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Levy ML, Bateman ED, Allan K, Bacharier LB, Bonini M, Boulet LP, Bourdin A, Brightling C, Brusselle G, Buhl R, Chakaya MJ, Cruz AA, Drazen J, Ducharme FM, Duijts L, Fleming L, Inoue H, Ko FWS, Krishnan JA, Masekela R, Mortimer K, Pitrez P, Salvi S, Sheikh A, Reddel HK, Yorgancıoğlu A. Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective. Lancet 2023; 402:1012-1016. [PMID: 37480934 DOI: 10.1016/s0140-6736(23)01358-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/24/2023]
Affiliation(s)
| | - Eric D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Keith Allan
- Department of Patient and Community Engagement, University Hospitals of Leicester, Leicester, UK
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matteo Bonini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico A Gemelli-IRCCS, Rome, Italy
| | | | - Arnaud Bourdin
- Department of Respiratory Diseases, University of Montpellier, Montpellier, France
| | - Chris Brightling
- Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | - Alvaro A Cruz
- ProAR Foundation and School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Jeffrey Drazen
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine, Sainte-Justine University Health Centre, University of Montreal, Montreal, QC, Canada
| | - Liesbeth Duijts
- Department of Pediatrics, Divisions of Respiratory Medicine and Allergology and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jerry A Krishnan
- Breathe Chicago Center, University of Illinois Chicago, Chicago, IL, USA
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
| | - Kevin Mortimer
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa; Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Cambridge Africa Department, University of Cambridge, Cambridge, UK
| | - Paulo Pitrez
- Pulmonology Department, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Aziz Sheikh
- Primary Care Research & Development and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Helen K Reddel
- Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Levy ML, Bacharier LB, Bateman E, Boulet LP, Brightling C, Buhl R, Brusselle G, Cruz AA, Drazen JM, Duijts L, Fleming L, Inoue H, Ko FWS, Krishnan JA, Mortimer K, Pitrez PM, Sheikh A, Yorgancıoğlu A, Reddel HK. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med 2023; 33:7. [PMID: 36754956 PMCID: PMC9907191 DOI: 10.1038/s41533-023-00330-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with "mild" asthma) as combination ICS-formoterol taken as needed for symptom relief. For patients with moderate-severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS-formoterol. Asthma treatment is not "one size fits all"; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications.
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Affiliation(s)
| | - Leonard B. Bacharier
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Eric Bateman
- grid.7836.a0000 0004 1937 1151Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Louis-Philippe Boulet
- grid.23856.3a0000 0004 1936 8390Québec Heart and Lung Institute, Université Laval, Québec City, QC Canada
| | - Chris Brightling
- grid.9918.90000 0004 1936 8411Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK
| | - Roland Buhl
- grid.410607.4Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Guy Brusselle
- grid.410566.00000 0004 0626 3303Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium ,grid.5645.2000000040459992XDepartments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alvaro A. Cruz
- grid.8399.b0000 0004 0372 8259ProAR Foundation and Federal University of Bahia, Salvador, Bahia Brazil
| | - Jeffrey M. Drazen
- grid.38142.3c000000041936754XBrigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, MA USA
| | - Liesbeth Duijts
- grid.5645.2000000040459992XDivisions of Respiratory Medicine and Allergology and Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Louise Fleming
- grid.7445.20000 0001 2113 8111National Heart and Lung Institute, Imperial College, London, UK
| | - Hiromasa Inoue
- grid.258333.c0000 0001 1167 1801Department of Pulmonary Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fanny W. S. Ko
- grid.10784.3a0000 0004 1937 0482Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jerry A. Krishnan
- grid.185648.60000 0001 2175 0319Breathe Chicago Center, University of Illinois Chicago, Chicago, IL USA
| | - Kevin Mortimer
- grid.513149.bLiverpool University Hospitals NHS Foundation Trust, Liverpool, UK ,grid.5335.00000000121885934University of Cambridge, Cambridge, UK ,grid.16463.360000 0001 0723 4123Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Paulo M. Pitrez
- grid.415169.e0000 0001 2198 9354Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Department of Primary Care Research & Development, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Arzu Yorgancıoğlu
- grid.411688.20000 0004 0595 6052Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - Helen K. Reddel
- grid.1013.30000 0004 1936 834XThe Woolcock Institute of Medical Research and The University of Sydney, Sydney, NSW Australia
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Ng SSS, Wong VWS, Wong GLH, Chu WCW, Chan TO, To KW, Ko FWS, Chan KP, Hui DS. Continuous Positive Airway Pressure Does Not Improve Nonalcoholic Fatty Liver Disease in Patients with Obstructive Sleep Apnea. A Randomized Clinical Trial. Am J Respir Crit Care Med 2021; 203:493-501. [PMID: 32926803 DOI: 10.1164/rccm.202005-1868oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is associated with development of nonalcoholic fatty liver disease (NAFLD). The effects of continuous positive airway pressure (CPAP) on NAFLD in patients with concomitant OSA are unknown.Objectives: To investigate the effects of autoadjusting CPAP versus subtherapeutic CPAP treatment over 6 months on NAFLD activities.Methods: Patients with NAFLD and OSA, as defined by respiratory event index ≥5/h diagnosed by a validated level 3 Embletta device, were randomized into group A) autoadjusting CPAP (4-20 cm H2O) or group B) subtherapeutic CPAP (pressure fixed at 4 cm H2O). The primary endpoint was the difference in changes in intrahepatic triglyceride as measured by proton magnetic resonance spectroscopy after 6 months of therapy. Key secondary endpoints included changes in controlled attenuation parameter (CAP) and liver stiffness measurement measured with transient elastography, and serum cytokeratin-18 fragment.Measurements and Main Results: A total of 120 patients were randomized equally into two groups. There were significant correlations between CAP and respiratory event index (r = 0.203, P = 0.026), percentage of total recording time with SaO2 < 90% (r = 0.265, P = 0.003), and oxygen desaturation index (r = 0.214, P = 0.019). After 6 months of treatment, there were no significant differences of changes in primary and secondary endpoints between the two treatment groups. Regression analysis showed that weight change over 6 months correlated with changes in both intrahepatic triglyceride and CAP (P < 0.001).Conclusions: Despite significant correlations between hepatic steatosis and markers of severity of OSA, CPAP alone did not improve hepatic steatosis and fibrosis. However, the additional role of weight reduction through lifestyle modification deserves further investigation.
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Affiliation(s)
- Susanna S S Ng
- SH Ho Sleep Apnea Management Center, Department of Medicine and Therapeutics
| | | | | | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tat-On Chan
- SH Ho Sleep Apnea Management Center, Department of Medicine and Therapeutics
| | - Kin-Wang To
- SH Ho Sleep Apnea Management Center, Department of Medicine and Therapeutics
| | - Fanny W S Ko
- SH Ho Sleep Apnea Management Center, Department of Medicine and Therapeutics
| | - Ka-Pang Chan
- SH Ho Sleep Apnea Management Center, Department of Medicine and Therapeutics
| | - David S Hui
- SH Ho Sleep Apnea Management Center, Department of Medicine and Therapeutics
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Ko FWS, Chan KP, Ngai J, Ng SS, Yip WH, Chan TO, Hui DSC. Reply. Respirology 2021; 26:504-506. [PMID: 33660367 DOI: 10.1111/resp.14024] [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: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny W S Ko
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Pang Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jenny Ngai
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - So-Shan Ng
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Ho Yip
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Tat-On Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David S C Hui
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Xia X, Qiu H, Kwok T, Ko FWS, Man CL, Ho KF. Time course of blood oxygen saturation responding to short-term fine particulate matter among elderly healthy subjects and patients with chronic obstructive pulmonary disease. Sci Total Environ 2020; 723:138022. [PMID: 32217387 DOI: 10.1016/j.scitotenv.2020.138022] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 06/10/2023]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often experience deteriorating gaseous exchange which in turn may result in declines in blood oxygen saturation (SpO2). Increasing evidence has also shown that elevated levels of fine particulate matter (PM2.5) may contribute to COPD pathogenesis. However, the acute effects of PM2.5 on SpO2 among COPD patients remain unclear, especially for its time course. Therefore, we conducted this panel study with 3-day real-time monitoring for personal PM2.5 exposure and concurrent SpO2 of 39 participants (20 COPD patients, 19 healthy participants), aged 60 to 90 years, in Hong Kong to explore the acute effects of personal PM2.5 exposure on SpO2 (within minutes to hours). We applied a linear mixed effect model to examine the associations between personal PM2.5 and SpO2, while adjusting for temporal trend, personal characteristics, weather conditions, and co-exposure to gaseous pollutants (ambient ozone, nitrogen dioxides, carbon monoxide, and atmospheric pressure). We found that short-term exposure to PM2.5 might result in acute declines of SpO2 within minutes, and the effects would last for several hours. An interquartile range increase of personal PM2.5 exposure (17.2 μg/m3) was associated with -0.19% (95% CI: -0.26% to -0.12%) changes of concurrent SpO2 for all participants. The most significant decline was observed at lag0-3 h, and then became insignificant at lag0-12 h. At lag0-1 h, estimated mean changes of SpO2 were -0.40% (95% CI: -0.55% to -0.24%) for COPD patients and -0.09% (95% CI: -0.23% to 0.06%) for healthy participants. Compared with healthy participants, the effects of PM2.5 exposure on SpO2 for COPD patients were slightly stronger and more acute. Reducing PM2.5 concentrations might be a useful approach to improve health status and reduce exacerbations for COPD patients.
