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Dharmage SC, Faner R, Agustí A. Treatable traits in pre-COPD: Time to extend the treatable traits paradigm beyond established disease. Respirology 2024; 29:551-562. [PMID: 38862131 DOI: 10.1111/resp.14760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024]
Abstract
To date, the treatable traits (TTs) approach has been applied in the context of managing diagnosed diseases. TTs are clinical characteristics and risk factors that can be identified clinically and/or biologically, and that merit treatment if present. There has been an exponential increase in the uptake of this approach by both researchers and clinicians. Realizing the potential of the TTs approach to pre-clinical disease, this expert review proposes that it is timely to consider acting on TTs present before a clinical diagnosis is made, which might help to prevent development of the full disease. Such an approach is ideal for diseases where there is a long pre-clinical phase, such as in chronic obstructive pulmonary disease (COPD). The term 'pre-COPD' has been recently proposed to identify patients with respiratory symptoms and/or structural or functional abnormalities without airflow limitation. They may eventually develop airflow limitation with time but patients with pre-COPD are likely to have traits that are already treatable. This review first outlines the contribution of recently generated knowledge into lifetime lung function trajectories and the conceptual framework of 'GETomics' to the field of pre-COPD. GETomics is a dynamic and cumulative model of interactions between genes and the environment throughout the lifetime that integrates information from multi-omics to understand aetiology and mechanisms of diseases. This review then discusses the current evidence on potential TTs in pre-COPD patients and makes recommendations for practice and future research. At a broader level, this review proposes that introducing the TTs in pre-COPD may help reenergize the preventive approaches to health and diseases.
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Affiliation(s)
- Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Rosa Faner
- Universitat de Barcelona, Biomedicine Department. Immunology Unit, Barcelona, Spain
- Fundació Clinic per a la Recerca Biomedica (FCRB-IDIBAPS), Institut Investigacions Biomediques, Barcelona, Spain
- Consorcio Investigacion Biomedica en Red (CIBER) ENfermedades Respiratorias, Barcelona, Spain
| | - Alvar Agustí
- Fundació Clinic per a la Recerca Biomedica (FCRB-IDIBAPS), Institut Investigacions Biomediques, Barcelona, Spain
- Consorcio Investigacion Biomedica en Red (CIBER) ENfermedades Respiratorias, Barcelona, Spain
- Cathedra Salud Respiratoria, Department of Medicine, University of Barcelona, Barcelona, Spain
- Pulmonary Division, Respiratory Institute, Clinic Barcelona, Barcelona, Spain
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Har-Shai L, Franco E, Shteinberg M, Adir Y, Ad-El D, Lavi I, Stein N, Har-Shai Y, Metanes I. Immediate Unilateral Subpectoral Implant-Based Breast Reconstruction does not Impair Pulmonary Functions: A Preliminary Prospective Study. Aesthetic Plast Surg 2024:10.1007/s00266-024-04021-1. [PMID: 38671243 DOI: 10.1007/s00266-024-04021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/11/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Implant-based breast reconstruction is one of the most common procedures among women with breast cancer undergoing mastectomy. Prosthetic devices may be positioned either beneath or above the pectoralis major muscle, which is considered an accessory muscle of ventilation. This preliminary prospective study aimed to investigate whether subpectoral unilateral implant-based breast reconstruction has any effect on patients' pulmonary functions. METHODS A prospective study of fourteen women who underwent immediate unilateral implant-based subpectoral breast reconstruction by a single surgeon over 10 months was conducted. Spirometry and maximal voluntary ventilation tests were conducted 1 day prior to surgery, and 1- and 3 months following breast reconstruction. ANOVA or Friedman test were used to compare pulmonary function tests before and after surgery. RESULTS Fourteen patients completed the study protocol. No statistically significant differences were found when comparing spirometry parameters in the three time points. CONCLUSIONS Pectoralis muscle release does not impair pulmonary function among patients undergoing immediate unilateral implant-based breast reconstruction following mastectomy. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Lior Har-Shai
- The Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St, 49100, Petah Tikva, Israel.
