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Bishop JA, Spencer LM, Dwyer TJ, McKeough ZJ, McAnulty A, Cheng S, Alison JA. Patterns of physical activity of people with COPD during participation in a pulmonary rehabilitation program. Respir Med 2024; 231:107724. [PMID: 38971337 DOI: 10.1016/j.rmed.2024.107724] [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: 04/15/2024] [Revised: 06/11/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Very few studies have examined patterns of physical activity (PA) during a pulmonary rehabilitation (PR) program in people with COPD. AIMS To compare the patterns of PA in: 1) the week before commencing PR (pre-PR) with a week during PR (PR week); 2) PR days and non-PR days during a PR week; 3) pre-PR and the week following PR completion (post-PR). METHODS This was a multicenter, prospective cohort study. Participants attended twice weekly supervised PR for 8-12 weeks. Daily step count (primary outcome), time in light activities, time in moderate to vigorous PA (MVPA), total sedentary time and sit-to-stand (STS) transitions were measured using a thigh worn accelerometer for seven days, at each assessment time point: pre-PR, PR week and post-PR. RESULTS 29 participants, mean age (SD) 69years(7), FEV1 53%pred(16). The PR week compared to pre-PR, showed higher daily: step count (mean difference (95%CI)), 941steps(388-1494); and MVPA, 11mins(6-15), with no difference in: time in light activities, -1min(-6-5); total sedentary time, 7mins(-21-36); or STS transitions, 0(-5-6). PR days compared to non-PR days showed higher: step count, 2810steps(1706-3913); time in light activities 11mins(1-20); time in MVPA, 27mins(17-35) and STS transitions, 8(4-12), with no difference in total sedentary time: -33mins(-80-15). There were no differences in any PA measures post-PR compared to pre-PR (p < 0.05). CONCLUSION Daily step count and time spent in MVPA increased significantly during the PR week, solely due to increased PA on days participants attended PR.
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Affiliation(s)
- Joshua A Bishop
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Department of Physiotherapy, Balmain Hospital, Balmain, Australia; Allied Health, Sydney Local Health District, Camperdown, Australia
| | - Lissa M Spencer
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia; Allied Health, Sydney Local Health District, Camperdown, Australia
| | - Tiffany J Dwyer
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Zoe J McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Amanda McAnulty
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia; Allied Health, Sydney Local Health District, Camperdown, Australia
| | - Sonia Cheng
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Jennifer A Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Allied Health, Sydney Local Health District, Camperdown, Australia.
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Uhlving HH, Specht L, Masmas TN, Bernsdorf M, Ifversen M. Late effects following HSCT for childhood ALL: A national single-center study using three different modalities of delivery of total body irradiation. Pediatr Blood Cancer 2024; 71:e31163. [PMID: 38943233 DOI: 10.1002/pbc.31163] [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: 04/10/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Total body irradiation (TBI) is a pivotal part of conditioning prior to hematopoietic stem cell transplantation (HSCT) for childhood acute lymphoblastic leukemia (ALL), yet evidence is sparse regarding the effect of TBI delivery techniques on acute and late toxicities. DESIGN In a national cohort of pediatric HSCT-recipients, we compared three TBI schedules; 12 Gray (Gy) delivered as (i) 4 Gy daily fractions from 2008 to 2011 (n = 12); (ii) 2 Gy fractions twice daily with two-dimensional (2D) planning technology from 2012 to 2015 (n = 16); and (iii) 2 Gy twice daily with three-dimensional (3D) planning intensity-modulated radiotherapy (IMRT) from 2016 to 2020 (n = 14). RESULTS The 5-year event-free survival was 75.0%, 81.3%, and 81.3% in Cohorts 1, 2, and 3, respectively. Acute toxicity assessed as maximum ferritin and C-reactive protein during the first 3 months post HSCT did not differ between cohorts, nor did the time to first hospital discharge (median 28, 32, and 31 days, p = .25). The incidences of acute graft-versus-host disease (GvHD) (66%, 56%, 71%) and chronic GvHD (25%, 31%, 14%) were comparable. Pulmonary function assessed by spirometry did not differ significantly. The 5-year cataract-free survival was 33.3%, 79%, and 100% in Cohorts 1, 2, and 3, respectively. We found a nonsignificant tendency toward more endocrinopathies in Cohort 1 compared to Cohorts 2 and 3. CONCLUSION The change of modality did not result in more relapses. More fractionation led to improvement with a lower incidence of cataract and a tendency toward fewer endocrinopathies. The effect of 3D-planning-IMRT technology requires further evaluation in larger studies.
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Affiliation(s)
- Hilde Hylland Uhlving
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lena Specht
- Department of Radiation Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tania Nicole Masmas
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mogens Bernsdorf
- Department of Radiation Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Ifversen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Guzmán-García JM, Romero-Saldaña M, Molina-Recio G, Álvarez-Fernández C, Jiménez-Mérida MDR, Molina-Luque R. Relationship between commonly defined metabolic health phenotypes and obesity with lung function in a working population: A cross-sectional study. Heart Lung 2024; 67:62-69. [PMID: 38703640 DOI: 10.1016/j.hrtlng.2024.04.017] [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: 02/04/2024] [Revised: 04/10/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Four phenotypes relate metabolism and obesity: metabolically healthy (MHO) and unhealthy (MUO) people with obesity and metabolically healthy (MHNO) and unhealthy (MUNO) people without obesity. No studies have addressed the association between these categories and lung function in the working population. OBJECTIVES The aim was to determine the relationship of phenotypes to lung ageing as measured by lung age and its relationship to lung dysfunction. METHODS A descriptive cross-sectional study was conducted in a working population. The outcome variable was lung function assessed by lung age. The four phenotypes of obesity and metabolic health (MHNO, MHO, MUO and MUNO) were determined using NCEP-ATP III criteria. Lung dysfunctions were classified into restrictive, obstructive, and mixed patterns. RESULTS The mean age of the participants was 43.7 years, ranging from 18 to 67 years. Of the 1860 workers, 51.3 % were women. The prevalences found were 71.4 %, 12 %, 10.6 % and 6 % for MHNO, MUO, MHO, and MUNO, respectively. MHO (β = 0.66; p = 0.591) was not associated with increased lung ageing compared with MHNO, but MUO (β = 7.1; p < 0.001) and MUNO (β = 6.6; p < 0.001) were. Concerning pulmonary dysfunctions, MUNO (OR = 1.93; p < 0.001) and MUO (OR = 2.91; p < 0.001) were found to be related to the presence of a restrictive pattern, and MUNO (OR = 2.40; p = 0.028) to the mixed pattern. CONCLUSION The results show that metabolic abnormalities, not obesity, are responsible for premature lung ageing and, therefore, lung function decline. In our study, having obesity without metabolic abnormality was not significantly associated with the presence of dysfunctional respiratory patterns.
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Affiliation(s)
- José-Miguel Guzmán-García
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
| | - Manuel Romero-Saldaña
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; Lifestyles, Innovation and Health Research Associate Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain.
| | - Guillermo Molina-Recio
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; Lifestyles, Innovation and Health Research Associate Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Carlos Álvarez-Fernández
- Department of Occupational Health and Safety, Cordoba City Council, Huerto de San Pedro el Real, Cordoba, Spain
| | - María Del Rocío Jiménez-Mérida
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
| | - Rafael Molina-Luque
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain; Lifestyles, Innovation and Health Research Associate Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
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Mozaffar T, Riou França L, Msihid J, Shukla P, Proskorovsky I, Zhou T, Periquet M, An Haack K, Pollissard L, Straub V. Efficacy of avalglucosidase alfa on forced vital capacity percent predicted in treatment-naïve patients with late-onset Pompe disease: A pooled analysis of clinical trials. Mol Genet Metab Rep 2024; 40:101109. [PMID: 39035044 PMCID: PMC11259910 DOI: 10.1016/j.ymgmr.2024.101109] [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: 12/06/2023] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 07/23/2024] Open
Abstract
Background The efficacy of avalglucosidase alfa (AVA) versus alglucosidase alfa (ALG) on forced vital capacity percent predicted (FVCpp) in patients with late-onset Pompe disease (LOPD) has been assessed in the Phase 3 COMET trial (NCT02782741). Due to the rarity of LOPD and thus small sample size in COMET, additional data were analyzed to gain further insights into the efficacy of AVA versus ALG. Methods Data from treatment-naive patients with LOPD were pooled from COMET and Phase 1/2 NEO1/NEO-EXT (NCT01898364/NCT02032524) trials for patients treated with AVA, and Phase 3 LOTS trial (NCT00158600) for patients treated with ALG. Regression analyses using mixed models with repeated measures consistent with those pre-specified in COMET were performed post-hoc. Analyses were adjusted for trials and differences in baseline characteristics. Four models were developed: Model 1 considered all trials; Model 2 included Phase 3 trials; Model 3 included Phase 3 trials and was adjusted for baseline ventilation use; Model 4 included COMET and NEO1/NEO-EXT (i.e., AVA trials only). Results Overall, 100 randomized patients from COMET (AVA, n = 51, ALG, n = 49), 60 from LOTS (ALG arm only), and three patients from NEO1/NEO-EXT (who received open-label AVA only) were considered for analysis. Mean age at enrollment was similar across trials (45.3-50.3 years); however, patients from LOTS had a longer mean duration of disease versus COMET and NEO1/NEO-EXT trials (9.0 years and 0.5-2.2 years, respectively) and younger mean age at diagnosis (36.2 years and 44.7-48.6 years, respectively). Least squares mean (95% confidence interval) improvement from baseline in FVCpp at Week 49-52 for AVA versus ALG was 2.43 (-0.13; 4.99) for COMET (n = 98); 2.31 (0.06; 4.57) for Model 1 (n = 160); 2.43 (0.21; 4.65) for Model 2 (n = 157); 2.80 (0.54; 5.05) for Model 3 (n = 154); and 2.27 (-0.30; 4.45) for Model 4 (n = 101). Conclusions Models 1 to 3, which had an increased sample size versus COMET, demonstrated a nominally significant effect on FVCpp favoring AVA versus ALG after 1 year of treatment, consistent with results from COMET.
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Affiliation(s)
- Tahseen Mozaffar
- Division of Neuromuscular Disorders, Department of Neurology, University of California, Irvine, CA, United States
| | | | | | | | | | | | | | | | | | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Hijleh AA, Berton DC, Neder-Serafini I, James M, Vincent S, Domnik N, Phillips D, O'Donnell DE, Neder JA. Sex- and age-adjusted reference values for dynamic inspiratory constraints during incremental cycle ergometry. Respir Physiol Neurobiol 2024; 327:104297. [PMID: 38871042 DOI: 10.1016/j.resp.2024.104297] [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: 04/08/2024] [Revised: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 06/15/2024]
Abstract
Activity-related dyspnea in chronic lung disease is centrally related to dynamic (dyn) inspiratory constraints to tidal volume expansion. Lack of reference values for exertional inspiratory reserve (IR) has limited the yield of cardiopulmonary exercise testing in exposing the underpinnings of this disabling symptom. One hundred fifty apparently healthy subjects (82 males) aged 40-85 underwent incremental cycle ergometry. Based on exercise inspiratory capacity (ICdyn), we generated centile-based reference values for the following metrics of IR as a function of absolute ventilation: IRdyn1 ([1-(tidal volume/ICdyn)] x 100) and IRdyn2 ([1-(end-inspiratory lung volume/total lung capacity] x 100). IRdyn1 and IRdyn2 standards were typically lower in females and older subjects (p<0.05 for sex and age versus ventilation interactions). Low IRdyn1 and IRdyn2 significantly predicted the burden of exertional dyspnea in both sexes (p<0.01). Using these sex and age-adjusted limits of reference, the clinician can adequately judge the presence and severity of abnormally low inspiratory reserves in dyspneic subjects undergoing cardiopulmonary exercise testing.
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Affiliation(s)
- Abed A Hijleh
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Danilo C Berton
- Pulmonary Function Tests Laboratory, Federal University of Rio Grande to Sul, Rua Ramiro Barcelos, 2350 Bloco A, Av. Protásio Alves, 211 - Bloco B e C - Santa Cecília, Porto Alegre, RS 90035-903, Brazil
| | - Igor Neder-Serafini
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Matthew James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Sandra Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Nicolle Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - Devin Phillips
- School of Kinesiology and Health Science, Faculty of Health, York University, Norman Bethune College, 170 Campus Walk Room 341, Toronto, ON M3J 1P3, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston General Hospital, Connell 2-200. 102 Stuart St., Kingston, ON K7L 2V7, Canada.
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D Almeida S, Norajitra T, Lüth CT, Wald T, Weru V, Nolden M, Jäger PF, von Stackelberg O, Heußel CP, Weinheimer O, Biederer J, Kauczor HU, Maier-Hein K. How do deep-learning models generalize across populations? Cross-ethnicity generalization of COPD detection. Insights Imaging 2024; 15:198. [PMID: 39112910 PMCID: PMC11306482 DOI: 10.1186/s13244-024-01781-x] [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: 05/02/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES To evaluate the performance and potential biases of deep-learning models in detecting chronic obstructive pulmonary disease (COPD) on chest CT scans across different ethnic groups, specifically non-Hispanic White (NHW) and African American (AA) populations. MATERIALS AND METHODS Inspiratory chest CT and clinical data from 7549 Genetic epidemiology of COPD individuals (mean age 62 years old, 56-69 interquartile range), including 5240 NHW and 2309 AA individuals, were retrospectively analyzed. Several factors influencing COPD binary classification performance on different ethnic populations were examined: (1) effects of training population: NHW-only, AA-only, balanced set (half NHW, half AA) and the entire set (NHW + AA all); (2) learning strategy: three supervised learning (SL) vs. three self-supervised learning (SSL) methods. Distribution shifts across ethnicity were further assessed for the top-performing methods. RESULTS The learning strategy significantly influenced model performance, with SSL methods achieving higher performances compared to SL methods (p < 0.001), across all training configurations. Training on balanced datasets containing NHW and AA individuals resulted in improved model performance compared to population-specific datasets. Distribution shifts were found between ethnicities for the same health status, particularly when models were trained on nearest-neighbor contrastive SSL. Training on a balanced dataset resulted in fewer distribution shifts across ethnicity and health status, highlighting its efficacy in reducing biases. CONCLUSION Our findings demonstrate that utilizing SSL methods and training on large and balanced datasets can enhance COPD detection model performance and reduce biases across diverse ethnic populations. These findings emphasize the importance of equitable AI-driven healthcare solutions for COPD diagnosis. CRITICAL RELEVANCE STATEMENT Self-supervised learning coupled with balanced datasets significantly improves COPD detection model performance, addressing biases across diverse ethnic populations and emphasizing the crucial role of equitable AI-driven healthcare solutions. KEY POINTS Self-supervised learning methods outperform supervised learning methods, showing higher AUC values (p < 0.001). Balanced datasets with non-Hispanic White and African American individuals improve model performance. Training on diverse datasets enhances COPD detection accuracy. Ethnically diverse datasets reduce bias in COPD detection models. SimCLR models mitigate biases in COPD detection across ethnicities.
