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Talker L, Dogan C, Neville D, Lim RH, Broomfield H, Lambert G, Selim A, Brown T, Wiffen L, Carter J, Ashdown HF, Hayward G, Vijaykumar E, Weiss ST, Chauhan A, Patel AX. Diagnosis and Severity Assessment of COPD Using a Novel Fast-Response Capnometer and Interpretable Machine Learning. COPD 2024; 21:2321379. [PMID: 38655897 DOI: 10.1080/15412555.2024.2321379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/15/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Spirometry is the gold standard for COPD diagnosis and severity determination, but is technique-dependent, nonspecific, and requires administration by a trained healthcare professional. There is a need for a fast, reliable, and precise alternative diagnostic test. This study's aim was to use interpretable machine learning to diagnose COPD and assess severity using 75-second carbon dioxide (CO2) breath records captured with TidalSense's N-TidalTM capnometer. METHOD For COPD diagnosis, machine learning algorithms were trained and evaluated on 294 COPD (including GOLD stages 1-4) and 705 non-COPD participants. A logistic regression model was also trained to distinguish GOLD 1 from GOLD 4 COPD with the output probability used as an index of severity. RESULTS The best diagnostic model achieved an AUROC of 0.890, sensitivity of 0.771, specificity of 0.850 and positive predictive value (PPV) of 0.834. Evaluating performance on all test capnograms that were confidently ruled in or out yielded PPV of 0.930 and NPV of 0.890. The severity determination model yielded an AUROC of 0.980, sensitivity of 0.958, specificity of 0.961 and PPV of 0.958 in distinguishing GOLD 1 from GOLD 4. Output probabilities from the severity determination model produced a correlation of 0.71 with percentage predicted FEV1. CONCLUSION The N-TidalTM device could be used alongside interpretable machine learning as an accurate, point-of-care diagnostic test for COPD, particularly in primary care as a rapid rule-in or rule-out test. N-TidalTM also could be effective in monitoring disease progression, providing a possible alternative to spirometry for disease monitoring.
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Affiliation(s)
- Leeran Talker
- Department of Machine Learning, TidalSense, Cambridge, UK
| | - Cihan Dogan
- Department of Machine Learning, TidalSense, Cambridge, UK
| | - Daniel Neville
- Respiratory Department, Portsmouth Hospitals University NHS Foundation Trust, Portsmouth, UK
| | - Rui Hen Lim
- Department of Machine Learning, TidalSense, Cambridge, UK
| | | | - Gabriel Lambert
- Department of Clinical Operations, TidalSense, Cambridge, UK
| | - Ahmed Selim
- Department of Machine Learning, TidalSense, Cambridge, UK
| | - Thomas Brown
- Respiratory Department, Portsmouth Hospitals University NHS Foundation Trust, Portsmouth, UK
| | - Laura Wiffen
- Respiratory Department, Portsmouth Hospitals University NHS Foundation Trust, Portsmouth, UK
| | - Julian Carter
- Department of Engineering, TidalSense, Cambridge, UK
| | - Helen F Ashdown
- Department of Primary Care Health Sciences, NIHR Community Healthcare MedTech and IVD Cooperative, University of Oxford, Oxford, UK
| | - Gail Hayward
- Department of Primary Care Health Sciences, NIHR Community Healthcare MedTech and IVD Cooperative, University of Oxford, Oxford, UK
| | | | - Scott T Weiss
- Department of Medicine, Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA
| | - Anoop Chauhan
- Respiratory Department, Portsmouth Hospitals University NHS Foundation Trust, Portsmouth, UK
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Başa Akdoğan B, Koca Kalkan I, Köycü Buhari G, Özdedeoğlu Ö, Ateş H, Aksu K, Öner Erkekol F. What is the Best Way to Diagnose Possible Asthma Patients with Negative Bronchodilator Reversibility Tests? J Asthma Allergy 2024; 17:113-122. [PMID: 38410137 PMCID: PMC10895991 DOI: 10.2147/jaa.s437756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
Objective The best method and strategy for the diagnosis of asthma remains unclear, especially in patients with negative bronchodilator reversibility test (BDRT). In our study, we aimed to investigate the diagnostic yield of peak expiratory flow (PEF) variability for this patient group. Methods A total of 50 patients with suspected asthma, all with negative BDR test, were included in the study. Demographic information and symptoms were recorded and PEF variability was monitored for 2 weeks. Metacolinbronchial provocation test (mBPT) was performed. Asthma was diagnosed when PEF variability ≥20% and/or positive mBPT was observed. Results 30 of 50 patients were diagnosed with asthma. After 1 month, 17 patients were evaluated for treatment outcomes. The sensitivity and specificity of PEF variability for different cut-off values (≥20%, >15% and >10%) were 61.5-83.3, 88.5-62.5 and 100-16.7, respectively. One of the most important findings of our study was the absence of variable airflow limitation or airway hyper reactivity in 39% patients with a previous diagnosis of asthma. Multiple logistic regression analysis revealed that a low baseline FEF25-75 value was an independent predictive factor for the diagnosis of asthma (p= 0.05). Conclusion The most efficient diagnostic test for asthma is still unclear due to many factors. Our study is one of the few studies on this subject. Although current diagnostic recommendations generally recommend a PEF variability of 10% for the diagnosis of asthma, this threshold may not be appropriate for the BDR-negative patient group. Our results suggest using a threshold value of <15% for PEF variability when excluding asthma and ≥20% when confirming the diagnosis of asthma in patients with clinically suspected but unproven reversibility. Furthermore, FEF25-75 is considered to be an important diagnostic parameter that should be included in diagnostic recommendations for asthma.
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Affiliation(s)
- Buket Başa Akdoğan
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Ilkay Koca Kalkan
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Gözde Köycü Buhari
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Özlem Özdedeoğlu
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Hale Ateş
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Kurtuluş Aksu
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Ferda Öner Erkekol
- Department of Chest Diseases, Division of Immunology and Allergy, University of Health Sciences Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
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Shin S, Whitmore GA, Boulet LP, Boulay MÈ, Côté A, Bergeron C, Lemière C, Lougheed MD, Vandemheen KL, Alvarez GG, Mulpuru S, Aaron SD. Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing. BMC Pulm Med 2023; 23:496. [PMID: 38071285 PMCID: PMC10709915 DOI: 10.1186/s12890-023-02806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Some patients with asthma demonstrate normal spirometry and remain undiagnosed without further testing. OBJECTIVE To determine clinical predictors of asthma in symptomatic adults with normal spirometry, and to generate a tool to help clinicians decide who should undergo bronchial challenge testing (BCT). METHODS Using random-digit dialling and population-based case-finding, we recruited adults from the community with respiratory symptoms and no previous history of diagnosed lung disease. Participants with normal pre- and post-bronchodilator spirometry subsequently underwent BCT. Asthma was diagnosed in those with symptoms and a methacholine provocative concentration (PC20) of < 8 mg/ml. Sputum and blood eosinophils, and exhaled nitric oxide were measured. Univariate analyses identified potentially predictive variables, which were then used to construct a multivariable logistic regression model to predict asthma. Model sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated. RESULTS Of 132 symptomatic individuals with normal spirometry, 34 (26%) had asthma. Of those ultimately diagnosed with asthma, 33 (97%) answered 'yes' to a question asking whether they experienced cough, chest tightness or wheezing provoked by exercise or cold air. Other univariate predictors of asthma included female sex, pre-bronchodilator FEV1 percentage predicted, and percent positive change in FEV1 post bronchodilator. A multivariable model containing these predictive variables yielded an AUC of 0.82 (95% CI: 0.72-0.91), a sensitivity of 82%, and a specificity of 66%. The model was used to construct a nomogram to advise clinicians which patients should be prioritized for BCT. CONCLUSIONS Four readily available patient characteristics demonstrated a high sensitivity and AUC for predicting undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry. These characteristics can potentially help clinicians to decide which individuals with normal spirometry should be investigated with bronchial challenge testing. However, further prospective validation of our decision tool is required.
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Affiliation(s)
- Sheojung Shin
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Marie-Ève Boulay
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Andréanne Côté
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Céline Bergeron
- The Lung Center, Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Fiore M, Ricci M, Rosso A, Flacco ME, Manzoli L. Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis. J Clin Med 2023; 12:6978. [PMID: 38002593 PMCID: PMC10672453 DOI: 10.3390/jcm12226978] [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: 09/02/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This meta-analysis of observational studies aimed at estimating the overall prevalence of overdiagnosis and overtreatment in subjects with a clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MedLine, Scopus, Embase and Cochrane databases were searched, and random-effect meta-analyses of proportions were stratified by spirometry criteria (Global Initiative for COPD (GOLD) or Lower Limit of Normal (LLN)), and setting (hospital or primary care). Forty-two studies were included. Combining the data from 39 datasets, including a total of 23,765 subjects, the pooled prevalence of COPD overdiagnosis, according to the GOLD definition, was 42.0% (95% Confidence Interval (CI): 37.3-46.8%). The pooled prevalence according to the LLN definition was 48.2% (40.6-55.9%). The overdiagnosis rate was higher in primary care than in hospital settings. Fourteen studies, including a total of 8183 individuals, were included in the meta-analysis estimating the prevalence of COPD overtreatment. The pooled rates of overtreatment according to GOLD and LLN definitions were 57.1% (40.9-72.6%) and 36.3% (17.8-57.2%), respectively. When spirometry is not used, a large proportion of patients are erroneously diagnosed with COPD. Approximately half of them are also incorrectly treated, with potential adverse effects and a massive inefficiency of resources allocation. Strategies to increase the compliance to current guidelines on COPD diagnosis are urgently needed.
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Affiliation(s)
- Matteo Fiore
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Matteo Ricci
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Lamberto Manzoli
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
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Talker L, Neville D, Wiffen L, Selim AB, Haines M, Carter JC, Broomfield H, Lim RH, Lambert G, Weiss ST, Hayward G, Brown T, Chauhan A, Patel AX. Machine diagnosis of chronic obstructive pulmonary disease using a novel fast-response capnometer. Respir Res 2023; 24:150. [PMID: 37268935 DOI: 10.1186/s12931-023-02460-z] [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: 03/29/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Although currently most widely used in mechanical ventilation and cardiopulmonary resuscitation, features of the carbon dioxide (CO2) waveform produced through capnometry have been shown to correlate with V/Q mismatch, dead space volume, type of breathing pattern, and small airway obstruction. This study applied feature engineering and machine learning techniques to capnography data collected by the N-Tidal™ device across four clinical studies to build a classifier that could distinguish CO2 recordings (capnograms) of patients with COPD from those without COPD. METHODS Capnography data from four longitudinal observational studies (CBRS, GBRS, CBRS2 and ABRS) was analysed from 295 patients, generating a total of 88,186 capnograms. CO2 sensor data was processed using TidalSense's regulated cloud platform, performing real-time geometric analysis on CO2 waveforms to generate 82 physiologic features per capnogram. These features were used to train machine learning classifiers to discriminate COPD from 'non-COPD' (a group that included healthy participants and those with other cardiorespiratory conditions); model performance was validated on independent test sets. RESULTS The best machine learning model (XGBoost) performance provided a class-balanced AUROC of 0.985 ± 0.013, positive predictive value (PPV) of 0.914 ± 0.039 and sensitivity of 0.915 ± 0.066 for a diagnosis of COPD. The waveform features that are most important for driving classification are related to the alpha angle and expiratory plateau regions. These features correlated with spirometry readings, supporting their proposed properties as markers of COPD. CONCLUSION The N-Tidal™ device can be used to accurately diagnose COPD in near-real-time, lending support to future use in a clinical setting. TRIAL REGISTRATION Please see NCT03615365, NCT02814253, NCT04504838 and NCT03356288.