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
| | - Eyal Franco
- The Unit of Plastic Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yochai Adir
- Pulmonology Institute and CF Center, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Dean Ad-El
- The Department of Reconstructive Plastic Surgery & Burns, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St, 49100, Petah Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Idit Lavi
- The Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Nili Stein
- The Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yaron Har-Shai
- The Unit of Plastic Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Issa Metanes
- The Unit of Plastic Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Wharton RC, Wang JG, Choi Y, Eisenberg E, Jackson MK, Hanson C, Liu B, Washko GR, Kalhan R, Jacobs DR, Bose S. Associations of a plant-centered diet and lung function across early to mid-adulthood: The CARDIA Lung Study. Respir Res 2024; 25:122. [PMID: 38468283 PMCID: PMC10926674 DOI: 10.1186/s12931-023-02632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/07/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Lung function throughout adulthood predicts morbidity and mortality even among adults without chronic respiratory disease. Diet quality may represent a modifiable risk factor for lung function impairment later in life. We investigated associations between nutritionally-rich plant-centered diet and lung function across early and middle adulthood from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS Diet was assessed at baseline and years 7 and 20 of follow-up using the validated CARDIA diet history questionnaire. Plant-centered diet quality was scored using the validated A Priori Diet Quality Score (APDQS), which weights food groups to measure adherence to a nutritionally-rich plant-centered diet for 20 beneficially rated foods and 13 adversely rated foods. Scores were cumulatively averaged over follow-up and categorized into quintiles. The primary outcome was lung function decline, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), measured at years 0, 2, 5, 10, 20, and 30. We estimated the association of APDQS with annual pulmonary function changes and cross-sectional differences in a repeated measures regression model, adjusting for clinically relevant covariates. RESULTS The study included 3,787 Black and White men and women aged 18-30 in 1985-86 and followed for 30 years. In multivariable repeated measures regression models, individuals in the lowest APDQS quintile (poorest diet) had declines in FEV1 that were 1.6 ml/year greater than individuals in the highest quintile (35.0 vs. 33.4 ml/year, ß ± SE per 1 SD change APDQS 0.94 ± 0.36, p = 0.009). Additionally, declines in FVC were 2.4 ml/year greater in the lowest APDQS quintile than those in the highest quintile (37.0 vs 34.6 ml/year, ß ± SE per 1 SD change APDQS 1.71 ± 0.46, p < 0.001). The association was not different between never and ever smokers (pint = 0.07 for FVC and 0.32 for FEV1). In sensitivity analyses where current asthma diagnosis and cardiorespiratory fitness were further adjusted, results remained similar. Cross-sectional analysis at each exam year also showed significant differences in lung function according to diet after covariate adjustment. CONCLUSIONS In this 30-year longitudinal cohort study, long-term adherence to a nutritionally-rich plant-centered diet was associated with cross-sectional differences in lung function as well as slower decline in lung function, highlighting diet quality as a potential treatable trait supporting long-term lung health.
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Affiliation(s)
- Robert C Wharton
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Jing Gennie Wang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yuni Choi
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Elliot Eisenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Mariah K Jackson
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Corrine Hanson
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Jacobs
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sonali Bose
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Han S, Xu Y, Wang Y. Association between pulmonary function and rapid kidney function decline: a longitudinal cohort study from CHARLS. BMJ Open Respir Res 2024; 11:e002107. [PMID: 38395458 PMCID: PMC10895224 DOI: 10.1136/bmjresp-2023-002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Pulmonary function has been reported to be associated with chronic kidney disease. However, the relationship between lung function and rapid kidney function decline remains unclear. METHODS Participants aged ≥45 years with complete data from the 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. Lung function, assessed by peak expiratory flow (PEF), and kidney function, assessed by estimated glomerular filtration rate (eGFR), were tested at the baseline and endpoint surveys. Rapid kidney function decline was defined as a decrease in eGFR ≥3 mL/min/1.73 m²/year, and ΔeGFR represented the difference between baseline and endpoint eGFR. Multivariate logistic regression models and linear regression models were employed to evaluate the association between PEF and the risk of rapid eGFR decline, as well as the correlation between PEF and ΔeGFR. RESULTS A total of 6159 participants were included, with 1157 (18.78%) individuals experiencing a rapid decline in eGFR. After adjusting for potential covariates, higher baseline PEF (Quartile 4 vs Quartile 1, OR=0.95, 95% CI 0.92 to 0.98) and elevated PEF % predicted (OR=0.96, 95% CI 0.94 to 0.99) were found to be associated with a lower risk of rapid eGFR decline. ΔeGFR decreased by 0.217 and 0.124 mL/min/1.73 m² for every 1 L/s increase in baseline PEF (β (95% CI): -0.217 (-0.393 to -0.042)) and 10% increase in PEF % predicted (β (95% CI): -0.124 (-0.237 to -0.011)), respectively. During the follow-up period, ΔeGFR decreased as PEF increased over time among participants in Quartile 1 (β per 1 L/s increase in ΔPEF=-0.581, 95% CI -1.003 to -0.158; β per 10% increase in ΔPEF % predicted=-0.279, 95% CI -0.515 to -0.043). CONCLUSIONS Higher PEF was associated with a slower longitudinal eGFR decline in middle-aged and older adults.
