sex. Modified Poisson regression models were used to assess the association of WC gain and the risk of COPD. During the 10-year follow-up, a total of 917 COPD cases were identified. From baseline to follow-up, the mean FEV1 decreased from 3.20 to 2.79L among male participants and 2.28-1.95L among female participants. Compared with participants who did not have abdominal obesity, at either, baseline or follow-up, participants with abdominal obesity of both sexes after the follow-up were associated with a greater risk of COPD regardless of abdominal obesity at baseline. The risk of incident COPD increased 19% among male participants (RR = 1.19, 95%CI = 1.04-1.48) and 14% among female participants (RR = 1.14, 95%CI = 1.01-1.40) when WC gain increased > 5% during the 10-year follow-up. The COPD risk decreased 18% among male participants with a WC change ≤ - 2.5% (RR = 0.82, 95%CI = 0.67-0.99). The risk of incident COPD was positively associated with increasing WC among Chinese adults of both sexes.
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Hurst JR, Han MK, Singh B, Sharma S, Kaur G, de Nigris E, Holmgren U, Siddiqui MK. Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review. Respir Res 2022; 23:213. [PMID: 35999538 PMCID: PMC9396841 DOI: 10.1186/s12931-022-02123-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD exacerbations are associated with a worsening of lung function, increased disease burden, and mortality, and, therefore, preventing their occurrence is an important goal of COPD management. This review was conducted to identify the evidence base regarding risk factors and predictors of moderate-to-severe exacerbations in patients with COPD. Methods A literature review was performed in Embase, MEDLINE, MEDLINE In-Process, and the Cochrane Central Register of Controlled Trials (CENTRAL). Searches were conducted from January 2015 to July 2019. Eligible publications were peer-reviewed journal articles, published in English, that reported risk factors or predictors for the occurrence of moderate-to-severe exacerbations in adults age ≥ 40 years with a diagnosis of COPD. Results The literature review identified 5112 references, of which 113 publications (reporting results for 76 studies) met the eligibility criteria and were included in the review. Among the 76 studies included, 61 were observational and 15 were randomized controlled clinical trials. Exacerbation history was the strongest predictor of future exacerbations, with 34 studies reporting a significant association between history of exacerbations and risk of future moderate or severe exacerbations. Other significant risk factors identified in multiple studies included disease severity or bronchodilator reversibility (39 studies), comorbidities (34 studies), higher symptom burden (17 studies), and higher blood eosinophil count (16 studies). Conclusions This systematic literature review identified several demographic and clinical characteristics that predict the future risk of COPD exacerbations. Prior exacerbation history was confirmed as the most important predictor of future exacerbations. These prognostic factors may help clinicians identify patients at high risk of exacerbations, which are a major driver of the global burden of COPD, including morbidity and mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02123-5.
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Affiliation(s)
- John R Hurst
- UCL Respiratory, University College London, London, WC1E 6BT, UK.
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
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14
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Li Z, Liu L, Zhang Z, Yang X, Li X, Gao Y, Huang K. A Novel CT-Based Radiomics Features Analysis for Identification and Severity Staging of COPD. Acad Radiol 2022; 29:663-673. [PMID: 35151548 DOI: 10.1016/j.acra.2022.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the role of radiomics based on Chest Computed Tomography (CT) in the identification and severity staging of chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS This retrospective analysis included 322 participants (249 COPD patients and 73 control subjects). In total, 1395 chest CT-based radiomics features were extracted from each participant's CT images. Three feature selection methods, including variance threshold, Select K Best method, and least absolute shrinkage and selection operator (LASSO), and two classification methods, including support vector machine (SVM) and logistic regression (LR), were used as identification and severity classification of COPD. Performance was compared by AUC, accuracy, sensitivity, specificity, precision, and F1-score. RESULTS 38 and 10 features were selected to construct radiomics models to detect and stage COPD, respectively. For COPD identification, SVM classifier achieved AUCs of 0.992 and 0.970, while LR classifier achieved AUCs of 0.993 and 0.972 in the training set and test set, respectively. For the severity staging of COPD, the mentioned two machine learning classifiers can better differentiate less severity (GOLD1 + GOLD2) group from greater severity (GOLD3 + GOLD4) group. The AUCs of SVM and LR is 0.907 and 0.903 in the training set, and that of 0.799 and 0.797 in the test set. CONCLUSION The present study showed that the novel radiomics approach based on chest CT images that can be used for COPD identification and severity classification, and the constructed radiomics model demonstrated acceptable performance.
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Affiliation(s)
- Zongli Li
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ligong Liu
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zuoqing Zhang
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xuhong Yang
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xuanyi Li
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanli Gao
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Chao-Yang Hospital, Capital Medical University, No 8 Gongti South Road, Beijing, 100020, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., K.H.), Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Department of Pulmonary and Critical Care Medicine (Z.L., Z.Z.), Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China; Department of Enterprise, Beijing e-Hualu Information Technology Corporation Limited (L. L.), Beijing, China; Dongsheng Science and Technology Park (X.Y.), Huiying Medical Technology Co., Ltd, Beijing, China; Department of Respiratory (X.L.), Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China; Department of Radiology (Y.G.), Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
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15
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Ban WH, Rhee CK. Role of nuclear factor erythroid 2-related factor 2 in chronic obstructive pulmonary disease. Tuberc Respir Dis (Seoul) 2022; 85:221-226. [PMID: 35255667 PMCID: PMC9263341 DOI: 10.4046/trd.2021.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/01/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation due to chronic airway inflammation and destruction of the alveolar structure from persistent exposure to oxidative stress. The body has various antioxidant mechanisms for efficiently coping with such oxidative stress. The nuclear factor erythroid 2-related factor 2 (Nrf2)–antioxidant response element (ARE) is a representative system. Dysregulation of the Nrf2-ARE pathway is responsible for the development and promotion of COPD. Furthermore, COPD severity is also closely related to this pathway. There has been a clinical impetus to use Nrf2 for diagnostic and therapeutic purposes. Therefore, in this work, we systematically reviewed the clinical significance of Nrf2 in COPD patients, and discuss the value of Nrf2 as a potential COPD biomarker.
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Affiliation(s)
- Woo Ho Ban
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Address for correspondence Chin Kook Rhee, M.D., Ph.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 06591, Republic of Korea Phone 82-2-2258-6067 Fax 82-2-599-3589 E-mail
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16
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Dai Z, Zeng H, Cui Y, Chen P, Chen Y. Subgroup analysis reveals higher reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease 2019. Sci Rep 2022; 12:757. [PMID: 35031681 PMCID: PMC8760288 DOI: 10.1038/s41598-021-04756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
To estimate the severity of the disease in outpatients with chronic obstructive pulmonary disease (COPD) in Hunan Province, China and use the subgroup analysis to evaluate the reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease (GOLD). COPD outpatients from 12 medical centers in Hunan Province, China were stratified into groups A–D, and group D patients were further stratified into subgroups D1–D3 according to the GOLD 2016 and 2019 comprehensive assessment. Demography, clinical characteristics and medications were compared among groups. In 1017 COPD outpatients, the distribution from group A to D and subgroup D1 to D3 was 41 (4.0%), 249 (24.5%), 17 (1.7%), 710 (69.8%) and 214 (30.2%), 204 (28.7%), 292 (41.1%), according to GOLD 2016. In terms of demographic and clinical characteristics related to A–D groups, there was a significant difference in COPD assessment test (CAT), modified Medical British Research Council (mMRC), the clinical COPD questionnaire(CCQ), age, BMI, education level, smoking history, comorbidities, the course of chronic bronchitis/emphysema, number of exacerbations/hospitalisations in the previous year, treatment protocols, forced expiratory volume in one second (FEV1) % predicted, and FEV1/forced vital capacity (FVC) (p < 0.01). Furthermore, some patients in groups C–D regrouped to groups A–B were all C1 and D1 subgroups according to GOLD 2019. Comparing subgroup D1 with group B, subgroup D2 and subgroup D3, it was found that the demography, clinical characteristics and medications of subgroup D1 were the closest to group B, according to GOLD 2016 (p < 0.01). The disease severity of outpatients with COPD in Hunan Province was more pronounced in group B and D and patients in groups A–D had different demography, clinical characteristics and medications. Subgroup analysis can explain to a certain extent that GOLD2019’s new comprehensive assessment is more reliable than GOLD 2016.
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Affiliation(s)
- Zhongshang Dai
- Second Xiangya Hospital of Central South University, Changsha, China.
| | - Huihui Zeng
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanan Cui
- Second Xiangya Hospital of Central South University, Changsha, China
| | - Ping Chen
- Second Xiangya Hospital of Central South University, Changsha, China.
| | - Yan Chen
- Second Xiangya Hospital of Central South University, Changsha, China.
