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Stewart S, Patel SK, Lancefield TF, Rodrigues TS, Doumtsis N, Jess A, Vaughan-Fowler ER, Chan YK, Ramchand J, Yates PA, Kwong JC, McDonald CF, Burrell LM. Vulnerability to environmental and climatic health provocations among women and men hospitalized with chronic heart disease: insights from the RESILIENCE TRIAL cohort. Eur J Cardiovasc Nurs 2024; 23:278-286. [PMID: 37625011 DOI: 10.1093/eurjcn/zvad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
AIMS We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health. METHODS AND RESULTS The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19-20% of women and men had a pre-existing pattern of seasonally linked hospitalization (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61-62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63 vs. 49%), lower education (30 vs. 14%), and living alone (48 vs. 29%) were more prevalent in women. CONCLUSION We successfully recruited women and men with multi-morbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes. REGISTRATION ClinicalTrials.org: NCT04614428.
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Affiliation(s)
- Simon Stewart
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sheila K Patel
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Terase F Lancefield
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Thalys S Rodrigues
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Nicholas Doumtsis
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Ashleigh Jess
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Emily-Rose Vaughan-Fowler
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Yih-Kai Chan
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Jay Ramchand
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul A Yates
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Aged Care, Austin Health, Melbourne, Victoria, Australia
| | - Jason C Kwong
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
- Department of Microbiology & Immunology, University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
- The Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
- The Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SMW, Czeisler CA. Association of Chronotype and Shiftwork with COVID-19 Infection. J Occup Environ Med 2024:00043764-990000000-00542. [PMID: 38595269 DOI: 10.1097/jom.0000000000003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. METHODS Cross-sectional survey of 19,821 U.S. adults. RESULTS COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration and comorbidities, morning chronotype was associated with a higher (aOR: 1.15, 95% CI 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). CONCLUSION Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.
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Affiliation(s)
| | | | | | | | | | | | | | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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Hoffman M, Burge AT, Wong N, McDonald CF, Chambers DC, Glaspole I, Mackintosh JA, Ekström M, Sköld M, Goh NSL, Corte TJ, Holland AE. Exertional Desaturation During the 6-Minute Walk Test vs Daily Life in People With Fibrotic Interstitial Lung Disease. Chest 2024; 165:632-635. [PMID: 37659620 DOI: 10.1016/j.chest.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Affiliation(s)
- Mariana Hoffman
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - Angela T Burge
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Nick Wong
- Monash Bioinformatics Platform, Monash University, Melbourne, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, VIC, Australia; Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
| | - Daniel C Chambers
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Thoracic Medicine, Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
| | - Ian Glaspole
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, VIC, Australia
| | - John A Mackintosh
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Thoracic Medicine, Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia
| | - Magnus Ekström
- Department of Clinical Sciences, Respiratory Medicine, Allergology, and Palliative Medicine, Lund University, Faculty of Medicine, Lund, Sweden
| | - Magnus Sköld
- Department of Medicine Solna and Center for Molecular Medicine, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden; Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Nicole S L Goh
- Institute for Breathing and Sleep, Melbourne, VIC, Australia; Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Central Clinical School, Sydney, NSW, Australia
| | - Anne E Holland
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SMW, Czeisler CA. Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 Infection. Am J Med 2024:S0002-9343(24)00109-8. [PMID: 38401674 DOI: 10.1016/j.amjmed.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Obstructive sleep apnea is associated with COVID-19 infection. Less clear is whether obstructive sleep apnea is a risk factor for the development of post-acute sequelae of SARS-CoV-2 infection (PASC). STUDY DESIGN Cross-sectional survey of a general population of 24,803 US adults to determine the association of obstructive sleep apnea with PASC. RESULTS COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence of persistent (>3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models, obstructive sleep apnea was associated with all putative PASC-related symptoms with the highest adjusted odds ratios being fever (2.053) and nervous/anxious (1.939). In 4 logistic regression models of overall PASC derived from elastic net regression, obstructive sleep apnea was associated with PASC (range of adjusted odds ratios: 1.934-2.071); this association was mitigated in those with treated obstructive sleep apnea. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%. CONCLUSION In a general population sample, obstructive sleep apnea is associated with the development of PASC-related symptoms and a global definition of PASC. Treated obstructive sleep apnea mitigates the latter risk. The presence of 3 or more PASC symptoms may be useful in identifying cases and for future research.
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Affiliation(s)
- Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine.
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
| | - Mark É Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, Mass; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
| | - Lauren A Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
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McDonald CF. Letter from Australia. Respirology 2024; 29:187-188. [PMID: 38176687 DOI: 10.1111/resp.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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Qin SX, Cheng FWT, Kwok WC, Fung LWY, Ma TT, Yiu HHE, Bloom C, McDonald CF, Cheung CL, Lai FTT, Chui CSL, Li X, Wong CKH, Wan EYF, Wong ICK, Chan EWY. Effectiveness and Respiratory Adverse Events Following Inactivated and mRNA COVID-19 Vaccines in Patients with COPD and Asthma: A Chinese Population-Based Study. Drug Saf 2024; 47:135-146. [PMID: 38085500 PMCID: PMC10821837 DOI: 10.1007/s40264-023-01364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Effectiveness and respiratory adverse events following coronavirus disease-2019 (COVID-19) vaccines have not been well investigated in Chinese patients with chronic obstructive pulmonary disease (COPD) and asthma. METHODS Using electronic health care records in Hong Kong, we included adults with COPD or asthma or both and hospitalised for severe respiratory exacerbation in a self-controlled case series (SCCS) study between 23/02/2021 and 30/11/2022. Conditional Poisson regression models were used to estimate the incidence of outcomes within exposure periods (28 days after each dose) compared with baseline periods. Cox proportional hazard models evaluated vaccine effectiveness (VE) against COVID-related mortality, hospitalisation, and severe complications, including admission to intensive care units or ventilatory support. The VE assessment was based on vaccine types and the number of doses. RESULTS In the SCCS, 343 CoronaVac recipients and 212 BNT162b2 recipients were included. No increased risk of outcomes was observed within the exposure periods. In the cohort study, 108,423 and 83,323 patients received ≥ 2 doses of CoronaVac and BNT162b2, respectively. The VE (95% CI) against COVID-related mortality, hospitalisation, and severe complications after two-dose CoronaVac was 77% (74-80%), 18% (6-23%), and 29% (12-43%), respectively, while for the two-dose regimen of BNT162b2, it was 92% (91-94%), 33% (30-37%), and 57% (45-66%), respectively. Higher VE against COVID-related mortality, hospitalisation, and severe complications was found for the three-dose regimen of CoronaVac (94%, 40%, and 71%) and BNT162b2 (98%, 65%, and 83%). Administering a fourth dose of either vaccine showed additional reductions in COVID-related outcomes. CONCLUSIONS Among people with COPD and asthma, the COVID-19 vaccines CoronaVac and BNT162b2 did not increase severe exacerbations and achieved moderate-to-high effectiveness against COVID-related outcomes. COVID-19 vaccination remains essential and should be encouraged to protect this vulnerable population in future epidemic waves.
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Affiliation(s)
- Simon Xiwen Qin
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Franco Wing Tak Cheng
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Wang Chun Kwok
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lydia W Y Fung
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Tian Tian Ma
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Hei Hang Edmund Yiu
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Chloe Bloom
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Christine F McDonald
- School of Medicine, University of Melbourne, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Ching-Lung Cheung
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China.
- Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.
| | - Esther Wai Yin Chan
- Centre for Safe Medicine Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-57, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China.
- , 02-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SM, Czeisler CA. Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 infection (PASC). medRxiv 2023:2023.12.30.23300666. [PMID: 38234859 PMCID: PMC10793517 DOI: 10.1101/2023.12.30.23300666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Obstructive sleep apnea (OSA) is associated with COVID-19 infection. Fewer investigations have assessed OSA as a possible risk for the development of Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Research Question In a general population, is OSA associated with increased odds of PASC-related symptoms and with an overall definition of PASC? Study Design Cross-sectional survey of a general population of 24,803 U.S. adults. Results COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence rates for a wide variety of persistent (> 3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models adjusted for demographic, anthropometric, comorbid medical and socioeconomic factors, OSA was associated with all putative PASC-related symptoms with the highest adjusted odds ratios (aOR) being fever (2.053) and nervous/anxious (1.939) respectively. Elastic net regression identified the 13 of 37 symptoms most strongly associated with COVID-19 infection. Four definitions of PASC were developed using these symptoms either weighted equally or proportionally by their regression coefficients. In all 4 logistic regression models using these definitions, OSA was associated with PASC (range of aORs: 1.934-2.071); this association was mitigated in those with treated OSA. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%. Conclusion In a general population sample, OSA is associated with the development of PASC-related symptoms and a global definition of PASC. A PASC definition requiring the presence of 3 or more symptoms may be useful in identifying cases and for future research.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I. Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F. Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Young PJ, Hodgson CL, Mackle D, Mather AM, Beasley R, Bellomo R, Bernard S, Brickell K, Deane AM, Eastwood G, Finfer S, Higgins AM, Hunt A, Lawrence C, Linke NJ, Litton E, McDonald CF, Moore J, Nichol AD, Olatunji S, Parke RL, Peake S, Secombe P, Seppelt IM, Turner A, Trapani T, Udy A, Kasza J. Protocol summary and statistical analysis plan for the low oxygen intervention for cardiac arrest injury limitation (LOGICAL) trial. CRIT CARE RESUSC 2023; 25:140-146. [PMID: 37876368 PMCID: PMC10581260 DOI: 10.1016/j.ccrj.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background The effect of conservative vs. liberal oxygen therapy on outcomes of intensive care unit (ICU) patients with hypoxic ischaemic encephalopathy (HIE) is uncertain and will be evaluated in the Low Oxygen Intervention for Cardiac Arrest injury Limitation (LOGICAL) trial. Objective The objective of this study was to summarise the protocol and statistical analysis plans for the LOGICAL trial. Design setting and participants LOGICAL is a randomised clinical trial in adults in the ICU who are comatose with suspected HIE (i.e., those who have not obeyed commands following return of spontaneous circulation after a cardiac arrest where there is clinical concern about possible brain damage). The LOGICAL trial will include 1400 participants and is being conducted as a substudy of the Mega Randomised registry trial comparing conservative vs. liberal oxygenation targets in adults receiving unplanned invasive mechanical ventilation in the ICU (Mega-ROX). Main outcome measures The primary outcome is survival with favourable neurological function at 180 days after randomisation as measured with the Extended Glasgow Outcome Scale (GOS-E). A favourable neurological outcome will be defined as a GOS-E score of lower moderate disability or better (i.e. a GOS-E score of 5-8). Secondary outcomes include survival time, day 180 mortality, duration of invasive mechanical ventilation, ICU length of stay, hospital length of stay, the proportion of patients discharged home, quality of life assessed at day 180 using the EQ-5D-5L, and cognitive function assessed at day 180 using the Montreal Cognitive Assessment (MoCA-blind). Conclusions The LOGICAL trial will provide reliable data on the impact of conservative vs. liberal oxygen therapy in ICU patients with suspected HIE following resuscitation from a cardiac arrest. Prepublication of the LOGICAL protocol and statistical analysis plan prior to trial conclusion will reduce the potential for outcome-reporting or analysis bias. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12621000518864).
