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Koc ÖM, Aslan D, Kramer M, Verbeek J, Van Malenstein H, van der Merwe S, Monbaliu D, Vos R, Verleden GM, Pirenne J, Nevens F. Outcomes of liver transplantation for hepatopulmonary syndrome in patients with concomitant respiratory disease. Clin Transplant 2024; 38:e15171. [PMID: 37897208 DOI: 10.1111/ctr.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/05/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND & AIMS Concomitant respiratory disease is a common finding in patients with hepatopulmonary syndrome (HPS). Among patients who underwent liver transplantation (LT) for HPS, we compared characteristics and outcome of patients with versus without concomitant respiratory disease. METHODS This single center retrospective observational study included patients with HPS who underwent LT between 1999 and 2020. RESULTS During the study period, 32 patients with HPS received a LT; nine (28%) with concomitant respiratory disease of whom one required a combined lung-liver transplantation. Patients with concomitant respiratory disease had higher PaCO2 (38 vs. 33 mm Hg, p = .031). The 30-day postoperative mortality was comparable, but the estimated cumulative probability of resolution of oxygen therapy after LT in HPS patients with versus those without concomitant respiratory disease was lower: 63% versus 91% at 12 months and 63% versus 100% at 18 months (HR 95% CI .140-.995, p = .040). In addition to the presence of concomitant respiratory disease (p = .040), history of smoking (p = .012), and high baseline 99mTcMAA shunt fraction (≥20%) (p = .050) were significantly associated with persistent need of oxygen therapy. The 5-year estimated cumulative probability of mortality in patients with concomitant respiratory disease was worse: 50% versus 23% (HR 95% CI .416-6.867, p = .463). CONCLUSIONS The presence of a concomitant respiratory disease did not increase the short-term postoperative mortality after LT in patients with HPS. However, it resulted in a longer need for oxygen therapy.
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Affiliation(s)
- Özgür M Koc
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Devrim Aslan
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Matthijs Kramer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jef Verbeek
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Hannah Van Malenstein
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Schalk van der Merwe
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Abdominal Transplantation Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, University Hospitals KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplantation Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven, Belgium
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2
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Shapiro I, Stein J, MacRae C, O'Reilly M. Pulse oximetry values from 33,080 participants in the Apple Heart & Movement Study. NPJ Digit Med 2023; 6:134. [PMID: 37500721 PMCID: PMC10374661 DOI: 10.1038/s41746-023-00851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 05/24/2023] [Indexed: 07/29/2023] Open
Abstract
Wearable devices that include pulse oximetry (SpO2) sensing afford the opportunity to capture oxygen saturation measurements from large cohorts under naturalistic conditions. We report here a cross-sectional analysis of 72 million SpO2 values collected from 33,080 individual participants in the Apple Heart and Movement Study, stratified by age, sex, body mass index (BMI), home altitude, and other demographic variables. Measurements aggregated by hour of day into 24-h SpO2 profiles exhibit similar circadian patterns for all demographic groups, being approximately sinusoidal with nadir near midnight local time, zenith near noon local time, and mean 0.8% lower saturation during overnight hours. Using SpO2 measurements averaged for each subject into mean nocturnal and daytime SpO2 values, we employ multivariate ordinary least squares regression to quantify population-level trends according to demographic factors. For the full cohort, regression coefficients obtained from models fit to daytime SpO2 are in close quantitative agreement with the corresponding values from published reference models for awake arterial oxygen saturation measured under controlled laboratory conditions. Regression models stratified by sex reveal significantly different age- and BMI-dependent SpO2 trends for females compared with males, although constant terms and regression coefficients for altitude do not differ between sexes. Incorporating categorical variables encoding self-reported race/ethnicity into the full-cohort regression models identifies small but statistically significant differences in daytime SpO2 (largest coefficient corresponding to 0.13% lower SpO2, for Hispanic study participants compared to White participants), but no significant differences between groups for nocturnal SpO2. Additional stratified analysis comparing regression models fit independently to subjects in each race/ethnicity group is suggestive of small differences in age- and sex-dependent trends, but indicates no significant difference in constant terms between any race/ethnicity groups for either daytime or nocturnal SpO2. The large diverse study population and study design employing automated background SpO2 measurements spanning the full 24-h circadian cycle enables the establishment of healthy population reference trends outside of clinical settings.
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Affiliation(s)
| | | | - Calum MacRae
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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3
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Nakhaie S, Yazdani R, Shakibi M, Torabian S, Pezeshki S, Bazrafshani MS, Azimi M, Salajegheh F. The effects of antihypertensive medications on severity and outcomes of hypertensive patients with COVID-19. J Hum Hypertens 2023; 37:511-518. [PMID: 35790875 PMCID: PMC9255835 DOI: 10.1038/s41371-022-00716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 02/03/2023]
Abstract
In Covid-19 pandemic, specific comorbidities are associated with the increased risk of worse outcomes and increased severity of lung injury and mortality. the aim of this study was to investigate the effects of antihypertensive medications on the severity and outcomes of hypertensive patients with COVID-19. This retrospective observational study conducted on patients with COVID-19 who referred to Afzalipour Hospital, Kerman, Iran during the six months from 19 February 2020 to 20 July 2020. The data were collected through medical chart reviews. We assessed 265 patients with Covid-19 and they stratified based on hypertension and type of antihypertension medications. The data were described and Student's t-test, Mann-Whitney U and Fisher exact test were run to compare the patients 'demographical and clinical information. The qualitative variables were compared using the by SPSS software version 23. The results of the present study showed that hypertension was a prevalent comorbidity among patients with COVID-19 and hypertensive patients compared to other patients without any comorbidity who were older (P-value: 0.03). The oxygen saturation was higher for the patients in the control group than hypertensive patients (P-value: 0.01). The severity of COVID-19 and its outcome were not different between the patients who took or did not take antihypertensive medications and also the type of antihypertensive medications. Hypertensive patients did not show any significant difference in survival, hospital stay, ICU admission, disease severity, and invasive medical ventilation in other normotensive patients with COVID-19.