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17
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Mapelli M, Salvioni E, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, La Rovere MT, Agostoni P. Brisk walking can be a maximal effort in heart failure patients: a comparison of cardiopulmonary exercise and 6 min walking test cardiorespiratory data. ESC Heart Fail 2021; 9:812-821. [PMID: 34970846 PMCID: PMC8934957 DOI: 10.1002/ehf2.13781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
Aims Cardiopulmonary exercise test (CPET) and 6 min walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self‐selected constant load test usually considered a submaximal, and therefore safer, exercise, but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity. Methods and results Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath‐by‐breath measurement of cardiorespiratory parameters. HF patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One hundred and fifty‐five subjects were enrolled, of whom 40 were healthy (59 ± 8 years; male 67%) and 115 were HF patients (69 ± 10 years; male 80%; left ventricular ejection fraction 34.6 ± 12.0%). CPET peakV̇O2 was 13.5 ± 3.5 mL/kg/min in HF patients and 28.1 ± 7.4 mL/kg/min in healthy subjects (P < 0.001). 6MWT‐V̇O2 was 98 ± 20% of the CPET peakV̇O2 values in HF patients, while 72 ± 20% in healthy subjects (P < 0.001). 6MWT‐V̇O2 was >110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2 < 12 mL/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as a percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as the absolute value, progressively increased as exercise limitation did. Conclusions In conclusion, the last minute of 6MWT must be perceived as a maximal or even supramaximal exercise activity in patients with more severe HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4-20138, Milan, Italy
| | | | - Mara Paneroni
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Simonetta Scalvini
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy
| | - Rosa Raimondo
- Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Varese, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza' Rome University, Rome, Italy
| | | | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Pavia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Parea, 4-20138, Milan, Italy
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18
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Oca MMD, Varela MVL, Menezes AMB, Wehrmeister FC, Ramirez L, Miravitlles M. Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study. J Bras Pneumol 2021; 47:e20210156. [PMID: 34787288 DOI: 10.36416/1806-3756/e20210156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. METHODS In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. RESULTS Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden's index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden's index (1.48). CONCLUSION GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.
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Affiliation(s)
| | | | - Ana Maria B Menezes
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas (RS) Brasil
| | - Fernando C Wehrmeister
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas (RS) Brasil
| | | | - Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, CIBER de Enfermedades Respiratorias, Barcelona, Spain
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19
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Sarwar F, Alam K, Chow CW, Saeed M, Malik RN. Pulmonary Dysfunction Augmenting Bacterial Aerosols in Leather Tanneries of Punjab, Pakistan. Int J Chron Obstruct Pulmon Dis 2021; 16:2925-2937. [PMID: 34737557 PMCID: PMC8560504 DOI: 10.2147/copd.s328129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Particulate matter-associated microbes in the workplace are a burning issue in occupational toxicology. Studies have reported on respiratory infections among tannery cohorts. This study uniquely presents measurements of airborne bacterial concentrations associated with varied particulate-matter sizes, their exposure, and consequent severity in occupational respiratory problems, all for different microenvironments within leather tanneries. METHODS Analyses included molecular identification of isolates, computation of mass median aerodynamic diameter of aerosols, tannery process-exposure dose (TPED) to bacterial aerosols, and spirometry and symptom assessment of impaired pulmonary function. RESULTS The highest bacterial concentrations were for rawhide treatment and finishing units, showing 3.6×103 and 3.7×103 CFU/m3, respectively. Identified bacterial species included Ochrobactrum pseudogrignonense, Neisseria bacilliformis, Enterobacter cloacae, Alcaligenes faecalis, Klebsiella pneumoniae, and Corynebacterium spp. Maximum and minimum values of mass median aerodynamic diameter were 8.3 µm and 0.65 µm for buffing and snuffing and production units, respectively. The highest TPED was 1,516.9 CFU/kg for finishing units. Respiratory symptoms in order of incidence were dyspnea > phlegm > cough > wheezing and tachypnea (equivalent). Bronchodilator measurements of FEV1, FVC, and PEF represent decline in lung function. Of 26 patients identified with COPD, most were working in rawhide treatment. CONCLUSION We conclude that exposure-infection synergy is also a cause of pulmonary ailments and COPD development, rather than the better-known exposure-smoking synergy.
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Affiliation(s)
- Fiza Sarwar
- Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Khan Alam
- Department of Physics, University of Peshawar, Peshawar, Pakistan
| | - Chung Wai Chow
- Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Muhammad Saeed
- Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Riffat Naseem Malik
- Environmental Biology and Ecotoxicology Laboratory, Department of Environmental Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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20
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Williams MT, Karlekar M, Coogan A, Shifrin M, Ascenzi J. Advance Care Planning in Chronically Ill Patients With an Episodic Disease Trajectory in the Acute Care Setting: A Quality Improvement Project. Am J Hosp Palliat Care 2021; 39:542-547. [PMID: 34378416 DOI: 10.1177/10499091211036706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Advance care planning (ACP) is a fluid discussion between patients and providers to define preferences for future medical care. In the acute care setting, ACP is limited due to lack of structured process for identifying persons who may benefit from ACP. This quality improvement (QI) project aimed to increase the frequency of ACP discussions and documentation of preferences by targeting geriatric patients with an episodic disease trajectory for ACP. METHODS This project used an intervention and comparison group design to target English-speaking, geriatric adults at a large academic medical center with a diagnosis of NYHA class III/IV HF and/or GOLD criteria III/IV COPD for ACP discussions. The intervention group was compared to a group with a range of diagnoses who were approached in a non-systematic way. RESULTS Thirteen (n = 13) participants completed all aspects of the QI project. Results showed a non-significant increase in the number of patients with a diagnosis of HF and/or COPD who participated in an ACP discussion when compared to the comparison group (n = 20, p = 0.131), as well as a non-significant increase in the number of ACP tools documented in the HER (53.8% compared to 30%) (x = 1.877, p = 0.171). CONCLUSION While this project demonstrated non-significant statistical results in the incidence and documentation of an ACP tool, this project increased the number of ACP discussions had, which is clinically significant.
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Affiliation(s)
- Molly T Williams
- 12328Vanderbilt University Medical Center, Nashville, TN, USA.,15851Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Mohana Karlekar
- 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Coogan
- 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Megan Shifrin
- 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Judy Ascenzi
- 15851Johns Hopkins University School of Nursing, Baltimore, MD, USA
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21
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Hoang QTM, Nguyen VK, Oberacher H, Fuchs D, Hernandez-Vargas EA, Borucki K, Waldburg N, Wippermann J, Schreiber J, Bruder D, Veluswamy P. Serum Concentration of the Phytohormone Abscisic Acid Is Associated With Immune-Regulatory Mediators and Is a Potential Biomarker of Disease Severity in Chronic Obstructive Pulmonary Disease. Front Med (Lausanne) 2021; 8:676058. [PMID: 34169084 PMCID: PMC8217626 DOI: 10.3389/fmed.2021.676058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
COPD and asthma are two distinct but sometimes overlapping diseases exhibiting varying degrees and types of inflammation on different stages of the disease. Although several biomarkers are defined to estimate the inflammatory endotype and stages in these diseases, there is still a need for new markers and potential therapeutic targets. We investigated the levels of a phytohormone, abscisic acid (ABA) and its receptor, LANCL2, in COPD patients and asthmatics. In addition, PPAR-γ that is activated by ABA in a ligand-binding domain-independent manner was also included in the study. In this study, we correlated ABA with COPD-propagating factors to define the possible role of ABA, in terms of immune regulation, inflammation, and disease stages. We collected blood from 101 COPD patients, 52 asthmatics, and 57 controls. Bronchoscopy was performed on five COPD patients and 29 controls. We employed (i) liquid chromatography–tandem mass spectrometry and HPLC to determine the ABA and indoleamine 2,3-dioxygenase levels, respectively; (ii) real-time PCR to quantify the gene expression of LANCL2 and PPAR-γ; (iii) Flow cytometry to quantify adipocytokines; and (iv) immunoturbidimetry and ELISA to measure CRP and cytokines, respectively. Finally, a multinomial regression model was used to predict the probability of using ABA as a biomarker. Blood ABA levels were significantly reduced in COPD patients and asthmatics compared to age- and gender-matched normal controls. However, PPAR-γ was elevated in COPD patients. Intriguingly, ABA was positively correlated with immune-regulatory factors and was negatively correlated with inflammatory markers, in COPD. Of note, ABA was increased in advanced COPD stages. We thereby conclude that ABA might be involved in regulation of COPD pathogenesis and might be regarded as a potential biomarker for COPD stages.
