1
|
Sun T, Wang J, Zheng M, Cai C, Yu J, Fu L, Duan L. Assessment of the Relationship Between Genetic Determinants of Obesity, Unhealthy Eating Habits and Chronic Obstructive Pulmonary Disease: A Mendelian Randomisation Study. COPD 2024; 21:2309236. [PMID: 38348880 DOI: 10.1080/15412555.2024.2309236] [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: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
Background: Clinical studies have shown that the onset and exacerbation of chronic obstructive pulmonary disease (COPD) are related to obesity and dietary behaviours, but the genetic relationship between them is not clear.Aims: To investigate the relationship between the genetic determinants of obesity, dietary habits (alcohol consumption, intake of sweets, salt intake) and COPD.Methods: Exposure and outcome datasets were obtained from the IEU Open GWAS project. The exposure dataset includes dietary habits (Salt added to food, Sweets intake, Alcohol consumption), obesity level (represented by body mass index (BMI) and body fat percentage (BFP) data sets.). The outcome dataset includes COPD and acute COPD admissions. The collected data were imported into the RStudio software and conducted Mendelian randomisation analysis. Additionally, heterogeneity and horizontal pleiotropy tests were conducted on the data to ensure the veracity of the results.Results: The results showed that BMI was positively correlated with the risk of acute COPD admission (OR = 1.74, 95% CI 1.39-2.18) and COPD (OR = 1.81, 95%CI 1.41-2.33). In addition, BFP was also a risk factor for COPD (OR = 1.98, 95% CI 1.42-2.77) and acute exacerbation of COPD admission (OR = 1.99, 95%CI 1.43-2.77). The increase of salt, sugar and alcohol consumption will not increase the risk of COPD and the risk of hospitalisation due to COPD.Conclusion: Therefore, we should strengthen the guidance of diet and living habits of obese patients. For patients with heavier weight and higher body fat rate, they should be instructed to lose weight and fat to prevent the occurrence of COPD. For obese patients with COPD, more attention should be paid to prevent the occurrence of acute exacerbation of COPD in advance.
Collapse
Affiliation(s)
- Tongyao Sun
- Shandong University of Traditional Chinese Medicine First Clinical Medical College, Shandong, China
| | - Jun Wang
- Respiratory and Critical Care Medicine Department, Shandong University of Traditional Chinese Medicine Second Affiliated Hospital, Shandong, China
| | - Min Zheng
- Shandong University of Traditional Chinese Medicine First Clinical Medical College, Shandong, China
| | - Chengsen Cai
- Respiratory and Critical Care Medicine Department, Shandong University of Traditional Chinese Medicine Second Affiliated Hospital, Shandong, China
| | - Jianjian Yu
- Respiratory and Critical Care Medicine Department, Shandong University of Traditional Chinese Medicine Second Affiliated Hospital, Shandong, China
| | - Lina Fu
- Respiratory and Critical Care Medicine Department, Shandong University of Traditional Chinese Medicine Second Affiliated Hospital, Shandong, China
| | - Lei Duan
- Medical Affairs Department, Shandong University of Traditional Chinese Medicine Second Affiliated Hospital, Shandong, China
| |
Collapse
|
2
|
Zhu Z. Advancements in automated classification of chronic obstructive pulmonary disease based on computed tomography imaging features through deep learning approaches. Respir Med 2024; 234:107809. [PMID: 39299523 DOI: 10.1016/j.rmed.2024.107809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) represents a global public health issue that significantly impairs patients' quality of life and overall health. As one of the primary causes of chronic respiratory diseases and global mortality, effective diagnosis and classification of COPD are crucial for clinical management. Pulmonary function tests (PFTs) are standard for diagnosing COPD, yet their accuracy is influenced by patient compliance and other factors, and they struggle to detect early disease pathologies. Furthermore, the complexity of COPD pathological changes poses additional challenges for clinical diagnosis, increasing the difficulty for physicians in practice. Recently, deep learning (DL) technologies have demonstrated significant potential in medical image analysis, particularly for the diagnosis and classification of COPD. By analyzing key radiological features such as airway alterations, emphysema, and vascular characteristics in Computed Tomography (CT) scan images, DL enhances diagnostic accuracy and efficiency, providing more precise treatment plans for COPD patients. This article reviews the latest research advancements in DL methods based on principal radiological features of COPD for its classification and discusses the advantages, challenges, and future research directions of DL in this field, aiming to provide new perspectives for the personalized management and treatment of COPD.