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Affiliation(s)
- Samira Nakhaie
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Rostam Yazdani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Shakibi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheila Torabian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Pezeshki
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Maliheh Sadat Bazrafshani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Azimi
- Department of Traditional Medicine, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Faranak Salajegheh
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Arima H, Koirala S, Nema K, Nakano M, Ito H, Poudel KM, Pandey K, Pandey BD, Yamamoto T. High prevalence of rheumatoid arthritis and its risk factors among Tibetan highlanders living in Tsarang, Mustang district of Nepal. J Physiol Anthropol 2022; 41:12. [PMID: 35366946 PMCID: PMC8976395 DOI: 10.1186/s40101-022-00283-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background In Tsarang (at 3560 m), which is located in Mustang, 62.7% of the residents answered that they had a subjective medical history of arthritis, and 41.1% of the residents answered that their families had a subjective medical history of arthritis on a survey conducted in 2017. The expression of hypoxia-inducible factor (HIF) and its effects are deeply involved in hypoxic adaptation in Tibetan highlanders. At the same time, HIF is also related to the onset of rheumatoid arthritis. Therefore, the adaptive mechanism acquired by Tibetan highlanders may promote the development of rheumatoid arthritis. The prevalence of rheumatoid arthritis is estimated to be approximately 0.5–1.0% worldwide. The objective of this study was to estimate the prevalence of rheumatoid arthritis in Tsarang residents using existing diagnostic criteria and to explore its risk factors. Methods An epidemiological survey was conducted in Tsarang in 2019. Data obtained from anthropometry and questionnaires were statistically analyzed. Biochemical measurements using blood samples were also performed, and the results were used to assess arthritis status. Residents’ joint status was scored, and arthritis was assessed based on the clinical disease activity index and ACR/EULAR 2010 criteria. Results Twenty-seven males and 50 females participated in this survey. In Tsarang, ACR/EULAR 2010 classified 4.3% of males and 7.1% of females as having rheumatoid arthritis, indicating a very high estimated prevalence. We also performed a multivariate analysis to explore its risk factors, and two factors, older age (standardized parameter estimate = 4.84E−01, 95% CI = [9.19E−02, 8.76E−01], p = 0.0170) and a history of living in urban areas (standardized parameter estimate = − 5.49E−01, 95% CI = [− 9.21E−01, 1.77E−01], p = 0.0050), significantly contributed to the higher ACR/EULAR 2010 score in females. In addition, three factors, having no spouse (standardized parameter estimate = 3.17E−01, 95% CI = [5.74E−02, 5.77E−01], p = 0.0179), having a smoking habit (standardized parameter estimate = 2.88E−01, 95% CI = [1.71E−02, 5.59E−01], p = 0.0377), and a history of living in urban areas (standardized parameter estimate = − 3.69E−01, 95% CI = [− 6.83E−01, − 5.60E−02], p = 0.0219), resulted in significantly higher clinical disease activity index scores in females. Furthermore, smoking habits were found to significantly increase blood hyaluronic acid in both males (standardized parameter estimate = 6.03E−01, 95% CI = [3.06E−01, 9.01E−01], p = 0.0020) and females (standardized parameter estimate = 4.87E−01, 95% CI = [5.63E−02, 9.18E−01], p = 0.0291). Conclusions In this study, we evaluated the symptoms of arthritis and estimated the prevalence of rheumatoid arthritis using classification criteria for Tibetan highlanders who have adapted to the hypoxic environment and fostered their own culture. The high prevalence of rheumatoid arthritis among Tsarang residents suggests that the hypoxic adaptation mechanism involving HIF in Tibetan highlanders may promote the onset or exacerbation of rheumatoid arthritis. The high prevalence of rheumatoid arthritis among Tibetan highlanders may be related not only to the environmental factors analyzed in this study but also to hypoxic adaptation genes. Further investigation is needed to clarify the genetic factors involved.
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Affiliation(s)
- Hiroaki Arima
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Sweta Koirala
- Nepal Development Society, Bharatpur-5, Chitwan, Nepal
| | - Kotaro Nema
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,School of Medical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Masayuki Nakano
- Department of Nutrition, Faculty of Health Sciences, Kochi Gakuen University, 292-26 Asahitenjin-cho, Kochi, Japan
| | - Hiromu Ito
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kapil Madi Poudel
- Institute of Medicine, Tribhuvan University, Maharajgung, 44600, Nepal
| | - Kishor Pandey
- Central Department of Zoology, Tribhuvan University, Kirtipur, Nepal
| | - Basu Dev Pandey
- Department of Molecular Epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. .,Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan. .,Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan.