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Affiliation(s)
- Quynh Trang Mi Hoang
- Department of Pneumonology, Otto-von-Guericke-University Magdeburg, University Hospital, Magdeburg, Germany.,Infection Immunology Group, Institute of Medical Microbiology and Hospital Hygiene, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Van Kinh Nguyen
- Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Esteban A Hernandez-Vargas
- Systems Medicine for Infectious Diseases, Frankfurt Institute for Advanced Studies, Frankfurt, Germany.,Instituto de Matematicas, Universidad Nacional Autónoma de México (UNAM), Queretaro, Mexico
| | - Katrin Borucki
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Jens Wippermann
- Heart Surgery Research, Department of Cardiothoracic Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
| | - Jens Schreiber
- Department of Pneumonology, Otto-von-Guericke-University Magdeburg, University Hospital, Magdeburg, Germany
| | - Dunja Bruder
- Infection Immunology Group, Institute of Medical Microbiology and Hospital Hygiene, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Immune Regulation Group, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Priya Veluswamy
- Infection Immunology Group, Institute of Medical Microbiology and Hospital Hygiene, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Hospital, Magdeburg, Germany.,Heart Surgery Research, Department of Cardiothoracic Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany
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22
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Fartoukh M, Demoule A, Sanchez O, Tuffet S, Bergot E, Godet C, Andrejak C, Pontier-Marchandise S, Parrot A, Mayaux J, Meyer G, Cluzel P, Sapoval M, Le Pennec V, Carette MF, Cadranel J, Rousseau A, Khalil A, Simon T. Randomised trial of first-line bronchial artery embolisation for non-severe haemoptysis of mild abundance. BMJ Open Respir Res 2021; 8:8/1/e000949. [PMID: 34088727 PMCID: PMC8183216 DOI: 10.1136/bmjresp-2021-000949] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Whereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis. Research question To assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance. Study design and methods This multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset <72 hours, 100–200 mL estimated bleeding amount), related to a systemic arterial mechanism. Patients were randomly assigned (1:1) to BAE associated with medical therapy or to medical therapy alone. Results Bleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery. Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved. Conclusion In non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events. Trial registration number NCT01278199
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Affiliation(s)
- Muriel Fartoukh
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Médecine intensive réanimation, Sorbonne Université, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, HEGP, AP-HP, Innovations Thérapeutiques en Hémostase, INSERM UMRS 1140, Université de Paris, Paris, France
| | - Sophie Tuffet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital Saint Antoine, Paris, France
| | - Emmanuel Bergot
- Department of Pulmonology, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Claire Andrejak
- Service de Pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, 80054 Amiens, France, Amiens, France
| | | | - Antoine Parrot
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Pneumologie et Oncologie thoracique, Centre Constitutif Maladies Pulmonaires Rares, APHP, Paris, France
| | - Julien Mayaux
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), APHP, Paris, France
| | - Guy Meyer
- Université de Paris; Service de Radiologie, HEGP, AP-HP, F-75015 Paris, France, Paris, France
| | - Philippe Cluzel
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Radiologie, Sorbonne Université, Paris, France
| | - Marc Sapoval
- Université de Paris; Service de Radiologie, HEGP, AP-HP, F-75015 Paris, France, Paris, France
| | - Vincent Le Pennec
- Service de radiologie diagnostique et thérapeutique - CHU Avenue de la Cote de Nacre - CS 30001 14033 Caen cedex 9, France, Caen, France
| | - Marie-France Carette
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Radiologie, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Pneumologie et Oncologie thoracique, Centre Constitutif Maladies Pulmonaires Rares, Sorbonne Université, GRC n°04, Theranoscan, Paris, France
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital Saint Antoine, Paris, France
| | - Antoine Khalil
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Tenon, Service de Radiologie, Sorbonne Université, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URC-CRC-CRB), Hôpital St Antoine, Paris, France, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
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23
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Jiang H, Wu X, Lian S, Zhang C, Liu S, Jiang Z. Effects of salbutamol on the kinetics of sevoflurane and the occurrence of early postoperative pulmonary complications in patients with mild-to-moderate chronic obstructive pulmonary disease: A randomized controlled study. PLoS One 2021; 16:e0251795. [PMID: 34015036 PMCID: PMC8136676 DOI: 10.1371/journal.pone.0251795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
Bronchodilators dilate the bronchi and increase lung volumes, thereby improving respiratory physiology in patients with chronic obstructive pulmonary disease (COPD). However, their effects on sevoflurane kinetics remain unknown. We aimed to determine whether inhaled salbutamol affected the wash-in and wash-out kinetics of sevoflurane and the occurrence of early postoperative pulmonary complications (PPCs) in patients with COPD undergoing elective surgery. This randomized, placebo-controlled study included 63 consecutive patients with COPD allocated to the salbutamol (n = 30) and control groups (n = 33). The salbutamol group received salbutamol aerosol (2 puffs of ~200 μg) 30 min before anesthesia induction and 30 min before surgery completion. The control group received a placebo. Sevoflurane kinetics were determined by collecting end-tidal samples from the first breaths at 1, 2, 3, 4, 5, 7, 10, and 15 min before the surgery (wash-in) and after closing the vaporizer (wash-out). PPCs were recorded for 7 days. The salbutamol group had higher end-tidal to inhaled sevoflurane ratios (p<0.05, p<0.01) than the control group, from 3 to 10 min during the wash-in period, but no significant differences were observed during the wash-out period. The arterial partial pressure of oxygen to the fraction of inhaled oxygen was significantly higher in the salbutamol group at 30 (320.3±17.6 vs. 291.5±29.6 mmHg; p = 0.033) and 60 min (327.8±32.3 vs. 309.2±30.5 mmHg; p = 0.003). The dead space to tidal volume ratios at 30 (20.5±6.4% vs. 26.3±6.0%, p = 0.042) and 60 min (19.6±5.1% vs. 24.8±5.5%, p = 0.007) and the incidence of bronchospasm (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.23–0.67, p = 0.023) and respiratory infiltration (OR 0.52, 95% CI, 0.40–0.65, p = 0.017) were lower in the salbutamol group. In patients with COPD, salbutamol accelerates the wash-in rate of sevoflurane and decreases the occurrence of postoperative bronchospasm and pulmonary infiltration within the first 7 days.
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Affiliation(s)
- Huayong Jiang
- Department of Anesthesia, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University of School of Medicine), Shaoxing, Zhejiang Province, PR China
| | - Xiujuan Wu
- Department of Nephrology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University of School of Medicine), Shaoxing, Zhejiang Province, PR China
| | - Shumei Lian
- Department of Anesthesia, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University of School of Medicine), Shaoxing, Zhejiang Province, PR China
| | - Changfeng Zhang
- Department of Anesthesia, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University of School of Medicine), Shaoxing, Zhejiang Province, PR China
| | - Shuyun Liu
- Department of Anesthesia, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University of School of Medicine), Shaoxing, Zhejiang Province, PR China
| | - Zongming Jiang
- Department of Anesthesia, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University of School of Medicine), Shaoxing, Zhejiang Province, PR China
- * E-mail:
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24
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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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25
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Kakavas S, Kotsiou OS, Perlikos F, Mermiri M, Mavrovounis G, Gourgoulianis K, Pantazopoulos I. Pulmonary function testing in COPD: looking beyond the curtain of FEV1. NPJ Prim Care Respir Med 2021; 31:23. [PMID: 33963190 PMCID: PMC8105397 DOI: 10.1038/s41533-021-00236-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/15/2021] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) management remains challenging due to the high heterogeneity of clinical symptoms and the complex pathophysiological basis of the disease. Airflow limitation, diagnosed by spirometry, remains the cornerstone of the diagnosis. However, the calculation of the forced expiratory volume in the first second (FEV1) alone, has limitations in uncovering the underlying complexity of the disease. Incorporating additional pulmonary function tests (PFTs) in the everyday clinical evaluation of COPD patients, like resting volume, capacity and airway resistance measurements, diffusion capacity measurements, forced oscillation technique, field and cardiopulmonary exercise testing and muscle strength evaluation, may prove essential in tailoring medical management to meet the needs of such a heterogeneous patient population. We aimed to provide a comprehensive overview of the available PFTs, which can be incorporated into the primary care physician's practice to enhance the efficiency of COPD management.
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Affiliation(s)
- Sotirios Kakavas
- Critical Care Department, Sismanogleio General Hospital, Athens, Greece
| | - Ourania S Kotsiou
- Department of Respiratory Medicine, University of Thessaly, School of Medicine, University General Hospital of Larisa, Thessaly, Greece
| | - Fotis Perlikos
- Department of Respiratory Medicine, Evangelismos General Hospital, Athens, Greece
| | - Maria Mermiri
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece.
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Konstantinos Gourgoulianis
- Department of Respiratory Medicine, University of Thessaly, School of Medicine, University General Hospital of Larisa, Thessaly, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
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26
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Klein SR, Gulart AA, Venâncio RS, Munari AB, Gavenda SG, Martins ACB, Mayer AF. Performance difference on the six-minute walk test on tracks of 20 and 30 meters for patients with chronic obstructive pulmonary disease: validity and reliability. Braz J Phys Ther 2021; 25:40-47. [PMID: 32007324 PMCID: PMC7817855 DOI: 10.1016/j.bjpt.2020.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/24/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Functional capacity assessment is important in patients with chronic obstructive pulmonary disease (COPD). It can be performed by the six-minute walk test (6MWT) on a 30-meter track. However, such space is not always available in clinical settings. OBJECTIVES To compare the performance between the 6MWT on a 30- (6MWT30) and 20-meter (6MWT20) track; to evaluate the validity and reliability of the 6MWT30 and the 6MWT20; and to determine for which patients track length has the greatest impact on performance. METHODS Patients with COPD randomly performed two 6MWT30 and two 6MWT20 on two different days and were also assessed using the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) scale. RESULTS Thirty patients (23 men; mean ± standard deviation FEV1%pred: 45.6 ± 12.1) participated in the study. They walked a greater distance on the 6MWT30 than on the 6MWT20 [mean difference: 22.1 m (95% CI: 12, 32 m)]. The longer the 6MWT30 distance, the greater the difference between the 2 tests (r = 0.51; p = 0.004). The 6MWT20 showed high reliability [ICC: 0.96 (95% CI: 0.77, 0.99)] and the results were associated with the distance walked on the 6MWT30 (r = 0.86), CAT (r = -0.53), and mMRC (r = -0.62). Patients who walked ≥430 m in the 6MWT30 presented a difference between the tests greater than those who walked <430 m (34.5 ± 23.3 m vs. 12.6 ± 24.1 m; respectively; p = 0.01). CONCLUSIONS Performance was higher on the 6MWT30, with the difference increasing as performance improved. Therefore, the 6MWT20 is valid and reliable to evaluate functional capacity but should not be considered interchangeable with the 6MWT30, especially for the less disabled patients with COPD.
