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Adame MJ, Raji M, Shan Y, Zhang Y, Kuo YF, Tripple JW. Association Between Aspirin-Exacerbated Respiratory Disease and Atherosclerotic Cardiovascular Disease: A Retrospective Review of US Claims Data. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3445-3453.e6. [PMID: 37468040 DOI: 10.1016/j.jaip.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) consists of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Asthma is associated with increased risk of atherosclerotic cardiovascular diseases (ASCVD). However, there is lack of data on association between AERD and ASCVD. OBJECTIVE To investigate the relationship between AERD and subsequent risk of ASCVD. METHODS An algorithm to find patients with AERD was generated and validated through chart review at our home institution. This algorithm was applied to a national insurance claims database to obtain data for a retrospective cohort study. Demographic and comorbidity data were obtained for propensity matching. Several methods of analysis were performed on the data. RESULTS A total of 571 patients met criteria for AERD; 3909 met criteria for asthma, CRSwNP, and no allergy to aspirin or NSAIDs (group 1); and 75,050 met criteria for asthma, CRS without nasal polyps, and no allergy to aspirin or NSAIDs (group 2). After covariate adjustment, AERD was significantly associated with ASCVD, including severe ASCVD, over groups 1 and 2 regardless of asthma severity. CONCLUSION Patients with AERD are at higher risk of ASCVD than patients with asthma and CRSwNP or CRS without nasal polyps, underscoring the need for early ASCVD screening and a consideration for aspirin desensitization or use of a nonaspirin antiplatelet agent in the setting of AERD and comorbid ASCVD.
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Affiliation(s)
- Michael J Adame
- Department of Internal Medicine, Division of Allergy and Immunology, the University of Texas Medical Branch, Galveston, Texas.
| | - Mukaila Raji
- Department of Internal Medicine, Division of Geriatrics, the University of Texas Medical Branch, Galveston, Texas
| | - Yong Shan
- Department of Biostatistics and Data Science, the University of Texas Medical Branch, Galveston, Texas
| | - Yuanyi Zhang
- Department of Biostatistics and Data Science, the University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Internal Medicine, Division of Geriatrics, the University of Texas Medical Branch, Galveston, Texas; Department of Biostatistics and Data Science, the University of Texas Medical Branch, Galveston, Texas
| | - Julia W Tripple
- Department of Internal Medicine, Division of Allergy and Immunology, the University of Texas Medical Branch, Galveston, Texas
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Machine-learning algorithms for asthma, COPD, and lung cancer risk assessment using circulating microbial extracellular vesicle data and their application to assess dietary effects. EXPERIMENTAL & MOLECULAR MEDICINE 2022; 54:1586-1595. [PMID: 36180580 PMCID: PMC9534896 DOI: 10.1038/s12276-022-00846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/17/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022]
Abstract
Although mounting evidence suggests that the microbiome has a tremendous influence on intractable disease, the relationship between circulating microbial extracellular vesicles (EVs) and respiratory disease remains unexplored. Here, we developed predictive diagnostic models for COPD, asthma, and lung cancer by applying machine learning to microbial EV metagenomes isolated from patient serum and coded by their accumulated taxonomic hierarchy. All models demonstrated high predictive strength with mean AUC values ranging from 0.93 to 0.99 with various important features at the genus and phylum levels. Application of the clinical models in mice showed that various foods reduced high-fat diet-associated asthma and lung cancer risk, while COPD was minimally affected. In conclusion, this study offers a novel methodology for respiratory disease prediction and highlights the utility of serum microbial EVs as data-rich features for noninvasive diagnosis. Artificial intelligence (AI) has enabled researchers to intercept microbial messages bearing clinically useful information about of a variety of respiratory disorders. The organisms that comprise our microbiome communicate via the release of tiny, biomolecule-laden membrane bubbles called ‘extracellular vesicles’ (EVs) into the bloodstream. EVs are also influenced by human disease. South Korean researchers led by Yoon-Keun Kim of MD Healthcare, Seoul, and Young-Koo Jee of Dankook University College of Medicine, Cheonan, have used an AI algorithm to assemble EV-based profiles that can discriminate between healthy people and those with conditions like asthma or lung cancer. Their analysis of 1727 patient serum samples revealed microbial signatures that enabled accurate diagnosis of several respiratory disorders. Preliminary experiments in mice suggest that certain dietary changes could help shift the microbiome of high-risk individuals towards a healthier profile.