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Affiliation(s)
- Silvia D Almeida
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
- Medical Faculty, Heidelberg University, Heidelberg, Germany.
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany.
| | - Tobias Norajitra
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Carsten T Lüth
- Interactive Machine Learning Group (IML), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tassilo Wald
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Vivienn Weru
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Nolden
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Pattern Analysis and Learning Group, Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul F Jäger
- Interactive Machine Learning Group (IML), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
| | - Claus Peter Heußel
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital, Heidelberg, Germany
| | - Oliver Weinheimer
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
| | - Jürgen Biederer
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Raina Bulvaris 19, Riga, LV-1586, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, D-24098, Kiel, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology, University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Medical Center, Heidelberg, Germany
- Helmholtz Imaging, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Pattern Analysis and Learning Group, Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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Aburub A, Darabseh MZ, Badran R, Shurrab AM, Amro AA, Ledger SJ. Ant-waist surgery adversely affects lung function: a cross-sectional study. Multidiscip Respir Med 2024; 19:984. [PMID: 39093016 PMCID: PMC11299848 DOI: 10.5826/mrm.2024.984] [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: 05/21/2024] [Accepted: 06/06/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Body contouring surgery for the removal of the 11th and 12th ribs is undertaken for aesthetic appeal in female and transgender populations. The potential adverse effects of the surgery on lung function and respiratory muscle strength have not been previously studied. Therefore, this study aimed to determine the effects of 'Ant-waist' surgery on lung function and respiratory muscle strength in individuals who had undergone surgery. METHODS This was a cross-sectional study with two groups, an Anti-waist group who had undergone surgery and an age and gender matched control group. Participants performed lung function tests to determine measurements of FEV1, FVC, FEV1/FVC, PEF, MIP, and MEP. Independent t-tests were performed to determine between-group differences in outcomes and Pearson's correlation coefficients determined the relationship between lung function and respiratory muscle strength, and number of years since surgery. RESULTS There was a significant between-group difference in FEV1 (-0.83; 95%CI -1.30, -0.36; p<0.001), FEV1%pred. (-34.91; 95%CI -48.92, -20.90; p<0.001), FVC%pred. (-22.73; 95%CI -32.84, -12.62; p<0.001), PEF%pred. (-44.18; 95%CI -61.52, -26.84; p<0.001) and MEP (-68.27; -102.48, -34.07; p<0.001). There were significantly large, negative correlations (r>0.5) between the number of years after surgery and FEV1 (p=0.002), FEV1%pred. (p=0.0001); and PEF%pred. (p=0.032). CONCLUSIONS This study has identified that aesthetic surgery for the removal of ribs 11 and 12 had a significant adverse effect on lung function and respiratory muscle strength in Jordanian females. The potential adverse effects should be carefully explained by surgeons to patients considering the surgery.
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Affiliation(s)
- Aseel Aburub
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Mohammad Z. Darabseh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Rahaf Badran
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Middle East University Amman, Jordan
| | - Ala’a M. Shurrab
- Department of Basic Medical Science, Faculty of Medicine, Al-Balqa Applied University, Al salt, Jordan
| | - Anwaar A. Amro
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Sean J. Ledger
- Physiotherapy, School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
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Hirata K, Iwaibara T, Nozaki M, Mochizuki N, Hirano S, Wada K. Changes in Lung Function Among Infants Born Extremely Preterm over a 20-Year Period in the Post-Surfactant Era: A Retrospective Study. J Pediatr 2024; 271:114082. [PMID: 38697609 DOI: 10.1016/j.jpeds.2024.114082] [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: 11/09/2023] [Revised: 03/24/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
Lung function was assessed at 8 years in 308 infants born extremely preterm between 1994 and 2013. Although lung function of those infants born at 22 through 25 weeks remained unchanged, those who were born at 26-27 weeks showed a significant improvement over the past 2 decades.
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Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
| | - Takayuki Iwaibara
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masatoshi Nozaki
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Narutaka Mochizuki
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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Cohen RA, Go LHT, Friedman L, Zell-Baran LM, Rose CS, Almberg KS. Resting diffusing capacity and severity of radiographic disease predict gas exchange abnormalities with exercise in former US coal miners. Am J Ind Med 2024; 67:732-740. [PMID: 38830640 DOI: 10.1002/ajim.23621] [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: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The US Department of Labor (DOL) does not fund diffusing capacity (DLCO) or metabolic measurements from cardiopulmonary exercise testing (CPET) for coal miners' disability evaluations. Although exercise arterial blood gas testing is covered, many miners are unable to perform maximal tests, and sampling at peak exercise can be challenging. We explored the relationship between resting DLCO, radiographic disease severity, and CPET abnormalities in former US coal miners. METHODS We analyzed data from miners evaluated between 2005 and 2015. Multivariable linear and logistic regression analyses were used to examine relationships between percent predicted (pp) forced expiratory volume in 1 s (FEV1pp), DLCOpp, VO2maxpp, A-a oxygen gradient (A-a)pp, dead space fraction (Vd/Vt), disabling oxygen tension (PO2), and radiographic findings of pneumoconiosis. RESULTS Data from 2015 male coal miners was analyzed. Mean tenure was 28 years (SD 8.6). Thirty-twopercent had an abnormal A-a gradient (>150 pp), 20% had elevated Vd/Vt (>0.33), and 34% a VO2max < 60 pp. DLCOpp strongly predicted a disabling PO2, with an odds ratio (OR) of 2.33 [2.09-2.60], compared to 1.18 [1.08-1.29] for FEV1. Each increase in subcategory of small opacity (simple) pneumoconiosis increased the odds of a disabling PO2 by 42% [1.29-1.57], controlling for age, body mass index, pack-years of tobacco smoke exposure, and years of coal mine employment. CONCLUSIONS DLCO is the best resting pulmonary function test predictor of CPET abnormalities. Radiographic severity of pneumoconiosis was also associated with CPET abnormalities. These findings support funding DLCO testing for impairment and suggest the term "small opacity" should replace "simple" pneumoconiosis to reflect significant associations with impairment.
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Affiliation(s)
- Robert A Cohen
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Leonard H T Go
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lee Friedman
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Kirsten S Almberg
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
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10
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Bakker JT, Hartman JE, Klooster K, Lynch DA, van der Molen MC, Charbonnier JP, Tsiaousis M, Vliegenthart R, Slebos DJ. Automated evaluation of diaphragm configuration based on chest CT in COPD patients. Eur Radiol Exp 2024; 8:87. [PMID: 39090324 PMCID: PMC11294507 DOI: 10.1186/s41747-024-00491-9] [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: 02/26/2024] [Accepted: 06/21/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Severe chronic obstructive pulmonary disease (COPD) often results in hyperinflation and flattening of the diaphragm. An automated computed tomography (CT)-based tool for quantifying diaphragm configuration, a biomarker for COPD, was developed in-house and tested in a large cohort of COPD patients. METHODS We used the LungQ platform to extract the lung-diaphragm intersection, as direct diaphragm segmentation is challenging. The tool computed the diaphragm index (surface area/projected surface area) as a measure of diaphragm configuration on inspiratory scans in a COPDGene subcohort. Visual inspection of 250 randomly selected segmentations served as a quality check. Associations between the diaphragm index, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, forced expiratory volume in 1 s (FEV1) % predicted, and CT-derived emphysema scores were explored using analysis of variance and Pearson correlation. RESULTS The tool yielded incomplete segmentation in 9.2% (2.4% major defect, 6.8% minor defect) of 250 randomly selected cases. In 8431 COPDGene subjects (4240 healthy; 4191 COPD), the diaphragm index was increasingly lower with higher GOLD stages (never-smoked 1.83 ± 0.16; GOLD-0 1.79 ± 0.18; GOLD-1 1.71 ± 0.15; GOLD-2: 1.67 ± 0.16; GOLD-3 1.58 ± 0.14; GOLD-4 1.54 ± 0.11) (p < 0.001). Associations were found between the diaphragm index and both FEV1% predicted (r = 0.44, p < 0.001) and emphysema score (r = -0.36, p < 0.001). CONCLUSION We developed an automated tool to quantify the diaphragm configuration in chest CT. The diaphragm index was associated with COPD severity, FEV1%predicted, and emphysema score. RELEVANCE STATEMENT Due to the hypothesized relationship between diaphragm dysfunction and diaphragm configuration in COPD patients, automatic quantification of diaphragm configuration may prove useful in evaluating treatment efficacy in terms of lung volume reduction. KEY POINTS Severe COPD changes diaphragm configuration to a flattened state, impeding function. An automated tool quantified diaphragm configuration on chest-CT providing a diaphragm index. The diaphragm index was correlated to COPD severity and may aid treatment assessment.
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Affiliation(s)
- Jens T Bakker
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands.
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
| | - Jorine E Hartman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Karin Klooster
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - David A Lynch
- National Jewish Health, Department of Radiology, Denver, CO, USA
| | - Marieke C van der Molen
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | | | | | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
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11
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Al Sa'idi L, Berton DC, Neder JA. The 2022 ERS/ATS z-score classification to grade airflow obstruction: relationship with exercise outcomes across the spectrum of COPD severity. Eur Respir J 2024; 64:2301960. [PMID: 38936965 DOI: 10.1183/13993003.01960-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Lamyaa Al Sa'idi
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
| | - Danilo C Berton
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
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12
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Raberin A, Manferdelli G, Schorderet F, Bourdillon N, Millet GP. Fitness Level- and Sex-Related Differences in Pulmonary Limitations to Maximal Exercise in Normoxia and Hypoxia. Med Sci Sports Exerc 2024; 56:1398-1407. [PMID: 38530208 DOI: 10.1249/mss.0000000000003433] [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: 03/27/2024]
Abstract
PURPOSE Both maximal-intensity exercise and altitude exposure challenge the pulmonary system that may reach its maximal capacities. Expiratory flow limitation (EFL) and exercise-induced hypoxemia (EIH) are common in endurance-trained athletes. Furthermore, because of their smaller airways and lung size, women, independently of their fitness level, may be more prone to pulmonary limitations during maximal-intensity exercise, particularly when performed in hypoxic conditions. The objective of this study was to investigate the impact of sex and fitness level on pulmonary limitations during maximal exercise in normoxia and their consequences in acute hypoxia. METHODS Fifty-one participants were distributed across four different groups according to sex and fitness level. Participants visited the laboratory on three occasions to perform maximal incremental cycling tests in normoxia and hypoxia (inspired oxygen fraction = 0.14) and two hypoxic chemosensitivity tests. Pulmonary function and ventilatory capacities were evaluated at each visit. RESULTS EIH was more prevalent (62.5% vs 22.2%, P = 0.004) and EFL less common (37.5% vs 70.4%, P = 0.019) in women than men. EIH prevalence was different ( P = 0.004) between groups of trained men (41.7%), control men (6.7%), trained women (50.0%), and control women (75.0%). All EIH men but only 40% of EIH women exhibited EFL. EFL individuals had higher slope ratio ( P = 0.029), higher ventilation (V̇ E ) ( P < 0.001), larger ΔVO 2max ( P = 0.019), and lower hypoxia-related V̇ E increase ( P < 0.001). CONCLUSIONS Women reported a higher EIH prevalence than men, regardless of their fitness level, despite a lower EFL prevalence. EFL seems mainly due to the imbalance between ventilatory demands and capacities. It restricts ventilation, leading to a larger performance impairment during maximal exercise in hypoxic conditions.
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Affiliation(s)
- Antoine Raberin
- Institute of Sport Sciences, University of Lausanne, Lausanne, SWITZERLAND
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13
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Cooper B, Stanojevic S. Is lung function in a race against time? Exp Physiol 2024; 109:1244-1245. [PMID: 38699789 PMCID: PMC11291856 DOI: 10.1113/ep091490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Brendan Cooper
- Lung Function & Sleep Department, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Sanja Stanojevic
- Department of Community Health and EpidemiologyDalhousie UniversityHalifaxNova ScotiaCanada
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14
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Freire C, Castiello F, Babarro I, Anguita-Ruiz A, Casas M, Vrijheid M, Sarzo B, Beneito A, Kadawathagedara M, Philippat C, Thomsen C, Sakhi AK, Lopez-Espinosa MJ. Association of prenatal exposure to phthalates and synthetic phenols with pubertal development in three European cohorts. Int J Hyg Environ Health 2024; 261:114418. [PMID: 38968838 DOI: 10.1016/j.ijheh.2024.114418] [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: 02/05/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND There is limited epidemiological evidence on the association of prenatal exposure to phthalates and synthetic phenols with altered pubertal timing. OBJECTIVE To examine the association of prenatal exposure to phthalates, bisphenol A (BPA), parabens, benzophenone 3 (BP-3), and triclosan (TCS) with pubertal development in girls and boys from three European cohorts. METHODS Urinary metabolites of six different phthalate diesters (DEP, DiBP, DnBP, BBzP, DEHP, and DiNP), BPA, methyl- (MePB), ethyl- (EtPB), propyl- (PrPB), and butyl-paraben (BuPB), BP-3, and TCS were quantified in one or two (1st and 3rd trimester) urine samples collected during pregnancy (1999-2008) from mothers in three birth cohorts: INMA (Spain), EDEN (France), and MoBa (Norway). Pubertal development of their children was assessed at a single visit at age 7-12 years (579 girls, 644 boys) using the parent-reported Pubertal Development Scale (PDS). Mixed-effect Poisson and g-computation and Bayesian Kernel Machine Regression (BKMR) were employed to examine associations of individual and combined prenatal chemical exposure, respectively, with the probability of overall pubertal onset, adrenarche, and gonadarche (stage 2+) in girls and boys. Effect modification by child body mass index (BMI) was also assessed. RESULTS Maternal concentrations of the molar sum of DEHP and of DiNP metabolites were associated with a slightly higher probability of having started puberty in boys (relative risk, RR [95% CI] = 1.13 [0.98-1.30] and 1.20 [1.06-1.34], respectively, for a two-fold increase in concentrations), with a stronger association for DiNP in boys with overweight or obesity. In contrast, BPA, BuPB, EtPB, and PrPB were associated with a lower probability of pubertal onset, adrenarche, and/or gonadarche in all boys (e.g. overall puberty, BPA: RR [95% CI] = 0.93 [0.85-1.01] and BuPB: 0.95 [0.90-1.00], respectively), and the association with BPA was stronger in boys with underweight/normal weight. In girls, MEHP and BPA were associated with delayed gonadarche in those with underweight/normal weight (RR [95% CI] = 0.86 [0.77-0.95] and 0.90 [0.84-0.97], respectively). Most of these associations were trimester specific. However, the chemical mixture was not associated with any pubertal outcome in boys or girls. CONCLUSIONS Prenatal exposure to certain phthalates and synthetic phenols such as BPA may impact the pubertal development of boys, and weight status may modify this effect. BPA may also alter the pubertal development of girls.
