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Silva MGS, Carvalho TL, de Azevedo Vieira JE, da Costa LR, da Silva DLO, Costa ALB, dos Anjos HPS, Lopes AJ. Evaluating performance on the Glittre-ADL test in men with long COVID 3 years after a SARS-CoV-2 infection. J Exerc Sci Fit 2024; 22:271-277. [PMID: 38601317 PMCID: PMC11002684 DOI: 10.1016/j.jesf.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Background/objective Many COVID-19 survivors, especially those who have been hospitalized, have been suffering numerous complications that limit their activities of daily living, although changes that persist 3 years after infection are still not known. We aimed to investigate the impact of long COVID on the Glittre-ADL test (TGlittre) 3 years after acute infection in men who needed hospitalization and explore whether the performance on the TGlittre is associated with impairments in lung function, muscle strength, physical function and quality of life (QoL). Methods Cross-sectional study with 42 men with long COVID who took the TGlittre. They underwent pulmonary function tests and measurements of handgrip strength and quadriceps strength (QS). Additionally, they also completed the Saint George Respiratory Questionnaire (SGRQ) and Functional Independence Measure (FIM). Results The mean age was 52 ± 10.6 years, while the mean time after diagnosis of COVID-19 was 37 ± 3.5 months. The mean TGlittre time was 3.3 (3.1-4.1) min, which was 10% greater than the time expected for normal individuals to complete it. The TGlittre time was correlated significantly with the QS (rs = -0.397, p = 0.009), pulmonary diffusion (rs = - 0.364, p = 0.017), FIM (rs = -0.364, p = 0.017) and the "activity" domain score of the SGRQ (rs = 0.327, p = 0.034). Conclusion Functional capacity on exertion as measured by the TGlittre time is normal in most men with long COVID 3 years after hospitalization. However, this improvement in functional capacity does not seem to be reflected in muscle strength or QoL, requiring continued monitoring even after 3 years.
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Affiliation(s)
- Mayra Gomes Soares Silva
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Thiago Lemos Carvalho
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | | | | | | | | | | | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
- Medical Sciences Post-Graduation Program, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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2
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Szarvas Z, Fekete M, Szollosi GJ, Kup K, Horvath R, Shimizu M, Tsuhiya F, Choi HE, Wu HT, Fazekas-Pongor V, Pete KN, Cserjesi R, Bakos R, Gobel O, Gyongyosi K, Pinter R, Kolozsvari D, Kovats Z, Yabluchanskiy A, Owens CD, Ungvari Z, Tarantini S, Horvath G, Muller V, Varga JT. Optimizing cardiopulmonary rehabilitation duration for long COVID patients: an exercise physiology monitoring approach. GeroScience 2024; 46:4163-4183. [PMID: 38771423 PMCID: PMC11336035 DOI: 10.1007/s11357-024-01179-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021-31/DEC/2022, while an age-matched control group (n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.
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Affiliation(s)
- Zsofia Szarvas
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Monika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gergo Jozsef Szollosi
- Coordination Center for Research in Social Sciences, Faculty of Economics and Business, University of Debrecen, Debrecen, Hungary
| | - Katica Kup
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Rita Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Maya Shimizu
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Fuko Tsuhiya
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ha Eun Choi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Huang-Tzu Wu
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Nedda Pete
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Renata Cserjesi
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Regina Bakos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Orsolya Gobel
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kata Gyongyosi
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Renata Pinter
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Dora Kolozsvari
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kovats
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cameron D Owens
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoltan Ungvari
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stefano Tarantini
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gabor Horvath
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Veronika Muller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Janos Tamas Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.
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Kaminsky DA, Anekonda VT, Verbanck S, Graham BL. Using the phase III slope of exhaled methane during a single breath D LCO test to assess ventilation heterogeneity. Respir Med 2024; 231:107725. [PMID: 38950682 DOI: 10.1016/j.rmed.2024.107725] [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: 01/20/2024] [Revised: 06/18/2024] [Accepted: 06/28/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The Phase III slope from a single breath nitrogen washout test provides information about ventilation heterogeneity (VH) in the lungs. PURPOSE To determine if the Phase III slope from the exhaled tracer gas concentration during a standard, single breath DLCO test using rapid gas analysis provides similar information about VH. BASIC PROCEDURES Retrospective analysis of clinical pulmonary function laboratory data including spirometry, lung volumes, and DLCO. The normalized Phase III slope from the exhaled CH4 concentration (SnCH4) was compared among different patterns of physiologic abnormality and with VA/TLC as an indicator of VH. MAIN FINDINGS SnCH4 was the steepest in the group with "Obstruction and Low DLCO", with significant differences between this group and the "Normal", "Obstruction with Normal DLCO", "Mixed Obstruction and Restriction" and "Isolated Low DLCO" groups. SnCH4 was steeper in current and former smokers compared to non-smokers. Among the entire study sample, SnCH4 correlated with VA/TLC (Spearman rho = -0.56, p < 0.01) and remained a significant determinant of VA/TLC by regression modeling. PRINCIPAL CONCLUSIONS The SnCH4 derived from a standard, single breath DLCO test using rapid gas analysis varied among distinct patterns of physiologic abnormalities and was associated with VA/TLC as a measure of VH.
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Affiliation(s)
- David A Kaminsky
- Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Given D213, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
| | - Vishwanath T Anekonda
- Department of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Sylvia Verbanck
- Respiratory Division, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Brian L Graham
- Emeritus Division of Respirology, Critical Care and Sleep Medicine University of Saskatchewan Saskatoon, SK, Canada.
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Raniszewska A, Kwiecień I, Rutkowska E, Bednarek J, Sokołowski R, Miklusz P, Rzepecki P, Jahnz-Różyk K. Imbalance of B-Cell Subpopulations in the Microenvironment of Sarcoidosis or Lung Cancer. Cells 2024; 13:1274. [PMID: 39120304 PMCID: PMC11311476 DOI: 10.3390/cells13151274] [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: 07/02/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
Although the role of T lymphocytes in sarcoidosis (SA) and lung cancer (LC) is quite well reported, the occurrence of B cells in disease microenvironments may suggest their potential role as natural modifiers of the immune response. The aim of this study was to investigate the B-cell profile and lymphocyte-related hematological parameters between patients with SA, LC and healthy controls (HCs). The cells were assessed by flow cytometry and a hematological analyzer in peripheral blood (PB) and material from lymph nodes (LNs) obtained by the EBUS/TBNA method. We showed that in SA patients, there were higher percentages of naïve B and CD21low B cells and a lower percentage of class-switched memory B cells than LC patients in LNs. We observed a higher median proportion of non-switched memory and transitional B cells in the PB of SA patients than in LC patients. We noticed the lowest median proportion of class-switched memory B cells in the PB from SA patients. LC patients had a higher percentage of RE-LYMP and AS-LYMP than SA patients. Our study presented a different profile of B-cell subpopulations in SA and LC patients, distinguishing dominant subpopulations, and showed the relocation from distant compartments of the circulation to the disease microenvironment, thus emphasizing their role.
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Affiliation(s)
- Agata Raniszewska
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland; (I.K.); (E.R.)
| | - Iwona Kwiecień
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland; (I.K.); (E.R.)
| | - Elżbieta Rutkowska
- Laboratory of Hematology and Flow Cytometry, Department of Internal Medicine and Hematology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland; (I.K.); (E.R.)
| | - Joanna Bednarek
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (P.M.); (K.J.-R.)
| | - Rafał Sokołowski
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (P.M.); (K.J.-R.)
| | - Piotr Miklusz
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (P.M.); (K.J.-R.)
| | - Piotr Rzepecki
- Department of Internal Medicine and Hematology, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland;
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergology and Clinical Immunology, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.B.); (R.S.); (P.M.); (K.J.-R.)
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Weisenburger G, Bunel V, Godet C, Salpin M, Mouren D, Menonville CTD, Goletto T, Marceau A, Borie R, Debray MP, Mal H. An underrecognized phenotype of pulmonary emphysema with marked pulmonary gas exchange but with mild or moderate airway obstruction. Respir Med Res 2024; 86:101086. [PMID: 39068737 DOI: 10.1016/j.resmer.2024.101086] [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: 07/10/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 07/30/2024]
Abstract
In patients with pulmonary emphysema and mild to moderate airflow limitation, one does not expect the features marked exertional dyspnea and hypoxemia as well as a profound decrease in diffusing capacity of the lung for carbon monoxide (DLCO). Here we describe this phenotype and its prognosis. From our database, we retrospectively selected cases associating emphysema, exertional breathlessness, O2 requirement at least upon exercise, forced expiratory volume in 1 sec (FEV1) ≥ 50% predicted, and DLCO ≤ 50% predicted, without associated combined pulmonary fibrosis and emphysema, right-to-left shunt, or severe pulmonary hypertension. Over a 12-year period, we identified 16 patients with emphysema and the above presentation. At the initial evaluation, the median age was 62 years (interquartile range 53.8-68.9). The median FEV1 and DLCO% predicted and mean pulmonary artery pressure were 86 (65-95)%, 38 (31-41)%, and 20 (17-25) mm Hg, respectively. On room air, the median arterial partial pressure of oxygen and partial pressure of carbon dioxide in arterial blood were 63.5 (55.8-69) mm Hg and 34.5 (31-36) mm Hg with increased median alveolar-arterial oxygen difference (46 [39-51] mm Hg). After the initial evaluation, the respiratory condition worsened in 13 of 14 (92.8%) patients with one or more re-evaluations (median follow-up 2.6 [0.9-5.8] years). In 12, lung transplantation was considered. Four patients died after 5.8, 5.7, 7.1, and 0.8 years of follow-up, respectively. We describe an underrecognized phenotype of pulmonary emphysema featuring a particular profile characterized by marked exertional dyspnea, impaired pulmonary gas exchange with low DLCO and marked oxygen desaturation at least on exercise but with mild or moderate airway obstruction.
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Affiliation(s)
- Gaelle Weisenburger
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Vincent Bunel
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Cendrine Godet
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Mathilde Salpin
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Domitille Mouren
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Charlotte Thibaut de Menonville
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Tiphaine Goletto
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Armelle Marceau
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | - Raphael Borie
- Service de pneumologie A, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France
| | | | - Hervé Mal
- Service de pneumologie B, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Inserm UMR1152, Université Paris7 Denis Diderot, 75018, Paris, France.
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6
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Dupuis A, Thierry A, Perotin JM, Ancel J, Dormoy V, Dury S, Deslée G, Launois C. Obesity Impact on Dyspnea in COPD Patients. Int J Chron Obstruct Pulmon Dis 2024; 19:1695-1706. [PMID: 39070800 PMCID: PMC11277818 DOI: 10.2147/copd.s450366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background The role of obesity on dyspnea in chronic obstructive pulmonary disease (COPD) patients remains unclear. We aimed to provide an assessment of dyspnea in COPD patients according to their Body Mass Index (BMI) and to investigate the impact of obesity on dyspnea according to COPD severity. Methods One hundred and twenty seven COPD patients with BMI ≥ 18.5 kg/m² (63% male, median (interquartile range) post bronchodilator forced expiratory volume of 1 second (post BD FEV1) at 51 (34-66) % pred) were consecutively included. Dyspnea was assessed by mMRC (Modified medical research council) scale. Lung function tests were recorded, and emphysema was quantified on CT-scan (computed tomography-scan). Results Twenty-five percent of the patients were obese (BMI ≥ 30kg/m²), 66% of patients experienced disabling dyspnea (mMRC ≥ 2). mMRC scores did not differ depending on BMI categories (2 (1-3) for normal weight, 2 (1-3) 1 for overweight and 2 (1-3) for obese patients; p = 0.71). Increased mMRC scores (0-1 versus 2-3 versus 4) were associated with decreased post BD-FEV1 (p < 0.01), higher static lung hyperinflation (inspiratory capacity/total lung capacity (IC/TLC), p < 0.01), reduced DLCO (p < 0.01) and higher emphysema scores (p < 0.01). Obese patients had reduced static lung hyperinflation (IC/TLC p < 0.01) and lower emphysema scores (p < 0.01) than non-obese patients. mMRC score increased with GOLD grades (1-2 versus 3-4) in non-obese patients but not in obese patients, in association with a trend towards reduced static lung hyperinflation and lower emphysema scores. Conclusion By contrast with non-obese patients, dyspnea did not increase with spirometric GOLD grades in obese patients. This might be explained by a reduced lung hyperinflation related to the mechanical effects of obesity and a less severe emphysema in severe COPD patients with obesity.
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Affiliation(s)
- Alexis Dupuis
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Aurore Thierry
- Université de Reims Champagne-Ardenne, VieFra, CHU Reims, Unité d’Aide Méthodologique, Reims, F-51100, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Julien Ancel
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Valérian Dormoy
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
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7
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Chai CS, Bin Ibrahim MA, Binti Azhar NA, Binti Roslan Z, Binti Harun R, Krishnabahawan SL, Karthigayan AAP, Binti Abdul Kadir RF, Binti Johari B, Ng DLC, Sim BLH, Liam CK, Bin Muttalif AR, Bin Rasit AH, Peariasamy KM, Bin Abdul Rani MF. Post-discharge spirometry evaluation in patients recovering from moderate-to-critical COVID-19: a cross-sectional study. Sci Rep 2024; 14:16413. [PMID: 39013943 PMCID: PMC11252397 DOI: 10.1038/s41598-024-67536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/12/2024] [Indexed: 07/18/2024] Open
Abstract
Understanding the prevalence of abnormal lung function and its associated factors among patients recovering from COVID-19 is crucial for enhancing post-COVID care strategies. This study primarily aimed to determine the prevalence and types of spirometry abnormalities among post-COVID-19 patients in Malaysia, with a secondary objective of identifying its associated factors. Conducted at the COVID-19 Research Clinic, Faculty of Medicine, University Technology MARA, from March 2021 to December 2022, this study included patients at least three months post-discharge from hospitals following moderate-to-critical COVID-19. Of 408 patients studied, abnormal spirometry was found in 46.8%, with 28.4% exhibiting a restrictive pattern, 17.4% showing preserved ratio impaired spirometry (PRISm), and 1.0% displaying an obstructive pattern. Factors independently associated with abnormal spirometry included consolidation on chest X-ray (OR 8.1, 95% CI 1.75-37.42, p = 0.008), underlying cardiovascular disease (OR 3.5, 95% CI 1.19-10.47, p = 0.023), ground-glass opacity on chest X-ray (OR 2.6, 95% CI 1.52-4.30, p < 0.001), and oxygen desaturation during the 6-min walk test (OR 1.9, 95% CI 1.20-3.06, p = 0.007). This study highlights that patients recovering from moderate-to-critical COVID-19 often exhibit abnormal spirometry, notably a restrictive pattern and PRISm. Routine spirometry screening for high-risk patients is recommended.