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Affiliation(s)
- Shisheng Han
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanqiu Xu
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Wang
- Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Bertels X, Ross JC, Faner R, Cho MH, Ikram MA, Brusselle GG, Lahousse L. Clinical relevance of lung function trajectory clusters in middle-aged and older adults. ERJ Open Res 2024; 10:00793-2023. [PMID: 38333649 PMCID: PMC10851953 DOI: 10.1183/23120541.00793-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 02/10/2024] Open
Abstract
Background The determinants and health outcomes of lung function trajectories in adults among the general population are poorly understood. We aimed to identify and characterise clusters of lung function trajectories in adults aged ≥45 years. Methods Gaussian finite-mixture modelling was applied to baseline and annualised change of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio z-scores in participants of the Rotterdam Study, a prospective population-based cohort study, with repeated spirometry (n=3884; mean±sd age 64.7±8.9 years). Longitudinal outcomes were all-cause mortality, respiratory outcomes (symptoms, COPD (FEV1/FVC <0.7 in absence of asthma), preserved ratio impaired spirometry (PRISm; FEV1/FVC ≥0.7 and FEV1 or FVC <80%)), smoking cessation and weight changes. Independent risk factors, including genetics, were identified by multiple logistic regression. Results We identified eight trajectory clusters, with the reference group having persistently normal spirometry (prevalence 42.8%). Three clusters showed higher mortality, adjusted for confounders: 1) the persistently low FEV1 cluster (prevalence 6.8%, hazard ratio (HR) 1.71, 95% CI 1.37-2.13); 2) rapid FEV1 decliners (prevalence 4.6%, HR 1.48, 95% CI 1.10-1.99); and 3) FVC decliners (prevalence 3.7%, HR 1.49, 95% CI 1.09-2.03). In contrast, FVC improvers (prevalence 6.7%, HR 0.61, 95% CI 0.41-0.90) and persistently high FEV1 (prevalence 29.2%, HR 0.82, 95% CI 0.69-0.98) were protective trajectory clusters. Clusters were characterised by differences in genetic predisposition (polygenic scores of FEV1 and FEV1/FVC), demographics, cigarette smoking, respiratory symptoms (chronic cough, wheezing and dyspnoea), cardiovascular factors (body mass index, hypertension and heart failure) and serum C-reactive protein levels. Frailty, weight changes and the development of respiratory symptoms, COPD and PRISm were significantly associated with trajectory clusters. Conclusions This study reveals clinically relevant lung function trajectory clusters in older adults of the general population.
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Affiliation(s)
- Xander Bertels
- Department of Bioanalysis, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - James C. Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rosa Faner
- Institut d'Investigacions Biomédiques August Pi i Sunyer, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Biomedical Sciences, University of Barcelona, Barcelona, Spain
- Centro Investigaciones Biomédicas en Red, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael H. Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy G. Brusselle
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Jenkins CR, Singh D, Ducharme FM, Raherison C, Lavoie KL. Asthma and Rhinitis Through the Lifespan of Nonpregnant Women. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3578-3584. [PMID: 37802256 DOI: 10.1016/j.jaip.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
Increasingly, clinical practice guidelines advocate a precision medicine-based approach to care for asthma. This focus requires knowledge of not only different asthma phenotypes and their associated biomarkers but also sex and gender differences through the lifespan. Evidence continues to build in favor of different lifetime prevalence, clinical presentations, responses to management, and long-term prognosis of asthma. Women transition through many biological and psychosocial phases in their lives, all of which may interact with, and influence, their health and well-being. Historically, explanations have focused on hormonal effects on asthma in reproductive life, but a greater understanding of mechanisms starting before birth and changing over a lifetime is now possible, with immunologic, inflammatory, and hormonal factors playing a role. This article describes the evidence for the differences in asthma and rhinitis between men and women at different stages of life, the potential underlying mechanisms that contribute to this, and the implications for management and research. Future research studies should systematically report sex differences in asthma so that this knowledge can be used to develop a personalized approach to care, to achieve best possible outcomes for all.
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Affiliation(s)
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University, Manchester, United Kingdom; NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Francine M Ducharme
- Department of Pediatrics, University of Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Chantal Raherison
- Department of Pulmonology, CHU Guadeloupe, French West Indies University, Guadeloupe, French West Indies
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montréal (UQAM), Montréal, QC, Canada; Montréal Behavioural Medicine Centre (MBMC), CIUSSS-NIM, Hopital du Sacre-Coeur de Montreal, Montréal, QC, Canada
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Yang J, He Y, Liao X, Hu J, Li K. Does postoperative pulmonary infection correlate with intestinal flora following gastric cancer surgery? - a nested case-control study. Front Microbiol 2023; 14:1267750. [PMID: 38029086 PMCID: PMC10658784 DOI: 10.3389/fmicb.2023.1267750] [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: 07/27/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The primary objective of this study was to investigate the potential correlation between gut microbes and postoperative pulmonary infection in gastric cancer patients. Additionally, we aimed to deduce the mechanism of differential functional genes in disease progression to gain a better understanding of the underlying pathophysiology. Methods A nested case-control study design was utilized to enroll patients with gastric cancer scheduled for surgery at West China Hospital of Sichuan University. Patients were categorized into two groups, namely, the pulmonary infection group and the control group, based on the development of postoperative pulmonary infection. Both groups were subjected to identical perioperative management protocols. Fecal samples were collected 24 h postoperatively and upon pulmonary infection diagnosis, along with matched controls. The collected samples were subjected to 16S rDNA and metagenomic analyses, and clinical data and blood samples were obtained for further analysis. Results A total of 180 fecal specimens were collected from 30 patients in both the pulmonary infection and control groups for 16S rDNA analysis, and 3 fecal samples from each group were selected for metagenomic analysis. The study revealed significant alterations in the functional genes of the intestinal microbiome in patients with postoperative pulmonary infection in gastric cancer, primarily involving Klebsiella, Enterobacter, Ruminococcus, and Collinsella. During postoperative pulmonary infection, gut flora and inflammatory factors were found to be associated with the lipopolysaccharide synthesis pathway and short-chain fatty acid (SCFA) synthesis pathway. Discussion The study identified enriched populations of Klebsiella, Escherella, and intestinal bacteria during pulmonary infection following gastric cancer surgery. These bacteria were found to regulate the lipopolysaccharide synthesis pathway, contributing to the initiation and progression of pulmonary infections. Inflammation modulation in patients with postoperative pulmonary infection may be mediated by short-chain fatty acids. The study also revealed that SCFA synthesis pathways were disrupted, affecting inflammation-related immunosuppression pathways. By controlling and maintaining intestinal barrier function, SCFAs may potentially reduce the occurrence of pulmonary infections after gastric cancer surgery. These findings suggest that targeting the gut microbiome and SCFA synthesis pathways may be a promising approach for preventing postoperative pulmonary infections in gastric cancer patients.