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Affiliation(s)
- Leeran Talker
- TidalSense Limited, 15a Vinery Rd, Cambridge, CB1 3DN, UK
| | - Daniel Neville
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Laura Wiffen
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Ahmed B Selim
- TidalSense Limited, 15a Vinery Rd, Cambridge, CB1 3DN, UK
| | - Matthew Haines
- TidalSense Limited, 15a Vinery Rd, Cambridge, CB1 3DN, UK
| | | | | | - Rui Hen Lim
- TidalSense Limited, 15a Vinery Rd, Cambridge, CB1 3DN, UK
| | | | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, NIHR Community Healthcare MedTech and IVD Cooperative, University of Oxford, Oxford, UK
| | - Thomas Brown
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Anoop Chauhan
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Ameera X Patel
- TidalSense Limited, 15a Vinery Rd, Cambridge, CB1 3DN, UK.
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Aptekarev T, Sokolovsky V, Furman E, Kalinina N, Furman G. Application of deep learning for bronchial asthma diagnostics using respiratory sound recordings. PeerJ Comput Sci 2023; 9:e1173. [PMID: 37346621 PMCID: PMC10280228 DOI: 10.7717/peerj-cs.1173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/08/2022] [Indexed: 06/23/2023]
Abstract
Methods of computer-assisted diagnostics that utilize deep learning techniques on recordings of respiratory sounds have been developed to diagnose bronchial asthma. In the course of the study an anonymous database containing audio files of respiratory sound recordings of patients suffering from different respiratory diseases and healthy volunteers has been accumulated and used to train the software and control its operation. The database consists of 1,238 records of respiratory sounds of patients and 133 records of volunteers. The age of tested persons was from 18 months to 47 years. The sound recordings were captured during calm breathing at four points: in the oral cavity, above the trachea, at the chest, the second intercostal space on the right side, and at the point on the back. The developed software provides binary classifications (diagnostics) of the type: "sick/healthy" and "asthmatic patient/non-asthmatic patient and healthy". For small test samples of 50 (control group) to 50 records (comparison group), the diagnostic sensitivity metric of the first classifier was 88%, its specificity metric -86% and accuracy metric -87%. The metrics for the classifier "asthmatic patient/non-asthmatic patient and healthy" were 92%, 82%, and 87%, respectively. The last model applied to analyze 941 records in asthmatic patients indicated the correct asthma diagnosis in 93% of cases. The proposed method is distinguished by the fact that the trained model enables diagnostics of bronchial asthma (including differential diagnostics) with high accuracy irrespective of the patient gender and age, stage of the disease, as well as the point of sound recording. The proposed method can be used as an additional screening method for preclinical bronchial asthma diagnostics and serve as a basis for developing methods of computer assisted patient condition monitoring including remote monitoring and real-time estimation of treatment effectiveness.
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Affiliation(s)
- Theodore Aptekarev
- Physics Department, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Evgeny Furman
- Department of Faculty and Hospital Pediatrics, Perm State Medical University named after Academician E. A. Wagner, Perm, Russia
| | - Natalia Kalinina
- Department of Faculty and Hospital Pediatrics, Perm State Medical University named after Academician E. A. Wagner, Perm, Russia
| | - Gregory Furman
- Physics Department, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Education Department, Tel-Hai College, Tel-Hai, Upper Galilee, Israel
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Prevalence of Spirometry Testing among Patients with Asthma and COPD in German General Practices. Healthcare (Basel) 2022; 10:healthcare10122570. [PMID: 36554093 PMCID: PMC9778268 DOI: 10.3390/healthcare10122570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The goal of this study was to estimate the prevalence of spirometry testing among patients with asthma and chronic obstructive pulmonary disease (COPD) in general practices (GPs) in Germany. This retrospective cross-sectional study was based on data from the Disease Analyzer database (IQVIA), This retrospective cross-sectional study included all patients with at least one confirmed asthma or COPD diagnosis in one of those 50 general practices in Germany between January 2020, and January 2021, as well as at least one visit to these general practices between January 2021, and January 2022. The main outcomes of the study aimed to ascertain the proportion of spirometry testing among asthma and COPD patients between January 2021, and January 2022, overall, and separately, in men, women, six age groups (≤30, 31−40, 41−50, 51−60, 61, 70, >70), and patients who received at least one prescription of anti-asthma or anti-COPD drugs. This study included 8835 patients with asthma only, 5597 with COPD only, and 1897 with both asthma and COPD diagnoses. Of these, 27.2% of COPD patients, 7% of asthma patients, and 54.7% of asthma + COPD patients, received spirometry testing during the study period. Among COPD and asthma + COPD patients, the prevalence of spirometry testing was much higher in women than in men (COPD: 31.6% vs. 23.2%; asthma + COPD: 59.6% vs. 46.3%) and much higher in treated than in non-treated patients (COPD: 31.7% vs. 15.0%; asthma + COPD: 57.5% vs. 27.8%). The prevalence of spirometry testing was relatively low among COPD and asthma patients followed in GP practices, but usually higher in female patients, treated patients, and patients suffering from both asthma and COPD.
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Airway Obstruction in Primary Care Patients: Need for Implementing Spirometry Use. Diagnostics (Basel) 2022; 12:diagnostics12112680. [PMID: 36359521 PMCID: PMC9689256 DOI: 10.3390/diagnostics12112680] [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: 09/09/2022] [Revised: 10/23/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: To detect early airway obstruction in an adult primary care setting. (2) Methods: Seventeen general practitioners (GP) were involved. A total of 912 patients consulting their GPs over 40 years were recruited: 583 of them (323M) agreed to perform/undergo all the procedures: respiratory questionnaire, mMRC questionnaire, and spirometry. We identified four subgroups: physician COPD patients; physician asthma patients; asthma-COPD overlap syndrome patients; and no respiratory diagnosis subjects, on the basis of physician diagnosis. For screening purposes, an FEV1/FVC < 70% was considered a marker of airway obstruction (AO). (3) Results: Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% showed airway obstruction: 26% mild, 56% moderate, 17% severe, and 1% very severe. In obstructed subjects, those reporting neither respiratory symptoms nor a physician’s respiratory diagnosis were 60% level I; 43% level II; 44% level III; and none level IV. Wheezing (p < 0.001), sputum (p = 0.01), older age (p < 0.0001), and male gender (p = 0.002) were the best predictors of airway obstruction. (4) Conclusions: A high prevalence of AO was found. In AO we found a high prevalence of subjects without respiratory symptoms or respiratory chronic diagnosis. Airway obstruction was predicted by the presence of wheezing, sputum, older age, and male gender.
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Enayat J, Mahdaviani SA, Rekabi M, Ghaini M, Eslamian G, Fallahi M, Ghazvineh S, Sharifinejad N, Raoufy MR, Velayati AA. Respiratory pattern complexity in newly-diagnosed asthmatic patients. Respir Physiol Neurobiol 2022; 300:103873. [PMID: 35217233 DOI: 10.1016/j.resp.2022.103873] [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: 10/16/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The intensity of respiratory symptoms and expiratory airflow limitations in asthma fluctuate over time. Some studies have reported variable complexity of the respiratory patterns in asthmatic patients. Thus, we conducted a novel study to assess the correlation between asthma severity and breathing pattern dynamics in newly-diagnosed asthmatic patients. METHODS A total of 20 newly-diagnosed asthmatic patients (7 male, 13 female) and 20 healthy cases (11 male, 9 female) were included. The respiratory patterns of all participants and the asthma severity for asthmatic patients were measured using a spirometer (before and after a bronchodilator exposure) and airflow recorder, respectively. The peak-to-peak intervals and the amplitude of peaks were considered as the inter-breath interval (IBI) and lung volume (LV) series. The Detrended Fluctuation Analysis (DFA), Sample Entropy (SampEn), Multi-scale Entropy (MSE), short-term (SD1) and long-term (SD2) variability, and IBI and LV Cross-Sample Entropy of the respiratory pattern dynamics were calculated using MATLAB (Mathwork, USA). RESULTS Asthma patients showed notable increase in the average of sample entropy in both IBI and LV parameters (p = 0.025 and p = 0.018, respectively) and also decreased synchronization between IBI and LV (p = 0.042). The multi-scale sample entropy of both IBI and LV was significantly higher in asthmatic patients (p < 0.05). Furthermore, SD1 and SD2 were higher in the patients with asthma (p < 0.05). Significant correlations were detected between spirometric (forced expiratory flow (FEF) change, pre FEF, pre forced expiratory volume in one second (FEV1) / forced vital capacity (FVC), FVC change) and respiratory pattern (mean-IBI, mean-LV, mean-respiratory rate (RR), coefficient of variation (CV)-IBI, CV-LV, cross-sample entropy) parameters (p < 0.05). Furthermore, we identified a negative correlation between CV of IBI and asthma severity (r = -0.52, p = 0.021). CONCLUSION Here, we took a novel approach and observed increased irregularity (more complexity) in the breathing pattern of patients newly-diagnosed with asthma. Remarkable correlations were detected between breathing complexity markers and spirometric indices along with disease severity in asthmatic patients. Thus, our data suggests respiratory pattern indices could be utilized as an indicator of asthma and its severity. However, more clinical data are required to support this conclusion.
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Affiliation(s)
- Javad Enayat
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Rekabi
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Ghaini
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Eslamian
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mazdak Fallahi
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Ghazvineh
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Niusha Sharifinejad
- Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ali Akbar Velayati
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bhati P, Anand P, Das J, Kommi K, Sen S, Hussain ME, Khanna GL. Predictors of physical performance in national level male Kho Kho players: a cross-sectional analysis. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Accuracy of portable spirometers in the diagnosis of chronic obstructive pulmonary disease A meta-analysis. NPJ Prim Care Respir Med 2022; 32:15. [PMID: 35440665 PMCID: PMC9019105 DOI: 10.1038/s41533-022-00275-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/11/2022] [Indexed: 12/03/2022] Open
Abstract
Portable spirometers has been approved for diagnosing chronic obstructive pulmonary disease (COPD). However, their diagnostic accuracy has not been reviewed. Therefore, the purpose of this study was to systematically evaluate the diagnostic value of portable spirometers in detecting COPD. A comprehensive literature search for relevant studies was conducted in PubMed, Embase, CNKI, Wan Fang, and Web of Science databases. Pooled sensitivity, specificity, summary receiver operating characteristic (SROC), area under the curve (AUC), and other related indices were calculated using the bivariate mixed-effect model. Subgroup analysis was performed to explore the source of heterogeneity. Thirty one studies were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR), SROC, and AUC of the SROC of portable spirometers were 0.85 (0.81–0.88), 0.85 (0.81–0.88), 5.6 (4.4–7.3), 0.18 (0.15–0.22), 31 (21–46) and 0.91 (0.89–0.94), respectively. Among the three commonly used types of portable spirometers, the accuracy of PIKO-6 was higher (0.95) than that of COPD-6 (0.91) and PEF (0.82). Subgroup analysis indicated that the accuracy of a multi-indices portable spirometer was higher than that of a single-index one (P < 0.05). In addition, portable spirometry performed by professional technicians in tertiary hospitals was more accurate than for those conducted by trained technicians in primary care facilities and communities (P < 0.05). Moreover, the accuracy of studies conducted in developing country was superior to developed country (P < 0.05). Portable spirometers have high accuracy in the diagnosis of COPD. Multi-index COPD-6 and PIKO-6 displayed higher accuracy than others. Standardized training of instrument operators should be considered to achieve reliable results.