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Affiliation(s)
- Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Muhammad Amin Bin Ibrahim
- Department of Internal Medicine, Faculty of Medicine, University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Nur Amira Binti Azhar
- Clinical Research Centre, Sungai Buloh Hospital, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Zulaika Binti Roslan
- Clinical Research Centre, Sungai Buloh Hospital, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Rozila Binti Harun
- Clinical Research Centre, Sungai Buloh Hospital, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Swarna Lata Krishnabahawan
- Clinical Research Centre, Sungai Buloh Hospital, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Aruna A P Karthigayan
- Department of Medicine, Sungai Buloh Hospital, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | | | - Busra Binti Johari
- Department of Radiology, Faculty of Medicine, University Technology MARA, Sungai Buloh, Selangor, Malaysia
| | - Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Benedict-Lim-Heng Sim
- Department of Medicine, Sungai Buloh Hospital, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abdul Razak Bin Muttalif
- Department of Medicine, Faculty of Medicine, MAHSA University Malaysia, Jenjarom, Selangor, Malaysia
| | - Ahmad Hata Bin Rasit
- Department of Orthopaedics, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
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8
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Gernhold L, Neurohr C, Tsitouras K, Lutz N, Briese S, Ghiani A. Hypercapnia and lung function parameters in chronic obstructive pulmonary disease. BMC Pulm Med 2024; 24:345. [PMID: 39014325 PMCID: PMC11251095 DOI: 10.1186/s12890-024-03151-1] [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: 04/12/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND In advanced chronic obstructive pulmonary disease (COPD), hypercapnia may occur due to severe bronchial obstruction with lung hyperinflation. Non-invasive ventilation (NIV) provides the standard of care intended to achieve physiological PCO2 levels, thereby reducing overall mortality. The present study aimed to evaluate pulmonary function parameters derived from spirometry (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1]), body plethysmography (residual volume [RV], total lung capacity [TLC]), and lung diffusion capacity for carbon monoxide (single-breath method [DCO-SB], alveolar-volume corrected values [DCO-VA]) as predictors of chronic hypercapnia in patients with advanced COPD. METHODS This monocentric, retrospective observational study included 423 COPD patients. Receiver operating characteristic (ROC) curve analysis and cross-validation were used to assess lung function parameters' diagnostic accuracy for predicting chronic hypercapnia, with the resulting performance expressed as area under the ROC curve (AUROC). We performed univariable and multivariable binary logistic regression analysis to determine if these parameters were independently associated with chronic hypercapnia, with probabilities reported as odds ratios [OR] with 95% confidence intervals [95%CI]. RESULTS FVC% (AUROC 0.77 [95%CI 0.72-0.81], P < 0.01) and FEV1% (AURIC 0.75 [95%CI 0.70-0.79], P < 0.01) exhibited reasonable accuracy in the prediction of chronic hypercapnia, whereas lung diffusion capacity performed poorly (AUROC 0.64 [95%CI 0.58-0.71] for DCO-SB%, P < 0.01). FVC% (OR 0.95 [95%CI 0.93-0.97], P < 0.01) and FEV1% (OR 0.97 [95%CI 0.94-0.99], P = 0.029) were the only parameters associated independently with chronic hypercapnia in logistic regression analysis. FVC and FEV1 thresholds that best separated hypercapnic from normocapnic subjects reached 56% and 33% of predicted values. CONCLUSIONS Routinely collected pulmonary function parameters, particularly FVC% and FEV1%, may predict chronic hypercapnia during COPD progression.
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Affiliation(s)
- Lukas Gernhold
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic GmbH, affiliated with Robert-Bosch-Hospital GmbH (Bosch Health Campus), Auerbachstr. 110, Stuttgart, 70376, Germany.
| | - Claus Neurohr
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic GmbH, affiliated with Robert-Bosch-Hospital GmbH (Bosch Health Campus), Auerbachstr. 110, Stuttgart, 70376, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Konstantinos Tsitouras
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic GmbH, affiliated with Robert-Bosch-Hospital GmbH (Bosch Health Campus), Auerbachstr. 110, Stuttgart, 70376, Germany
| | - Nina Lutz
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic GmbH, affiliated with Robert-Bosch-Hospital GmbH (Bosch Health Campus), Auerbachstr. 110, Stuttgart, 70376, Germany
| | - Selina Briese
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic GmbH, affiliated with Robert-Bosch-Hospital GmbH (Bosch Health Campus), Auerbachstr. 110, Stuttgart, 70376, Germany
| | - Alessandro Ghiani
- Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart - Schillerhoehe Lung Clinic GmbH, affiliated with Robert-Bosch-Hospital GmbH (Bosch Health Campus), Auerbachstr. 110, Stuttgart, 70376, Germany
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9
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Wynberg E, Han AX, van Willigen HDG, Verveen A, van Pul L, Maurer I, van Leeuwen EM, van den Aardweg JG, de Jong MD, Nieuwkerk P, Prins M, Kootstra NA, de Bree GJ. Inflammatory profiles are associated with long COVID up to 6 months after COVID-19 onset: A prospective cohort study of individuals with mild to critical COVID-19. PLoS One 2024; 19:e0304990. [PMID: 39008486 PMCID: PMC11249251 DOI: 10.1371/journal.pone.0304990] [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: 07/13/2023] [Accepted: 05/17/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND After initial COVID-19, immune dysregulation may persist and drive post-acute sequelae of COVID-19 (PASC). We described longitudinal trajectories of cytokines in adults up to 6 months following SARS-CoV-2 infection and explored early predictors of PASC. METHODS RECoVERED is a prospective cohort of individuals with laboratory-confirmed SARS-CoV-2 infection between May 2020 and June 2021 in Amsterdam, the Netherlands. Serum was collected at weeks 4, 12 and 24 of follow-up. Monthly symptom questionnaires were completed from month 2 after COVID-19 onset onwards; lung diffusion capacity (DLCO) was tested at 6 months. Cytokine concentrations were analysed by human magnetic Luminex screening assay. We used a linear mixed-effects model to study log-concentrations of cytokines over time, assessing their association with socio-demographic and clinical characteristics that were included in the model as fixed effects. RESULTS 186/349 (53%) participants had ≥2 serum samples and were included in current analyses. Of these, 101/186 (54%: 45/101[45%] female, median age 55 years [IQR = 45-64]) reported PASC at 12 and 24 weeks after COVID-19 onset. We included 37 reference samples (17/37[46%] female, median age 49 years [IQR = 40-56]). In a multivariate model, PASC was associated with raised CRP and abnormal diffusion capacity with raised IL10, IL17, IL6, IP10 and TNFα at 24 weeks. Early (0-4 week) IL-1β and BMI at COVID-19 onset were predictive of PASC at 24 weeks. CONCLUSIONS Our findings indicate that immune dysregulation plays an important role in PASC pathogenesis, especially among individuals with reduced pulmonary function. Early IL-1β shows promise as a predictor of PASC.
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Affiliation(s)
- Elke Wynberg
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Alvin X Han
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Hugo D G van Willigen
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Anouk Verveen
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Lisa van Pul
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Irma Maurer
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Ester M van Leeuwen
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Joost G van den Aardweg
- Department of Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Neeltje A Kootstra
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Godelieve J de Bree
- Department of Infectious Diseases, Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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10
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Xu X, Han Q, Lin X, Lin J, Wang S. Association between dietary niacin intake and lung function among American adults: A cross-sectional analysis from national health and nutrition examination survey, 2007-2012. Heliyon 2024; 10:e33482. [PMID: 39027602 PMCID: PMC11255858 DOI: 10.1016/j.heliyon.2024.e33482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 06/08/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Background The pathogenesis of pulmonary senescence involves immune system dysregulation, oxidative stress, and mitochondrial dysfunction. The effects on lung function of niacin, an essential coenzyme involved in mitochondrial energy metabolism with known antioxidant properties, are poorly understood. Methods This cross-sectional study used data from the 2007-2012 National Health and Nutrition Examination Survey, including spirometry data and niacin intake information of 9706 adults. This study investigated various spirometry measures, such as forced expiratory volume in 1 s, forced vital capacity, pulse expiratory flow, (forced expiratory volume in 1 s)/(forced vital capacity)ratio, and predicted forced expiratory volume in 1 s and forced vital capacity percentages. Additionally, a secondary analysis was conducted using Global Initiative for Chronic Obstructive Lung Disease and chronic obstructive pulmonary disease. Foundation Spirometry Grade criteria to assess the relationship between niacin intake, airflow limitation, and obstruction. Multivariate regression models were used to adjust for relevant covariates. Results The study included 9706 U S. adults (4788 men and 4918 women) with a median age of 46.2 years. After adjusting for relevant factors, a positive correlation was observed between niacin intake and lung function. Compared to the lowest quintile of niacin intake (Q1, ≤14.5 mg/day), individuals in the highest quintile (Q5, >34.5 mg/day) exhibited significant increases in lung function parameters, including forced expiratory volume in 1s (69.84 mL, p = 0.003), pulse expiratory flow (254.48 mL, p < 0.001), (forced expiratory volume in 1 s)/(forced vital capacity)(0.01, p = 0.041), percent predicted forced expiratory volume in 1 s(2.05, p = 0.002), and percent predicted forced vital capacity(1.29, p = 0.042).Subset analyses of individuals with spirometry-defined airflow obstruction showed associations of high niacin intake with significantly improved forced expiratory volume, pulse expiratory flow, and percent predicted pulse expiratory flow and an interaction among race, education, and smoking status with respect to the relationship between niacin intake and lung function parameters. Conclusions Higher niacin intake was associated with increased measures of lung function. A diet rich in niacin-containing foods may play a role in improving lung health.
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Affiliation(s)
- Xiaoli Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- School of Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qiong Han
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- School of Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Xiaoying Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jianping Lin
- School of Health, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Shizhong Wang
- School of Health, Fujian Medical University, Fuzhou, Fujian Province, China
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11
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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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12
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Molina-Hernández N, Rodríguez-Sanz D, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Vicente-Campos D, Marugán-Rubio D, Gutiérrez-Torre SE, Calvo-Lobo C. Effectiveness of simultaneous bilateral visual diaphragm biofeedback under low back pain: influence of age and sex. Front Physiol 2024; 15:1407594. [PMID: 39045217 PMCID: PMC11263192 DOI: 10.3389/fphys.2024.1407594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction: The aim of the present study was to determine the effectiveness of simultaneous bilateral visual diaphragm biofeedback (BFB) from ultrasonography in conjunction with inspiratory muscle training (IMT) on diaphragmatic thickness during normal breathing and respiratory and clinical outcomes in patients with non-specific low back pain (NSLBP) and determine the influence of age and sex. Methods: A single-blind randomized clinical trial was carried out (NCT04582812). A total sample of 96 patients with NSLBP was recruited and randomized by sex-based stratification into IMT (n = 48) and BFB + IMT (n = 48) interventions over 8 weeks. Bilateral diaphragmatic thickness at maximum inspiration (Tins) and expiration (Texp), respiratory pressures, lung function, pain intensity, bilateral pressure pain threshold (PPT), disability, and quality of life were measured at baseline and after 8 weeks. Results: The BFB + IMT group showed significant differences (p < 0.05) with increased left hemidiaphragm thickness at Tins and Tins-exp (d = 0.38-053), and right and left PPT (d = 0.71-0.74) versus the IMT group. The interaction with sex was statistically significant (p = 0.007; F(1,81) = 7.756; ηp 2 = 0.087) and higher left hemidiaphragm thickness at Tins was predicted by the BFB + IMT group (R 2 = 0.099; β = 0.050; F(1,82) = 8.997; p = 0.004) and male sex (R 2 = 0.079; β = 0.045; F(1,81) = 7.756;p = 0.007). Furthermore, greater left hemidiaphragm thickness at Tins-exp was predicted by younger age (R 2 = 0.052; β = -0.001; F(1,82) = 4.540; p = 0.036). Discussion: The simultaneous bilateral visual diaphragm biofeedback by ultrasonography in conjunction with IMT was effective in both increasing the left diaphragmatic thickness during inspiration, which was positively influenced and predicted by male sex and younger age, and increasing the bilateral PPT of the paraspinal muscles in patients with NSLBP.
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Affiliation(s)
- Nerea Molina-Hernández
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | | | - Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
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13
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Suarez-Castillejo C, Calvo N, Preda L, Córdova Díaz R, Toledo-Pons N, Martínez J, Pons J, Vives-Borràs M, Pericàs P, Ramón L, Iglesias A, Cànaves-Gómez L, Valera Felices JL, Morell-García D, Núñez B, Sauleda J, Sala-Llinàs E, Alonso-Fernández A. Cardiopulmonary Complications after Pulmonary Embolism in COVID-19. Int J Mol Sci 2024; 25:7270. [PMID: 39000378 PMCID: PMC11242326 DOI: 10.3390/ijms25137270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/14/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
Although pulmonary embolism (PE) is a frequent complication in COVID-19, its consequences remain unknown. We performed pulmonary function tests, echocardiography and computed tomography pulmonary angiography and identified blood biomarkers in a cohort of consecutive hospitalized COVID-19 patients with pneumonia to describe and compare medium-term outcomes according to the presence of PE, as well as to explore their potential predictors. A total of 141 patients (56 with PE) were followed up during a median of 6 months. Post-COVID-19 radiological lung abnormalities (PCRLA) and impaired diffusing capacity for carbon monoxide (DLCOc) were found in 55.2% and 67.6% cases, respectively. A total of 7.3% had PE, and 6.7% presented an intermediate-high probability of pulmonary hypertension. No significant difference was found between PE and non-PE patients. Univariate analysis showed that age > 65, some clinical severity factors, surfactant protein-D, baseline C-reactive protein, and both peak red cell distribution width and Interleukin (IL)-10 were associated with DLCOc < 80%. A score for PCRLA prediction including age > 65, minimum lymphocyte count, and IL-1β concentration on admission was constructed with excellent overall performance. In conclusion, reduced DLCOc and PCRLA were common in COVID-19 patients after hospital discharge, but PE did not increase the risk. A PCRLA predictive score was developed, which needs further validation.