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Affiliation(s)
- Paul J. Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Anne M. Mather
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Victorian Heart Hospital, Melbourne, Victoria, Australia
| | - Kathy Brickell
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
| | - Adam M. Deane
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Glenn Eastwood
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University College London, London, United Kingdom
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Anna Hunt
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Cassie Lawrence
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Natalie J. Linke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Edward Litton
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Intensive Care Unit, Fiona Stanley Hospital, Robin Warren Drive, Murdoch, Western Australia, Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - James Moore
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | - Shaanti Olatunji
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rachael L. Parke
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Sandra Peake
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Secombe
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Ian M. Seppelt
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - for the LOGICAL management committee, the Australian and New Zealand Intensive Care Society Clinical Trials Group, and the Irish Critical Care Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Victorian Heart Hospital, Melbourne, Victoria, Australia
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University College London, London, United Kingdom
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Intensive Care Unit, Fiona Stanley Hospital, Robin Warren Drive, Murdoch, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Dahan A, Farina S, Holmes NE, Kachel S, McDonald CF, Lewis JE, Marhoon N, Yanase F, Yang N, Bellomo R. Subsegmental pulmonary embolism and anticoagulant therapy: the impact of clinical context. Intern Med J 2023; 53:1435-1443. [PMID: 35499105 DOI: 10.1111/imj.15789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anticoagulation for subsegmental pulmonary embolism (SSPE) is controversial. AIM To assess the impact of clinical context on anticoagulation and outcomes of SSPE. METHODS We electronically searched computed tomography pulmonary angiogram reports to identify SSPE. We extracted demographic, risk factor, investigations and outcome data from the electronic medical record. We stratified patients according to anticoagulation and no anticoagulation. RESULTS From 1 January 2017 to 31 December 2019, we identified 166 patients with SSPE in 5827 pulmonary angiogram reports. Of these, 123 (74%) received anticoagulation. Compared with non-anticoagulated patients, such patients had a different clinical context: higher rates of previous venous thromboembolism (11% vs 0%; P = 0.019), more recent surgery (26% vs 9%; P = 0.015), more elevated serum D-dimer (22% vs 5%; P = 0.004), more lung parenchymal abnormalities (76% vs 61%; P = 0.037) and were almost twice as likely to require inpatient care (76% vs 42%; P < 0.001). Such patients also had twice the all-cause mortality at 1 year (32% vs 16%). CONCLUSIONS SSPE is diagnosed in almost 3% of pulmonary angiograms and is associated with high mortality, regardless of anticoagulation, due to coexistent disease processes rather than SSPE. Anticoagulation appears dominant but markedly affected by the clinical context of risk factors, alternative indications and illness severity. Thus, the controversy is partly artificial because anticoagulation after SSPE is clinically contextual with SSPE as only one of several factors.
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Affiliation(s)
- Ariel Dahan
- Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Sergio Farina
- Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Natasha E Holmes
- Data Analytics Research and Evaluation, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Stefan Kachel
- Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane E Lewis
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Nada Marhoon
- Data Analytics Research and Evaluation, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Natalie Yang
- Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Data Analytics Research and Evaluation, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
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10
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SM, Czeisler CA. Association of Chronotype and Shiftwork with COVID-19 Infection. medRxiv 2023:2023.07.06.23292337. [PMID: 37461617 PMCID: PMC10350136 DOI: 10.1101/2023.07.06.23292337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Objective This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods Cross-sectional survey of 19,821 U.S. adults. Results COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift work, sleep duration and comorbidities, morning chronotype was associated with a higher (aOR: 1.15, 95% CI 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I. Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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11
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane R, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SM, Czeisler CA. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults. J Clin Sleep Med 2023; 19:1303-1311. [PMID: 37279079 PMCID: PMC10315594 DOI: 10.5664/jcsm.10588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? METHODS This was a cross-sectional survey of a diverse sample of 15,057 US adults. RESULTS COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized. CONCLUSIONS In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization. CITATION Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med. 2023;19(7):1303-1311.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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12
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SMW, Czeisler CA. Insomnia, Poor Sleep Quality and Sleep Duration and Risk for COVID-19 Infection and Hospitalization. Am J Med 2023:S0002-9343(23)00248-6. [PMID: 37075878 PMCID: PMC10108572 DOI: 10.1016/j.amjmed.2023.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Medical comorbidities increase the risk of severe acute COVID-19 illness. Although sleep problems are common after COVID-19 infection, it is unclear whether insomnia, poor sleep quality and extremely long or short sleep increase risk of developing COVID-19 infection or hospitalization. METHODS Cross-sectional survey of a diverse sample of 19,926 U.S. adults RESULTS: COVID-19 infection and hospitalization prevalence rates were 40.1% and 2.9% respectively. Insomnia and poor sleep quality were reported in 19.8% and 40.1% respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but excluding participants who reported COVID-19 associated sleep problems, poor sleep quality but not insomnia was associated with COVID-19 infection (aOR: 1.16, 95%CI: 1.07-1.26) and COVID-19 hospitalization (aOR: 1.50, 95% CI: 1.18-1.91). In comparison to habitual sleep duration of 7-8 hours, sleep durations less than 7 hours (aOR: 1.14, 95% CI: 1.06-1.23) and sleep duration of 12 hours (aOR: 1.61, 95% CI: 1.12-2.31) were associated with increased odds of COVID-19 infection. Overall, the relationship between COVID-19 infection and hours of sleep followed a quadratic (U shaped) pattern. No association between sleep duration and COVID-19 hospitalization was observed. CONCLUSION In a general population sample, poor sleep quality and extremes of sleep duration are associated with greater odds of having had a COVID-19 infection; poor sleep quality was associated with an increased requirement of hospitalization for severe COVID-19 illness. These observations suggest that inclusion of healthy sleep practices in public health messaging may reduce the impact of the COVID-19 pandemic.
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Affiliation(s)
- Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA.
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Monash University, Melbourne, Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
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13
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Nakazawa A, Dowman LM, Cox NS, Brazzale DJ, McDonald CF, Hill CJ, Lee A, Holland AE. Prescribing walking training in interstitial lung disease from the 6-minute walk test. Physiother Theory Pract 2023; 39:873-877. [PMID: 35073825 DOI: 10.1080/09593985.2022.2029992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE Endurance training during PR requires exercise prescription at sufficient intensity to achieve physiological benefits. This analysis sought to investigate whether walking training prescribed from 6-minute walk test (6MWT) average speed provides an appropriate training intensity for people with ILD during PR. METHODS Individuals with ILD completed cardiopulmonary exercise test (CPET) and 6MWT in random order. A 10-minute constant speed treadmill walk test (10MTW) was undertaken at 80% of the average 6MWT speed. Oxygen uptake (VO2) was measured during all tests. Percentage VO2peak during 10MTW was main outcome measure. RESULTS Eleven people with ILD (age 71 (8) years; forced vital capacity 73 (18) %predicted, 6-minute walk distance 481 (99) meters, and VO2peak during CPET 1.3 (0.2) L.min-1) undertook testing. Average VO2peak during 10MTW was 91 (18) % of CPET VO2peak [range 67-116%]. Participants who achieved a greater VO2peak during CPET walked at a smaller %VO2peak during 10MTW (r = -0.6; p = .04). CONCLUSIONS For people with ILD, walking training prescribed at 80% of 6MWT average speed can provide adequate exercise training intensity for PR.
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Affiliation(s)
- Atsuhito Nakazawa
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Leona M Dowman
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Narelle S Cox
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Danny J Brazzale
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Catherine J Hill
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Annemarie Lee
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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14
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Cox NS, Holland AE, Jones AW, McDonald CF, O'Halloran P, Mahal A, Hepworth G, Lannin NA. Implementation of offering choice of pulmonary rehabilitation location to people with COPD: a protocol for the process evaluation of a cluster randomised controlled trial. Trials 2023; 24:173. [PMID: 36890526 PMCID: PMC9994770 DOI: 10.1186/s13063-023-07179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is a core component of management people with chronic obstructive pulmonary disease (COPD); yet, people with COPD face significant barriers to attending centre-based PR programs. The emergence of new models of PR, remotely delivered directly into people's homes, has the potential to improve rehabilitation access and completion by providing patients with a choice of rehabilitation location (centre or home). However, offering patients a choice of rehabilitation model is not usual practice. We are undertaking a 14-site cluster randomised controlled trial to determine whether offering choice of PR location improves rehabilitation completion rates resulting in reduced all-cause unplanned hospitalisation over 12 months. The aim of this paper is to describe the protocol for the process evaluation of the HomeBase2 trial. METHODS A mixed methods process evaluation, to be undertaken in real time, has been developed in accordance with UK Medical Research Council (MRC) recommendations on process evaluation of complex interventions. This protocol describes the intended use of two theoretical frameworks (RE-AIM framework (Reach; Effectiveness; Adoption; Implementation; Maintenance) and Theoretical Domains Framework (TDF)) to synthesise findings and interpret data from a combination of qualitative (semi-structured interviews) and quantitative (questionnaires, clinical outcome data, intervention fidelity) methodologies. Data will be collected at an intervention, patient and clinician level. Qualitative and quantitative data will be used to derive context-specific potential and actual barriers and facilitators to offering patients choice of rehabilitation location. Acceptability and sustainability of the intervention will be evaluated for future scale-up. DISCUSSION The process evaluation described here will appraise the clinical implementation of offering a choice of rehabilitation program location for people with COPD. It will identify and evaluate key factors for future scale-up and sustainability and scale-up of offering choice of pulmonary rehabilitation program model for people. TRIAL REGISTRATION ClinicalTrials.gov NCT04217330 Registration date: January 3 2020.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Institute for Breathing and Sleep, Melbourne, Australia.