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Affiliation(s)
- Carmen Freire
- Department of Legal Medicine, Toxicology, and Physical Anthropology, School of Medicine, University of Granada, 18016, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - Francesca Castiello
- Pediatric Unit, Germans Trias I Pujol University Hospital, 08916, Badalona, Spain
| | - Izaro Babarro
- Faculty of Medicine and Nursing, University of the Basque Country (UPV/EU), 20014, Donostia/San Sebastián, Spain; Biogipuzkoa Health Research Institute, 20014, Donostia/San Sebastián, Spain
| | - Augusto Anguita-Ruiz
- ISGlobal, 08036, Barcelona, Spain; CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Maribel Casas
- ISGlobal, 08036, Barcelona, Spain; Universitat Pompeu Fabra, 08005, Barcelona, Spain
| | - Martine Vrijheid
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain; ISGlobal, 08036, Barcelona, Spain; Universitat Pompeu Fabra, 08005, Barcelona, Spain
| | - Blanca Sarzo
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Jaume I University-University of Valencia, 46020, Valencia, Spain
| | - Andrea Beneito
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Jaume I University-University of Valencia, 46020, Valencia, Spain
| | - Manik Kadawathagedara
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Claire Philippat
- University Grenoble Alpes, Inserm, U1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, 38000, Grenoble, France
| | - Cathrine Thomsen
- Department of Food Safety, Norwegian Institute of Public Health, 0456, Oslo, Norway
| | - Amrit Kaur Sakhi
- Department of Food Safety, Norwegian Institute of Public Health, 0456, Oslo, Norway
| | - Maria-Jose Lopez-Espinosa
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Jaume I University-University of Valencia, 46020, Valencia, Spain; Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, 46010, Valencia, Spain
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15
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Lim YT, Williams TC, Langley RJ, Weir E. Mepolizumab in children and adolescents with severe eosinophilic asthma not eligible for omalizumab: a single Center experience. J Asthma 2024; 61:793-800. [PMID: 38240489 DOI: 10.1080/02770903.2024.2303767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Mepolizumab is an anti-interleukin-5 monoclonal antibody shown to reduce asthma exacerbations in adults and adolescents with severe eosinophilic asthma. AIM To assess the impact of mepolizumab on children and adolescents over 12 months by examining steroid usage, asthma-related hospitalizations, Asthma Control Test (ACT) scores, fractional exhaled nitric oxide concentration (FeNO), forced expiratory volume in 1 s (FEV1), mid expiratory flow (FEF25-75%), and blood eosinophil count. METHODS Retrospective analysis performed between October 2015 and December 2022. Data was reviewed 12 months before and after commencing mepolizumab. Mepolizumab was offered if the patient had severe eosinophilic asthma and were unresponsive to or ineligible for omalizumab. RESULTS Sixteen participants (age 7-17, 8 males, 8 females) received subcutaneous mepolizumab monthly with no serious adverse reactions. Incidence of hospital admissions fell significantly (IRR 0.33, p = 0.007). Among the 11 patients receiving daily oral corticosteroids, 3 were weaned off daily oral steroids and 3 patients' daily dose was significantly reduced (mean Δ-0.095 ± 0.071 mg/kg, p = 0.0012). Eosinophil count was decreased (mean Δ-0.85 x 109/L, p < 0.001). There was no significant change in mean overall steroid burden per patient (mean Δ-1445.63 ± 1603.18 mg, p = 0.10), ACT scores (mean Δ2.88 ± 6.71, p = 0.17), FEV1 z-scores (mean Δ-0.99 ± 1.88, p = 0.053), FEF25-75% z-scores (mean Δ-0.65 ± 1.61, p = 0.13), FeNO (mean Δ-20.09 ± 80.86, p = 0.34), or number of courses of oral steroids given for asthma attacks (IRR 0.71, p = 0.09). CONCLUSION Among children and adolescents with severe eosinophilic asthma ineligible for or not responsive to omalizumab, mepolizumab therapy exhibited significant reduction in rate of asthma-related hospitalizations and significant decrease in daily steroid dosage.
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Affiliation(s)
- Y T Lim
- Department of Paediatric Respiratory, Royal Hospital for Children, Glasgow, UK
| | - T C Williams
- Department of Paediatric Respiratory, Royal Hospital for Children, Glasgow, UK
| | - R J Langley
- Department of Paediatric Respiratory, Royal Hospital for Children, Glasgow, UK
| | - E Weir
- Department of Paediatric Respiratory, Royal Hospital for Children, Glasgow, UK
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16
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Ioachimescu OC, Stoller JK. Area under the inspiratory flow-volume curve (AIN): Proposed normative values. PLoS One 2024; 19:e0307966. [PMID: 39088417 PMCID: PMC11293737 DOI: 10.1371/journal.pone.0307966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/15/2024] [Indexed: 08/03/2024] Open
Abstract
RATIONALE Area under expiratory flow-volume curve (AEX) has been shown to be a valuable functional measurement in respiratory physiology. Area under inspiratory flow-volume loop (AIN) also shows promise in characterizing upper and/or lower airflow obstruction. OBJECTIVES we aimed here to develop normative reference values for AIN, able to ascertain deviations from normal. METHODS We analyzed AIN in 4,980 spirometry tests recorded in non-smoking, healthy individuals in the Pulmonary Function Testing Laboratory. RESULTS The mean (95% confidence interval, CI), standard deviation and median (25th-75th interquartile range) AIN were 16.05 (15.79-16.31), 9.08 and 14.72 (9.12-21.42) L2·sec-1, respectively. The mean (95% CI) and standard deviation of the best-trial measurements for square root of AIN (Sqrt AIN) were 3.84 (3.81-3.87) and 1.14; 4.15 (4.12-4.18) and 1.03 in men, and 2.68 (2.63-2.72) and 0.72 L·sec-1/2 in women. The mean (standard deviation) of pre- and post-bronchodilator Sqrt AIN were 3.71 (1.17) and 3.81 (1.19) L·sec-1/2, respectively. The mean (95% CI), standard deviation and lowest 5th percentile (lower limit of normal, LLN) of Sqrt AIN/Sqrt AEX (%) were 101.3 (100.82-101.88), 18.7, and 71.8%; stratified by gender, it was 102.2 (101.6-102.8), 18.6, and 72.8% in men, and 98 (96.9-99.2), 18.8, and 68.6% in women, respectively. CONCLUSIONS The availability of area under the inspiratory flow-volume curve (AIN) and the derived indices offers a promising opportunity to assess upper airway disease (e.g., involvement of larynx, trachea or major bronchi), especially because some of these measurements appear to be independent of age, race, height, and weight.
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Affiliation(s)
- Octavian C. Ioachimescu
- Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Adjunct Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America
- Staff Physician, Clement J. Zablocki Veteran Affairs Medical Center, Milwaukee, Wisconsin, United States of America
| | - James K. Stoller
- Jean Wall Bennett Professor of Medicine and Chair, Education Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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17
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Adegunsoye A, Bachman WM, Flaherty KR, Li Z, Gupta S. Use of Race-Specific Equations in Pulmonary Function Tests Impedes Potential Eligibility for Care and Treatment of Pulmonary Fibrosis. Ann Am Thorac Soc 2024; 21:1156-1165. [PMID: 38386005 PMCID: PMC11298987 DOI: 10.1513/annalsats.202309-797oc] [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: 09/13/2023] [Accepted: 02/21/2024] [Indexed: 02/23/2024] Open
Abstract
Rationale: The use of race-specific reference values to evaluate pulmonary function has long been embedded into clinical practice; however, there is a growing consensus that this practice may be inappropriate and that the use of race-neutral equations should be adopted to improve access to health care. Objectives: To evaluate whether the use of race-neutral equations to assess percent predicted forced vital capacity (FVC%pred) impacts eligibility for clinical trials, antifibrotic therapy, and referral for lung transplantation in Black, Hispanic/Latino, and White patients with interstitial lung disease (ILD). Methods: FVC%pred values for patients from the Pulmonary Fibrosis Foundation Patient Registry were calculated using race-specific (Hankinson and colleagues, 1999), race-agnostic (Global Lung Function Initiative [GLI]-2012), and race-neutral (GLI-2022 or GLI-Global) equations. Eligibility for ILD clinical trials (FVC%pred >45% and <90%), antifibrotic therapy (FVC%pred >55% and <82%), and lung transplantation referral (FVC%pred <70%) based on GLI-2022 and GLI-2012 equations were compared with those based on the Hankinson 1999 equation. Results: Baseline characteristics were available for 1,882 patients (Black, n = 104; Hispanic/Latino, n = 103; White, n = 1,675), and outcomes were evaluated in 1,531 patients with FVC%pred within ±90 days of registry enrollment (Black, n = 78; Hispanic/Latino, n = 72; White, n = 1,381). Black patients were younger at the time of consent and more likely to be female compared with Hispanic/Latino or White patients. Compared with GLI-2022, the Hankinson 1999 equation misclassified 22% of Black patients, 14% of Hispanic/Latino patients, and 12% of White patients for ILD clinical trial eligibility; 21% of Black patients, 17% of Hispanic/Latino patients, and 19% of White patients for antifibrotic therapy eligibility; and 6% of Black patients, 14% of Hispanic/Latino patients, and 12% of White patients for lung transplantation referral. Similar trends were observed when comparing the GLI-2012 and Hankinson 1999 equations. Conclusions: Misclassification of patients for critical interventions is highly prevalent when using the Hankinson 1999 equation and highlights the need to consider adopting the race-neutral GLI-2022 equation for enhanced accuracy and more equitable representation in pulmonary health care. Our results make a compelling case for reevaluating the use of race as a physiological variable and emphasize the pressing need for continuous innovation to ensure equal and optimal care for all patients regardless of their race or ethnicity. Clinical trial registered with www.clinicaltrials.gov (NCT02758808).
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Affiliation(s)
- Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care, Department of Medicine, The University of Chicago, Chicago, Illinois
| | | | - Kevin R. Flaherty
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and
| | - Zhongze Li
- Statistical Analysis of Biomedical and Educational Research Group, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Sachin Gupta
- Genentech, Inc., South San Francisco, California; and
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18
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Shanthikumar S, Gower WA, Cooke KR, Bergeron A, Schultz KR, Barochia A, Tamae-Kakazu M, Charbek E, Reardon EE, Calvo C, Casey A, Cheng PC, Cole TS, Davies SM, Das S, De A, Deterding RR, Liptzin DR, Mechinaud F, Rayment JH, Robinson PD, Siddaiah R, Stone A, Srinivasin S, Towe CT, Yanik GA, Iyer NP, Goldfarb SB. Diagnosis of Post-Hematopoietic Stem Cell Transplantation Bronchiolitis Obliterans Syndrome in Children: Time for a Rethink? Transplant Cell Ther 2024; 30:760-769. [PMID: 38897861 DOI: 10.1016/j.jtct.2024.05.012] [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: 03/06/2024] [Revised: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
Hematopoietic stem cell transplantation (HSCT) is undertaken in children with the aim of curing a range of malignant and nonmalignant conditions. Unfortunately, pulmonary complications, especially bronchiolitis obliterans syndrome (BOS), are significant sources of morbidity and mortality post-HSCT. Currently, criteria developed by a National Institutes of Health (NIH) working group are used to diagnose BOS in children post-HSCT. Unfortunately, during the development of a recent American Thoracic Society (ATS) Clinical Practice Guideline on this topic, it became apparent that the NIH criteria have significant limitations in the pediatric population, leading to late diagnosis of BOS. Specific limitations include use of an outdated pulmonary function testing reference equation, a reliance on spirometry, use of a fixed forced expiratory volume in 1 second (FEV1) threshold, focus on obstructive defects defined by FEV1/vital capacity, and failure to acknowledge that BOS and infection can coexist. In this review, we summarize the evidence regarding the limitations of the current criteria. We also suggest potential evidence-based ideas for improving these criteria. Finally, we highlight a new proposed criteria for post-HSCT BOS in children that were developed by the authors of the recently published ATS clinical practice guideline, along with a pathway forward for improving timely diagnosis of BOS in children post-HSCT.