Collapse
Affiliation(s)
- Zirui Zhu
- School of Medicine, Xiamen University, Xiamen 361102, China; National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361102, China.
| |
Collapse
|
3
|
Farrell LA, O’Rourke MB, Padula MP, Souza-Fonseca-Guimaraes F, Caramori G, Wark PAB, Dharmage SC, Hansbro PM. The Current Molecular and Cellular Landscape of Chronic Obstructive Pulmonary Disease (COPD): A Review of Therapies and Efforts towards Personalized Treatment. Proteomes 2024; 12:23. [PMID: 39189263 PMCID: PMC11348234 DOI: 10.3390/proteomes12030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) ranks as the third leading cause of global illness and mortality. It is commonly triggered by exposure to respiratory irritants like cigarette smoke or biofuel pollutants. This multifaceted condition manifests through an array of symptoms and lung irregularities, characterized by chronic inflammation and reduced lung function. Present therapies primarily rely on maintenance medications to alleviate symptoms, but fall short in impeding disease advancement. COPD's diverse nature, influenced by various phenotypes, complicates diagnosis, necessitating precise molecular characterization. Omics-driven methodologies, including biomarker identification and therapeutic target exploration, offer a promising avenue for addressing COPD's complexity. This analysis underscores the critical necessity of improving molecular profiling to deepen our comprehension of COPD and identify potential therapeutic targets. Moreover, it advocates for tailoring treatment strategies to individual phenotypes. Through comprehensive exploration-based molecular characterization and the adoption of personalized methodologies, innovative treatments may emerge that are capable of altering the trajectory of COPD, instilling optimism for efficacious disease-modifying interventions.
Collapse
Affiliation(s)
- Luke A. Farrell
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Centre for Inflammation, Ultimo, NSW 2007, Australia;
| | - Matthew B. O’Rourke
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Centre for Inflammation, Ultimo, NSW 2007, Australia;
| | - Matthew P. Padula
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | | | - Gaetano Caramori
- Pulmonology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Peter A. B. Wark
- School of Translational Medicine, Monash University, Melbourne, VIC 3000, Australia;
| | - Shymali C. Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3000, Australia;
| | - Phillip M. Hansbro
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Centre for Inflammation, Ultimo, NSW 2007, Australia;
| |
Collapse
|
4
|
Sivapalan P, Eklöf J, Bonnesen B, Tønnesen L, Wilcke T, Jensen JUS. Individualised treatment of COPD exacerbations using biomarkers. Ugeskr Laeger 2024; 186:V09230560. [PMID: 38606705 DOI: 10.61409/v09230560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This review highlights key aspects of treating chronic obstructive pulmonary disease (COPD) exacerbation, focusing on the optimisation of systemic corticosteroid and antibiotic use through personalised treatment using biomarkers. Eosinophil-guided therapy reduces corticosteroid usage which might reduce side effects, while procalcitonin-guided therapy contributes to reduced antibiotic consumption. These approaches, documented through well-conducted randomized controlled trials, suggest the possibility of enhancing COPD exacerbation management, reducing potential side effects, and addressing concerns related to antibiotic resistance.