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5
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Mizokami T, Akiyama M, Ikeda Y. Kaempferol as a phytochemical increases ATP content in C2C12 myotubes under hypoxic conditions. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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6
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Xiao T, Wijnant SRA, Licher S, Terzikhan N, Lahousse L, Ikram MK, Brusselle GG, Ikram MA. Lung Function Impairment and the Risk of Incident Dementia: The Rotterdam Study. J Alzheimers Dis 2021; 82:621-630. [PMID: 34057085 PMCID: PMC8385522 DOI: 10.3233/jad-210162] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The etiology of dementia may partly be underpinned by impaired lung function via systemic inflammation and hypoxia. OBJECTIVE To prospectively examine the association between chronic obstructive pulmonary disease (COPD) and subclinical impairments in lung function and the risk of dementia. METHODS In the Rotterdam Study, we assessed the risk of incident dementia in participants with Preserved Ratio Impaired Spirometry (PRISm; FEV1/FVC≥0.7, FEV1 < 80% predicted) and in participants with COPD (FEV1/FVC < 0.7) compared to those with normal spirometry (controls; FEV1/FVC≥0.7, FEV1≥80% predicted). Hazard ratios (HRs) with 95% confidence intervals (CI) for dementia were adjusted for age, sex, education attainment, smoking status, systolic blood pressure, body mass index, triglycerides, comorbidities and Apolipoprotein E (APOE) genotype. RESULTS Of 4,765 participants, 110 (2.3%) developed dementia after 3.3 years. Compared to controls, participants with PRISm, but not COPD, had an increased risk for all-type dementia (adjusted HRPRISm 2.70; 95% CI, 1.53-4.75; adjusted HRCOPD 1.03; 95% CI, 0.61-1.74). These findings were primarily driven by men and smokers. Similarly, participants with FVC% predicted values in the lowest quartile compared to those in the highest quartile were at increased risk of all-type dementia (adjusted HR 2.28; 95% CI, 1.31-3.98), as well as Alzheimer's disease (AD; adjusted HR 2.13; 95% CI, 1.13-4.02). CONCLUSION Participants with PRISm or a low FVC% predicted lung function were at increased risk of dementia, compared to those with normal spirometry or a higher FVC% predicted, respectively. Further research is needed to elucidate whether this association is causal and how PRISm might contribute to dementia pathogenesis.
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Affiliation(s)
- Tian Xiao
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sara R A Wijnant
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Silvan Licher
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natalie Terzikhan
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Badgujar KC, Badgujar AB, Dhangar DV, Badgujar VC. Importance and use of pulse oximeter in COVID-19 pandemic: general factors affecting the sensitivity of pulse oximeter. Chem Ind 2020. [DOI: 10.1080/00194506.2020.1845988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | - Vivek C. Badgujar
- Department of Chemistry, Pratap College of Arts, Science and Commerce, Amalner, India
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Melbye H, Helgeland J, Karlstad Ø, Ariansen I, Langhammer A, Wisløff T, Nafstad P, Nystad W. Is the Disease Burden from COPD in Norway Falling off? A Study of Time Trends in Three Different Data Sources. Int J Chron Obstruct Pulmon Dis 2020; 15:323-334. [PMID: 32103931 PMCID: PMC7024866 DOI: 10.2147/copd.s235106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background Less smoking should lead to fewer COPD cases. We aimed at estimating time trends in the prevalence and burden of COPD in Norway from 2001 to 2017. Methods We used pre-bronchodilator spirometry and other health data from persons aged 40–84 years in three surveys of the Tromsø Study, 2001–2002, 2007–2008 and 2015–2016. We applied spirometry lower limits of normal (LLN) according to Global Lung Initiative 2012. Age-standardized prevalence was determined. We defined COPD as FEV1/FVC<LLN in subjects reporting dyspnea or coughing, and moderate to severe COPD when FEV1 <LLN was found in addition. We identified hospitalizations due to COPD exacerbations in the Norwegian Patient Registry 2010–2017, and retrieved the use of COPD medication from the Norwegian Prescription Database. Change in prevalence was analyzed by logistic regression. Results In the Tromsø Study, the age-standardized prevalence of daily smoking dropped from 29.9% to 14.1% among women and from 31.4% to 12.8% among men (P<0.0001). The age-standardized prevalence of COPD dropped from 7.6% to 5.6% among women (P=0.2) and from 7.3% to 5.6% among men (P=0.003) and of moderate to severe COPD from 5.2% to 2.7% among women (P=0.0003) and from 4.6% to 3.2% among men (P=0.0008). Among men, the yearly age-standardized prevalence of hospitalization due to COPD exacerbation decreased from 3.6 to 3.0 per 1000 inhabitants aged 40–84 years (P<0.0001). Correspondingly, dispensing oral corticosteroids or/and antibiotics for COPD exacerbations dropped from 6.6 to 5.8 per 1000 (P<0.0001), while dispensing maintenance treatment increased (P<0.0001). Conclusion COPD morbidity decreased between 2001 and 2017, which might partly be due to less smoking. The drop in smoking prevalence gives promise of a further substantial decrease in the coming decades.