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Affiliation(s)
- Xi Xia
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China.
| | - Timothy Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China.
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chung Ling Man
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Kin-Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Qiu H, Xia X, Man CL, Ko FWS, Yim SHL, Kwok TCY, Ho KF. Real-Time Monitoring of the Effects of Personal Temperature Exposure on the Blood Oxygen Saturation Level in Elderly People with and without Chronic Obstructive Pulmonary Disease: A Panel Study in Hong Kong. Environ Sci Technol 2020; 54:6869-6877. [PMID: 32363866 DOI: 10.1021/acs.est.0c01799] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Few studies have investigated the short-term effect of personal temperature exposure on blood oxygen saturation (SpO2). We conducted this longitudinal panel study with real-time monitoring of SpO2 and environmental exposure for 3 continuous days for 20 patients with chronic obstructive pulmonary disease (COPD) and 20 healthy volunteers in Hong Kong, to explore the time course (from minutes to hours) of change in SpO2 in response to temperature in elderly people. We employed a generalized additive mixed model to evaluate the acute effects of personal temperature exposure on changes in SpO2 and risk of oxygen desaturation while adjusting for seasonality, environmental co-exposures, and personal characteristics. We observed a concurrent decline in SpO2 by 0.27% (95% confidence interval [CI]: 0.22-0.32%) and an increase in the risk of oxygen desaturation by an OR of 1.14 (95% CI, 1.10-1.18) associated with a 1 °C increase in personal temperature, and the association lasted over several hours. Results showed that the decline in SpO2 in elderly people was associated with an increase in personal temperature exposure within minutes to hours, particularly in women and male patients with COPD. Temperature-induced oxygen desaturation may play a pivotal role in COPD exacerbation.
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Affiliation(s)
- Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
| | - Xi Xia
- School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Chung Ling Man
- School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Fanny W S Ko
- Division of Respiratory Medicine, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | - Steve H L Yim
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
- Department of Geography and Resource Management, The Chinese University of Hong Kong, HKSAR, China
| | - Timothy C Y Kwok
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, HKSAR, China
| | - Kin-Fai Ho
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
- School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
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Ko FWS, Hui DSC. Asthma-COPD overlap: No formal definition and simple diagnostic tool so far? Respirology 2019; 25:672-673. [PMID: 31858657 DOI: 10.1111/resp.13764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny W S Ko
- S.H. Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - David S C Hui
- S.H. Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Affiliation(s)
- Fanny W S Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Don D Sin
- University of British Columbia (UBC), Division of Respiratory Medicine and UBC Centre for Heart Lung Innovation (HLI), St Paul's Hospital, Vancouver, BC, Canada
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Kim WJ, Gupta V, Nishimura M, Makita H, Idolor L, Roa C, Loh LC, Ong CK, Wang JS, Boonsawat W, Gunasekera KD, Madegedara D, Kuo HP, Wang CH, Wang C, Yang T, Lin YX, Ko FWS, Hui DSC, Lan LTT, Vu QTT, Bhome AB, Ng A, Seo JB, Lee BY, Lee JS, Oh YM, Lee SD. Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities. Int J Tuberc Lung Dis 2019; 22:820-826. [PMID: 29914609 DOI: 10.5588/ijtld.17.0524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment. OBJECTIVE To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup. METHODS Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis. RESULTS Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score. CONCLUSION Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.
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Affiliation(s)
- W J Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon, Korea
| | - V Gupta
- Department of Internal Medicine, Kangwon National University, Chuncheon, Korea, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - M Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - H Makita
- Division of Respiratory Medicine, Department of Internal Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - L Idolor
- Section of Respiratory Services and Physical Therapy and Rehabilitation Lung Center of the Philippines, Quezon City
| | - C Roa
- College of Medicine and Philippine General Hospital, University of the Philippines, Manila, The Philippines
| | - L-C Loh
- Department of Medicine, Penang Medical College, Penang, Malaysia
| | - C-K Ong
- Department of Medicine, Penang Medical College, Penang, Malaysia
| | - J-S Wang
- Taipei Medical University, Taipei, Taiwan
| | - W Boonsawat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - K D Gunasekera
- Central Chest Clinic, National Hospital of Sri Lanka, Colombo
| | - D Madegedara
- Respiratory Disease Treatment Unit, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - H-P Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - C-H Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - C Wang
- Department of Respiratory and Critical Care Medicine, Beijing China-Japan Friendship Hospital, Beijing
| | - T Yang
- Department of Respiratory and Critical Care Medicine, Beijing China-Japan Friendship Hospital, Beijing
| | - Y-X Lin
- Beijing Institute of Respiratory Medicine, Department of Respiratory and Critical Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
| | - F W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - D S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - L T T Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Q T T Vu
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - A B Bhome
- Indian Coalition of Obstructive Lung Diseases Network, Pune, Maharashtra, India
| | - A Ng
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - J B Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - B Y Lee
- Division of Allergy and Respiratory Diseases, Soon Chun Hyang University Hospital, Seoul
| | - J S Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y-M Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S-D Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ng SSS, Chan TO, To KW, Chan KKP, Ngai J, Yip WH, Lo RLP, Ko FWS, Hui DSC. Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control. Respirology 2018; 23:1055-1062. [PMID: 29992713 DOI: 10.1111/resp.13363] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/26/2018] [Accepted: 06/05/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Unrecognized obstructive sleep apnoea syndrome (OSAS) may lead to poor asthma control despite optimal therapy. We assessed asthma control, airway responsiveness, daytime sleepiness and health status at baseline and 3 months after continuous positive airway pressure (CPAP) treatment among asthma patients with nocturnal symptoms and OSAS. METHODS Patients with nocturnal asthma symptoms despite receiving at least moderate-dose inhaled corticosteroid and long-acting bronchodilators underwent a home sleep study using 'Embletta' portable diagnostic system. Patients with significant OSAS (apnoea-hypopnoea index (AHI) ≥10/h) were randomized to receive either CPAP or conservative treatment for 3 months. RESULTS Among 145 patients recruited, 122 underwent sleep study with 41 (33.6%) having AHI ≥10/h. Patients with significant OSAS had higher BMI (27.4 (5.1) vs 25.1 (4.5) kg/m2 , P = 0.016), bigger neck circumference (36.6 (3.1) vs 34.8 (3.6) cm, P = 0.006) and lower minimum SaO2 (80.7 (6.6) vs 87.2 (3.9) %, P < 0.001). Using intention-to-treat analysis among 37 patients with AHI ≥10/h (CPAP group (n = 17) vs control group (n = 20)), there was no significant difference in Asthma Control Test score (CPAP 3.2 (2.7) vs control 2.4 (5.7), P = 0.568) but the CPAP group had a greater improvement in Epworth Sleepiness Scale (-3.0 (4.5) vs 0.5(3.8), P = 0.014), Asthma Quality of Life Questionnaire (0.6 (0.8) vs 0.02 (0.7), P = 0.022) and vitality domain in the SF-36 questionnaire (14.7 (16.8) vs 0.3 (16.2), P = 0.012) after 3 months. Data are presented as mean (SD) unless otherwise stated. CONCLUSION A high prevalence of OSAS was found among patients with asthma and snoring. CPAP therapy for 3 months did not enhance asthma control but improved daytime sleepiness, quality of life and vitality.
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Affiliation(s)
- Susanna S S Ng
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Tat-On Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Kin-Wang To
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Ken K P Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Jenny Ngai
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Wing-Ho Yip
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Rachel L P Lo
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - Fanny W S Ko
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
| | - David S C Hui
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Princes of Wales Hospital, Shatin, Hong Kong, China
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11
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Benton MJ, Lim TK, Ko FWS, Kan-O K, Mak JCW. Year in review 2017: Chronic obstructive pulmonary disease and asthma. Respirology 2018; 23:538-545. [PMID: 29502339 DOI: 10.1111/resp.13285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado, Colorado Springs, CO, USA
| | - Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Keiko Kan-O
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Judith C W Mak
- Department of Medicine, The University of Hong Kong, Hong Kong.,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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12
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Affiliation(s)
- Fanny W S Ko
- From the Departments of Medicine and Therapeutics (F.W.S.K.) and Pediatrics (G.W.K.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, China
| | - Gary W K Wong
- From the Departments of Medicine and Therapeutics (F.W.S.K.) and Pediatrics (G.W.K.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, China
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13
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Lim TK, Ko FWS, Benton MJ, Berge MVD, Mak J. Year in review 2016: Chronic obstructive pulmonary disease and asthma. Respirology 2017; 22:820-828. [PMID: 28371172 DOI: 10.1111/resp.13037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado, Colorado Springs, Colorado, USA
| | - Maarten Van den Berge
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith Mak
- Department of Medicine, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong.,Department of Pharmacology and Pharmacy, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong
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14
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Ko FWS, Cheung NK, Rainer TH, Lum C, Wong I, Hui DSC. Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomised controlled trial. Thorax 2016; 72:122-128. [DOI: 10.1136/thoraxjnl-2016-208396] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/09/2016] [Accepted: 06/13/2016] [Indexed: 11/04/2022]
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15
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Lee N, Chan PKS, Tam WWS, Chan MCW, Lui GCY, Kwok AK, Ko FWS, Ng SSS, Yung IMH, Wong RYK, Hui DSC. Virological response to peramivir treatment in adults hospitalised for influenza-associated lower respiratory tract infections. Int J Antimicrob Agents 2016; 48:215-9. [PMID: 27319273 DOI: 10.1016/j.ijantimicag.2016.05.003] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 11/25/2022]
Abstract
An open-label trial on intravenous peramivir was conducted among adult patients hospitalised for influenza-associated lower respiratory tract complications (LRTCs). Virus culture and quantitative reverse transcription PCR (qRT-PCR) were performed serially until Day 10. Peramivir treatment was associated with viral RNA decline as well as culture and RNA negativity, which occurred at rates comparable with those of oseltamivir: by Day 5, viral load decline -2.5 log10 copies/mL [βinteraction -0.071, standard error (SE) 0.121, 95% confidence interval (CI) -0.309 to 0.167]; culture-negative, 94% (vs. 95%); and RNA-negative, 44% (vs. 36%). Extended treatment of >5 days was required in 69% of cases because of slow clinical resolution and viral clearance in LRTCs. Peramivir was well tolerated. These data are useful for future trial design in this unique population.