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Physiotherapy, Alfred Health, Melbourne, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Department of Immunology and Pathology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ajay Mahal
- The Nossal Global Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Occupational Therapy, Alfred Health, Melbourne, Australia
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15
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Cox NS, Lee JYT, McDonald CF, Mahal A, Alison JA, Wootton R, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Corbett M, Handley E, Burge AT, Holland AE. Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study. Chest 2022:S0012-3692(22)04344-6. [PMID: 36574926 DOI: 10.1016/j.chest.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging. RESEARCH QUESTION To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program? STUDY DESIGN AND METHODS Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes. RESULTS One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss. INTERPRETATION Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear. TRIAL REGISTRY ClinicalTrials.gov; No.: ACTRN12616000360415; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne.
| | - Joanna Y T Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne; Respiratory and Sleep Medicine Clinic, Melbourne; Faculty of Medicine, Melbourne
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne; Melbourne
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia; Allied Health Research and Education Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Austin Health, Melbourne
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne
| | | | | | - Kathryn Barker
- Community Based Rehabilitation Service, Western Health, Melbourne
| | - Hayley Crute
- Physiotherapy Service, Wimmera Health Care Group, Horsham
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Bruna Wageck
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Pawel Czupryn
- Physiotherapy Service, West Wimmera Health Service, Nhill, VIC
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
| | - Emma Handley
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne; Institute for Breathing and Sleep, Melbourne; Department of Physiotherapy, Alfred Health, Melbourne
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16
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Dabscheck E, George J, Hermann K, McDonald CF, McDonald VM, McNamara R, O’Brien M, Smith B, Zwar NA, Yang IA. COPD‐X
Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update. Med J Aust 2022; 217:415-423. [DOI: 10.5694/mja2.51708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Johnson George
- Centre for Medicine Use and Safety Monash University Melbourne VIC
| | | | | | | | - Renae McNamara
- Prince of Wales Hospital and Community Health Services Sydney NSW
| | | | | | | | - Ian A Yang
- University of Queensland Brisbane QLD
- Prince Charles Hospital Brisbane QLD
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17
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Burge AT, Malaguti C, Hoffman M, Shiell A, McDonald CF, Berlowitz DJ, Holland AE. Efficacy of Repeating Pulmonary Rehabilitation in People with COPD: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2022; 17:1871-1882. [PMID: 35999942 PMCID: PMC9393021 DOI: 10.2147/copd.s368336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is an effective intervention for people with chronic obstructive pulmonary disease (COPD). People with COPD undertake repeat programs, but synthesis of evidence regarding such practice has not been undertaken. The aim of this systematic review was to establish the effects of repeating pulmonary rehabilitation subsequent to an initial program in people with COPD. Methods Studies where participants with COPD undertook >1 pulmonary rehabilitation program were included, incorporating RCT (randomized controlled trial) and non-randomized studies. Electronic database searches were undertaken. Two authors independently undertook study identification, data extraction and risk of bias assessment. The primary outcome was health-related quality of life (HRQoL); secondary outcomes were exercise capacity, hospitalizations and exacerbations, adherence, mortality and adverse events. Narrative synthesis was undertaken for clinically heterogeneous trials. Data from RCTs and non-randomized studies were not combined for analysis. Results Ten included studies (2 RCTs) involved 907 participants with COPD (n=653 had undertaken >1 program). The majority of studies were at high risk of bias. One RCT (n=33) reported no difference in HRQol after a repeat program vs usual care following exacerbation (Chronic Respiratory Disease Questionnaire dyspnea domain score MD 0.4, 95% CI -0.5 to 3). In stable patients, clinically important and statistically significant improvements in HRQoL and exercise capacity were reported after repeat programs, but of a smaller magnitude than initial programs. There was evidence for reductions in exacerbations and hospitalizations, and shorter hospital length of stay for patients who repeated a program twice in 12 months compared to those who repeated once. No data for mortality or adverse events were available. Conclusion This systematic review provides limited evidence for benefits of repeating pulmonary rehabilitation in people with COPD, including improved HRQoL and exercise capacity, and reduced hospitalizations. However, most studies have high risk of bias, which reduces the certainty of these conclusions. Study Registration PROSPERO (CRD42020215093).
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Affiliation(s)
- Angela T Burge
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Carla Malaguti
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Faculty of Physiotherapy, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Mariana Hoffman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Alan Shiell
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - David J Berlowitz
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
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18
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Joshi E, Mann JM, Goodwin ME, Collins AL, Atkins NE, Khor YH, McDonald CF. Perceptions of Individuals With Chronic Lung Disease on Home Use of Pulse Oximetry. Respir Care 2022; 67:801-806. [PMID: 35504723 PMCID: PMC9994095 DOI: 10.4187/respcare.09708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulse oximeters are often used at home by patients with chronic respiratory diseases and more recently for remote monitoring of patients with COVID-19. There are no published data outside a supervised telemedicine setting regarding patients' experiences with these devices. Our objective was to explore patients' usage patterns and perceptions of using pulse oximetry at home. METHODS Patients with chronic respiratory disease who had a pulse oximeter at home were recruited to complete a structured survey. RESULTS Thirty participants with a range of chronic respiratory diseases (mean age 71 y, 16 females) were recruited. Most participants (83%) used home oxygen therapy. Pulse oximeters were bought online (46.7%), at a pharmacy (40%), at a medical equipment store (6.7%), through a clinic (3.3%), or from an oxygen supplier (3.3%). Use was self-initiated in 56.7% of cases and was based on a health care-related recommendation in 26.7% of cases. Sixty percent of participants used the oximeter daily, with 90% expressing confidence in interpreting their oximeter readings primarily due to education from health care professionals and in-patient experiences. Almost all participants adjusted their activity levels or management based upon oximeter readings. Most participants reported that using a pulse oximeter at home was helpful in judging their physical limitations and provided reassurance and confidence in their disease management. CONCLUSIONS Subjects appeared confident in their use of home pulse oximetry. Health professionals should identify patients who use pulse oximeters for monitoring and ensure that they are able to interpret readings correctly and, if appropriate, adjust management safely.
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Affiliation(s)
- Esha Joshi
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; and Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Jennifer M Mann
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; and Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Maureen E Goodwin
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Allison L Collins
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; and Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Naomi E Atkins
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
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19
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Harrison AC, Robinson JF, Tu L, McDonald CF, Khor YH. Multidisciplinary Care and Prognosis in Patients With COPD and Interstitial Lung Disease Prescribed Long-Term Oxygen Therapy. Respir Care 2022; 67:667-675. [PMID: 35504724 PMCID: PMC9994206 DOI: 10.4187/respcare.09446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Home oxygen therapy is prescribed for patients with advanced lung disease based on the criteria established in landmark trials in subjects with COPD. In clinical practice, its use has been extrapolated to other diseases, including interstitial lung disease (ILD). Patients with COPD and ILD experience a high symptom burden and require access to specialized multidisciplinary care. We aimed to evaluate the health-related outcomes and supportive care needs of patients with COPD and ILD receiving home oxygen therapy. METHODS This was a retrospective cohort study using the oxygen database of a quaternary metropolitan teaching hospital. Patients with a diagnosis of COPD or ILD who were prescribed home oxygen therapy between January 2012-December 2018 were identified. Demographic information, results of physiologic testing, comorbidities, hospitalizations, and mortality data were collected. RESULTS Three hundred and eighty-four subjects were included for analysis, of whom 56% were male. The median age was 75 y. The majority (59%) had a diagnosis of COPD. Long-term oxygen therapy (LTOT) was prescribed for 187 (48.7%), with no significant demographic differences between those with COPD or ILD. Another 187 were prescribed ambulatory oxygen alone, with 55 transitioning to LTOT during the study period. Most subjects (65.4%) were referred for pulmonary rehabilitation; however, palliative care referrals were generally low (22.9%). Referrals to other medical specialties and allied health were common (82%). Transplant-free survival after commencement of LTOT was poor, with 38% of subjects surviving at 5 y. The 5-y survival of subjects with ILD after commencing on LTOT was 10% compared to 52% for those with COPD. Multivariable Cox regression analyses showed that the only predictor of survival after commencing LTOT was the principal respiratory diagnosis. CONCLUSIONS This study found that subjects prescribed LTOT had poor transplant-free survival after initiation, which was significantly worse for those with ILD compared to those with COPD. Despite their poor overall survival, worse than many cancers, only a minority were referred for palliative care input. Referrals to pulmonary rehabilitation were also suboptimal. This patient population had complex care needs requiring multidisciplinary management. Appropriate and early referrals to palliative care and improved care coordination for this complex group of patients are key areas for improvement in clinical practice.
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Affiliation(s)
- Amelia Ca Harrison
- Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; and Institute for Breathing and Sleep, Victoria, Australia
| | - Julien F Robinson
- Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; and Institute for Breathing and Sleep, Victoria, Australia
| | - Laura Tu
- Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Victoria, Australia
| | - Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Victoria, Australia.
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20
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Douglass JA, Lodge C, Chan S, Doherty A, Tan JA, Jin C, Stewart A, Southcott AM, Gillman A, Lee J, Csutoros D, Hannan L, Ruane L, Barnes S, Irving L, Harun NS, Lachapelle P, Spriggs K, Sutherland M, See K, McDonald CF, Conron M, Radhakrishna N, Worsnop C, Johnston FH, Davies JM, Bryant V, Iles L, Ranson D, Spanos P, Vicendese D, Lowe A, Newbigin EJ, Bardin P, Dharmage S. Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study. J Allergy Clin Immunol 2022; 149:1607-1616. [PMID: 34774618 DOI: 10.1016/j.jaci.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Asthma epidemics associated with thunderstorms have had catastrophic effects on individuals and emergency services. Seasonal allergic rhinitis (SAR) is present in the vast majority of people who develop thunderstorm asthma (TA), but there is little evidence regarding risk factors for TA among the SAR population. OBJECTIVE We sought to identify risk factors for a history of TA and hospital presentation in a cohort of individuals with SAR. METHODS This multicenter study recruited adults from Melbourne, Australia, with a past diagnosis of TA and/or self-reported SAR. Clinical information, spirometry results, white blood cell count, ryegrass pollen-specific (RGP-sp) IgE concentration, and fractional exhaled nitric oxide were measured to identify risk factors for a history of TA in individuals with SAR. RESULTS From a total of 228 individuals with SAR, 35% (80 of 228) reported SAR only (the I-SAR group), 37% (84 of 228) reported TA symptoms but had not attended hospital for treatment (the O-TA group), and 28% (64 of 228) had presented to the hospital for TA (the H-TA group). All patients in the H-TA group reported a previous asthma diagnosis. Logistic regression analysis of factors associated with O-TA and H-TA indicated that lower FEV1 value and an Asthma Control Questionnaire score higher than 1.5 were associated with H-TA. Higher blood RGP-sp IgE concentration, eosinophil counts, and fractional exhaled nitric oxide level were significantly associated with both O-TA and H-TA. Receiver operating curve analysis showed an RGP-sp IgE concentration higher than 10.1 kU/L and a prebronchodilator FEV1 value of 90% or lower to be biomarkers of increased H-TA risk. CONCLUSION Clinical tests can identify risk of a history of TA in individuals with SAR and thereby inform patient-specific treatment recommendations.