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Affiliation(s)
- Carla Suarez-Castillejo
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Néstor Calvo
- Servicio de Radiodiagnóstico, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Luminita Preda
- Servicio de Radiodiagnóstico, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Rocío Córdova Díaz
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Nuria Toledo-Pons
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Joaquín Martínez
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Jaume Pons
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Servicio de Cardiología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Miquel Vives-Borràs
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Servicio de Cardiología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, 07122 Palma, Spain
| | - Pere Pericàs
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Servicio de Cardiología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Luisa Ramón
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Amanda Iglesias
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Laura Cànaves-Gómez
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Jose Luis Valera Felices
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Daniel Morell-García
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
| | - Belén Núñez
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
| | - Jaume Sauleda
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, 07122 Palma, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ernest Sala-Llinàs
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, 07122 Palma, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alberto Alonso-Fernández
- Servicio de Neumología, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, 07122 Palma, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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14
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Raju S, Siddharthan T, McCormack MC, Patel SR, Kunisaki KM, D'Souza G, Cho JHJ, Stosor V, Morris A, Margolick JB, Brown TT, Punjabi NM. Influence of Impaired Diffusing Capacity and Sleep-disordered Breathing on Nocturnal Hypoxemia and Health Outcomes in Men with and without Human Immunodeficiency Virus. Ann Am Thorac Soc 2024; 21:1085-1093. [PMID: 38498872 DOI: 10.1513/annalsats.202309-757oc] [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: 09/01/2023] [Accepted: 03/18/2024] [Indexed: 03/20/2024] Open
Abstract
Rationale: Nocturnal hypoxemia is common in sleep-disordered breathing (SDB) and is associated with increased morbidity and mortality. Although impaired diffusing capacity of the lung for carbon monoxide (DlCO) is associated with daytime hypoxemia, its influence on SDB-related nocturnal hypoxemia is not known. Objectives: To characterize the effects of DlCO impairment on SDB-related nocturnal hypoxemia and associated health outcomes. Methods: Data from a multicenter cohort of men with and without human immunodeficiency virus (HIV) infection, with concomitant measures of DlCO and home-based polysomnography (n = 544), were analyzed. Multivariable quantile regression models characterized associations between DlCO and several measures of SDB-related hypoxemia (e.g., total sleep time with oxygen saturation as measured by pulse oximetry [SpO2] < 90% [T90]). Structural equation models were used to assess associations of impaired DlCO and SDB-related hypoxemia measures with prevalent hypertension and type 2 diabetes. Results: DlCO impairment (<80% predicted) was associated with sleep-related hypoxemia. Participants with severe SDB (apnea-hypopnea index ⩾ 30 events/h) and impaired DlCO had higher T90 (median difference, 15.0% [95% confidence interval (CI), 10.3% to 19.7%]) and average SDB-related desaturation (median difference, 1.0 [95% CI, 0.5 to 1.5]) and lower nadir SpO2 (median difference, -8.2% [95% CI, -11.4% to -4.9%]) and average SpO2 during sleep (median difference, -1.1% [95% CI, -2.1% to -0.01%]) than those with severe SDB and preserved DlCO. Higher T90 was associated with higher adjusted odds of prevalent hypertension (odds ratio, 1.39 [95% CI, 1.14 to 1.70]) and type 2 diabetes (odds ratio, 1.25 [95% CI, 1.07 to 1.46]). Conclusions: DlCO impairment in severe SDB was associated with sleep-related hypoxemia, prevalent hypertension, and type 2 diabetes. Assessment of SDB should be considered in those with impaired DlCO to guide testing and risk stratification strategies.
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Affiliation(s)
- Sarath Raju
- Division of Pulmonary and Critical Care Medicine and
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care Medicine and
- Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Sanjay R Patel
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken M Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
- Divison of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Gypsyamber D'Souza
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joshua Hyong-Jin Cho
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California; and
| | - Valentina Stosor
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, and
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine and
- Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, Florida
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15
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Zahraei HN, Schleich F, Louis G, Gerday S, Sabbe M, Bougard N, Guissard F, Paulus V, Henket M, Petre B, Donneau AF, Louis R. Evidence for 2 clusters among patients with noneosinophilic asthma. Ann Allergy Asthma Immunol 2024; 133:57-63.e4. [PMID: 38499060 DOI: 10.1016/j.anai.2024.03.012] [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: 01/05/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Although asthma is often seen as an eosinophilic disease associated with atopy, patients with noneosinophilic asthma represent a substantial part of the population with asthma. OBJECTIVE To apply an unsupervised clustering method in a cohort of 588 patients with noneosinophilic asthma (sputum eosinophils < 3%) recruited from an asthma clinic of a secondary care center. METHODS Our cluster analysis of the whole cohort identified 2 subgroups as cluster 1 (n = 417) and cluster 2 (n = 171). RESULTS Cluster 1 comprised a predominantly female group with late disease onset, a low proportion of atopy (24%), and a substantial smoking history (53%). In this cluster, treatment burden was low (<50% of inhaled corticosteroid users); asthma control and quality of life were poor, with median Asthma Control Test, Asthma Control Questionnaire, and Asthma Quality of Life scores of 16, 1.7, and 4.5, respectively, whereas lung function was preserved with a median postbronchodilation forced expiratory volume in 1 second of 93% predicted. Cluster 2 was a predominantly male group, almost exclusively comprising patients with atopy (99%) with early disease onset and a moderate treatment burden (median inhaled corticosteroids dose 800 µg/d equivalent beclomethasone). In cluster 2, asthma was partially controlled, with median Asthma Control Test and Asthma Control Questionnaire scores reaching 18 and 1.3, respectively, and lung function well preserved with a median postbronchodilation of 95% predicted. Although systemic and airway neutrophilic inflammation was the dominant pattern in cluster 1, cluster 2 essentially comprised paucigranulocytic asthma with moderately elevated fraction exhaled nitric oxide. CONCLUSION Noneosinophilic asthma splits into 2 clusters distinguishing by disease onset, atopic status, smoking history, systemic and airway inflammation, and disease control and quality of life.
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Affiliation(s)
- Halehsadat Nekoee Zahraei
- Biostatistics Unit, Department of Public Health, University of Liège, Liège, Belgium; Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | | | - Gilles Louis
- Department of Public Health, University of Liège, Liège, Belgium
| | - Sara Gerday
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | - Mare Sabbe
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | - Nicolas Bougard
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | | | - Virginie Paulus
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | - Monique Henket
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | - Benoit Petre
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium
| | | | - Renaud Louis
- Department of Pneumology, GIGA, University of Liège, Liège, Belgium.
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Yadav H, Herasevich S, Zhang Z, White BA, Hefazi Torghabeh M, Hogan WJ, Schulte PJ, Niven AS, Gajic O. Pulmonary function as a continuum of risk: critical care utilization and survival after allogeneic hematopoietic stem cell transplantation - a multicenter cohort study. Bone Marrow Transplant 2024; 59:942-949. [PMID: 38493276 DOI: 10.1038/s41409-024-02265-8] [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: 09/13/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
Abnormal pre-transplant pulmonary function tests (PFTs) are associated with reduced survival after allogeneic HCT. Existing scoring systems consider risk dichotomously, attributing risk only to those with abnormal lung function. In a multicenter cohort of 1717 allo-HCT recipients, we examined the association between pre-transplant PFT measures and need for ICU admission (120d), frequency of mechanical ventilation (120d) and overall survival (5 y). Predictive models were developed and validated using Cox proportional hazards, incorporating age, FEV1 (forced expiratory volume in 1-second) and diffusing capacity (DLCO). In univariate analysis, hazard ratios for each outcome (95% CI) were: mechanical ventilation (FEV1: 0.60 [0.52-0.69], DLCO: 0.69 [0.61-0.77], p < 0.001), ICU admission (FEV1: 0.74 [0.67-0.82], DLCO: 0.79 [0.72-0.86], p < 0.001) and overall survival (FEV1: HR 0.87 [0.81-0.94], DLCO: 0.83 [0.77-0.89], p < 0.001). A multivariable Cox model was developed and compared to the HCT-CI Pulmonary score in a validation cohort. This model was better at predicting need for ICU admission and mechanical ventilation, while both models predicted overall survival (p < 0.001). In conclusion, the risk conferred by pre-transplant pulmonary function should be considered in a continuous rather than dichotomous manner. A more granular prognostication system can better inform risk of critical care utilization in the early post-HCT period.
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Affiliation(s)
- Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zhenmei Zhang
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bradley A White
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Philip J Schulte
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Ora J, Giorgino FM, Bettin FR, Gabriele M, Rogliani P. Pulmonary Function Tests: Easy Interpretation in Three Steps. J Clin Med 2024; 13:3655. [PMID: 38999220 PMCID: PMC11242573 DOI: 10.3390/jcm13133655] [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: 05/02/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Pulmonary function tests (PFTs) are pivotal in diagnosing and managing a broad spectrum of respiratory disorders. These tests provide critical insights into lung health, guiding diagnoses, assessing disease severity, and shaping patient management strategies. This review addresses the complexities and nuances inherent in interpreting PFT data, particularly in light of recent updates from the European Respiratory Society (ERS) and American Thoracic Society (ATS). These updates have refined interpretive strategies, moving away from definitive diagnostic uses of spirometry to a more probabilistic approach that better accounts for individual variability through the use of Z-scores and lower limits of normal (LLNs). Significantly, this narrative review delves into the philosophical shift in spirometry interpretation, highlighting the transition from direct clinical diagnostics to a more nuanced evaluation geared towards determining the likelihood of disease. It critiques the reliance on fixed ratios and emphasizes the need for reference values that consider demographic variables such as age, sex, height, and ethnicity, in line with the latest Global Lung Function Initiative (GLI) equations. Despite these advances, challenges remain in ensuring uniformity across different predictive models and reference equations, which can affect the accuracy and consistency of interpretations. This paper proposes a streamlined three-step framework for interpreting PFTs, aiming to unify and simplify the process to enhance clarity and reliability across various medical specialties. This approach not only aids in accurate patient assessments but also mitigates the potential for misdiagnosis and ensures more effective patient management. By synthesizing contemporary guidelines and integrating robust physiological principles, this review fosters a standardized yet flexible approach to PFT interpretation that is both scientifically sound and practically feasible.
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Affiliation(s)
- Josuel Ora
- Division of Respiratory Medicine, University Hospital Tor Vergata, 00133 Rome, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Emergency Medicine, Fondazione Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | | | - Federica Roberta Bettin
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Mariachiara Gabriele
- Division of Respiratory Medicine, University Hospital Tor Vergata, 00133 Rome, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital Tor Vergata, 00133 Rome, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Dal Negro RW, Turco P, Povero M. mRNA vaccines protect from the lung microvasculature injury and the capillary blood volume loss occurring in SARS-CoV-2 paucisymptomatic infections. Multidiscip Respir Med 2024; 19:973. [PMID: 38833210 PMCID: PMC11186436 DOI: 10.5826/mrm.2024.973] [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: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION The reduction of lung capillary blood volume (Vc) had been identified as the microvascular injury mostly underlying the respiratory Long-COVID syndrome following post-COVID-19 pneumonia. The same kind of injury have been recently also found in several individuals after milder paucisymptomatic SARS-CoV-2 infections. Though current guidelines strongly recommend vac-cination, studies aimed to investigate the in vivo protection of anti-SARS-CoV-2 vaccines on lung microvascular targets still are missing to our best knowledge. AIM to assess the protection of mRNA vaccines from the reduction of lung capillary blood volume (Vc) caused by pauci-symptomatic SARS.CoV-2 infections in vaccinated compared to unvaccinated individuals. METHODS Non-smoking individuals with recent paucisymptomatic SARS-CoV-2 infection were divided into vaccinated and unvaccinated groups. Lung function parameters, including single-breath diffusing capacity and microvascular blood volume, were compared between groups. RESULTS fifty vaccinated and twenty-five unvaccinated well-matched individuals were studied. Differently than usual lung function parameters, only the single-breath simultaneous assessment of sDLCO, sDLNO/sDLCO ratio and Vc allowed to identify the occurrence of the lung microvascular injury with high sensitivity and specificity (p<0.001). CONCLUSION mRNA vaccines proved to exert a high protection from the loss of lung capillary blood volume (Vc) induced by SARS.CoV-2 paucisymptomatic infections (p<0.001). The availability of this non-invasive investigational model should be regarded as a very helpful tool for assessing and comparing in vivo the protective effect of mRNA vaccines on the human microvascular structures of the deep lung.
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Affiliation(s)
- Roberto W. Dal Negro
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy
| | - Paola Turco
- AdRes Health Economics and Outcomes Research, Torino, Italy
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19
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Molina-Hernández N, Rodríguez-Sanz D, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Vicente-Campos D, Marugán-Rubio D, Gutiérrez-Torre SE, Calvo-Lobo C. A Secondary Analysis of Gender Respiratory Features for Ultrasonography Bilateral Diaphragm Thickness, Respiratory Pressures, and Pulmonary Function in Low Back Pain. Tomography 2024; 10:880-893. [PMID: 38921944 PMCID: PMC11209459 DOI: 10.3390/tomography10060067] [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: 04/21/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of the present study was to determine the gender respiratory differences of bilateral diaphragm thickness, respiratory pressures, and pulmonary function in patients with low back pain (LBP). A sample of 90 participants with nonspecific LBP was recruited and matched paired by sex (45 women and 45 men). Respiratory outcomes included bilateral diaphragm thickness by ultrasonography, respiratory muscle strength by maximum inspiratory (MIP) and expiratory (MEP) pressures, and pulmonary function by forced expiratory volume during 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC spirometry parameters. The comparison of respiratory outcomes presented significant differences (p < 0.001), with a large effect size (d = 1.26-1.58) showing means differences (95% CI) for MIP of -32.26 (-42.99, -21.53) cm H2O, MEP of -50.66 (-64.08, -37.25) cm H2O, FEV1 of -0.92 (-1.18, -0.65) L, and FVC of -1.00 (-1.32, -0.69) L, with lower values for females versus males. Gender-based respiratory differences were presented for maximum respiratory pressures and pulmonary function in patients with nonspecific LBP. Women presented greater inspiratory and expiratory muscle weakness as well as worse lung function, although these differences were not linked to diaphragm thickness during normal breathing.
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Affiliation(s)
- Nerea Molina-Hernández
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | | | - Ricardo Becerro-de-Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | | | - Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
- Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
| | - Samuel Eloy Gutiérrez-Torre
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
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20
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Yadav H, Torghabeh MH, Hoskote SS, Pennington KM, Lim KG, Scanlon PD, Niven AS, Hogan WJ. Adjusting diffusing capacity for anemia in patients undergoing allogeneic HCT: a comparison of two methodologies. Curr Res Transl Med 2024; 72:103432. [PMID: 38244276 PMCID: PMC11102530 DOI: 10.1016/j.retram.2023.103432] [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: 07/18/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Diffusing capacity (DLCO) measurements are affected by hemoglobin. Two adjustment equations are used: Cotes (recommended by ATS/ERS) and Dinakara (used in the hematopoietic stem cell transplantation comorbidity index [HCT-CI]). It is unknown how these methods compare, and which is better from a prognostication standpoint. STUDY DESIGN This is a retrospective cohort of 1273 adult patients who underwent allogeneic HCT, completed a pre-transplant DLCO and had a concurrent hemoglobin measurement. Non-relapse mortality was measured using competing risk analysis. RESULTS Patients had normal spirometry (FEV1 99.7% [IQR: 89.4-109.8%; FVC 100.1% [IQR: 91.0-109.6%] predicted), left ventricular ejection fraction (57.2[6.7]%) and right ventricular systolic pressure (30.1[7.0] mmHg). Cotes-DLCO was 85.6% (IQR: 76.5-95.7%) and Dinakara-DLCO was 103.6% (IQR: 90.7-117.2%) predicted. For anemic patients (Hb<10g/dL), Cotes-DLCO was 84.2% (IQR: 73.9-94.1%) while Dinakara-DLCO 111.0% (97.3-124.7%) predicted. Cotes-DLCO increased HCT-CI score for 323 (25.4%) and decreased for 4 (0.3%) patients. Cotes-DLCO was superior for predicting non-relapse mortality: for both mild (66-80% predicted, HR 1.55 [95%CI: 1.26-1.92, p < 0.001]) and moderate (<65% predicted, HR 2.11 [95%CI: 1.55-2.87, p<0.001]) impairment. In contrast, for Dinakara-DLCO, only mild impairment (HR 1.69 [95%CI 1.26-2.27, p < 0.001]) was associated with lower survival while moderate impairment was not (HR 1.44 [95%CI: 0.64-3.21, p = 0.4]). In multivariable analyses, after adjusting for demographics, hematologic variables, cardiac function and FEV1, Cotes-DLCO was predictive of overall survival at 1-year (OR 0.98 [95%CI: 0.97-1.00], p = 0.01), but Dinakara-DLCO was not (OR 1.00 [95%CI: 0.98-1.00], p = 0.20). CONCLUSION The ERS/ATS recommended Cotes method likely underestimates DLCO in patients with anemia, whereas the Dinakara (used in the HCT-CI score) overestimates DLCO. The Cotes method is superior to the Dinakara method score in predicting overall survival and relapse-free survival in patients undergoing allogeneic HCT.