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Para O, Montagnani A, Guidi S, Bertù L, Manfellotto D, Campanini M, Fontanella A, Dentali F. Hospitalization and mortality for acute exacerbation of asthma: an Italian population-based study. Intern Emerg Med 2022; 17:1107-1113. [PMID: 35103927 DOI: 10.1007/s11739-021-02923-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
Abstract
Asthma is an ever-increasing disease with a highly variable prevalence among different ethnic groups. Information on hospital admission for acute exacerbation of asthma in adult patients and data regarding short-term prognosis of these patients are limited. We, thus, performed an epidemiological study on hospital admission for asthma acute exacerbation in Italy using hospital discharge database records derived from all Italian hospitals. Patients > 15 years old were identified using clinical Modification (ICD-9-CM) codes. Information on baseline characteristics, vital status at discharge, duration of hospitalization, and up to five secondary discharge diagnoses was collected. Comorbidity was evaluated using the Charlson comorbidity index (CCI). During the observation period (2013-2014), 20,056 patients with asthma acute exacerbation were hospitalized. Median length of hospitalization was 7.9 days (interquartile range 4-10) and mean in-hospital mortality was 0.8%. In-hospital mortality and length of hospitalization varied among different regions (from 0 to 2.9% and from 6.5 to 8.9 days, respectively). Old age, invasive and non-invasive mechanical ventilation, and CCI resulted as significantly associated with higher in-hospital mortality. Our study results, on a large sample of patients, confirm that hospitalization for asthma acute exacerbation is not uncommon among Italian current population. Older age, high CCI, and use of ventilator support were associated with a higher mortality rate. These findings should be analyzed to set up appropriate health care policies on patients with asthma.
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Affiliation(s)
- Ombretta Para
- Internal Medicine 1, Careggi University Hospital, Florence, Italy.
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Stefano Guidi
- Internal Medicine 1, Careggi University Hospital, Florence, Italy
| | - Lorenza Bertù
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Dario Manfellotto
- Department of Internal Medicine, Fatebenefratelli Hospital, Rome, Italy
| | - Mauro Campanini
- Department of Internal Medicine, AOU Maggiore Della Carità, Novara, Italy
| | - Andrea Fontanella
- Department of Internal Medicine, Ospedale del Buon Consiglio, Naples, Italy
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
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Ni H, Aye SZ, Naing C. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 5:CD013506. [PMID: 35616126 PMCID: PMC9134202 DOI: 10.1002/14651858.cd013506.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic and progressive disease, often punctuated by recurrent flare-ups or exacerbations. Magnesium sulfate, having a bronchodilatory effect, may have a potential role as an adjunct treatment in COPD exacerbations. However, comprehensive evidence of its effects is required to facilitate clinical decision-making. OBJECTIVES To assess the effects of magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease in adults. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization (WHO) trials portal, EU Clinical Trials Register and Iranian Registry of Clinical Trials. We also searched the proceedings of major respiratory conferences and reference lists of included studies up to 2 August 2021. SELECTION CRITERIA We included single- or double-blind parallel-group randomised controlled trials (RCTs) assessing magnesium sulfate in adults with COPD exacerbations. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. The primary outcomes were: hospital admissions (from the emergency room); need for non-invasive ventilation (NIV), assisted ventilation or admission to intensive-care unit (ICU); and serious adverse events. Secondary outcomes were: length of hospital stay, mortality, adverse events, dyspnoea score, lung function and blood gas measurements. We assessed confidence in the evidence using GRADE methodology. For missing data, we contacted the study investigators. MAIN RESULTS We identified 11 RCTs (10 double-blind and 1 single-blind) with a total 762 participants. The mean age of participants ranged from 62 to 76 years. Trials were single- or two-centre trials conducted in Iran, New Zealand, Nepal, Turkey, the UK, Tunisia and the USA between 2004 and 2018. We judged studies to be at low or unclear risk of bias for most of the domains. Three studies were at high risk for blinding and other biases. Intravenous magnesium sulfate versus placebo Seven studies (24 to 77 participants) were included. Fewer people may require hospital admission with magnesium infusion compared to placebo (odds ratio (OR) 0.45, 95% CI 0.23 to 0.88; number needed to treat for an additional beneficial outcome (NNTB) = 7; 3 studies, 170 participants; low-certainty evidence). Intravenous magnesium may result in little to no difference in the requirement for non-invasive ventilation (OR 0.74, 95% CI 0.31 to 1.75; very low-certainty evidence). There were no reported cases of endotracheal intubation (2 studies, 107 participants) or serious adverse events (1 study, 77 participants) in either group. Included studies