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Affiliation(s)
- Jie Yang
- Colorectal Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuhua He
- Colorectal Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xi Liao
- Colorectal Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jiankun Hu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ka Li
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Papi A, Corren J, Castro M, Domingo C, Rogers L, Chapman KR, Jackson DJ, Daizadeh N, Pandit-Abid N, Gall R, Jacob-Nara JA, Rowe PJ, Deniz Y, Ortiz B. Dupilumab reduced impact of severe exacerbations on lung function in patients with moderate-to-severe type 2 asthma. Allergy 2023; 78:233-243. [PMID: 35899469 PMCID: PMC10087924 DOI: 10.1111/all.15456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Severe asthma exacerbations increase the risk of accelerated lung function decline. This analysis examined the effect of dupilumab on forced expiratory volume in 1 s (FEV1 ) in patients with moderate-to-severe asthma and elevated type 2 biomarkers from phase 3 LIBERTY ASTHMA QUEST (NCT02414854). METHODS Changes from baseline in pre- and post-bronchodilator (BD) FEV1 and 5-item Asthma Control Questionnaire (ACQ-5) scores were assessed in patients with elevated type 2 biomarkers at baseline (type 2-150/25: eosinophils ≥150 cells/μl and/or fractional exhaled nitric oxide [FeNO] ≥25 ppb; type 2-300/25: eosinophils ≥300 cells/μl and/or FeNO ≥25 ppb), stratified as exacerbators (≥1 severe exacerbation during the study) or non-exacerbators. RESULTS In exacerbators and non-exacerbators, dupilumab increased pre-BD FEV1 by Week 2 vs placebo; differences were maintained to Week 52 (type 2-150/25: LS mean difference (LSMD) vs placebo: 0.17 L (95% CI: 0.10-0.24) and 0.17 L (0.12-0.23); type 2-300/25: 0.22 L (0.13-0.30) and 0.21 L (0.15-0.28)), in exacerbators and non-exacerbators, respectively (p < .0001). Similar trends were seen for post-BD FEV1 . Dupilumab vs placebo also showed significantly greater improvements in post-BD FEV1 0-42 days after first severe exacerbation in type 2-150/25 (LSMD vs placebo: 0.13 L [0.06-0.20]; p = .006) and type 2-300/25 (0.14 L [0.06-0.22]; p = .001) patients. ACQ-5 improvements were greater with dupilumab vs placebo in both groups. CONCLUSION Dupilumab treatment led to improvements in lung function independent of exacerbations and appeared to reduce the impact of exacerbations on lung function in patients who experienced a severe exacerbation during the study.
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Affiliation(s)
- Alberto Papi
- Respiratory Medicine, University of Ferrara and Emergency Department, University Hospital, Ferrara, Italy
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mario Castro
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Christian Domingo
- Pulmonary Service, Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Linda Rogers
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - Rebecca Gall
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Paul J Rowe
- Sanofi, Bridgewater Township, New Jersey, USA
| | - Yamo Deniz
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Benjamin Ortiz
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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Rabbani G, Nimmi N, Benke GP, Dharmage SC, Bui D, Sim MR, Abramson MJ, Alif SM. Ever and cumulative occupational exposure and lung function decline in longitudinal population-based studies: a systematic review and meta-analysis. Occup Environ Med 2023; 80:51-60. [PMID: 36280382 DOI: 10.1136/oemed-2022-108237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Adverse occupational exposures can accelerate age-related lung function decline. Some longitudinal population-based studies have investigated this association. This study aims to examine this association using findings reported by longitudinal population-based studies. METHODS Ovid Medline, PubMed, Embase, and Web of Science were searched using keywords and text words related to occupational exposures and lung function and 12 longitudinal population-based studies were identified using predefined inclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Lung function decline was defined as annual loss of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) or the ratio (FEV1/FVC). Fixed and random-effects meta-analyses were conducted to calculate pooled estimates for ever and cumulative exposures. Heterogeneity was assessed using the I2 test, and publication bias was evaluated using funnel plots. RESULTS Ever exposures to gases/fumes, vapours, gases, dusts, fumes (VGDF) and aromatic solvents were significantly associated with FEV1 decline in meta-analyses. Cumulative exposures for these three occupational agents observed a similar trend of FEV1 decline. Ever exposures to fungicides and cumulative exposures to biological dust, fungicides and insecticides were associated with FEV1 decline in fixed-effect models only. No statistically significant association was observed between mineral dust, herbicides and metals and FEV1 decline in meta-analyses. CONCLUSION Pooled estimates from the longitudinal population-based studies have provided evidence that occupational exposures are associated with FEV1 decline. Specific exposure control and respiratory health surveillance are required to protect the lung health of the workers.