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12
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Ortiz-Prado E, Encalada S, Mosquera J, Simbaña-Rivera K, Gomez-Barreno L, Duta D, Ochoa I, Izquierdo-Condoy JS, Vasconez E, Burgos G, Calvopiña M, Viscor G. A comparative analysis of lung function and spirometry parameters in genotype-controlled natives living at low and high altitude. BMC Pulm Med 2022; 22:100. [PMID: 35313848 PMCID: PMC8939107 DOI: 10.1186/s12890-022-01889-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background The reference values for lung function are associated to anatomical and lung morphology parameters, but anthropometry it is not the only influencing factor: altitude and genetics are two important agents affecting respiratory physiology. Altitude and its influence on respiratory function has been studied independently of genetics, considering early and long-term acclimatization. Objective The objective of this study is to evaluate lung function through a spirometry study in autochthonous Kichwas permanently living at low and high-altitude. Methodology A cross-sectional study of spirometry differences between genetically matched lowland Kichwas from Limoncocha (230 m) at Amazonian basin and high-altitude Kichwas from Oyacachi (3180 m) in Andean highlands. The sample size estimates permitted to recruited 118 patients (40 men and 78 women) from Limoncocha and 95 (39 men and 56 women) from Oyacachi. Chi-square method was used to analyze association or independence of categorical variables, while Student’s t test was applied to comparison of means within quantitative variables. ANOVA, or in the case that the variables didn’t meet the criteria of normality, Kruskal Wallis test were used to compare more than two groups. Results The FVC and the FEV1 were significantly greater among highlanders than lowlanders (p value < 0.001), with a proportion difference of 15.2% for men and 8.5% for women. The FEV1/FVC was significantly higher among lowlanders than highlanders for men and women. A restrictive pattern was found in 12.9% of the participants. Conclusion Residents of Oyacachi had greater FVC and FEV1 than their peers from Limoncocha, a finding physiologically plausible according to published literature. Lung size and greater ventilatory capacities could be an adaptive mechanism developed by the highlander in response to hypoxia. Our results support the fact that this difference in FVC and FEV1 is a compensatory mechanism towards lower barometric and alveolar partial pressure of oxygen pressure.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador. .,Department of Cell Biology, Physiology and Immunology, Universidad de Barcelona, Barcelona, Spain.
| | - Sebastián Encalada
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Johanna Mosquera
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Katherine Simbaña-Rivera
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Lenin Gomez-Barreno
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Diego Duta
- Limoncocha Community Health Unit, Limoncocha, Ecuador
| | - Israel Ochoa
- Oyacachi Community Health Unit, Oyacachi, Ecuador
| | - Juan S Izquierdo-Condoy
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Eduardo Vasconez
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - German Burgos
- Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | - Manuel Calvopiña
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Calle de los Colimes y Avenida De los Granados, 170137, Quito, Ecuador
| | - Ginés Viscor
- Department of Cell Biology, Physiology and Immunology, Universidad de Barcelona, Barcelona, Spain
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13
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Gelman A, Furman E, Kalinina N, Malinin S, Furman G, Sheludko V, Sokolovsky V. Computer-Aided Detection of Respiratory Sounds in Bronchial Asthma Patients Based on Machine Learning Method. Sovrem Tekhnologii Med 2022; 14:45-51. [PMID: 37181833 PMCID: PMC10171063 DOI: 10.17691/stm2022.14.5.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Indexed: 05/16/2023] Open
Abstract
The aim of the study is to develop a method for detection of pathological respiratory sound, caused by bronchial asthma, with the aid of machine learning techniques. Materials and Methods To build and train neural networks, we used the records of respiratory sounds of bronchial asthma patients at different stages of the disease (n=951) aged from several months to 47 years old and healthy volunteers (n=167). The sounds were recorded with calm breathing at four points: at the oral cavity, above the trachea, on the chest (second intercostal space on the right side), and at a point on the back. Results The method developed for computer-aided detection of respiratory sounds allows to diagnose sounds typical for bronchial asthma in 89.4% of cases with 89.3% sensitivity and 86.0% specificity regardless of sex and age of the patients, stage of the disease, and the point of sound recording.
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Affiliation(s)
- A. Gelman
- Laboratory Engineer, Department of Physics; Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel
| | - E.G. Furman
- Professor, Corresponding Member of Russian Academy of Sciences, Head of Faculty and Hospital Pediatrics Department; Perm State Medical University named after Academician E.A. Wagner, 26 Petropavlovskaya St., Perm, 614990, Russia
- Corresponding author: Evgeny G. Furman, e-mail:
| | - N.M. Kalinina
- Resident; Perm State Medical University named after Academician E.A. Wagner, 26 Petropavlovskaya St., Perm, 614990, Russia
| | - S.V. Malinin
- Researcher; Perm State Medical University named after Academician E.A. Wagner, 26 Petropavlovskaya St., Perm, 614990, Russia
| | - G.B. Furman
- Professor, Department of Physics; Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel
| | - V.S. Sheludko
- Leading Researcher, Central Scientific Research Laboratory; Perm State Medical University named after Academician E.A. Wagner, 26 Petropavlovskaya St., Perm, 614990, Russia
| | - V.L. Sokolovsky
- Professor, Department of Physics; Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel
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14
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Attanasi M, Sferrazza Papa S, Porreca A, Sferrazza Papa GF, Di Filippo P, Piloni F, Dodi G, Sansone F, Di Pillo S, Chiarelli F. Use of lung ultrasound in school-aged children with wheezing. Front Pediatr 2022; 10:926252. [PMID: 36699291 PMCID: PMC9869023 DOI: 10.3389/fped.2022.926252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is limited information available on fast and safe bedside tools that could help clinicians establish whether the pathological process underlying cases of wheezing is due to asthmatic exacerbation, asthmatic bronchitis, or pneumonia. The study's aim was to characterize Lung Ultrasound (LUS) in school-aged children with wheezing and evaluate its use for their follow-up treatment. MATERIALS AND METHODS We carried out a cross-sectional study involving 68 consecutive outpatients (mean age 9.9 years) with wheezing and suggestive signs of an acute respiratory infection. An expert sonographer, blinded to all subject characteristics, clinical course, and the study pediatrician's diagnosis, performed an LUS after spirometry and before BDT. The severity of acute respiratory symptoms was determined using the Pediatric Respiratory Assessment Measure (PRAM) score. RESULTS The LUS was positive in 38.2% (26/68) of patients [12 (46.1%) with multiple B-lines, 24 (92.3%) with consolidation, and 22 (84.6%) with pleural abnormalities]. In patients with pneumonia, asthmatic bronchitis, and asthma, the percentages of those patients with a positive LUS were 100%, 57.7%, and 0%, respectively. Of note, patients with a positive LUS were associated with an increased need for hospital admission (30.8% vs. 2.4%, p = 0.001), administration of oxygen therapy (14.6% vs. 0%, p = 0.009), oral corticosteroids (84.6% vs. 19.0%, p < 0.001), and antibiotics (88.5% vs. 11.9%, p < 0.001); and a higher median value of PRAM score (4.0 (2.0-7.0) vs. 2.0 (1.0-5.0); p < 0.001). CONCLUSIONS Our findings would suggest the use of LUS as a safe and cheap tool used by clinicians to define the diagnosis of school-aged children with wheezing of unknown causes.
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Affiliation(s)
- Marina Attanasi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Simone Sferrazza Papa
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe F Sferrazza Papa
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Paola Di Filippo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesca Piloni
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Giulia Dodi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Sansone
- 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
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15
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van den Berg OE, Shaddock EJ, Stacey SL, Feldman C, Barth RE, Grobbee DE, Venter WDF, Klipstein-Grobusch K, Vos AG. The influence of HIV infection and antiretroviral treatment on pulmonary function in individuals in an urban setting in sub-Saharan Africa. South Afr J HIV Med 2021; 22:1312. [PMID: 34858656 PMCID: PMC8603101 DOI: 10.4102/sajhivmed.v22i1.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background With the roll-out of antiretroviral treatment (ART), the life expectancy of people with HIV and, hence, morbidity from non-communicable diseases, including pulmonary diseases, have increased. Objectives This research study aims to investigate whether HIV infection and ART use are associated with pulmonary function, given the high frequency of pulmonary infections, including tuberculosis (TB), associated with HIV. Method Adults living with HIV (ART-naïve, on first- or second-line ART), and age and sex matched HIV-negative controls were included in a cross-sectional study in Johannesburg, South Africa. Spirometry was performed to determine lung function, measuring the forced expiratory volume in one second (FEV1), the forced vital capacity (FVC) and the FEV1/FVC ratio before (pre), and after (post), short-acting bronchodilator. The association of HIV infection and ART use with pulmonary function was analysed using linear regression models, adjusting for age, gender, body surface area (BSA), employment, education, smoking and TB. Results Overall, 548 participants (62% women) were included with a mean age of 38 (standard deviation [s.d.] 9.5) years. No effect of HIV or ART on post-FEV1 was observed in adjusted analysis. Additional adjustment for TB resulted in a higher post-FEV1 in participants on ART compared with HIV-negative participants, whereas TB was associated with a lower FEV1. No effect of HIV and ART on post-FEV1/FVC was observed. Conclusion HIV infection and ART use were not associated with reduced pulmonary function in this urban African population. Tuberculosis showed a mediating effect on the association between HIV, ART and pulmonary function.
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Affiliation(s)
- Oda E van den Berg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erica J Shaddock
- Charlotte Maxeke Johannesburg Academic Hospital, Division of Pulmonology and Critical Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah L Stacey
- Charlotte Maxeke Johannesburg Academic Hospital, Division of Pulmonology and Critical Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital, Division of Pulmonology and Critical Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roos E Barth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem D F Venter
- Ezintsha, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alinda G Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Ezintsha, University of the Witwatersrand, Johannesburg, South Africa
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16
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Raherison-Semjen C, Guilleminault L, Billiart I, Chenivesse C, De Oliveira A, Izadifar A, Lorenzo A, Nocent C, Oster JP, Padovani M, Perez T, Russier M, Steinecker M, Didier A. [Update of the 2021 recommendations for the management and follow-up of adult asthmatic patients under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2021; 38:1048-1083. [PMID: 34799211 DOI: 10.1016/j.rmr.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- C Raherison-Semjen
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France.
| | - L Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity), INSERM, UMR1291, CNRS UMR5051, université Toulouse III, CRISALIS F-CRIN, Toulouse, France
| | | | - C Chenivesse
- CHRU de Lille, service de pneumo-allergologie, 59000 Lille, France
| | - A De Oliveira
- Sorbonne université, département de médecine générale, Paris, France
| | - A Izadifar
- Département de pneumologie, centre cardiologique du Nord, Saint-Denis, France
| | - A Lorenzo
- Sorbonne université, département de médecine générale, Paris, France
| | - C Nocent
- CHG Côte Basque, Bayonne, France
| | - J P Oster
- Service de pneumologie, centre hospitalier Louis-Pasteur, Colmar, France
| | - M Padovani
- Espace Santé Ii, La Seyne-sur-Mer, France
| | - T Perez
- CHRU de Lille, service d'explorations fonctionnelles, 59000 Lille, France
| | - M Russier
- Service de pneumo-allergologie, CHR Orléans, Orléans, France
| | - M Steinecker
- Sorbonne université, département de médecine générale, Paris, France
| | - A Didier
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France; Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
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17
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Jordon LH, Gore RB, Rusk RA, Knox-Brown B, Marciniak SJ. The role of impulse oscillometry in the management of asthma when forced expiratory maneuvers are contraindicated: case series and literature review. J Asthma 2021; 59:1577-1583. [PMID: 34112043 DOI: 10.1080/02770903.2021.1941088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: The impulse oscillometry system (IOS) provides an alternative method of lung function testing for patients in whom forced expiratory manoeuvres are contraindicated, such as those with inherited vascular connective tissue disorders. Here we examine the role of IOS in the diagnosis and monitoring of asthma in such patients through a clinical case series and literature review.Methods: The clinical case series comprised of data from 12 patients with inherited connective tissue disorders representing 32 clinical encounters. Of these, 11 encounters were for asthma diagnosis and 21 were for asthma monitoring. Symptoms, exhaled nitric oxide (FeNO) and IOS were assessed at each encounter.Results: In the clinical case series, 5 of 6 patients with likely asthma (as determined by physician review and exhaled nitric oxide testing) had abnormal IOS parameters compared with 0 of 5 of those with unlikely asthma. In the monitoring group, 11 encounters resulted in treatment escalation (demonstrating suboptimal control), and 8 resulted in no change to treatment (good control). Six of 11 of those with suboptimal control had abnormalities in ≥3 IOS parameters, with R5 and R5-20 most frequently affected. Only 1 of 8 of those with good control had abnormalities in ≥3 IOS parameters.Conclusions: IOS can be used as an alternative to conventional lung function testing to support the diagnosis and monitoring of asthma when forced expiratory manoeuvres are contraindicated. Larger studies are required to establish severity and treatment escalation thresholds and provide clearer comparisons with spirometry values.