did not report intensive care unit (ICU) admission or deaths. Magnesium infusion may reduce the length of hospital stay by a mean difference (MD) of 2.7 days (95% CI 4.73 days to 0.66 days; 2 studies, 54 participants; low-certainty evidence) and improve dyspnoea score by a standardised mean difference of -1.40 (95% CI -1.83 to -0.96; 2 studies, 101 participants; low-certainty evidence). We were uncertain about the effect of magnesium infusion on improving lung function or oxygen saturation. For all adverse events, the Peto OR was 0.14 (95% CI 0.02 to 1.00; 102 participants); however, the event rate was too low to reach a robust conclusion. Nebulised magnesium sulfate versus placebo Three studies (20 to 172 participants) were included. Magnesium inhalation may have little to no impact on hospital admission (OR 0.77, 95% CI 0.21 to 2.82; very low-certainty evidence) or need for ventilatory support (NIV or mechanical ventilation) (OR 0.33, 95% CI 0.01 to 8.20; very low-certainty evidence). It may result in fewer ICU admissions compared to placebo (OR 0.39, 95% CI 0.15 to 1.00; very low-certainty evidence) and improvement in dyspnoea (MD -14.37, 95% CI -26.00 to -2.74; 1 study, 20 participants; very low-certainty evidence). There were no serious adverse events reported in either group. There was one reported death in the placebo arm in one trial, but the number of participants was too small for a conclusion. There was limited evidence about the effect of magnesium inhalation on length of hospital stay, lung function outcomes or oxygen saturation. Included studies did not report adverse events. Magnesium sulfate versus ipratropium bromide A single study with 124 participants assessed nebulised magnesium sulfate plus intravenous magnesium infusion versus nebulised ipratropium plus intravenous normal saline. There was little to no difference between these groups in terms of hospital admission (OR 1.62, 95% CI 0.78 to 3.37), endotracheal intubation (OR 1.69, 95% CI 0.61 to 4.71) and length of hospital stay (MD 1.10 days, 95% CI -0.22 to 2.42), all with very low-certainty evidence. There were no data available for non-invasive ventilation, ICU admission and serious adverse events. Adverse events were not reported. AUTHORS' CONCLUSIONS: Intravenous magnesium sulfate may be associated with fewer hospital admissions, reduced length of hospital stay and improved dyspnoea scores compared to placebo. There is no evidence of a difference between magnesium infusion and placebo for NIV, lung function, oxygen saturation or adverse events. We found no evidence for ICU admission, endotracheal intubation, serious adverse events or mortality. For nebulised magnesium sulfate, we are unable to draw conclusions about its effects in COPD exacerbations for most of the outcomes. Studies reported possibly lower ICU admissions and a lesser degree of dyspnoea with magnesium inhalation compared to placebo; however, larger studies are required to yield a more precise estimate for these outcomes. Similarly, we could not identify any robust evidence for magnesium sulfate compared to ipratropium bromide. Future well-designed multicentre trials with larger samples are required, including subgroups according to severity of exacerbations and COPD phenotypes.
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Affiliation(s)
- Han Ni
- Department of Medicine, Newcastle University Medicine Malaysia, Johor, Malaysia
| | - Swe Zin Aye
- Department of Paediatrics and Child Health, Quest International University Perak, Ipoh, Malaysia
| | - Cho Naing
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
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Taha M, Mishra T, Shokr M, Sharma A, Taha M, Samavati L. Burden and impact of arrhythmias in asthma-related hospitalizations: Insight from the national inpatient sample. J Arrhythm 2021; 37:113-120. [PMID: 33664893 PMCID: PMC7896478 DOI: 10.1002/joa3.12452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to analyze the burden and impact of cardiac arrhythmias in adult patients hospitalized with asthma exacerbation using the nationwide inpatient database. METHODS We used the National Inpatient Sample (NIS) database (2010-2014) to identify arrhythmias in asthma-related hospitalization and its impact on inpatient mortality, hospital length of stay (LOS), and hospitalization charges. We also used multivariable analysis to identify predictors of in-hospital arrhythmia and mortality. RESULTS We identified 12,988,129 patients hospitalized with primary diagnosis of asthma; among them, 2,014,459(16%) patients had cardiac arrhythmia. The most frequent arrhythmia identified is atrial fibrillation (AFib) (8.95%). The AFib and non-AFib arrhythmia group had higher mortality (3.40% & 2.22% vs 0.74%), mean length of stay (LOS) (5.9 & 5.4 vs 4.2 days), and hospital charges ($53,172 & $51,105 vs $34,585) as compared to the non-arrhythmia group (P < .005). Predictors of arrhythmia in asthma-related hospitalization were history of PCI or CABG, valvular heart disease, congestive heart failure (CHF), and acute respiratory failure. Predictors of higher mortality in arrhythmia group were acute respiratory failure, sepsis, and acute myocardial infarction. CONCLUSIONS Around 16% of adult patients hospitalized with asthma exacerbation experience arrythmia (mostly AFib 8.95%). The presence of arrhythmias was associated with higher in-hospital mortality, LOS, and hospital charges in hospitalized asthmatics.
