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Ward C, Alamer A, Jones R, Lawton M, Griffin M, Drinnan M, Forrest I, Patterson J. Integrating Aerodigestive Investigations in Progressive Pulmonary Fibrosis. Am J Respir Crit Care Med 2024; 210:530. [PMID: 38941617 PMCID: PMC11351811 DOI: 10.1164/rccm.202405-1008le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/27/2024] [Indexed: 06/30/2024] Open
Affiliation(s)
- Chris Ward
- Translational and Clinical Research Institute, School of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amal Alamer
- Translational and Clinical Research Institute, School of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Respiratory Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rhys Jones
- Upper Gastrointestinal and General Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Michelle Lawton
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mike Griffin
- Royal College of Surgeons of Edinburgh, Edinburgh, Scotland
| | - Michael Drinnan
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom; and
| | - Ian Forrest
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Joanne Patterson
- School of Health Sciences, University of Liverpool, Liverpool, United Kingdom
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Sykes DL, Crooks MG, Hart SP, Jackson W, Gallagher J, Morice AH. Investigating the diagnostic utility of high-resolution oesophageal manometry in patients with refractory respiratory symptoms. Respir Med 2022; 202:106985. [PMID: 36115315 DOI: 10.1016/j.rmed.2022.106985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/27/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The interaction between the respiratory and gastrointestinal systems, and the role of the latter in the development of respiratory pathology, has been examined with a focus on gastro-oesophageal reflux disease (GORD). However, little data exists examining the link between oesophageal motility and respiratory disease. AIMS AND OBJECTIVES In this study, we examined patterns in oesophageal motility using high-resolution oesophageal manometry (HROM) in patients with refractory respiratory symptoms. METHODS Data were collected retrospectively for all patients that were investigated using HROM at a single centre for refractory respiratory symptoms between January 1st, 2011-December 1st, 2021. Patients were selected for investigation based on airway reflux symptoms, measured by the Hull Airways Reflux Questionnaire (HARQ). RESULTS 441 patients were investigated with HROM (64% female, mean age = 56.5 [SD = 13.9]). The commonest diagnoses of these patients were Chronic Cough (77%, n = 339), Asthma (10%, n = 44), and Interstitial Lung Disease (7%, n = 29). The prevalence of oesophageal dysmotility was 66% in our cohort. Those with oesophageal dysmotility had significantly higher HARQ scores than those with normal motility (40.6 vs 35.3, p < 0.001) and there was a significant inverse correlation between HARQ scores and distal contractile integral (DCI), a measure of oesophageal contractility. CONCLUSIONS Two-thirds of patients with refractory respiratory symptoms were found to have oesophageal dysmotility on HROM. These findings suggest motility disorders of the oesophagus may contribute to the development and progression of respiratory disease. This study highlights the need for further prospective study of the relationship between oesophageal dysmotility and respiratory disease.
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Affiliation(s)
- Dominic L Sykes
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Respiratory Research Group, Hull York Medical School, Hull, UK.
| | - Michael G Crooks
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Respiratory Research Group, Hull York Medical School, Hull, UK
| | - Simon P Hart
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Respiratory Research Group, Hull York Medical School, Hull, UK
| | | | | | - Alyn H Morice
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Respiratory Research Group, Hull York Medical School, Hull, UK
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The Curious Case of Cough in Interstitial Lung Diseases. Chest 2022; 162:501-502. [DOI: 10.1016/j.chest.2022.04.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
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Delameillieure A, Vandekerkhof S, Van Grootven B, Wuyts WA, Dobbels F. Care programs and their components for patients with idiopathic pulmonary fibrosis: a systematic review. Respir Res 2021; 22:229. [PMID: 34399748 PMCID: PMC8365984 DOI: 10.1186/s12931-021-01815-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The multidimensional and complex care needs of patients with idiopathic pulmonary fibrosis (IPF) call for appropriate care models. This systematic review aimed to identify care models or components thereof that have been developed for patients with IPF in the outpatient clinical care, to describe their characteristics from the perspective of chronic integrated care and to describe their outcomes. METHODS A systematic review was conducted using state-of-the-art methodology with searches in PubMed/Medline, Embase, CINAHL and Web Of Science. Researchers independently selected studies and collected data, which were described according to the Chronic Care Model (CCM). RESULTS Eighteen articles were included describing 13 new care models or components. The most commonly described CCM elements were 'delivery system design' (77%) and 'self-management support' (69%), with emphasis on team-based and multidisciplinary care provision and education. The most frequently described outcome was health-related quality of life. CONCLUSIONS Given the high need for integrated care and the scarcity and heterogeneity of data, developing, evaluating and implementing new models of care for patients with IPF and the comprehensive reporting of these endeavours should be a priority for research and clinical care.