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Affiliation(s)
- Louise H Jordon
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Robin B Gore
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Rosemary A Rusk
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ben Knox-Brown
- Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Stefan J Marciniak
- Department of Cardiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Respiratory Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,Cambridge Institute for Medical Research (CIMR), University of Cambridge, Cambridge, UK
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18
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Papadopoulos NG, Miligkos M, Xepapadaki P. A Current Perspective of Allergic Asthma: From Mechanisms to Management. Handb Exp Pharmacol 2021; 268:69-93. [PMID: 34085124 DOI: 10.1007/164_2021_483] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Asthma is a result of heterogenous, complex gene-environment interactions with variable clinical phenotypes, inflammation, and remodeling. It affects more than 330 million of people worldwide throughout their educational and working lives, while exacerbations put a heavy cost/burden on productivity. Childhood asthma is characterized by a predominance of allergic sensitization and multimorbidity, while in adults polysensitization has been positively associated with asthma occurrence. Despite significant improvements in recent decades, asthma management remains challenging. Recently, a group of specialists suggested that the term "asthma" should be preferably used as a descriptive term for symptoms. Moreover, type 2 inflammation has emerged as a pivotal disease mechanism including overlapping endotypes of specific IgE production, while type 2-low asthma includes several disease endotypes. Optimal asthma control requires both appropriate pharmacological interventions, tailored to each patient, as well as trigger avoidance measures. Regular monitoring for maintenance of symptom control, preservation of lung function, and detection of treatment-related adverse effects are warranted. Allergen-specific immunotherapy and the advent of new targeted therapies for patients with difficult to control asthma offer diverse treatment options. The current review summarizes up-to-date knowledge on epidemiology, definitions, diagnosis, and current therapeutic strategies.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece. .,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - Michael Miligkos
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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19
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Jankrift N, Kellerer C, Magnussen H, Nowak D, Jörres RA, Schneider A. The role of clinical signs and spirometry in the diagnosis of obstructive airway diseases: a systematic analysis adapted to general practice settings. J Thorac Dis 2021; 13:3369-3382. [PMID: 34277033 PMCID: PMC8264721 DOI: 10.21037/jtd-20-3539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
Background In general practice (GP), the diagnosis of obstructive airway diseases much relies on diagnostic questions, in view of the limited availability of lung function. We systematically assessed the relative importance of such questions for diagnosing asthma and chronic obstructive pulmonary disease (COPD), either without or with information from spirometry. Methods We used data obtained in a pulmonary practice to ensure the validity of diagnoses and assessments. Subjects with a diagnosis of COPD (n=260), or asthma (n=433), or other respiratory diseases (n=230), and subjects without respiratory diseases (n=364, controls) were included. The diagnostic questions comprised eight items, covering smoking history, self-attributed allergic rhinitis, dyspnea, cough, phlegm and wheeze. Optionally standard parameters of the flow-volume-curve were included. Decision trees for the diagnosis of COPD and asthma were constructed, moreover a probabilistic diagnostic network based on the results of path analyses describing the relationship between variables. Results In the decision trees, age, sex, current smoking, wheezing, dyspnea upon mild exertion, self-attributed allergic rhinitis, phlegm, forced expiratory volume in one second (FEV1), and expiratory flow rates were relevant, depending on the diagnostic comparison, while cough, dyspnea upon strong exertion and ex-smoker status were not relevant. In contrast, the probabilistic network for the diagnosis of COPD and asthma versus controls incorporated all diagnostic questions, i.e., dyspnea upon mild or strong exertion, current smoking, ex-smoking, wheezing, cough and phlegm but from spirometry only FEV1. Depending on the individual pattern, the probability for COPD could raise from 25% to 81%, while the diagnostic gain for asthma was lower. Conclusions The study developed simple diagnostic algorithms for asthma and COPD that take into account the relative importance of clinical signs and history, as well as spirometric data if available. The diagnostic accuracy was especially high for COPD. These algorithms may be helpful as a starting point in the standardisation of diagnostic strategies in GP practices. Trial registration The study is registered under DRKS00013935 at German Clinical Trials Register (DRKS, Date of registration 01/03/2018).
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Affiliation(s)
- Neele Jankrift
- Technical University of Munich, School of Medicine, Institute of General Practice and Health Services Research, Munich, Germany
| | - Christina Kellerer
- Technical University of Munich, School of Medicine, Institute of General Practice and Health Services Research, Munich, Germany.,Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Comprehensive Pneumology Center (CPC) Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Helgo Magnussen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Comprehensive Pneumology Center (CPC) Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Rudolf A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, Comprehensive Pneumology Center (CPC) Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Antonius Schneider
- Technical University of Munich, School of Medicine, Institute of General Practice and Health Services Research, Munich, Germany
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20
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Almeshari MA, Stockley J, Sapey E. The diagnosis of asthma. Can physiological tests of small airways function help? Chron Respir Dis 2021; 18:14799731211053332. [PMID: 34693751 PMCID: PMC8543738 DOI: 10.1177/14799731211053332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Asthma is a common, chronic, and heterogeneous disease with a global impact and substantial economic costs. It is also associated with significant mortality and morbidity and the burden of undiagnosed asthma is significant. Asthma can be difficult to diagnose as there is no gold standard test and, while spirometry is central in diagnosing asthma, it may not be sufficient to confirm or exclude the diagnosis. The most commonly reported spirometric measures (forced expiratory volume in one second (FEV1) and forced vital capacity assess function in the larger airways. However, small airway dysfunction is highly prevalent in asthma and some studies suggest small airway involvement is one of the earliest disease manifestations. Moreover, there are new inhaled therapies with ultrafine particles that are specifically designed to target the small airways. Potentially, tests of small airways may more accurately diagnose early or mild asthma and assess the response to treatment than spirometry. Furthermore, some assessment techniques do not rely on forced ventilatory manoeuvres and may, therefore, be easier for certain groups to perform. This review discusses the current evidence of small airways tests in asthma and future research that may be needed to further assess their utility.
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Affiliation(s)
- Mohammed A Almeshari
- Rehabilitation Health Sciences
Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Institute of Inflammation and
Ageing, University of
Birmingham, Birmingham, UK
- Mohammed A. Almeshari, Institute of
Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B152TT,
UK.
| | - James Stockley
- Department of Lung Function and
Sleep, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and
Ageing, University of
Birmingham, Birmingham, UK
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Dziewa I, Craig T, Al-Shaikhly T. How Frequently Is Asthma Objectively Demonstrated before Starting a Biologic? Quality Assessment of a Group Practice of Allergists and Immunologists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249482. [PMID: 33352823 PMCID: PMC7766929 DOI: 10.3390/ijerph17249482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022]
Abstract
Worldwide, asthma-related healthcare cost remains a major burden. Individuals with severe asthma account for 50% of that cost. Although they are expensive, biologics such as anti-IL5 and anti-IgE agents promise cost-effectiveness when judiciously used to decrease asthma-related hospitalization and the debilitating side effects of systemic corticosteroids. Before considering biologics to treat patients with asthma, current guidelines recommend confirmation of asthma and control of comorbid diseases. Diagnostic confirmation of asthma can be challenging among individuals with severe asthma. In this quality assessment study, we determined the frequency of objective asthma confirmation and addressing of comorbidities prior to starting biologics at a group practice of allergists and immunologists. We surveyed our specialty providers to understand habit(s) leading to the observed results. We identified 40 adult patients who started on biologic modifiers for asthma over the past 5 years. Only 58% of these patients had a proper diagnosis of asthma. Providers underutilized several diagnostic methods that may prove useful in confirming asthma diagnosis in this patient population. The factors contributing to poor asthma control were rarely addressed. A sense of urgency to initiate biologics was the primary reason for the observed results. Further interventions are needed to improve asthma diagnosis and management prior to the initiation of biologic therapeutics.
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Affiliation(s)
- Iwona Dziewa
- Section of Allergy and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA;
- Correspondence:
| | - Timothy Craig
- Section of Allergy and Immunology, Department of Medicine and Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA;
| | - Taha Al-Shaikhly
- Section of Allergy and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA;
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Almeshari MA, Alobaidi NY, Edgar RG, Stockley J, Sapey E. Physiological tests of small airways function in diagnosing asthma: a systematic review. BMJ Open Respir Res 2020; 7:e000770. [PMID: 33371011 PMCID: PMC7754643 DOI: 10.1136/bmjresp-2020-000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Asthma is a common, heterogeneous disease that is characterised by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use spirometric measures for asthma assessment. This systematic review aimed to assess whether the most commonly reported tests of small airways function could contribute to the diagnosis of asthma. METHODS Standard systematic review methodology was used, and a range of electronic databases was searched (Embase, MEDLINE, CINAHL, CENTRAL, Web of Science, DARE). Studies that included physiological tests of small airways function to diagnose asthma in adults were included, with no restrictions on language or date. The risk of bias and quality assessment tools used were Agency for Healthcare Research and Quality tool for cross-sectional studies and Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic test accuracy (DTA) studies. RESULTS 7072 studies were identified and 10 studies met review criteria. 7 included oscillation techniques and 5 included maximal mid-expiratory flow (MMEF). Studies were small and of variable quality. In oscillometry, total resistance (R5) and reactance at 5 Hz (X5) was altered in asthma compared with healthy controls. The percentage predicted of MMEF was lower in patients with asthma compared with controls in all studies and lower than the % predicted forced expiratory volume in 1 s. In DTA of oscillometry, R5 showed a sensitivity between 69% and 72% and specificity between 61% and 86%. CONCLUSION There were differences in the results of physiological tests of small airway function in patients with asthma compared with controls. However, studies are small and heterogeneous. Further studies are needed to assess the effectiveness of these tests on a larger scale, including studies to determine which test methodology is the most useful in asthma.
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Affiliation(s)
- Mohammed A Almeshari
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nowaf Y Alobaidi
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Ross G Edgar
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - James Stockley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Eosinophil microRNAs Play a Regulatory Role in Allergic Diseases Included in the Atopic March. Int J Mol Sci 2020; 21:ijms21239011. [PMID: 33260893 PMCID: PMC7730597 DOI: 10.3390/ijms21239011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022] Open
Abstract
(1) Background: The atopic march is defined by the increased prevalence of allergic diseases after atopic dermatitis onset. In fact, atopic dermatitis is believed to play an important role in allergen sensitization via the damaged skin barrier, leading to allergic diseases such as allergic asthma and allergic rhinitis. The eosinophil, a pro-inflammatory cell that contributes to epithelial damage, is one of the various cells recruited in the inflammatory reactions characterizing these diseases. Few studies were conducted on the transcriptome of this cell type and even less on their specific microRNA (miRNA) profile, which could modulate pathogenesis of allergic diseases and clinical manifestations post-transcriptionally. Actually, their implication in allergic diseases is not fully understood, but they are believed to play a role in inflammation-related patterns and epithelial cell proliferation. (2) Methods: Next-generation sequencing was performed on RNA samples from eosinophils of individuals with atopic dermatitis, atopy, allergic rhinitis and asthma to obtain differential counts of primary miRNA (pri-miRNA); these were also analyzed for asthma-related phenotypes such as forced expiratory volume in one second (FEV1), immunoglobulin E (IgE) and provocative concentration of methacholine inducing a 20% fall in forced expiratory volume in 1 s (PC20) levels, as well as FEV1 to forced vital capacity (FEV1/FVC) ratio. (3) Results: Eighteen miRNAs from eosinophils were identified to be significantly different between affected individuals and unaffected ones. Based on counts from these miRNAs, individuals were then clustered into groups using Ward's method on Euclidian distances. Groups were found to be explained by asthma diagnosis, familial history of respiratory diseases and allergic rhinitis as well as neutrophil counts. (4) Conclusions: The 18 differential miRNA counts for the studying phenotypes allow a better understanding of the epigenetic mechanisms underlying the development of the allergic diseases included in the atopic march.