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Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia; Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - William A Gower
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kenneth R Cooke
- Department of Oncology, Pediatric Blood and Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Anne Bergeron
- Pneumology Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Kirk R Schultz
- Pediatric Hematology/Oncology/BMT, BC Children's Research Institute/UBC, Vancouver, British Columbia, Canada
| | - Amisha Barochia
- Laboratory of Asthma and Lung Inflammation, Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Maximiliano Tamae-Kakazu
- Division of Pulmonary and Critical Care, Corewell Health, Grand Rapids, Michigan; Department of Medicine, Michigan State University College of Human Medicine, Michigan
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri
| | - Erin E Reardon
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia
| | - Charlotte Calvo
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Paris Cité University, Paris, France; Human Immunology, Pathophysiology and Immunotherapy, INSERM UMR-976, Institut de Recherche Saint-Louis, Paris, France
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pi Chun Cheng
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Theresa S Cole
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Infection & immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shailendra Das
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Alive De
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Robin R Deterding
- Chief Pediatric Pulmonary and Sleep Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Deborah R Liptzin
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Francoise Mechinaud
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Paris Cité University, Paris, France
| | - Jonathan H Rayment
- Division of Respiratory Medicine, BC Children's Hospital, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Paul D Robinson
- Department of Respiratory Medicine, Queensland Children's Hospital, Queensland, Australia; Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Queensland, Australia; Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, New South Wales, Australia
| | - Roopa Siddaiah
- Division of Pulmonology, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Anne Stone
- Division of Pediatric Pulmonology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Saumini Srinivasin
- Department of Pediatrics, University of Tennessee College of Medicine, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Christopher T Towe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Gregory A Yanik
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan
| | - Narayan P Iyer
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Samuel B Goldfarb
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Division of Pulmonary Medicine, Masonic Children's Hospital, Minneapolis, Minnesota
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19
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Brems JH, Balasubramanian A, Raju S, Putcha N, Fawzy A, Hansel NN, Wise RA, McCormack MC. Changes in Spirometry Interpretative Strategies: Implications for Classifying COPD and Predicting Exacerbations. Chest 2024; 166:294-303. [PMID: 38537688 DOI: 10.1016/j.chest.2024.03.034] [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: 01/16/2024] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Recent guidelines for spirometry interpretation recommend both race-neutral reference equations and use of z score thresholds to define severity of airflow obstruction. RESEARCH QUESTION How does the transition from race-specific to race-neutral equations impact severity classifications for patients with COPD when using % predicted vs z score thresholds, and do changes in severity correspond to clinical risk? STUDY DESIGN AND METHODS This retrospective cohort study included Black and White patients with COPD and available spirometry from the Johns Hopkins Health System. Global Lung Function Initiative (GLI) 2012 (race-specific) equations and GLI Global (race-neutral) equations were used to determine FEV1 % predicted and z score values. Patients were classified as having mild, moderate, or severe disease according to % predicted or z score thresholds. Associations between a change in severity classification from race-specific to race-neutral with COPD exacerbations and all-cause hospitalizations were evaluated using logistic regression. RESULTS This cohort included 13,324 patients, of whom 9,232 patients (69.3%) were White (mean age, 65.7 years) and 4,092 patients (30.7%) were Black (mean age, 61.1 years). More Black than White patients showed a change in severity classification between approaches when using % predicted thresholds (20.2% vs 6.1%; P < .001), but not with z score thresholds (12.6% vs 12.3%; P = .68). An increased severity classification with a race-neutral approach was associated with increased risk of exacerbation when using z score thresholds (OR, 2.34; 95% CI, 1.51-3.63), but not when using % predicted thresholds (OR, 1.08; 95% CI, 0.61-1.93). A decreased severity classification with a race-neutral approach was associated with lower risk of exacerbation with both % predicted (OR, 0.49; 95% CI, 0.28-0.87) and z score (OR 0.67; 95% CI, 0.50-0.90) thresholds. INTERPRETATION The proportions of Black and White individuals reclassified were similar with z score thresholds, and changes in severity corresponded to clinical risk with z scores. These results support recent recommendations for use of race-neutral equations and z score thresholds for spirometry interpretation.
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Affiliation(s)
- J Henry Brems
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Berman Institute of Bioethics (J. H. B.), Johns Hopkins University, Baltimore, MD.
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Sarath Raju
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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20
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Kanj AN, Niven AS, Cowl CT, Yadav H. Rethinking the Role of Race in Lung Function: The Shift to Race-Neutral Spirometry Interpretation. Mayo Clin Proc 2024:S0025-6196(24)00263-5. [PMID: 39093270 DOI: 10.1016/j.mayocp.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/25/2024] [Accepted: 05/24/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Amjad N Kanj
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Clayton T Cowl
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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21
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Te Hennepe N, Steegh VLJM, Pouw MH, Roukema J, De Kleuver M, Van Hooff ML. Pulmonary function in patients with adolescent idiopathic scoliosis: an explorative study of a wearable smart shirt as a measurement instrument. Spine Deform 2024:10.1007/s43390-024-00938-4. [PMID: 39085742 DOI: 10.1007/s43390-024-00938-4] [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: 03/12/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) presents various challenges, including respiratory symptoms that impact pulmonary function. This study aims to explore the feasibility of using a smart shirt for continuous monitoring of lung volumes and heart rate during routine activities in AIS patients. METHODS A single-center exploratory feasibility study was conducted with AIS patients aged 16-22 years with a thoracic curvature of ≥ 30 degrees and absence of respiratory comorbidities. A smart shirt was utilized to continuously monitor cardiopulmonary parameters during mild exercise, which included a standardized walking route with the ascent of multiple stairs. RESULTS Five participants completed the study. Baseline spirometry measurements showed a range of values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio. During mild exercise, participants exhibited variability in tidal volume, heart rate, breathing rate, and minute ventilation, with increases observed during stair climbing. Breathlessness levels also varied throughout the activity but did not correlate with the measured lung volumes. Overall, the use of the smart shirt for assessing pulmonary function in AIS patients was deemed feasible and well tolerated by participants during the test activities. CONCLUSION The study confirms the feasibility of using a smart shirt for continuous measurement of cardiopulmonary parameters in AIS patients during daily activities. Incongruities between spirometry results and perceived dyspnea exists, which questions the nature of the perceived dyspnea. Further research is needed to validate these findings and explore the impact of AIS characteristics on measurement accuracy.
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Affiliation(s)
- N Te Hennepe
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - V L J M Steegh
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M H Pouw
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Roukema
- Department of Pediatrics, Division of Respiratory Medicine, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M De Kleuver
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M L Van Hooff
- Department of Orthopedic Research, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
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22
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Kinaupenne M, Van Biervliet S, Van Hoorenbeeck K, Schaballie H, Vandekerckhove K, Demeyer H, De Craemer M. Lower physical activity levels in youth with Cystic Fibrosis compared to healthy controls: a multicentre comparative study. Respir Med 2024:107749. [PMID: 39089391 DOI: 10.1016/j.rmed.2024.107749] [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: 06/19/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Regular physical activity (PA) offers significant health benefits on both short (i.e., emotional well-being) and long term (i.e., fewer hospitalizations) in Youth with Cystic Fibrosis (YwCF). Regardless, evidence on PA levels in YwCF compared to healthy controls (HC) is inconsistent. Additionally, PA is a multidimensional outcome influenced by several factors such as Quadriceps strength and functional performance. Therefore, we aimed to assess whether PA, Quadriceps strength and functional performance differ between YwCF and HC across different age groups (i.e., children and adolescents). METHODS YwCF aged 6-17 from two Belgian CF centres and age- and sex-matched HC were recruited. PA was measured with an ActiGraph GT3X+BT during 7 consecutive days. Isometric Quadriceps strength was assessed with a Hand Held Dynamometer and functional performance with a sit-to stand test (STS) and standing long jump (SLJ). RESULTS A total of 49 YwCF (44% male; 11.3±3.3 years) and 49 HC (48% male; 11.9±3.5 years) were included. On average days, YwCF performed 4±6.4 minutes less light PA and 7.5±6.7 minutes less moderate-to-vigorous PA compared to HC (p=0.04; p=0.01). The differences in moderate-to-vigorous PA seem more pronounced in children (6-11 years)(p=0.04). Furthermore, YwCF had similar Quadriceps strength to HC but had lower scores on the STS and SLJ (p=0.50, p=0.08; p=0.02). CONCLUSIONS This study shows lower PA levels and functional performance for YwCF, indicating that there is an urgent need for interventions promoting PA in YwCF. PA promotion will become increasingly important in the post modulator area to prevent health risks associated with low PA.
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Affiliation(s)
- Manon Kinaupenne
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Stephanie Van Biervliet
- Department of Pediatrics, Centre for Cystic Fibrosis, Ghent University Hospital, Ghent, Belgium
| | | | - Heidi Schaballie
- Department of Pediatrics, Centre for Cystic Fibrosis, Ghent University Hospital, Ghent, Belgium
| | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
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23
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Wu WW. Association of Naples Prognostic Score and Lung Health: A Population-Based Study. Respir Med 2024; 232:107751. [PMID: 39089390 DOI: 10.1016/j.rmed.2024.107751] [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: 03/19/2024] [Revised: 06/22/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The Naples Prognostic Score (NPS) is a novel indicator of inflammatory and nutritional status, but its relationship to lung health is unknown. OBJECTIVE To evaluate the relationship of NPS to lung health problems. METHODS A total of 15,600 participants aged 20 years or older with an available assessment of chronic lung diseases were enrolled from the National Health and Nutrition Examination Survey 2007-2012. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Associations of NPS with chronic lung disease (diagnosed asthma, chronic bronchitis, and emphysema), respiratory symptoms (cough, phlegm production, wheeze, and exertional dyspnea), and spirometric measurements (FEV1, FVC, and obstructive or restrictive spirometry pattern) were evaluated. Kaplan-Meier survival analysis and multiple Cox regressions were used to assess the significance of NPS in relation to all-cause mortality and chronic lower respiratory diseases mortality in participants. Furthermore, to comprehensively assess the association between NSP and chronic lower respiratory diseases mortality, Fine-Gray subdistribution hazards model was performed to analyze non-chronic lower respiratory diseases mortality as a competitive risk. RESULTS People with a higher NPS score were associated with greater odds of asthma, chronic bronchitis, respiratory symptoms (including phlegm production, wheeze, and exertional dyspnea), and a greater risk of obstructive and restrictive spirometry. A higher NPS score was significantly associated with decreased FEV1 and FVC in both overall participants and those with lung health problems. Longitudinally, we found that those in the category with highest NPS were at greater risk of all-cause mortality and chronic lower respiratory diseases mortality in those with chronic lung disease, and respiratory symptoms. CONCLUSIONS An elevated NPS is associated with a host of adverse pulmonary outcomes. Prospective studies to define NPS as a biomarker for impaired lung health are warranted.
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Affiliation(s)
- Wen Wen Wu
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; West China School of Medicine, Sichuan University, Chengdu, PR China.
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24
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McKinnon C, Thorat T, Craft A, Higgins M. Real-world impact of ivacaftor in people with cystic fibrosis and select ivacaftor-responsive mutations. BMJ Open Respir Res 2024; 11:e002033. [PMID: 39074961 PMCID: PMC11288149 DOI: 10.1136/bmjresp-2023-002033] [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: 08/24/2023] [Accepted: 06/24/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Ivacaftor approval was extended to people with cystic fibrosis (CF) with ≥1 of 28 additional ivacaftor-responsive mutations in the USA in 2017 based on preclinical in vitro data. This retrospective, observational study assessed real-world clinical response to ivacaftor in people with CF with ≥1 of these mutations, using data from the US Cystic Fibrosis Foundation Patient Registry. METHODS Participants aged ≥2 years with ≥1 of 28 eligible mutations initiating ivacaftor between May 2017 and December 2018 were included. Clinical outcomes data were evaluated for ≤1 year before and ≤2 years after ivacaftor initiation. Participants initiating ivacaftor between May and December 2017 (2017 cohort) were used for the primary analysis because up to 2 years of post-ivacaftor-initiation data were available. Analyses were descriptive; key outcomes included percent predicted forced expiratory volume in 1 s (ppFEV1), body mass index (BMI) and BMI z-score, pulmonary exacerbations (PEx) and hospitalisations. RESULTS The study included 1004 eligible participants. In the 2017 cohort (n=613), mean absolute change in ppFEV1 from pre-ivacaftor initiation was 1.9 (95% CI 1.4, 2.4) and 1.8 (95% CI 1.0, 2.7) percentage points in years 1 and 2 post-ivacaftor initiation, respectively; mean absolute change in BMI was 0.6 (95% CI 0.5, 0.7) and 1.0 (95% CI 0.8, 1.2) kg/m2 in years 1 and 2, respectively; BMI z-score was unchanged. Annualised event rates of PEx and hospitalisations per patient-year were lower with ivacaftor (0.24 (95% CI 0.21, 0.26) and 0.28 (95% CI 0.25, 0.31), respectively) compared with pre-ivacaftor initiation (0.41 (95% CI 0.37, 0.46) and 0.45 (95% CI 0.41, 0.49), respectively). CONCLUSIONS These real-world observational study findings support the effectiveness of ivacaftor in people with CF aged ≥2 years with selected CFTR mutations.
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Affiliation(s)
- Craig McKinnon
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, USA
| | - Teja Thorat
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, USA
| | - Alexander Craft
- Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, USA
| | - Mark Higgins
- Vertex Pharmaceuticals (Europe) Limited, London, UK
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25
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Visser S, Lawler C, Fermoyle CC, Spencer LM, McAnulty AJ, Alison JA, Webster S, Troy L, Jo H, Hayen A, Corte TJ. The 1-minute sit-to-stand test as a screening tool to assess exercise-induced oxygen desaturation in normoxemic people with interstitial lung disease. Respir Med 2024:107748. [PMID: 39074595 DOI: 10.1016/j.rmed.2024.107748] [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: 02/01/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND In patients with interstitial lung disease (ILD), exercise-induced desaturation during the six-minute walk test (6MWT), specifically nadir oxygen saturation (nSpO2) of ≤88% is a negative prognostic marker. As the 6MWT is often impractical for ILD patients, the aim of this study is to compare the 1-minute sit-to-stand test (1minSTS) with the 6MWT to detect exercise-induced desaturation. METHODS Participants were recruited from a tertiary referral clinic with both tests performed on the same day. Utilising Bland-Altman analysis, the relationship between nSpO2 on 1minSTS and 6MWT was determined. An area under the receiver operating characteristic curve (AUC) determined the ability of nSpO2 on 1minSTS test to predict SpO2 ≤88% on 6MWT. RESULTS Fifty participants completed the study (idiopathic pulmonary fibrosis n=24,48%; connective tissue disease associated ILD n=20,40%; other ILD n=6,12%). Mean (SD) FVC%pred was 73±16%, mean DLCO%pred 57±16% and resting SpO2 99±1%. The 1minSTS resulted in less exercise-induced oxygen desaturation, with a median IQR nSpO2 of 95% (89-98) and 93% (85-96) respectively (p<0.001). Moderate agreement was determined between the nSpO2 on both tests, with a mean difference of 3.2% [-14 to +3.0%]. The 1minSTS test accurately identified participants with nSpO2 ≤88% on 6MWT (AUC 0.96). Oxygen desaturation ≤ 94% during the 1minSTS test provided 100% sensitivity and 87% specificity for oxygen desaturation ≤88% at 6MWT. CONCLUSION This study demonstrates that exercise-induced oxygen desaturation during the 1minSTS test correlates with oxygen desaturation on 6MWT. The 1minSTS may be a practical screening tool for ILD patients who would benefit from further exercise testing.