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Affiliation(s)
- N Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - P K S Chan
- Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - W W S Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - M C W Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - G C Y Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - A K Kwok
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - F W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - S S S Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - I M H Yung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - R Y K Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - D S C Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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16
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Wong TS, Xiang YT, Tsoh J, Ungvari GS, Ko FWS, Hui DSC, Chiu HFK. Suicidal ideation in Chinese patients with chronic obstructive pulmonary disease: a controlled study. Psychogeriatrics 2016; 16:172-6. [PMID: 26115202 DOI: 10.1111/psyg.12135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/16/2013] [Revised: 09/29/2013] [Accepted: 04/26/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND No study has been published on the prevalence of suicidal behaviour in older Chinese patients with chronic obstructive pulmonary disease (COPD). This study examined the 1-year prevalence of suicidal ideation in older Chinese COPD patients and explored its demographic and clinical correlates. METHODS A consecutive sample of 143 COPD patients and 211 matched control subjects were recruited and interviewed using structured, standardized instruments. RESULTS The 1-year prevalence of suicidal ideation in COPD patients and controls were 15.4% and 10.9%, respectively. In multivariate analyses, suicidal ideation was significantly associated with the severity of depressive symptoms in COPD patients. CONCLUSION Suicidal ideation was not higher in COPD patients than in controls.
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Affiliation(s)
- Tak-Shun Wong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Joshua Tsoh
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Gabor S Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia.,The University of Notre Dame Australia/Marian Centre, Perth, Western Australia, Australia
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - David S C Hui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
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17
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Grainge C, Thomas PS, Mak JCW, Benton MJ, Lim TK, Ko FWS. Year in review 2015: Asthma and chronic obstructive pulmonary disease. Respirology 2016; 21:765-75. [PMID: 27028730 DOI: 10.1111/resp.12771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Chris Grainge
- School of Medicine and Public Health, Centre for Asthma and Respiratory Disease, The University of Newcastle.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle
| | - Paul S Thomas
- Inflammation and Infection Research Centre and Prince of Wales' Hospital Clinical School, Faculty of Medicine, University of New South Wales, Kensington.,Department of Respiratory Medicine, Prince of Wales' Hospital, Randwick, New South Wales, Australia
| | - Judith C W Mak
- Department of Medicine and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Melissa J Benton
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado Colorado Springs, Colorado, USA
| | - Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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18
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Ng SSS, Chan RSM, Woo J, Chan TO, Cheung BHK, Sea MMM, To KW, Chan KKP, Ngai J, Yip WH, Ko FWS, Hui DSC. A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA. Chest 2016; 148:1193-1203. [PMID: 25763792 DOI: 10.1378/chest.14-3016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA. METHODS This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring. RESULTS In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (-1.8 kg/m2, 6.0% of the initial BMI; -0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (-3.5 in the LMP group vs -1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months. CONCLUSIONS LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Susanna S S Ng
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Ruth S M Chan
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Jean Woo
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Tat-On Chan
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Bernice H K Cheung
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Mandy M M Sea
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Kin-Wang To
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Ken K P Chan
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Jenny Ngai
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Wing-Ho Yip
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Fanny W S Ko
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - David S C Hui
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
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19
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Li MY, Yuan HL, Ko FWS, Wu B, Long X, Du J, Wu J, Ng CSH, Wan IYP, Mok TSK, Hui DSC, Underwood MJ, Chen GG. Antineoplastic effects of 15(S)-hydroxyeicosatetraenoic acid and 13-S-hydroxyoctadecadienoic acid in non-small cell lung cancer. Cancer 2015; 121 Suppl 17:3130-45. [PMID: 26331820 DOI: 10.1002/cncr.29547] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 04/27/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous studies have shown that the levels of 15-lipoxygenase 1 (15-LOX-1) and 15-LOX-2 as well as their metabolites 13-S-hydroxyoctadecadienoic acid (13(S)-HODE) and 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) are significantly reduced in smokers with non-small cell lung carcinoma (NSCLC). Furthermore, animal model experiments have indicated that the reduction of these molecules occurs before the establishment of cigarette smoking carcinogen-induced lung tumors, and this suggests roles in lung tumorigenesis. However, the functions of these molecules remain unknown in NSCLC. METHODS NSCLC cells were treated with exogenous 13(S)-HODE and 15(S)-HETE, and then the ways in which they affected cell function were examined. 15-LOX-1 and 15-LOX-2 were also overexpressed in tumor cells to restore these 2 enzymes to generate endogenous 13(S)-HODE and 15(S)-HETE before cell function was assessed. RESULTS The application of exogenous 13(S)-HODE and 15(S)-HETE significantly enhanced the activity of peroxisome proliferator-activated receptor γ (PPARγ), inhibited cell proliferation, induced apoptosis, and activated caspases 9 and 3. The overexpression of 15-LOX-1 and 15-LOX-2 obviously promoted the endogenous levels of 13(S)-HODE and 15(S)-HETE, which were demonstrated to be more effective in the inhibition of NSCLC. CONCLUSIONS This study has demonstrated that exogenous or endogenous 13(S)-HODE and 15(S)-HETE can functionally inhibit NSCLC, likely by activating PPARγ. The restoration of 15-LOX activity to increase the production of endogenous 15(S)-HETE and 13(S)-HODE may offer a novel research direction for molecular targeting treatment of smoking-related NSCLC. This strategy can potentially avoid side effects associated with the application of synthetic PPARγ ligands.
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Affiliation(s)
- Ming-Yue Li
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Hui-Ling Yuan
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Department of Breast Surgery, Dongguan People's Hospital, Dongguan, People's Republic of China
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Bin Wu
- Department of Respiratory Medicine, Affiliated Hospital of Guang Dong Medical College, Zhanjiang, People's Republic of China
| | - Xiang Long
- Shenzhen Hospital, Peking University, Shenzhen, People's Republic of China
| | - Jing Du
- Shenzhen Hospital, Peking University, Shenzhen, People's Republic of China
| | - Jun Wu
- Department of Respiratory Medicine, Affiliated Hospital of Guang Dong Medical College, Zhanjiang, People's Republic of China
| | - Calvin S H Ng
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Innes Y P Wan
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Tony S K Mok
- Department of Clinical Oncology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - David S C Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Malcolm J Underwood
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - George G Chen
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, People's Republic of China
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20
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Ko FWS, Yan BP, Lam YY, Chu JHY, Chan KP, Hui DSC. Undiagnosed airflow limitation is common in patients with coronary artery disease and associated with cardiac stress. Respirology 2015; 21:137-42. [PMID: 26510536 DOI: 10.1111/resp.12668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Smoking is a common risk factor for coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD). We evaluated the prevalence of undiagnosed COPD in patients with CAD and assessed the relationship between airflow obstruction and markers of cardiac stress. METHODS We recruited prospectively consecutive patients aged >40 years without known history of chronic lung disease (e.g. asthma, COPD, bronchiectasis) who had undergone percutaneous coronary intervention (PCI) for obstructive CAD between August 2009 and October 2010. Spirometry was performed and serum ST2, a novel biomarker of cardiomyocyte stress and fibrosis, was measured by enzyme-linked immunosorbent assay. RESULTS Among 475 subjects (mean age 64 ± 9.7, range 42-85 years, 87.2% males, 58.5% current or ex-smokers) who underwent spirometry, 51 (10.7%) had undiagnosed airflow obstruction with FEV1 /FVC ratio <70%. Of these 51 subjects, 14 (2.9%), 23 (4.8%) and 14 (2.9%) had FEV1 ≥80, 50-80 and 30-50% predicted normal, respectively. ST2 level was measured in all the subjects with undiagnosed airflow obstruction and in 290 subjects with normal lung function. There was no significant difference in left ventricular ejection fraction on echocardiogram between subjects with and without airflow obstruction. Patients with severe airflow obstruction had a higher level of cardiac stress marker ST2 than those with mild and moderate airflow obstruction (rho = -0.214, P ≤ 0.001). CONCLUSION Undiagnosed airflow obstruction is common among patients with CAD who have undergone PCI. Severity of airflow limitation is associated with increasing cardiac stress.