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Affiliation(s)
| | - Naima Nimmi
- Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria, Australia
| | - Geza P Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh Bui
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheikh M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Mahut B, Bokov P, Beydon N, Delclaux C. Longitudinal assessment of loss and gain of lung function in childhood asthma. J Asthma 2023; 60:24-31. [PMID: 34958615 DOI: 10.1080/02770903.2021.2023176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Childhood Asthma Management Program revealed that 25.7% of children with mild to moderate asthma exhibit loss of lung function. The objective was to assess the trajectories of function by means of serial FEV1 in asthmatic children participating in out-of-hospital follow-up. METHODS A total of 295 children (199 boys) who had undergone at least 10 spirometry tests from the age of 8 were selected from a single-center open cohort. The annualized rate of change (slope) for prebronchodilator FEV1 (percent predicted) was estimated for each participant and three patterns were defined: significantly positive slope, significantly negative slope, and null slope (non-significant P-value; Pearson test). The standard deviation (SD) of each individual slope was recorded as a variability criterion of FEV1. RESULTS The median (25th; 75th percentile) age at inclusion and the last visit was 8.5 (8.2; 9.3) and 15.4 (14.8, 16.0) years, respectively. Tracking of function (null slope) was observed in 68.8% of the children, while 27.8% showed a loss of function or reduced growth (negative slope) and 3.4% showed a gain in function (positive slope). The children characterized by loss of function depicted a better initial function and a lower FEV1 variability during their follow-up than children with tracking or gain of lung function. At the last visit, these children were characterized by a lower lung function than children with tracking or gain of lung function. CONCLUSION Better initial FEV1 value and less FEV1 variability are associated with loss of lung function or reduced lung growth in asthmatic children.
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Affiliation(s)
| | - Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, AP-HP, Hôpital Robert Debré, Paris, France
| | - Nicole Beydon
- Service de Physiologie Pédiatrique-Centre du Sommeil, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, AP-HP, Hôpital Robert Debré, Paris, France
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11
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Cho MH, Hobbs BD, Silverman EK. Genetics of chronic obstructive pulmonary disease: understanding the pathobiology and heterogeneity of a complex disorder. THE LANCET. RESPIRATORY MEDICINE 2022; 10:485-496. [PMID: 35427534 PMCID: PMC11197974 DOI: 10.1016/s2213-2600(21)00510-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 12/20/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a deadly and highly morbid disease. Susceptibility to and heterogeneity of COPD are incompletely explained by environmental factors such as cigarette smoking. Family-based and population-based studies have shown that a substantial proportion of COPD risk is related to genetic variation. Genetic association studies have identified hundreds of genetic variants that affect risk for COPD, decreased lung function, and other COPD-related traits. These genetic variants are associated with other pulmonary and non-pulmonary traits, demonstrate a genetic basis for at least part of COPD heterogeneity, have a substantial effect on COPD risk in aggregate, implicate early-life events in COPD pathogenesis, and often involve genes not previously suspected to have a role in COPD. Additional progress will require larger genetic studies with more ancestral diversity, improved profiling of rare variants, and better statistical methods. Through integration of genetic data with other omics data and comprehensive COPD phenotypes, as well as functional description of causal mechanisms for genetic risk variants, COPD genetics will continue to inform novel approaches to understanding the pathobiology of COPD and developing new strategies for management and treatment.
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Affiliation(s)
- Michael H Cho
- Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Brian D Hobbs
- Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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12
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Ward C, Shukla SD, Walters EH. Air Pollution as a Risk Factor for Lung Cancer: Potential Mechanisms. Am J Respir Crit Care Med 2021; 205:367. [PMID: 34788195 PMCID: PMC8887005 DOI: 10.1164/rccm.202108-2010le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Chris Ward
- Freeman Hospital, William Leech Centre for Lung Research, Newcastle upon Tyne , United Kingdom of Great Britain and Northern Ireland
| | - Shakti D Shukla
- University of Technology Sydney, 1994, Graduate School of Pharmacy, Sydney, New South Wales, Australia
| | - E Haydn Walters
- Tasmanian School of Medicine, Discipline of Medicine, HOBART, Tasmania, Australia;
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13
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14
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The Underappreciated Role of Epithelial Mesenchymal Transition in Chronic Obstructive Pulmonary Disease and Its Strong Link to Lung Cancer. Biomolecules 2021; 11:biom11091394. [PMID: 34572606 PMCID: PMC8472619 DOI: 10.3390/biom11091394] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022] Open
Abstract
The World Health Organisation reported COPD to be the third leading cause of death globally in 2019, and in 2020, the most common cause of cancer death was lung cancer; when these linked conditions are added together they come near the top of the leading causes of mortality. The cell-biological program termed epithelial-to-mesenchymal transition (EMT) plays an important role in organ development, fibrosis and cancer progression. Over the past decade there has emerged a substantial literature that also links EMT specifically to the pathophysiology of chronic obstructive pulmonary disease (COPD) as primarily an airway fibrosis disease; COPD is a recognised strong independent risk factor for the development of lung cancer, over and above the risks associated with smoking. In this review, our primary focus is to highlight these linkages and alert both the COPD and lung cancer fields to these complex interactions. We emphasise the need for inter-disciplinary attention and research focused on the likely crucial roles of EMT (and potential for its inhibition) with recognition of its strategic place mechanistically in both COPD and lung cancer. As part of this we discuss the future potential directions for novel therapeutic opportunities, including evidence-based strategic repurposing of currently used familiar/approved medications.