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Affiliation(s)
- Simone Visser
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia.
| | - Chloe Lawler
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Caitlin C Fermoyle
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Lissa M Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Amanda J McAnulty
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jennifer A Alison
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Allied Health, Sydney Local Health District, Sydney, Australia
| | - Susanne Webster
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lauren Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
| | - Helen Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
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Ahn HS, Lee SY, Kang MJ, Hong SB, Song JW, Do KH, Yeom J, Yu J, Oh Y, Hong JY, Chung EH, Kim K, Hong SJ. Polyhexamethylene guanidine aerosol causes irreversible changes in blood proteins that associated with the severity of lung injury. JOURNAL OF HAZARDOUS MATERIALS 2024; 478:135359. [PMID: 39126856 DOI: 10.1016/j.jhazmat.2024.135359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/04/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
Polyhexamethylene guanidine (PHMG) is a positively charged polymer used as a disinfectant that kills microbes but can cause pulmonary fibrosis if inhaled. After the long-term risks were confirmed in South Korea, it became crucial to measure toxicity through diverse surrogate biomarkers, not only proteins, especially after these hazardous chemicals had cleared from the body. These biomarkers, identified by their biological functions rather than simple numerical calculations, effectively explained the imbalance of pulmonary surfactant caused by fibrosis from PHMG exposure. These long-term studies on children exposed to PHMG has shown that blood protein indicators, primarily related to apolipoproteins and extracellular matrix, can distinguish the degree of exposure to humidifier disinfectants (HDs). We defined the extreme gradient boosting models and computed reflection scores based on just ten selected proteins, which were also verified in adult women exposed to HD. The reflection scores successfully discriminated between the HD-exposed and unexposed groups in both children and adult females (AUROC: 0.957 and 0.974, respectively) and had a strong negative correlation with lung function indicators. Even after an average of more than 10 years, blood is still considered a meaningful specimen for assessing the impact of environmental exposure to toxic substances, with proteins providing in identifying the pathological severity of such conditions.
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Affiliation(s)
- Hee-Sung Ahn
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Seoul, South Korea.
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Mi-Jin Kang
- Humidifier Disinfectant Health Center, Asan Medical Center, Seoul, South Korea.
| | - Sang Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Jeounghun Yeom
- Prometabio Research Institute, prometabio co., ltd., Gyeonggi-do, South Korea.
| | - Jiyoung Yu
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Seoul, South Korea.
| | - Yumi Oh
- Department of Biomedical Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Jeong Yeon Hong
- Department of Biomedical Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
| | - Kyunggon Kim
- Convergence Medicine Research Center, Asan Institute for Life Sciences, Seoul, South Korea; Department of Biomedical Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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27
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Steffen K, Bahr R, Clarsen B, Fossan B, Fredriksen H, Gjelsvik H, Haugvad L, Hoksrud AF, Iversen E, Koivisto-Mørk A, Moen E, Røstad V, Reier-Nilsen T, Torgalsen T, Berge HM. Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: what did we learn? Br J Sports Med 2024; 58:826-835. [PMID: 38744502 PMCID: PMC11287577 DOI: 10.1136/bjsports-2023-107942] [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] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE A periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed to determine the prevalence of conditions identified by a PHE among Paralympic and Olympic athletes over four consecutive Games cycles from Rio de Janeiro 2016 to Beijing 2022 and to assess the benefits and potential pitfalls of a comprehensive PHE programme in detecting existing injuries, illnesses and other health issues. METHODS We collected extensive health history and clinical examination data on elite athletes: medical history, ECG, blood pressure, blood samples, spirometry, musculoskeletal health, cognitive function, mental health and compliance with public health programmes. RESULTS The final cohort included 87 Paralympic and 367 Olympic athletes, representing 565 PHE cycles. Musculoskeletal problems and unspecified pain, infections and allergies were the most frequent health issues. High blood pressure was the most prevalent cardiovascular finding, and vitamin D deficiency the most common laboratory abnormality. Most athletes complied with the public childhood vaccination programmes, but fewer with recommended cancer screening. Follow-up of health issues was variable. CONCLUSION Our PHE programme identified musculoskeletal problems, infections, allergies, elevated blood pressure and vitamin D deficiency as common health conditions. Longitudinal follow-up of health conditions identified during screening and improved compliance with public health and cancer screening programmes is needed to determine the true benefits of athlete care prompted by the PHE.
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Affiliation(s)
- Kathrin Steffen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Bjørn Fossan
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Hilde Fredriksen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Hilde Gjelsvik
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Lars Haugvad
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | | | - Erik Iversen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | | | - Ellen Moen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Vibeke Røstad
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | | | - Thomas Torgalsen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Hilde Moseby Berge
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Choi H, Oak CH, Jung MH, Jang TW, Nam SJ, Yoon T. Trend of prevalence and characteristics of preserved ratio impaired spirometry (PRISm): Nationwide population-based survey between 2010 and 2019. PLoS One 2024; 19:e0307302. [PMID: 39042610 PMCID: PMC11265705 DOI: 10.1371/journal.pone.0307302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE This study aimed to evaluate the prevalence, trends, and factors of preserved ratio with impaired spirometry (PRISm) by using a nationally representative sample. PATIENTS AND METHODS The datasets of the Korea National Health and Nutrition Examination Survey 2010-2019 were used: of total 32,949 participants aged ≥40 and no missing data on spirometry, 24,523 with normal, 4,623 with obstructive, and 3,803 with PRISm were identified. PRISm was defined as FEV1/FVC ≥70% and FEV1% of the predicted value (%pred) <80. PRISm-lower limit of normal (LLN) was defined when FEV1/FVC ≥LLN and FEV1 RESULTS Estimated average prevalence of PRISm was 10.4% (PRISm-LLN 11.1%). Joinpoint regression analyses found a relatively stable trend of PRISm for both fixed ratio and LLN. The multivariable-adjusted logistic regression model showed female sex, BMI ≥25 kg/m2, metabolic syndrome, hypertriglyceridemia, abdominal obesity, low HDL-choleterol, hypertension, and diabetes were associated with the increased probability of PRISm. CONCLUSION Whenever a PRISm pattern is identified in a clinical context, it may be necessary to measure absolute lung volumes to investigate underlying physiological abnormalities and to identify factors that is modifiable.
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Affiliation(s)
- Hyunji Choi
- Department of Laboratory Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Chul-Ho Oak
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Mann-Hong Jung
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Tae-Won Jang
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Sung-Jin Nam
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Taemin Yoon
- Center for Future Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
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Di Raimondo D, Pirera E, Pintus C, De Rosa R, Profita M, Musiari G, Siscaro G, Tuttolomondo A. The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications. Nutrients 2024; 16:2303. [PMID: 39064746 PMCID: PMC11279935 DOI: 10.3390/nu16142303] [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: 06/19/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Current management of COPD is predominantly focused on respiratory aspects. A multidimensional assessment including nutritional assessment, quality of life and disability provides a more reliable perspective of the true complexity of COPD patients. METHODS This was a prospective observational study of 120 elderly COPD patients at high risk of acute exacerbations. The Mini Nutritional Assessment (MNA) was administered in addition to the usual respiratory assessment. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. RESULTS The median MNA Short Form (SF) score was 11 (8-12), 39 participants (32.50%) had a normal nutritional status, 57 (47.5%) were at risk of malnutrition and 24 (20%) were malnourished. Our multivariate linear regression models showed that the MNA score was associated with dyspnea and respiratory symptom severity, assessed by the Modified British Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) score, with spirometric variables, in particular with the severity of airflow limitation based on the value of FEV1, and with poorer QoL, as assessed by the EQ-5D-3 questionnaire. Competing risk analysis according to nutritional status based on the MNA Total Score showed that COPD participants "at risk of malnutrition" and "malnourished" had a higher risk of moderate to severe acute exacerbations with sub-hazard ratios of 3.08 (1.40-6.80), p = 0.015, and 4.64 (1.71-12.55), p = 0.0002, respectively. CONCLUSION Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value.
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Affiliation(s)
- Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
- PhD Programme “Molecular and Clinical Medicine”, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
| | - Edoardo Pirera
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Chiara Pintus
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Riccardo De Rosa
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Martina Profita
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Gaia Musiari
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
- PhD Programme “Molecular and Clinical Medicine”, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
| | | | - Antonino Tuttolomondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
- PhD Programme “Molecular and Clinical Medicine”, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
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Pezzuto B, Contini M, Berna G, Galotta A, Cattaneo G, Maragna R, Gugliandolo P, Agostoni P. Dynamic trend of lung fluid movement during exercise in heart failure: From lung imaging to alveolar-capillary membrane function. Int J Cardiol 2024; 407:132041. [PMID: 38643800 DOI: 10.1016/j.ijcard.2024.132041] [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: 08/13/2023] [Revised: 03/10/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND In chronic heart failure (HF), exercise-induced increase in pulmonary capillary pressure may cause an increase of pulmonary congestion, or the development of pulmonary oedema. We sought to assess in HF patients the exercise-induced intra-thoracic fluid movements, by measuring plasma brain natriuretic peptide (BNP), lung comets and lung diffusion for carbon monoxide (DLCO) and nitric oxide (DLNO), as markers of hemodynamic load changes, interstitial space and alveolar-capillary membrane fluids, respectively. METHODS AND RESULTS Twenty-four reduced ejection fraction HF patients underwent BNP, lung comets and DLCO/DLNO measurements before, at peak and 1 h after the end of a maximal cardiopulmonary exercise test. BNP significantly increased at peak from 549 (328-841) to 691 (382-1207, p < 0.0001) pg/mL and almost completely returned to baseline value 1 h after exercise. Comets number increased at peak from 9.4 ± 8.2 to 24.3 ± 16.7, returning to baseline (9.7 ± 7.4) after 1 h (p < 0.0001). DLCO did not change significantly at peak (from 18.01 ± 4.72 to 18.22 ± 4.73 mL/min/mmHg), but was significantly reduced at 1 h (16.97 ± 4.26 mL/min/mmHg) compared to both baseline (p = 0.0211) and peak (p = 0.0174). DLNO showed a not significant trend toward lower values 1 h post-exercise. CONCLUSIONS Moderate/severe HF patients have a 2-step intra-thoracic fluid movement with exercise: the first during active exercise, from the vascular space toward the interstitial space, as confirmed by comets increase, without any effect on diffusion, and the second, during recovery, toward the alveolar-capillary membrane, clearing the interstitial space but worsening gas diffusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Baral A, Lee S, Hussaini F, Matthew B, Lebron A, Wang M, Hsu LY, Moss J, Wen H. Clinical Trial Validation of Automated Segmentation and Scoring of Pulmonary Cysts in Thoracic CT Scans. Diagnostics (Basel) 2024; 14:1529. [PMID: 39061666 PMCID: PMC11276404 DOI: 10.3390/diagnostics14141529] [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: 06/13/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
In cystic lung diseases such as lymphangioleiomyomatosis (LAM), a CT-based cyst score that measures the percentage of the lung volume occupied by cysts is a common index of the cyst burden in the lungs. Although the current semi-automatic measurement of the cyst score is well established, it is susceptible to human operator variabilities. We recently developed a fully automatic method incorporating adaptive features in place of manual adjustments. In this clinical study, the automatic method is validated against the standard method in several aspects. These include the agreement between the cyst scores of the two methods, the agreement of each method with independent tests of pulmonary function, and the temporal consistency of the measurements in the consecutive visits of the same patients. We found that the automatic method agreed with the standard method as well as the agreement between two trained operators running the same standard method; both methods obtained the same level of correlation with laboratory pulmonary function tests; the automated method had better temporal consistency than the standard method (p < 0.0001). The study indicates that the automatic method could replace the standard method and provide better consistency in assessing the extent of cystic changes in the lungs of patients.
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Affiliation(s)
- Aneesha Baral
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
| | - Simone Lee
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
| | - Farah Hussaini
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
| | - Brianna Matthew
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
| | - Alfredo Lebron
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
| | - Muyang Wang
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
| | - Li-Yueh Hsu
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Han Wen
- Laboratory of Imaging Physics, Biochemistry and Biophysics Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (A.B.); (S.L.); (F.H.); (B.M.); (A.L.); (M.W.)
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Roberts G, Valovirta E, Halken S, Eng PA, Mäkelä MJ, Lødrup Carlsen KC, Knecht R, Malmberg LP. Diagnosing new-onset asthma in a paediatric clinical trial setting in school-age children. FRONTIERS IN ALLERGY 2024; 5:1418922. [PMID: 39081649 PMCID: PMC11287659 DOI: 10.3389/falgy.2024.1418922] [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: 04/17/2024] [Accepted: 05/21/2024] [Indexed: 08/02/2024] Open
Abstract
Asthma is a common chronic disease in children. It is a dynamic condition-symptoms change over time, and the outcome of diagnostic tests can vary. Consequently, evaluating the onset of asthma at a single point in time, perhaps when patients are asymptomatic with limited impairment of the lung function, may result in false diagnostic conclusions. The absence of consistent gold-standard diagnostic criteria in children challenges the ability of any study to ascertain an effect of treatment on asthma prevention. A comprehensive review of the diagnostic criteria used for new-onset asthma in school-age children was conducted based on existing recommendations from published clinical guidance, alongside evidence from paediatric asthma prevention trials. Findings from the review were used to propose suggestions for diagnosing new-onset asthma in future asthma prevention trials. Despite an overall lack of consensus in the published clinical guidance, there are similarities between the various recommendations for diagnosing asthma in children, which typically involve assessing the variable symptoms and supplementing the medical history with objective measures of lung function. For future paediatric asthma prevention trials, we suggest that paediatric clinical trials should use a new-onset asthma definition that incorporates the concepts of "possible", "probable" and "confirmed" asthma. "Possible" asthma would capture self-reported features of chronic symptoms and symptom relief with β2-agonist bronchodilator (suggesting reversibility). "Probable" asthma would include symptom chronicity, self-reported symptom relief with β2-agonist bronchodilator, and objective features of asthma (reversibility or bronchial hyper-responsiveness). A "confirmed" diagnosis would be made only if there is a positive response to controller therapy. These suggestions aim to improve the diagnosis of new-onset childhood asthma in clinical trials, which will be useful in the design and conduct of future paediatric asthma prevention trials.