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Affiliation(s)
- Jo A Douglass
- Department of Medicine, The University of Melbourne, Parkville, Australia.
| | - Caroline Lodge
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
| | - Samantha Chan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Alice Doherty
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
| | - Ju Ann Tan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Celina Jin
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Alastair Stewart
- Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Australia
| | - Anne M Southcott
- Department of Respiratory and Sleep Medicine, Western Health, Footscray, Australia
| | - Andrew Gillman
- Department of Respiratory and Sleep Medicine, Western Health, Footscray, Australia
| | - Joy Lee
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Danny Csutoros
- Department of Health and Human Services, State Government of Victoria, Melbourne, Australia
| | - Liam Hannan
- Department of Respiratory Medicine, Northern Health, Epping, Australia
| | - Laurence Ruane
- Monash Lung, Sleep, Allergy and Immunology, Monash Hospital and University, Clayton, Australia
| | - Sara Barnes
- Department of Allergy, Monash Health, Clayton, Australia
| | - Lou Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Nur-Shirin Harun
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | | | - Kymble Spriggs
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Sutherland
- Department of Medicine, The University of Melbourne, Richmond, Australia
| | - Katharine See
- Department of Respiratory Medicine, Northern Health, Epping, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Matthew Conron
- Department of Respiratory Medicine, St. Vincent's Hospital, Fitzroy, Australia
| | | | - Christopher Worsnop
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Janet M Davies
- Centre for Immunology and Infection Control, The University of Queensland, Herston, Australia
| | - Vanessa Bryant
- Immunology Division, Walter and Eliza Hall Institute of Medical Research 1G Royal Parade, Parkville, Australia
| | - Linda Iles
- Victorian Institute of Forensic Medicine, Monash University, Southbank, Australia
| | - David Ranson
- Victorian Institute of Forensic Medicine, Monash University, Southbank, Australia
| | | | - Don Vicendese
- Department of Mathematics and Statistics, La Trobe University, Essendon, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
| | - Edward J Newbigin
- School of BioSciences, The University of Melbourne, Parkville, Australia
| | - Philip Bardin
- Monash Lung, Sleep, Allergy and Immunology, Monash Hospital and University, Clayton, Australia
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
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Jeganathan V, Knight S, Bricknell M, Ridgers A, Wong R, Brazzale DJ, Ruehland WR, Rahman MA, Leong TL, McDonald CF. Impact of smoking status and chronic obstructive pulmonary disease on pulmonary complications post lung cancer surgery. PLoS One 2022; 17:e0266052. [PMID: 35349598 PMCID: PMC8963579 DOI: 10.1371/journal.pone.0266052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Smoking and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of post-operative pulmonary complications (PPCs) following lung cancer resection. It remains unclear whether smoking cessation reduces this risk. Methods Retrospective review of a large, prospectively collected database of over 1000 consecutive resections for lung cancer in a quaternary lung cancer centre over a 23-year period. Results One thousand and thirteen patients underwent curative-intent lobectomy or pneumonectomy between 1995 and 2018. Three hundred and sixty-two patients (36%) were ex-smokers, 314 (31%) were current smokers and 111 (11%) were never smokers. A pre-operative diagnosis of COPD was present in 57% of current smokers, 57% of ex-smokers and 20% of never smokers. Just over 25% of patients experienced a PPC. PPCs were more frequent in current smokers compared to never smokers (27% vs 17%, p = 0.036), however, no difference was seen between current and ex-smokers (p = 0.412) or between never and ex-smokers (p = 0.113). Those with a diagnosis of COPD, independent of smoking status, had a higher frequency of both PPCs (65% vs 35%, p<0.01) and overall complications (60% vs 40%, p<0.01) as well as a longer length of hospital stay (10 vs 9 days, p<0.01). Conclusion Smoking and COPD are both associated with a higher rate of PPCs post lung cancer resection. COPD, independent of smoking status, is also associated with an increased overall post-operative complication rate and length of hospital stay. An emphasis on COPD treatment optimisation, rather than smoking cessation in isolation, may help improve post-operative outcomes.
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Affiliation(s)
- Vishnu Jeganathan
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- * E-mail:
| | - Simon Knight
- Department of Thoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Matthew Bricknell
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Anna Ridgers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Raymond Wong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Danny J. Brazzale
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Warren R. Ruehland
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, Australia
| | - Tracy L. Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
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22
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Holland AE, Jones AW, Mahal A, Lannin NA, Cox N, Hepworth G, O'Halloran P, McDonald CF. Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e057311. [PMID: 35410931 PMCID: PMC9003613 DOI: 10.1136/bmjopen-2021-057311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model. METHOD AND ANALYSIS This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial. ETHICS AND DISSEMINATION Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies. TRIAL REGISTRATION NUMBER NCT04217330.
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Affiliation(s)
- Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ajay Mahal
- The Nossal Global Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Allied Health (Occupational Therapy), Alfred Health, Melbourne, Victoria, Australia
| | - Narelle Cox
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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23
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Barnett A, Beasley R, Buchan C, Chien J, Farah CS, King G, McDonald CF, Miller B, Munsif M, Psirides A, Reid L, Roberts M, Smallwood N, Smith S. Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: 'Swimming between the flags'. Respirology 2022; 27:262-276. [PMID: 35178831 PMCID: PMC9303673 DOI: 10.1111/resp.14218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022]
Abstract
Oxygen is a life-saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non-invasive ventilation and humidified high-flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand.
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Affiliation(s)
- Adrian Barnett
- Department of Respiratory and Sleep MedicineMater Public HospitalSouth BrisbaneQueenslandAustralia
| | - Richard Beasley
- Medical Research Institute of New Zealand & Capital Coast District Health BoardWellingtonNew Zealand
| | - Catherine Buchan
- Department of Respiratory and Sleep MedicineThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Immunology and Respiratory MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jimmy Chien
- Department of Respiratory and Sleep MedicineWestmead Hospital, Ludwig Engel Centre for Respiratory Research and University of SydneySydneyNew South WalesAustralia
| | - Claude S. Farah
- Department of Respiratory Medicine, Concord HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| | - Gregory King
- Department of Respiratory and Sleep Medicine, Royal North Shore HospitalWoolcock Institute of Medical Research and University of SydneySydneyNew South WalesAustralia
| | - Christine F. McDonald
- Department of Respiratory and Sleep MedicineAustin Health and University of MelbourneMelbourneVictoriaAustralia
| | - Belinda Miller
- Department of Respiratory MedicineThe Alfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - Maitri Munsif
- Department of Respiratory and Sleep MedicineAustin Health and University of MelbourneMelbourneVictoriaAustralia
| | - Alex Psirides
- Intensive Care UnitWellington Regional Hospital, Capital and Coast District Health BoardWellingtonNew Zealand
| | - Lynette Reid
- Respiratory MedicineRoyal Hobart HospitalHobartTasmaniaAustralia
| | - Mary Roberts
- Department of Respiratory and Sleep MedicineWestmead Hospital, Ludwig Engel Centre for Respiratory Research and University of SydneySydneyNew South WalesAustralia
| | - Natasha Smallwood
- Department of Respiratory and Sleep MedicineThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Immunology and Respiratory MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Smith
- School of Nursing and MidwiferyWestern Sydney UniversitySydneyNew South WalesAustralia
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24
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AlShareef S, McDonald CF, Lee J. Clinical and Lung Function Outcomes After Anti-IgE or Anti-IL5 Therapy in Severe Asthma. J Asthma Allergy 2022; 15:209-217. [PMID: 35210787 PMCID: PMC8857973 DOI: 10.2147/jaa.s348137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although there have been indirect comparisons of the relative efficacy of mepolizumab (anti-IL-5) and benralizumab (anti-IL-5Rα) in severe asthma patients, long-term direct head-to-head comparisons are lacking. Here, we (i) examined the effect of mepolizumab, benralizumab, and omalizumab on symptom control and lung function parameters over time; and (ii) compared the efficacy of mepolizumab and benralizumab on symptom control and lung function outcomes. Methods This was a retrospective study of patients with severe asthma taking anti-IgE (omalizumab; n = 24), anti-IL5 (mepolizumab, n = 23), or anti-IL-Rα (benralizumab; n = 12) therapy. Data were extracted on (i) Asthma Control Questionnaire (ACQ-5) scores; (ii) forced expiratory volume over 1 second (FEV1); and (iii) peak expiratory flow rate (PEFR) at 4–6 months and 1 year and documented reductions in exacerbations. Clinical and lung function outcomes were compared between patients taking mepolizumab and benralizumab and over time. Results There were significant decreases in ACQ-5 scores (3.3 ± 0.93 to 1.7 ± 0.98 for mepolizumab, 3.5 ± 0.72 to 1.6 ±0.89 for benralizumab, and 3.5 ± 0.95 to 1.7 ± 1.1 for omalizumab; t-test, all p < 0.0001) but not increases in FEV1 and PEFR for all three agents after 4–6 months of therapy, which persisted but did not decrease further at one year. There were trends toward a greater percentage increase in FEV1 and PEFR from baseline and a decrease in the number of exacerbations in patients taking benralizumab than those taking mepolizumab. Conclusion Although limited by a small sample size, this real-world, head-to-head comparison of mepolizumab and benralizumab is consistent with comparative data on asthma biologicals and indirect comparisons showing no major difference in efficacy. The study also generates new testable hypotheses about the efficacy of asthma biologicals in different patient populations.
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Affiliation(s)
- Saad AlShareef
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 13317-4233, Saudi Arabia
- Correspondence: Saad AlShareef, Email
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Joy Lee
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
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25
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Abstract
Long-term home oxygen therapy improves survival in patients with chronic obstructive pulmonary disease and persistent, severe hypoxaemia. It is uncertain that this benefit extends to patients with other chronic lung diseases. Oxygen is a treatment for hypoxaemia, not breathlessness. To confirm hypoxaemia, blood gas analysis is recommended before prescribing oxygen. There is limited and conflicting evidence that portable oxygen for exertional use is of benefit to patients with chronic obstructive pulmonary disease who do not have severe hypoxaemia. Laboratory studies show improvements in exercise capacity and dyspnoea, but these do not translate into significant benefits in the home setting. Patients should be educated regarding the expected benefits, risks and burdens of home oxygen therapy. It is particularly important that the patient does not smoke.