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Affiliation(s)
- Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States.
| | - Mehrdad Hefazi Torghabeh
- Division of Pulmonary and Critical Care Medicine, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, United States
| | - Sumedh S Hoskote
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - Kelly M Pennington
- Division of Hematology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, United States
| | - Kaiser G Lim
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - Paul D Scanlon
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - William J Hogan
- Division of Pulmonary and Critical Care Medicine, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, United States
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21
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Millan-Billi P, Castellví I, Martinez-Martinez L, Mariscal A, Barril S, D'Alessandro M, Franquet T, Castillo D. Diagnostic Value of Krebs von den Lungen (KL-6) for Interstitial Lung Disease: A European Prospective Cohort. Arch Bronconeumol 2024; 60:350-355. [PMID: 38644152 DOI: 10.1016/j.arbres.2024.03.028] [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: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Krebs von den Lungen 6 (KL-6) is a mucin-1 glycoprotein produced by type II pneumocytes. High levels of KL-6 in blood may be found in patients with lung fibrosis. In Asia this biomarker is used for diagnosis and prognosis in interstitial lung diseases (ILD). There is a lack of information regarding KL-6 cut-off point for diagnosis and prognosis in European population. The aim of this study was to establish the cut-off point for serum KL-6 associated with the presence of ILD in the Spanish population. METHODS Prospective study including subjects who underwent chest HRCT, PFTs and autoimmune blood analysis. Two groups were created: non-ILD subjects and ILD patients. Serum KL-6 concentrations were measured using a Lumipulse KL-6 reagent assay and the optimal cut-off value was evaluated by a ROC analysis. Data on demographics and smoking history was also collected. RESULTS One hundred seventy-nine patients were included, 102 with ILD. Median serum KL-6 values overall were 762U/mL, 1080 (±787)U/mL for the ILD group vs 340 (±152)U/mL for the non-ILD group (p<0.0001). The main radiological pattern was NSIP (43%). ROC analysis showed greater specificity (86%) and sensitivity (82%) for KL-6 465U/mL for detecting ILD patients. The multivariate logistic regression model pointed to the male sex, higher KL-6 values, lower FVC and low DLCO values as independent factors associated with ILD. CONCLUSION Serum KL-6 values greater than 465U/mL have excellent sensitivity and specificity for detecting ILD in our Spanish cohort. Multicentre studies are needed to validate our results.
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Affiliation(s)
- Paloma Millan-Billi
- Respiratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Iván Castellví
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Martinez-Martinez
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain
| | - Anais Mariscal
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain
| | - Silvia Barril
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain; Respiratory Medicine Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Miriana D'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Tomás Franquet
- Radiology Department, Thoracic Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diego Castillo
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain.
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Severyn NT, Esparza P, Gao H, Mickler EA, Albrecht ME, Fisher AJ, Yakubov B, Cook TG, Slaven JE, Walts AD, Tepper RS, Lahm T. Effect of estrogen receptor α on cardiopulmonary adaptation to chronic developmental hypoxia in a rat model. Am J Physiol Lung Cell Mol Physiol 2024; 326:L786-L795. [PMID: 38713613 DOI: 10.1152/ajplung.00161.2023] [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: 05/18/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 05/09/2024] Open
Abstract
Humans living at high-altitude (HA) have adapted to this environment by increasing pulmonary vascular and alveolar growth. RNA sequencing data from a novel murine model that mimics this phenotypical response to HA suggested estrogen signaling via estrogen receptor alpha (ERα) may be involved in this adaptation. We hypothesized ERα was a key mediator in the cardiopulmonary adaptation to chronic hypoxia and sought to delineate the mechanistic role ERα contributes to this process by exposing novel loss-of-function ERα mutant (ERαMut) rats to simulated HA. ERα mutant or wild-type (wt) rats were exposed to normoxia or hypoxia starting at conception and continued postnatally until 6 wk of age. Both wt and ERαMut animals born and raised in hypoxia exhibited lower body mass and higher hematocrits, total alveolar volumes (Va), diffusion capacities of carbon monoxide (DLCO), pulmonary arteriole (PA) wall thickness, and Fulton indices than normoxia animals. Right ventricle adaptation was maintained in the setting of hypoxia. Although no major physiologic differences were seen between wt and ERαMut animals at either exposure, ERαMut animals exhibited smaller mean linear intercepts (MLI) and increased PA total and lumen areas. Hypoxia exposure or ERα loss-of-function did not affect lung mRNA abundance of vascular endothelial growth factor, angiopoietin 2, or apelin. Sexual dimorphisms were noted in PA wall thickness and PA lumen area in ERαMut rats. In summary, in room air-exposed rats and rats with peri- and postnatal hypoxia exposure, ERα loss-of-function was associated with decreased alveolar size (primarily driven by hypoxic animals) and increased PA remodeling.NEW & NOTEWORTHY By exposing novel loss-of-function estrogen receptor alpha (Erα) mutant rats to a novel model of human high-altitude exposure, we demonstrate that ERα has subtle but inconsistent effects on endpoints relevant to cardiopulmonary adaptation to chronic hypoxia. Given that we observed some histologic, sex, and genotype differences, further research into cell-specific effects of ERα during hypoxia-induced cardiopulmonary adaptation is warranted.
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Affiliation(s)
- Nicholas T Severyn
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Kentucky School of Medicine, Lexington, Kentucky, United States
| | - Patricia Esparza
- Division of Pulmonology, Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Huanling Gao
- Division of Pulmonology, Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Elizabeth A Mickler
- Division of Pulmonology and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Marjorie E Albrecht
- Division of Pulmonology and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Amanda J Fisher
- Division of Pulmonology and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Bahktiyor Yakubov
- Division of Pulmonology and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Todd G Cook
- Division of Pulmonology and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - James E Slaven
- Division of Pulmonology, Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Avram D Walts
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Robert S Tepper
- Division of Pulmonology, Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Tim Lahm
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, United States
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, United States
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States
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Benn BS, Lippitt WL, Cortopassi I, Balasubramani GK, Barbosa EM, Drake WP, Herzog E, Gibson K, Chen ES, Koth LL, Fuhrman C, Lynch DA, Kaminski N, Wisniewski SR, Carlson NE, Maier LA. Chest CT Imaging Provides More Information Than Chest Radiography Alone in Determining Extent of Physiologic Impairment in Pulmonary Sarcoidosis. Chest 2024:S0012-3692(24)00674-3. [PMID: 38830401 DOI: 10.1016/j.chest.2024.04.031] [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: 12/08/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Sarcoidosis staging primarily has relied on the Scadding chest radiographic system, although chest CT imaging is finding increased clinical use. RESEARCH QUESTION Whether standardized chest CT scan assessment provides additional understanding of lung function beyond Scadding stage and demographics is unknown and the focus of this study. STUDY DESIGN AND METHODS We used the National Heart, Lung, and Blood Institute study Genomics Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis cases of sarcoidosis (n = 351) with Scadding stage and chest CT scans obtained in a standardized manner. One chest radiologist scored all CT scans with a visual scoring system, with a subset read by another chest radiologist. We compared demographic features, Scadding stage, and CT scan findings and the correlation between these measures. Associations between spirometry results and Dlco, CT scan findings, and Scadding stage were determined using regression analysis (n = 318). Agreement between readers was evaluated using Cohen's κ value. RESULTS CT scan features were inconsistent with Scadding stage in approximately 40% of cases. Most CT scan features assessed on visual scoring were associated negatively with lung function. Associations persisted for FEV1 and Dlco when adjusting for Scadding stage, although some CT scan feature associations with FVC became insignificant. Scadding stage was associated primarily with FEV1, and inclusion of CT scan features reduced significance in association between Scadding stage and lung function. Multivariable regression modeling to identify radiologic measures explaining lung function included Scadding stage for FEV1 and FEV1 to FVC ratio (P < .05) and marginally for Dlco (P < .15). Combinations of CT scan measures accounted for Scadding stage for FVC. Correlations among Scadding stage and CT scan features were noted. Agreement between readers was poor to moderate for presence or absence of CT scan features and poor for degree and location of abnormality. INTERPRETATION CT scan features explained additional variability in lung function beyond Scadding stage, with some CT scan features obviating the associations between lung function and Scadding stage. Whether CT scan features, phenotypes, or endotypes could be useful for managing patients with sarcoidosis needs more study.
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Affiliation(s)
- Bryan S Benn
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - William L Lippitt
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora
| | - Isabel Cortopassi
- Department of Radiology, Mayo Clinic College of Medicine and Science, Jacksonville, FL
| | - G K Balasubramani
- Department of Epidemiology and Clinical and Translations Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Eduardo Mortani Barbosa
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Wonder P Drake
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Erica Herzog
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kevin Gibson
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Edward S Chen
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Laura L Koth
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Carl Fuhrman
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Stephen R Wisniewski
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora
| | - Lisa A Maier
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Medicine, National Jewish Health, Denver, CO.
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24
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Ghanei M, Philip KEJ, Moghadam MRS, Hosseini H, Babaie A, Roustanezhad M, Hopkinson NS. Pulmonary rehabilitation in Iranian outpatients with mustard gas lung disease: a randomised controlled trial. BMJ Open 2024; 14:e083085. [PMID: 38806414 PMCID: PMC11138312 DOI: 10.1136/bmjopen-2023-083085] [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: 12/11/2023] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE People with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be beneficial in this condition. DESIGN An assessor-blind, two-armed, parallel-design randomised controlled clinical trial. SETTING Secondary care clinics in Iran. PARTICIPANTS 60 men with breathlessness due to respiratory disease caused by documented mustard gas exposure, mean (SD) age 52.7 (4.36) years, MRC dyspnoea score 3.5 (0.7), St. George's Respiratory Questionnaire (SGRQ) 72.3 (15.2). INTERVENTIONS Participants were allocated either to a 6-week course of thrice-weekly PR (n=31) or to usual care (n=29), with 6-week data for 28 and 26, respectively. OUTCOME MEASURES Primary endpoint was change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Secondary endpoints included 6 min walk distance, quadriceps strength and bulk, body composition and health status. For logistical reasons, blood tests that had been originally planned were not performed and 12-month follow-up was available for only a small proportion. RESULTS At 6 weeks, cycle endurance time increased from 377 (140) s to 787 (343) s with PR vs 495 (171) s to 479 (159) s for usual care, effect size +383 (231) s (p<0.001). PR also improved 6 min walk distance+103.2 m (63.6-142.9) (p<0.001), MRC dyspnoea score -0.36 (-0.65 to -0.07) (p=0.016) and quality of life; SGRQ -8.43 (-13.38 to -3.48) p<0.001, as well as quadriceps strength+9.28 Nm (1.89 to 16.66) p=0.015. CONCLUSION These data suggest that PR can improve exercise capacity and quality of life in people with breathlessness due to mustard gas lung disease and support the wider provision of this form of care. TRIAL REGISTRATION NUMBER IRCT2016051127848N1.
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Affiliation(s)
- Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Hamed Hosseini
- Clinical Trial Center, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Aliakbar Babaie
- Janbazan Medical and Engineering Research Center, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Roustanezhad
- Janbazan Medical and Engineering Research Center, Tehran, Iran (the Islamic Republic of)
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25
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Lippitt WL, Maier LA, Fingerlin TE, Lynch DA, Yadav R, Rieck J, Hill AC, Liao SY, Mroz MM, Barkes BQ, Chae KJ, Hwang HJ, Carlson NE. The textures of sarcoidosis: quantifying lung disease through variograms. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.20.24307618. [PMID: 38826353 PMCID: PMC11142277 DOI: 10.1101/2024.05.20.24307618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Objective Sarcoidosis is a granulomatous disease affecting the lungs in over 90% of patients. Qualitative assessment of chest CT by radiologists is standard clinical practice and reliable quantification of disease from CT would support ongoing efforts to identify sarcoidosis phenotypes. Standard imaging feature engineering techniques such as radiomics suffer from extreme sensitivity to image acquisition and processing, potentially impeding generalizability of research to clinical populations. In this work, we instead investigate approaches to engineering variogram-based features with the intent to identify a robust, generalizable pipeline for image quantification in the study of sarcoidosis. Approach For a cohort of more than 300 individuals with sarcoidosis, we investigated 24 feature engineering pipelines differing by decisions for image registration to a template lung, empirical and model variogram estimation methods, and feature harmonization for CT scanner model, and subsequently 48 sets of phenotypes produced through unsupervised clustering. We then assessed sensitivity of engineered features, phenotypes produced through unsupervised clustering, and sarcoidosis disease signal strength to pipeline. Main results We found that variogram features had low to mild association with scanner model and associations were reduced by image registration. For each feature type, features were also typically robust to all pipeline decisions except image registration. Strength of disease signal as measured by association with pulmonary function testing and some radiologist visual assessments was strong (optimistic AUC ≈ 0.9, p ≪ 0.0001 in models for architectural distortion, conglomerate mass, fibrotic abnormality, and traction bronchiectasis) and fairly consistent across engineering approaches regardless of registration and harmonization for CT scanner. Significance Variogram-based features appear to be a suitable approach to image quantification in support of generalizable research in pulmonary sarcoidosis.
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Affiliation(s)
- William L Lippitt
- Dept of Biostatistics and Informatics, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa A Maier
- Dept of Medicine, National Jewish Health, Denver, CO, USA
- Dept of Medicine, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Dept of Environmental and Occupational Health, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tasha E Fingerlin
- Dept of Biostatistics and Informatics, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Dept of Immunology and Genomic Medicine, National Jewish Health, Denver, CO, USA
| | - David A Lynch
- Dept of Radiology, National Jewish Health, Denver, CO, USA
| | - Ruchi Yadav
- Dept of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jared Rieck
- Dept of Biostatistics and Informatics, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew C Hill
- Dept of Biostatistics and Informatics, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shu-Yi Liao
- Dept of Medicine, National Jewish Health, Denver, CO, USA
- Dept of Medicine, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Kum Ju Chae
- Dept of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeollabuk-do, Korea
| | - Hye Jeon Hwang
- Dept of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, Korea
| | - Nichole E Carlson
- Dept of Biostatistics and Informatics, Uni. of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Jang JH, Choe EJ, Jung SY, Ko J, Kim DW, Lee JH. A study on the prevalence and prognosis of progressive pulmonary fibrosis: A retrospective observational study. Medicine (Baltimore) 2024; 103:e38226. [PMID: 38758869 PMCID: PMC11098177 DOI: 10.1097/md.0000000000038226] [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: 01/17/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024] Open
Abstract
Interstitial lung disease (ILD) encompasses a heterogeneous group of more than 200 diffuse parenchymal lung diseases with various clinical courses. Disease progression is one of the most important prognostic factors, and, the definition of progressive pulmonary fibrosis (PPF) has recently been established. This study aimed to estimate the prevalence, risk factors, and prognosis of PPF among patients with non-idiopathic pulmonary fibrosis (IPF) in real-world practice. A total of 215 patients were retrospectively analyzed between January 2010 and June 2023 at the Haeundae Paik Hospital in the Republic of Korea. According to the criteria proposed in 2022 by Raghu et al, PPF defined as a condition that satisfies 2 or more of the following in the past year: worsening of respiratory symptoms, physiological evidence of disease progression, and radiological evidence of disease progression. The median age of the subjects was 67 years and 63.7% were female. A total of 40% was diagnosed with PPF and connective tissue disease-associated ILD (52.3%) was the most common type, followed by nonspecific interstitial pneumonitis (NSIP) (25.6%) and cryptogenic organizing pneumonitis (16.3%). In multivariate logistic regression for predicting PPF, both the use of steroids and immunosuppressants (OR: 2.57, 95% CI: 1.41-4.67, P = .002) and home oxygen use (OR: 25.17, 95% CI: 3.21-197.24, P = .002) were independent risk factors. During the follow-up period, the mortality rate was significantly higher in the PPF group than in the non-PPF group (24.4% vs 2.3%, P < .001). In the survival analysis using the Cox proportional hazard regression model, disease progression, older age and lower forced vital capacity (FVC) were independent risk factors for mortality. Our study demonstrated that the prevalence of PPF was 40%. Concomitant therapy of steroids with an immunosuppressants and home oxygen use are risk factors for PPF. PPF itself was significantly associated with high mortality rates. Risk factors for mortality were disease progression, older age, and lower FVC.