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Affiliation(s)
- Suelen Roberta Klein
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Aline Almeida Gulart
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Raysa Silva Venâncio
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Physical Therapy Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Anelise Bauer Munari
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Simone Graciosa Gavenda
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Physical Therapy Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Ana Carolina Benedet Martins
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Anamaria Fleig Mayer
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Physical Therapy Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
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Mapelli M, Salvioni E, Bonomi A, Gugliandolo P, De Martino F, Vignati C, Berna G, Agostoni P. How Patients With Heart Failure Perform Daily Life Activities. Circ Heart Fail 2020; 13:e007503. [DOI: 10.1161/circheartfailure.120.007503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Cardiopulmonary exercise test and 6-minute walking test are frequently used tools to evaluate physical performance in heart failure (HF), but they do neither represent activities of daily living (ADLs) nor fully reproduce patients’ symptoms. We assessed differences in task oxygen uptake, both as absolute value and as percentage of peak oxygen consumption (peakVO
2
), ventilation efficiency (VE/VCO
2
ratio), and dyspnea intensity (Borg scale) in HF and healthy subjects during standard ADLs and other common physical actions.
Methods:
Healthy and HF subjects (ejection fraction <45%, stable conditions) underwent cardiopulmonary exercise test. All of them, carrying a wearable metabolic cart, performed a 6-minute walking test, two 4-minute treadmill exercises (at 2 and 3 km/h), and ADLs: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 minutes), ADL6 (climbing 1 flight of stairs carrying a load).
Results:
Sixty patients with HF (age 65.2±12.1 years; ejection fraction 30.4±6.7%, peakVO
2
14.2±4.0 mL/[min·kg]) and 40 healthy volunteers (58.9±8.2 years, peakVO
2
28.1±7.4 mL/[min·kg]) were enrolled. For each exercise, patients showed higher VE/VCO
2
ratio, percentage of peakVO
2
, and Borg scale value than controls, while absolute values of task oxygen uptake and exercise duration were lower and higher, respectively, in all activities, except for treadmill (fixed execution time and intensity). Differently from Borg Scale data, metabolic values and exercise time length changed in parallel with HF severity, except for ADL duration in very short (ADL3) and composite (ADL1) activities. Borg scale values correlated with percentage of peakVO
2
.
Conclusions:
During ADLs, patients self-regulated activities in parallel with HF severity by decreasing intensity (VO
2
) and prolonging the effort.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M.M., C.V., P.A.)
| | - Elisabetta Salvioni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
| | - Paola Gugliandolo
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
| | - Fabiana De Martino
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M.M., C.V., P.A.)
| | - Giovanni Berna
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy (M.M., E.S., A.B., P.G., F.D.M., C.V., G.B., P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M.M., C.V., P.A.)
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28
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Zafiraki VK, Kosmacheva ED, Shulzhenko LV, Kizhvatova NV, Nemtsova EA, Pershukov IV. [3-years outcome of follow-up of patients with chronic obstructive pulmonary disease successfully treated by percutaneous coronary intervention due to acute coronary syndrome]. ACTA ACUST UNITED AC 2020; 60:84-91. [PMID: 33131479 DOI: 10.18087/cardio.2020.9.n1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate results of three-year follow-up in patients after acute coronary syndrome (ACS) associated with chronic obstructive pulmonary disease (COPD) and to identify predictors for delayed serious cardiovascular adverse (SCVAE) events.Material and methods This prospective cohort study included 119 patients with verified COPD who had ACS after a successful urgent percutaneous coronary intervention and were discharged from the hospital without in-hospital complications. Incidence of and time to SCVAE (cardiovascular death, myocardial infarction, stroke, repeated unscheduled myocardial revascularization) were recorded. SCVAE predictors were identified with the Cox regression by stepwise inclusion of variables into the model.Results SCVAE occurred in 33.6 % of ACS patients with COPD. The high rate of repeated myocardial revascularization mostly contributed to the development of delayed SCVAEs (19.3 % of patients). Independent predictors of SCVAE included the total number of stenoses in major coronary artery branches; ankle-brachial index; glomerular filtration rate calculated with the CKD-EPI equation; frequent COPD exacerbations; functional residual capacity of the lungs; and 6-min walk distance.Conclusion New independent predictors of SCVAE were identified in COPD patients after ACS with percutaneous coronary intervention and stenting, including distance in the 6-min walk test, frequent COPD exacerbations, and functional residual volume of the lungs as an index of pulmonary hyperinflation.
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Affiliation(s)
- V K Zafiraki
- «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia Regional Clinical Hospital #1, Krasnodar, Russia
| | - E D Kosmacheva
- «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - L V Shulzhenko
- «Kuban State Medical University» of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - N V Kizhvatova
- Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - E A Nemtsova
- Scientific Research Institution - Ochapovsky S.V. Regional Clinical Hospital #1, Krasnodar, Russia
| | - I V Pershukov
- Osh State University, Osh, Kyrgyzstan Voronezh Regional Clinical Hospital #1, Voronezh, Russia
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29
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Mega TA, Anbese ZK, Yoo SD. Mortality and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory diseases in Jimma Medical Center; Jimma, Ethiopia: Prospective observational study. PLoS One 2020; 15:e0239055. [PMID: 32966334 PMCID: PMC7510970 DOI: 10.1371/journal.pone.0239055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/28/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma exacerbations are associated with ill health, increased mortality, and health care costs. However, there is limited evidence regarding mortality and its predictors among patients treated for COPD and asthma exacerbations in low-income nations, particularly in Ethiopia. METHODS A-6 month prospective observational study was conducted from April 20-September 20, 2019. Data were collected on socio-demographic, baseline clinical characteristics and outcomes of asthma and COPD exacerbations. Data were entered into Epi-Data version 4.02.01 for cleaning and exported to STATA 14.0 for analysis. Kaplan-Meier (Log-rank test) was used to compare the baseline survival experience of the study participants and Cox proportional hazard regression analysis was conducted to determine the predictors of mortality. Adjusted hazard ratios (AHRs) with two-sided p-value <0.05 were considered statistically significant. RESULTS A total of 130 patients (60% males) were included. The median (interquartile range (IQR)) age of the study participants was 59(50-70) years. The median (IQR) survival time to death was 17.5 (10-26) days. The total proportion of in-hospital mortality was 10.78% (14/130), and the incidence rate of mortality was 2.56 per 1000 person-years. The duration of oxygen therapy ≥16hours/day (AHR = 6.330, 95% CI [1.092-36.679], and old age (AHR = 1.066, 95% CI [1.0001-1.136] were the independent predictors of in-hospital mortality. CONCLUSION In this study, the in-hospital mortality rate was very high. Moreover, prolonged oxygen therapy (≥16hours/day) and old age were independently associated with in-hospital mortality. Therefore, special attention should be given to recipients of prolonged oxygen therapy and the elderly during hospital stay.
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Affiliation(s)
- Teshale Ayele Mega
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenebe Keno Anbese
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harari regional state, Haramaya, Ethiopia
| | - Samuel D. Yoo
- School of Medicine, Institute of Health Science, Jimma University, Oromia regional state, Jimma, Ethiopia
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30
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Irritable bowel syndrome increases the risk of chronic obstructive pulmonary disease: A retrospective cohort study. Sci Rep 2020; 10:10008. [PMID: 32561774 PMCID: PMC7305148 DOI: 10.1038/s41598-020-66707-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Both inflammation and infection are associated with the development of irritable bowel syndrome (IBS) and chronic obstructive pulmonary disease (COPD). The purpose of this study is to further elucidate the association between IBS and COPD through a retrospective cohort study. We enrolled IBS patients diagnosed between 2000 and 2011 with follow-up for at least one year. The non-IBS patients as comparison group were selected with 1:3 matching by propensity score. Statistical analysis was utilized to assess the differences in characteristic distribution, and to compare the cumulative incidence of COPD between the IBS and non-IBS cohorts. We selected 14,021 IBS patients and 42,068 non-IBS patients for comparison. The IBS patients exhibited a significant risk to develop COPD compared with non-IBS patients. Additionally, the cumulative incidence rate of COPD in the IBS cohort increased significantly during the follow-up period of more than ten years, compared to the non-IBS cohort, based on the Kaplan-Meier analysis. The risk of COPD was also significantly decreased in those patients with more than eighteen IBS-related clinical visits. This retrospective cohort study demonstrates the significantly increased risk of COPD in patients with IBS. Therefore, early inspection and prevention of COPD is essential for patients with IBS.