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15
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Sit G, Letellier N, Iwatsubo Y, Goldberg M, Leynaert B, Nadif R, Ribet C, Roche N, Roquelaure Y, Varraso R, Zins M, Descatha A, Le Moual N, Dumas O. Occupational Exposures to Organic Solvents and Asthma Symptoms in the CONSTANCES Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179258. [PMID: 34501848 PMCID: PMC8431091 DOI: 10.3390/ijerph18179258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 01/17/2023]
Abstract
Solvents are used in many workplaces and may be airway irritants but few studies have examined their association with asthma. We studied this question in CONSTANCES (cohort of ‘CONSulTANts des Centres d’Examens de Santé’), a large French cohort. Current asthma and asthma symptom scores were defined by participant-reported respiratory symptoms, asthma medication or attacks, and the sum of 5 symptoms, in the past 12 months, respectively. Lifetime exposures to 5 organic solvents, paints and inks were assessed by questionnaire and a population-based Job-Exposure Matrix (JEM). Cross-sectional associations between exposures and outcomes were evaluated by gender using logistic and negative binomial regressions adjusted for age, smoking habits and body mass index. Analyses included 115,757 adults (54% women, mean age 47 years, 9% current asthma). Self-reported exposure to ≥1 solvent was significantly associated with current asthma in men and women, whereas using the JEM, a significant association was observed only in women. Significant associations between exposures to ≥1 solvent and asthma symptom score were observed for both self-report (mean score ratio, 95%CI, women: 1.36, 1.31–1.42; men: 1.34, 1.30–1.40) and JEM (women: 1.10, 1.07–1.15; men: 1.14, 1.09–1.18). Exposure to specific solvents was significantly associated with higher asthma symptom score. Occupational exposure to solvents should be systematically sought when caring for asthma.
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Affiliation(s)
- Guillaume Sit
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
| | - Noémie Letellier
- Herbert Wertheim School of Public Health and Human Longevity Science & Scripps, Institution of Oceanography, UC San Diego, La Jolla, CA 92093, USA;
| | - Yuriko Iwatsubo
- Santé publique France Direction Santé Environnement Travail, 94415 Saint-Maurice, France;
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, 94807 Villejuif, France; (M.G.); (C.R.); (M.Z.)
- Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
| | - Céline Ribet
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, 94807 Villejuif, France; (M.G.); (C.R.); (M.Z.)
| | - Nicolas Roche
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
- APHP Centre—Université de Paris, Hôpital et Institut Cochin, Service de Pneumologie, 75014 Paris, France
| | - Yves Roquelaure
- UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S1085, F-49000 Angers, France;
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
| | - Marie Zins
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, 94807 Villejuif, France; (M.G.); (C.R.); (M.Z.)
- Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Alexis Descatha
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
- UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S1085, F-49000 Angers, France;
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
- Correspondence:
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP, 94807 Villejuif, France; (G.S.); (B.L.); (R.N.); (N.R.); (R.V.); (A.D.); (O.D.)
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Krings JG, Goss CW, Lew D, Samant M, McGregor MC, Boomer J, Bacharier LB, Sheshadri A, Hall C, Brownell J, Schechtman KB, Peterson S, McEleney S, Mauger DT, Fahy JV, Fain SB, Denlinger LC, Israel E, Washko G, Hoffman E, Wenzel SE, Castro M. Quantitative CT metrics are associated with longitudinal lung function decline and future asthma exacerbations: Results from SARP-3. J Allergy Clin Immunol 2021; 148:752-762. [PMID: 33577895 PMCID: PMC8349941 DOI: 10.1016/j.jaci.2021.01.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/02/2020] [Accepted: 01/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Currently, there is limited knowledge regarding which imaging assessments of asthma are associated with accelerated longitudinal decline in lung function. OBJECTIVES We aimed to assess whether quantitative computed tomography (qCT) metrics are associated with longitudinal decline in lung function and morbidity in asthma. METHODS We analyzed 205 qCT scans of adult patients with asthma and calculated baseline markers of airway remodeling, lung density, and pointwise regional change in lung volume (Jacobian measures) for each participant. Using multivariable regression models, we then assessed the association of qCT measurements with the outcomes of future change in lung function, future exacerbation rate, and changes in validated measurements of morbidity. RESULTS Greater baseline wall area percent (β = -0.15 [95% CI = -0.26 to -0.05]; P < .01), hyperinflation percent (β = -0.25 [95% CI = -0.41 to -0.09]; P < .01), and Jacobian gradient measurements (cranial-caudal β = 10.64 [95% CI = 3.79-17.49]; P < .01; posterior-anterior β = -9.14, [95% CI = -15.49 to -2.78]; P < .01) were associated with more severe future lung function decline. Additionally, greater wall area percent (rate ratio = 1.06 [95% CI = 1.01-1.10]; P = .02) and air trapping percent (rate ratio =1.01 [95% CI = 1.00-1.02]; P = .03), as well as lower decline in the Jacobian determinant mean (rate ratio = 0.58 [95% CI = 0.41-0.82]; P < .01) and Jacobian determinant standard deviation (rate ratio = 0.52 [95% CI = 0.32-0.85]; P = .01), were associated with a greater rate of future exacerbations. However, imaging metrics were not associated with clinically meaningful changes in scores on validated asthma morbidity questionnaires. CONCLUSIONS Baseline qCT measures of more severe airway remodeling, more small airway disease and hyperinflation, and less pointwise regional change in lung volumes were associated with future lung function decline and asthma exacerbations.