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The use of a direct bronchial challenge test in primary care to diagnose asthma. NPJ Prim Care Respir Med 2020; 30:45. [PMID: 33067465 PMCID: PMC7567813 DOI: 10.1038/s41533-020-00202-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/14/2020] [Indexed: 11/09/2022] Open
Abstract
Many asthmatics in primary care have mild symptoms and lack airflow obstruction. If variable expiratory airflow limitation cannot be determined by spirometry or peak expiratory flow, despite a history of respiratory symptoms, a positive bronchial challenge test (BCT) can confirm the diagnosis of asthma. However, BCT is traditionally performed in secondary care. In this observational real-life study, we retrospectively analyze 5-year data of a primary care diagnostic center carrying out BCT by histamine provocation. In total, 998 primary care patients aged ≥16 years underwent BCT, without any adverse events reported. To explore diagnostic accuracy, we examine 584 patients with a high pretest probability of asthma. Fifty-seven percent of these patients have a positive BCT result and can be accurately diagnosed with asthma. Our real-life data show BCT is safe and feasible in a suitably equipped primary care diagnostic center. Furthermore, it could potentially reduce diagnostic referrals to secondary care.
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Kellerer C, Wagenpfeil S, Daines L, Jörres RA, Hapfelmeier A, Schneider A. Diagnostic accuracy of FeNO [fractional exhaled nitric oxide] and asthma symptoms increased when evaluated with a superior reference standard. J Clin Epidemiol 2020; 129:86-96. [PMID: 33038543 DOI: 10.1016/j.jclinepi.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/22/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of the study is to determine the impact of changing reference standards (RS), namely spirometry vs. whole-body plethysmography (WBP), on estimation of the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) and clinical signs and symptoms (CSS) as index tests regarding asthma diagnosis. STUDY DESIGN AND SETTING This was a diagnostic study conducted in 393 patients attending a private practice of pneumologists with complaints suspicious of asthma. First, the index tests were compared with the diagnostic results of spirometry in terms of forced expiratory volume in the first second (FEV1) responsiveness. Second, the index tests were compared with the results of WBP in terms of specific airway resistance and FEV1 responsiveness. Areas under the curve (AUC) were compared with a generalized estimating equation approach based on binary logistic regression. RESULTS FeNO values and CSS 'wheezing' and 'allergic rhinitis' showed higher specificities (P < 0.001) and sensitivities (not significant) when evaluated with WBP; also, Youden indices increased in these CSS (P < 0.05). AUC of FeNO in combination with 'wheezing' and 'allergic rhinitis' when WBP was used as RS (AUC = 0.724; 95% confidence interval 0.672 to 0.776) was higher compared with spirometry as RS (AUC = 0.654; 95% confidence interval 0.585 to 0.722) (P < 0.001). CONCLUSION In case of asthma, superior RS led to more favorable assessment of index tests. FeNO measurement might have been underestimated in some previous studies.
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Affiliation(s)
- Christina Kellerer
- Institute of General Practice and Health Services Research, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University, Homburg, Germany
| | - Luke Daines
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Institute for Medical Statistics and Epidemiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Capnovolumetry in combination with clinical history for the diagnosis of asthma and COPD. NPJ Prim Care Respir Med 2020; 30:32. [PMID: 32732930 PMCID: PMC7393160 DOI: 10.1038/s41533-020-00190-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/19/2020] [Indexed: 11/09/2022] Open
Abstract
Capnovolumetry performed during resting ventilation is an easily applicable diagnostic tool sensitive to airway obstruction. In the present analysis, we investigated in which way capnovolumetric parameters can be combined with basic anamnestic information to support the diagnosis of asthma and COPD. Among 1400 patients of a previous diagnostic study, we selected 1057 patients with a diagnosis of asthma (n = 433), COPD (n = 260), or without respiratory disease (n = 364). Besides performing capnovolumetry, patients answered questions on symptoms and smoking status. Logistic regression analysis, single decision trees (CHAID), and ensembles of trees (random forest) were used to identify diagnostic patterns of asthma and COPD. In the random forest approach, area/volume of phase 3, dyspnea upon strong exertion, s3/s2, and current smoking were identified as relevant parameters for COPD vs control. For asthma vs control, they were wheezing, volume of phase 2, current smoking, and dyspnea at strong exertion. For COPD vs asthma, s3/s2 was the primary criterion, followed by current smoking and smoking history. These parameters were also identified as relevant in single decision trees. Regarding the diagnosis of asthma vs control, COPD vs control, and COPD vs asthma, the area under the curve was 0.623, 0.875, and 0.880, respectively, in the random forest approach. Our results indicate that for the diagnosis of asthma and COPD capnovolumetry can be combined with basic anamnestic information in a simple, intuitive, and efficient manner. As capnovolumetry requires less cooperation from the patient than spirometry, this approach might be helpful for clinical practice.
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Fletcher MJ, Tsiligianni I, Kocks JWH, Cave A, Chunhua C, Sousa JCD, Román-Rodríguez M, Thomas M, Kardos P, Stonham C, Khoo EM, Leather D, van der Molen T. Improving primary care management of asthma: do we know what really works? NPJ Prim Care Respir Med 2020; 30:29. [PMID: 32555169 PMCID: PMC7300034 DOI: 10.1038/s41533-020-0184-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
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Affiliation(s)
- Monica J Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W H Kocks
- General Practitioners Research Institute, 59713 GH, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Andrew Cave
- Department of Family Medicine, 6-10 University Terrace, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Chi Chunhua
- Peking University First Hospital, Beijing, China
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- 33ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel Román-Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Mike Thomas
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, SO16 5ST, UK
| | - Peter Kardos
- Respiratory, Allergy and Sleep Unit at Red Cross Maingau Hospital, Friedberger Anlage 31-32, 60316, Frankfurt, Germany
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - David Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van de Hei SJ, Flokstra-de Blok BMJ, Baretta HJ, Doornewaard NE, van der Molen T, Patberg KW, Ruberg ECM, Schermer TRJ, Steenbruggen I, van den Berg JWK, Kocks JWH. Quality of spirometry and related diagnosis in primary care with a focus on clinical use. NPJ Prim Care Respir Med 2020; 30:22. [PMID: 32415077 PMCID: PMC7229174 DOI: 10.1038/s41533-020-0177-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/07/2020] [Indexed: 11/09/2022] Open
Abstract
American and European societies' (ATS/ERS) criteria for spirometry are often not met in primary care. Yet, it is unknown if quality is sufficient for daily clinical use. We evaluated quality of spirometry in primary care based on clinical usefulness, meeting ATS/ERS criteria and agreement on diagnosis between general practitioners (GPs) and pulmonologists. GPs included ten consecutive spirometry tests and detailed history questionnaires of patients who underwent spirometry as part of usual care. GPs and two pulmonologists assessed the spirometry tests and questionnaires on clinical usefulness and formulated a diagnosis. In total, 149 participants covering 15 GPs were included. Low agreements were found on diagnosis between GPs and pulmonologists 1 (κ = 0.39) and 2 (κ = 0.44). GPs and pulmonologists rated >88% of the tests as clinically useful, although 13% met ATS/ERS criteria. This real-life study demonstrated that clinical usefulness of routine primary care spirometry tests was high, although agreement on diagnosis was low.
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Affiliation(s)
- S J van de Hei
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - B M J Flokstra-de Blok
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- General Practitioners Research Institute, Groningen, the Netherlands
| | - H J Baretta
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - N E Doornewaard
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T van der Molen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - K W Patberg
- Department of Pulmonology, Isala Hospital, Zwolle, the Netherlands
| | - E C M Ruberg
- Pulmonary Laboratory, Isala, Zwolle, the Netherlands
| | - T R J Schermer
- Department of Primary Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - J W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- General Practitioners Research Institute, Groningen, the Netherlands
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Feinstein L, Wilkerson J, Salo PM, MacNell N, Bridge MF, Fessler MB, Thorne PS, Mendy A, Cohn RD, Curry MD, Zeldin DC. Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease. Epidemiology 2020; 31:459-466. [PMID: 32028323 PMCID: PMC7138734 DOI: 10.1097/ede.0000000000001176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Various questionnaire-based definitions of chronic obstructive pulmonary disease (COPD) have been applied using the US representative National Health and Nutrition Examination Survey (NHANES), but few have been validated against objective lung function data. We validated two prior definitions that incorporated self-reported physician diagnosis, respiratory symptoms, and/or smoking. We also validated a new definition that we developed empirically using gradient boosting, an ensemble machine learning method. METHODS Data came from 7,996 individuals 40-79 years who participated in NHANES 2007-2012 and underwent spirometry. We considered participants "true" COPD cases if their ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity was below 0.7 or the lower limit of normal. We stratified all analyses by smoking history. We developed a gradient boosting model for smokers only; predictors assessed (25 total) included sociodemographics, inhalant exposures, clinical variables, and respiratory symptoms. RESULTS The spirometry-based COPD prevalence was 26% for smokers and 8% for never smokers. Among smokers, using questionnaire-based definitions resulted in a COPD prevalence ranging from 11% to 16%, sensitivity ranging from 18% to 35%, and specificity ranging from 88% to 92%. The new definition classified participants based on age, bronchodilator use, body mass index (BMI), smoking pack-years, and occupational organic dust exposure, and resulted in the highest sensitivity (35%) and specificity (92%) among smokers. Among never smokers, the COPD prevalence ranged from 4% to 5%, and we attained good specificity (96%) at the expense of sensitivity (9-10%). CONCLUSION Our results can be used to parametrize misclassification assumptions for quantitative bias analysis when pulmonary function data are unavailable.
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Affiliation(s)
- Lydia Feinstein
- Social & Scientific Systems, Durham, NC
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Paivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
| | | | | | - Michael B Fessler
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
| | - Angelico Mendy
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
| | - Richard D Cohn
- Social & Scientific Systems, Durham, NC
- Independent consultant, Chapel Hill, NC
| | | | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
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Daines L, Lewis S, Schneider A, Sheikh A, Pinnock H. Defining high probability when making a diagnosis of asthma in primary care: mixed-methods consensus workshop. BMJ Open 2020; 10:e034559. [PMID: 32317260 PMCID: PMC7204930 DOI: 10.1136/bmjopen-2019-034559] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Making the diagnosis of asthma is challenging. Guidelines recommend that clinicians identify a group at 'high probability' of asthma. High probability, however, is not numerically defined giving rise to uncertainty. The aim of this work was to build consensus on what constitutes a high probability of asthma in primary care. High probability was defined as the probability threshold at which there is enough information to make a firm diagnosis of asthma, and a subsequent negative test would not alter that opinion (assumed to be a false negative). DESIGN Mixed-methods study. SETTING A consensus workshop using modified nominal group technique was held during an international respiratory conference. PARTICIPANTS International conference attendees eligible if they had knowledge/experience of working in primary care, respiratory medicine and spoke English. METHODS Participants took part in facilitated discussions and voted over three rounds on what constituted a high probability of asthma diagnosis. The workshop was audio-recorded, transcribed and qualitatively analysed. RESULTS Based on final votes, the mean value for a high probability of asthma in primary care was 75% (SD 7.6), representing a perceived trade-off between limiting the number of false positives (more likely if a lower threshold was used) and pragmatism on the basis that first-line preventive therapies (ie, low-dose inhaled corticosteroids) are relatively low risk. The need to review response to treatment was strongly emphasised for detecting non-responders and reviewing the diagnosis. CONCLUSION A consensus probability of 75% was the threshold at which the primary care participants in this workshop felt confident to establish the diagnosis of asthma, albeit with the caveat that a review of treatment response was essential. Contextual factors, including availability and timing of tests and the ease with which patients could be reviewed, influenced participants' decision making.