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Affiliation(s)
- Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Jon Helgeland
- Norwegian Institute of Public Health, Division of Health Services, Oslo, Norway
| | - Øystein Karlstad
- Norwegian Institute of Public Health, Department of Non-Communicable Diseases, Oslo, Norway
| | - Inger Ariansen
- Norwegian Institute of Public Health, Department of Non-Communicable Diseases, Oslo, Norway
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torbjørn Wisløff
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Per Nafstad
- Norwegian Institute of Public Health, Department of Non-Communicable Diseases, Oslo, Norway
| | - Wenche Nystad
- Norwegian Institute of Public Health, Department of Non-Communicable Diseases, Oslo, Norway
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9
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Børvik T, Evensen LH, Morelli VM, Melbye H, Brækkan SK, Hansen J. Impact of respiratory symptoms and oxygen saturation on the risk of incident venous thromboembolism-the Tromsø study. Res Pract Thromb Haemost 2020; 4:255-262. [PMID: 32110756 PMCID: PMC7040548 DOI: 10.1002/rth2.12299] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with risk of venous thromboembolism (VTE). It remains unknown whether individual respiratory symptoms and lowered oxygen saturation (SpO2), individually and in combination with COPD, affect the risk of VTE. OBJECTIVES To investigate whether measures of respiratory impairments including respiratory symptoms and SpO2, individually and combined with COPD, were associated with an increased risk of VTE. METHODS Spirometry, SpO2, and self-reported respiratory symptoms were collected in 8686 participants from the fifth (2001-2002) and sixth (2007-2008) surveys of the Tromsø Study. Incident VTE events were registered from the date of inclusion to December 31, 2016. Cox regression models with exposures and confounders as time-varying covariates (for repeated measurements) were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE. RESULTS During a median follow-up of 9.1 years, 330 participants developed incident VTE. Subjects with SpO2 ≤ 96% (lowest 20th percentile) had a 1.5-fold higher risk of VTE (adjusted HR, 1.48; 95% CI, 1.13-1.93) compared with those with SpO2 ≥ 98%. Severe respiratory symptoms (dyspnea, cough, and phlegm) were associated with a 1.4- to 2.0-fold higher risk of VTE compared with no such symptoms. COPD, combined with respiratory symptoms or lowered SpO2, had an additive effect on the VTE risk. CONCLUSIONS Lowered SpO2 and severe respiratory symptoms were associated with increased VTE risk. COPD combined with respiratory impairments had an additive effect on VTE risk, and may suggest particular attention on VTE preventive strategies in COPD patients with respiratory impairments.
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Affiliation(s)
- Trond Børvik
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Line H. Evensen
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Vania M. Morelli
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Hasse Melbye
- General Practice Research UnitDepartment of Community MedicineUiT‐The Arctic University of NorwayTromsøNorway
| | - Sigrid K. Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC)Department of Clinical MedicineUiT‐The Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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10
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Increase in Airway Obstruction between 1993 and 2012 in Switzerland. An Observational Study. Ann Am Thorac Soc 2020; 17:457-465. [PMID: 31991089 DOI: 10.1513/annalsats.201907-542oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Most studies determining the prevalence of airway obstruction are limited to short time periods.Objectives: Because temporal trends of obstruction in populations are largely unknown, we determined the prevalence of airway obstruction over 20 years in yearly general population samples in Switzerland between 1993 and 2012.Methods: We analyzed data of 85,789 participants aged 35 years and older who provided spirometric measurements as part of the LuftiBus lung function campaign. We linked data from the 2003-2012 period to the Swiss National Cohort to adjust for annual population differences. Spirometry was performed without bronchodilation, according to American Thoracic Society guidelines. We used Global Lung Initiative (GLI) and Hankinson reference equations to identify obstruction.Results: Obstruction prevalence increased between 1993 and 2012 from 6.1% (95% confidence interval [CI], 5.5 to 6.7) to 15.6% (95% CI, 13.8 to 17.3) based on GLI estimates and from 5.3% (95% CI, 4.7 to 5.9) to 15.4% (95% CI, 13.6 to 17.1) based on Hankinson estimates. When adjusted for participant demographics, air pollutant and occupational exposures, altitude, and season, the prevalence ratios of obstruction were 1.54 (95% CI, 1.22 to 1.93) and 1.65 (95% CI, 1.33 to 2.04) for GLI- and Hankinson-defined airway obstruction, respectively, for 2012 compared with 2003.Conclusions: Though prebronchodilator measurements likely overestimate the prevalence of airway obstruction in absolute terms compared with post-bronchodilator measurements, we found an increase in airway obstruction prevalence. Even with adjustment for several well-known risk factors for obstruction to make the populations across the years more comparable, we still saw a statistically significant increase in prevalence over this time period.