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Affiliation(s)
- Ji Hoon Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Eun Jun Choe
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - So Young Jung
- Division of Dermatology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Junghae Ko
- Division of Endocrinology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dae-Wook Kim
- Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Mercier C, Thoreau B, Flament T, Legué S, Pearson A, Jobard S, Marchand-Adam S, Plantier L, Diot E. High Prevalence of the Lung Ultrasound Interstitial Syndrome in Systemic Sclerosis Patients with Normal HRCT and Lung Function-A Pilot Study. J Clin Med 2024; 13:2885. [PMID: 38792426 PMCID: PMC11121911 DOI: 10.3390/jcm13102885] [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: 03/15/2024] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: High-resolution computed tomography (HRCT) may lack sensitivity for the early detection of interstitial lung disease associated with systemic sclerosis (SSc-ILD). Lung ultrasound is an emerging technique for the diagnosis of SSc-ILD. This cross-sectional study aimed to describe the prevalence of ultrasound interstitial syndrome in SSc patients with normal HRCT and pulmonary function tests (PFT). Methods: Thirty SSc patients with normal HRCT, FVC > 80% predicted and DLCO > 70% predicted were included. Echocardiography and PFT including impulse oscillometry and cardiopulmonary exercise testing were performed. Lung ultrasound was analyzed by two blinded operators. Patients were classified into two groups, according to the presence or absence of ultrasound interstitial syndrome, defined as the sum of B-lines in all thoracic areas ≥10 and/or pleural line thickness >3 mm on at least one thoracic area and/or a pleural line irregularity score >16%. Results: Ultrasound interstitial syndrome was present in 12 patients (40%). Inter-reader agreement for the diagnosis of ultrasound interstitial syndrome defined by the Kappa coefficient was 0.93 (95%CI 0.79-1.00). Patients with ultrasound interstitial syndrome were younger (37 years vs. 53 years, p = 0.009), more often had pitting scars (n = 7/12 vs. 3/18, p = 0.045) and had lower FVC (102 vs. 110% pred, p = 0.009), TLC (114 vs. 122% pred, p = 0.042) and low-frequency respiratory system reactance (Xrs5 Z-score 0.16 vs. 1.02, p = 0.018), while pulmonary gas exchange was similar. Conclusions: Ultrasound interstitial syndrome was detected in 12/30 SSc patients with normal HRCT and PFT. Patients with ultrasound interstitial syndrome had differences in lung function consistent with reduced respiratory compliance, suggesting minimal and/or early suspected SSc-ILD.
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Affiliation(s)
- Camille Mercier
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
| | - Benjamin Thoreau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), 75610 Paris, France;
- Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Cité, 75006 Paris, France
| | - Thomas Flament
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Lung Ultrasound Working Group (G-ECHO), Société de Pneumologie de Langue Française, Île-de-France, 75935 Paris, France
| | - Sylvie Legué
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Lung Ultrasound Working Group (G-ECHO), Société de Pneumologie de Langue Française, Île-de-France, 75935 Paris, France
| | | | - Stephanie Jobard
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
| | - Sylvain Marchand-Adam
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Centre d’Etudes des Pathologies Respiratoires (CEPR), Institut National de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1100, Université de Tours, 37032 Tours, France
| | - Laurent Plantier
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Centre d’Etudes des Pathologies Respiratoires (CEPR), Institut National de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1100, Université de Tours, 37032 Tours, France
| | - Elisabeth Diot
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
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28
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Kłos K, Jaskóła-Polkowska D, Plewka-Barcik K, Rożyńska R, Pietruszka-Wałęka E, Żabicka M, Kania-Pudło M, Maliborski A, Plicht K, Angielski G, Wojtyszek A, Jahnz-Różyk K, Chciałowski A. Pulmonary Function, Computed Tomography Lung Abnormalities, and Small Airway Disease after COVID-19: 3-, 6-, and 9-Month Follow-Up. J Clin Med 2024; 13:2733. [PMID: 38792275 PMCID: PMC11122501 DOI: 10.3390/jcm13102733] [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: 03/10/2024] [Revised: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Coronavirus disease 2019 (COVID-19) course may differ among individuals-in particular, those with comorbidities may have severe pneumonia, requiring oxygen supplementation or mechanical ventilation. Post-COVID-19 long-term structural changes in imaging studies can contribute to persistent respiratory disturbance. This study aimed to investigate COVID-19 sequels affecting the possibility of persistent structural lung tissue abnormalities and their influence on the respiratory function of peripheral airways and gas transfer. Methods: Patients were divided into two groups according to severity grades described by the World Health Organization. Among the 176 hospitalized patients were 154 patients with mask oxygen supplementation and 22 patients with high-flow nasal cannula (HFNC) or mechanical ventilation. All tests were performed at 3, 6, and 9 months post-hospitalization. Results: Patients in the severe/critical group had lower lung volumes in FVC, FVC%, FEV1, FEV1%, LC, TLC%, and DLCO% at three months post-hospitalization. At 6 and 9 months, neither group had significant FVC and FEV1 value improvements. The MEF 25-75 values were not significantly higher in the mild/moderate group than in the severe/critical group at three months. There were weak significant correlations between FVC and FEV1, MEF50, MEF 75, plethysmography TLC, disturbances in DLCO, and total CT abnormalities in the severe/critical group at three months. In a mild/moderate group, there was a significant negative correlation between the spirometry, plethysmography parameters, and CT lesions in all periods. Conclusions: Persistent respiratory symptoms post-COVID-19 can result from fibrotic lung parenchyma and post-infectious stenotic small airway changes not visible in CT, probably due to persistent inflammation.
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Affiliation(s)
- Krzysztof Kłos
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| | - Dominika Jaskóła-Polkowska
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| | - Katarzyna Plewka-Barcik
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| | - Renata Rożyńska
- Department of Internal Medicine, Allergology, Pneumonology and Clinical Immunology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (R.R.); (K.J.-R.)
| | - Ewa Pietruszka-Wałęka
- Department of Internal Medicine, Allergology, Pneumonology and Clinical Immunology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (R.R.); (K.J.-R.)
| | - Magdalena Żabicka
- Department of Radiology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (M.Ż.); (M.K.-P.); (A.M.)
| | - Marta Kania-Pudło
- Department of Radiology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (M.Ż.); (M.K.-P.); (A.M.)
| | - Artur Maliborski
- Department of Radiology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (M.Ż.); (M.K.-P.); (A.M.)
| | - Katarzyna Plicht
- 7th Polish Navy Hospital, Polanki Str. 117, 80-305 Gdansk, Poland; (K.P.); (G.A.); (A.W.)
| | - Grzegorz Angielski
- 7th Polish Navy Hospital, Polanki Str. 117, 80-305 Gdansk, Poland; (K.P.); (G.A.); (A.W.)
| | - Andrzej Wojtyszek
- 7th Polish Navy Hospital, Polanki Str. 117, 80-305 Gdansk, Poland; (K.P.); (G.A.); (A.W.)
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Allergology, Pneumonology and Clinical Immunology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (R.R.); (K.J.-R.)
| | - Andrzej Chciałowski
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
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Zanini U, Luppi F, Kaur K, Anzani N, Franco G, Ferrara G, Kalluri M, Mura M. Use of 6-minute walk distance to predict lung transplant-free survival in fibrosing non-IPF interstitial lung diseases. Respirology 2024; 29:387-395. [PMID: 38320863 DOI: 10.1111/resp.14669] [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: 10/08/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND OBJECTIVE The identification of progression in patients with fibrosing non-idiopathic pulmonary fibrosis (IPF) interstitial lung diseases (ILDs) represents an ongoing clinical challenge. Lung function decline alone may have significant limitations in the detection of clinically significant progression. We hypothesized that longitudinal changes of 6-min walk distance (6MWD) from baseline, simultaneously considered with measures of lung function, may independently predict survival and identifying clinically significant progression of disease. METHODS Forced vital capacity (FVC), diffusing lung capacity (DLCO) and 6MWD were considered both at baseline and at 1 year in a discovery cohort (n = 105) and in a validation cohort (n = 138) from different centres. The primary endpoint was lung transplant (LTx)-free survival. RESULTS Average follow-up was 3 years in both cohorts. Combined incidence of deaths and LTx was 29% and 21%, respectively. No collinearity and no strong correlations were observed among FVC, DLCO and 6MWD longitudinal changes. While age, gender and BMI were not significant, 6MWD decline ≥24 m predicted LTx-free-survival significantly and independently from FVC and DLCO declines, with high sensitivity and specificity, in both the discovery and the validation cohorts. Although FVC and DLCO declines remained significant predictors of LTx-free survival, 6MWD decline was more accurate than the proposed ATS/ERS/JRS/ALAT functional criteria. Results were confirmed after stratifying patients by baseline FVC. CONCLUSION Longitudinal declines of 6MWD are associated with poor survival in fibrosing ILDs across a wide range of baseline severity, with high accuracy. 6MWD longitudinal decline is largely independent from lung function decline and may be integrated into the routine assessment of progression.
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Affiliation(s)
- Umberto Zanini
- Department of Medicine and Surgery, University of Milan-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", Monza, Italy
- Division of Pulmonary Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milan-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", Monza, Italy
| | - Karina Kaur
- Division of Pulmonary Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Niccolò Anzani
- Department of Medicine and Surgery, University of Milan-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", Monza, Italy
| | - Giovanni Franco
- Department of Medicine and Surgery, University of Milan-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", Monza, Italy
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Meena Kalluri
- Division of Pulmonary Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Marco Mura
- Division of Respirology, Western University, London, Ontario, Canada
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Curnow AC, Huang L, Fischl MA, Floris-Moore M, Morris A, Nouraie M, Reddy DB, Seaberg EC, Sheth AN, Tien PC, Wang RJ. Hepatitis C Virus Clearance and Diffusing Capacity for Carbon Monoxide in Women With and Without Human Immunodeficiency Virus. Open Forum Infect Dis 2024; 11:ofae251. [PMID: 38770208 PMCID: PMC11103618 DOI: 10.1093/ofid/ofae251] [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: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Hepatitis C virus (HCV) infection is associated with extrahepatic effects, including reduced diffusing capacity of the lungs. It is unknown whether clearance of HCV infection is associated with improved diffusing capacity. In this sample of women with and without human immunodeficiency virus, there was no association between HCV clearance and diffusing capacity.
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Affiliation(s)
- Andrew C Curnow
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Laurence Huang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Divya B Reddy
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Richard J Wang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Groot Lipman KB, Boellaard TN, de Gooijer CJ, Bogveradze N, Hong EK, Landolfi F, Castagnoli F, Vakhidova N, Smesseim I, van der Heijden F, Beets-Tan RG, Wittenberg R, Bodalal Z, Burgers JA, Trebeschi S. Artificial Intelligence-based Quantification of Pleural Plaque Volume and Association With Lung Function in Asbestos-exposed Patients. J Thorac Imaging 2024; 39:165-172. [PMID: 37905941 PMCID: PMC11027965 DOI: 10.1097/rti.0000000000000759] [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] [Indexed: 11/02/2023]
Abstract
PURPOSE Pleural plaques (PPs) are morphologic manifestations of long-term asbestos exposure. The relationship between PP and lung function is not well understood, whereas the time-consuming nature of PP delineation to obtain volume impedes research. To automate the laborious task of delineation, we aimed to develop automatic artificial intelligence (AI)-driven segmentation of PP. Moreover, we aimed to explore the relationship between pleural plaque volume (PPV) and pulmonary function tests. MATERIALS AND METHODS Radiologists manually delineated PPs retrospectively in computed tomography (CT) images of patients with occupational exposure to asbestos (May 2014 to November 2019). We trained an AI model with a no-new-UNet architecture. The Dice Similarity Coefficient quantified the overlap between AI and radiologists. The Spearman correlation coefficient ( r ) was used for the correlation between PPV and pulmonary function test metrics. When recorded, these were vital capacity (VC), forced vital capacity (FVC), and diffusing capacity for carbon monoxide (DLCO). RESULTS We trained the AI system on 422 CT scans in 5 folds, each time with a different fold (n = 84 to 85) as a test set. On these independent test sets combined, the correlation between the predicted volumes and the ground truth was r = 0.90, and the median overlap was 0.71 Dice Similarity Coefficient. We found weak to moderate correlations with PPV for VC (n = 80, r = -0.40) and FVC (n = 82, r = -0.38), but no correlation for DLCO (n = 84, r = -0.09). When the cohort was split on the median PPV, we observed statistically significantly lower VC ( P = 0.001) and FVC ( P = 0.04) values for the higher PPV patients, but not for DLCO ( P = 0.19). CONCLUSION We successfully developed an AI algorithm to automatically segment PP in CT images to enable fast volume extraction. Moreover, we have observed that PPV is associated with loss in VC and FVC.