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31
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Vahedian-Azimi A, Bashar FR, Boushra MN, Quinn JW, Miller AC. Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients. Int J Crit Illn Inj Sci 2020; 10:99-104. [PMID: 32904565 PMCID: PMC7456290 DOI: 10.4103/ijciis.ijciis_37_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 05/02/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives: The negative inspiratory force (NIF) has been used to help clinicians predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the utility of the traditional threshold of ≤−30 cmH
2O may not be appropriate for patients with chronic obstructive pulmonary disease (COPD). This study aims to define the optimal predictive NIF threshold for COPD patients. Methods: A prospective-observational multi-center study was conducted in intensive care units of six academic medical centers. All patients had COPD and were intubated for hypercapnic respiratory failure. The process of weaning from MV was conducted according to the defined hospital protocol. NIF was measured after 120 min of spontaneous breathing trial (SBT). The sensitivity, specificity, positive, and negative predictive value (PPV, NPV), positive and negative likelihood ratios (LR+, LR−) were calculated, and the diagnostic accuracy recorded. Results: A total of 90 patients with COPD (39 males and 51 females) were included. Of these, 43 patients (47.8%) were successfully extubated whereas 47 patients (52.2%) failed SBT or required re-intubation (P = 0.654). The threshold value of ≤−25 cmH2O offered the optimal performance in COPD patients: area under the receiver operating characteristic (ROC) curves ROC curves 0.836, sensitivity 95.0%, specificity 86.0%, PPV 84.4%, and NPV 95.6%., LR+ 6.79, LR− 0.06, and the diagnostic accuracy 90.7%. Conclusions: In mechanically ventilated COPD patients with hypercapnic respiratory failure, the NIF threshold of ≤−25 cmH2O was a moderate-to-good predictor for successful ventilator liberation, and outperforms the traditional threshold of ≤−30 cmH2O.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid R Bashar
- Department of Anesthesia and Critical Care, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marina N Boushra
- Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Joseph W Quinn
- Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.,Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Andrew C Miller
- Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.,Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
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32
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Gulart AA, Munari AB, Klein SR, Venâncio RS, Alexandre HF, Mayer AF. The London Chest Activity of Daily Living scale cut-off point to discriminate functional status in patients with chronic obstructive pulmonary disease. Braz J Phys Ther 2020; 24:264-272. [PMID: 30948247 PMCID: PMC7253922 DOI: 10.1016/j.bjpt.2019.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/12/2019] [Accepted: 03/18/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the cut-off point for the London Chest Activity of Daily Living scale in order to better discriminate functional status. Secondarily, to determine which of the scores (total or %total) is better associated with clinical outcomes of a pulmonary rehabilitation program. METHODS Sixty-one patients with chronic obstructive pulmonary disease performed the following tests: spirometry; Chronic Obstructive Pulmonary Disease Assessment Test; Saint George's Respiratory Questionnaire; modified Medical Research Council, the body-mass index, airflow obstruction, dyspnea, and exercise capacity index; six-minute walk test; physical activity in daily life assessment and London Chest Activity of Daily Living scale. Thirty-eight patients were evaluated pre- and post-pulmonary rehabilitation . The cut-off point was determined using the receiver operating characteristic curve with six-minute walk test (cut-off point: 82%pred), modified Medical Research Council (cut-off point: 2), level of physical (in)activity (cut-off point: 80min per day in physical activity ≥3 metabolic equivalent of task) and presence/absence of severe physical inactivity (cut-off point: 4580 steps per day) as anchors. RESULTS A cut-off point found for all anchors was 28%: modified Medical Research Council [sensitivity=83%; specificity=72%; area under the curve=0.80]; level of physical (in)activity [sensitivity=65%; specificity=59%; area under the curve=0.67] and classification of severe physical inactivity [sensitivity=70%; specificity=62%; area under the curve=0.70]. The patients who scored ≤28% in %total score of London Chest Activity of Daily Living had lower modified Medical Research Council , Chronic Obstructive Pulmonary Disease Assessment Test, Saint George's Respiratory Questionnaire, body-mass index, airflow obstruction, dyspnea and exercise capacity index and sitting time than who scored >28%, and higher forced expiratory volume in the first second, time in physical activity ≥3 metabolic equivalent of task, steps per day and six-minute walk distance. The %total score of London Chest Activity of Daily Living correlated better with clinical outcomes than the total score. CONCLUSIONS The cut-off point of 28% is sensitive and specific to distinguish the functional status in patients with chronic obstructive pulmonary disease. The %total score of the London Chest Activity of Daily Living reflects better outcomes of chronic obstructive pulmonary disease when compared to total score.
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Affiliation(s)
- Aline Almeida Gulart
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Anelise Bauer Munari
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Suelen Roberta Klein
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Raysa Silva Venâncio
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Physical Therapy Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Hellen Fontão Alexandre
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Physical Therapy Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Anamaria Fleig Mayer
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Human Movement Sciences Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil; Physical Therapy Graduate Program, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.
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Nowak M, Brożek GM, Zejda JE, Jankowski M, Pierzchała W. Impact of changing GOLD guidelines (2007-2011-2017) on assignment of a COPD patient to disease severity category. Postepy Dermatol Alergol 2020; 37:221-228. [PMID: 32489358 PMCID: PMC7262811 DOI: 10.5114/ada.2018.79143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/16/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The international standard for the recognition and treatment of chronic obstructive pulmonary disease (COPD) is guided by a regularly updated set of criteria developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). AIM To investigate the impact of updated COPD management guidelines from 2007 to 2017 (GOLD 2007, GOLD 2011 and GOLD 2017) on the assignment of patients into individual therapeutic groups, examining both individual and population dimensions. MATERIAL AND METHODS Each of 500 randomly chosen primary care physicians in Poland provided information on 10 individual COPD patients (disease history, clinical status, treatment and pharmacotherapy). This data was used to simulate the consequences of the implementation of the GOLD 2007, 2011 and 2017 guidelines. RESULTS A group of 298 physicians of 500 approached provided information on 2597 patients (64.2% males) aged 29-96 (61.6 ±11.1 years). Based on GOLD 2007 guidelines, most patients (56.7%) presented a severe stage of COPD. GOLD 2011 updates would significantly increase the proportion of patients with the most severe stage of disease, and this group would be predominantly classified as moderate or severe in GOLD 2007. The implementation of GOLD 2017 guidelines would result in a significant migration of patients towards the lightest (category A) form of the disease. CONCLUSIONS Updates to the GOLD 2007 COPD guidelines for GOLD 2011 and 2017 would have a significant impact on the classification of patients for particular therapeutic groups. As a result of the migration of patients to particular therapeutic groups, the pharmacological treatment would also change.
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Affiliation(s)
| | - Grzegorz M Brożek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan E Zejda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mateusz Jankowski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Bhatta L, Leivseth L, Mai XM, Henriksen AH, Carslake D, Chen Y, Langhammer A, Brumpton BM. GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study. Int J Chron Obstruct Pulmon Dis 2020; 15:225-233. [PMID: 32099347 PMCID: PMC6999582 DOI: 10.2147/copd.s228958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995-1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (ptrend=0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.
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Affiliation(s)
- Laxmi Bhatta
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - David Carslake
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yue Chen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway
| | - Ben Michael Brumpton
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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35
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Donohue JF, Kerwin E, Sethi S, Haumann B, Pendyala S, Dean L, Barnes CN, Moran EJ, Crater G. Maintained therapeutic effect of revefenacin over 52 weeks in moderate to very severe Chronic Obstructive Pulmonary Disease (COPD). Respir Res 2019; 20:241. [PMID: 31666076 PMCID: PMC6822411 DOI: 10.1186/s12931-019-1187-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/11/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Revefenacin is a long-acting muscarinic antagonist that was recently approved for the nebulized treatment of chronic obstructive pulmonary disease (COPD). Although shorter duration studies have documented the efficacy of revefenacin in COPD, longer-term efficacy has not been described. In a recent 52-week safety trial, revefenacin was well tolerated and had a favorable benefit-risk profile. Here we report exploratory efficacy and health outcomes in patients receiving revefenacin 175 μg or 88 μg daily during the 52-week trial. METHODS In this randomized, parallel-group, 52-week trial (NCT02518139), 1055 participants with moderate to very severe COPD received revefenacin 175 μg or 88 μg in a double-blind manner, or open-label active control tiotropium. RESULTS Over the 52-week treatment period, both doses of revefenacin, as well as tiotropium, elicited significant (all p < 0.0003) improvements from baseline in trough forced expiratory volume in 1 s (FEV1). The trough FEV1 profile (least squares mean change from baseline) for revefenacin 175 μg ranged from 52.3-124.3 mL and the trough FEV1 profile for tiotropium ranged from 79.7-112.8 mL. In subgroup comparisons, the effect of revefenacin on trough FEV1 was comparable in patients taking concomitant long-acting β-agonists, with or without inhaled corticosteroids, with patients who were not taking these medications. There were statistically significant (p < 0.05) improvements in all measured health status outcomes (evaluated using St. George's Respiratory Questionnaire, COPD Assessment Test, Clinical COPD Questionnaire and Baseline and Transition Dyspnea Index) from 3 months onward, in all treatment arms. CONCLUSIONS Significant sustained improvements from baseline in trough FEV1 and respiratory health outcomes were demonstrated for 175-μg revefenacin over 52 weeks, further supporting its use as a once-daily bronchodilator for the nebulized treatment of patients with COPD. TRIAL REGISTRATION NCT02518139 ; Registered 5 August 2015.