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11
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Chaumont M, Tagliatti V, Channan EM, Colet JM, Bernard A, Morra S, Deprez G, Van Muylem A, Debbas N, Schaefer T, Faoro V, van de Borne P. Short halt in vaping modifies cardiorespiratory parameters and urine metabolome: a randomized trial. Am J Physiol Lung Cell Mol Physiol 2019; 318:L331-L344. [PMID: 31721596 PMCID: PMC7052663 DOI: 10.1152/ajplung.00268.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Propylene glycol and glycerol are e-cigarette constituents that facilitate liquid vaporization and nicotine transport. As these small hydrophilic molecules quickly cross the lung epithelium, we hypothesized that short-term cessation of vaping in regular users would completely clear aerosol deposit from the lungs and reverse vaping-induced cardiorespiratory toxicity. We aimed to assess the acute effects of vaping and their reversibility on biological/clinical cardiorespiratory parameters [serum/urine pneumoproteins, hemodynamic parameters, lung-function test and diffusing capacities, transcutaneous gas tensions (primary outcome), and skin microcirculatory blood flow]. Regular e-cigarette users were enrolled in this randomized, investigator-blinded, three-period crossover study. The periods consisted of nicotine-vaping (nicotine-session), nicotine-free vaping (nicotine-free-session), and complete cessation of vaping (stop-session), all maintained for 5 days before the session began. Multiparametric metabolomic analyses were used to verify subjects' protocol compliance. Biological/clinical cardiorespiratory parameters were assessed at the beginning of each session (baseline) and after acute vaping exposure. Compared with the nicotine- and nicotine-free-sessions, a specific metabolomic signature characterized the stop-session. Baseline serum club cell protein-16 was higher during the stop-session than the other sessions (P < 0.01), and heart rate was higher in the nicotine-session (P < 0.001). Compared with acute sham-vaping in the stop-session, acute nicotine-vaping (nicotine-session) and acute nicotine-free vaping (nicotine-free-session) slightly decreased skin oxygen tension (P < 0.05). In regular e-cigarette-users, short-term vaping cessation seemed to shift baseline urine metabolome and increased serum club cell protein-16 concentration, suggesting a decrease in lung inflammation. Additionally, acute vaping with and without nicotine decreased slightly transcutaneous oxygen tension, likely as a result of lung gas exchanges disturbances.
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Affiliation(s)
- Martin Chaumont
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Vanessa Tagliatti
- Department of Human Biology and Toxicology, University of Mons, Mons, Belgium
| | - El Mehdi Channan
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marie Colet
- Department of Human Biology and Toxicology, University of Mons, Mons, Belgium
| | - Alfred Bernard
- Laboratory of Toxicology and Applied Pharmacology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Sofia Morra
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Guillaume Deprez
- Department of Clinical Chemistry, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Van Muylem
- Chest Department, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nadia Debbas
- Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Schaefer
- Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- Cardio-Pulmonary Exercise Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Institute for Translational Research in Cardiovascular and Respiratory Sciences, Université Libre de Bruxelles, Brussels, Belgium
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Development and validation of models to predict respiratory function in persons with long-term spinal cord injury. Spinal Cord 2019; 57:1064-1075. [PMID: 31217518 DOI: 10.1038/s41393-019-0313-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 01/01/2023]
Abstract
STUDY DESIGN Multicenter, cross-sectional study. OBJECTIVES To validate previously developed respiratory function prediction models for persons with long-term spinal cord injury (SCI) and if necessary develop and validate new models. SETTING Ten SCI rehabilitation centers. METHODS Five respiratory function parameters were measured in adults with chronic, traumatic, motor complete SCI (C4-T12). First, the models published in 2012 were validated using Bland-Altman plots. Then, new models were calculated using 80% of the dataset by multiple regression analysis with the candidate predictors gender, age, height, weight, time post injury (TPI), lesion level, and smoking. In a third step, the new models were validated using the other 20% of the dataset by Bland-Altman plots. RESULTS In total 613 participants were included. For persons with long-term SCI, the 2012 models were poorly predictive, especially for respiratory muscle strength (R2 = 0.4). Significant predictors for all respiratory function parameters in the new models (R2 = 0.7-0.8) were lesion level, gender and weight. Small effects on single outcome parameters were observed for TPI and age whereas smoking had no effect. For the new models the mean differences between measured and predicted values for respiratory muscle strength were 4.0 ± 36.0 cm H2O and for lung function parameters -0.5 ± 1.2 L (FVC), -0.3 ± 0.9 L (FEV1) and -0.5 ± 2.0 L/s (PEF). CONCLUSION We did not find better models for lung function in long-term SCI but those for respiratory muscle strength showed better accuracy. SPONSORSHIP The content of this publication was developed under grant from Wings for Life, grant number WFL-CH-017/14.