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Affiliation(s)
- Muhanad Taha
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Tushar Mishra
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mohamed Shokr
- Cardiology Department Leon H. Charney Division of Cardiology, Cardiac Electrophysiology NYU Langone Health New York University Grossman School of Medicine New York NY USA
| | - Aditi Sharma
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mazen Taha
- Faculty of Medicine Cairo University Giza Egypt
| | - Lobelia Samavati
- Department of Pulmonary Critical Care and Sleep Division Wayne State University Detroit MI USA
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Balkissoon R. Journal Club: Do Inhaled Corticosteroids Reduce All-Cause Mortality in Chronic Obstructive Pulmonary Disease? What is the Latest Evidence? CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:1-3. [PMID: 33513661 PMCID: PMC8047612 DOI: 10.15326/jcopdf.2020.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Ni H, Naing C, Aye SZ. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2020; 2020:CD013506. [PMCID: PMC6956619 DOI: 10.1002/14651858.cd013506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease in adults.
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Affiliation(s)
- Han Ni
- SEGi UniversityFaculty of MedicineHospital Sibu, Jalan Ulu OyaSibuSarawakMalaysia96000
| | - Cho Naing
- International Medical UniversityKuala LumpurMalaysia
- James Cook UniversityDivision of Tropical Health and MedicineTownsvilleAustralia
| | - Swe Zin Aye
- Quest International University PerakDepartment of Paediatrics and Child HealthNo 122AJalan Haji EusoffIpohPerakMalaysia30250
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Gómez Sáenz JT, Gérez Callejas MJ, Hidalgo Requena A, Ginel Mendoza L, González Aguilera J, Quintano Jiménez JA. [Mortality due to asthma in Spain, 1990-2015]. Semergen 2019; 45:449-457. [PMID: 31105029 DOI: 10.1016/j.semerg.2019.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe.
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Fatal Asthma: An Audit of 30 Million Patient-Years of Health Plan Membership from 2007 to 2015. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:597-605. [PMID: 30193940 DOI: 10.1016/j.jaip.2018.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Without accurate data on deaths directly caused by asthma, prevention will be difficult. OBJECTIVE To determine how often asthma could be confirmed as a proximal cause of death in a large well-defined population with active health plan membership and no acute barriers to medical care. METHODS All deaths occurring in active Kaiser Permanente Southern California health plan members between 2007 and 2015 were identified. Asthma-coded deaths were manually audited for cause. Health care and asthma medication use in the 6 months before death were determined. RESULTS There were 248 (0.80 per 100,000 patient-years) unaudited asthma-coded deaths. There were only 63 (26.5%) (0.20 per 100,000 patient-years) asthma-confirmed deaths. Individuals with asthma-confirmed deaths were younger, less likely to have ever smoked, and had fewer emergency visits in the 6 months before death compared with those with asthma excluded. Individuals with asthma-confirmed deaths used preventative inhalers at very low rates. We unexpectedly found that ever inclusion in the 2016 National Committee for Quality Assurance health effectiveness data and information set (HEDIS) for persistent asthma was associated with a higher risk of all-cause early death. Individuals with asthma-confirmed deaths were also unlikely to be in the HEDIS asthma dataset in the year they died, thus not targeted for outreach. CONCLUSIONS Audit-confirmed fatal asthma is more likely to occur in younger, nonsmoking, individuals, using very low rates of preventive inhalers. This will be a very difficult group to prospectively identify and manage effectively. Further research into the reasons for early death after HEDIS asthma dataset inclusion is warranted.