Collapse
Affiliation(s)
- Pradeesh Sivapalan
- Lungemedicinsk Afdeling, Afdeling for Medicinske Sygdomme, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Josefin Eklöf
- Lungemedicinsk Afdeling, Afdeling for Medicinske Sygdomme, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Barbara Bonnesen
- Lungemedicinsk Afdeling, Afdeling for Medicinske Sygdomme, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Louise Tønnesen
- Lungemedicinsk Afdeling, Afdeling for Medicinske Sygdomme, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Torgny Wilcke
- Lungemedicinsk Afdeling, Afdeling for Medicinske Sygdomme, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Jens-Ulrik Stæhr Jensen
- Lungemedicinsk Afdeling, Afdeling for Medicinske Sygdomme, Københavns Universitetshospital - Herlev og Gentofte Hospital
| |
Collapse
|
5
|
Shi Y, Xu Z, Pu S, Xu K, Wang Y, Zhang C. Association Between Serum Klotho and Chronic Obstructive Pulmonary Disease in US Middle-Aged and Older Individuals: A Cross-Sectional Study from NHANES 2013-2016. Int J Chron Obstruct Pulmon Dis 2024; 19:543-553. [PMID: 38435124 PMCID: PMC10906733 DOI: 10.2147/copd.s451859] [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: 11/26/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose This study sought to examine the potential association between serum Klotho levels and the prevalence of COPD in the United States. Patients and Methods This study was a cross-sectional analysis involving 4361 adults aged 40-79 years participating in the US National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2016. Our investigation utilized multivariate logistic regression and restricted cubic spline (RCS) regression to explore the potential correlation between serum Klotho concentrations and the prevalence of COPD. Additionally, we conducted stratified and interaction analyses to evaluate the consistency and potential modifiers of this relationship. Results In this study encompassing 4631 patients (with an average age of 57.6 years, 47.5% of whom were male), 445 individuals (10.2%) were identified as having COPD. In the fully adjusted model, ln-transformed serum Klotho was negatively associated with COPD (OR = 0.71; 95% CI: 0.51-0.99; p = 0.043). Meanwhile, compared with quartile 1, serum Klotho levels in quartiles 2-4 yielded odds ratios (ORs) (95% CI) for COPD were 0.84 (0.63~1.11), 0.76 (0.56~1.02), 0.84 (0.62~1.13), respectively. A negative relationship was observed between the ln-transformed serum Klotho and occurrence of COPD (nonlinear: p = 0.140). the association between ln-transformed serum Klotho and COPD were stable in stratified analyses. Conclusion Serum Klotho was negatively associated with the incidence of COPD, when ln-transformed Klotho concentration increased by 1 unit, the risk of COPD was 29% lower.
Collapse
Affiliation(s)
- Yushan Shi
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 25000, People’s Republic of China
| | - Zhangmeng Xu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610075, People’s Republic of China
| | - Shuangshuang Pu
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 25000, People’s Republic of China
| | - Kanghong Xu
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 25000, People’s Republic of China
| | - Yanan Wang
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 25000, People’s Republic of China
| | - Chunlai Zhang
- Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 25000, People’s Republic of China
| |
Collapse
|
6
|
Gan Q, Wu Y, Su X, Wang J, Zhang H, Zhang N, Wu K. Inhaled Dual PDE3/4 Inhibitor Ensifentrine for Chronic Obstructive Pulmonary Disease: A Potential Therapeutic Perspective. Am J Respir Crit Care Med 2024; 209:223-224. [PMID: 37939381 PMCID: PMC10806418 DOI: 10.1164/rccm.202307-1143le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/08/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- Qiming Gan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yanjuan Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiaofen Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jingcun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Haojie Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Kang Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
7
|
Brauwers B, Machado FVC, Beijers RJHCG, Spruit MA, Franssen FME. Combined Exercise Training and Nutritional Interventions or Pharmacological Treatments to Improve Exercise Capacity and Body Composition in Chronic Obstructive Pulmonary Disease: A Narrative Review. Nutrients 2023; 15:5136. [PMID: 38140395 PMCID: PMC10747351 DOI: 10.3390/nu15245136] [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: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that is associated with significant morbidity, mortality, and healthcare costs. The burden of respiratory symptoms and airflow limitation can translate to reduced physical activity, in turn contributing to poor exercise capacity, muscle dysfunction, and body composition abnormalities. These extrapulmonary features of the disease are targeted during pulmonary rehabilitation, which provides patients with tailored therapies to improve the physical and emotional status. Patients with COPD can be divided into metabolic phenotypes, including cachectic, sarcopenic, normal weight, obese, and sarcopenic with hidden obesity. To date, there have been many studies performed investigating the individual effects of exercise training programs as well as nutritional and pharmacological treatments to improve exercise capacity and body composition in patients with COPD. However, little research is available investigating the combined effect of exercise training with nutritional or pharmacological treatments on these outcomes. Therefore, this review focuses on exploring the potential additional beneficial effects of combinations of exercise training and nutritional or pharmacological treatments to target exercise capacity and body composition in patients with COPD with different metabolic phenotypes.