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BOLD signal physiology: Models and applications. Neuroimage 2019; 187:116-127. [DOI: 10.1016/j.neuroimage.2018.03.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 03/08/2018] [Indexed: 12/14/2022] Open
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Serpa Neto A, Bos LD, Campos PPZA, Hemmes SNT, Bluth T, Calfee CS, Ferner M, Güldner A, Hollmann MW, India I, Kiss T, Laufenberg-Feldmann R, Sprung J, Sulemanji D, Unzueta C, Vidal Melo MF, Weingarten TN, Tuip-de Boer AM, Pelosi P, Gama de Abreu M, Schultz MJ. Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis. Eur J Anaesthesiol 2018; 35:702-709. [PMID: 29957706 DOI: 10.1097/eja.0000000000000846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING Operating rooms of six hospitals in Europe and USA. DESIGN Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml; P < 0.001), IL-6 (2.3 [1.5 to 4.0] vs. 4.0 [2.9 to 6.5] pg ml; P < 0.001) and IL-8 (4.7 [3.1 to 8.1] vs. 8.1 [6.0 to 13.9] pg ml; P < 0.001). Phenotype 2 patients had the highest incidence of PPC (69.8 vs. 34.2% in type 1; P < 0.001). There was no interaction between phenotype and PEEP level for the development of PPCs (43.2% in high PEEP vs. 25.6% in low PEEP in phenotype 1, and 73.6% in high PEEP and 65.7% in low PEEP in phenotype 2; P for interaction = 0.503). CONCLUSION Patients at risk of PPCs and undergoing open abdominal surgery can be clustered based on pre-operative plasma biomarker concentrations. The two identified phenotypes have different incidences of PPCs. Biologic phenotyping could be useful in future randomised controlled trials of intra-operative ventilation. TRIAL REGISTRATION The PROtective Ventilation with HIgh or LOw PEEP trial, including the substudy from which data were used for the present analysis, was registered at ClinicalTrials.gov (NCT01441791).
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Affiliation(s)
- Ary Serpa Neto
- From the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil (ASN, PPZAC), Department of Intensive Care, Academic Medical Center (ASN, LDB, PPZAC, SNTH, MJS), Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center (LDB, MJS), Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (SNTH, MWH, AMT-dB), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (TB, AG, TK, MGdA), Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, California, USA (CSC), Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (MF), Department of Anaesthesiology, Hospital de Sant Pau, Barcelona, Spain (II), Department of Anaesthesiology, University Hospital Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (RL-F), Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota (JS, TNW), Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA (DS, MFVM), Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy (PP) and Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand (MJS). PROVHILO = PROtective Ventilation with HIgh or LOw PEEP-trial. PROVE = PROtective VEntilation (http://www.provenet.eu)
| | - Lieuwe D Bos
- From the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil (ASN, PPZAC), Department of Intensive Care, Academic Medical Center (ASN, LDB, PPZAC, SNTH, MJS), Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center (LDB, MJS), Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (SNTH, MWH, AMT-dB), Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (TB, AG, TK, MGdA), Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, California, USA (CSC), Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (MF), Department of Anaesthesiology, Hospital de Sant Pau, Barcelona, Spain (II), Department of Anaesthesiology, University Hospital Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany (RL-F), Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota (JS, TNW), Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA (DS, MFVM), Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy (PP) and Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand (MJS). PROVHILO = PROtective Ventilation with HIgh or LOw PEEP-trial. PROVE = PROtective VEntilation (http://www.provenet.eu)
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Shah P, Yauney G, Gupta O, Patalano II V, Mohit M, Merchant R, Subramanian SV. Technology-enabled examinations of cardiac rhythm, optic nerve, oral health, tympanic membrane, gait and coordination evaluated jointly with routine health screenings: an observational study at the 2015 Kumbh Mela in India. BMJ Open 2018; 8:e018774. [PMID: 29678964 PMCID: PMC5914894 DOI: 10.1136/bmjopen-2017-018774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Technology-enabled non-invasive diagnostic screening (TES) using smartphones and other point-of-care medical devices was evaluated in conjunction with conventional routine health screenings for the primary care screening of patients. DESIGN Dental conditions, cardiac ECG arrhythmias, tympanic membrane disorders, blood oxygenation levels, optic nerve disorders and neurological fitness were evaluated using FDA-approved advanced smartphone powered technologies. Routine health screenings were also conducted. A novel remote web platform was developed to allow expert physicians to examine TES data and compare efficacy with routine health screenings. SETTING The study was conducted at a primary care centre during the 2015 Kumbh Mela in Maharashtra, India. PARTICIPANTS 494 consenting 18-90 years old adults attending the 2015 Kumbh Mela were tested. RESULTS TES and routine health screenings identified unique clinical conditions in distinct patients. Intraoral fluorescent imaging classified 63.3% of the population with dental caries and periodontal diseases. An association between poor oral health and cardiovascular illnesses was also identified. Tympanic membrane imaging detected eardrum abnormalities in 13.0% of the population, several with a medical history of hearing difficulties. Gait and coordination issues were discovered in eight subjects and one subject had arrhythmia. Cross-correlations were observed between low oxygen saturation and low body mass index (BMI) with smokers (p=0.0087 and p=0.0122, respectively), and high BMI was associated with elevated blood pressure in middle-aged subjects. CONCLUSIONS TES synergistically identified clinically significant abnormalities in several subjects who otherwise presented as normal in routine health screenings. Physicians validated TES findings and used routine health screening data and medical history responses for comprehensive diagnoses for at-risk patients. TES identified high prevalence of oral diseases, hypertension, obesity and ophthalmic conditions among the middle-aged and elderly Indian population, calling for public health interventions.