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Affiliation(s)
- Fanny W S Ko
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yat-yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jojo H Y Chu
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Pang Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David S C Hui
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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21
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Xiang YT, Wong TS, Tsoh J, Ungvari GS, Correll CU, Sareen J, Penner-Goeke K, Ko FWS, Hui DSC, Chiu HFK. Quality of life in older patients with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study. Perspect Psychiatr Care 2015; 51:121-7. [PMID: 24890904 DOI: 10.1111/ppc.12073] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/01/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To date, there have been few studies examining quality of life (QOL) in older patients with chronic obstructive pulmonary disease (COPD) in China. The aim of the study was to assess QOL in Chinese older patients with COPD and explore its demographic and clinical correlates. DESIGN AND METHODS Case-control study of 142 outpatients with COPD and 218 matched control subjects without COPD. COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥ 2 major COPD symptoms or > 1 major + minor COPD symptoms for ≥ 2 consecutive days). Controls were recruited from social centers in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale (IADL), life events were evaluated with the Life Event Scale, depressive disorders were diagnosed using the Geriatric Depression Scale (GDS), and QOL was measured using the Medical Outcomes Study Short Form-12 (SF-12) and St. George's Respiratory Questionnaire (SGRQ). FINDINGS Compared to controls, patients had significantly lower scores in the physical (PCS score), but not in the mental (MCS score) QOL domain. Multivariate analyses showed that more hospitalizations in the past year significantly contributed to higher PCS score (p = .03), while higher GDS total score contributed to lower MCS score (p = .003). Severe and very severe COPD, more physical illnesses, and higher IADL total score each independently contributed to higher SGRQ total score, explaining 40.0% of the variance (p < .001). PRACTICE IMPLICATIONS Our results suggest that therapeutic and psychosocial interventions alleviating depressive symptoms, severe COPD, comorbidities, and improving IADL in Chinese patients with COPD are likely of considerable benefit for improving QOL in patients with COPD.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China; Faculty of Health Sciences, University of Macau, Macao SAR, China
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22
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Ng SSS, Chan TO, To KW, Chan KKP, Ngai J, Tung A, Ko FWS, Hui DSC. Prevalence of obstructive sleep apnea syndrome and CPAP adherence in the elderly Chinese population. PLoS One 2015; 10:e0119829. [PMID: 25774657 PMCID: PMC4361659 DOI: 10.1371/journal.pone.0119829] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 06/06/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study assessed the prevalence of obstructive sleep apnea syndrome (OSAS) and CPAP adherence in the elderly Chinese in Hong Kong. METHODS We conducted a sleep questionnaire survey among the elders aged ≥60 years in the community centres followed by level 3 home sleep study (Embletta). Subjects with an apnea hypopnea index (AHI) ≥ 15/hr alone and those with AHI ≥ 5/hr plus either cardiovascular risk factors or Epworth Sleepiness Score (ESS) ≥ 10 were offered CPAP treatment. RESULTS Altogether 819 subjects were interviewed with mean (SD) age of 73.9 (7.5) years, BMI 24.2 (3.6) kg/m2, neck circumference 34.9 (3.4) cm and ESS 6.6 (5.2). Daytime sleepiness was reported by 72.4%, snoring loudly 5.1% and witnessed apnea 4%. Among 234 subjects who underwent home sleep study, 156 (66.7%), 102 (43.6%), 70 (29.9%) and 45 (19.2%) had AHI ≥ 5, ≥ 10, ≥ 15 and ≥ 20/hr respectively, with the prevalence increasing with age and BMI. In the sample, 149 subjects (63.7%) were classified as having OSAS, as defined by an AHI ≥ 5/hr with associated symptoms, involving 81 men (74.3%) and 68 women (54.4%). Neck circumference and snoring frequency were the only positive independent factors associated with the AHI and the diagnosis of OSAS. Among 141 subjects who were offered CPAP treatment, 30 accepted CPAP prescription with improvement of ESS and cognitive function over 12 months with CPAP usage of 4.2 (2.2) h/night. CONCLUSION This study showed a high prevalence of OSAS among the community elders in Hong Kong. Home CPAP acceptance was low but there was significant improvement of subjective sleepiness and cognitive function among those on CPAP treatment.
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Affiliation(s)
- Susanna S. S. Ng
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Tat-On Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Kin-Wang To
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Ken K. P. Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Jenny Ngai
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Alvin Tung
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Fanny W. S. Ko
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - David S. C. Hui
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
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Lim TK, Ko FWS, Thomas PS, Grainge C, Yang IA. Year in review 2014: Chronic obstructive pulmonary disease, asthma and airway biology. Respirology 2015; 20:510-8. [PMID: 25682705 DOI: 10.1111/resp.12488] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Tow Keang Lim
- Department of Medicine, National University Hospital, Singapore
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Liu KH, Chu WCW, To KW, Ko FWS, Ng SSS, Ngai JCL, Chan JWS, Ahuja AT, Hui DSC. Mesenteric fat thickness is associated with increased risk of obstructive sleep apnoea. Respirology 2014; 19:92-7. [PMID: 23927388 DOI: 10.1111/resp.12164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 12/28/2012] [Revised: 02/21/2013] [Accepted: 07/03/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Mesenteric fat is a type of intraperitoneal adipose tissue draining into portal circulation. The objective of this study was to investigate the relationships between mesenteric fat thickness and obstructive sleep apnoea (OSA) in patients with suspected OSA. METHODS One hundred forty-nine subjects (men: 114; women: 35) with suspected OSA underwent ultrasound examinations of mesenteric, preperitoneal and subcutaneous fat thickness after overnight polysomnography. Body mass index (BMI) and neck circumference were recorded. RESULTS The subjects with OSA (n = 130, apnoea/hypopnoea index (AHI) >5/h) had greater neck circumference, higher BMI, and greater mesenteric and preperitoneal fat thickness than those without OSA (n = 19, AHI ≤ 5/h). There was positive correlation of AHI with mesenteric (r = 0.43, P < 0.001) and preperitoneal fat thickness (r = 0.3, P < 0.001), whereas no significant association was observed between AHI and subcutaneous fat thickness (r = 0.09, P = 0.27). On multivariate logistic regression, after adjustments for gender, age, BMI, neck circumference, and preperitoneal and subcutaneous fat thickness, the mesenteric fat thickness had a positive association with the presence of moderate OSA and severe OSA, with odds ratios of 7.18 and 7.45 for every 1 cm increase in mesenteric fat thickness when AHI was defined as ≥15/h and AHI ≥ 30/h, respectively. CONCLUSIONS Mesenteric fat thickness is associated with increased risk of OSA, independent of other abdominal fat thickness, BMI and neck circumference. Sonographic measurement is potentially a useful tool for further evaluating the complex association of visceral fat, metabolic syndrome and OSA.
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Affiliation(s)
- Kin Hung Liu
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Wong TS, Xiang YT, Tsoh J, Ungvari GS, Ko FWS, Hui DSC, Chiu HFK. Depressive disorders in older patients with chronic obstructive pulmonary disease (COPD) in Hong Kong: a controlled study. Aging Ment Health 2014; 18:588-92. [PMID: 24261630 DOI: 10.1080/13607863.2013.856862] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVE There have been few studies examining the relationship between chronic obstructive pulmonary disease (COPD) and psychiatric morbidity in Hong Kong. This study aimed to examine the prevalence of depressive disorders (major depression, dysthymia and adjustment disorder with depressed mood) in Chinese patients with COPD and explore their demographic and clinical correlates. METHOD A total of 146 patients aged 50 years and above with COPD and 220 age and gender matched control subjects without COPD formed the study sample. Data of demographic and clinical characteristics were collected by a form designed for this study. Activity of daily living was assessed by the Instrumental Activities of Daily Living Scale and life events were evaluated by the Life Event Scale. Depressive disorders were determined using the Chinese version of the Structured Clinical Interview for DSM-IV. RESULTS The point prevalence of DSM-IV depressive disorders in patients with COPD and controls were 15.1% and 3.6%, respectively. Multivariate analyses revealed that female sex and severe impairment in daily activity functioning were independently associated with depressive disorders. Only 22.7% of the depressed COPD patients had consulted psychiatrists in the past three months. CONCLUSION Depressive disorders are significantly higher in COPD patients than controls. The low percentage of depressed patients with COPD seeking psychiatric treatment suggests that there is an unmet need in the psychiatric care of COPD patients.
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Affiliation(s)
- Tak-Shun Wong
- a Department of Psychiatry , Chinese University of Hong Kong , Hong Kong , China
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Ko FWS, Lim TK, Hancox RJ, Yang IA. Year in review 2013: Chronic obstructive pulmonary disease, asthma and airway biology. Respirology 2014; 19:438-47. [PMID: 24708033 DOI: 10.1111/resp.12252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/27/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Leung TF, Ko FWS, Sy HY, Tsui SKW, Wong GWK. Differences in asthma genetics between Chinese and other populations. J Allergy Clin Immunol 2013; 133:42-8. [PMID: 24188974 DOI: 10.1016/j.jaci.2013.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 01/14/2023]
Abstract
Asthma is caused by complex gene-gene and gene-environment interactions. Most asthma genes are not replicable across populations, which is possibly because of differences in the epidemiology of these genes. Our case-control association and next-generation sequencing studies revealed substantial discrepancies in the frequencies of single nucleotide polymorphisms (SNPs) and haplotype blocks for asthma genes between Chinese and other populations. The minor allele frequencies for nearly half of our studied SNPs differed by 0.2 or greater between southern Chinese subjects in Hong Kong and European white populations, African populations, or both. Because genome-wide association studies for asthma have not been performed in Chinese subjects, we cannot tell whether the genomic findings of recent consortium-based genome-wide association studies are applicable to our population. In addition, our group performed Roche 454 pyrosequencing on a 100-kb area spanning each of 10 asthma loci in 24 healthy Hong Kong children. For the 17q21 locus, there was substantial variation in the haplotype structures that were constructed from 224 common SNPs among Hong Kong subjects and 6 ethnic groups under the 1000 Genomes Project. Sixteen mostly small haplotype blocks were formed in Hong Kong, whereas 6 haplotype blocks were identified in Han Chinese in Beijing and central European subjects and 11 and 19 blocks were identified in Puerto Rican and Yoruba African subjects. In conclusion, differences in allele frequencies of asthma genes and haplotype structures of asthma loci are found between Chinese subjects and other ethnic groups. These sequence variations must be considered during the selection of tagging SNPs for replicating genetic associations between populations.