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Kumbhare S, Strange C. Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States. South Med J 2018; 111:293-298. [PMID: 29767222 DOI: 10.14423/smj.0000000000000807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is recognized increasingly as a distinct clinical entity and is associated with higher comorbidities compared with patients with asthma and COPD alone. Little is known about the leading causes of death related to ACO in the US general population, however. Our aim was to define the causes of mortality among patients with ACO compared with asthma and COPD in the US population. METHODS We examined questions using the National Health and Nutrition Examination Survey III database linked to the National Death Index. The data from 4434 participants were stratified into 4 groups, those with asthma, COPD, ACO, and those without any obstructive lung disease. We examined baseline demographics and used multivariate logistic regression to model the impact of demographics, smoking, and self-reported, physician-diagnosed lung disease on mortality generating odds ratios (ORs) and confidence intervals (CIs). RESULTS Among 4434 participants, 120 (2.7%), 340 (7.6%), and 126 (2.8%) participants self-reported diagnoses of asthma, COPD, and ACO syndrome, respectively. Patients with COPD were older (69.7 ± 10.9 years) than other groups. Cardiovascular disease, malignancy, and chronic lower respiratory disease were frequent causes of death. The mortality rates for cardiovascular disease and malignancy were not significantly different among respiratory disease categories. Deaths resulting from chronic respiratory disease were higher in the ACO group (OR 4.9, 95% CI 2.5-9.4) and the COPD group (OR 2.9, 95% CI 1.5-5.4) when compared with those without obstructive lung disease (P < 0.0001). CONCLUSIONS Although cardiovascular- and malignancy-related deaths are common, a higher proportion of mortality in ACO and COPD is attributed to chronic lung disease.
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Affiliation(s)
- Suchit Kumbhare
- From the Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston
| | - Charlie Strange
- From the Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston
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Van den Borre L, Deboosere P. Health risks in the cleaning industry: a Belgian census-linked mortality study (1991–2011). Int Arch Occup Environ Health 2017; 91:13-21. [DOI: 10.1007/s00420-017-1252-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 08/07/2017] [Indexed: 02/08/2023]
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He H, Sun Y, Sun B, Zhan Q. Application of a parametric model in the mortality risk analysis of ICU patients with severe COPD. CLINICAL RESPIRATORY JOURNAL 2016; 12:491-498. [PMID: 27606821 DOI: 10.1111/crj.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/06/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the mortality risk factors of patients with severe chronic obstructive pulmonary disease (COPD) in the intensive care unit (ICU) by utilizing parametric model of survival analysis, and to estimate patients' prognoses based on the risk and survival functions in the model. METHODS The clinical data and outcomes of COPD patients admitted to a respiratory intensive care unit (RICU) at Beijing Chao-Yang Hospital from January 2009 to June 2014 were prospectively collected. Based on the clinical outcomes, these patients were divided into a survival group and a death group. A univariate analysis was conducted to identify statistically significant variables. According to the distribution characteristics of these data, residual plots were prepared for an exponential model, a Weibull model and a Gamma model. The Gamma model was determined to be the best fitted for these data and was used as the analytical tool. Therefore, the variables with differences obtained from the univariate analysis were put into the Gamma model to determine the patients' mortality risk factors. The risk and survival functions were also generated according to the model formula. RESULTS A total of 160 patients (111 survival, 49 death) were enrolled. The univariate analysis showed that, compared with the survival group, patients in the death group had higher Charlson Comorbidity Index score (CCI), higher body temperature, higher white blood cell counts, higher proportions of neutrophils, higher serum creatinine levels and higher pH levels; lower resting carbon dioxide pressure (PCO2 ); and more cases complicated with invasive pulmonary aspergillosis (IPA). A further analysis with the Gamma model revealed that concurrent or non-concurrent IPA, white blood cell count, pH level and PCO2 were associated with the patients' mortality risk and that the predicted value (PV) of the patients' mortality risk = 2.8655 + 0.4070 × IPA + 0.0048 × WBC + 0.0049 × pH - 0.0097 × PCO2 . Moreover, the survival function formula was obtained according to the Gamma model: S(x) = 1 - I (0.7507 x, -3.3773), where I is an incomplete gamma function. CONCLUSION Formula generated from parametric model may help to predict the prognosis of patients with severe COPD in ICU, and this method need to be evaluated in further studies. According to our formula, IPA is an important risk factor of mortality for patients with severe COPD in the ICU.