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Affiliation(s)
| | - Edward Kerwin
- Clinical Research Institute of Southern Oregon, PC, Medford, OR USA
| | - Sanjay Sethi
- University at Buffalo, State University of New York, Buffalo, NY USA
| | - Brett Haumann
- Theravance Biopharma US, Inc., 901 Gateway Boulevard, South San Francisco, CA 94080 USA
| | - Srikanth Pendyala
- Theravance Biopharma US, Inc., 901 Gateway Boulevard, South San Francisco, CA 94080 USA
| | - Lorna Dean
- Theravance Biopharma US, Inc., 901 Gateway Boulevard, South San Francisco, CA 94080 USA
| | - Chris N. Barnes
- Theravance Biopharma US, Inc., 901 Gateway Boulevard, South San Francisco, CA 94080 USA
| | - Edmund J. Moran
- Theravance Biopharma US, Inc., 901 Gateway Boulevard, South San Francisco, CA 94080 USA
| | - Glenn Crater
- Theravance Biopharma US, Inc., 901 Gateway Boulevard, South San Francisco, CA 94080 USA
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Hao W, Li M, Zhang Y, Zhang C, Wang P. Comparative Study of Cytokine Levels in Different Respiratory Samples in Mild-to-Moderate AECOPD Patients. Lung 2019; 197:565-572. [PMID: 31451927 DOI: 10.1007/s00408-019-00263-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Matrix metalloproteinase-12 (MMP-12) and Tissue inhibitor of metalloproteinase-4 (TIMP-4) play important roles in the pathophysiology of chronic obstructive pulmonary disease (COPD). Subjects of many previous studies were patients with severe and very severe COPD. However, there are comparatively few studies on patients with mild-to-moderate COPD. Our aim was to measure MMP-12 and TIMP-4 levels and to compare its levels in various materials in patients with mild-to-moderate acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We also compared which of the two materials of these biomarkers was better correlated with disease severity and DODE index. METHODS A total of 39 patients with AECOPD and 25 control subjects were enrolled in our study. MMP-12 and TIMP-4 in different respiratory samples were detected by ELISA. RESULTS Expression levels of MMP-12 in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) and TIMP-4 in BALF were significantly higher in AECOPD patients than that in healthy subjects (P < 0.001). However, there was no significant difference in TIMP-4 level in EBC of AECOPD patients compared to healthy subjects (P = 0.0527). The levels of MMP-12 in BALF and EBC and TIMP-4 in BAFL of AECOPD patients were significantly correlated with FEV1% predicted (P < 0.001). However, in AECOPD patients, there was no significant correlation between TIMP-4 levels in EBC and BODE index (r = 0.4175, P = 0.0559). CONCLUSION During mild-to-moderate AECOPD, the levels of MMP-12 and TIMP-4 in BALF were better correlated with FEV1% predicted and BODE index than that in EBC, indicating that they may be new target interventions for pharmacology to prevent and/or treat AECOPD.
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Affiliation(s)
- Wendong Hao
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China.
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yunqing Zhang
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China
| | - Cailian Zhang
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China
| | - Ping Wang
- Department of Respiratory Medicine, The Affiliated Hospital of Yan'an University, Yan'an, 716099, Shaanxi, People's Republic of China
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Chen S, Zhang Z, Chen L, Zhang J. miRNA‑101‑3p.1 as an independent diagnostic biomarker aggravates chronic obstructive pulmonary disease via activation of the EGFR/PI3K/AKT signaling pathway. Mol Med Rep 2019; 20:4293-4302. [PMID: 31545413 DOI: 10.3892/mmr.2019.10657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/28/2019] [Indexed: 11/06/2022] Open
Abstract
Exploring independent biomarkers and delineating pathogenic mechanisms could improve the early diagnosis and treatment of chronic obstructive pulmonary disease (COPD). In the present study, a study was conducted to determine the diagnostic potential of miRNA‑101‑3p.1 in identifying stable COPD (SCOPD) and acute exacerbation of COPD (AECOPD) patients and to reveal the molecular mechanism by which miRNA‑101‑3p.1 regulates COPD progression. miRNA‑101‑3p.1 profiles in peripheral blood mononuclear cells of COPD patients were evaluated. Subsequently, receiver operating characteristic curves were created to demonstrate the diagnostic accuracy of miRNA‑101‑3p.1 in discriminating SCOPD and AECOPD. Finally, the molecular mechanism by which miRNA‑101‑3p.1 regulates COPD progression was explored. The present study revealed that patients with COPD, and especially patients with AECOPD, had significantly increased levels of miRNA‑101‑3p.1 and the level of miRNA‑101‑3p.1 was closely correlated with CAT score and FEV1% predicted. Notably, miRNA‑101‑3p.1 accurately discriminated SCOPD and AECOPD. Furthermore, increasing miRNA‑101‑3p.1 promoted cell proliferation and induced the expression of inflammatory cytokines. Mechanistic investigations revealed that miRNA‑101‑3p.1 inhibited the expression of von Hippel‑Lindau tumor suppressor (pVHL) and ubiquitin conjugating enzyme E2 D1 (UBE2D1). pVHL and UBE2D1 co‑upregulated HIF‑1α, and HIF‑1α mediated activation of the EGFR/PI3K/AKT signaling pathway. The present results collectively demonstrated that miRNA‑101‑3p.1 could act as an independent biomarker for the diagnosis of SCOPD and AECOPD, and that miRNA‑101‑3p.1 facilitates COPD progression by activating the EGFR/PI3K/AKT signaling pathway.
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Affiliation(s)
- Shuifang Chen
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zeying Zhang
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Lina Chen
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jianli Zhang
- Respiratory Department of Internal Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Gäbler M, Ohrenberger G, Funk GC. Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties. ERJ Open Res 2019; 5:00163-2018. [PMID: 31544110 PMCID: PMC6745412 DOI: 10.1183/23120541.00163-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION End-stage chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure are often treated by representatives from different medical specialties. This study investigates if the choice of treatment is influenced by the medical specialty. METHODS An online cross-sectional survey among four Austrian medical societies was performed, accompanied by a case vignette of a geriatric end-stage COPD patient with acute respiratory failure. Respondents had to choose between noninvasive ventilation (NIV), a conservative treatment attempt (without NIV) and a palliative approach. Ethical considerations and their impact on decision making were also assessed. RESULTS Responses of 162 physicians (67 from intensive care units (ICUs), 51 from pulmonology or internal departments and 44 from geriatric or palliative care) were included. The decision for NIV (instead of a conservative or palliative approach) was associated with working in an ICU (OR 14.9, 95% CI 1.87-118.8) and in a pulmonology or internal department (OR 9.4, 95% CI 1.14-78.42) compared with working in geriatric or palliative care (Model 1). The decision for palliative care was negatively associated with working in a pulmonology or internal department (OR 0.16, 95% CI 0.05-0.47) and (nonsignificantly) in an ICU (OR 0.41, 95% CI 0.15-1.12) (Model 2). CONCLUSIONS Department association was shown to be an independent predictor for treatment decisions in end-stage COPD with acute respiratory failure. Further research on these differences and influential factors is necessary.
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Affiliation(s)
- Martin Gäbler
- Institute of Preventive and Applied Sports Medicine, Krems University Hospital, Karl Landsteiner University of Health Sciences, Krems, Austria
- Dept of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital, Vienna, Austria
| | | | - Georg-Christian Funk
- Medical Dept II and Karl-Landsteiner Institute für Lungenforschung und Pneumologische Onkologie Wilheminenspital, Vienna, Austria
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Global Initiative for Chronic Obstructive Lung Disease: The Changes Made. Cureus 2019; 11:e4985. [PMID: 31453045 PMCID: PMC6701900 DOI: 10.7759/cureus.4985] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/24/2019] [Indexed: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease or COPD is one of the conditions that physicians frequently see in both the hospital and outpatient setting. In order to improve diagnostic and treatment outcomes, the Global Strategy for the Diagnosis, Management and Prevention of COPD, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was created in 2001. Every year, a new report is generated based on an analysis of published studies which attempts to improve the way physicians handle COPD. GOLD reports are considered to be essential evidence-based reference tools for the implementation of effective management plans, and represent the current best practices for the care of patients with COPD. The 2017 report greatly revised the guidelines and added a few components that changed the system of COPD diagnosis and treatment. This review article addresses those changes, explains the current guidelines, and draws attention to areas that still require improvement.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Southern Medical University, Guangzhou, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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GÜNAYDIN FE, KALKAN N, GÜNLÜOĞLU G, AKTEPE EN, DEMİRKOL B, ALTIN S. The relationship between serum levels of surfactant protein D in COPD exacerbation severity and mortality. Turk J Med Sci 2019; 49:888-893. [PMID: 31083857 PMCID: PMC7018249 DOI: 10.3906/sag-1809-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background/aim Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. In COPD patients, various inflammatory markers such as cytokines and acute phase proteins, which show systemic inflammation in the circulation, increase during exacerbations. In our study, we aimed to determine the relationship between serum SP-D levels and exacerbation severity, clinical course of the disease, and early mortality after discharge. Materials and methods Fifty hospitalized patients with COPD acute exacerbation (46 male and 4 female) were recruited in this study. Thirty-three of the subjects (31 male and 2 female) were reevaluated after discharge. Venous blood samples were taken from all patients and followed up for exacerbation frequency, hospital admission, and mortality for 12 months. Results Serum SP-D levels in the stable period of the patients were lower than exacerbation (P < 0.001). The median exacerbation period SP-D level of the patients admitted to emergency department in the first month was statistically significantly higher than that of the patients who were not admitted (P < 0.05) after discharge. There was a correlation between the rate of emergency admission and serum SP-D levels during the 12-month period after discharge (P = 0.04 (r = 0.29)). Conclusion Our study showed that serum SP-D was found to be a useful biomarker in predicting emergency admission and predictor of the health status of COPD patients but did not predict early mortality after the exacerbation.