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Affiliation(s)
- Ting F Leung
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - Fanny W S Ko
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Hing Y Sy
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - Stephen K W Tsui
- School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Gary W K Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.
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Abstract
Asthma is characterized by recurrent and reversible airflow obstruction, which is routinely monitored by history and physical examination, spirometry and home peak flow diaries. As airway inflammation is central to asthma pathogenesis, its monitoring should be part of patient management plans. Fractional exhaled nitric oxide level (FeNO) is the most extensively studied biomarker of airway inflammation, and FeNO references were higher in Chinese (Asians) than Whites. Published evidence was inconclusive as to whether FeNO is a useful management strategy for asthma. Other biomarkers include direct (histamine, methacholine) and indirect (adenosine, hypertonic saline) challenges of bronchial hyperresponsiveness (BHR), induced sputum and exhaled breath condensate (EBC). A management strategy that normalized sputum eosinophils among adult patients resulted in reductions of BHR and asthma exacerbations. However, subsequent adult and pediatric studies failed to replicate these benefits. Asthma phenotypes as defined by inflammatory cell populations in sputum were also not stable over a 12-month period. A recent meta-analysis concluded that induced sputum is not accurate enough to be applied in routine monitoring of childhood asthma. There is poor correlation between biomarkers that reflect different asthma dimensions: spirometry (airway caliber), BHR (airway reactivity) and FeNO or induced sputum (airway inflammation). Lastly, EBC is easily obtained noninvasively by cooling expired air. Many biomarkers ranging from acidity (pH), leukotrienes, aldehydes, cytokines to growth factors have been described. However, significant overlap between groups and technical difficulty in measuring low levels of inflammatory molecules are the major obstacles for EBC research. Metabolomics is an emerging analytical method for EBC biomarkers. In conclusion, both FeNO and induced sputum are useful asthma biomarkers. However, they will only form part of the clinical picture. Longitudinal studies with focused hypotheses and well-designed protocols are needed to establish the roles of these biomarkers in asthma management. The measurement of biomarkers in EBC remains a research tool.
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Affiliation(s)
- Ting F Leung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Wong GWK, Leung TF, Ko FWS. Changing prevalence of allergic diseases in the Asia-pacific region. Allergy Asthma Immunol Res 2013; 5:251-7. [PMID: 24003381 PMCID: PMC3756171 DOI: 10.4168/aair.2013.5.5.251] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/06/2012] [Indexed: 01/15/2023]
Abstract
Asia-Pacific is one of the most densely populated regions of the world and is experiencing rapid economic changes and urbanization. Environmental pollution is a significant problem associated with the rapid modernization of many cities in South Asia. It is not surprising that the prevalences of asthma and allergies are increasing rapidly, although the underlying reasons remain largely unknown. Many studies from this region have documented the changing prevalence of allergic diseases in various parts of the world. However, the methodologies used were neither standardized nor validated, making the results difficult to evaluate. The International Study of Asthma and Allergies in Childhood (ISAAC) has provided a global epidemiology map of asthma and allergic diseases, as well as the trend of changes in the prevalence of these diseases. Allergic sensitization is extremely common in many Asian communities. However, the prevalence of allergic diseases remains relatively rare. The rapid urbanization in the region, which increases environmental pollution and can affect the rural environment, will likely increase the prevalence of asthma and allergies in Asia.
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Affiliation(s)
- Gary W K Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Abstract
Limited data suggest that outdoor air pollution (such as ambient air pollution or traffic-related air pollution) and indoor air pollution (such as second-hand smoking and biomass fuel combustion exposure) are associated with the development of chronic obstructive pulmonary disease (COPD), but there is insufficient evidence to prove a causal relationship at this stage. It also appears that outdoor air pollution is a significant environmental trigger for acute exacerbation of COPD, leading to increasing symptoms, emergency department visits, hospital admissions and even mortality. Improving ambient air pollution and decreasing indoor biomass combustion exposure by improving home ventilation are effective measures that may substantially improve the health of the general public.
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Affiliation(s)
- Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
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Affiliation(s)
- Darryl A Knight
- UBC James Hogg Research Centre, Institute for Heart + Lung Health, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada.
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Ngai SPC, Jones AYM, Hui-Chan CWY, Ko FWS, Hui DSC. An adjunct intervention for management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). J Altern Complement Med 2012; 19:178-81. [PMID: 22775329 DOI: 10.1089/acm.2011.0222] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Application of transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS) is a noninvasive intervention that has recently been shown to alleviate dyspnea in patients with stable chronic obstructive pulmonary disease (COPD). This case report aims to explore the role of Acu-TENS in patients diagnosed with COPD during the acute exacerbation. STUDY DESIGN The study design was a case report. SETTING The study was conducted in an inpatient setting. SUBJECT The subject was a 74-year-old man admitted to the hospital due to acute exacerbation of COPD (AECOPD). INTERVENTION Treatment consisted of application of TENS on EX-B1 (Dingchuan) for 45 minutes. OUTCOME MEASURES Oxygen saturation, heart rate, and dyspnea score were measured before, immediately after, and 45 minutes after Acu-TENS intervention. Other than the physiologic measures, 10 mL of venous blood was taken from the cubital vein for assessment of β-endorphin level, white blood cell count, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) level before and immediately postintervention. RESULTS Postintervention, improved oxygen saturation, and reduction in heart rate and dyspneic sensation were observed accompanied by a raised blood β-endorphin level but the level of white blood cell count, TNF-α, and CRP remain unchanged. CONCLUSIONS Application of 45 minutes Acu-TENS appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive Acu-TENS therapy during acute exacerbation warrants further investigation.
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Affiliation(s)
- Shirley P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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Ko FWS, Hui DSC, Leung TF, Chu HY, Wong GWK, Tung AHM, Ngai JCN, Ng SSS, Lai CKW. Evaluation of the asthma control test: a reliable determinant of disease stability and a predictor of future exacerbations. Respirology 2012; 17:370-8. [PMID: 22107482 DOI: 10.1111/j.1440-1843.2011.02105.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE This study assessed the asthma control test (ACT) cut-off values for asthma control according to the Global Initiative for Asthma guideline in adults and the effectiveness of ACT scores in predicting exacerbations and serial changes in ACT scores over time in relation to treatment decisions. METHODS Subjects completed ACT together with same-day spirometry and fractional concentration of exhaled nitric oxide (FeNO) measurement at baseline and at 3 months. Physicians, blinded to the ACT scores and FeNO values, assessed the patient's asthma control in the past month and adjusted the asthma medications according to management guidelines. Asthma exacerbations and urgent health-care utilization (HCU) at 6 months were recorded. RESULTS Three hundred seventy-nine (120 men) asthmatics completed the study. The ACT cut-off for uncontrolled and partly controlled asthma were ≤19 (sensitivity 0.74, specificity 0.67, % correctly classified 69.5) and ≤22, respectively (sensitivity 0.73, specificity 0.71, % correctly classified 72.1). Baseline ACT score had an odds ratio of 2.34 (95% confidence interval: 1.48-3.69) and 2.66 (1.70-4.18) for urgent HCU and exacerbations, respectively, at 6 months (P < 0.0001). However, baseline FeNO and spirometry values had no association with urgent HCU and exacerbations. The 3-month ACT score of ≤20 correlated best with step-up of asthma medications (sensitivity 0.65, specificity 0.81, % correctly classified 72.8). For serial changes of ACT scores over 3 months, the cut-off value was best at ≤3 for treatment decisions with low sensitivity (0.23) and % correctly classified (57.3%) values. CONCLUSIONS Single measurement of ACT is useful for assessing asthma control, prediction of exacerbation and changes in treatment decisions.
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Affiliation(s)
- Fanny W S Ko
- Departments of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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Lai CKW, Ko FWS, Bhome A, DE Guia TS, Wong GWK, Zainudin BMZ, Nang AN, Boonsawat W, Cho SH, Gunasekera KD, Hong JG, Hsu JY, Viet NN, Yunus F, Mukhopadhyay A. Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia. Respirology 2011; 16:688-97. [PMID: 21362102 DOI: 10.1111/j.1440-1843.2011.01954.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health-care utilization. METHODS Asthma Insights and Reality in Asia-Pacific Phase 2 (AIRIAP 2) was a cross-sectional, community-based survey of 4805 subjects with asthma from urban centres across Asia. A symptom control index was derived from the AIRIAP 2 questionnaire using the GINA control criteria for day- and night-time symptoms, need for rescue medication, activity limitation and exacerbations; lung function was excluded. The main outcomes were asthma control, based on these GINA criteria and the ACT, and the relationship between control and self-reported urgent health-care utilization (hospitalization, emergency room visits or other unscheduled urgent visits) related to asthma over the previous 12months. RESULTS Each of the symptom criteria was significantly associated with urgent health-care utilization, with odds ratios (ORs) ranging from 2.25 (95% confidence interval (CI): 1.94-2.61) for daytime symptoms to 2.57 (95% CI: 2.29-2.90) for nocturnal awakening. Similarly, control status was significantly associated with urgent health-care utilization, with ORs of 0.19 (95% CI: 0.13-0.28), 0.70 (95% CI: 0.65-0.76) and 1.00 for controlled, partly controlled and uncontrolled, respectively. The optimal ACT cut-off score for identifying uncontrolled asthma was ≤19 for subjects aged ≥12years. Urgent health-care utilization was reported by 57.2% versus 28.7% of patients scoring ≤19 versus >19 (P<0.001). CONCLUSIONS The GINA control classification and the ACT are valid symptom-based measures that are significantly associated with urgent health-care utilization.