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Affiliation(s)
- James G Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, St Louis, Mo
| | - Charles W Goss
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Mo
| | - Daphne Lew
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Mo
| | - Maanasi Samant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, St Louis, Mo
| | - Mary Clare McGregor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, St Louis, Mo
| | - Jonathan Boomer
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kan
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Ajay Sheshadri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
| | - Chase Hall
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kan
| | - Joshua Brownell
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin, Madison, Wis
| | - Ken B Schechtman
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Mo
| | | | | | - David T Mauger
- Division of Statistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, the University of California San Francisco, San Francisco, Calif
| | - Sean B Fain
- Department of Radiology and Biomedical Engineering, University of Wisconsin, Madison, Wis
| | - Loren C Denlinger
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin, Madison, Wis
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - George Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Eric Hoffman
- Department of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA
| | - Sally E Wenzel
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, the University of Pittsburgh, Pittsburgh, Pa
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kan.
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17
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Airborne Occupational Exposures and Lung Function in the Lifelines Cohort Study. Ann Am Thorac Soc 2021; 18:60-67. [PMID: 32795190 DOI: 10.1513/annalsats.201909-678oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale: The association between airborne occupational exposures and lung function level is inconsistent in the general population. Moreover, little is known about the association between occupational exposures and annual lung function decline.Objectives: We investigated the association between occupational exposures and lung function level and annual lung function decline in the population-based Lifelines cohort study.Methods: We included 55,631 adults with baseline spirometry and reliable job code-13,759 of these subjects were aged ≥30 years and underwent spirometry again after 4.5 years of follow-up. Occupational exposures in the current or last-held job at baseline were estimated with the ALOHA+ job-exposure matrix. Linear regression analyses adjusted for covariates were used to test the association between each occupational exposure-biological dust, mineral dust, gases and fumes, pesticides, solvents, and metals-and lung function level and annual lung function decline. Interactions were used to test effect modification by sex or smoking.Results: Exposures to biological dust, mineral dust, gases and fumes, insecticides, fungicides, and aromatic solvents were associated with a lower lung function level at baseline. The effects were larger in males and smokers compared with females and nonsmokers, respectively. However, no association between occupational exposures and the rate of annual lung function decline was found between baseline and follow-up.Conclusions: In this study, airborne occupational exposures are associated with lower lung function level but not with a faster lung function decline. These negative effects are more pronounced among males and smokers.
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18
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Walters EH, Shukla SD, Mahmood MQ, Ward C. Fully integrating pathophysiological insights in COPD: an updated working disease model to broaden therapeutic vision. Eur Respir Rev 2021; 30:200364. [PMID: 34039673 PMCID: PMC9488955 DOI: 10.1183/16000617.0364-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Our starting point is that relatively new findings into the pathogenesis and pathophysiology of airway disease in smokers that lead to chronic obstructive pulmonary disease (COPD) need to be reassessed as a whole and integrated into "mainstream" thinking along with traditional concepts which have stood the test of time. Such a refining of the accepted disease paradigm is urgently needed as thinking on therapeutic targets is currently under active reconsideration. We feel that generalised airway wall "inflammation" is unduly over-emphasised, and highlight the patchy and variable nature of the pathology (with the core being airway remodelling). In addition, we present evidence for airway wall disease in smokers/COPD as including a hypocellular, hypovascular, destructive, fibrotic pathology, with a likely spectrum of epithelial-mesenchymal transition states as significant drivers of this remodelling. Furthermore, we present data from a number of research modalities and integrate this with the aetiology of lung cancer, the role of chronic airway luminal colonisation/infection by a specific group of "respiratory" bacteria in smokers (which results in luminal inflammation) and the central role for oxidative stress on the epithelium. We suggest translation of these insights into more focus on asymptomatic smokers and early COPD, with the potential for fresh preventive and therapeutic approaches.