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Affiliation(s)
- Pratik Shah
- Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Gregory Yauney
- Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Otkrist Gupta
- Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Vincent Patalano II
- Department of Ophthalmology, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Opthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mrinal Mohit
- Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Rikin Merchant
- Department of Prosthodontics, Karmaveer Bhausaheb Hiray Dental College and Hospital, Nashik, Maharashtra, India
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
BACKGROUND Hypoxemia is associated with worse outcomes in COPD. The aim of the study was to investigate the prevalence, incidence, and risk factors of hypoxic respiratory failure (HRF) in COPD. PATIENTS AND METHODS This was a longitudinal analysis of data from the Swedish National Register of COPD. HRF was defined as resting saturation ≤88% or long-term oxygen therapy. Risk factors for developing HRF were analyzed using multiple logistic regression and receiver operating characteristic curve analysis. RESULTS A total of 3,061 patients were included; mean forced expiratory volume in 1 second was 1.47 L; mean age was 70 years; and 54% were females. Median follow-up time was 1.8 years (interquartile range 1.3-2.4 years). HRF was present in 43 (1.4%) patients at baseline and 74 (2.4%) patients at follow-up. Among patients without HRF at baseline, 49 (1.6%) developed HRF during follow-up. The risk was highest for patients in Global initiative for Chronic Obstructive Lung Disease (GOLD) 2017 stage IV or groups C or D at baseline. Developing HRF was independently predicted by lower forced expiratory volume in 1 second and lower COPD Assessment Test score, with a c-statistic of 0.84 (95% CI, 0.70-0.91). When the multivariable model used the GOLD 2017 variables stages I-IV and the dichotomized variables frequent exacerbations and COPD Assessment Test ≥10; the c-statistic increased slightly to 0.86 (95% CI, 0.80-0.92; P<0.0001). CONCLUSION In patients with COPD, the prevalence and incidence of HRF was low and was predicted well by more severe air flow limitation and worse health status. The risk is highest in patients with GOLD stage IV and GOLD groups C or D.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro
| | - Magnus Ekström
- Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Danielsen SE, Løchen ML, Medbø A, Vold ML, Melbye H. A new diagnosis of asthma or COPD is linked to smoking cessation - the Tromsø study. Int J Chron Obstruct Pulmon Dis 2016; 11:1453-8. [PMID: 27418818 PMCID: PMC4934533 DOI: 10.2147/copd.s108046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Patients with COPD have had a lower tendency to quit smoking compared to patients with coronary heart disease (CHD). We wanted to investigate if this is still true in a Norwegian population. Methods Our data came from the fifth and sixth Tromsø surveys, which took place in 2001–2002 and 2007–2008. The predictors of smoking cessation were evaluated in a cohort of 4,497 participants who had stated their smoking status in both surveys. Results Of the 4,497 subjects in the cohort, 1,150 (25.6%) reported daily smoking in Tromsø 5. In Tromsø 6, 428 had quit (37.2%). A new diagnosis of obstructive lung disease (asthma or COPD) and CHD were both associated with increased quitting rates, 50.6% (P=0.01) and 52.1% (P=0.02), respectively. In multivariable logistic regression analysis with smoking cessation as outcome, the odds ratios (ORs) of a new diagnosis of obstructive lung disease and of CHD were 1.7 (1.1–2.7) and 1.7 (1.0–2.9), respectively. Male sex had an OR of 1.4 (1.1–1.8) compared to women in the multivariable model, whereas the ORs of an educational length of 13–16 years and ≥17 years compared to shorter education were 1.6 (1.1–2.2) and 2.5 (1.5–4.1), respectively. Conclusion The general trend of smoking cessation in the population was confirmed. Increased rates of smoking cessation were associated with a new diagnosis of heart or lung disease, and obstructive lung disease was just as strongly linked to smoking cessation as was CHD. This should encourage the pursuit of early diagnosis of COPD.
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Affiliation(s)
| | - Maja-Lisa Løchen
- Department of Community Medicine, The Arctic University of Norway
| | - Astri Medbø
- Department of Community Medicine, The Arctic University of Norway
| | - Monica Linea Vold
- Department of Respiratory Medicine, University Hospital of North Norway
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Guan Z, Lv Y, Liu J, Liu L, Yuan H, Shen X. Smoking Cessation Can Reduce the Incidence of Postoperative Hypoxemia After On-Pump Coronary Artery Bypass Grafting Surgery. J Cardiothorac Vasc Anesth 2016; 30:1545-1549. [PMID: 27554230 DOI: 10.1053/j.jvca.2016.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine whether smoking cessation can reduce the incidence of postoperative hypoxemia (POH) after on-pump coronary artery bypass grafting (CABG) surgery. DESIGN Prospective, single-center, observational study. SETTING Single-center university teaching hospital. PARTICIPANTS The study comprised 300 patients undergoing on-pump CABG surgery who met the inclusion criteria. Patients were divided into the following 3 groups according to smoking status: sustained quitters (n = 132)-smoking cessation for more than 1 month and less than 1 year; quitters (n = 95)-smoking cessation for more than 1 week and less than 1 month; and smokers (n = 73)-smoking at least 1 cigarette per day for at least 1 year. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the incidence of POH after on-pump CABG surgery. Secondary outcomes included length of postoperative mechanical ventilation and intensive care unit stay between the POH group and non-POH group. There were significant decreases of POH incidence in the sustained quitters and quitters compared with the smokers both after intensive care unit (ICU) admission and 24 hours after surgery (18.2%, 18.9%, v 32.9%; p = 0.036 and 9.8%, 10.5%, v 26%; p = 0.003, respectively), and there was no significant difference in POH incidence between the sustained quitters and quitters. The length of postoperative mechanical ventilation was longer in smokers than in sustained quitters and quitters (15.9±6.1 h v 11.9±5.3 h and 13.0±5.8 h, respectively; p<0.05), but there were no significant differences in the length of ICU stay among the 3 groups (54.2±7.5 h v 55.1±7.5 h and 53.7±6.6 h, respectively; p = 0.333). CONCLUSIONS Smoking cessation can reduce POH after on-pump CABG surgery, and it also can shorten the length of postoperative mechanical ventilation.