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Affiliation(s)
- Christopher K W Lai
- The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, Singapore.
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Ko FWS, Ip MSM, Chu CM, So LKY, Lam DCL, Hui DSC. Prevalence of allergic rhinitis and its associated morbidity in adults with asthma: a multicentre study. Hong Kong Med J 2010; 16:354-361. [PMID: 20889999] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVES To assess the prevalence of allergic rhinitis in adult patients with asthma in Hong Kong, and to compare the morbidity endured by asthma patients with and without allergic rhinitis. DESIGN Cross-sectional study. SETTING Respiratory clinics of four major public hospitals in Hong Kong. PATIENTS A total of 600 adults with asthma were recruited from March to May 2007. MAIN OUTCOME MEASURES Doctors and patients completed separate questionnaires evaluating symptoms, treatment, and health care utilisation. Spirometry data were obtained for a subgroup of patients at the time of survey completion. RESULTS The patients consisted of 267 males and 333 females, with 251 having spirometry data. The mean pre-bronchodilator 1-second forced expiratory volume predicted among those who had spirometry performed was 88% (standard deviation, 28%). In all, 50% of the patients had intermittent and 50% had persistent asthma. Over three quarters (463/600; 77%) of patients had experienced allergic rhinitis symptoms in the past 12 months, of whom 96% had a previous diagnosis of allergic rhinitis. Asthmatics without allergic rhinitis symptoms had higher rates of visits to doctors, pharmacy visits, emergency department attendances, and hospitalisations for asthma than those with both conditions. Among subjects with asthma and allergic rhinitis, those taking nasal steroid (226/463; 49%) had lower rates of emergency department visits (13 vs 25%, P=0.002) and hospitalisations (7 vs 13%, P=0.045) for asthma than those who were not. CONCLUSION Allergic rhinitis is a common co-morbid condition of asthma in this hospital clinic cohort. Treatment of allergic rhinitis with intra-nasal steroid was associated with less health care utilisation for asthma.
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MESH Headings
- Administration, Intranasal
- Adult
- Aged
- Asthma/epidemiology
- Asthma/physiopathology
- Cross-Sectional Studies
- Female
- Forced Expiratory Volume
- Glucocorticoids/administration & dosage
- Glucocorticoids/therapeutic use
- Hong Kong/epidemiology
- Hospitalization/statistics & numerical data
- Hospitals, Public
- Humans
- Male
- Middle Aged
- Prevalence
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/epidemiology
- Spirometry
- Surveys and Questionnaires
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Affiliation(s)
- Fanny W S Ko
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Ng SSS, Chan TO, To KW, Ngai J, Tung A, Ko FWS, Hui DSC. Validation of Embletta portable diagnostic system for identifying patients with suspected obstructive sleep apnoea syndrome (OSAS). Respirology 2010; 15:336-42. [PMID: 20199644 DOI: 10.1111/j.1440-1843.2009.01697.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED The Embletta portable diagnostic system is highly sensitive and specific in quantifying the AHI and differentiating obstructive and supine events when compared against hospital-based PSG in patients with suspected OSAS. The simple device may be useful for screening and diagnostic purpose when access to PSG is limited. BACKGROUND AND OBJECTIVES This study aimed to evaluate the diagnostic accuracy of Embletta portable diagnostic system (PDS, Medcare, Reykjavik, Iceland) for the screening of sleep apnoea in clinical practice. METHODS The Embletta PDS is a digital three-channel recording device that measures airflow through a nasal cannula connected to a pressure transducer, oxygen saturation plus both respiratory and abdominal movements via built-in effort and body position sensors. An AHI is determined based on recording time. Nocturnal polysomnography (Alice 4, Healthdyne, Atlanta, USA), with airflow measured by a nasal pressure transducer (PTAF2, Pro-Tech, Woodinville, WA, USA)) and Embletta PDS recordings, was performed simultaneously in consecutive patients with suspected OSA syndrome. The PSG recordings were analysed manually by a blinded investigator. RESULTS Ninety subjects were recruited and 10 failed Embletta PDS studies due to measurement failure. Among the remaining 80 subjects, 63 were males. The mean age (SD) was 51.4 (11.9) years old, BMI 27.1(4.2) kg/m2, neck circumference 38.6 (3.6) cm and Epworth Sleepiness Score 9.7 (5.3). The AHI obtained by the Embletta PDS correlated closely with that obtained by PSG (Pearson correlation, r=0.979, P<0.001). Comparison of AHI based on the Embletta PDS against the PSG demonstrated high sensitivity at AHI>or=5/h (sensitivity 0.924 and specificity 0.857) and high specificity at AHI>or=20/h (sensitivity 0.853 and specificity 0.957). CONCLUSIONS The Embletta PDS is a highly sensitive and specific screening device in quantifying AHI when compared against PSG in patients with suspected OSA syndrome.
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Affiliation(s)
- Susanna S S Ng
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, HK, China
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Ngai SPC, Jones AYM, Hui-Chan CWY, Ko FWS, Hui DSC. Effect of 4 weeks of Acu-TENS on functional capacity and beta-endorphin level in subjects with chronic obstructive pulmonary disease: a randomized controlled trial. Respir Physiol Neurobiol 2010; 173:29-36. [PMID: 20601209 DOI: 10.1016/j.resp.2010.06.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/24/2010] [Accepted: 06/07/2010] [Indexed: 02/07/2023]
Abstract
Our recent studies showed that one session of transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) improved forced expiratory volume in 1s (FEV(1)) in patients with chronic obstructive pulmonary disease (COPD). This study investigated the effect of 4-week Acu-TENS on physical and psychosocial function in these patients. Twenty-eight patients were randomly allocated to receive 4-weeks of 45-min, 5-days/week, of either Acu-TENS (over Dingchuan), Placebo-TENS (same protocol without electrical output), or Sham-TENS (over the patellae). Variables measured before and after intervention included FEV(1), forced vital capacity (FVC), 6-min walk distance (6MWD), St. George's Respiratory Questionnaire score (SGRQ), beta-endorphin and blood inflammatory marker levels. Only the Acu-TENS group attained significant improvement in FEV(1) (p=0.046), physical activity (p=0.007) and total SGRQ score (p=0.028). The increase in beta-endorphin (p=0.012) correlated positively with the improvement in FEV(1) (r=0.526, p=0.008). To conclude, 4 weeks of Acu-TENS improved the functional capacity of patients with COPD, probably due to the bronchodilation induced by beta-endorphin elevation.
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Affiliation(s)
- Shirley P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Ko FWS, Chan AMW, Chan HS, Kong AYF, Leung RCC, Mok TYW, Tse HH, Lai CKW. Are Hong Kong doctors following the Global Initiative for Asthma guidelines: a questionnaire "Survey on Asthma Management"? Hong Kong Med J 2010; 16:86-893. [PMID: 20354241] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To assess the standard of asthma management by doctors in Hong Kong. DESIGN Cross-sectional postal questionnaire survey. SETTING Hong Kong. PARTICIPANTS Practising doctors registered with the Medical Council of Hong Kong were sent a questionnaire between August and December 2007. MAIN OUTCOME MEASURES Respondents' responses to questions on demographic data, parameters routinely used to assess asthma control, the pattern of asthma medication prescribing, and seven different case scenarios assessing their ability to classify asthma control and management. RESULTS. We received 410 completed questionnaires from general practitioners (55%), internists (22%), paediatricians (11%), and other specialists (12%). The majority (82%) explained the pathology of asthma to at least some of their patients and tried to identify aggravating factors of the asthma (91%). Fewer observed the inhalation technique of their patients (68%) and prescribed a written asthma management plan (33%). The main medications prescribed to adults and children with asthma were inhaled corticosteroids, inhaled short-acting beta-2 agonists, and combinations of an inhaled corticosteroid and a long-acting beta-2 agonist. In adults and children, long-acting beta-2 agonist alone (without inhaled corticosteroid) was being used to treat asthma by 45% and 36% of the doctors, respectively. Also, 94% of the respondents correctly classified the control status in four out of the seven case scenarios and 31% chose the correct medications when responding to seven of the 14 questions asked. CONCLUSIONS Asthma management practice of Hong Kong doctors falls short of the standards recommended by international guidelines. More effort in improving their knowledge is urgently warranted.
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Affiliation(s)
- F W S Ko
- Hong Kong Thoracic Society, Hong Kong.