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Affiliation(s)
- Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, United Kingdom
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Erkka Valovirta
- Terveystalo Allergy Clinic, Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland
| | - Susanne Halken
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Peter A. Eng
- Section of Paediatric Pulmonology and Allergy, Children’s Hospital, Aarau, Switzerland
| | - Mika J. Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Karin C. Lødrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - L. Pekka Malmberg
- Unit of Clinical Physiology, Skin and Allergy Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Trudzinski FC, Jörres RA, Alter P, Watz H, Vogelmeier CF, Kauczor HU, Thangamani S, Debic M, Welte T, Behr J, Kahnert K, Bals R, Herr C, Heußel CP, Biederer J, von Stackelberg O, Fähndrich S, Wouters EFM, Waschki B, Rabe KF, Herth FJF, Palm V. Midregional Proatrial Natriuretic Peptide (MRproANP) is associated with vertebral fractures and low bone density in patients with chronic obstructive pulmonary disease (COPD). Respir Res 2024; 25:274. [PMID: 39003487 PMCID: PMC11245771 DOI: 10.1186/s12931-024-02902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Patients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD. RESEARCH QUESTION We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD. METHODS Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses. RESULTS Among 418 participants (58% male, median age 64 years, FEV1 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV1% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density. INTERPRETATION MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization. TRIAL REGISTRATION ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.
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Affiliation(s)
- Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine), German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik University of Heidelberg, Röntgenstrasse 1, 69126, Heidelberg, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, German Center for Lung Research (DZL), LMU University Hospital, Ludwig-Maximilians-University (LMU), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), Philipps University of Marburg (UMR), Marburg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Subasini Thangamani
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Manuel Debic
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, CPC Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, CPC Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
- MediCenterGermering, Germering, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Christian Herr
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Claus Peter Heußel
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, Kiel, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - Sebastian Fähndrich
- Department of Pneumology, University Medical Centre Freiburg, Freiburg, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Medical Faculty, Sigmund Freud University, Vienna, Austria
- Department of Internal Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Benjamin Waschki
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Pulmonary Research Institute, Woehrendamm 80, 22927, Grosshansdorf, Germany
- Department of Pneumology, Itzehoe Hospital, Itzehoe, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Pulmonary Research Institute, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine), German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik University of Heidelberg, Röntgenstrasse 1, 69126, Heidelberg, Germany
| | - Viktoria Palm
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
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Beydon N, Abou Taam R, Delclaux C, Du Boisbaudry C, Gauthier R, Ioan I, Le Bourgeois M, Giroux-Metges MA, Matecki S. [Pulmonary function test: The testing of children]. Rev Mal Respir 2024:S0761-8425(24)00231-6. [PMID: 39003097 DOI: 10.1016/j.rmr.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/30/2024] [Indexed: 07/15/2024]
Abstract
In paediatrics, the pulmonary function test (PFT) is most often performed to support the diagnosis or in follow-up of asthma patients. Whatever the pathology responsible for respiratory symptoms and/or functional impairment, repeated PFTs make it possible to establish a prognosis (pulmonary function trajectories…) and to orient preventive interventions. PFT can be performed routinely from the age of three years, provided that the following requirements are met: suitable techniques and equipment, staff trained to apply the techniques and to receive young children, reference values for each technique indicating the limits of normal values and of between-test significant variation. From the age of three, children can be subjected to tidal breathing measurement of: resistance of the respiratory system (oscillometry, Rrs; airflow interruption, Rint) or of airways specific resistance (sRaw) and functional residual capacity (by applying a dilution technique). With maturity, the child will become capable of mobilizing his or her slow vital capacity to measure total lung capacity (TLC), once again by applying a dilution technique, then later by breathing against a closed shutter (plethysmography TLC and Raw). Finally, the child will be able to carry out forced expiration (forced spirometry) along with all of the other PFTs. It is important to take into account the paediatric adaptations specified in the international recommendations regarding the performance, reproducibility and quality of PFTs targeting this population.
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Affiliation(s)
- N Beydon
- Inserm U938, unité fonctionnelle d'explorations fonctionnelles respiratoire et somnologie, centre de recherche Saint-Antoine, hôpital Armand-Trousseau, Sorbonne université, AP-HP, 75012 Paris, France.
| | - R Abou Taam
- Laboratoire d'explorations fonctionnelles respiratoires pédiatriques, service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, université de Paris, AP-HP, Paris, France
| | - C Delclaux
- Inserm NeuroDiderot, service de physiologie et centre du sommeil, hôpital Robert-Debré, université Paris-Cité, AP-HP, 75019 Paris, France
| | - C Du Boisbaudry
- EA 4324 Orphy, service d'explorations fonctionnelles, centre hospitalier de Brest, 29200 Brest, France
| | - R Gauthier
- Service de cardiologie et pneumo-allergologie pédiatriques, unité d'explorations fonctionnelles respiratoires pédiatriques, CHU d'Amiens-Picardie, Amiens, France
| | - I Ioan
- Service de physiologie, unité d'explorations fonctionnelles pédiatriques, hôpital d'Enfants, CHRU de Nancy, Nancy, France
| | - M Le Bourgeois
- Laboratoire d'explorations fonctionnelles respiratoires pédiatriques, service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, université de Paris, AP-HP, Paris, France
| | - M-A Giroux-Metges
- EA 4324 Orphy, service d'explorations fonctionnelles, centre hospitalier de Brest, 29200 Brest, France
| | - S Matecki
- Inserm U1046, Physiology and experimental Medicine: Heart-Muscle UMR CNRS 9214, Unité d'Exploration Fonctionnelle Pédiatrique, Université de Montpellier, CHU de Montpellier, Montpellier, France
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Schechter MS, Ostrenga JS, Cromwell EA, Ren CL, Fink AK, Sanders DB, Morgan WJ. Treatment of small as well as large declines in lung function enhances recovery to baseline in people with CF. Pediatr Pulmonol 2024. [PMID: 38995116 DOI: 10.1002/ppul.27176] [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: 03/30/2024] [Revised: 06/01/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The benefit of antibiotic treatment of acute drops in FEV1 percent predicted (FEV1pp) has been clearly established, but data from the early 2000s showed inconsistent treatment. Further, there is no empirical evidence for what magnitude of drop is clinically significant. METHODS We used data from the CF Foundation Patient Registry (CFFPR) from 2016 to 2019 to determine the association between treatment (any IV antibiotics, only oral or newly prescribed inhaled antibiotics, or no antibiotic therapy) following a decline of ≥5% from baseline FEV1pp and return to 100% baseline FEV1pp days using multivariable logistic regression including an interaction between the magnitude of decline and treatment category. RESULTS Overall, 16,495 PWCF had a decline: 16.5% were treated with IV antibiotics, 25.0% non-IV antibiotics, and 58.5% received no antibiotics. Antibiotic treatment was more likely for those with lower lung function, history of a positive PA culture, older age and larger FEV1 decline (p < 0.001). Treatment with IV antibiotics or oral/inhaled antibiotics was associated with a higher odds of recovery to baseline compared to no treatment across all levels of decline, including declines of 5%-10%. CONCLUSIONS A large proportion of acute drops in FEV1pp continue to be untreated, especially in younger patients and those with higher baseline lung function. Acute drops as small as 5% predicted are less likely to be recovered if antibiotic treatment is not prescribed. These findings suggest the need for more aggressive antimicrobial treatment of acute drops in FEV1, including those of a magnitude previously believed to be associated with self-recovery.
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Affiliation(s)
- Michael S Schechter
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Clement L Ren
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aliza K Fink
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
- National Organization for Rare Disorders, Washington, District of Columbia, USA
| | - D B Sanders
- Indiana University., Indianapolis, Indiana, USA
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Özsezen B, Yalçın E, Emiralioğlu N, Konşuk Ünlü H, Ademhan Tural D, Caka C, Sunman B, Doğru D, Özçelik U, Kiper N. The predictive role of lung clearance index on FEV 1 decline in cystic fibrosis. Turk J Pediatr 2024; 66:297-308. [PMID: 39024602 DOI: 10.24953/turkjpediatr.2024.4516] [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: 02/03/2023] [Accepted: 06/10/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The lung clearance index (LCI) is a sensitive lung function index that is used to detect early lung disease changes in children with cystic fibrosis (CF). This study aimed to define the predictive role of baseline LCI, along with other potential factors on the change in forced expiratory volume in one second (FEV1) during one-year follow-up in CF patients who had a percent predicted (pp) FEV1≥80. METHODS LCI was concurrently performed on 57 CF patients who had ppFEV1 ≥80 at month zero. The ppFEV1 decline was evaluated prospectively during the one year follow up. The primary outcome of ppFEV1 decline in the study group in one year was dichotomized according to the median value for the decline in ppFEV1, which was 3.7. The LCI value predicting ppFEV1 decline at the end of one year was calculated with receiver operating characteristic curve analysis. Regression analysis was performed. Furthermore, a decision tree was constructed using classification and regression tree methods to better define the potential effect of confounders on the ppFEV1 decline. RESULTS The LCI value for predicting ppFEV1 decline >3.7% at the end of one year was 8.2 (area under the curve: 0.80) Multivariable regression analysis showed that the absence of the F508del mutation in at least one allele, LCI >8.2 and initial FEV1 z-score were predictors of a ppFEV1 decline >3.7 (p<0.001). Factors altering ppFEV1 decline>3.7% at the end of one-year evaluated by decision trees were as follows: initial FEV1 z-score, type of CFTR mutation, LCI value and initial weight-for-age z-score. CONCLUSIONS LCI is sensitive for predicting ppFEV1 decline in patients with ppFEV1 ≥80 along with the initial FEV1-z-score and type of CFTR mutation.
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Affiliation(s)
- Beste Özsezen
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Hande Konşuk Ünlü
- Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Canan Caka
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Birce Sunman
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ugur Özçelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Hua-Huy T, Pham-Ngoc H, Aubourg F, Lorut C, Roche N, Dinh-Xuan AT. Deciphering Alveolo-Capillary Gas Transfer Disturbances in Patients Recovering from COVID-19 Lung Disease. J Pers Med 2024; 14:738. [PMID: 39063992 PMCID: PMC11278216 DOI: 10.3390/jpm14070738] [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: 06/23/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Impaired lung gas exchange is commonly seen in patients with pulmonary involvement related to SARS-CoV-2 acute infection or post-acute COVID-19 syndrome (PACS). The primary aim of our study was to assess lung gas transfer, measuring the pulmonary diffusion capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) in all COVID-19 patients. Our secondary aim was to decipher the respective roles of perturbed lung membrane conductance (DM) and reduced pulmonary capillary volume (VC) in patients with impaired lung gas exchange. From May to October 2020, we measured DLNO-DLCO in 118 patients during their post-COVID-19 period (4.6 months after infection) to decipher alveolo-capillary gas transfer disturbances. DLNO-DLCO measurement was also performed in 28 healthy non-smokers as controls. Patients were classified into three groups according to the severity (mild, moderate, and severe) of acute COVID-19 infection. Patients with mild COVID-19 had normal lung volumes and airways expiratory flows but impaired pulmonary gas exchange, as shown by the significant decreases in DLNO, DLCO, DM, and VC as compared with controls. VC was significantly impaired and the DLNO/DLCO ratio was increased in patients with moderate (n = 4, 11%) and severe COVID-19 (n = 23, 49%). Abnormal membrane conductance was also seen in all three groups of post-COVID-19 patients. These findings suggest a persistent alveolo-capillary gas transfer defect, implying not only reduced membrane conductance but also abnormal pulmonary vascular capacitance in all PACS patients, even those with a milder form of COVID-19 infection.
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Affiliation(s)
- Thông Hua-Huy
- Lung Function & Respiratory Physiology Unit, Department of Respiratory Physiology and Sleep Medicine, Assistance Publique—Hôpitaux de Paris, Cochin Hospital, University Paris Cité, 75006 Paris, France
| | - Hà Pham-Ngoc
- Lung Function & Respiratory Physiology Unit, Department of Respiratory Physiology and Sleep Medicine, Assistance Publique—Hôpitaux de Paris, Cochin Hospital, University Paris Cité, 75006 Paris, France
| | - Frédérique Aubourg
- Lung Function & Respiratory Physiology Unit, Department of Respiratory Physiology and Sleep Medicine, Assistance Publique—Hôpitaux de Paris, Cochin Hospital, University Paris Cité, 75006 Paris, France
| | - Christine Lorut
- Department of Respiratory Medicine, APHP Centre, Institut Cochin (UMR 1016), Assistance Publique—Hôpitaux de Paris, Cochin Hospital, University Paris Cité, 75006 Paris, France
| | - Nicolas Roche
- Department of Respiratory Medicine, APHP Centre, Institut Cochin (UMR 1016), Assistance Publique—Hôpitaux de Paris, Cochin Hospital, University Paris Cité, 75006 Paris, France
| | - Anh Tuan Dinh-Xuan
- Lung Function & Respiratory Physiology Unit, Department of Respiratory Physiology and Sleep Medicine, Assistance Publique—Hôpitaux de Paris, Cochin Hospital, University Paris Cité, 75006 Paris, France
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38
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Go LHT, Almberg KS, Friedman LS, Zell-Baran L, Rose CS, Cohen RA. Measuring lung diffusing capacity: an opportunity for improved medical surveillance and disability evaluation of coal miners. Occup Environ Med 2024; 81:296-301. [PMID: 38886046 DOI: 10.1136/oemed-2023-109380] [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: 12/15/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Spirometry is the primary lung function test utilised for medical surveillance and disability examination for coal mine dust lung disease. However, spirometry likely underestimates physiologic impairment. We sought to characterise abnormalities of single-breath diffusing capacity for carbon monoxide (DLCO) among a population of former coal miners. METHODS Data from 3115 former coal miners evaluated at a West Virginia black lung clinic between 2006 and 2015 were retrospectively analysed to study the association between diffusion impairment (abnormally low DLCO), resting spirometry and the presence and severity of coal workers' pneumoconiosis on chest radiography. We developed ordinary least squares linear regression models to evaluate factors associated with per cent predicted DLCO (DLCOpp). RESULTS Diffusion impairment was identified in 20.2% of subjects. Ten per cent of all miners with normal spirometry had diffusion impairment including 7.4% of never smokers. The prevalence of diffusion impairment increased with worsening radiographic category of pneumoconiosis. Mean DLCOpp decreased with increasing small opacity profusion subcategory in miners without progressive massive fibrosis. Linear regression analysis also showed significant decreases in DLCOpp with increasing small opacity profusion and presence of large opacities. CONCLUSIONS Diffusion impairment is common among former coal miners, including among never smokers, miners without radiographic pneumoconiosis and miners with normal spirometry. These findings demonstrate the value of including DLCO testing in disability examinations of former coal miners and an important role for its use in medical surveillance of working miners to detect early chronic lung disease.