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Affiliation(s)
- Luke Daines
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steff Lewis
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Liu C, Tham CW, De Roza J, Chong BY, Koh YL, Tan NC. The Association Between Beliefs and Adherence to Inhaled Controller Medication Among Older Adults with Asthma: A Cross-Sectional Study in Primary Care. Patient Prefer Adherence 2020; 14:1351-1359. [PMID: 32801665 PMCID: PMC7414975 DOI: 10.2147/ppa.s266871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While illness perceptions and medication beliefs have been shown to be associated with inhaled corticosteroid (ICS) adherence in younger adults with asthma, their impact on older adults is less understood. This study aimed to determine the prevalence of ICS adherence among older Asian adults and to assess the association between ICS adherence, illness perceptions and medication beliefs. METHODS A questionnaire survey on older multi-ethnic Asian patients, aged ≥60 years, with physician-diagnosed asthma, was conducted in two Singapore public primary care clinics. The scores of the Medication Adherence Report Scale for asthma (MARS) were computed to determine the adherence to ICS alone or in combination with LABA. Illness perceptions and medication beliefs were assessed by the scores from the Brief-Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ), respectively. Logistic regression analyses were used to identify factors associated with ICS adherence. RESULTS Analyses of 323 participants (57% males; Chinese 73.7%, Malay 12.7%, Indian 12.4%; mean age 71.5 years) showed that 40.9% of them had good adherence to ICS (mean MARS score≥4.5). Good adherence to ICS was associated with perception of asthma as a chronic illness (OR=1.22; 95% CI=1.10-1.35; p<0.001), belief of ICS as an essential medication (2.67; 1.76-4.06; p<0.001) and fewer concerns about its use (0.39; 0.26-0.60; p<0.001). Patients on combined ICS-LABA therapy had higher adherence (2.50; 1.41-4.44; p=0.02) than those on ICS monotherapy. CONCLUSION Four in ten older patients with asthma were adherent to ICS. Perception of medication necessity, chronicity of illness, concerns and use of ICS-LABA medication were associated with adherence.
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Affiliation(s)
- Changwei Liu
- National Healthcare Group Polyclinics, Singapore
- Correspondence: Changwei Liu National Healthcare Group Polyclinics, 21 Geylang East Central389707, Singapore Email
| | | | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke-NUS Family Medicine Academic Clinical Programme, Singapore
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Quantitative and qualitative evaluation of spirometry for COPD screening in general practice. Respir Med Res 2019; 77:31-36. [PMID: 32035336 DOI: 10.1016/j.resmer.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/06/2019] [Accepted: 07/10/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Proper diagnosis of COPD remains a challenge. Spirometry testing in primary care may help to reduce misdiagnosis, but its reliability as a diagnostic instrument needs to be assessed. OBJECTIVES To investigate (1) the validity of spirometry testing performed in primary care and (2) the accuracy of the diagnostic of airflow limitation obtained by these tests. METHODS Subjects attending a COPD screening programme had screening spirometry performed either by general practitioners (GPs) or by trained nurses or technicians, who had all received two 3-hour training sessions. Subjects with airflow limitation and a subset of subjects with normal spirometry at screening were invited to undergo confirmatory spirometry performed by trained nurses in a pulmonary function laboratory. RESULTS Of the 4610 subjects who attended the screening sessions, 96.5% had a valid screening spirometry test. A total of 392 subjects attended the confirmatory sessions. Values measured by screening spirometry were satisfactory compared with those of confirmatory spirometry (rc=0.83). Taking confirmatory spirometry as reference, the positive predictive value of screening spirometry for the diagnosis of persistent airflow limitation was 93% with a specificity of 95%. Agreement for the diagnosis of persistent airflow limitation was substantial (k=0.80). CONCLUSION Spirometry performed in primary care by trained personnel reliably identifies persistent airflow limitation. This may encourage pulmonologists to collaborate with primary care providers with the aim of improving appropriate diagnosis of COPD.
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Shende P, Vaidya J, Kulkarni YA. Bio-inspired nano-engineered strip for semiquantitative FeNO analysis. J Breath Res 2019; 13:046002. [PMID: 31063980 DOI: 10.1088/1752-7163/ab1faf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A point-of-care, non-invasive, low-cost and sensitive nano-biodiagnostic is needed in today's age for rapid and accurate self-diagnosis as well as for the management of asthma, which is advantageous for low resource areas where asthma is prevalent. The objective of this research work was to prepare the miniature, nanosponges coated paper strip to detect the asthma using certain biomarkers present in exhaled air. The asthma biomarker, nitric oxide present in exhaled air (FeNO) was chosen, which on reaction with nanosponges of diazotizing agent gave significant color change. The pyromellitic anhydride cross-linked β-cyclodextrin-based nanosponges of sulfanilamide and N-(1-naphthyl) ethylenediamine dihydrochloride were prepared using a polymer condensation method and coated on Whatman filter paper strip (1 × 5 cm2). The thickness of coating was found to be uniform (400 ± 50 μm) which was determined using SEM analysis. The Hue-Saturation-Value scale was used to detect the color change using a smartphone app. We also investigated the performance of a nano-engineered paper strip by comparing this with commercially available, FDA approved FeNO analyzer-NIOX MINO. Our findings demonstrated no significant difference in results obtained using both the techniques. Besides good repeatability, the paper strip showed increasing saturation with NO concentration and the capacity to detect the biomarker down to mean value of 20.33 ppb level. The successful validation and method comparison indicated that a bioinspired strip can provide on-site analysis and daily monitoring for diagnosis and management of asthma.
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Affiliation(s)
- Pravin Shende
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM's NMIMS, V.L. Mehta road, Vile Parle (W), Mumbai, India
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Kellerer C, Jankrift N, Jörres RA, Klütsch K, Wagenpfeil S, Linde K, Schneider A. Diagnostic accuracy of capnovolumetry for the identification of airway obstruction - results of a diagnostic study in ambulatory care. Respir Res 2019; 20:92. [PMID: 31092254 PMCID: PMC6521502 DOI: 10.1186/s12931-019-1067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the known weaknesses of spirometry is its dependence on patients' cooperation, which can only partially be alleviated by educational efforts. Therefore, procedures less dependent on cooperation might be of value in clinical practice. We investigated the diagnostic accuracy of ultrasound-based capnovolumetry for the identification of airway obstruction. METHODS Consecutive patients from a pulmonary outpatient clinic were included in the diagnostic study. As reference standard, the presence of airway obstruction was evaluated via spirometry and bodyplethysmography. Capnovolumetry was performed as index test with an ultrasound spirometer providing a surrogate measure of exhaled carbon dioxide. Receiver operating characteristic (ROC) analysis was performed using the ratio of slopes of expiratory phases 3 and 2 (s3/s2) ≥ 0.10 as primary capnovolumetric parameter for the recognition of airway obstruction. Logistic regression was performed as secondary analysis to identify further useful capnovolumetric parameters. The diagnostic potential of capnovolumetry to identify more severe degrees of airway obstruction was evaluated additionally. RESULTS Of 1400 patients recruited, 1287 patients were included into the analysis. Airway obstruction was present in 29% of patients. The area under the ROC-curve (AUC) of s3/s2 was 0.678 (95% CI 0.645, 0.710); sensitivity of s3/s2 ≥ 0.10 was 47.7 (95% CI 42.7, 52.8)%, specificity 79.0 (95% CI 76.3, 81.6)%. When combining this parameter with three other parameters derived from regression analysis (ratio area/volume phase 3, slope phase 3, volume phase 2), an AUC of 0.772 (95% CI 0.743, 0.801) was obtained. For severe airway obstruction (FEV1 ≤ 50% predicted) sensitivity of s3/s2 ≥ 0.10 was 75.9 (95% CI 67.1, 83.0)%, specificity 75.8 (95% CI 73.3, 78.1)%; for very severe airway obstruction (FEV1 ≤ 30% predicted) sensitivity was 86.7 (95% CI 70.3, 94.7)%, specificity 72.8 (95% CI 70.3, 75.2)%. Sensitivities increased and specificities decreased considerably when the combined capnovolumetric score was used as index test. CONCLUSIONS Capnovolumetry by way of an ultrasound spirometer had a statistically significant albeit moderate potential for the recognition of airway obstruction in a heterogeneous population of patients typically found in clinical practice. Diagnostic accuracy of the capnovolumetric device increased with the severity of airway obstruction. TRIAL REGISTRATION The study is registered under DRKS00013935 at German Clinical Trials Register (DRKS).
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Affiliation(s)
- Christina Kellerer
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstraße 47, 81667 Munich, Germany
| | - Neele Jankrift
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstraße 47, 81667 Munich, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Klaus Klütsch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University, Homburg, Germany
| | - Klaus Linde
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstraße 47, 81667 Munich, Germany
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstraße 47, 81667 Munich, Germany
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Chen A, Halton AJ, Rhoades RD, Booth JC, Shi X, Bu X, Wu N, Chae J. Wireless Wearable Ultrasound Sensor on a Paper Substrate to Characterize Respiratory Behavior. ACS Sens 2019; 4:944-952. [PMID: 30855133 DOI: 10.1021/acssensors.9b00043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Respiratory behavior contains crucial parameters to feature lung functionality, including respiratory rate, profile, and volume. The current well-adopted method to characterize respiratory behavior is spirometry using a spirometer, which is bulky, heavy, expensive, requires a trained provider to operate, and is incapable of continuous monitoring of respiratory behavior, which is often critical to assess chronic respiratory diseases. This work presents a wireless wearable sensor on a paper substrate that is capable of continuous monitoring of respiratory behavior and delivering the clinically relevant respiratory information to a smartphone. The wireless wearable sensor was attached on the midway of the xiphoid process and the costal margin, corresponding to the abdomen-apposed rib cage, based on the anatomical and experimental analysis. The sensor, with a footprint of 40 × 35 × 6 mm3 and weighing 6.5 g, including a 2.7 g battery, consists of three subsystems, (i) ultrasound emitter, (ii) ultrasound receiver, and (iii) data acquisition and wireless transmitter. The sensor converts the linear strain at the wearing site to the lung volume change by measuring the change in ultrasound pressure as a function of the distance between the emitter and the receiver. The temporal lung volume change data, directly converted from the ultrasound pressure, is wirelessly transmitted to a smartphone where a custom-designed app computes to show volume-time and flow rate-volume loop graphs, standard respiratory analysis plots. The app analyzes the plots to show the clinically relevant respiratory behavioral parameters, such as forced vital capacity (FVC) and forced expiratory volume delivered in the first second (FEV1). Potential user-induced error on sensor placement and temperature sensitivity were studied to demonstrate the sensor maintains its performance within a reasonable range of those variables. Eight volunteers were recruited to evaluate the sensor, which showed the mean deviation of the FEV1/FVC ratio in the range of 0.00-4.25% when benchmarked by the spirometer. The continuous measurement of respiratory behavioral parameters helps track the progression of the respiratory diseases, including asthma progression to provide alerts to relevant caregivers to seek needed timely treatment.