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Lee YT, Lai LH, Sung JJY, Ko FWS, Hui DSC. Endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases: local experience of a novel investigation. Hong Kong Med J 2010; 16:121-125. [PMID: 20354246] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To study the efficacy and safety of endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases in Hong Kong. DESIGN Retrospective review of prospectively collected data. SETTING University teaching hospital, Hong Kong. PATIENTS A total of 125 consecutive patients with various mediastinal and pulmonary lesions that underwent trans-oesophageal endoscopic ultrasonography-guided fine-needle aspiration from July 1998 to June 2007. MAIN OUTCOME MEASURES The diagnostic accuracy and safety of the procedure and its influence in patient management. RESULTS Malignancy was confirmed in 62 (50%) of the patients and excluded in 42 (34%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic ultrasonography-guided fine-needle aspiration in diagnosing mediastinal malignancies were 75% (95% confidence interval, 64-83%), 100% (90-100%), 100% (93-100%), 67% (54-78%), and 83%, respectively. Eighty-six (69%) of the patients had their initial plan of invasive investigations changed. Only one (0.8%) patient developed a septic complication in a mediastinal cyst after puncturing, and was treated surgically. CONCLUSIONS Trans-oesophageal endoscopic ultrasonography-guided fine-needle aspiration is a minimally invasive, effective, and safe method of diagnosing malignant mediastinal disease. It may reduce the need for other invasive investigations.
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Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Kuan WP, Tam LS, Wong CK, Ko FWS, Li T, Zhu T, Li EK. CXCL 9 and CXCL 10 as Sensitive markers of disease activity in patients with rheumatoid arthritis. J Rheumatol 2009; 37:257-64. [PMID: 20032101 DOI: 10.3899/jrheum.090769] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess whether serum levels of CC and CXC chemokines correlate with disease activity in patients with rheumatoid arthritis (RA), and to determine whether these effects predict clinical response. METHODS Serum levels of the chemokines CC (CCL2, CCL5) and CXC (CXCL8, CXCL9, CXCL10) were quantified at baseline and after 12 weeks of treatment with disease-modifying antirheumatic drugs or biologic agents in 28 patients using flow cytometry. Serum from 40 healthy individuals was collected for comparison at baseline. Response to treatment was classified according to the European League Against Rheumatism (EULAR) response criteria. Remission of disease was defined as a Disease Activity Score < 2.6. RESULTS The baseline serum concentrations of CC and CXC chemokines were significantly elevated in patients with active RA compared to healthy controls (p < 0.05) except for CCL2. Significant improvement in all disease activity measurements was observed after 12 weeks of treatment. Seventeen (60.7%) patients achieved good to moderate response based on the EULAR response criteria, and 5 (17.9%) patients achieved remission. The improvement in clinical activity in patients with RA was accompanied by a significant reduction in the serum concentration of CXCL9 and CXCL10 (p < 0.001). A significant reduction in the serum level of CXCL10 was also observed in the group that achieved EULAR response. Serum concentration of CCL5 remained significantly elevated in patients with RA (n = 5) who achieved remission compared to the healthy controls (p < 0.05). CONCLUSION Serum concentration of CXCL9 and CXCL10 may serve as sensitive biomarkers for disease activity in patients with RA.
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Affiliation(s)
- Woon Pang Kuan
- Department of Rheumatology, Hospital Selayang, Selangor, Malaysia
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Chan JWM, Ko FWS, Ng CK, Yeung AWT, Yee WKS, So LKY, Lam B, Wong MML, Choo KL, Ho ASS, Tse PY, Fung SL, Lo CK, Yu WC. Management of patients admitted with pneumothorax: a multi-centre study of the practice and outcomes in Hong Kong. Hong Kong Med J 2009; 15:427-433. [PMID: 19966346] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To examine the management practice of pneumothorax in hospitalised patients in Hong Kong, especially the choice of drainage options and their success rates, as well as the factors associated with procedural failures. DESIGN Retrospective study. SETTING Multi-centre study involving 12 public hospitals in Hong Kong. PATIENTS All adult patients admitted as an emergency in the year 2004 with a discharge diagnosis of 'pneumothorax' were included. Data on the management and outcomes of the various types of pneumothoraces were collected from their case records. RESULTS Altogether these patients had 1091 episodes (476 primary spontaneous pneumothoraces, 483 secondary spontaneous pneumothoraces, 87 iatrogenic pneumothoraces, and 45 traumatic pneumothoraces). Conservative treatment was offered in 182 (17%) episodes, which were more common among patients with small primary spontaneous pneumothoraces (71%). Simple aspiration was performed to treat 122 (11%) of such episodes, and had a success rate of 15%. Aspiration failure was associated with having a pneumothorax of size 2 cm or larger (odds ratio=3.7; 95% confidence interval, 1.2-11.5; P=0.03) and a smoking history (4.1; 1.2-14.3; P=0.03). Intercostal tube drainage was employed in 890 (82%) episodes, with a success rate of 77%. Failure of intercostal tube drainage was associated with application of suction (odds ratio=4.1; 95% confidence interval, 2.8-5.9; P<0.001) and presence of any tube complications (1.55; 1.0-2.3; P=0.03). Small-bore catheters (<14 French) were used in 12 (1%) of the episodes only. Tube complications were encountered in 214 (24%) episodes. CONCLUSION Notwithstanding recommendations from international guidelines, simple aspiration and intercostal tube drainage with small-bore catheters were not commonly employed in the management of hospitalised patients with the various types of pneumothoraces in Hong Kong.
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Lee JSW, Kwok T, Chui PY, Ko FWS, Lo WK, Kam WC, Mok HLF, Lo R, Woo J. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr 2009; 29:453-8. [PMID: 19910085 DOI: 10.1016/j.clnu.2009.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Continuous pump feeding is often used to reduce aspiration risk in older patients on tube feeding, but its effectiveness in preventing aspiration pneumonia is unproven. A randomized controlled trial was therefore performed to examine the effectiveness of continuous pump feeding in decreasing the incidence of pneumonia in tube-fed older hospital patients. METHODS One hundred and seventy eight elderly patients from three convalescence hospitals and one infirmary, on nasogastric tube feeding, were randomly assigned to have intermittent bolus (bolus) or continuous pump (pump) feeding for 4weeks. The primary outcome was the incidence of pneumonia. The secondary outcome was mortality. RESULTS Eighty five subjects were randomized into the pump group and 93 in the bolus group. The groups were comparable in age, nutritional and functional status, co-morbidities and history of pneumonia, except that there were more women in the pump group. Within 4weeks, 15 subjects (17.6%) in the pump group and 18 (19.4%) in the bolus group developed pneumonia. Seven subjects (8.2%) in pump group and 13 subjects (14.0%) in bolus group died. There was no significant difference in either pneumonia or death rates between the two groups. CONCLUSION Continuous pump feeding did not significantly affect the rates of pneumonia or mortality in tube-fed older hospital patients when compared with intermittent bolus feeding.
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Affiliation(s)
- J S W Lee
- Department of Medicine & Geriatrics, Shatin Hospital, Hong Kong SAR, China
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Ngai SPC, Jones AYM, Hui-Chan CWY, Ko FWS, Hui DSC. Effect of Acu-TENS on post-exercise expiratory lung volume in subjects with asthma-A randomized controlled trial. Respir Physiol Neurobiol 2009; 167:348-53. [PMID: 19540365 DOI: 10.1016/j.resp.2009.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 06/06/2009] [Accepted: 06/10/2009] [Indexed: 11/28/2022]
Abstract
This study examined the effect of transcutaneous electrical nerve stimulation applied over acupoints (Acu-TENS) on forced expiratory volume, in patients with asthma, after exercise. Thirty subjects were randomly assigned to three groups. Group 1 received Acu-TENS over acupuncture points Lieque and Dingchuan for 45 min prior to a symptom-limited treadmill exercise test. Group 2 had Acu-TENS similarly applied prior to and throughout the exercise test. Group 3 mimicked Group 1 but without any electrical output from the device. Forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) were recorded before, immediately after and at 20-min intervals post-exercise for 1h. Immediately after exercise, FEV(1) and FVC rose in Group 2 (p=0.015), but decreased in Group 1 and more so in Group 3. The differences became even more marked at 20, 40 and 60 min. Adjunctive Acu-TENS therapy appears to reduce decline of FEV(1) following exercise training in patients with asthma.
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Affiliation(s)
- Shirley P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Leung TF, Ko FWS, Wong GWK, Li CY, Yung E, Hui DSC, Lai CKW. Predicting changes in clinical status of young asthmatics: clinical scores or objective parameters? Pediatr Pulmonol 2009; 44:442-9. [PMID: 19382219 DOI: 10.1002/ppul.20977] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 11/10/2022]
Abstract
Preventing asthma exacerbation is an important goal of asthma management. The existing clinical tools are not good in predicting asthma exacerbations in young children. Childhood Asthma Control Test (C-ACT) was recently published to be a simple tool for assessing disease control in young children. This study investigated C-ACT and other disease-related factors for indicating longitudinal changes in asthma status and predicting asthma exacerbations. During the same clinic visit, asthma patients aged 4-11 years completed the Chinese version of C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Asthma exacerbations during the next 6 months were recorded. Ninety-seven patients were recruited, with their mean (standard deviation [SD]) age being 9.2 (2.0) years. Thirty-six (37.1%) patients had uncontrolled asthma at baseline. C-ACT, DSS, and FEV(1) differed among patients with different control status (P < 0.001 for C-ACT and DSS; P = 0.028 for FEV(1)). Thirty-two patients had asthma exacerbations during the 6-month follow-up. Changes in patients' C-ACT scores correlated with changes in asthma control status, DSS, and FEV(1) (P = 0.019, 0.034, and 0.020, respectively). C-ACT score was lower among patients with asthma exacerbations (mean [SD]: 22.9 [4.2] vs. 24.5 [2.1]; P = 0.015). Logistic regression confirmed that the occurrence of asthma exacerbations was associated only with baseline C-ACT (B = -0.203, P = 0.042). In conclusion, C-ACT is better than DSS and objective parameters in reflecting changes in asthma status and predicting asthma exacerbations in young children.