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Affiliation(s)
- Kevin B.W. Groot Lipman
- Department of Radiology
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam
- Technical Medicine, University of Twente, Enschede
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | | | | | - Nino Bogveradze
- Department of Radiology
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
- Academic Pridon Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, GA
| | - Eun Kyoung Hong
- Department of Radiology
- Seoul National University Hospital, Seoul, South Korea
| | - Federica Landolfi
- Department of Radiology
- Radiology Unit, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesca Castagnoli
- Department of Radiology
- Department of Radiology, University of Brescia, Brescia, IT
- Department of Radiology, Royal Marsden Hospital, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | | | - Illaa Smesseim
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam
| | - Ferdi van der Heijden
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Regina G.H. Beets-Tan
- Department of Radiology
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
- Faculty of Health Sciences, University of Southern Denmark, Odense, DK
| | | | - Zuhir Bodalal
- Department of Radiology
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - Jacobus A. Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam
| | - Stefano Trebeschi
- Department of Radiology
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
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Liu X, Zhu H, Peng Y, Liu Y, Shi X. Twenty-Four week Taichi training improves pulmonary diffusion capacity and glycemic control in patients with Type 2 diabetes mellitus. PLoS One 2024; 19:e0299495. [PMID: 38635535 PMCID: PMC11025805 DOI: 10.1371/journal.pone.0299495] [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: 06/09/2023] [Accepted: 02/11/2024] [Indexed: 04/20/2024] Open
Abstract
This study evaluated the effect of 24-week Taichi training and Taichi plus resistance band training on pulmonary diffusion capacity and glycemic control in patients with Type 2 diabetes mellitus (T2DM). Forty-eight patients with T2DM were randomly divided into three groups: Group A-Taichi training: practiced Taichi 60 min/day, 6 days/week for 24 weeks; Group B-Taichi plus resistance band training: practiced 60-min Taichi 4 days/week plus 60-min resistance band training 2 days/week for 24 weeks; and Group C-controls: maintaining their daily lifestyles. Stepwise multiple regression analysis was applied to predict diffusion capacity of the lungs for carbon monoxide (DLCO) by fasting blood glucose, insulin, glycosylated hemoglobin (HbA1c), tumour necrosis factor alpha (TNF-α), von Willebrand Factor (vWF), interleukin-6 (IL-6), intercellular adhesion molecule 1 (ICAM-1), endothelial nitric oxide synthase (eNOS), nitric oxide (NO), endothelin-1 (ET-1), vascular endothelial growth factor, and prostaglandin I-2. Taichi with or without resistance band training significantly improved DLCO, increased insulin sensitivity, eNOS and NO, and reduced fasting blood glucose, insulin, HbA1c, TNF-α, vWF, IL-6, ICAM-1, and ET-1. There was no change in any of these variables in the control group. DLCO was significantly predicted (R2 = 0.82) by insulin sensitivity (standard-β = 0.415, P<0.001), eNOS (standard-β = 0.128, P = 0.017), TNF-α (standard-β = -0.259, P = 0.001), vWF (standard-β = -0.201, P = 0.007), and IL-6 (standard-β = -0.175, P = 0.032) in patients with T2DM. The impact of insulin sensitivity was the most important predictor for the variation of DLCO based on the multiple regression modeling. This study demonstrates that 24-week Taichi training and Taichi plus resistance band training effectively improve pulmonary diffusion capacity and blood glycemic control in patients with T2DM. Variation of DLCO is explained by improved insulin sensitivity and endothelial function, and reduced inflammatory markers, including TNF-α, vWF, and IL-6.
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Affiliation(s)
- Xiaoli Liu
- Department of Physical Education, Xihua University, Chengdu, Sichuan, China
- Department of Physical Education, Hubei Minzu University, Enshi, Hubei, China
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Huan Zhu
- Department of Physical Education, Hubei Minzu University, Enshi, Hubei, China
| | - Yong Peng
- Department of Physical Education, Hubei Minzu University, Enshi, Hubei, China
| | - Yaofeng Liu
- Department of Physical Education, Hubei Minzu University, Enshi, Hubei, China
| | - Xiangrong Shi
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
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Lee H, Kim SY, Park YS, Choi SM, Lee JH, Park J. Prognostic implication of 1-year decline in diffusing capacity in newly diagnosed idiopathic pulmonary fibrosis. Sci Rep 2024; 14:8857. [PMID: 38632477 PMCID: PMC11024342 DOI: 10.1038/s41598-024-59649-5] [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: 07/31/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
The progression of idiopathic pulmonary fibrosis (IPF) is assessed through serial monitoring of forced vital capacity (FVC). Currently, data regarding the clinical significance of longitudinal changes in diffusing capacity for carbon monoxide (DLCO) is lacking. We investigated the prognostic implications of a 1-year decline in DLCO in 319 patients newly diagnosed with IPF at a tertiary hospital between January 2010 and December 2020. Changes in FVC and DLCO over the first year after the initial diagnosis were reviewed; a decline in FVC ≥ 5% and DLCO ≥ 10% predicted were considered significant changes. During the first year after diagnosis, a significant decline in FVC and DLCO was observed in 101 (31.7%) and 64 (20.1%) patients, respectively. Multivariable analysis showed that a 1-year decline in FVC ≥ 5% predicted (aHR 2.74, 95% CI 1.88-4.00) and 1-year decline in DLCO ≥ 10% predicted (aHR 2.31, 95% CI 1.47-3.62) were independently associated with a higher risk of subsequent mortality. The prognostic impact of a decline in DLCO remained significant regardless of changes in FVC, presence of emphysema, or radiographic indications of pulmonary hypertension. Therefore, serial monitoring of DLCO should be recommended because it may offer additional prognostic information compared with monitoring of FVC alone.
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Affiliation(s)
- Hyeonsu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - So Yeon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jimyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Pereira HLA, Mancuzo EV, Ribeiro-Samora GA, Albuquerque Pataro AC, Dos Reis Estrella D, Pereira DAG, Parreira VF. Concurrent validity between field tests and cardiopulmonary exercise testing in patients with idiopathic pulmonary fibrosis. Physiother Theory Pract 2024:1-9. [PMID: 38602319 DOI: 10.1080/09593985.2024.2341245] [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: 10/18/2023] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Maximal treadmill cardiopulmonary exercise testing is the gold standard for assessing functional capacity in patients with idiopathic pulmonary fibrosis (IPF). PURPOSE Primarily to investigate the concurrent validity between three field tests and cardiopulmonary exercise testing in these patients. METHODS Patients performed the cardiopulmonary exercise testing, a six-minute walk test, an incremental shuttle walk test, and, the Glittre-ADL test. For cardiopulmonary exercise testing, the ten seconds with the higher average of the peak oxygen uptake obtained within the last 30 seconds were considered; for six-minute walk test and incremental shuttle walk test, the longer distance; and for the Glittre-ADL test, the shorter time spent. Concurrent validity was assessed using different regression models based on the best adjustment of the data. RESULTS Twenty-two patients with IPF were assessed, aged: 68 ± 8.1 years, 13 male. Patients presented a peak oxygen uptake of 16.5 ± 3.6 mL.kg-1.min1, achieving a distance of 512.6 ± 102.8 meters in the six-minute walk test and 415.7 ± 125.1 meters in incremental shuttle walk test. The walking distance in the six-minute walk test and the incremental shuttle walk test explained, respectively, 64% and 56% peak oxygen uptake variance observed in the cardiopulmonary exercise testing (R2 = 0.64,p < .001; R2 = 0.56,p < .001). The time spent in the Glittre-ADL test was 233.4 ± 88.7 seconds and explained 47% of the peak oxygen uptake variance observed in cardiopulmonary exercise testing (R2 = 0.47,p = .001). CONCLUSION The six-minute walk test, incremental shuttle walk test, and Glittre-ADL test were considered valid tests to explain the peak oxygen uptake variance obtained by the cardiopulmonary exercise testing in patients with IPF.
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Affiliation(s)
| | - Eliane Viana Mancuzo
- Department of Medical Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giane Amorim Ribeiro-Samora
- Visiting Professor at Physiotherapy Program, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Anna Clara Albuquerque Pataro
- Department of Physiotherapy - Undergraduate student, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Deborah Dos Reis Estrella
- Sciences Applied to Adult Health Care Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Verônica Franco Parreira
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Lorenzana I, Galera R, Casitas R, Martínez-Cerón E, Castillo MA, Alfaro E, Cubillos-Zapata C, García-Río F. Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients. Respir Med 2024; 225:107597. [PMID: 38499274 DOI: 10.1016/j.rmed.2024.107597] [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: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients. METHODS A cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation. RESULTS 58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5-14.8 vs. 7.2; 95% CI, 7.1-7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010-8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385-11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087-2.581). CONCLUSION In stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.
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Affiliation(s)
- Isabel Lorenzana
- Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Raúl Galera
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Raquel Casitas
- Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain; Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Elisabet Martínez-Cerón
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Enrique Alfaro
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Francisco García-Río
- Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain; Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
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Cornelissen ME, Leliveld A, Baalbaki N, Gach D, van der Lee I, Nossent EJ, Bloemsma LD, Maitland-van der Zee AH. Pulmonary function 3-6 months after acute COVID-19: A systematic review and multicentre cohort study. Heliyon 2024; 10:e27964. [PMID: 38533004 PMCID: PMC10963328 DOI: 10.1016/j.heliyon.2024.e27964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
Aims To describe pulmonary function 3-6 months following acute COVID-19, to evaluate potential predictors of decreased pulmonary function and to review literature for the effect of COVID-19 on pulmonary function. Materials and methods A systematic review and cohort study were conducted. Within the P4O2 COVID-19 cohort, 95 patients aged 40-65 years were recruited from outpatient post-COVID-19 clinics in five Dutch hospitals between May 2021-September 2022. At 3-6 months post COVID-19, medical records data and biological samples were collected and questionnaires were administered. In addition, pulmonary function tests (PFTs), including spirometry and transfer factor, were performed. To identify factors associated with PFTs, linear regression analyses were conducted, adjusted for covariates. Results In PFTs (n = 90), mean ± SD % of predicted was 89.7 ± 18.2 for forced vital capacity (FVC) and 79.8 ± 20.0 for transfer factor for carbon monoxide (DLCO). FVC was Conclusion A low DLCO 3-6 months following acute COVID-19 was observed more often than a low FVC, both in the P4O2 COVID-19 study and the literature review.
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Affiliation(s)
- Merel E.B. Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Asabi Leliveld
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Nadia Baalbaki
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Debbie Gach
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
- School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Ivo van der Lee
- Department of Pulmonology, Spaarne Hospital, the Netherlands
| | - Esther J. Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
| | - Lizan D. Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
| | - Anke H. Maitland-van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
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Jörres RA, Buess C, Piecyk A, Thompson B, Stanojevic S, Magnussen H. The total-breath method yields higher values of DLCO and TLC than the conventional method. BMC Pulm Med 2024; 24:127. [PMID: 38475751 PMCID: PMC10936061 DOI: 10.1186/s12890-024-02932-y] [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: 05/19/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The 2017 ATS/ERS technical standard for measuring the single-breath diffusing capacity (DLCO) proposed the "rapid-gas-analyzer" (RGA) or, equivalently, "total-breath" (TB) method for the determination of total lung capacity (TLC). In this study, we compared DLCO and TLC values estimated using the TB and conventional method, and how estimated TLC using these two methods compared to that determined by body plethysmography. METHOD A total of 95 people with COPD (GOLD grades 1-4) and 23 healthy subjects were studied using the EasyOne Pro (ndd Medical Technologies, Switzerland) and Master Screen Body (Vyaire Medical, Höchberg, Germany). RESULTS On average the TB method resulted in higher values of DLCO (mean ± SD Δ = 0.469 ± 0.267; 95%CI: 0.420; 0.517 mmol*min-1*kPa-1) and TLC (Δ = 0.495 ± 0.371; 95%CI: 0.427; 0.562 L) compared with the conventional method. In healthy subjects the ratio between TB and conventional DLCO was close to one. TLC estimated using both methods was lower than that determined by plethysmography. The difference was smaller for the TB method (Δ = 1.064 ± 0.740; 95%CI: 0.929; 1.199 L) compared with the conventional method (Δ = 1.558 ± 0.940; 95%CI: 1.387; 1.739 L). TLC from body plethysmography could be estimated as a function of TB TLC and FEV1 Z-Score with an accuracy (normalized root mean square difference) of 9.1%. CONCLUSION The total-breath method yielded higher values of DLCO and TLC than the conventional analysis, especially in subjects with COPD. TLC from the total-breath method can also be used to estimate plethysmographic TLC with better accuracy than the conventional method. The study is registered under clinicaltrial.gov NCT04531293.
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Affiliation(s)
- Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ziemssenstraße 5, Munich, 80336, Germany.
| | | | | | - Bruce Thompson
- Melbourne School of Health Science, The University of Melbourne, Victoria, Australia
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Helgo Magnussen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
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Donaldson MA, Donohoe K, Assayag D, Durand C, Fisher JH, Johannson K, Kolb M, Lok SD, Manganas H, Marcoux V, Min B, Morisset J, Marinescu DC, Ryerson CJ. Characteristics of pulse oximetry and arterial blood gas in patients with fibrotic interstitial lung disease. BMJ Open Respir Res 2024; 11:e002250. [PMID: 38479819 PMCID: PMC10941153 DOI: 10.1136/bmjresp-2023-002250] [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: 12/12/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Fibrotic interstitial lung disease (ILD) is frequently associated with abnormal oxygenation; however, little is known about the accuracy of oxygen saturation by pulse oximetry (SpO2) compared with arterial blood gas (ABG) saturation (SaO2), the factors that influence the partial pressure of carbon dioxide (PaCO2) and the impact of PaCO2 on outcomes in patients with fibrotic ILD. STUDY DESIGN AND METHODS Patients with fibrotic ILD enrolled in a large prospective registry with a room air ABG were included. Prespecified analyses included testing the correlation between SaO2 and SpO2, the difference between SaO2 and SpO2, the association of baseline characteristics with both the difference between SaO2 and SpO2 and the PaCO2, the association of baseline characteristics with acid-base category, and the association of PaCO2 and acid-base category with time to death or transplant. RESULTS A total of 532 patients with fibrotic ILD were included. Mean resting SaO2 was 92±4% and SpO2 was 95±3%. Mean PaCO2 was 38±6 mmHg, with 135 patients having PaCO2 <35 mmHg and 62 having PaCO2 >45 mmHg. Correlation between SaO2 and SpO2 was mild to moderate (r=0.39), with SpO2 on average 3.0% higher than SaO2. No baseline characteristics were associated with the difference in SaO2 and SpO2. Variables associated with either elevated or abnormal (elevated or low) PaCO2 included higher smoking pack-years and lower baseline forced vital capacity (FVC). Lower baseline lung function was associated with an increased risk of chronic respiratory acidosis. PaCO2 and acid-base status were not associated with time to death or transplant. INTERPRETATION SaO2 and SpO2 are weakly-to-moderately correlated in fibrotic ILD, with limited ability to accurately predict this difference. Abnormal PaCO2 was associated with baseline FVC but was not associated with outcomes.