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Affiliation(s)
- Fatma Esra GÜNAYDIN
- Department of Allergy and Immunology, Faculty of Medicine, Uludağ University, BursaTurkey
| | - Nurdan KALKAN
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Gülşah GÜNLÜOĞLU
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Esma Nur AKTEPE
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Barış DEMİRKOL
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
| | - Sedat ALTIN
- Department of Pulmonary Diseases, Health Sciences University Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbulTurkey
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Dua R, Kumari R, Yadav V, Ranjan M, Kumar S, Mishra M, Tripathi S. New combined assessment of chronic obstructive pulmonary disease: Utilization, pitfalls, and association with spirometry. Lung India 2019; 36:183-187. [PMID: 31031335 PMCID: PMC6503706 DOI: 10.4103/lungindia.lungindia_163_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Classification of chronic obstructive pulmonary (COPD) disease has changed from being solely based on spirometric variables to combined assessment including symptom scores and history of exacerbations/ hospitalizations. There is both lack of awareness regarding change in its assessment as well as underutilization due to time constraints and seeming complexity. Moreover, treatment of COPD needs to be tailored according to the new combined assessment. Aims Current study was planned to look at current stratification of patients according to new revised combined assessment (Global Initiative for Chronic Obstructive Lung Disease GOLD 2017) in comparison to old(GOLD 2011) as well as its incorporation in clinical practice. Co-relation between revised combined assessment and spirometric staging was also assessed. Methods 418 consecutive COPD patients were enrolled, their dyspnea scores in terms of modified medical research council scale (mMRC), preceding history of hospitalization/ exacerbation over preceding one year and spirometric variables were recorded. Their stratification according to old and new classification recorded. Their past treatment records were reviewed and combined assessment if done recorded. Results Substantial shift of categories is seen from C and D respectively to stage A and B on applying the new classification compared to old i.e more severe to less severe. Secondly, revised combined assessment is still highly underutilized. Revised combined assessment has positive co-relation with spirometry and post bronchodilator forced expiratory volume in 1 second(FEV1). Conclusions Management of substantial number of stable COPD patients may need to be stepped down in accordance with revised combined assessment. There is a need to disseminate information regarding change in COPD classification and stress on its incorporation in our day-to day clinical practice. Revised combined assessment has positive co-relation with spirometry, stressing its utility even in peripheral centers without spirometry facilities.
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Affiliation(s)
- Ruchi Dua
- Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Ranjeeta Kumari
- Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Vivek Yadav
- Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Mayur Ranjan
- Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Subodh Kumar
- Department of Emergency and Trauma, AIIMS, Rishikesh, Uttarakhand, India
| | - Mayank Mishra
- Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India
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Lee SJ, Yun SS, Ju S, You JW, Cho YJ, Jeong YY, Kim JY, Kim HC, Lee JD. Validity of the GOLD 2017 classification in the prediction of mortality and respiratory hospitalization in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:911-919. [PMID: 31118600 PMCID: PMC6499138 DOI: 10.2147/copd.s191362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/29/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) released an updated document in 2017 that excluded the spirometric parameter in the classification of patients. The validity of this new classification system in predicting mortality and respiratory hospitalization is still uncertain. Methods: Outpatients (n=149) with chronic obstructive pulmonary disease (COPD) who underwent spirometry and six-minutes walking test from October 2011 to September 2013 were enrolled. The overall mortality and rate of respiratory hospitalization over a median of 61 months were analyzed. Kaplan-Meier survival analyses, receiver operaing curve analyses with areas under the curve (AUCs), and logistic regression analyses for GOLD 2007, GOLD 2011, GOLD 2017, and/or BODE index were performed to evaluate their abilities to predict mortality and respiratory hospitalization. Results: Forty-two (53.2%) patients in 2011 GOLD C or D group were categorized into 2017 GOLD A or B group. The odds ratios of GOLD 2017 group C and group D relative to group A were 7.55 (95% CI, 1.25-45.8) and 25.0 (95% CI, 6.01-102.9) for respiratory hospitalization. Patients in GOLD 2017 group A and group B had significantly better survival (log-rank test, p<0.001) compared with patients in group D; however, survival among patients in GOLD 2007 groups and GOLD 2011 groups was comparable. The AUC values for GOLD 2007, GOLD 2011, GOLD 2017, and BODE index were 0.573, 0.624, 0.691, 0.692 for mortality (p=0.013) and 0.697, 0.707, 0.741, and 0.754 for respiratory hospitalization (p=0.296), respectively. Conclusion: The new GOLD classification may perform better than the previous classifications in terms of predicting mortality and respiratory hospitalization.
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Affiliation(s)
- Seung Jun Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sang Suk Yun
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Sunmi Ju
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jung Wan You
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yu Ji Cho
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yi Yeong Jeong
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ju-Young Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ho Cheol Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jong Deog Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Vestbo J, Vogelmeier CF, Small M, Siddall J, Fogel R, Kostikas K. Inhaled corticosteroid use by exacerbations and eosinophils: a real-world COPD population. Int J Chron Obstruct Pulmon Dis 2019; 14:853-861. [PMID: 31114183 PMCID: PMC6489586 DOI: 10.2147/copd.s189585] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Blood eosinophils may predict response to inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) where ICS is recommended in patients at high risk of exacerbations. The proportion of patients who may benefit the most from ICS-based therapy was quantified in a real-world population. Materials and methods: European data from the Adelphi Real World Respiratory Disease Specific Programme™ 2017 survey were collected from consecutive COPD patients by participating physicians. Overall, 1,528 patients were assessable for Global Initiative for COPD (GOLD) 2017 status and were included in the analysis. Results: More GOLD D patients had elevated eosinophil counts compared with GOLD B. The proportions of GOLD D patients with a history of ≥2 exacerbations and eosinophil counts of ≥150, ≥300, and ≥400 cells/µL were 81.2%, 39.4%, and 24.6%, respectively. In total, 10.6% of the patients had ≥300 eosinophils/µL and a history of ≥2 exacerbations. ICS-based therapy was received by 41.5% of GOLD B and 68.0% of GOLD D patients. Conclusion: There was no apparent relation between ICS use and eosinophil blood count. There are differences in the distributions of patients with frequent exacerbations and/or high blood eosinophil counts and the use of ICS in COPD. These data may provide information for the implementation of future treatment recommendations.
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Affiliation(s)
- Jørgen Vestbo
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Claus F Vogelmeier
- Department for Pulmonary Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Mark Small
- Respiratory Research, Adelphi Real World, Bollington, UK
| | - James Siddall
- Respiratory Research, Adelphi Real World, Bollington, UK
| | - Robert Fogel
- Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland
| | - Konstantinos Kostikas
- Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland.,Respiratory Medicine Department, University of Ionnina Medical School, Ionnina, Greece
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Cui Y, Dai Z, Luo L, Chen P, Chen Y. Classification and treatment of chronic obstructive pulmonary disease outpatients in China according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017: comparison with GOLD 2014. J Thorac Dis 2019; 11:1303-1315. [PMID: 31179072 DOI: 10.21037/jtd.2019.03.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed new classification criteria for patients with chronic obstructive pulmonary disease (COPD), which categorizes them into groups A-D based on risk of exacerbations and symptoms. The impact of the 2017 revisions on categorization and subsequent drug selection has been insufficiently studied in China. Methods This observational, multicenter, cross-sectional study recruited patients attending the outpatient clinics of 12 tertiary hospitals in China between April 2016 and July 2018. Patients were classified according to the GOLD 2014 and 2017 classification criteria and profiled based on categorization, demographics, clinical characteristics, and treatment regimens. Results In total, 1,278 COPD patients [mean age (±SD), 62.4±8.4 years; body mass index (BMI), 22.3±3.4 kg/m2] were included. According to the GOLD 2014 and 2017 classification criteria, the distribution in groups A-D was 58 (4.5%), 288 (22.5%), 28 (2.2%), 904 (70.7%) and 71 (5.6%), 573 (44.8%), 15 (1.2%), 619 (48.4%), respectively. Overall, 32% of patients in groups C-D were reclassified to groups A-B. Based on both GOLD 2014 and 2017, low BMI and education level were independent risk factors for high risk of exacerbation (i.e., being in groups C-D) (P<0.05). The patients who were reclassified from group D to B were younger and had fewer symptoms than those who remained in group D. The most frequently prescribed regimen was triple inhaled treatment (39.4%). Inhaled corticosteroids (ICS) were prescribed across all groups, and 205 (71.9%) of the 285 patients who were reclassified from group D to B were treated with ICS. Conclusions GOLD 2017 reclassified COPD patients to low-risk groups. The risk of exacerbation increased with decreased BMI or education levels. Overtreatment was observed in many patients, and physicians should reexamine treatment patterns for patients reclassified into low-risk groups.