Collapse
Affiliation(s)
- Bente Brauwers
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Felipe V. C. Machado
- BIOMED (Biomedical Research Institute), REVAL (Rehabilitation Research Centre), Hasselt University, 3590 Hasselt, Belgium;
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| |
Collapse
|
8
|
Ran B, Zhang Y, Wu Y, Wen F. Association between depression and COPD: results from the NHANES 2013-2018 and a bidirectional Mendelian randomization analysis. Expert Rev Respir Med 2023; 17:1061-1068. [PMID: 38085600 DOI: 10.1080/17476348.2023.2282022] [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: 10/14/2023] [Accepted: 11/07/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Observational studies showed a bidirectional association between depression and chronic obstructive pulmonary disease (COPD). However, it is unclear whether the observed association is causal. Thus we estimated the relationship using observational studies combined with bidirectional Mendelian randomization [MR]. MATERIALS AND METHODS The study included 9977 participants from the 2013-2018 National Health and Nutrition Examination Survey and used weighted logistic regression analysis to assess the association between depression and COPD, followed by a bidirectional Mendelian randomization analysis to verify their causality. RESULTS Adjusted-weighted logistic regression in observational studies showed a significant association between COPD and mild depression (OR (95% CI): 1.81 (1.30, 2.52), P = 0.002) and COPD and depression (OR (95% CI): 1.93 (1.49, 2.50), P < 0.001). MR suggested depression may play a causal role in COPD risk (OR (95% CI): 1.45 (1.32, 1.60), P < 0.001), but more evidence for reverse causation is lacking (reverse MR OR (95% CI): 1.03 (0.99, 1.07), P = 0.151). CONCLUSION In conclusion, our study found depression may play a potential causal role in the morbidity of COPD suggesting depression might be the etiology of COPD. This finding needs to be validated in further prospective cohort studies with large sample sizes and adequate follow-up time.
Collapse
Affiliation(s)
- Bi Ran
- Department of Respiratory and Critical Care Medicine, West China Hospital and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Sichuan University, Chengdu, Sichuan, China
| | - Yutian Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Sichuan University, Chengdu, Sichuan, China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Sichuan University, Chengdu, Sichuan, China
| | - Fuqiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
9
|
Klitgaard A, Ibsen R, Hilberg O, Løkke A. Study protocol: pneumonia and inhaled corticosteroid treatment patterns in chronic obstructive pulmonary disease - a cohort study using sequence analysis (PICCS). BMJ Open 2023; 13:e072685. [PMID: 37263696 DOI: 10.1136/bmjopen-2023-072685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Treatment with inhaled corticosteroids (ICS) is a widely used treatment in chronic obstructive pulmonary disease. The main effects include a reduction in the number of exacerbations and, for some patients, an increase in expected mortality. Unfortunately, the treatment is also linked to an increased risk of pneumonia, and very little is known about which patients experience this increased risk. There is a need for identification of patient characteristics associated with increased risk of pneumonia and treatment with ICS. METHODS AND ANALYSIS This is a register-based cohort study that uses the nationwide Danish registers. Data from several registers in the years 2008-2018 will be merged on an individual level using the personal identification numbers that are unique to every citizen in Denmark. Clusters based on pneumonia incidence and ICS treatment patterns will be explored with a sequence analysis in a 3-year follow-up period. ETHICS AND DISSEMINATION This is a register-based study and research ethics approval is not required according to Danish Law and National Ethics Committee Guidelines. The results will be submitted to peer-reviewed journals and reported at appropriate national and international meetings.
Collapse
Affiliation(s)
- Allan Klitgaard
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
10
|
Impulse Oscillometry as a Diagnostic Test for Pulmonary Emphysema in a Clinical Setting. J Clin Med 2023; 12:jcm12041547. [PMID: 36836082 PMCID: PMC9967696 DOI: 10.3390/jcm12041547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Body plethysmography (BP) is the standard pulmonary function test (PFT) in pulmonary emphysema diagnosis, but not all patients can cooperate to this procedure. An alternative PFT, impulse oscillometry (IOS), has not been investigated in emphysema diagnosis. We investigated the diagnostic accuracy of IOS in the diagnosis of emphysema. Eighty-eight patients from the pulmonary outpatient clinic at Lillebaelt Hospital, Vejle, Denmark, were included in this cross-sectional study. A BP and an IOS were performed in all patients. Computed tomography scan verified presence of emphysema in 20 patients. The diagnostic accuracy of BP and IOS for emphysema was evaluated with two multivariable logistic regression models: Model 1 (BP variables) and Model 2 (IOS variables). Model 1 had a cross-validated area under the ROC curve (CV-AUC) = 0.892 (95% CI: 0.654-0.943), a positive predictive value (PPV) = 59.3%, and a negative predictive value (NPV) = 95.0%. Model 2 had a CV-AUC = 0.839 (95% CI: 0.688-0.931), a PPV = 55.2%, and an NPV = 93.7%. We found no statistically significant difference between the AUC of the two models. IOS is quick and easy to perform, and it can be used as a reliable rule-out method for emphysema.