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Affiliation(s)
- Mira A Donaldson
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Donohoe
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Celine Durand
- Département de Médecine, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kerri Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stacey D Lok
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hélène Manganas
- Département de Médecine, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bohyung Min
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julie Morisset
- Département de Médecine, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Daniel-Costin Marinescu
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Thomas G, Weiss E, Del Buono MG, Moroni F, West J, Myers R, Kontos E, Golino M, Abbate A, Canada JM. Early reduction in cardiorespiratory fitness and diastolic reserve following radiation therapy for lung cancer. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:15. [PMID: 38468295 PMCID: PMC10929088 DOI: 10.1186/s40959-024-00216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Contemporary radiotherapy for the treatment of lung cancer is effective in targeting tumor tissue while limiting heart exposure, yet cardiac toxicity still occurs, often becoming clinically apparent years later. Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular, cancer-related, and overall mortality and may serve as a sensitive measure of subclinical cardiac toxicity following anti-cancer treatments. Prior work has demonstrated a significant relationship between reduced CRF and impaired left-ventricular (LV) diastolic reserve in cancer survivors following thoracic radiotherapy. The purpose of this study was to assess early longitudinal changes in CRF and cardiac function in patients with lung cancer following radiotherapy. METHODS Ten patients (69 [61-76] years, 70% female) with lung cancer without known cardiovascular disease scheduled to receive radiotherapy involving a clinically-relevant heart dose (≥ 5 Gy to > 10% of heart volume) were evaluated prior to and following treatment. Changes in CRF (peak oxygen consumption [VO2peak], oxygen uptake efficiency slope [OUES]), cardiac function (LV ejection fraction [LVEF], rest and exercise diastolic function [diastolic functional reserve index (DFRI)]), cardiac biomarkers (N-terminal pro-brain natriuretic peptide [NT-proBNP], high-sensitivity C-reactive protein [hsCRP]), and health-related quality of life (HRQOL; Functional Assessment of Cancer Therapy-General-7 [FACT-G7]) were measured. RESULTS The VO2peak was reduced at baseline (1.245 [0.882-1.605] L·min- 1; 70 [62-86] %-predicted) and significantly declined (1.095 [0.810-1.448] L·min- 1, P = 0.047; 62 [56-76] %-predicted, P = 0.005) at 6.0 [3.0-6.0] months post-radiotherapy. Similarly, a significant decline in the OUES was observed (1.63 [1.27-1.88] to 1.57 [1.12-1.75], P = 0.032). Systolic cardiac function was normal at baseline and did not change following radiotherapy (LVEF; 62 [56-65]% to 66 [57-68]%, P = 0.475). The DFRI significantly declined following radiotherapy (34.9 [22.7-41.6] vs. 12.8 [3.1-35.9]). The hsCRP increased significantly from 4.4 [1.4-5.8] to 6.1 [3.7-20.7] g/L, P = 0.047 with a trend towards higher levels of NT-proBNP (65 [49-125] to 121 [88-191] pg/mL, P = 0.110). Health-related quality of life significantly decreased (FACT-G7; 21.5 [18.8-25] to 15.5 [11.5-20]; P = 0.021) post-radiotherapy. CONCLUSIONS Patients with lung cancer receiving radiotherapy with a clinically-significant heart dose experience reductions in CRF (VO2peak, OUES) as early as six months following treatment with concurrent reductions in diastolic reserve (DFRI), HRQOL, and increases in cardiac biomarkers (NT-proBNP, hsCRP).
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Affiliation(s)
- Georgia Thomas
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA.
| | - Elisabeth Weiss
- VCU Massey Cancer Center; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Francesco Moroni
- Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Josh West
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Rachel Myers
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Emily Kontos
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Michele Golino
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Abbate
- Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
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Kim JS, Ma SF, Ma JZ, Huang Y, Bonham CA, Oldham JM, Adegunsoye A, Strek ME, Flaherty KR, Strickland E, Udofia I, Mooney JJ, Ghosh S, Maddipati K, Noth I. Associations of Plasma Omega-3 Fatty Acids With Progression and Survival in Pulmonary Fibrosis. Chest 2024; 165:621-631. [PMID: 37866772 PMCID: PMC10925547 DOI: 10.1016/j.chest.2023.09.035] [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: 04/12/2023] [Revised: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Preclinical experiments suggest protective effects of omega-3 fatty acids and their metabolites in lung injury and fibrosis. Whether higher intake of omega-3 fatty acids is associated with disease progression and survival in humans with pulmonary fibrosis is unknown. RESEARCH QUESTION What are the associations of plasma omega-3 fatty acid levels (a validated marker of omega-3 nutritional intake) with disease progression and transplant-free survival in pulmonary fibrosis? STUDY DESIGN AND METHODS Omega-3 fatty acid levels were measured from plasma samples of patients with clinically diagnosed pulmonary fibrosis from the Pulmonary Fibrosis Foundation Patient Registry (n = 150), University of Virginia (n = 58), and University of Chicago (n = 101) cohorts. The N-3 index (docosahexaenoic acid + eicosapentaenoic acid) was the primary exposure variable of interest. Linear-mixed effects models with random intercept and slope were used to examine associations of plasma omega-3 fatty acid levels with changes in FVC and diffusing capacity for carbon monoxide over a period of 12 months. Cox proportional hazards models were used to examine transplant-free survival. Stratified analyses by telomere length were performed in the University of Chicago cohort. RESULTS Most of the cohort were patients with idiopathic pulmonary fibrosis (88%) and male patients (74%). One-unit increment in log-transformed N-3 index plasma level was associated with a change in diffusing capacity for carbon monoxide of 1.43 mL/min/mm Hg per 12 months (95% CI, 0.46-2.41) and a hazard ratio for transplant-free survival of 0.44 (95% CI, 0.24-0.83). Cardiovascular disease history, smoking, and antifibrotic usage did not significantly modify associations. Omega-3 fatty acid levels were not significantly associated with changes in FVC. Higher eicosapentaenoic acid plasma levels were associated with longer transplant-free survival among University of Chicago participants with shorter telomere length (P value for interaction = .02). INTERPRETATION Further research is needed to investigate underlying biological mechanisms and whether omega-3 fatty acids are a potential disease-modifying therapy.
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Affiliation(s)
- John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA; Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Shwu-Fan Ma
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Jennie Z Ma
- Department of Public Health, University of Virginia School of Medicine, Charlottesville, VA
| | - Yong Huang
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Catherine A Bonham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Justin M Oldham
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Mary E Strek
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Emma Strickland
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | | | - Shrestha Ghosh
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Immunology, Harvard Medical School, Boston, MA
| | | | - Imre Noth
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
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Ravndal M, Idorn L, Nielsen KG, Hjortdal V. Lung Function in Fontan Patients Over a Ten-Year Period: Is the Fontan Circulation Impairing Lung Development? Pediatr Cardiol 2024; 45:500-512. [PMID: 38273050 PMCID: PMC10891202 DOI: 10.1007/s00246-023-03389-2] [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: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Few studies have investigated how the Fontan circulation affects lung function, and no studies have investigated the development of lung function over longer time in these patients. We aimed to describe the development of lung function in Fontan patients over a 10-year period. Pulmonary function tests (PFT), including spirometry and diffusion capacity for Carbon Monoxide (DLCO) and Nitric Oxide (DLNO), were conducted in a Danish Fontan cohort in 2011 (PFT-I). In 2021, re-investigations were performed (PFT-II). We investigated changes in percent predicted (%pred) lung function from PFT-I to PFT-II. Patients were categorized into a pediatric group (age under 18 at PFT-I) and an adult group (age 18 or older at PFT-I). Out of the 81 patients completing PFT-I, 48 completed PFT-II. In the pediatric group (32 patients), there were significant declines in %pred forced expiratory volume in 1s (99.7 (92.4, 104.4)-89.3 (84.9, 97.2), p < 0,001), forced vital capacity (98.3 (87.8, 106.1)-96.7 (86.7, 100.6), p = 0.008), and alveolar volume (95.5 (89.5, 101.6)-89.5 (79.7, 93.2), p < 0.001). The corresponding measurements remained stable in the adult group. However, the median %pred DLNO significantly declined in the adult group (58.4 (53.3, 63.5)-53.7 (44.1, 57.3), p = 0.005). Over a 10-year period, several lung function parameters declined significantly in the younger Fontan patients, suggesting possible impairments in lung development during growth. The decline in %pred DLNO in the adult patient group indicates deterioration of the membrane component of diffusion capacity, implying that the Fontan circulation might negatively affect the alveolar membrane over time.
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Affiliation(s)
- Maren Ravndal
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Lars Idorn
- Section of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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42
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Guler SA, Marinescu DC, Cox G, Durand C, Fisher JH, Grant-Orser A, Goobie GC, Hambly N, Johannson KA, Khalil N, Kolb M, Lok S, MacIsaac S, Manganas H, Marcoux V, Morisset J, Scallan C, Shapera S, Sun K, Zheng B, Ryerson CJ, Wong AW. The Clinical Frailty Scale for Risk Stratification in Patients With Fibrotic Interstitial Lung Disease. Chest 2024:S0012-3692(24)00279-4. [PMID: 38423280 DOI: 10.1016/j.chest.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Previous studies have shown the importance of frailty in patients with fibrotic interstitial lung disease (ILD). RESEARCH QUESTION Is the Clinical Frailty Scale (CFS) a valid tool to improve risk stratification in patients with fibrotic ILD? STUDY DESIGN AND METHODS Patients with fibrotic ILD were included from the prospective multicenter Canadian Registry for Pulmonary Fibrosis. The CFS was assessed using available information from initial ILD clinic visits. Patients were stratified into fit (CFS score 1-3), vulnerable (CFS score 4), and frail (CFS score 5-9) subgroups. Cox proportional hazards and logistic regression models with mixed effects were used to estimate time to death or lung transplantation. A derivation and validation cohort was used to establish prognostic performance. Trajectories of functional tests were compared using joint models. RESULTS Of the 1,587 patients with fibrotic ILD, 858 (54%) were fit, 400 (25%) were vulnerable, and 329 (21%) were frail. Frailty was a risk factor for early mortality (hazard ratio, 5.58; 95% CI, 3.64-5.76, P < .001) in the entire cohort, in individual ILD diagnoses, and after adjustment for potential confounders. Adding frailty to established risk prediction parameters improved the prognostic performance in derivation and validation cohorts. Patients in the frail subgroup had larger annual declines in FVC % predicted than patients in the fit subgroup (-2.32; 95% CI, -3.39 to -1.17 vs -1.55; 95% CI, -2.04 to -1.15, respectively; P = .02). INTERPRETATION The simple and practical CFS is associated with pulmonary and physical function decline in patients with fibrotic ILD and provides additional prognostic accuracy in clinical practice.
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Affiliation(s)
- Sabina A Guler
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Lung Precision Medicine (LPM), Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.
| | - Daniel-Costin Marinescu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Gerard Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Celine Durand
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Gillian C Goobie
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Nathan Hambly
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stacey Lok
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sarah MacIsaac
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helene Manganas
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julie Morisset
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Ciaran Scallan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelly Sun
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Boyang Zheng
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Rheumatology, McGill University, Montreal, QC, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Lu T, Lahousse L, Wijnant S, Chen J, Brusselle GG, van Hoek M, Zillikens MC. The AGE-RAGE axis associates with chronic pulmonary diseases and smoking in the Rotterdam study. Respir Res 2024; 25:85. [PMID: 38336742 PMCID: PMC10858545 DOI: 10.1186/s12931-024-02698-1] [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: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and asthma associate with high morbidity and mortality. High levels of advanced glycation end products (AGEs) were found in tissue and plasma of COPD patients but their role in COPD and asthma is unclear. METHODS In the Rotterdam Study (n = 2577), AGEs (by skin autofluorescence (SAF)), FEV1 and lung diffusing capacity (DLCOc and DLCOc /alveolar volume [VA]) were measured. Associations of SAF with asthma, COPD, GOLD stage, and lung function were analyzed using logistic and linear regression adjusted for covariates, followed by interaction and stratification analyses. sRAGE and EN-RAGE associations with COPD prevalence were analyzed by logistic regression. RESULTS SAF associated with COPD prevalence (OR = 1.299 [1.060, 1.591]) but not when adjusted for smoking (OR = 1.106 [0.89, 1.363]). SAF associated with FEV1% predicted (β=-3.384 [-4.877, -1.892]), DLCOc (β=-0.212 [-0.327, -0.097]) and GOLD stage (OR = 4.073, p = 0.001, stage 3&4 versus 1). Stratified, the association between SAF and FEV1%predicted was stronger in COPD (β=-6.362 [-9.055, -3.670]) than non-COPD (β=-1.712 [-3.306, -0.118]). Association of SAF with DLCOc and DLCOc/VA were confined to COPD (β=-0.550 [-0.909, -0.191]; β=-0.065 [-0.117, -0.014] respectively). SAF interacted with former smoking and COPD prevalence for associations with lung function. Lower sRAGE and higher EN-RAGE associated with COPD prevalence (OR = 0.575[0.354, 0.931]; OR = 1.778[1.142, 2.768], respectively). CONCLUSIONS Associations between SAF, lung function and COPD prevalence were strongly influenced by smoking. SAF associated with COPD severity and its association with lung function was more prominent within COPD. These results fuel further research into interrelations and causality between SAF, smoking and COPD. TAKE-HOME MESSAGE Skin AGEs associated with prevalence and severity of COPD and lung function in the general population with a stronger effect in COPD, calling for further research into interrelations and causality between SAF, smoking and COPD.
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Affiliation(s)
- Tianqi Lu
- Department of Internal Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Sara Wijnant
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Jinluan Chen
- Department of Internal Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015GD, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015GD, Rotterdam, The Netherlands.
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Eddy RL, Mummy D, Zhang S, Dai H, Bechtel A, Schmidt A, Frizzell B, Gerayeli FV, Leipsic JA, Leung JM, Driehuys B, Que LG, Castro M, Sin DD, Niedbalski PJ. Cluster Analysis to Identify Long COVID Phenotypes Using 129Xe Magnetic Resonance Imaging: A Multi-centre Evaluation. Eur Respir J 2024; 63:2302301. [PMID: 38331459 PMCID: PMC10973687 DOI: 10.1183/13993003.02301-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Long COVID impacts ∼10% of people diagnosed with COVID-19, yet the pathophysiology driving ongoing symptoms is poorly understood. We hypothesised that 129Xe magnetic resonance imaging (MRI) could identify unique pulmonary phenotypic subgroups of long COVID, therefore we evaluated ventilation and gas exchange measurements with cluster analysis to generate imaging-based phenotypes. METHODS COVID-negative controls and participants who previously tested positive for COVID-19 underwent 129XeMRI ∼14-months post-acute infection across three centres. Long COVID was defined as persistent dyspnea, chest tightness, cough, fatigue, nausea and/or loss of taste/smell at MRI; participants reporting no symptoms were considered fully-recovered. 129XeMRI ventilation defect percent (VDP) and membrane (Mem)/Gas, red blood cell (RBC)/Mem and RBC/Gas ratios were used in k-means clustering for long COVID, and measurements were compared using ANOVA with post-hoc Bonferroni correction. RESULTS We evaluated 135 participants across three centres: 28 COVID-negative (40±16yrs), 34 fully-recovered (42±14yrs) and 73 long COVID (49±13yrs). RBC/Mem (p=0.03) and FEV1 (p=0.04) were different between long- and COVID-negative; FEV1 and all other pulmonary function tests (PFTs) were within normal ranges. Four unique long COVID clusters were identified compared with recovered and COVID-negative. Cluster1 was the youngest with normal MRI and mild gas-trapping; Cluster2 was the oldest, characterised by reduced RBC/Mem but normal PFTs; Cluster3 had mildly increased Mem/Gas with normal PFTs; and Cluster4 had markedly increased Mem/Gas with concomitant reduction in RBC/Mem and restrictive PFT pattern. CONCLUSION We identified four 129XeMRI long COVID phenotypes with distinct characteristics. 129XeMRI can dissect pathophysiologic heterogeneity of long COVID to enable personalised patient care.