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Affiliation(s)
- Ang Chen
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Andrew Joshua Halton
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Rachel Diane Rhoades
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Jayden Charles Booth
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Xinhao Shi
- College of Electrical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Xiangli Bu
- College of Electrical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Ning Wu
- College of Electrical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Junseok Chae
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
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Cavaleiro Rufo J, Paciência I, Mendes FC, Farraia M, Rodolfo A, Silva D, de Oliveira Fernandes E, Delgado L, Moreira A. Exhaled breath condensate volatilome allows sensitive diagnosis of persistent asthma. Allergy 2019; 74:527-534. [PMID: 30156012 DOI: 10.1111/all.13596] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis and phenotyping of paediatric asthma are particularly complex due to the lack of currently available sensitive diagnostic tools. This often results in uncertainties associated with inhaled steroid therapy prescription. Therefore, this study aimed to investigate whether volatile organic compounds measured in exhaled breath condensate can be used as biomarkers for asthma diagnosis in the paediatric population. METHODS A total of 64 participants, aged 6-18 years, were recruited on a random basis during visits to an outpatient allergy clinic and to a juvenile football team training session. Lung function, airway reversibility and skin prick tests were performed. Exhaled breath condensate samples were collected, and breathprints were assessed using an electronic nose. Information on medical diagnosis of asthma, rhinitis and atopic dermatitis was retrieved for each participant. A hierarchical cluster model based on the volatilome profiles was then created. RESULTS A two-cluster exhaled volatile organic compound-based hierarchical model was able to significantly discriminate individuals with asthma from those without the disease (AUC = 0.81 [0.69-0.93], P < 0.001). Individuals who had persistent asthma and were prescribed corticosteroid therapy by the physician were also significantly distinguished in the model (AUC = 0.81 [0.70-0.92], P < 0.001). Despite being less specific, the method showed higher overall accuracy, sensitivity and AUC values when compared to spirometry with bronchodilation. CONCLUSIONS Analysis of the exhaled breath condensate volatilome allowed the distinction of paediatric individuals with a medical diagnosis of asthma, identifying those in need of corticosteroid therapy.
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Affiliation(s)
- João Cavaleiro Rufo
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- EPIUnit - Instituto de Saúde Pública; Universidade do Porto; Porto Portugal
- Grupo de Energia e Ambiente Construído; Instituto de Ciência e Inovação em Engenharia Mecânica e Industrial; Porto Portugal
| | - Inês Paciência
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- EPIUnit - Instituto de Saúde Pública; Universidade do Porto; Porto Portugal
- Grupo de Energia e Ambiente Construído; Instituto de Ciência e Inovação em Engenharia Mecânica e Industrial; Porto Portugal
| | - Francisca Castro Mendes
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
| | - Mariana Farraia
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
| | - Ana Rodolfo
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Departamento de Imunoalergologia; Centro Hospitalar S. João EPE; Porto Portugal
| | - Diana Silva
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Departamento de Imunoalergologia; Centro Hospitalar S. João EPE; Porto Portugal
| | - Eduardo de Oliveira Fernandes
- Grupo de Energia e Ambiente Construído; Instituto de Ciência e Inovação em Engenharia Mecânica e Industrial; Porto Portugal
| | - Luís Delgado
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- Departamento de Imunoalergologia; Centro Hospitalar S. João EPE; Porto Portugal
| | - André Moreira
- Imunologia Básica e Clínica; Departamento de Patologia; Faculdade de Medicina; Universidade do Porto; Porto Portugal
- EPIUnit - Instituto de Saúde Pública; Universidade do Porto; Porto Portugal
- Departamento de Imunoalergologia; Centro Hospitalar S. João EPE; Porto Portugal
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Cherrez-Ojeda I, Felix M, Vanegas E, Mata VL. Pneumomediastinum, Tracheal Diverticulum, and Probable Asthma: Coincidence or Possible Association? A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1267-1271. [PMID: 30356031 PMCID: PMC6213822 DOI: 10.12659/ajcr.911413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 25 Final Diagnosis: Spontaneous pneumomediastinum Symptoms: Chest discomfort • exertional dyspnea • wheezing Medication: — Clinical Procedure: — Specialty: Pulmonology
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Valeria L Mata
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
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Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and Overdiagnosis of Asthma. Am J Respir Crit Care Med 2018; 198:1012-1020. [DOI: 10.1164/rccm.201804-0682ci] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis Philippe Boulet
- Institut de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Helen K. Reddel
- Woolcock Institute of Medical Research, Sydney, Australia; and
| | - Andrea S. Gershon
- Department of Medicine, The University of Toronto, Toronto, Ontario, Canada
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Thériault R, Raz A. Patterns of bronchial challenge testing in Canada. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2018; 54:06. [PMID: 31297005 PMCID: PMC6591799 DOI: 10.29390/cjrt-2018-006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bronchial challenge testing (BCT) measures airway hyperresponsiveness; asthma guidelines recommend using BCT when symptoms manifest despite normal spirometry. Improper application of these guidelines commonly results in the misdiagnosis of asthma. Yet, statistics concerning BCT remain largely obscure. The current paper addresses this gap and explores how various health variables may elucidate adherence to asthma guidelines and patterns of BCT across Canadian provinces. METHODS Using the Access to Information Act, medical financial claims for BCT (or equivalent procedures) were requested from each of the Canadian provinces and territories. Based on the available information (from provinces only), correlations between frequency of BCT claims and medical demographics (e.g., prevalence of respirologists, health expenditures) are reported. RESULTS Controlling for population or for people with asthma, physicians from Québec claim four times more BCT per year than those in other provinces; physicians from Alberta close to eight-fold fewer. The number of respirologists per capita and BCT per capita correlated moderately, r(132) = 0.582, p < 0.001, [95% CI 0.421, 0.716]. Excluding "outliers" (i.e., British Columbia, Alberta, and Saskatchewan) greatly strengthened this correlation, r(87) = 0.930, p < 0.001, [95% CI 0.883, 0.958]. DISCUSSION These findings demonstrate that provinces vary in their use of BCT. This result seems to stem, at least in part, from differences in the prevalence of respirologists. Interestingly, geographic region appears to wield a strong influence; in the correlation between number of tests and number of respirologists, physicians from Western provinces (i.e., Alberta, Saskatchewan, and British Columbia) administered fewer tests than their Eastern colleagues. Given the association between inadequate application of BCT and misdiagnosis of asthma, physicians should pay special attention to the Canadian guidelines when considering an asthma diagnosis.
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Affiliation(s)
- Rémi Thériault
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Amir Raz
- Faculty of Medicine, McGill University, Montréal, QC, Canada
- Institute for Community and Family Psychiatry, Montréal, QC, Canada
- The Lady Davis Institute for Medical Research at the Jewish General Hospital, Montréal, QC, Canada
- Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, CA, USA
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Daines L, McLean S, Buelo A, Lewis S, Sheikh A, Pinnock H. Clinical prediction models to support the diagnosis of asthma in primary care: a systematic review protocol. NPJ Prim Care Respir Med 2018; 28:15. [PMID: 29777106 PMCID: PMC5959853 DOI: 10.1038/s41533-018-0086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 02/01/2023] Open
Abstract
Substantial over-diagnosis and under-diagnosis of asthma in adults and children has recently been reported. As asthma is mostly diagnosed in non-specialist settings, a clinical prediction model (CPM) to aid the diagnosis of asthma in primary care may help improve diagnostic accuracy. We aim to systematically identify, describe, compare, and synthesise existing CPMs designed to support the diagnosis of asthma in children and adults presenting with symptoms suggestive of the disease, in primary care settings or equivalent populations. We will systematically search Medline, Embase and CINAHL from 1 January 1990 to present. Any CPM derived for use in a primary care population will be included. Equivalent populations in countries without a developed primary care service will also be included. The probability of asthma diagnosis will be the primary outcome. We will include CPMs designed for use in clinical practice to aid the diagnostic decision making of a healthcare professional during the assessment of an individual with symptoms suggestive of asthma. We will include derivation studies, and external model validation studies. Two reviewers will independently screen titles/abstracts and full texts for eligibility and extract data from included papers. The CHARMS checklist (or PROBAST if available) will be used to assess risk of bias within each study. Results will be summarised by narrative synthesis with meta-analyses completed if possible. This systematic review will provide comprehensive information about existing CPMs for the diagnosis of asthma in primary care and will inform the development of a future diagnostic model.
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Affiliation(s)
- L Daines
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland.
| | - S McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - A Buelo
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, Scotland
| | - S Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - A Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - H Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
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Wu J, Dong M, Rigatto C, Liu Y, Lin F. Lab-on-chip technology for chronic disease diagnosis. NPJ Digit Med 2018; 1:7. [PMID: 31304292 PMCID: PMC6550168 DOI: 10.1038/s41746-017-0014-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/28/2017] [Accepted: 12/11/2017] [Indexed: 02/03/2023] Open
Abstract
Various types of chronic diseases (CD) are the leading causes of disability and death worldwide. While those diseases are chronic in nature, accurate and timely clinical decision making is critically required. Current diagnosis procedures are often lengthy and costly, which present a major bottleneck for effective CD healthcare. Rapid, reliable and low-cost diagnostic tools at point-of-care (PoC) are therefore on high demand. Owing to miniaturization, lab-on-chip (LoC) technology has high potential to enable improved biomedical applications in terms of low-cost, high-throughput, ease-of-operation and analysis. In this direction, research toward developing new LoC-based PoC systems for CD diagnosis is fast growing into an emerging area. Some studies in this area began to incorporate digital and mobile technologies. Here we review the recent developments of this area with the focus on chronic respiratory diseases (CRD), diabetes, and chronic kidney diseases (CKD). We conclude by discussing the challenges, opportunities and future perspectives of this field.
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Affiliation(s)
- Jiandong Wu
- 1Department of Physics and Astronomy, University of Manitoba, Winnipeg, MB Canada
| | - Meili Dong
- 1Department of Physics and Astronomy, University of Manitoba, Winnipeg, MB Canada.,2Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui China
| | | | - Yong Liu
- 2Institute of Applied Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui China
| | - Francis Lin
- 1Department of Physics and Astronomy, University of Manitoba, Winnipeg, MB Canada
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Cheng SWM, McKeough Z, Alison J, Dennis S, Hamer M, Stamatakis E. Associations of total and type-specific physical activity with mortality in chronic obstructive pulmonary disease: a population-based cohort study. BMC Public Health 2018; 18:268. [PMID: 29454345 PMCID: PMC5816365 DOI: 10.1186/s12889-018-5167-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular physical activity is recommended for all people with chronic obstructive pulmonary disease (COPD), but the dose of physical activity required to gain mortality benefit in this population is not yet known. This aim of this study was to examine the associations of total and type-specific physical activity with mortality risk in people with COPD. METHODS People with COPD aged ≥40 years were identified from the 1997 Health Survey for England and the 1998 and 2003 Scottish Health Survey cohorts. Self-reported total physical activity, moderate-vigorous intensity physical activity (MVPA), walking, domestic physical activity, and sport/exercise were assessed at baseline. Cox proportional hazards models were used to examine the associations between physical activity and mortality risk. RESULTS Two thousand three hundred ninety-eight participants with COPD were included in the analysis and followed up for a mean 8.5 (SD 3.9) years. For both total physical activity and MVPA, we observed dose-response associations with all-cause and cardiovascular disease (CVD) mortality risk, and with respiratory mortality risk to a lesser extent. Compared to those who reported no physical activity, participants who met the physical activity guidelines demonstrated the greatest reductions in all-cause (HR 0.56, 95% CI 0.45-0.69), CVD (HR 0.48, 95% CI 0.32-0.71) and respiratory mortality risk (HR 0.40, 95% CI 0.24-0.67). Participants who reported a level of physical activity of at least half the dosage recommended by the guidelines also had a reduced risk of all-cause (HR 0.75, 95% CI 0.56-1.00) and CVD mortality (HR 0.48, 95% CI 0.26-0.88). Dose-response associations with mortality risk were demonstrated for walking and sport/exercise, but not domestic physical activity. CONCLUSIONS We found a dose-response association between physical activity and all-cause and CVD mortality risk in people with COPD, with protective effects appearing at levels considerably lower than the general physical activity recommendations. People with COPD may benefit from engagement in low levels of physical activity, particularly walking and structured exercise.