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26
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Granger CL, Edbrooke L, Antippa P, Wright G, McDonald CF, Lamb KE, Irving L, Krishnasamy M, Abo S, Whish-Wilson GA, Truong D, Denehy L, Parry SM. Effect of a postoperative home-based exercise and self-management programme on physical function in people with lung cancer (CAPACITY): protocol for a randomised controlled trial. BMJ Open Respir Res 2022; 9:9/1/e001189. [PMID: 35039313 PMCID: PMC8765028 DOI: 10.1136/bmjresp-2021-001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Exercise is important in the postoperative management of lung cancer, yet no strong evidence exists for delivery of home-based programmes. Our feasibility (phase I) study established feasibility of a home-based exercise and self-management programme (the programme) delivered postoperatively. This efficacy (phase II) study aims to determine whether the programme, compared with usual care, is effective in improving physical function (primary outcome) in patients after lung cancer surgery. METHODS AND ANALYSIS This will be a prospective, multisite, two-arm parallel 1:1, randomised controlled superiority trial with assessors blinded to group allocation. 112 participants scheduled for surgery for lung cancer will be recruited and randomised to usual care (no exercise programme) or, usual care plus the 12-week programme. The primary outcome is physical function measured with the EORTC QLQ c30 questionnaire. Secondary outcomes include health-related quality of life (HRQoL); exercise capacity; muscle strength; physical activity levels and patient reported outcomes. HRQoL and patient-reported outcomes will be measured to 12 months, and survival to 5 years. In a substudy, patient experience interviews will be conducted in a subgroup of intervention participants. ETHICS AND DISSEMINATION Ethics approval was gained from all sites. Results will be submitted for publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617001283369.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia .,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Research and Education Lead Program, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Methods and Implementation Support for Clinical Health research platform MISCH, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.,Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shaza Abo
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina A Whish-Wilson
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dominic Truong
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Selina M Parry
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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27
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Perret JL, Vicendese D, Simons K, Jarvis DL, Lowe AJ, Lodge CJ, Bui DS, Tan D, Burgess JA, Erbas B, Bickerstaffe A, Hancock K, Thompson BR, Hamilton GS, Adams R, Benke GP, Thomas PS, Frith P, McDonald CF, Blakely T, Abramson MJ, Walters EH, Minelli C, Dharmage SC. Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts. BMJ Open Respir Res 2021; 8:8/1/e001138. [PMID: 34857526 PMCID: PMC8640628 DOI: 10.1136/bmjresp-2021-001138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. Objective To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). Setting General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. Participants For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41–45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51–55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40–49 and 50–59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). Statistical method Risk-prediction models were developed using randomForest then externally validated. Results Area under the receiver operating characteristic curve (AUCROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUCROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40–49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. Conclusion This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted ‘COPD cases’ at a much earlier age.
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Affiliation(s)
- Jennifer L Perret
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia .,Department of Respiratory and Sleep Medicine, The Austin Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, VIC, Australia
| | - Don Vicendese
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,The Department of Mathematics and Statistics, La Trobe University, Bundoora, VIC, Australia
| | - Koen Simons
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debbie L Jarvis
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Adrian J Lowe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Dinh S Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Daniel Tan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John A Burgess
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Adrian Bickerstaffe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Bruce R Thompson
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Garun S Hamilton
- Department of Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, VIC, Australia.,School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health (AISH), Flinders University, Adelaide, SA, Australia
| | - Geza P Benke
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul S Thomas
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter Frith
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, The Austin Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep (IBAS), Melbourne, VIC, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - E Haydn Walters
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Cosetta Minelli
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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28
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Dowman LM, May AK, Hill CJ, Bondarenko J, Spencer L, Morris NR, Alison JA, Walsh J, Goh NSL, Corte T, Glaspole I, Chambers DC, McDonald CF, Holland AE. High intensity interval training versus moderate intensity continuous training for people with interstitial lung disease: protocol for a randomised controlled trial. BMC Pulm Med 2021; 21:361. [PMID: 34758808 PMCID: PMC8582173 DOI: 10.1186/s12890-021-01704-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Interstitial lung disease is a debilitating condition associated with significant dyspnoea, fatigue, and poor exercise tolerance. Pulmonary rehabilitation is an effective and key intervention in people with interstitial lung disease. However, despite the best efforts of patients and clinicians, many of those who participate are not achieving clinically meaningful benefits. This assessor-blinded, multi-centre, randomised controlled trial aims to compare the clinical benefits of high intensity interval exercise training versus the standard pulmonary rehabilitation method of continuous training at moderate intensity in people with fibrotic interstitial lung disease. Methods Eligible participants will be randomised to either a standard pulmonary rehabilitation group using moderate intensity continuous exercise training or high intensity interval exercise training. Participants in both groups will undertake an 8-week pulmonary rehabilitation program of twice-weekly supervised exercise training including aerobic (cycling) and strengthening exercises. In addition, participants in both groups will be prescribed a home exercise program. Outcomes will be assessed at baseline, upon completion of the intervention and at six months following the intervention by a blinded assessor. The primary outcome is endurance time on a constant work rate test. Secondary outcomes are functional capacity (6-min walk distance), health-related quality of life (Chronic Respiratory Disease Questionnaire (CRQ), St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis specific version (SGRQ-I), breathlessness (Dyspnoea 12, Modified Medical Research Council Dyspnoea Scale), fatigue (fatigue severity scale), anxiety (Hospital Anxiety and Depression Scale), physical activity level (GeneActiv), skeletal muscle changes (ultrasonography) and completion and adherence to pulmonary rehabilitation. Discussion The standard exercise training strategies used in pulmonary rehabilitation may not provide an optimal exercise training stimulus for people with interstitial lung disease. This study will determine whether high intensity interval training can produce equivalent or even superior changes in exercise performance and symptoms. If high intensity interval training proves effective, it will provide an exercise training strategy that can readily be implemented into clinical practice for people with interstitial lung disease. Trial registration ClinicalTrials.gov Registry (NCT03800914). Registered 11 January 2019, https://clinicaltrials.gov/ct2/show/NCT03800914 Australian New Zealand Clinical Trials Registry ACTRN12619000019101. Registered 9 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376050&isReview=true
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Affiliation(s)
- Leona M Dowman
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia. .,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia. .,Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia. .,Institute for Breathing and Sleep, Melbourne, VIC, Australia.
| | - Anthony K May
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Catherine J Hill
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Janet Bondarenko
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Lissa Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Norman R Morris
- School of Health Sciences and Social Work, The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Metro North Hospital and Health Service, The Prince Charles Hospital, Allied Health Research Collaborative, Chermside, QLD, Australia
| | - Jennifer A Alison
- Allied Health Professorial Unit, Sydney Local Health District, Sydney, NSW, Australia.,Faculty of Medicine and Health Science, Sydney School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - James Walsh
- School of Health Sciences and Social Work, The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Metro North Hospital and Health Service, The Prince Charles Hospital, Allied Health Research Collaborative, Chermside, QLD, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Tamera Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Ian Glaspole
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Holland
- Respiratory Research @ Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
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29
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Cox NS, Lahham A, McDonald CF, Mahal A, O'Halloran P, Hepworth G, Spencer L, McNamara RJ, Bondarenko J, Macdonald H, Gavin S, Burge AT, Le Maitre C, Ringin C, Webb E, Nichols A, Tsai LL, Luxton N, van Hilten S, Santos M, Crute H, Byrne M, Boursinos H, Broe J, Corbett M, Marceau T, Warrick B, Boote C, Melinz J, Holland AE. Home-based pulmonary rehabilitation early after hospitalisation in COPD (early HomeBase): protocol for a randomised controlled trial. BMJ Open Respir Res 2021; 8:e001107. [PMID: 34819323 PMCID: PMC8614151 DOI: 10.1136/bmjresp-2021-001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations of respiratory disease, frequently requiring hospital admission. Pulmonary rehabilitation can reduce the likelihood of future hospitalisation, but programme uptake is poor. This study aims to compare hospital readmission rates, clinical outcomes and costs between people with COPD who undertake a home-based programme of pulmonary rehabilitation commenced early (within 2 weeks) of hospital discharge with usual care. METHODS A multisite randomised controlled trial, powered for superiority, will be conducted in Australia. Eligible patients admitted to one of the participating sites for an exacerbation of COPD will be invited to participate. Participants will be randomised 1:1. Intervention group participants will undertake an 8-week programme of home-based pulmonary rehabilitation commencing within 2 weeks of hospital discharge. Control group participants will receive usual care and a weekly phone call for attention control. Outcomes will be measured by a blinded assessor at baseline, after the intervention (week 9-10 posthospital discharge), and at 12 months follow-up. The primary outcome is hospital readmission at 12 months follow-up. ETHICS AND DISSEMINATION Human Research Ethics approval for all sites provided by Alfred Health (Project 51216). Findings will be published in peer-reviewed journals, conferences and lay publications. TRIAL REGISTRATION NUMBER ACTRN12619001122145.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Lissa Spencer
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Janet Bondarenko
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Samantha Gavin
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Cade Ringin
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Elizabeth Webb
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Ling-Ling Tsai
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nia Luxton
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Stephanie van Hilten
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Mary Santos
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Megan Byrne
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Broe
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tunya Marceau
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Brooke Warrick
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | | | - Joanna Melinz
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology & Pathology, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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30
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Cox NS, McDonald CF, Mahal A, Alison JA, Wootton R, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Corbett M, Handley E, Burge AT, Holland AE. Telerehabilitation for chronic respiratory disease: a randomised controlled equivalence trial. Thorax 2021; 77:643-651. [PMID: 34650004 DOI: 10.1136/thoraxjnl-2021-216934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. This study investigated whether home-based telerehabilitation was equivalent to centre-based pulmonary rehabilitation in people with chronic respiratory disease. METHODS A multicentre randomised controlled trial with assessor blinding, powered for equivalence was undertaken. Individuals with a chronic respiratory disease referred to pulmonary rehabilitation at four participating sites (one rural) were eligible and randomised using concealed allocation to pulmonary rehabilitation or telerehabilitation. Both programmes were two times per week for 8 weeks. The primary outcome was change in Chronic Respiratory Disease Questionnaire Dyspnoea (CRQ-D) domain at end-rehabilitation, with a prespecified equivalence margin of 2.5 points. Follow-up was at 12 months. Secondary outcomes included exercise capacity, health-related quality of life, symptoms, self-efficacy and psychological well-being. RESULTS 142 participants were randomised to pulmonary rehabilitation or telerehabilitation with 96% and 97% included in the intention-to-treat analysis, respectively. There were no significant differences between groups for any outcome at either time point. Both groups achieved meaningful improvement in dyspnoea and exercise capacity at end-rehabilitation. However, we were unable to confirm equivalence of telerehabilitation for the primary outcome ΔCRQ-D at end-rehabilitation (mean difference (MD) (95% CI) -1 point (-3 to 1)), and inferiority of telerehabilitation could not be excluded at either time point (12-month follow-up: MD -1 point (95% CI -4 to 1)). At end-rehabilitation, telerehabilitation demonstrated equivalence for 6-minute walk distance (MD -6 m, 95% CI -26 to 15) with possibly superiority of telerehabilitation at 12 months (MD 14 m, 95% CI -10 to 38). CONCLUSION telerehabilitation may not be equivalent to centre-based pulmonary rehabilitation for all outcomes, but is safe and achieves clinically meaningful benefits. When centre-based pulmonary rehabilitation is not available, telerehabilitation may provide an alternative programme model. TRIAL REGISTRATION NUMBER ACtelerehabilitationN12616000360415.