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Affiliation(s)
- Leonard H T Go
- Environmental and Occupational Health Sciences Division, University of Illinois Chicago, Chicago, Illinois, USA
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kirsten S Almberg
- Environmental and Occupational Health Sciences Division, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lee S Friedman
- Environmental and Occupational Health Sciences Division, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lauren Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Robert A Cohen
- Environmental and Occupational Health Sciences Division, University of Illinois Chicago, Chicago, Illinois, USA
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Arce SC, Aguirre-Franco C, Schonffeldt-Guerrero P, Rodríguez-Flores C, Gochicoa-Rangel L. Changes in the Functional Classification of Spirometry Using the New Interpretation Standard 2022: A Multicenter Study. Arch Bronconeumol 2024:S0300-2896(24)00247-3. [PMID: 39068054 DOI: 10.1016/j.arbres.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/28/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Pulmonary function tests are vital for diagnosing lung diseases, assessing treatment responses, and monitoring respiratory health. Recent updates to interpretive standards by the European Respiratory and American Thoracic Societies (ERS/ATS) in 2022 introduced significant changes compared to the 2005 standards. They include incorporating lung volume measurements, non-specific and mixed disorders, introducing z-scores for functional abnormality assessment, reducing severity categories from five to three, and revising criteria for positive bronchodilator responses. METHODS We conducted a retrospective, multi-center study across four centers using spirometric data spanning from 2002 to 2022. We categorized spirometry results using both the 2005 and 2022 ATS/ERS standards and calculated predicted values following the GLI 2012 equation (Caucasian subset). RESULTS Among 79,039 subjects, we observed that 23% shifted from an obstructive diagnosis under the 2005 standard to a mixed pattern diagnosis under the 2022 standard, necessitating lung volume assessments. In the evaluation of bronchodilator responses among 59,203 tests, 12.3% of those initially classified as responders were reclassified as non-responders with the new standards. We found variations in severity categorization across age groups, with older patients tending to receive milder severity classifications and younger individuals receiving greater severity classifications under the 2022 standards. CONCLUSIONS The 2022 document emphasizes early lung volume assessment, potentially leading to increased utilization of more complex tests. Furthermore, the bronchodilator response was predominant in extreme age groups and among individuals with milder spirometric impairments. This shift may impact treatment decisions, potentially initiating medication in milder cases and de-escalating treatment in more severe cases.
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Affiliation(s)
- Santiago C Arce
- Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Argentina.
| | - Carlos Aguirre-Franco
- Laboratorio de Pruebas de Función Pulmonar, Fundación Neumológica Colombiana, Bogotá, Colombia
| | | | | | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias «Ismael Cosío Villegas», Ciudad de México, Mexico
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Usemann J, Mozun R, Kuehni CE, de Hoogh K, Flueckiger B, Singer F, Zwahlen M, Moeller A, Latzin P. Air pollution exposure during pregnancy and lung function in childhood: The LUIS study. Pediatr Pulmonol 2024. [PMID: 38980223 DOI: 10.1002/ppul.27169] [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: 02/26/2024] [Revised: 05/13/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The adverse effects of high air pollution levels on childhood lung function are well-known. Limited evidence exists on the effects of moderate exposure levels during early life on childhood lung function. We investigated the association of exposure to moderate air pollution during pregnancy, infancy, and preschool time with lung function at school age in a Swiss population-based study. METHODS Fine-scale spatiotemporal model estimates of particulate matter with a diameter <2.5 µm (PM2.5) and nitrogen dioxide (NO2) were linked with residential address histories. We compared air pollution exposures within different time windows (whole pregnancy, first, second, and third trimester of pregnancy, first year of life, preschool age) with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) measured cross-sectionally using linear regression models adjusted for potential confounders. RESULTS We included 2182 children, ages 6-17 years. Prenatal air pollution exposure was associated with reduced lung function at school age. In children aged 12 years, per 10 µg·m-3 increase in PM2.5 during pregnancy, FEV1 was 55 mL lower (95% CI -84 to -25 mL) and FVC 62 mL lower (95% CI -96 to -28 mL). Associations were age-dependent since they were stronger in younger and weaker in older children. PM2.5 exposure after birth was not associated with reduced lung function. There was no association between NO2 exposure and lung function. CONCLUSION In utero lung development is most sensitive to air pollution exposure, since even modest PM2.5 exposure during the prenatal time was associated with reduced lung function, most prominent in younger children.
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Affiliation(s)
- Jakob Usemann
- Department of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
- University Children's Hospital Basel (UKBB), Basel, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Rebeca Mozun
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Intensive Care and Neonatology, Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudia E Kuehni
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Benjamin Flueckiger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Florian Singer
- Department of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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41
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Emiralioğlu N, Çakır B, Sertçelik A, Yalçın E, Kiper N, Şen V, Altıntaş DU, Serbes M, Çokuğraş H, Kılınç AA, Başkan AK, Hepkaya E, Yazan H, Türel Ö, Kafi HM, Yılmaz Aİ, Ünal G, Çağlar T, Damadoğlu E, Irmak İ, Demir E, Öztürk G, Bingöl A, Başaran E, Sapan N, Aslan AT, Asfuroğlu P, Harmancı K, Köse M, Hangül M, Özdemir A, Tuğcu G, Polat SE, Özcan G, Gayretli ZG, Keskin Ö, Bilgiç S, Yüksel H, Özdoğan Ş, Topal E, Çaltepe G, Can D, Ekren PK, Kılıç M, Süleyman A, Eyüboğlu TŞ, Cinel G, Pekcan S, Çobanoğlu N, Çakır E, Özçelik U, Doğru D. Factors associated with pulmonary function decline of patients in the cystic fibrosis registry of Turkey: A retrospective cohort study. Pediatr Pulmonol 2024. [PMID: 38980199 DOI: 10.1002/ppul.27165] [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: 09/24/2023] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The decline in pulmonary function is a predictor of disease progression in patients with cystic fibrosis (CF). This study aimed to determine the decline rate of percent predicted forced expiratory volume in 1 s (ppFEV1) based on the data of the CF Registry of Turkey. The secondary aim was to investigate the risk factors related to the decline in ppFEV1. METHODS A retrospective cohort study of CF patients over 6 years old, with pulmonary function data over at least 2 years of follow-up was extracted from the national CF registry for years 2017-2019. Patients were classified according to disease severity and age groups. Multivariate analysis was used to predict the decline in ppFEV1 and to investigate the associated risk factors. RESULTS A total of 1722 pulmonary function test results were available from 574 patients over the study period. Mean diagnostic age was older and weight for age, height for age, and body mass index z scores were significantly lower in the group of ppFEV1 < 40, while chronic Pseudomonas aeruginosa (p < .001) and mucoid P. aeruginosa colonization (p < .001) were significantly higher in this group (p < .001). Overall mean annual ppFEV1 decline was -0.97% (95% confidence interval [CI] = -0.02 to -1.92%). The mean change of ppFEV1 was significantly higher in the group with ppFEV1 ≥ 70 compared with the other (ppFEV1 < 40 and ppFEV1: 40-69) two groups (p = .004). Chronic P. aeruginosa colonization (odds ratio [OR] = 1.79 95% CI = 1.26-2.54; p = .01) and initial ppFEV1 ≥ 70 (OR = 2.98 95% CI = 1.06-8.36), p = .038) were associated with significant ppFEV1 decline in the whole cohort. CONCLUSIONS This data analysis recommends close follow-up of patients with normal initial ppFEV1 levels at baseline; advocates for early interventions for P. aeruginosa; and underlines the importance of nutritional interventions to slow down lung disease progression.
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Affiliation(s)
- Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Banu Çakır
- Department of Public Health, Division of Epidemiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Sertçelik
- Department of Public Health, Division of Epidemiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Velat Şen
- Department of Pediatric Pulmonology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Derya Ufuk Altıntaş
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mahir Serbes
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Azer Kılıç Başkan
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Evrim Hepkaya
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmi Alem University Faculty of Medicine, İstanbul, Turkey
| | - Özden Türel
- Department of Pediatric Pulmonology, Bezmi Alem University Faculty of Medicine, İstanbul, Turkey
| | - Hale Molla Kafi
- Department of Pediatric Pulmonology, Bezmi Alem University Faculty of Medicine, İstanbul, Turkey
| | - Aslı İmran Yılmaz
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Tuğçe Çağlar
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Ebru Damadoğlu
- Department of Adult Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlim Irmak
- Department of Adult Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esen Demir
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gökçen Öztürk
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayşen Bingöl
- Department of Pediatric Allergy, Immunology and Pulmonology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erdem Başaran
- Department of Pediatric Allergy, Immunology and Pulmonology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nihat Sapan
- Department of Pediatric Allergy, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ayşe Tana Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pelin Asfuroğlu
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Koray Harmancı
- Department of Pediatric Allergy, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Mehmet Köse
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Melih Hangül
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ali Özdemir
- Department of Pediatric Pulmonology, Mersin City Hospital, Mersin, Turkey
| | - Gökçen Tuğcu
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | | | - Gizem Özcan
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Gökçe Gayretli
- Department of Pediatric Infectious Disease, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Özlem Keskin
- Department of Pediatric Allergy and Immunology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Sevgi Bilgiç
- Department of Pediatric Allergy and Immunology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Hasan Yüksel
- Department of Pediatric Allergy, Immunology and Pulmonology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Şebnem Özdoğan
- Department of Pediatric Pulmonology, Sarıyer Hamidiye Etfal Hospital, İstanbul, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy and Immunology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Gönül Çaltepe
- Department of Pediatric Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Demet Can
- Department of Pediatric Pulmonology, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Pervin Korkmaz Ekren
- Department of Adult Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Kılıç
- Department of Pediatric Allergy and Immunology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ayşe Süleyman
- Department of Pediatric Allergy and Immunology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Güzin Cinel
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Uğur Özçelik
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Verbanck S, Vekens K, Smets D, Hanon S, Vanderhelst E. Prediction of post-operative lung physiology revisited. Respirology 2024. [PMID: 38977323 DOI: 10.1111/resp.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/20/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karolien Vekens
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dirk Smets
- Department of Thoracic Surgery, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Shane Hanon
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Eef Vanderhelst
- Respiratory Division, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Kawatoko K, Washio Y, Ohara T, Fukuyama S, Honda T, Hata J, Nakazawa T, Kan-o K, Inoue H, Matsumoto K, Nakao T, Kitazono T, Okamoto I, Ninomiya T. Risks of Dementia in a General Japanese Older Population With Preserved Ratio Impaired Spirometry: The Hisayama Study. J Epidemiol 2024; 34:331-339. [PMID: 38044087 PMCID: PMC11167264 DOI: 10.2188/jea.je20230207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Studies on the association between preserved ratio impaired spirometry (PRISm) and dementia are limited. Indeed, PRISm has often been overlooked or ignored as an index of lung function impairment. Therefore, we investigated the association of PRISm with the risk for the development of dementia in an older Japanese population. METHODS A total of 1,202 community-dwelling, older Japanese participants aged ≥65 years without dementia were followed up for a median of 5.0 years. Participants were categorized by spirometry as follows: normal spirometry (FEV1/FVC ≥0.70 and FEV1 ≥80% predicted), PRISm (≥0.70 and <80%), airflow limitation (AFL) Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 (<0.70 and ≥80%), and AFL GOLD 2 to 4 (<0.70 and <80%). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were computed using a Cox proportional hazards model. RESULTS During the follow-up period, 122 participants developed dementia. The age- and sex-adjusted incidences of dementia in the participants with normal spirometry, PRISm, AFL GOLD 1, and AFL GOLD 2 to 4 were 20.5, 37.0, 18.4, and 28.6 per 1,000 person-years, respectively. Participants with PRISm had a higher risk of dementia (HR 2.04; 95% CI, 1.19-3.49) than those with normal spirometry after adjusting for confounders. Moreover, both reduced FEV1% predicted values and FVC% predicted values were associated with the risk of dementia. CONCLUSION PRISm was associated with an increased risk of dementia in a general older Japanese population.
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Affiliation(s)
- Kenji Kawatoko
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoru Fukuyama
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Respiratory Medicine, National Hospital Organization Omuta National Hospital, Fukuoka, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taro Nakazawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiko Kan-o
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Koichiro Matsumoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Respiratory Medicine, Fukuoka Dental College Medical and Dental Hospital, Fukuoka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Isamu Okamoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Medbo J, Imberg H, Hansen C, Krantz C, de Monestrol I, Svedberg M. Telemedicine and home spirometry in cystic fibrosis: A prospective multicenter study. Pediatr Pulmonol 2024. [PMID: 38963304 DOI: 10.1002/ppul.27166] [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: 12/28/2023] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES Telehealth and home spirometry feasibility for children has been established, but their impact on cystic fibrosis (CF) disease progression remains unassessed. We aimed to evaluate the effects of telehealth and home spirometry on CF disease progression and care. METHODS Children with CF aged 5-17 years from all Swedish CF centers were provided with home spirometers. A minimum of two in-person visits were replaced with telemedicine visits and participants were instructed to conduct home spirometry before visits. Linear mixed-effects models were used to compare annual CF disease trajectories during the intervention period and prepandemic period (1 January 2019 to 28 February 2020). Participants and caregivers completed study questionnaires. RESULTS A total of 59 individuals completed the study over a mean (SD) period of 6.8 (1.4) months, made 3.1 (1.0) physical visits and 2.2 (0.6) telehealth visits per patient year during the study period. The mean difference (95% CI) between the intervention and prepandemic period progression rate for FEV1%, lung clearance index and BMI were -0.4 (-1.3 to 0.5, p = 0.39), 0.11 (-0.07 to 0.28, p = 0.25) and -0.02 (-0.13 to 0.08, p = 0.70), respectively. There were no major shifts in the incidence of airway pathogens, sputum cultures, or antibiotics use between the periods (p > 0.05). The intervention did not increase stress. Almost all participants and caregivers expressed a desire to continue with home spirometry and telemedicine. CONCLUSION Combining telehealth and physical visits with access to home spirometry demonstrated comparable effectiveness as exclusively in-person care with enhanced flexibility and personalization of CF care.