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Affiliation(s)
- Hangyong He
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongti Nanlu, Beijing 100020, China
| | - Ying Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongti Nanlu, Beijing 100020, China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No.8 Gongti Nanlu, Beijing 100020, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No.2 Yinghuadongjie, Chaoyang district Beijing 100029, China
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Sathish Babu M, Sreesoorya KP, Menon SK, Saha S, Srinivasan AR, Arul Vijaya Vani S, Reeta R, Kuzhandai Velu V. Putative Role of Cardio Metabolic Risk Among Poorly Controlled Asthmatics in South Indian Population. Indian J Clin Biochem 2016; 32:225-229. [PMID: 28428699 DOI: 10.1007/s12291-016-0595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022]
Abstract
Mortality and morbidity attributed to asthma remains to be the biggest nightmare worldwide. Hence, the study was aimed to compare the cardio metabolic risk factors as assessed by Body mass index (BMI), waist hip ratio (WHR), serum triacylglycerol and uric acid in well controlled and poorly controlled asthmatics and to correlate these parameters with the severity of asthma. A case control study was conducted on 90 subjects who were segregated into well controlled asthmatics (n = 30) and poorly controlled asthmatics (n = 30) who were diagnosed based on Global initiative for Asthma management guidelines and healthy volunteers (n = 30). Centrifuged fasting venous blood samples were used for biochemical analysis, pulmonary function test, BMI, and waist hip ratio (WHR) were measured. The statistical analysis was done using SPSS version 17. There was a significant increase in BMI, WHR, lipid profile, serum uric acid and decrease in forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC in poorly controlled asthmatics. There was a significant association between FEV1 and serum uric acid, BMI and Triacylgycerol in poorly controlled asthmatics. Poorly controlled asthmatics have greater risk of developing cardiometabolic problems. Serum uric acid can be used as one of the severity markers in asthma to assess cardio metabolic risk.
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Affiliation(s)
- Murugaiyan Sathish Babu
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
| | - K P Sreesoorya
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
| | - Surendra K Menon
- Department of Pulmonary Medicine, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607403 India
| | - Subiman Saha
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
| | - A R Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
| | - S Arul Vijaya Vani
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
| | - R Reeta
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
| | - V Kuzhandai Velu
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute Pillayarkuppam, Puducherry, 607402 India
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14
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Crosbie PAJ, Crosbie EJ, Aspinall-O'Dea M, Walker M, Harrison R, Pernemalm M, Shah R, Joseph L, Booton R, Pierce A, Whetton AD. ERK and AKT phosphorylation status in lung cancer and emphysema using nanocapillary isoelectric focusing. BMJ Open Respir Res 2016; 3:e000114. [PMID: 26918193 PMCID: PMC4762086 DOI: 10.1136/bmjresp-2015-000114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/02/2016] [Accepted: 01/04/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Emphysema is an independent risk factor for the development of lung cancer in smokers. Activation of oncogenic signalling proteins AKT and ERK by phosphorylation has an established role in the development of lung cancer and has also been implicated in the pathogenesis of emphysema. The aim of this study was to compare the protein level and phosphorylation status of AKT and ERK in paired lung cancer and emphysema tissue using a highly sensitive phosphoprotein analysis approach. METHODS An antibody-based, nanocapillary isoelectric focusing (cIEF) assay was used to determine the relative quantities and phosphorylation status of AKT and ERK in tumour and matched lung tissue from patients, with or without evidence of emphysema, undergoing curative resection for non-small cell lung cancer. RESULTS 20 patients with adenocarcinoma (n=9) or squamous cell carcinoma (n=11) of the lung were included (mean age 67.3 years (SD 7.5, range 47-80 years)), 12 were men and all were current (n=10) or former smokers (n=10). Paired macroscopically normal lung tissue was either histologically normal (n=7) or showed emphysema (n=13). Total and phosphorylated AKT levels were fourfold (p=0.0001) and fivefold (p=0.001) higher in tumour compared with matched lung, respectively. There was no correlation with tumour histology, stage or differentiation; however, total AKT signal in tumour was significantly correlated with fluorodeoxyglucose avidity on positron emission tomography-CT scan (r=0.53, p=0.035). Total ERK was not differentially expressed, but doubly phosphorylated (activated) ERK was threefold higher in emphysema (23.5%, SD 9.2) than either matched tumour (8.8%, SD 8.6) or normal lung tissue (8.3%, SD 9.0) and correlated with the histological severity of emphysema (p=0.005). CONCLUSIONS cIEF offers opportunities for quantifying subtle shifts in the phosphorylation status of oncoproteins in nanogram amounts of lung tissue. ERK activation is a feature of emphysema.