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Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia .,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer A Alison
- School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Allied Health Research and Education Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Richard Wootton
- Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromso, Norway
| | | | - Paolo Zanaboni
- Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromso, Norway.,Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | | | - Kathryn Barker
- Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Hayley Crute
- Wimmera Health Care Group, Horsham, Victoria, Australia
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Bruna Wageck
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Helen Boursinos
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Amanda Nichols
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Pawel Czupryn
- West Wimmera Health Service, Nhill, Victoria, Australia
| | - Monique Corbett
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Emma Handley
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Hospital, Melbourne, Victoria, Australia
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31
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Dobric A, De Luca SN, Spencer SJ, Bozinovski S, Saling MM, McDonald CF, Vlahos R. Novel pharmacological strategies to treat cognitive dysfunction in chronic obstructive pulmonary disease. Pharmacol Ther 2021; 233:108017. [PMID: 34626675 DOI: 10.1016/j.pharmthera.2021.108017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and currently the 3rd largest cause of death in the world, with approximately 3.23 million deaths per year. Globally, the financial burden of COPD is approximately €82 billion per year and causes substantial morbidity and mortality. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities and viral and bacterial-induced acute exacerbations (AECOPD). Recent clinical studies have shown that cognitive dysfunction is present in up to 60% of people with COPD, with impairments in executive function, memory, and attention, impacting on important outcomes such as quality of life, hospitalisation and survival. The high prevalence of cognitive dysfunction in COPD may also help explain the insufficient adherence to therapeutic plans and strategies, thus worsening disease progression in people with COPD. However, the mechanisms underlying the impaired neuropathology and cognition in COPD remain largely unknown. In this review, we propose that the observed pulmonary oxidative burden and inflammatory response of people with COPD 'spills over' into the systemic circulation, resulting in damage to the brain and leading to cognitive dysfunction. As such, drugs targeting the lungs and comorbidities concurrently represent an exciting and unique therapeutic opportunity to treat COPD and cognitive impairments, which may lead to the production of novel targets to prevent and reverse the debilitating and life-threatening effects of cognitive dysfunction in COPD.
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Affiliation(s)
- Aleksandar Dobric
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Simone N De Luca
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Sarah J Spencer
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia; ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Melbourne, VIC, Australia
| | - Steven Bozinovski
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Michael M Saling
- Clinical Neuropsychology, The University of Melbourne and Austin Health, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia; Department of Respiratory & Sleep Medicine, The University of Melbourne and Austin Health, Melbourne, VIC, Australia
| | - Ross Vlahos
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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32
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Yang IA, McDonald CF, Francis JJ. Behaviour change: The key to implementing evidence on COPD prevention, diagnosis and management. Respirology 2021; 26:1021-1023. [PMID: 34595794 DOI: 10.1111/resp.14160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Ian A Yang
- The Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine F McDonald
- Austin Hospital, Institute for Breathing and Sleep, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jill J Francis
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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33
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Munsif M, McDonald CF. ACP provided 2 conditional recommendations on use of high-flow nasal oxygen in acute respiratory failure. Ann Intern Med 2021; 174:JC98. [PMID: 34487451 DOI: 10.7326/acpj202109210-098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, et al. Appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021;174:977-84. 33900796.
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Affiliation(s)
- Maitri Munsif
- Austin Hospital, Melbourne, Victoria, Australia (M.M., C.F.M.)
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34
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Malaguti C, Holland AE, McDonald CF, Mahal A, Alison JA, Hill CJ, Zanaboni P, O'Halloran P, Bondarenko J, Macdonald H, Barker K, Crute H, Mellerick C, Wageck B, Boursinos H, Lahham A, Nichols A, Czupryn P, Burge AT, Cox NS. Community Participation by People with Chronic Obstructive Pulmonary Disease. COPD 2021; 18:533-540. [PMID: 34424802 DOI: 10.1080/15412555.2021.1966761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Little is known regarding community participation in individuals with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore community participation in individuals with COPD and to determine whether there is an association between community participation and activity-related outcome variables commonly collected during pulmonary rehabilitation assessment. We also sought to investigate which of these variables might influence community participation in people with COPD. Ninety-nine individuals with COPD were enrolled (67 ± 9 years, FEV1: 55 ± 22% predicted). We assessed community participation (Community Participation Indicator (CPI) and European Social Survey (ESS) for formal and informal community participation), daily physical activity levels (activity monitor), exercise capacity (6-minute walk test), breathlessness (Modified Medical Research Council, MMRC scale), self-efficacy (Pulmonary Rehabilitation Adapted Index of Self-Efficacy) and anxiety and depression (Hospital Anxiety and Depression Scale). Higher levels of community participation on the CPI were associated with older age and greater levels of physical activity (total, light and moderate-to-vigorous) (all rs = 0.30, p < 0.05). Older age and more moderate-to-vigorous physical activity independently predicted greater community participation measured by CPI. Higher levels of depression symptoms were associated with less formal and informal community participation on ESS (rs = -0.25). More formal community participation on ESS was weakly (rs = 0.2-0.3) associated with older age, better lung function, exercise capacity and self-efficacy, and less breathlessness. Self-efficacy, exercise capacity, and age independently predicted formal community participation in individuals with COPD. Strategies to optimize self-efficacy and improve exercise capacity may be useful to enhance community participation in people with COPD.
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Affiliation(s)
- Carla Malaguti
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Anne E Holland
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Allied Health Research and Education Unit, Sydney Local Health District, Sydney, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Heather Macdonald
- Community Rehabilitation, Wimmera Health Care Group, Horsham Victoria, Australia
| | - Kathryn Barker
- Community Based Rehabilitation, Western Health, Melbourne, Australia
| | - Hayley Crute
- Physiotherapy, Wimmera Health Care Group, Horsham Victoria, Australia
| | - Christie Mellerick
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Bruna Wageck
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Helen Boursinos
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Aroub Lahham
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Amanda Nichols
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia
| | | | - Angela T Burge
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Narelle S Cox
- Allergy, Clinical Immunology, and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
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35
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Robinson DH, Wimaleswaran H, McDonald CF, Howard ME, Willcox A. Pulmonary embolus in patients with COVID-19: an Australian perspective. Intern Med J 2021; 51:1324-1327. [PMID: 34423548 PMCID: PMC8653313 DOI: 10.1111/imj.15405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/11/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
Pulmonary embolus (PE) is a known complication of coronavirus disease 2019 (COVID‐19). The diagnosis of PE in our hospitalised patients with COVID‐19 correlated with more severe disease and occurred despite the use of routine thromboprophylaxis. Higher D‐dimers were seen on admission in patients who developed PE and rose at PE diagnosis, suggesting a role for D‐dimer in risk stratification.
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Affiliation(s)
- Danielle H Robinson
- Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia
| | - Hari Wimaleswaran
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Abbey Willcox
- Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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36
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McDonald CF. Vaping and the lung: New evidence from the silent zone? Respirology 2021; 26:906-907. [PMID: 34409673 DOI: 10.1111/resp.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
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37
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Drewett GP, Chan RK, Jones N, Wimaleswaran H, Howard ME, McDonald CF, Kwong J, Smibert O, Holmes NE, Trubiano JA. Risk factors for readmission following inpatient management of COVID-19 in a low-prevalence setting. Intern Med J 2021; 51:821-823. [PMID: 34047021 PMCID: PMC8206980 DOI: 10.1111/imj.15218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- George P Drewett
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - R Kimberley Chan
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Nicholas Jones
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, VIC, Australia
| | - Hari Wimaleswaran
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, VIC, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Jason Kwong
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Department of Microbiology & Immunology, University of Melbourne, VIC, Australia
| | - Olivia Smibert
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Dept of Oncology, Peter McCallum Cancer Centre, University of Melbourne, VIC, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Parkville, VIC, Australia.,Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, VIC, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, VIC, Australia
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38
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Burge AT, Holland AE, McDonald CF, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahhama A, Gillies R, Mahald A. "Willingness to Pay": The Value Attributed to Program Location by Pulmonary Rehabilitation Participants. COPD 2021; 18:281-287. [PMID: 34060968 DOI: 10.1080/15412555.2021.1924127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The "contingent valuation" method is used to quantify the value of services not available in traditional markets, by assessing the monetary value an individual ascribes to the benefit provided by an intervention. The aim of this study was to determine preferences for home or center-based pulmonary rehabilitation for participants with chronic obstructive pulmonary disease (COPD) using the "willingness to pay" (WTP) approach, the most widely used technique to elicit strengths of individual preferences. This is a secondary analysis of a randomized controlled equivalence trial comparing center-based and home-based pulmonary rehabilitation. At their final session, participants were asked to nominate the maximum that they would be willing to pay to undertake home-based pulmonary rehabilitation in preference to a center-based program. Regression analyses were used to investigate relationships between participant features and WTP values. Data were available for 141/163 eligible study participants (mean age 69 [SD 10] years, n = 82 female). In order to undertake home-based pulmonary rehabilitation in preference to a conventional center-based program, participants were willing to pay was mean $AUD176 (SD 255) (median $83 [IQR 0 to 244]). No significant difference for WTP values was observed between groups (p = 0.98). A WTP value above zero was related to home ownership (odds ratio [OR] 2.95, p = 0.02) and worse baseline SF-36 physical component score (OR 0.94, p = 0.02). This preliminary evidence for WTP in the context of pulmonary rehabilitation indicated the need for further exploration of preferences for treatment location in people with COPD to inform new models of service delivery.