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Affiliation(s)
- Rachel L Eddy
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - David Mummy
- Department of Radiology, Duke University, Durham, NC, USA
| | - Shuo Zhang
- Department of Radiology, Duke University, Durham, NC, USA
| | - Haoran Dai
- Department of Medical Physics, Duke University, Durham, NC, USA
| | - Aryil Bechtel
- Department of Radiology, Duke University, Durham, NC, USA
| | - Alexandra Schmidt
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Bradie Frizzell
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Firoozeh V Gerayeli
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon A Leipsic
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Janice M Leung
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Bastiaan Driehuys
- Department of Radiology, Duke University, Durham, NC, USA
- Department of Medical Physics, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Loretta G Que
- Division of Pulmonary, Department of Medicine, Duke University, Durham, NC, USA
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Peter J Niedbalski
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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45
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Bojahr J, Jörres RA, Kronseder A, Weber F, Ledderhos C, Roiu I, Karrasch S, Nowak D, Teupser D, Königer C. Effects of training flights of combat jet pilots on parameters of airway function, diffusing capacity and systemic oxidative stress, and their association with flight parameters. Eur J Med Res 2024; 29:100. [PMID: 38317201 PMCID: PMC10840181 DOI: 10.1186/s40001-024-01668-z] [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: 06/22/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Fighter aircraft pilots are regularly exposed to physiological challenges from high acceleration (Gz) forces, as well as increased breathing pressure and oxygen supply in the support systems. We studied whether effects on the lung and systemic oxidative stress were detectable after real training flights comprising of a wide variety of exposure conditions, and their combinations. METHODS Thirty-five pilots of the German Air Force performed 145 flights with the Eurofighter Typhoon. Prior to and after flight lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), alveolar volume (VA), and diffusing capacities per volume (KCO, KNO) were assessed. In addition, the fractional concentration of exhaled nitric oxide (FeNO) was determined, and urine samples for the analysis of molecular species related to 8-hydroxy-2'-deoxyguanosine (8-OHdG) were taken. For statistical analysis, mixed ANOVA models were used. RESULTS DLNO, DLCO, KNO, KCO and VA were reduced (p < 0.001) after flights, mean ± SD changes being 2.9 ± 5.0, 3.2 ± 5.2, 1.5 ± 3.7, 1.9 ± 3.7 and 1.4 ± 3.1%, respectively, while FeNO decreased by 11.1% and the ratio of 8-OHdG to creatinine increased by 15.7 ± 37.8%. The reductions of DLNO (DLCO) were smaller (p < 0.001) than those of KNO (KCO). In repeated flights on different days, baseline values were restored. Amongst various flight parameters comprising Gz-forces and/or being indicative of positive pressure breathing and oxygenation support, the combination of long flight duration and high altitude appeared to be linked to greater changes in DLNO and DLCO. CONCLUSIONS The pattern of reductions in diffusing capacities suggests effects arising from atelectasis and increased diffusion barrier, without changes in capillary blood volume. The decrease in exhaled endogenous NO suggests bronchial mucosal irritation and/or local oxidative stress, and the increase in urinary oxidized guanosine species suggests systemic oxidative stress. Although changes were small and not clinically relevant, their presence demonstrated physiological effects of real training flights in a modern 4th generation fighter jet.
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Affiliation(s)
- Janina Bojahr
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.
- Federal Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Angelika Kronseder
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Frank Weber
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
| | - Carla Ledderhos
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
| | - Immanuel Roiu
- 74th Tactical Air Wing of the German Air Force, Neuburg, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute for Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Königer
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
- Occupational Medicine Department, Medical Support Center Munich, Munich, Germany
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Bruorton M, Donnelley M, Goddard T, O'Connor A, Parsons D, Phillips J, Carson-Chahhoud K, Tai A. Pilot study of paediatric regional lung function assessment via X-ray velocimetry (XV) imaging in children with normal lungs and in children with cystic fibrosis. BMJ Open 2024; 14:e080034. [PMID: 38316593 PMCID: PMC10860032 DOI: 10.1136/bmjopen-2023-080034] [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: 09/19/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Cystic fibrosis (CF) is a life-limiting autosomal recessive genetic condition. It is caused by mutations in the gene that encodes for a chloride and bicarbonate conducting transmembrane channel. X-ray velocimetry (XV) is a novel form of X-ray imaging that can generate lung ventilation data through the breathing cycle. XV technology has been validated in multiple animal models, including the β-ENaC mouse model of CF lung disease. It has since been assessed in early-phase clinical trials in adult human subjects; however, there is a paucity of data in the paediatric cohort, including in CF. The aim of this pilot study was to investigate the feasibility of performing a single-centre cohort study in paediatric patients with CF and in those with normal lungs to demonstrate the appropriateness of proceeding with further studies of XV in these cohorts. METHODS AND ANALYSIS This is a cross-sectional, single-centre, pilot study. It will recruit children aged 3-18 years to have XV lung imaging performed, as well as paired pulmonary function testing. The study will aim to recruit 20 children without CF with normal lungs and 20 children with CF. The primary outcome will be the feasibility of recruiting children and performing XV testing. Secondary outcomes will include comparisons between XV and current assessments of pulmonary function and structure. ETHICS AND DISSEMINATION This project has ethical approval granted by The Women's and Children's Hospital Human Research Ethics Committee (HREC ID 2021/HRE00396). Findings will be disseminated through peer-reviewed publication and conferences. TRIAL REGISTRATION NUMBER ACTRN12623000109606.
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Affiliation(s)
- Matthew Bruorton
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Respiratory and Sleep Department, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Martin Donnelley
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas Goddard
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Respiratory and Sleep Department, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Antonia O'Connor
- Sleep Department, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
- University of New South Wales, Sydney, Sydney, Australia
| | - David Parsons
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Respiratory and Sleep Department, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Jessica Phillips
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Respiratory and Sleep Department, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Kristin Carson-Chahhoud
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Respiratory and Sleep Department, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Andrew Tai
- Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Respiratory and Sleep Department, Women's and Children's Health Network, North Adelaide, South Australia, Australia
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Soliman S, Soliman H, Crézé M, Brillet PY, Montani D, Savale L, Jais X, Bulifon S, Jutant EM, Rius E, Devilder M, Beurnier A, Colle R, Gasnier M, Pham T, Morin L, Noel N, Lecoq AL, Becquemont L, Figueiredo S, Harrois A, Bellin MF, Monnet X, Meyrignac O. Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort. Eur Radiol 2024; 34:1037-1052. [PMID: 37572192 DOI: 10.1007/s00330-023-10044-0] [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: 05/29/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. MATERIALS AND METHODS We conducted a prospective single-center study among patients hospitalized for COVID-19 between March and May 2020. Patients with residual symptoms or admitted into intensive care units were investigated 4 months after discharge by a chest CT (CCT) and pulmonary function tests (PFTs). The primary endpoint was the rate of persistent radiological fibrotic lesions after 4 months. Secondary endpoints included further CCT evaluation at 9 and 16 months, correlation of fibrotic lesions with clinical and PFT evaluation, and assessment of predictive factors. RESULTS Among the 1151 patients hospitalized for COVID-19, 169 patients performed a CCT at 4 months. CCTs showed pulmonary fibrotic lesions in 19% of the patients (32/169). These lesions were persistent at 9 months and 16 months in 97% (29/30) and 95% of patients (18/19) respectively. There was no significant clinical difference based on dyspnea scale in patients with pulmonary fibrosis. However, PFT evaluation showed significantly decreased diffusing lung capacity for carbon monoxide (p < 0.001) and total lung capacity (p < 0.001) in patients with radiological lesions. In multivariate analysis, the predictive factors of radiological pulmonary fibrotic lesions were pulmonary embolism (OR = 9.0), high-flow oxygen (OR = 6.37), and mechanical ventilation (OR = 3.49). CONCLUSION At 4 months, 19% of patients investigated after hospitalization for COVID-19 had radiological pulmonary fibrotic lesions; they persisted up to 16 months. CLINICAL RELEVANCE STATEMENT Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. The prevalence of persisting lesions after COVID-19 remains unclear. We assessed this prevalence and predictive factors leading to fibrotic lesions in a large cohort. The respiratory clinical impact of these lesions was also assessed. KEY POINTS • Nineteen percent of patients hospitalized for COVID-19 had radiological fibrotic lesions at 4 months, remaining stable at 16 months. • COVID-19 fibrotic lesions did not match any infiltrative lung disease pattern. • COVID-19 fibrotic lesions were associated with pulmonary function test abnormalities but did not lead to clinical respiratory manifestation.
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Affiliation(s)
- Samer Soliman
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
| | - Heithem Soliman
- Service de Gastro-Entérologie, Université Paris-Cité, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
| | - Maud Crézé
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Pierre-Yves Brillet
- Service de Radiologie Diagnostique, Université Sorbonne Paris-Nord, AP-HP, Hôpital Avicenne, Bobigny, France
| | - David Montani
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Sophie Bulifon
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Etienne-Marie Jutant
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Emily Rius
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Matthieu Devilder
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Antoine Beurnier
- DMU 5 Thorinno, Service de Physiologie Et d'Explorations Fonctionnelles Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Romain Colle
- DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France
| | - Matthieu Gasnier
- DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France
| | - Tài Pham
- DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Luc Morin
- Service de Réanimation Pédiatrique Et Médecine Néonatale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Santé de L'Enfant Et de L'Adolescent, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- DMU 7 Endocrinologie-Immunités-Inflammations Cancer-Urgences, Service de Médecine Interne Et Immunologie Clinique, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - Samy Figueiredo
- DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-France Bellin
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Olivier Meyrignac
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Sansone F, Di Filippo P, Russo D, Sgrazzutti L, Di Pillo S, Chiarelli F, Attanasi M. Lung function assessment in children with Long-Covid syndrome. Pediatr Pulmonol 2024; 59:472-481. [PMID: 38088231 DOI: 10.1002/ppul.26779] [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: 12/26/2022] [Revised: 10/31/2023] [Accepted: 11/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION A significant percentage of patients who survived the Coronavirus Infection Disease 2019 (COVID-19) showed persistent general and respiratory symptoms even months after recovery. This condition, called Post-Acute Sequelae of COVID-19 or Long-Covid syndrome (LCS), has been described also in children with positive history for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Little is known about the pathophysiologic mechanisms underlying this syndrome. The aim of this study was to investigate any difference between children with LCS and asymptomatic peers with previous COVID-19 in terms of lung function and lung ultrasound (LUS) patterns. Secondly, we tested associations between lung function abnormalities and LUS findings with Long-Covid. METHODS We carried out a prospective, descriptive, observational study including 58 children aged 5-17 years: 28 with LCS compared to 30 asymptomatic children with previous COVID-19. We collected demographic data, history of asthma, allergy or smoke exposure, and acute COVID-19 symptoms. After a median period of 4.5 months (1%-95% range 2-21) since the infection, lung function was assessed by spirometry, body plethysmography, diffusion lung capacity for carbon monoxide (DLCO). Airways inflammation was investigated by fractional exhaled nitric oxide (FeNO). LUS was performed independently by two experienced clinicians. RESULTS We found that children with LCS were older than controls (mean (SD) 12 (4.1) vs. 9.7 (2.6); p = .04). Children with LCS complained more frequently fatigue (46.4%), cough (17.9%), exercise intolerance (14.3%) and dyspnea (14.3%). Lung function was normal and similar between the two groups. The frequency of LUS abnormalities was similar between the two groups (43.3% children with LCS vs. 56.7% controls; p = .436). Children with LCS showed lower FeNO values (log difference -0.30 (CI 95% -0.50, -0.10)), but no association of LCS with a lower lung function and abnormal LUS findings was found. CONCLUSIONS LCS seems to be more frequent in older age children. Lung functional and structural abnormalities were not different between children with LCS and asymptomatic subjects with previous COVID-19. In addition, children with LCS showed lower FeNO values than controls, suggesting its potential role as a marker in LCS. However, further and larger studies are needed to confirm our findings.
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Affiliation(s)
- Francesco Sansone
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Paola Di Filippo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Daniele Russo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Laura Sgrazzutti
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Marina Attanasi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
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Devalla L, Ghewade B, Jadhav U, Annareddy S. Resolving the Complexity: A Comprehensive Review on Carbon Monoxide Diffusion Capacity in Chronic Obstructive Pulmonary Disease Patients. Cureus 2024; 16:e53492. [PMID: 38440009 PMCID: PMC10911056 DOI: 10.7759/cureus.53492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
This review comprehensively examines the intricate relationship between carbon monoxide (CO) diffusion capacity and chronic obstructive pulmonary disease (COPD). COPD, comprising chronic bronchitis and emphysema, presents a substantial global health burden, necessitating a nuanced understanding of pulmonary function parameters for effective diagnosis and management. The review delves into the physiological underpinnings, measurement techniques, and factors influencing CO diffusion capacity, emphasizing its pivotal role in assessing alveolar gas exchange efficiency. Key findings elucidate correlations between altered diffusion capacity and the severity of COPD, providing clinicians with valuable insights into disease progression. Considerations of age, gender, and ethnic disparities in normal CO diffusion capacity values highlight the importance of personalized interpretations. The clinical implications extend beyond diagnosis, influencing COPD management and prognostication, with potential applications in predicting treatment response. The review outlines avenues for future research, including advancements in measurement technologies and the exploration of novel imaging modalities and biomarkers. Ultimately, this review serves as a foundation for refining diagnostic approaches and treatment strategies and enhancing patient care in the dynamic landscape of COPD.
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Affiliation(s)
- Lokesh Devalla
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ulhas Jadhav
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Srinivasulareddy Annareddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Schoeberlein MI, Frisiras CE, Coffman KE. The effect of heat on lung diffusing capacity for carbon monoxide (DLCO) during cycling exercise. Eur J Appl Physiol 2024; 124:469-477. [PMID: 37548661 DOI: 10.1007/s00421-023-05280-7] [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: 04/05/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE This study aimed to quantify the combined effects of heat exposure and exercise of increasing intensity on pulmonary blood flow using lung diffusing capacity for carbon monoxide (DLCO) as an indirect measure. We hypothesized that, during exercise in the heat, the well-documented increase in skin blood flow for thermoregulation would lead to alterations in pulmonary blood flow and a subsequent fall in DLCO versus a thermoneutral condition. METHODS Nine healthy subjects (4 F/5 M, 20-45 years, VO2max 46.7 ± 5.8 mL/kg/min) completed three 15-min stages including rest and during cycling at 20 and 40% of maximum workload (Wmax) in either thermoneutral (TN; 22.2 ± 0.6 °C) or heat (HT; 39.4 ± 0.4 °C) conditions. DLCO, minute ventilation (VE), oxygen consumption ([Formula: see text]), heart rate (HR), and core (TC) and skin temperature (Tsk) were measured. RESULTS DLCO showed a significant interaction between exercise intensity and heat (P = 0.019); post hoc testing revealed that DLCO was higher at 40% of Wmax in HT vs. TN (53.2 ± 10.6 vs 50.0 ± 10.3 mL/min/mmHg, P = 0.003) only. VE and [Formula: see text] showed no difference in HT vs. TN. HR was higher in HT vs. TN (P < 0.001). TC and Tsk showed a significant interaction between temperature and intensity (P < 0.05). CONCLUSION The unexpected increase in DLCO during exercise in HT vs. TN conditions suggests a larger lung surface area for gas exchange, perhaps due to increased pulmonary capillary recruitment and/or distension secondary to a higher cardiac output (Q) in the heat. This study furthers our understanding of how heat exposure might impact pulmonary blood flow, specifically as assessed via DLCO.
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Affiliation(s)
| | | | - Kirsten E Coffman
- Department of Exercise Science, University of Puget Sound, Tacoma, WA, USA.
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