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Affiliation(s)
- Philip A J Crosbie
- North West Lung Centre, University Hospital of South Manchester, Manchester, UK; Stem Cell and Leukaemia Proteomics Laboratory, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma J Crosbie
- Institute of Cancer Sciences, University of Manchester, St Mary's Hospital , Manchester , UK
| | - Mark Aspinall-O'Dea
- Stem Cell and Leukaemia Proteomics Laboratory , University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - Michael Walker
- Stem Cell and Leukaemia Proteomics Laboratory , University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - Rebecca Harrison
- Manchester Medical School, University of Manchester , Manchester , UK
| | - Maria Pernemalm
- Department of Oncology and Pathology , Karolinska Institutet, SciLifeLab , Stockholm , Sweden
| | - Rajesh Shah
- Department of Thoracic Surgery , University Hospital of South Manchester , Manchester , UK
| | - Leena Joseph
- Department of Pathology , University Hospital of South Manchester , Manchester , UK
| | - Richard Booton
- North West Lung Centre, University Hospital of South Manchester , Manchester , UK
| | - Andrew Pierce
- Stem Cell and Leukaemia Proteomics Laboratory , University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - Anthony D Whetton
- Stem Cell and Leukaemia Proteomics Laboratory , University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
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15
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Abroug F, Dachraoui F, Ouanes-Besbes L. Our paper 20 years later: the unfulfilled promises of nebulised adrenaline in acute severe asthma. Intensive Care Med 2016; 42:429-431. [PMID: 26825950 DOI: 10.1007/s00134-016-4210-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Fekri Abroug
- Intensive Care Unit, CHU Fatouma Bourguiba, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP15, University of Monastir, Monastir, Tunisia.
| | - Fahmi Dachraoui
- Intensive Care Unit, CHU Fatouma Bourguiba, 5000, Monastir, Tunisia.,Research Laboratory LR12SP15, University of Monastir, Monastir, Tunisia
| | - Lamia Ouanes-Besbes
- Intensive Care Unit, CHU Fatouma Bourguiba, 5000, Monastir, Tunisia.,Research Laboratory LR12SP15, University of Monastir, Monastir, Tunisia
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16
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Kupiainen H, Kuokkanen M, Kontto J, Virtamo J, Salomaa V, Lindqvist A, Kilpeläinen M, Laitinen T. CHRNA5/CHRNA3 Locus Associates with Increased Mortality among Smokers. COPD 2016; 13:464-70. [PMID: 26751916 DOI: 10.3109/15412555.2015.1049260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Polymorphisms in the nicotinic acetylcholine receptor gene (CHRNA5/CHRNA3 locus) have been associated with several smoking related traits such as nicotine dependence, cigarette consumption, smoking cessation, lung cancer, and COPD. The aim of this candidate gene study was to study the locus among the Finnish COPD patients and long-term smokers with regard to COPD risk, smoking behavior, cancer, and all-cause mortality. Genotyping of rs1051730, the locus tagging SNP was done in two longitudinal cohorts: Finnish COPD patients (N = 575, 74% men) and long-term smokers, all men (N = 1911). Finnish population sample (N = 1730) was used as controls. The analyses were done using logistic and Cox regression. The main findings were that the minor allele increased the risk of COPD when compared to the Finnish population at large (OR = 1.4, 95% CI 1.2-1.7, p = 3.2 × 10-5). Homozygosity for the risk allele was associated in both cohorts with all-cause mortality (crude HR 2.2, 95% CI 1.2-3.8 and 1.3, 95% CI 1.1-1.5, respectively), with any type of cancer (crude OR 2.3, 95% CI 1.0-5.1) among the COPD patients and with the number of pack-years (crude OR 1.4, 95% CI 1.1-1.9) among the male smokers. CHRNA5/CHRNA3 locus tagged by rs1051730, which has been previously associated with several smoking related diseases was now shown to be associated also with increased all-cause mortality among long-term smokers with or without clinical COPD further emphasizing the clinical importance of the finding.