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Affiliation(s)
- E Haydn Walters
- School of Medicine and Menzies Institute, University of Tasmania, Hobart, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Malik Q Mahmood
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Chris Ward
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Medical School, Newcastle University, UK
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19
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Halayko AJ, Pascoe CD, Gereige JD, Peters MC, Cohen RT, Woodruff PG. Update in Adult Asthma 2020. Am J Respir Crit Care Med 2021; 204:395-402. [PMID: 34181860 DOI: 10.1164/rccm.202103-0552up] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrew J Halayko
- University of Manitoba, 8664, SECTION OF RESPIRATORY DISEASES, Winnipeg, Manitoba, Canada.,University of Manitoba, 8664, Biology of Breathing Group, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher D Pascoe
- University of Manitoba, 8664, Physiology and Pathophysiology, Winnipeg, Manitoba, Canada.,University of Manitoba Children's Hospital Research Institute of Manitoba, 423136, Winnipeg, Manitoba, Canada
| | - Jessica D Gereige
- Boston University School of Medicine, 12259, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Department of Medicine, Boston, Massachusetts, United States
| | - Michael C Peters
- University of California San Francisco, 8785, Pulmonary and Critical Care, San Francisco, California, United States
| | - Robyn T Cohen
- Boston University School of Medicine, 12259, Pediatrics, Boston, Massachusetts, United States
| | - Prescott G Woodruff
- UCSF, 8785, Division of Pulmonary and Critical Care Medicine, Department of Medicine and CVRI, San Francisco, California, United States;
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20
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Ritchie AI, Baker JR, Parekh TM, Allinson JP, Bhatt SP, Donnelly LE, Donaldson GC. Update in Chronic Obstructive Pulmonary Disease 2020. Am J Respir Crit Care Med 2021; 204:14-22. [PMID: 33856972 DOI: 10.1164/rccm.202102-0253up] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andy I Ritchie
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jonathon R Baker
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Trisha M Parekh
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - James P Allinson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Louise E Donnelly
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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21
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Hegewald MJ. Impact of obesity on pulmonary function: current understanding and knowledge gaps. Curr Opin Pulm Med 2021; 27:132-140. [PMID: 33394747 DOI: 10.1097/mcp.0000000000000754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Obesity is an increasing world-wide public health concern. Obesity both causes respiratory symptoms and contributes to many cardiorespiratory diseases. The effects of obesity on commonly used lung function tests are reviewed. RECENT FINDINGS The effects of obesity on lung function are attributed both to mechanical factors and to complex metabolic effects that contribute to a pro-inflammatory state. The effects of obesity on lung function correlate with BMI and correlate even better when the distribution of excess adipose tissue is taken into account, with central obesity associated with more prominent abnormalities. Obesity is associated with marked decreases in expiratory reserve volume and functional residual capacity. Total lung capacity, residual volume, and spirometry are less affected by obesity and are generally within the normal range except with severe obesity. Obesity decreases total respiratory system compliance primarily because of decreased lung compliance, with only mild effects on chest wall compliance. Obesity is associated with impaired gas transfer with decreases in oxygenation and varied but usually mild effects on diffusing capacity for carbon monoxide, while the carbon monoxide transfer coefficient is often increased. SUMMARY Obesity has significant effects on lung function. The relative contribution of the mechanical effects of obesity and the production of inflammatory cytokines by adipose tissue on lung function needs further study.
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Affiliation(s)
- Matthew J Hegewald
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray
- Division of Respiratory, Critical Care, & Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, USA
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22
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Lange P, Ahmed E, Lahmar ZM, Martinez FJ, Bourdin A. Natural history and mechanisms of COPD. Respirology 2021; 26:298-321. [PMID: 33506971 DOI: 10.1111/resp.14007] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
The natural history of COPD is complex, and the disease is best understood as a syndrome resulting from numerous interacting factors throughout the life cycle with smoking being the strongest inciting feature. Unfortunately, diagnosis is often delayed with several longitudinal cohort studies shedding light on the long 'preclinical' period of COPD. It is now accepted that individuals presenting with different COPD phenotypes may experience varying natural history of their disease. This includes its inception, early stages and progression to established disease. Several scenarios regarding lung function course are possible, but it may conceptually be helpful to distinguish between individuals with normal maximally attained lung function in their early adulthood who thereafter experience faster than normal FEV1 decline, and those who may achieve a lower than normal maximally attained lung function. This may be the main mechanism behind COPD in the latter group, as the decline in FEV1 during their adult life may be normal or only slightly faster than normal. Regardless of the FEV1 trajectory, continuous smoking is strongly associated with disease progression, development of structural lung disease and poor prognosis. In developing countries, factors such as exposure to biomass and sequelae after tuberculosis may lead to a more airway-centred COPD phenotype than seen in smokers. Mechanistically, COPD is characterized by a combination of structural and inflammatory changes. It is unlikely that all patients share the same individual or combined mechanisms given the heterogeneity of resultant phenotypes. Lung explants, bronchial biopsies and other tissue studies have revealed important features. At the small airway level, progression of COPD is clinically imperceptible, and the pathological course of the disease is poorly described. Asthmatic features can further add confusion. However, the small airway epithelium is likely to represent a key focus of the disease, combining impaired subepithelial crosstalk and structural/inflammatory changes. Insufficient resolution of inflammatory processes may facilitate these changes. Pathologically, epithelial metaplasia, inversion of the goblet to ciliated cell ratio, enlargement of the submucosal glands and neutrophil and CD8-T-cell infiltration can be detected. Evidence of type 2 inflammation is gaining interest in the light of new therapeutic agents. Alarmin biology is a promising area that may permit control of inflammation and partial reversal of structural changes in COPD. Here, we review the latest work describing the development and progression of COPD with a focus on lung function trajectories, exacerbations and survival. We also review mechanisms focusing on epithelial changes associated with COPD and lack of resolution characterizing the underlying inflammatory processes.
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Affiliation(s)
- Peter Lange
- Department of Internal Medicine, Section of Respiratory Medicine, Copenhagen University Hospital - Herlev, Herlev, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Engi Ahmed
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France.,Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, INSERM, Montpellier, France
| | - Zakaria Mohamed Lahmar
- Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, INSERM, Montpellier, France
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Arnaud Bourdin
- Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, INSERM, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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