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Affiliation(s)
| | - Zoe McKeough
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Jennifer Alison
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Mark Hamer
- University of Loughborough, Loughborough, UK
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, Australia
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Verberne LDM, Leemrijse CJ, Swinkels ICS, van Dijk CE, de Bakker DH, Nielen MMJ. Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice. NPJ Prim Care Respir Med 2017; 27:63. [PMID: 29167434 PMCID: PMC5700136 DOI: 10.1038/s41533-017-0065-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022] Open
Abstract
Guidelines for management of chronic obstructive pulmonary disease (COPD) primarily focus on the prevention of weight loss, while overweight and obesity are highly prevalent in patients with milder stages of COPD. This cross-sectional study examines the association of overweight and obesity with the prevalence of comorbid disorders and prescribed medication for obstructive airway disease, in patients with mild to moderate COPD. Data were used from electronic health records of 380 Dutch general practices in 2014. In total, we identified 4938 patients with mild or moderate COPD based on spirometry data, and a recorded body mass index (BMI) of ≥21 kg/m2. Outcomes in overweight (BMI ≥ 25 and <30 kg/m2) and obese (BMI ≥30 kg/m2) patients with COPD were compared to those with a normal weight (BMI ≥ 21 and <25 kg/m2), by logistic multilevel analyses. Compared to COPD patients with a normal weight, positive associations were found for diabetes, osteoarthritis, and hypertension, for both overweight (OR: 1.4-1.7) and obese (OR: 2.4-3.8) patients, and for heart failure in obese patients (OR: 2.3). Osteoporosis was less prevalent in overweight (OR: 0.7) and obese (OR: 0.5) patients, and anxiety disorders in obese patients (OR: 0.5). No associations were found for coronary heart disease, stroke, sleep disturbance, depression, and pneumonia. Furthermore, obese patients were in general more often prescribed medication for obstructive airway disease compared to patients with a normal weight. The findings of this study underline the need to increase awareness in general practitioners for excess weight in patients with mild to moderate COPD.
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Affiliation(s)
- Lisa D M Verberne
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Chantal J Leemrijse
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ilse C S Swinkels
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Christel E van Dijk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Dinny H de Bakker
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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A novel statistical model for analyzing data of a systematic review generates optimal cutoff values for fractional exhaled nitric oxide for asthma diagnosis. J Clin Epidemiol 2017; 92:69-78. [PMID: 28916487 DOI: 10.1016/j.jclinepi.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Measurement of fractional exhaled nitric oxide (FENO) might substitute bronchial provocation for diagnosing asthma. However, optimal FENO thresholds for diagnosing asthma remain unclear. We reanalyzed data collected for a systematic review investigating the diagnostic accuracy of FENO measurement to exploit all available thresholds under consideration of pretest probabilities using a newly developed statistical model. STUDY DESIGN AND SETTING One hundred and fifty data sets for a total of 53 different cutoffs extracted from 26 studies with 4,518 participants were analyzed with the multiple thresholds model. This model allows identifying thresholds at which the test is likely to perform best. RESULTS Diagnosing asthma might only be possible in a meaningful manner when the pretest probability of asthma is at least 30%. In that case, FENO > 50 ppb leads to a positive predictive value of 0.76 [95% confidence interval (CI): 0.29-0.96]. Excluding asthma might only be possible, when the pretest probability of asthma is 30% at maximum. Then, FENO < 20 ppb leads to a negative predictive value of 0.86 (95% CI 0.66-0.95). CONCLUSION The multiple thresholds model generates a more comprehensive and more clinically useful picture of the effects of different thresholds, which facilitates the determination of optimal thresholds for diagnosing or excluding asthma with FENO measurement.
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45
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Meneghini AC, Paulino ACB, Pereira LP, Vianna EO. Accuracy of spirometry for detection of asthma: a cross-sectional study. SAO PAULO MED J 2017; 135:428-433. [PMID: 29211208 PMCID: PMC10027253 DOI: 10.1590/1516-3180.2017.0041250517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. DESIGN AND SETTING Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. METHODS Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. RESULTS Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. CONCLUSION Spirometry, as a single test, has limitations for detecting asthma in the general population.
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Affiliation(s)
- Andréa Cristina Meneghini
- MSc. Doctoral Student, Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.
| | - Ana Carolina Botto Paulino
- MSc. Nurse, Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.
| | - Luciano Penha Pereira
- MD, MSc. Preceptor of Internship, Pneumology Service, Hospital Santa Casa de Ribeirão Preto, Ribeirão Preto (SP), Brazil.
| | - Elcio Oliveira Vianna
- MD, PhD. Associate Professor, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.
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MacNeil J, Loves RH, Aaron SD. Addressing the misdiagnosis of asthma in adults: where does it go wrong? Expert Rev Respir Med 2016; 10:1187-1198. [PMID: 27677224 DOI: 10.1080/17476348.2016.1242415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Asthma is diagnosed based on patients' respiratory symptoms of wheeze, cough, chest tightness and/or dyspnea together with physiologic evidence of variable and reversible expiratory airflow limitation. A high prevalence of overdiagnosis, underdiagnosis and misdiagnosis of adult asthma has been reported in the literature. Areas covered: Misdiagnosis of asthma in adults can occur in the community due to physicians' failure to confirm airflow limitation using spirometry, the relatively poor sensitivity of spirometry to absolutely rule in asthma, the complexity of multiple asthma phenotypes and endotypes, and the inherent day to day variability of asthma symptoms and airflow limitation. Consequences of asthma misdiagnosis to the patient and to the healthcare system include increased medication costs, increased potential side effects related to unnecessary use of medications and lost opportunities to diagnose the true cause of patients' respiratory symptoms. Expert commentary: Here we provide a review of the problem of misdiagnosis of adult asthma and suggestions for how to decrease the risk of misdiagnosis.
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Affiliation(s)
- Jenna MacNeil
- a Department of Medicine , The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada
| | - Robyn H Loves
- a Department of Medicine , The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada
| | - Shawn D Aaron
- a Department of Medicine , The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada
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Jaradat NA, Al Zabadi H, Rahhal B, Hussein AMA, Mahmoud JS, Mansour B, Khasati AI, Issa A. The effect of inhalation of Citrus sinensis flowers and Mentha spicata leave essential oils on lung function and exercise performance: a quasi-experimental uncontrolled before-and-after study. J Int Soc Sports Nutr 2016; 13:36. [PMID: 27688737 PMCID: PMC5034497 DOI: 10.1186/s12970-016-0146-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, there has been an increased interest in the effects of essential oils on athletic performances and other physiological effects. This study aimed to assess the effects of Citrus sinensis flower and Mentha spicata leaves essential oils inhalation in two different groups of athlete male students on their exercise performance and lung function. METHODS Twenty physical education students volunteered to participate in the study. The subjects were randomly assigned into two groups: Mentha spicata and Citrus sinensis (ten participants each). One group was nebulized by Citrus sinensis flower oil and the other by Mentha spicata leaves oil in a concentration of (0.02 ml/kg of body mass) which was mixed with 2 ml of normal saline for 5 min before a 1500 m running tests. Lung function tests were measured using a spirometer for each student pre and post nebulization giving the same running distance pre and post oils inhalation. RESULTS A lung function tests showed an improvement on the lung status for the students after inhaling of the oils. Interestingly, there was a significant increase in Forced Expiratory Volume in the first second and Forced Vital Capacity after inhalation for the both oils. Moreover significant reductions in the means of the running time were observed among these two groups. The normal spirometry results were 50 %, while after inhalation with M. spicata oil the ratio were 60 %. CONCLUSION Our findings support the effectiveness of M. spicata and C. sinensis essential oils on the exercise performance and respiratory function parameters. However, our conclusion and generalisability of our results should be interpreted with caution due to small sample size and lack of control groups, randomization or masking. We recommend further investigations to explain the mechanism of actions for these two essential oils on exercise performance and respiratory parameters. TRIAL REGISTRATION ISRCTN10133422, Registered: May 3, 2016.
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Affiliation(s)
- Nidal Amin Jaradat
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Hamzeh Al Zabadi
- Public Health Division, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Belal Rahhal
- Physiology, Pharmacology and Toxicology Division, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Azmi Mahmoud Ali Hussein
- Physiology, Pharmacology and Toxicology Division, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Jamal Shaker Mahmoud
- Faculty of Physical Education, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Basel Mansour
- Faculty of Law, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | | | - Abdelkhaleq Issa
- Faculty of Humanities, An-Najah National University, P.O. Box 7, Nablus, Palestine
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Abstract
OBJECTIVE Summarize developed evidence-based diagnostic and treatment guidelines for work-related asthma (WRA). METHODS Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed. RESULTS Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery. CONCLUSION Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA.
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Karrasch S, Linde K, Rücker G, Sommer H, Karsch-Völk M, Kleijnen J, Jörres RA, Schneider A. Accuracy of FENO for diagnosing asthma: a systematic review. Thorax 2016; 72:109-116. [PMID: 27388487 DOI: 10.1136/thoraxjnl-2016-208704] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/02/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Measurement of FENO might substitute bronchial provocation for diagnosing asthma. We aimed to investigate the diagnostic accuracy of FENO measurement compared with established reference standard. METHODS Systematic review and diagnostic meta-analysis. Data sources were Medline, Embase and Scopus up to 29 November 2015. Sensitivity and specificity were estimated using a bivariate model. Additionally, summary receiver-operating characteristic curves were estimated. RESULTS 26 studies with 4518 participants (median 113) were included. Risk of bias was considered low for six of seven items in five studies and for five items in seven studies. The overall sensitivity in the meta-analysis was 0.65 (95% CI 0.58 to 0.72), the overall specificity 0.82 (0.76 to 0.86), the diagnostic OR 9.23 (6.55 to 13.01) and the area under the curve 0.80 (0.77 to 0.85). In meta-regression analyses, higher cut-off values were associated with increasing specificity (OR 1.46 per 10 ppb increase in cut-off) while there was no association with sensitivity. Sensitivities varied significantly within the different FENO devices, but not specificities. Neither prevalence, age, use of bronchoprovocation in >90% of participants or as exclusive reference standard test, nor risk of bias were significantly associated with diagnostic accuracy. CONCLUSIONS There appears to be a fair accuracy of FENO for making the diagnosis of asthma. The overall specificity was higher than sensitivity, which indicates a higher diagnostic potential for ruling in than for ruling out the diagnosis of asthma.
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Affiliation(s)
- Stefan Karrasch
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Klaus Linde
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Gerta Rücker
- Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harriet Sommer
- Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marlies Karsch-Völk
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, Escrick, York, UK.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Warman K, Silver E. A primary care-based asthma program improves recognition and treatment of persistent asthma in inner-city children compared to routine care. J Asthma 2016; 53:930-7. [PMID: 27187499 DOI: 10.3109/02770903.2016.1161051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine whether a primary care-based asthma program that applies the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-2007 criteria to classify asthma severity increases detection of persistent asthma in inner-city children and affects "step of care" compared to routine care. METHODS A retrospective chart review was conducted of 97 consecutive children referred to the asthma program from 2011-2013. Asthma severity documented during routine health care maintenance visits was compared to the asthma severity assessed during the asthma program visit using five standardized questions and spirometry. Medication plan "step of care" was compared pre- and post- the asthma program visit. RESULTS 79 children, ages 5-19 years old (mean = 9.6), had spirometry tracings meeting American Thoracic Society criteria and were included in this study. 53% were male. The majority of children were Latino (45.6%) or African American (35.4%). At the asthma program visit, more children were identified with moderate or severe persistent asthma based upon clinical questions (47.9%), spirometry (56.9%) or combined criteria (75.3%) than had been identified during routine care (15.2%); all p < .05. After the asthma program visit, more children were prescribed controller medications (82.3% vs 63.3%; p < .05) and 40.6% had their medication plan stepped up. CONCLUSIONS In this population of inner-city children, asthma severity was under-recognized and undertreated during routine care. A primary care based asthma program, which formalized applying EPR-3 criteria, increased detection of persistent asthma and led to "step-ups" in treatment plans.
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Affiliation(s)
- Karen Warman
- a Department of Pediatrics, The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Ellen Silver
- a Department of Pediatrics, The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA
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