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Affiliation(s)
- Henna Kupiainen
- a Department of Pulmonary Diseases and Clinical Allergology , University of Turku and Turku University Hospital, Turku, Finland.,b Department of Pulmonary Diseases and Clinical Allergology , Helsinki University Central Hospital , Helsinki , Finland
| | - Mikko Kuokkanen
- b Department of Pulmonary Diseases and Clinical Allergology , Helsinki University Central Hospital , Helsinki , Finland.,c Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Kontto
- c Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Jarmo Virtamo
- c Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- c Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Ari Lindqvist
- b Department of Pulmonary Diseases and Clinical Allergology , Helsinki University Central Hospital , Helsinki , Finland
| | - Maritta Kilpeläinen
- a Department of Pulmonary Diseases and Clinical Allergology , University of Turku and Turku University Hospital, Turku, Finland
| | - Tarja Laitinen
- a Department of Pulmonary Diseases and Clinical Allergology , University of Turku and Turku University Hospital, Turku, Finland
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17
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Cook S, Quint JK, Vasiljev M, Leon DA. Self-reported symptoms of chronic cough and breathlessness in working-age men in the city of Izhevsk, Russia: associations with cardiovascular disease risk factors and comorbidities. BMJ Open Respir Res 2015; 2:e000104. [PMID: 26793315 PMCID: PMC4709862 DOI: 10.1136/bmjresp-2015-000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Very little is known about the prevalence of respiratory symptoms or their associations with other health conditions in Russia. METHODS Between 2008 and 2010, a sample of 983 men resident in Izhevsk, Russia, took part in a cross-sectional survey. Presence of respiratory symptoms was determined from self-report of chronic productive cough and breathlessness assessed using the British Medical Research Council (MRC) breathlessness scale. Self-reported physical and mental health were measured using the 12-Item Short-Form Health Survey (SF-12). Hypertension was assessed from mean blood pressure measured at the health check and/or self-reported use of antihypertensive medication. Other comorbidities were assessed from self-report. Logistic regression models were fitted assessing the association between respiratory symptoms and comorbidities. Linear regression models were fitted to investigate the association between respiratory symptoms and self-reported health scores. All models were adjusted for age, education and smoking status. RESULTS The age-standardised prevalence of cough and breathlessness was 20.9% (prevalence with breathlessness MRC grade 3 or above 3.7%). The majority of men with respiratory symptoms (87.3%) were current smokers. Cough and breathlessness were associated with substantially worse self-reported physical and mental health (test for trend with severity of breathlessness p<0.001). Those with chronic cough and grade 3 or above breathlessness had higher odds of having hypertension (OR 3.03; 95% CI 1.36 to 6.74), diabetes (OR 10.55; 95% CI 2.69 to 41.37), angina pectoris (OR 7.54; 95% CI 3.61 to 15.73), previous myocardial infarction (OR 7.61; 95% CI 2.10 to 27.4) and previous stroke (OR 6.61; 95% CI 1.75 to 23.34) compared with those without respiratory symptoms. CONCLUSIONS The prevalence of respiratory symptoms was high. Strong associations were found between respiratory symptoms and cardiovascular comorbidities. These are of particular importance given the extremely high level of cardiovascular disease mortality in Russia.
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Affiliation(s)
- Sarah Cook
- Department of Non Communicable Disease Epidemiology , London School of Hygiene & Tropical Medicine , London , UK
| | - Jennifer K Quint
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - David A Leon
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Arctic University of Norway, UiT, Tromsø, Norway
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18
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Harada T, Yamasaki A, Fukushima T, Hashimoto K, Takata M, Kodani M, Okazaki R, Takeda K, Watanabe M, Kurai J, Shimizu E. Causes of death in patients with asthma and asthma-chronic obstructive pulmonary disease overlap syndrome. Int J Chron Obstruct Pulmon Dis 2015; 10:595-602. [PMID: 25834418 PMCID: PMC4370684 DOI: 10.2147/copd.s77491] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background The administration of inhaled corticosteroids and worldwide usage of several asthma guidelines have improved asthma mortality. Elderly patients with asthma show high mortality rates, and may have several comorbidities, including overlap with chronic obstructive pulmonary disease (COPD). Among patients showing asthma overlapped with COPD (asthma–COPD overlap syndrome; ACOS), mortality is worse than for asthma alone. Therefore, we investigated comorbidities, malignancies, and causes of death in patients with asthma and ACOS. Methods This was a retrospective study. From January 2000 to March 2012, 650 patients were followed up at Tottori University Hospital. Medical records were reviewed to collect data regarding patient characteristics and comorbidities, and causes of death were recorded for patients who died during the study period. Results Eighty-seven patients died during the study period. The most frequent cause of death was malignancy. The proportion of malignant disease was 21.7% in all patients, 19.4% in patients with asthma alone, and 32.4% in patients with ACOS. One patient died from an asthma attack during this period. Conclusion The most frequent cause of death in patients with asthma and ACOS was malignant disease. It is necessary to control not only asthma but also comorbidities in patients with asthma, especially in those with ACOS.
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Affiliation(s)
- Tomoya Harada
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Akira Yamasaki
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Takehito Fukushima
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Kiyoshi Hashimoto
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Miki Takata
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Masahiro Kodani
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Ryota Okazaki
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Kenichi Takeda
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Masanari Watanabe
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Jun Kurai
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
| | - Eiji Shimizu
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan
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