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Affiliation(s)
| | - Yi Lv
- Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jingjie Liu
- Department of Neurology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Liu
- Departments of *Anesthesiology and
| | - Hui Yuan
- Departments of *Anesthesiology and
| | - Xin Shen
- Departments of *Anesthesiology and
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Børvik T, Brækkan SK, Enga K, Schirmer H, Brodin EE, Melbye H, Hansen JB. COPD and risk of venous thromboembolism and mortality in a general population. Eur Respir J 2015; 47:473-81. [PMID: 26585434 DOI: 10.1183/13993003.00402-2015] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/23/2015] [Indexed: 01/01/2023]
Abstract
The relationship between chronic obstructive pulmonary disease (COPD) and risk of venous thromboembolism (VTE) has been scarcely studied in the general population. We aimed to investigate the association between COPD and risk of VTE and mortality in a population-based cohort.Spirometry was conducted in 8646 males and females, participating in the fifth (2001-02) and sixth (2007-08) surveys of the Tromsø Study. Incident VTE events during follow-up were registered from the date of inclusion to December 31, 2011. Cox-regression models with COPD stages and confounders as time varying covariates were used to calculate hazard ratios with 95% confidence intervals for VTE and all-cause mortality.During a median follow-up of 6.2 years, 215 subjects developed VTE. Subjects with COPD stage III/IV had a two-fold higher risk of secondary VTE compared to subjects with normal airflow (HR 2.05, 95% CI 1.02-4.10). COPD patients, particularly those with stage III/IV disease, with VTE had a higher mortality rate than COPD patients without VTE (50.2% versus 5.6% per year).Our findings suggest that patients with severe COPD may have increased risk of secondary VTE, and that COPD patients with VTE have a higher mortality rate than COPD patients without VTE.
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Affiliation(s)
- Trond Børvik
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Kristin Enga
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ellen E Brodin
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Hasse Melbye
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - John-Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Centre (TREC), Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Haematological Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Post-operative pulmonary complications: Understanding definitions and risk assessment. Best Pract Res Clin Anaesthesiol 2015; 29:315-30. [DOI: 10.1016/j.bpa.2015.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/23/2015] [Accepted: 10/08/2015] [Indexed: 01/28/2023]
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Appleton SL, Vakulin A, McEvoy RD, Wittert GA, Martin SA, Grant JF, Taylor AW, Antic NA, Catcheside PG, Adams RJ. Nocturnal Hypoxemia and Severe Obstructive Sleep Apnea are Associated with Incident Type 2 Diabetes in a Population Cohort of Men. J Clin Sleep Med 2015; 11:609-14. [PMID: 25766697 DOI: 10.5664/jcsm.4768] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/22/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Studies examining the longitudinal association of untreated obstructive sleep apnea (OSA) with diabetes in population samples are limited. This study therefore examined the relationship between previously undiagnosed OSA with incident type 2 diabetes in community-dwelling men aged ≥ 40 y. METHODS The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study is a longitudinal population-based cohort in Adelaide, South Australia. Clinic assessments at baseline and follow-up identified diabetes (self-reported doctor diagnosed, fasting plasma glucose ≥ 7.0 mmol/L, glycated hemoglobin ≥ 6.5% or diabetes medication use) and included anthropometry. At cohort follow-up (2010-2012), n = 837 underwent full in-home unattended polysomnography (PSG, Embletta X100, Broomfield, CO). RESULTS Of 736 men free of diabetes at baseline, incident diabetes occurred in 66 (9.0%) over a mean follow-up time of 56 mo (standard deviation = 5, range: 48-74 mo). Incident diabetes was associated with current oxygen desaturation index (3%) ≥ 16 events/h (odds ratio [OR]: 1.85 [1.06-3.21]), and severe OSA [OR: 2.6 (1.1-6.1)], in adjusted models including age, percentage total body fat, and weight gain (> 5 cm waist circumference). An age-adjusted association of incident diabetes with percentage of total sleep time with oxygen saturation < 90% did not persist after adjustment for percentage of body fat. No modification of these relationships by excessive daytime sleepiness was observed. CONCLUSIONS Severe undiagnosed OSA and nocturnal hypoxemia were independently associated with the development of diabetes. A reduction in the burden of undiagnosed OSA and undiagnosed diabetes is likely to occur if patients presenting with one disorder are assessed for the other.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Central Clinical School, University of Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Gary A Wittert
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia.,Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sean A Martin
- Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet F Grant
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Anne W Taylor
- Population Research & Outcomes Studies, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Nick A Antic
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute of Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia.,Department of Medicine, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, Australia
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