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Affiliation(s)
- Angela T Burge
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Narelle S Cox
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
| | | | - Caroline Nicolson
- Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Aroub Lahhama
- Institute for Breathing and Sleep, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Rebecca Gillies
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Ajay Mahald
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Khor YH, Saravanan K, Holland AE, Lee JYT, Ryerson CJ, McDonald CF, Goh NSL. A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease. Sci Rep 2021; 11:6874. [PMID: 33767311 PMCID: PMC7994303 DOI: 10.1038/s41598-021-86326-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Dyspnoea is a cardinal symptom of fibrotic interstitial lung disease (ILD), with a lack of proven effective therapies. With emerging evidence of the role of facial and nasal airflow for relieving breathlessness, this pilot study was conducted to examine the feasibility of conducting a clinical trial of a handheld fan (HHF) for dyspnoea management in patients with fibrotic ILD. In this mixed-methods, randomised, assessor-blinded, controlled trial, 30 participants with fibrotic ILD who were dyspnoeic with a modified Medical Research Council Dyspnoea grade ≥ 2 were randomised to a HHF for symptom control or no intervention for 2 weeks. Primary outcomes were trial feasibility, change in Dyspnoea-12 scores at Week 2, and participants’ perspectives on using a HHF for dyspnoea management. Study recruitment was completed within nine months at a single site. Successful assessor blinding was achieved in the fan group [Bang’s Blinding Index − 0.08 (95% CI − 0.45, 0.30)] but not the control group [0.47 (0.12, 0.81)]. There were no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes. During qualitative interviews, participants reported that using the HHF relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit. Oxygen-experienced participants described the HHF being easier to use, but not as effective for symptomatic relief, compared to oxygen therapy. Our results confirmed the feasibility of a clinical trial of a HHF in fibrotic ILD. There was a high level of patient acceptance of a HHF for managing dyspnoea, with patients reporting both symptomatic benefits and ease of use.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia. .,Institute for Breathing and Sleep, Heidelberg, VIC, Australia. .,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia. .,Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.
| | | | - Anne E Holland
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Joanna Y T Lee
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Nicole S L Goh
- Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Institute for Breathing and Sleep, Heidelberg, VIC, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
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Moholdt T, Afoakwah C, Scuffham P, McDonald CF, Burrell LM, Stewart S. Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway. BMC Public Health 2021; 21:549. [PMID: 33743642 PMCID: PMC7980726 DOI: 10.1186/s12889-021-10503-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background Although it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. Methods Baseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986, 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays. Results During 33.5 (IQR 17.1–34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43–45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20–22 deaths per season) of these cardiovascular-related. December 25th–27th was the deadliest 3-day period of the year; being associated with 138 (95% CI 96–147) and 102 (95% CI 72–132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st–21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16–1.27) and 1.17 (95% 1.11–1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant (P < 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed. Conclusion Beyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly; contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10503-7.
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Affiliation(s)
- Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,The Women's Clinic, St.Olav Hospital, Trondheim, Norway
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Institute for Breathing and Sleep, University of Melbourne, Melbourne, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia
| | - Simon Stewart
- Torrens University Australia, South Australia, Wakefield Campus, Adelaide, SA, 5000, Australia. .,University of Glasgow, Glasgow, Scotland, UK.
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Philip J, Collins A, Smallwood N, Chang YK, Mo L, Yang IA, Corte T, McDonald CF, Hui D. Referral criteria to palliative care for patients with respiratory disease: a systematic review. Eur Respir J 2021; 58:13993003.04307-2020. [PMID: 33737407 DOI: 10.1183/13993003.04307-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Advanced non-malignant respiratory diseases are associated with significant patient morbidity, yet access to palliative care occurs late, if at all. AIM To examine referral criteria for palliative care among patients with advanced non-malignant respiratory disease, with a view to developing a standardised set of referral criteria. DESIGN Systematic review of all studies reporting on referral criteria to palliative care in advanced non-malignant respiratory disease, with a focus on chronic obstructive pulmonary disease and interstitial lung disease. DATA SOURCES A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using electronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed). RESULTS Searches yielded 2052 unique titles, which were screened for eligibility resulting in 62 studies addressing referral criteria to palliative care in advanced non-malignant respiratory disease. Of 18 categories put forward for referral to palliative care, the most commonly discussed factors were hospital use (69% of papers), indicators of poor respiratory status (47%), physical and emotional symptoms (37%), functional decline (29%), need for advanced respiratory therapies (27%), and disease progression (26%). CONCLUSION Clinicians consider referral to specialist palliative care for a wide range of disease- and needs-based criteria. Our findings highlight the need to standardise palliative care access by developing consensus referral criteria for patients with advanced non-malignant respiratory illnesses.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Parkville, Australia .,Palliative Care Service, St Vincent's Hospital, Fitzroy, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Natasha Smallwood
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA.,The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tamera Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, National Health and Medical Research Council, New South Wales, Australia
| | - Christine F McDonald
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
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Sha J, Worsnop CJ, Leaver BA, Vagias C, Kinsella P, Rahman MA, McDonald CF. Hospitalised exacerbations of chronic obstructive pulmonary disease: adherence to guideline recommendations in an Australian teaching hospital. Intern Med J 2021; 50:453-459. [PMID: 31157943 DOI: 10.1111/imj.14378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optimal management of exacerbations of chronic obstructive pulmonary disease (COPD) reduces patient morbidity and healthcare system burden. COPD guidelines, including the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the COPD-X Plan, provide evidence-based recommendations, but adherence in hospital practice is variable. AIMS To examine current practice in management of COPD exacerbations at an Australian teaching hospital and to compare with COPD-X Plan recommendations. METHODS Data were collected retrospectively from electronic medical records for admissions occurring during 1 May to 31 August 2016, and compared with recommendations from the COPD-X Plan. RESULTS A total of 134 patients (n = 68 females) was admitted for a COPD exacerbation during the study period. Mean age was 75.4 ± 10.2 years and 33.6% were current smokers. Airflow obstruction on spirometry was confirmed in 67.2% (mean forced expiratory volume in 1 s was 53 ± 22% predicted (1.2 ± 0.5 L)). Excellent adherence to the COPD-X Plan was demonstrated in the ordering of chest radiographs (97%) and electrocardiograms (94%). Supplemental oxygen was appropriately provided to all patients with oxygen saturation of <88%. All patients with confirmed hypercapnic respiratory failure were managed with non-invasive ventilation. Corticosteroids and bronchodilators were prescribed for the majority of patients. Areas of suboptimal practice included inadequate usage of arterial blood gases, excess supplemental oxygen in the absence of hypoxaemia, over-prescription of intravenous antimicrobials, low referral rates to pulmonary rehabilitation and insufficient smoking cessation counselling. CONCLUSIONS Level of adherence to guideline recommendations in the management of COPD exacerbations is inadequate and further strategies are required to elevate standards of practice.
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Affiliation(s)
- Joy Sha
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Christopher J Worsnop
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Benjamin A Leaver
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Christopher Vagias
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Paul Kinsella
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Muhammad A Rahman
- La Trobe University/Austin Health Clinical School of Nursing and Midwifery, College of Science, Health and Engineering, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Cox NS, McDonald CF, Gleeson M, Wood L, Hall S, Hill C, Bondarenko J, Holland AE. Challenges of evaluating the effect of exercise training on salivary IgA in people with COPD. Clin Respir J 2021; 15:699-701. [PMID: 33548086 DOI: 10.1111/crj.13337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Narelle S Cox
- Faculty Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia.,School of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maree Gleeson
- School of Biomedical Science and Pharmacy, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Lisa Wood
- School of Biomedical Science and Pharmacy, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Sharron Hall
- School of Biomedical Science and Pharmacy, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Catherine Hill
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia
| | - Anne E Holland
- Faculty Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia
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Cox NS, Dal Corso S, Hansen H, McDonald CF, Hill CJ, Zanaboni P, Alison JA, O'Halloran P, Macdonald H, Holland AE. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021; 1:CD013040. [PMID: 33511633 PMCID: PMC8095032 DOI: 10.1002/14651858.cd013040.pub2] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pulmonary rehabilitation is a proven, effective intervention for people with chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and bronchiectasis. However, relatively few people attend or complete a program, due to factors including a lack of programs, issues associated with travel and transport, and other health issues. Traditionally, pulmonary rehabilitation is delivered in-person on an outpatient basis at a hospital or other healthcare facility (referred to as centre-based pulmonary rehabilitation). Newer, alternative modes of pulmonary rehabilitation delivery include home-based models and the use of telehealth. Telerehabilitation is the delivery of rehabilitation services at a distance, using information and communication technology. To date, there has not been a comprehensive assessment of the clinical efficacy or safety of telerehabilitation, or its ability to improve uptake and access to rehabilitation services, for people with chronic respiratory disease. OBJECTIVES To determine the effectiveness and safety of telerehabilitation for people with chronic respiratory disease. SEARCH METHODS We searched the Cochrane Airways Trials Register, and the Cochrane Central Register of Controlled Trials; six databases including MEDLINE and Embase; and three trials registries, up to 30 November 2020. We checked reference lists of all included studies for additional references, and handsearched relevant respiratory journals and meeting abstracts. SELECTION CRITERIA All randomised controlled trials and controlled clinical trials of telerehabilitation for the delivery of pulmonary rehabilitation were eligible for inclusion. The telerehabilitation intervention was required to include exercise training, with at least 50% of the rehabilitation intervention being delivered by telerehabilitation. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane. We assessed the risk of bias for all studies, and used the ROBINS-I tool to assess bias in non-randomised controlled clinical trials. We assessed the certainty of evidence with GRADE. Comparisons were telerehabilitation compared to traditional in-person (centre-based) pulmonary rehabilitation, and telerehabilitation compared to no rehabilitation. We analysed studies of telerehabilitation for maintenance rehabilitation separately from trials of telerehabilitation for initial primary pulmonary rehabilitation. MAIN RESULTS We included a total of 15 studies (32 reports) with 1904 participants, using five different models of telerehabilitation. Almost all (99%) participants had chronic obstructive pulmonary disease (COPD). Three studies were controlled clinical trials. For primary pulmonary rehabilitation, there was probably little or no difference between telerehabilitation and in-person pulmonary rehabilitation for exercise capacity measured as 6-Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) -10.82 m to 10.94 m; 556 participants; four studies; moderate-certainty evidence). There may also be little or no difference for quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD -1.26, 95% CI -3.97 to 1.45; 274 participants; two studies; low-certainty evidence), or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI -0.13 to 0.40; 426 participants; three studies; low-certainty evidence). Participants were more likely to complete a program of telerehabilitation, with a 93% completion rate (95% CI 90% to 96%), compared to a 70% completion rate for in-person rehabilitation. When compared to no rehabilitation control, trials of primary telerehabilitation may increase exercise capacity on 6MWD (MD 22.17 m, 95% CI -38.89 m to 83.23 m; 94 participants; two studies; low-certainty evidence) and may also increase 6MWD when delivered as maintenance rehabilitation (MD 78.1 m, 95% CI 49.6 m to 106.6 m; 209 participants; two studies; low-certainty evidence). No adverse effects of telerehabilitation were noted over and above any reported for in-person rehabilitation or no rehabilitation. AUTHORS' CONCLUSIONS This review suggests that primary pulmonary rehabilitation, or maintenance rehabilitation, delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre-based pulmonary rehabilitation, with no safety issues identified. However, the certainty of the evidence provided by this review is limited by the small number of studies, of varying telerehabilitation models, with relatively few participants. Future research should consider the clinical effect of telerehabilitation for individuals with chronic respiratory diseases other than COPD, the duration of benefit of telerehabilitation beyond the period of the intervention, and the economic cost of telerehabilitation.