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Affiliation(s)
- Anouk Delameillieure
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000 Leuven, Belgium
| | - Sarah Vandekerkhof
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000 Leuven, Belgium
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000 Leuven, Belgium
- Research Foundation-Flandres, Brussels, Belgium
| | - Wim A. Wuyts
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000 Leuven, Belgium
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Althuwaybi A, Al Quaimi M, Krishnan A, Jones R, Pearson J, Ward C. Hospitalization Outcomes for COVID-19 in Patients with Interstitial Lung Disease: A Potential Role for Aerodigestive Pathophysiology? Am J Respir Crit Care Med 2021; 203:521-522. [PMID: 33217241 PMCID: PMC7885845 DOI: 10.1164/rccm.202010-4031le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Amaran Krishnan
- Newcastle University Newcastle upon Tyne, United Kingdom.,York Teaching Hospital NHS Foundation Trust York, United Kingdom and
| | - Rhys Jones
- The James Cook University Hospital Middlesbrough, United Kingdom
| | | | - Chris Ward
- Newcastle University Newcastle upon Tyne, United Kingdom
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Abstract
Microaspiration, or silent aspiration, is commonly suspected in patients with refractory respiratory symptoms, including unexplained chronic cough, asthma, chronic obstructive pulmonary disease, bronchiolitis, bronchiectasis, and idiopathic pulmonary fibrosis. This suspicion is driven by the high prevalence of gastroesophageal reflux in these otherwise disparate disorders. Frequently, patients receive aggressive treatment for gastroesophageal reflux disease as a means of treating their underlying respiratory conditions, even in the absence of overt symptoms of reflux. However, clinical trials have not demonstrated a clear impact on outcomes with this strategy, and in some instances there may be potential for harm. Mechanistic studies have increasingly used gastric biomarkers obtained directly from the airways to confirm the association between reflux and respiratory disease, but results are limited by methodologic flaws and correlation. The best evidence of aspiration directly causing respiratory disorders is the histopathologic detection of foreign bodies. For most of the other chronic respiratory disorders, microaspiration may be uncommon or a secondary aggravating factor, as in patients with acute exacerbations of chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis. In some cases, microaspiration is probably not a significant factor at all, such as in unexplained chronic cough. It is important to distinguish between conditions in which aspiration is primarily or directly causal and conditions in which aspiration may be indirectly aggravating, to help identify whether interventions targeting reflux and aspiration precautions should be recommended to patients. Our clinical review examines some of the evidence supporting reflux-aspiration as a mechanism for several chronic respiratory disorders and offers some management considerations when reflux-aspiration is suspected.
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McDonnell MJ, Hunt EB, Ward C, Pearson JP, O'Toole D, Laffey JG, Murphy DM, Rutherford RM. Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review. ERJ Open Res 2020; 6:00190-2019. [PMID: 33693049 PMCID: PMC7927787 DOI: 10.1183/23120541.00190-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies. Gastro-oesophageal reflux disease is prevalent among patients with chronic respiratory disease. A number of medical and surgical treatment options are available for GORD. This review examines available evidence in the setting of chronic lung disease.https://bit.ly/34TcMJS
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Affiliation(s)
- Melissa J McDonnell
- Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.,Lung Biology Group, National University of Ireland, Galway, Ireland.,Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Eoin B Hunt
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
| | - Chris Ward
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Jeffrey P Pearson
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Daniel O'Toole
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - Desmond M Murphy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
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Mackintosh JA, Desai SR, Adamali H, Patel K, Chua F, Devaraj A, Kouranos V, Kokosi M, Margaritopoulos G, Renzoni EA, Wells AU, Molyneaux PL, Kumar S, Maher TM, George PM. In patients with idiopathic pulmonary fibrosis the presence of hiatus hernia is associated with disease progression and mortality. Eur Respir J 2019; 53:13993003.02412-2018. [DOI: 10.1183/13993003.02412-2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/18/2019] [Indexed: 11/05/2022]
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