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Affiliation(s)
- Yanan Cui
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Zhongshang Dai
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Lijuan Luo
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Ping Chen
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
| | - Yan Chen
- Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China
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Brożek GM, Nowak M, Zejda JE, Jankowski M, Lawson J, Pierzchała W. Consequences of Changing the GOLD Reports (2007–2011–2017) on the Treatment Regimen of Patients with COPD. COPD 2019; 16:126-132. [DOI: 10.1080/15412555.2019.1615872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Grzegorz Marek Brożek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Jan Eugeniusz Zejda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Mateusz Jankowski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Joshua Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Cavalleri MA, Diaz DE Teran T, Barlascini CO, Banfi P, Nicolini A. How to treat COPD: a critical appraisal of the FLAME Trial. Panminerva Med 2019; 64:115-116. [PMID: 30727710 DOI: 10.23736/s0031-0808.19.03569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maurizio A Cavalleri
- Department of Internal Medicine, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Teresa Diaz DE Teran
- Unit of Sleep and non Invasive Ventilation, Pulmonary, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Cornelius O Barlascini
- Unit of Hygiene and Health Medicine, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Paolo Banfi
- Unit of Pulmonary Medicine, Don Gnocchi IRCCS Foundation, Milan, Italy
| | - Antonello Nicolini
- Unit of Respiratory Diseases, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy -
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Cook NS, Kostikas K, Gruenberger JB, Shah B, Pathak P, Kaur VP, Mudumby A, Sharma R, Gutzwiller FS. Patients' perspectives on COPD: findings from a social media listening study. ERJ Open Res 2019; 5:00128-2018. [PMID: 30775374 PMCID: PMC6368996 DOI: 10.1183/23120541.00128-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/21/2018] [Indexed: 11/14/2022] Open
Abstract
We utilised social media listening (SML) to obtain patients' perspectives on symptoms, diagnosis and comorbidities associated with chronic obstructive pulmonary disease (COPD) and its impact on patients' quality of life (QoL). A comprehensive search on social media platforms was performed for English language content posted between July 2016 and January 2018 using COPD-related terms. Social Studio, a social media data aggregator tool, was used to capture relevant records. The content was manually curated to analyse and map psychological aspects with descriptive statistics applied on aggregated findings. A total of 849 posts from patients or caregivers ("patient insights") were considered for the analysis, corresponding to postings of 695 unique individuals. Based on 734 mentions of symptoms from 849 posts by potential patients/caregivers, cough (27%), mucus (25%) and shortness of breath (21%) were the most frequent; analysis by perceived COPD severity indicated these to be common across all severities. Difficulty in mucus clearance (24% of 268 mentions) and sadness (40% of 129 mentions) were top among the aspects impacting physical and emotional QoL, respectively. SML from patients with COPD indicated that relief from cough, mucus production and shortness of breath would be the most desirable aspects of disease management from a patient's perspective.
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Affiliation(s)
| | | | | | - Bhavik Shah
- Novartis Healthcare Pvt Ltd, Hyderabad, India
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48
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Kostikas K, Greulich T, Mackay AJ, Lossi NS, Aalamian-Mattheis M, Nunez X, Pagano VA, Patalano F, Clemens A, Vogelmeier CF. Treatment response in COPD: does FEV 1 say it all? A post hoc analysis of the CRYSTAL study. ERJ Open Res 2019; 5:00243-2018. [PMID: 30815470 PMCID: PMC6387992 DOI: 10.1183/23120541.00243-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 01/19/2023] Open
Abstract
The association between clinically relevant changes in patient-reported outcomes (PROs) and forced expiratory volume in 1 s (FEV1) in patients with chronic obstructive pulmonary disease (COPD) has rarely been investigated. Using CRYSTAL, a 12-week open-label study in symptomatic, nonfrequently exacerbating patients with moderate COPD, we assessed at baseline the correlations between several PROs (Baseline Dyspnoea Index, modified Medical Research Council dyspnoea scale, COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ)), and between FEV1 and PROs. Associations between clinically relevant responses in FEV1, CAT, CCQ and Transition Dyspnoea Index (TDI) at week 12 were also assessed. Using data from 4324 patients, a strong correlation was observed between CAT and CCQ (rs=0.793) at baseline, with moderate or weak correlations between other PROs, and no correlation between FEV1 and any PRO. At week 12, 2774 (64.2%) patients were responders regarding TDI, CAT or CCQ, with 583 (13.5%) responding using all three measures. In comparison, 3235 (74.8%) were responders regarding FEV1, TDI, CAT or CCQ, with 307 (7.1%) responding concerning all four parameters. Increases in lung function were accompanied by clinically relevant improvements of PROs in a minority of patients. Our results also suggest that PROs are not interchangeable. Thus, the observed treatment success in a clinical trial may depend on the selected parameters.
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Affiliation(s)
| | - Timm Greulich
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Alexander J. Mackay
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | | | | | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland
- Dept of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- These two authors contributed equally to this work
| | - Claus F. Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Giessen, Germany
- These two authors contributed equally to this work
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49
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Gayle A, Dickinson S, Morris K, Poole C, Mathioudakis AG, Vestbo J. What is the impact of GOLD 2017 recommendations in primary care? - a descriptive study of patient classifications, treatment burden and costs. Int J Chron Obstruct Pulmon Dis 2018; 13:3485-3492. [PMID: 30498338 PMCID: PMC6207393 DOI: 10.2147/copd.s173664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The changes in grading of disease severity and treatment recommendations for patients with COPD in the 2017 GOLD strategy may present an opportunity for reducing treatment burden for the patients and costs to the health care system. The aim of this study was to assess the implications of the GOLD 2017 grading system in terms of change in distribution across GOLD groups A-D for existing patients in UK primary care and estimate the potential cost savings of implementing GOLD 2017 treatment recommendations in UK primary care. PATIENTS AND METHODS Using electronic health record data from the Clinical Practice Research Datalink (CPRD), patients aged ≥35 years with spirometry-confirmed COPD, receiving care during 2016, were included. The cohort was graded according to the GOLD 2017 groups (A-D), and treatment costs were calculated, according to corresponding recommendations, to observe the difference in actual vs predicted costs. RESULTS When applying GOLD 2013 criteria, less than half of the cohort (46%) was assigned to GOLD A or B, as compared to 86% when applying the GOLD 2017 grading. The actual mean annual maintenance treatment cost was £542 per patient vs a predicted £389 for treatment according to the 2017 GOLD strategy. CONCLUSION There is a potential to make significant cost savings by implementing the grading and treatment recommendations from the 2017 GOLD strategy.
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Affiliation(s)
- Alicia Gayle
- Market Access, Boehringer Ingelheim Ltd, Bracknell, UK,
| | - Scott Dickinson
- Medical and Scientific Affairs, Boehringer Ingelheim Ltd, Bracknell, UK
| | - Kevin Morris
- Market Access, Boehringer Ingelheim Ltd, Bracknell, UK,
| | - Chris Poole
- Market Access, Boehringer Ingelheim Ltd, Bracknell, UK,
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
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50
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Hu YH, Liang ZY, Xu LM, Xu WH, Liao H, Li R, Wang K, Xu Y, Ou CQ, Chen X. Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China. Int J Chron Obstruct Pulmon Dis 2018; 13:3011-3019. [PMID: 30319249 PMCID: PMC6167996 DOI: 10.2147/copd.s174668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Compared with the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD), there have been significant changes in the 2017 GOLD classification. The purpose of this study was to analyze the changes in clinical characteristics of the new A-B-C-D system and to explore its role in comprehensive assessment of COPD. Subjects and methods A total of 631 stable COPD patients were included in a cross-sectional survey. Data collected included baseline data and pulmonary function testing results, respiratory muscle strength, symptoms and quality of life, exercise capacity, nutritional status, and anxiety and depression as a comprehensive assessment. Based on the 2011 GOLD and 2017 GOLD classifications, patients were divided into Groups A1–D1 and Groups A2–D2, respectively. Results In the 2011 GOLD, 64 subjects in Group C1 were reclassified into Group A2 (41.6%), while 77 subjects in Group D1 were reclassified into Group B2 (27.1%). The old and new grading systems were somewhat consistent (Cohen’s kappa=0.6963, P<0.001). Lung function was lower, while the body mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE index) was higher in Group A2 than in Group A1 (P<0.001). In Group B2, lung function, 6-minute walking distance (6MWD), and respiratory muscle strength were significantly lower than in Group B1 (P<0.001), while the BODE index (P<0.001) was higher. In comprehensive assessment, subjects in Groups B2 and D2 had significantly lower lung function, 6MWD, respiratory muscle strength, quality of life, higher symptom scores, and BODE index than subjects in Group A2 (P<0.001). The differences between Group A2 and C2 were small. Conclusion Compared with the 2011 GOLD, the 2017 GOLD reclassified more patients into Groups A and B, those with significantly worse lung function and higher BODE index. In the comprehensive assessment of the new classification, Groups B and D may have greater disease severity. However, the effectiveness of the new grading system in predicting patient prognosis, and its guidance on the use of drugs, remains to be explored in future studies.
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Affiliation(s)
- Yu-He Hu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Zhen-Yu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Mei Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Wen-Hui Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Hao Liao
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Rui Li
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Kai Wang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Ying Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
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