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Affiliation(s)
- Narelle S Cox
- Institute for Breathing and Sleep, Melbourne, Australia
- Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Simone Dal Corso
- Graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Austin Hospital, Melbourne, Australia
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jennifer A Alison
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Allied Health Research and Education Unit, Sydney Local Health District, Sydney, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Heather Macdonald
- Community Rehabilitation, Wimmera Health Care Group, Horsham, Australia
| | - Anne E Holland
- Institute for Breathing and Sleep, Melbourne, Australia
- Physiotherapy, Alfred Health, Melbourne, Australia
- Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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Wageck B, Cox NS, McDonald CF, Burge AT, Mahal A, Hill CJ, Lee AL, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, Holland AE. The Impact of COPD Exacerbations in the Year Following Pulmonary Rehabilitation: Secondary Analysis of a Randomised Controlled Trial. Int J Chron Obstruct Pulmon Dis 2021; 15:3423-3431. [PMID: 33408472 PMCID: PMC7781036 DOI: 10.2147/copd.s271094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months. Methods This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA). Results A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV1) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEV1%predicted (0.98, 95% CI 0.96 to 0.99). Conclusion Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management.
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Affiliation(s)
| | - Narelle S Cox
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Angela T Burge
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Ajay Mahal
- The Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Annemarie L Lee
- Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Caroline Nicolson
- Department of Pulmonary Hypertension, Alfred Health, Melbourne, Australia.,Physiotherapy Department, Monash University, Melbourne, Australia
| | - Paul O'Halloran
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Aroub Lahham
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Rebecca Gillies
- La Trobe University, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia
| | - Anne E Holland
- La Trobe University, Melbourne, Australia.,Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia
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Abstract
Hodkinson A, Bower P, Grigoroglou C, et al. Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ. 2020;370:m2521. 32816816.
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Holland AE, Corte T, Chambers DC, Palmer AJ, Ekström MP, Glaspole I, Goh NSL, Hepworth G, Khor YH, Hoffman M, Vlahos R, Sköld M, Dowman L, Troy LK, Prasad JD, Walsh J, McDonald CF. Ambulatory oxygen for treatment of exertional hypoxaemia in pulmonary fibrosis (PFOX trial): a randomised controlled trial. BMJ Open 2020; 10:e040798. [PMID: 33318119 PMCID: PMC7737108 DOI: 10.1136/bmjopen-2020-040798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interstitial lung diseases are characterised by scarring of lung tissue that leads to reduced transfer of oxygen into the blood, decreased exercise capacity and premature death. Ambulatory oxygen therapy may be used to treat exertional oxyhaemoglobin desaturation, but there is little evidence to support its efficacy and there is wide variation in clinical practice. This study aims to compare the clinical efficacy and cost-effectiveness of ambulatory oxygen versus ambulatory air in people with fibrotic interstitial lung disease and exertional desaturation. METHODS AND ANALYSIS A randomised, controlled trial with blinding of participants, clinicians and researchers will be conducted at trial sites in Australia and Sweden. Eligible participants will be randomised 1:1 into two groups. Intervention participants will receive ambulatory oxygen therapy using a portable oxygen concentrator (POC) during daily activities and control participants will use an identical POC modified to deliver air. Outcomes will be assessed at baseline, 3 months and 6 months. The primary outcome is change in physical activity measured by number of steps per day using a physical activity monitor (StepWatch). Secondary outcomes are functional capacity (6-minute walk distance), health-related quality of life (St George Respiratory Questionnaire, EQ-5D-5L and King's Brief Interstitial Lung Disease Questionnaire), breathlessness (Dyspnoea-12), fatigue (Fatigue Severity Scale), anxiety and depression (Hospital Anxiety and Depression Scale), physical activity level (GENEActive), oxygen saturation in daily life, POC usage, and plasma markers of skeletal muscle metabolism, systematic inflammation and oxidative stress. A cost-effectiveness evaluation will also be undertaken. ETHICS AND DISSEMINATION Ethical approval has been granted in Australia by Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/42) with governance approval at all Australian sites, and in Sweden (Lund Dnr: 2019-02963). The results will be published in peer-reviewed scientific journals, presented at conferences and disseminated to consumers in publications for lay audiences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03737409).
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Affiliation(s)
- Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrew J Palmer
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Health Economics Research Group, Menzies Institute for Medical Research, The University of Tasmania, Hobart, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Magnus Per Ekström
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole S L Goh
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Yet H Khor
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ross Vlahos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, Australia
| | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Leona Dowman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Lauren K Troy
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jyotika D Prasad
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Walsh
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
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Perera M, El Khoury J, Chinni V, Bolton D, Qu L, Johnson P, Trubiano J, McDonald CF, Jones D, Bellomo R, Patel O, Ischia J. Randomised controlled trial for high-dose intravenous zinc as adjunctive therapy in SARS-CoV-2 (COVID-19) positive critically ill patients: trial protocol. BMJ Open 2020; 10:e040580. [PMID: 33268419 PMCID: PMC7712927 DOI: 10.1136/bmjopen-2020-040580] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION SARS-CoV-2 (COVID-19) has caused an international pandemic of respiratory illness, resulting in significant healthcare and economic turmoil. To date, no robust vaccine or treatment has been identified. Elemental zinc has previously been demonstrated to have beneficial effects on coronaviruses and other viral respiratory infections due to its effect on RNA polymerase. Additionally, zinc has well-demonstrated protective effects against hypoxic injury-a clear mechanism of end-organ injury in respiratory distress syndrome. We aimed to assess the effect of high-dose intravenous zinc (HDIVZn) on SARS-CoV-2 infection. The end of study analyses will evaluate the reduction of impact of oxygen saturations or requirement of oxygen supplementation. METHODS AND ANALYSIS We designed a double-blind randomised controlled trial of daily HDIVZn (0.5 mg/kg) versus placebo. Primary outcome measures are lowest oxygen saturation (or greatest level of supplemental oxygenation) for non-ventilated patients and worst PaO2/FiO2 for ventilated patients. Following power calculations, 60 hospitalised patients and 100 ventilated patients will be recruited to demonstrate a 20% difference. The duration of follow-up is up to the point of discharge. ETHICS AND DISSEMINATION Ethical approval was obtained through the independent Human Research Ethics Committee. Participant recruitment will commence in May 2020. Results will be published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER ACTRN126200000454976.
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Affiliation(s)
- Marlon Perera
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - John El Khoury
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Vidyasagar Chinni
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Liang Qu
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Paul Johnson
- Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Jason Trubiano
- Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | | | - Daryl Jones
- Intensive Care Unit Austin Hospital, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rinaldo Bellomo
- Intensive Care Unit Austin Hospital, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Oneel Patel
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph Ischia
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
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Grimwood CL, Holland AE, McDonald CF, Mahal A, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, Burge AT. Comparison of self-report and administrative data sources to capture health care resource use in people with chronic obstructive pulmonary disease following pulmonary rehabilitation. BMC Health Serv Res 2020; 20:1061. [PMID: 33228654 PMCID: PMC7682690 DOI: 10.1186/s12913-020-05920-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background The optimal method to collect accurate healthcare utilisation data in people with chronic obstructive pulmonary disease (COPD) is not well established. The aim of this study was to determine feasibility and compare self-report and administrative data sources to capture health care resource use in people with COPD for 12 months following pulmonary rehabilitation. Methods This is a secondary analysis of a randomised controlled equivalence trial comparing centre-based and home-based pulmonary rehabilitation. Healthcare utilisation data were collected for 12 months following pulmonary rehabilitation from self-report (monthly telephone questionnaires and diaries) and administrative sources (Medicare Benefits Schedule, medical records). Feasibility was assessed by the proportion of self-reports completed and accuracy was established using month-by-month and per participant comparison of self-reports with administrative data. Results Data were available for 145/163 eligible study participants (89%, mean age 69 (SD 9) years, mean forced expiratory volume in 1 s 51 (SD 19) % predicted; n = 83 male). For 1725 months where data collection was possible, 1160 (67%) telephone questionnaires and 331 (19%) diaries were completed. Accuracy of recall varied according to type of health care encounter and self-report method, being higher for telephone questionnaire report of emergency department presentation (Kappa 0.656, p < 0.001; specificity 99%, sensitivity 59%) and hospital admission (Kappa 0.669, p < 0.001; specificity 97%, sensitivity 68%) and lower for general practitioner (Kappa 0.400, p < 0.001; specificity 62%, sensitivity 78%) and medical specialist appointments (Kappa 0.458, p < 0.001; specificity 88%, sensitivity 58%). A wide variety of non-medical encounters were reported (allied health and nursing) which were not captured in administrative data. Conclusion For self-reported methods of healthcare utilisation in people with COPD following pulmonary rehabilitation, monthly telephone questionnaires were more frequently completed and more accurate than diaries. Compared to administrative records, self-reports of emergency department presentations and inpatient admissions were more accurate than for general practitioner and medical specialist appointments. Trial registration NCT01423227 at clinicaltrials.gov Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05920-0.
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Affiliation(s)
- Chantal L Grimwood
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Anne E Holland
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Physiotherapy, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Annemarie L Lee
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Physiotherapy, Monash University, Building B, McMahons Rd, Frankston, VIC, 3199, Australia
| | - Narelle S Cox
- La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Rosemary Moore
- Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Caroline Nicolson
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia.,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Paul O'Halloran
- Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Aroub Lahham
- La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Rebecca Gillies
- La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Angela T Burge
- Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia. .,La Trobe University Clinical School, Level 4 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia. .,Institute for Breathing and Sleep, Level 5, Harold Stokes Building, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.
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McDonald CF, Jones S, Beckert L, Bonevski B, Buchanan T, Bozier J, Carson‐Chahhoud KV, Chapman DG, Dobler CC, Foster JM, Hamor P, Hodge S, Holmes PW, Larcombe AN, Marshall HM, McCallum GB, Miller A, Pattemore P, Roseby R, See HV, Stone E, Thompson BR, Ween MP, Peters MJ. Electronic cigarettes: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25:1082-1089. [PMID: 32713105 PMCID: PMC7540297 DOI: 10.1111/resp.13904] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/08/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
The TSANZ develops position statements where insufficient data exist to write formal clinical guidelines. In 2018, the TSANZ addressed the question of potential benefits and health impacts of electronic cigarettes (EC). The working party included groups focused on health impacts, smoking cessation, youth issues and priority populations. The 2018 report on the Public Health Consequences of E-Cigarettes from the United States NASEM was accepted as reflective of evidence to mid-2017. A search for papers subsequently published in peer-reviewed journals was conducted in August 2018. A small number of robust and important papers published until March 2019 were also identified and included. Groups identified studies that extended, modified or contradicted the NASEM report. A total of 3793 papers were identified and reviewed, with summaries and draft position statements developed and presented to TSANZ membership in April 2019. After feedback from members and external reviewers, a collection of position statements was finalized in December 2019. EC have adverse lung effects and harmful effects of long-term use are unknown. EC are unsuitable consumer products for recreational use, part-substitution for smoking or long-term exclusive use by former smokers. Smokers who require support to quit smoking should be directed towards approved medication in conjunction with behavioural support as having the strongest evidence for efficacy and safety. No specific EC product can be recommended as effective and safe for smoking cessation. Smoking cessation claims in relation to EC should be assessed by established regulators.
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