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Affiliation(s)
- Jakob Medbo
- Department of Pediatrics, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia's Children Hospital, Gothenburg, Sweden
| | | | - Christine Hansen
- Department of Pediatrics, Lund CF Centre, Skåne University Hospital, Lund, Sweden
| | - Christina Krantz
- Department of Pediatrics, Uppsala CF Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Isabelle de Monestrol
- Stockholm CF Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institute, Stockholm, Sweden
| | - Marcus Svedberg
- Department of Pediatrics, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia's Children Hospital, Gothenburg, Sweden
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Bayfield KJ, Weinheimer O, Middleton A, Boyton C, Fitzpatrick R, Kennedy B, Blaxland A, Jayasuriya G, Caplain N, Wielpütz MO, Yu L, Galban CJ, Robinson TE, Bartholmai B, Gustafsson P, Fitzgerald D, Selvadurai H, Robinson PD. Comparative sensitivity of early cystic fibrosis lung disease detection tools in school aged children. J Cyst Fibros 2024:S1569-1993(24)00075-4. [PMID: 38969602 DOI: 10.1016/j.jcf.2024.05.012] [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: 10/14/2023] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Effective detection of early lung disease in cystic fibrosis (CF) is critical to understanding early pathogenesis and evaluating early intervention strategies. We aimed to compare ability of several proposed sensitive functional tools to detect early CF lung disease as defined by CT structural disease in school aged children. METHODS 50 CF subjects (mean±SD 11.2 ± 3.5y, range 5-18y) with early lung disease (FEV1≥70 % predicted: 95.7 ± 11.8 %) performed spirometry, Multiple breath washout (MBW, including trapped gas assessment), oscillometry, cardiopulmonary exercise testing (CPET) and simultaneous spirometer-directed low-dose CT imaging. CT data were analysed using well-evaluated fully quantitative software for bronchiectasis and air trapping (AT). RESULTS CT bronchiectasis and AT occurred in 24 % and 58 % of patients, respectively. Of the functional tools, MBW detected the highest rates of abnormality: Scond 82 %, MBWTG RV 78 %, LCI 74 %, MBWTG IC 68 % and Sacin 51 %. CPET VO2peak detected slightly higher rates of abnormality (9 %) than spirometry-based FEV1 (2 %). For oscillometry AX (14 %) performed better than Rrs (2 %) whereas Xrs and R5-19 failed to detect any abnormality. LCI and Scond correlated with bronchiectasis (r = 0.55-0.64, p < 0.001) and AT (r = 0.73-0.74, p < 0.001). MBW-assessed trapped gas was detectable in 92 % of subjects and concordant with CT-assessed AT in 74 %. CONCLUSIONS Significant structural and functional deficits occur in early CF lung disease, as detected by CT and MBW. For MBW, additional utility, beyond that offered by LCI, was suggested for Scond and MBW-assessed gas trapping. Our study reinforces the complementary nature of these tools and the limited utility of conventional oscillometry and CPET in this setting.
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Affiliation(s)
- Katie J Bayfield
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research DZL, Heidelberg, Germany
| | - Anna Middleton
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christie Boyton
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Rachel Fitzpatrick
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Brendan Kennedy
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anneliese Blaxland
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Geshani Jayasuriya
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Neil Caplain
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg, German Center for Lung Research DZL, Heidelberg, Germany
| | - Lifeng Yu
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Craig J Galban
- Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
| | - Terry E Robinson
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Brian Bartholmai
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Per Gustafsson
- Department of Paediatrics, Central Hospital, Skövde, Sweden
| | - Dominic Fitzgerald
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Paul D Robinson
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia; Children's Health and Environment Program, Child Health Research Centre, University of Queensland, South Brisbane, Australia.
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Qvarfordt M, Lampa E, Cai GH, Lind L, Elmståhl S, Svartengren M. Bioelectrical impedance and lung function-associations with gender and central obesity: results of the EpiHealth study. BMC Pulm Med 2024; 24:319. [PMID: 38965493 PMCID: PMC11225376 DOI: 10.1186/s12890-024-03128-0] [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: 06/30/2023] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Obesity is a major public health concern associated with various health problems, including respiratory impairment. Bioelectrical impedance (BIA) is used in health screening to assess body fat. However, there is no consensus in healthcare on how body fat should be assessed in relation to lung function. In this study, we aimed to investigate how BIA in relation to waist circumference contribute, using data from a large Swedish population study. METHODS A total of 17,097 participants (aged 45-75 years) were included in the study. The relationships between fat mass, waist circumference, and lung function were analysed using weighted quantile sum regression. RESULTS Increased fat mass was significantly associated with decreased lung function (FEV1, FVC) in both sexes. Also, the influence of trunk fat and waist circumference on FVC and FEV1 differed by sex: in males, waist circumference and trunk fat had nearly equal importance for FVC (variable weights of 0.42 and 0.41), whereas in females, trunk fat was significantly more important (variable weights 0.84 and 0.14). For FEV1, waist circumference was more important in males, while trunk fat was more significant in females (variable weights male 0.68 and 0.28 and 0.23 and 0.77 in female). CONCLUSIONS Our results suggest that trunk fat should be considered when assessing the impact of adipose tissue on lung function and should potentially be included in the health controls.
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Affiliation(s)
- Mikaela Qvarfordt
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
- Department of Laboratory Medicine, Clinical Physiology, Karolinska Institute, Stockholm, Sweden.
| | - Erik Lampa
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Gui-Hong Cai
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Magnus Svartengren
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
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Merino-Hernández A, Muñoz-Cutillas A, Ramos-Navarro C, Bellón-Alonso S, Rodríguez-Cimadevilla JL, González-Pacheco N, Rodríguez-Fernández R, Sánchez-Luna M. Long-term lung function follow-up of preterm infants less than 32 weeks of gestational age. Pediatr Pulmonol 2024. [PMID: 38958223 DOI: 10.1002/ppul.27158] [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: 04/08/2024] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Preterm infants, particularly those with bronchopulmonary dysplasia (BPD), are at risk of lung development problems. Over the last decades, lung protective strategies have been used, decreasing the risk of chronic lung disease. OBJECTIVE To evaluate the pulmonary function test (PFT) of preterm infants born after the introduction of lung protective strategies and to assess perinatal determinants of impaired lung function in this population. METHODS A prospective, observational, single-center study was conducted in the neonatal unit of a high-complexity hospital. The study included newborns with less than 32 weeks gestational age born between 2012 and 2014, who were followed up until they reach school age. For the main outcome, two groups were stablished: no BPD or grade 1 BPD (no BPD/1) and grade 2 or 3 BPD (BPD 2/3). RESULTS Out of 327 patients, 116 were included. BPD was diagnosed in 49.1% (47), with 50.9% (29) classified as grade 1, 35.1% (20) as grade 2, and 14.0% (8) as grade 3. Mean age at PFT was 8.59 years (SD 0.90). Mean FEV1% was 95.36% (SD 13.21) and FEV1 z-score -0.36 (SD 1.12); FVC% 97.53% (SD 12.59) and FVC z-score -0.20 (SD 1.06); FEV1/FVC ratio 85.84% (SD 8.34) and z-score -0.24 (SD 1.34). When comparing patients with no BPD/1 and BPD 2/3, we observed differences in all pulmonary function parameters, which persisted after adjusting for gestational age. No differences in PFT were observed between patients without BPD and those with grade 1 BPD. Most patients (76.7%, 89) had normal spirometry pattern, with obstructive pattern observed in 12.9% (15), restrictive pattern in 9.5% (11), and mixed pattern in 0.9% (1) of patients. CONCLUSION Preterm infants with BPD 2/3 showed a decrease in all pulmonary function parameters compared to preterm infants with no BPD/1; an effect that was independent of gestational age. Among patients with BPD who had an altered PFT pattern, the most common pattern was obstructive, followed by restrictive and then, mixed.
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Affiliation(s)
- Amaia Merino-Hernández
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Agustin Muñoz-Cutillas
- Universidad Complutense de Madrid, Madrid, Spain
- Pediatric Pulmonology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Ramos-Navarro
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Noelia González-Pacheco
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Rodríguez-Fernández
- Universidad Complutense de Madrid, Madrid, Spain
- Pediatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Neonatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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Hayashi Y, Tanabe N, Matsumoto H, Shimizu K, Sakamoto R, Oguma T, Sunadome H, Sato A, Sato S, Hirai T. Associations of fractional exhaled nitric oxide with airway dimension and mucus plugs on ultra-high-resolution computed tomography in former smokers and nonsmokers with asthma. Allergol Int 2024; 73:397-405. [PMID: 38403524 DOI: 10.1016/j.alit.2024.01.013] [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: 12/14/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Associations of fractional exhaled nitric oxide (FeNO) with airway wall remodeling and mucus plugs remain to be explored in smokers and nonsmokers with asthma. Ultra-high-resolution computed tomography (U-HRCT), which allows accurate structural quantification of airways >1 mm in diameter, was used in this study to examine whether higher FeNO was associated with thicker walls of the 3rd to 6th generation airways and mucus plugging in patients with asthma. METHODS The retrospective analyses included consecutive former smokers and nonsmokers with asthma who underwent U-HRCT in a hospital. The ratio of wall area to summed lumen and wall area was calculated as the wall area percent (WA%). Mucus plugging was visually scored. RESULTS Ninety-seven patients with asthma (including 59 former smokers) were classified into low (<20 ppb), middle (20-35 ppb), and high (>35 ppb) FeNO groups (n = 24, 26, and 47). In analysis including all patients and subanalysis including nonsmokers or former smokers, WA% in the 6th generation airways was consistently higher in the high FeNO group than in the low FeNO group, whereas WA% in the 3rd to 5th generation airways was not. In multivariable models, WA% in the 6th generation airways and the rate of mucus plugging were higher in the high FeNO group than in the low FeNO group after adjusting for age, sex, body mass index, smoking status, lung volume, and allergic rhinitis presence. CONCLUSIONS Higher FeNO may reflect the inflammation and remodeling of relatively peripheral airways in asthma in both former smokers and nonsmokers.
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Affiliation(s)
- Yusuke Hayashi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine & Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kaoruko Shimizu
- Division of Emergent Respiratory and Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Medicine, Kyoto City Hospital, Kyoto, Japan
| | - Hironobu Sunadome
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Saegebrecht LS, Röhlig M, Schaub F, Ballmann M, Stachs O, Fischer DC. Glycemic Variability and the Thickness of Retinal Layers in Cystic Fibrosis Patients with and without Cystic Fibrosis Related Diabetes. Curr Eye Res 2024; 49:759-767. [PMID: 38557392 DOI: 10.1080/02713683.2024.2333770] [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: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Patients with cystic fibrosis (CF) are at risk to develop CF related diabetes (CFRD) and subsequently even diabetic neuro- and/or vasculopathy. We sought to determine if there are typical signs of diabetes-related retinal alterations present in CF patients with preserved and impaired glycemic control. METHODS During routine annual examination CF patients were offered an additional 7-day period of real time continuous glucose monitoring (rtCGM) and an ophthalmological examination including retinal optical coherence tomography (OCT). Patients were categorized according to the glycemic control, i.e. the results of an oral glucose tolerance test (OGTT) and rtCGM were taken into consideration. OCT data was analyzed by our previously published visual analysis software generating dedicated and spatially resolved deviation maps for visualization and quantification of differences in total retinal thickness and thickness of retinal nerve fiber layer (RNFL) as well as ganglion cell layer (GCL) in comparison to age-matched healthy controls and patients with either type 1 or type 2 diabetes mellitus. RESULTS Results of the rtCGM and/or OGTT enabled discrimination between patients with normal glycemic control (CFNG; n = 6), with abnormal glycemic control (CFAG; n = 6) and overt CFRD (n = 4). OCT data indicates gradually increasing retinal thinning in all 3 groups, depending on the degree of glucose metabolism disorder compared to healthy controls. At the foveal region total retinal thickness and GCL thickness were significantly thinner in CFRD patients compared to CFNG patients (total retinal thickness: 260.4 µm (239.3-270.8) vs. 275.4 µm (254.3-289.5); GCL: 11.82 µm (11.16-15.25) vs. 17.30 µm (13.95-19.82); each p < 0.05). CONCLUSION Although we investigated a rather small number of patients, we obtained evidence that intraretinal neurodegenerative changes occur in each of our subgroups (CFNG, CFAG, CFRD). Beyond this, our results favor the detrimental role of additional diabetes, as the deviations from healthy controls were most pronounced in the CFRD group and are similar to those seen in patients suffering from type 1 or type 2 diabetes.
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Affiliation(s)
- Luisa S Saegebrecht
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Martin Röhlig
- Institute of Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Manfred Ballmann
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
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Nkereuwem E, Agbla S, Njai B, Edem VF, Jatta ML, Owolabi O, Masterton U, Jah F, Danso M, Fofana AN, Samateh W, Darboe ML, Owusu SA, Bush A, Kampmann B, Togun T. Post-tuberculosis respiratory impairment in Gambian children and adolescents: A cross-sectional analysis. Pediatr Pulmonol 2024; 59:1912-1921. [PMID: 38629432 DOI: 10.1002/ppul.27009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Although post-tuberculosis lung disease (PTLD) is a known consequence of pulmonary tuberculosis (pTB), few studies have reported the prevalence and spectrum of PTLD in children and adolescents. METHODS Children and adolescent (≤19 years) survivors of pTB in the Western Regions of The Gambia underwent a respiratory symptom screening, chest X-ray (CXR) and spirometry at TB treatment completion. Variables associated with lung function impairment were identified through logistic regression models. RESULTS Between March 2022 and July 2023, 79 participants were recruited. The median age was 15.6 years (IQR: 11.8, 17.9); the majority, 53/79 (67.1%), were treated for bacteriologically confirmed pTB, and 8/79 (10.1%) were children and adolescents living with HIV. At pTB treatment completion, 28/79 (35.4%) reported respiratory symptoms, 37/78 (47.4%) had radiological sequelae, and 45/79 (57.0%) had abnormal spirometry. The most common respiratory sequelae were cough (21/79, 26.6%), fibrosis on CXR (22/78, 28.2%), and restrictive spirometry (41/79, 51.9%). Age at TB diagnosis over ten years, undernutrition and fibrosis on CXR at treatment completion were significantly associated with abnormal spirometry (p = .050, .004, and .038, respectively). CONCLUSION Chronic respiratory symptoms, abnormal CXR, and impaired lung function are common and under-reported consequences of pTB in children and adolescents. Post-TB evaluation and monitoring may be necessary to improve patient outcomes.
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Affiliation(s)
- Esin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Schadrac Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, UK
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Bintou Njai
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Victory Fabian Edem
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Muhammed Lamin Jatta
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Olumuyiwa Owolabi
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Uma Masterton
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Fatoumatta Jah
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Madikoi Danso
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Aunty Nyima Fofana
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Wandifa Samateh
- National Leprosy and Tuberculosis Control Programme, Kanifing, The Gambia
| | | | - Sheila Ageiwaa Owusu
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, National Heart & Lung Institute, Imperial College London - Royal Brompton Campus, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Charité Centre for Global Health, Institute of International Health, Berlin, Germany
| | - Toyin Togun
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
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