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Affiliation(s)
- Ting F Leung
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Leung TF, Ko FWS, Sy HY, Wong E, Li CY, Yung E, Hui DSC, Wong GWK, Lai CKW. Identifying uncontrolled asthma in young children: clinical scores or objective variables? J Asthma 2009; 46:130-5. [PMID: 19253117 DOI: 10.1080/02770900802468533] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children. METHODS During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. RESULTS The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV(1)) differed among patients with different control status (p < 0.001 for C-ACT and DSS; p = 0.014 for FEV(1)). Logistic regression confirmed that UA was associated with DSS (p < 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV(1) (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p < 0.001), followed by PEF (p = 0.006) and FEV(1) (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA. CONCLUSIONS C-ACT is better than objective parameters in identifying young Chinese children with UA.
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Affiliation(s)
- T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Miravitlles M, Murio C, Tirado-Conde G, Levy G, Muellerova H, Soriano JB, Ramirez-Venegas A, Ko FWS, Canelos-Estrella B, Giugno E, Bergna M, Chérrez I, Anzueto A. Geographic differences in clinical characteristics and management of COPD: the EPOCA study. Int J Chron Obstruct Pulmon Dis 2009; 3:803-14. [PMID: 19281096 PMCID: PMC2650616 DOI: 10.2147/copd.s4257] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [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] [Indexed: 11/23/2022] Open
Abstract
AIMS Data on differences in clinical characteristics and management of COPD in different countries and settings are limited. We aimed to characterize the profile of patients with COPD in a number of countries and their treatment in order to evaluate adherence to recommendations of international guidelines. METHOD This was an observational, international, cross-sectional study on patients with physician-diagnosed COPD. Demographic and clinical characteristics, risk factors, and treatment were collected by their physician via an internet web-based questionnaire developed for the study. RESULTS A total of 77 investigators from 17 countries provided data on 833 patients. The countries with the highest number of patients included were: Argentina (128), Ecuador (134), Spain (162), and Hong Kong (153). Overall, 79.3% were men and 81% former smokers, with a mean FEV1 = 42.7%, ranging from 34.3% in Hong Kong to 58.8% in Ecuador. Patients reported a mean of 1.6 exacerbations the previous year, with this frequency being significantly and negatively correlated with FEV1 (%) (r = -0.256; p < 0.0001). Treatment with short-acting bronchodilators and theophyllines was more frequent in Ecuador and Hong Kong compared with Spain and Argentina, and in patients belonging to lower socioeconomic levels (p < 0.0001 for all comparisons). Inadequacy of treatment with inhaled corticosteroids and theophyllines was high, with significant differences among countries. CONCLUSIONS Differences in the clinical characteristics and management of COPD were significant across countries. Adherence to international guidelines appears to be low. Efforts should be made to disseminate and adapt guidelines to the socioeconomic reality of different settings.
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Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, Spain.
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Ko FWS, Leung TF, Hui DSC, Chu HY, Wong GWK, Wong E, Tung AHM, Lai CKW. Asthma Control Test correlates well with the treatment decisions made by asthma specialists. Respirology 2009; 14:559-66. [PMID: 19383110 DOI: 10.1111/j.1440-1843.2009.01514.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Poor assessment of asthma control results in suboptimal treatment. Identifying parameters that accurately assess control will benefit treatment decisions. The Asthma Control Test (ACT) is a five-item questionnaire for the assessment of asthma control. This study evaluated its correlation with the treatment decisions made by asthma specialists in an outpatient clinic setting, and compared its performance with other conventional parameters including spirometry, PEF rate (PEFR), fractional exhaled nitric oxide (FeNO) and BHR. METHODS The 383 (122 men) study subjects completed a 1-month diary on symptoms and PEFR before the assessment. All subjects then completed the ACT together with same-day spirometry and FeNO measurement. BHR to methacholine was performed in 73 subjects in the week before assessment. Asthma specialists, blinded to the results of the ACT, FeNO and BHR (but not spirometry and PEFR), assessed the patients' level of control according to the 2006 version of the Global Initiative for Asthma guidelines and made appropriate treatment decision. RESULTS The group mean (SD) age was 46.1 (13.4) years with pre-bronchodilator FEV(1) 84.72 (20.81) % predicted. Receiver operating characteristic (ROC) curve analysis found that an ACT score of < or = 20 best correlated with uncontrolled asthma (area under curve (AUC) = 0.76) with a sensitivity of 70.5%, specificity 76.0%, positive predictive value 76.2% and negative predictive value 70.2% for predicting step-up of asthma therapy. On ROC analysis, the ACT score had the highest AUC (0.81 (P < 0.001)) for changing asthma therapy when compared with FeNO, spirometry, PEFR and BHR parameters CONCLUSIONS The ACT correlated better with treatment decisions made by asthma specialists than spirometry, PEFR and FeNO.
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Affiliation(s)
- Fanny W S Ko
- Department of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Abstract
A recently identified interleukin (IL)-17-producing T-helper (Th) lymphocyte subset, which comprises Th17 cells producing hallmark cytokines IL-17A, IL-17F and IL-22, is involved in chronic inflammatory diseases. Elevated gene and protein expressions of IL-17 are manifested in allergic asthma. We further characterized the activation of Th17 cells in asthmatic patients. Peripheral blood mononuclear cells (PBMC) were purified from 31 asthmatic patients and 20 sex- and age-matched control subjects. The number of IL-17A secreting cells in peripheral blood was enumerated by enzyme-linked immunosorbent spot assay. Cell surface expression of Th17-related chemokine receptor CCR6, and plasma level of IL-17A, IL-17F and IL-22, and ex vivo production of IL-17A and IL-22 were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively. The number of peripheral Th17 lymphocytes, expression of CCR6 on Th cells, and ex vivo IL-23, anti-CD3 and anti-CD28 induced production of IL-22 by PBMC were significantly elevated in asthmatic patients compared with control subjects (all p < 0.01). This clinical study further confirmed increased number of peripheral Th17 lymphocytes and cell surface expression of CCR6 receptors on Th cells in asthmatic patients. Pro-inflammatory cytokine IL-23 can exacerbate disease severity by activating pathogenic Th17 lymphocytes to release downstream inflammatory cytokine IL-22 in asthma.
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Affiliation(s)
- C K Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong
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Lun SWM, Wong CK, Ko FWS, Hui DSC, Lam CWK. Expression and functional analysis of toll-like receptors of peripheral blood cells in asthmatic patients: implication for immunopathological mechanism in asthma. J Clin Immunol 2008; 29:330-42. [PMID: 19067129 DOI: 10.1007/s10875-008-9269-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 11/19/2008] [Indexed: 01/09/2023]
Abstract
BACKGROUND We investigated the expression profile of toll-like receptors (TLRs) and TLR ligand-activated production profile of asthma-related inflammatory cytokines in asthmatic patients. The expression of TLR1-8 on monocytes, CD4+ T helper lymphocytes, CD8+ T cytotoxic lymphocytes, CD19+ B lymphocytes, and dendritic cells, and ex vivo production of cytokines from peripheral blood mononuclear cells activated by TLR ligands were measured by flow cytometry. DISCUSSION Ex vivo productions of TNF-alpha, IL-10, and IL-1beta by TLR4 and TLR5 ligand LPS and flagellin were significantly lower in asthmatic patients (all P < 0.05). Expression of TLR4 and TLR5 was also found to be significantly lower in asthmatic patients when compared to that of control subjects (all P < 0.05). Therefore, the decreased activation of TLR4 and TLR5 in asthmatic patients might contribute to the immunopathological mechanisms of asthma by reducing the release of Th1 and anti-inflammatory cytokines.
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Affiliation(s)
- Samantha W M Lun
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Ko FWS, Woo J, Tam W, Lai CKW, Ngai J, Kwok T, Hui DSC. Prevalence and risk factors of airflow obstruction in an elderly Chinese population. Eur Respir J 2008; 32:1472-8. [PMID: 18684847 DOI: 10.1183/09031936.00058708] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is common practice to use a forced expiratory volume in one second (FEV(1))/ forced vital capacity (FVC) ratio of <70% as evidence of airflow obstruction. As the FEV(1)/FVC ratio falls with age, the lower limit of normal range (LLN), defined as the bottom 5% in a health reference population, of FEV(1)/FVC ratio has been suggested as a better index to reduce over-diagnosis of chronic obstructive pulmonary disease (COPD), particularly in the elderly. However, there are no large scale studies that focus on the diagnosis of COPD in the elderly based on these definitions. The present prospective epidemiological study involved 1,149 elderly subjects aged > or =60 yrs in the community. Detailed questionnaires, pre- and post-bronchodilator spirometry were performed. In total, 1,008 subjects (mean age 74.2+/-6.4 yrs; 271 males) completed satisfactory spirometry testing. Airflow obstruction was present in 25.9% as defined by the post-bronchodilator FEV(1)/FVC ratio of <70% and in 12.4% defined by the LLN of FEV(1)/FVC ratio. Moderate COPD, at least, was found in 14.0% of patients according to the post-bronchodilator FEV(1)/FVC ratio of <70% and in 8.5% of patients according to LLN of FEV(1)/FVC ratio. In the present elderly Chinese population (mostly females, with low education level and previous exposure to biomass during formative years), the prevalence of chronic obstructive pulmonary disease varied markedly depending on definitions adopted. Further longitudinal studies are needed to determine the precise definition of chronic obstructive pulmonary disease.
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Affiliation(s)
- F W S Ko
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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