Collapse
|
11
|
Yousuf AJ, Mohammed S, Carr L, Yavari Ramsheh M, Micieli C, Mistry V, Haldar K, Wright A, Novotny P, Parker S, Glover S, Finch J, Quann N, Brookes CL, Hobson R, Ibrahim W, Russell RJ, John C, Grimbaldeston MA, Choy DF, Cheung D, Steiner M, Greening NJ, Brightling CE. Astegolimab, an anti-ST2, in chronic obstructive pulmonary disease (COPD-ST2OP): a phase 2a, placebo-controlled trial. THE LANCET. RESPIRATORY MEDICINE 2022; 10:469-477. [PMID: 35339234 DOI: 10.1016/s2213-2600(21)00556-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory airway disease. The epithelial-derived IL-33 and its receptor ST2 have been implicated in airway inflammation and infection. We aimed to determine whether astegolimab, a selective ST2 IgG2 monoclonal antibody, reduces exacerbations in COPD. METHODS COPD-ST2OP was a single-centre, randomised, double-blinded, placebo-controlled phase 2a trial in moderate-to-very severe COPD. Participants were randomly assigned (1:1) with a web-based system to received 490 mg subcutaneous astegolimab or subcutaneous placebo, every 4 weeks for 44 weeks. The primary endpoint was exacerbation rate assessed for 48 weeks assessed with a negative binomial count model in the intention-to-treat population, with prespecified subgroup analysis by baseline blood eosinophil count. The model was the number of exacerbations over the 48-week treatment period, with treatment group as a covariate. Safety was assessed in the whole study population until week 60. Secondary endpoints included Saint George's Respiratory Questionnaire for COPD (SGRQ-C), FEV1, and blood and sputum cell counts. The trial was registered with ClinicalTrials.gov, NCT03615040. FINDINGS The exacerbation rate at 48 weeks in the intention-to-treat analysis was not significantly different between the astegolimab group (2·18 [95% CI 1·59 to 2·78]) and the placebo group (2·81 [2·05 to 3·58]; rate ratio 0·78 [95% CI 0·53 to 1·14]; p=0·19]). In the prespecified analysis stratifying patients by blood eosinophil count, patients with 170 or fewer cells per μL had 0·69 exacerbations (0·39 to 1·21), whereas those with more than 170 cells per μL had 0·83 exacerbations (0·49 to 1·40). For the secondary outcomes, the mean difference between the SGRQ-C in the astegolimab group versus placebo group was -3·3 (95% CI -6·4 to -0·2; p=0·039), and mean difference in FEV1 between the two groups was 40 mL (-10 to 90; p=0·094). The difference in geometric mean ratios between the two groups for blood eosinophil counts was 0·59 (95% CI 0·51 to 0·69; p<0·001) and 0·25 (0·19 to 0·33; p<0·001) for sputum eosinophil counts. Incidence of treatment-emergent adverse events was similar between groups. INTERPRETATION In patients with moderate-to-very severe COPD, astegolimab did not significantly reduce exacerbation rate, but did improve health status compared with placebo. FUNDING Funded by Genentech and National Institute for Health Research Biomedical Research Centres.
Collapse
Affiliation(s)
- Ahmed J Yousuf
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Seid Mohammed
- Leicester Clinical Trials Unit, College of Life Sciences, University of Leicester, Leicester, UK
| | - Liesl Carr
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Mohammadali Yavari Ramsheh
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Claudia Micieli
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Vijay Mistry
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Kairobi Haldar
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Adam Wright
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Petr Novotny
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sarah Parker
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sarah Glover
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Joanne Finch
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Niamh Quann
- Leicester Clinical Trials Unit, College of Life Sciences, University of Leicester, Leicester, UK
| | - Cassandra L Brookes
- Leicester Clinical Trials Unit, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachel Hobson
- Leicester Clinical Trials Unit, College of Life Sciences, University of Leicester, Leicester, UK
| | - Wadah Ibrahim
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Richard J Russell
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Michael Steiner
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil J Greening
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Christopher E Brightling
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre Respiratory Medicine, Department of Respiratory Sciences, University of Leicester, Leicester, UK.
| |
Collapse
|
12
|
NUCERA F, BIANCO A, DAVID T, SALVATO I, ADCOCK IM, CARAMORI G. Treatable traits in COPD patients. Minerva Med 2022; 113:449-459. [DOI: 10.23736/s0026-4806.22.08001-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|