Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study

BACKGROUND

Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function.

METHODS

Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis.

RESULTS

The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

CONCLUSION

The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.

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Key Words

• Breathlessness
• Dyspnoea
• Lung function
• Spirometry

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Affiliation(s)

A Müller Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
E F Wouters Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
P Koul Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
T Welte Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
I Harrabi Faculté de Médecine, Sousse, Tunisia
A Rashid RCSI and UCD Malaysia Campus, Penang, Malaysia
L C Loh RUMC, Penang, Malaysia
M Al Ghobain King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
A Elsony The Epidemiological Laboratory, Khartoum, Sudan
R Ahmed The Epidemiological Laboratory, Khartoum, Sudan
J Potts National Heart and Lung Institute, Imperial College London, London, UK
K Mortimer University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
F Rodrigues Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
S N Paraguas Philippine College of Chest Physicians, Manila, Philippines
S Juvekar KEM Hospital Research Centre, Pune, India
D Agarwal KEM Hospital Research Centre, Pune, India
D Obaseki Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
T Gislason Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
T Seemungal Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
A A Nafees Aga Khan University, Karachi, Pakistan
C Jenkins Woolcock Institute of Medical Research, Sydney, Australia
H B Dias Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
F M E Franssen Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
M Studnicka Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
C Janson Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
H H Cherkaski Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
M El Biaze Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
P A Mahesh Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
J Cardoso Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
P Burney National Heart and Lung Institute, Imperial College London, London, UK
S Hartl Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
D J A Janssen Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
A F S Amaral National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK

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Southeastern Brazil inland tropicalization: Köppen system applied for detecting climate change throughout 100 years of meteorological observed data

Many regions around the world are facing climate changes, with substantial increase in air temperature over the past decades, which is mainly related to continental and global warming forced by the higher greenhouse gas (GHG) emissions. The objectives of this study were to use the Köppen climate classification to detect local climate change based on a historical series of 100 years and to assess if such change is related to those that are occurring in other spatial scales as a likely consequence of increasing GHG. This paper brings a content full of innovative results. The study area presented an average annual air temperature increase by 0.9 °C between 1917 and 2016, rising from 21.4 °C for the first climatological normal (1917-1946) to 22.3 °C for the last one (1987-2016). Furthermore, in the summer months, the temperature rose from 24.5 to 25.3 °C, and in the winter months, such increase was from 17.1 (1917-1946) to 18.3 °C (1987-2016). Our findings showed the subtropical conditions (Cfa in Köppen's classification) in the study area persisted from the beginning of the analysis (1917-1946) until the climatological normal of 1979-2008, with a clear tendency of tropicalization after that with a change in the climate type of Piracicaba from subtropical to tropical, which can now be classified as tropical with dry winter (Aw climate type). The local average air temperature showed concordances with the long-term air temperature anomalies from regional, continental, and global scales, indicating that all of them may be linked with increasing GHG emissions, since well-defined long-term linear relationships (r ² = 0.99) were observed between continental and global average air temperature anomalies and atmospheric CO₂ concentration observed at the NOAA Lab in Mauna Loa in the last 59 years. While the local and regional forcing effects remain to be fully unraveled, our study provided a valid and strong scientific sound evidence that climate change occurred in Piracicaba, southeastern Brazil, in the last 100 years.

Assessing the performance of two gridded weather data for sugarcane crop simulations with a process-based model in Center-South Brazil

High-quality measured weather data (MWD) are essential for long-term and in-season crop model applications. When MWD is not available, one alternative for crop simulations is to employ gridded weather data (GWD), which needs to be evaluated a priori. Therefore, this study aimed to evaluate the impact of weather data from two GWD sources (NASA and XAVIER), in the way that they are available for end users, on simulating sugarcane crop performance within the APSIM-Sugar model at traditional sites where sugarcane is grown in Center-South Brazil, compared to simulations with MWD. Besides, this study also evaluated the impact of replacing GWD rainfall by the site-specific measured data on such simulations. A common sugarcane cropping system was repeatedly simulated between 1997 and 2015 for different combinations of climate input. Both NASA and XAVIER appear to be interesting for applications that only require temperature and solar radiation for predictions, such as crop phenology and potential yield. Nonetheless, GWD should be used with caution for crop model applications that rely on accurate estimation of crop water balance, canopy development, and biomass accumulation, at least with crop models that run at a daily time-step. The replacement of gridded rainfall with measured rainfall was pivotal for improving sugarcane simulations, as observed for cane yield, by increasing both agreement (NASA d index from 0.67 to 0.90; XAVIER d from 0.73 to 0.93) and R² (NASA from 0.35 to 0.76; XAVIER from 0.43 to 0.79) and reducing root mean square errors (RMSE) from 32.8 to 16.3 t/ha when simulated with other variables of NASA data and from 27.9 to 12.7 t/ha when having XAVIER data as input. Therefore, while using both GWD sets without any correction, it is recommended to replace gridded rainfall by measured values, whenever possible, to improve sugarcane simulations in Center-South Brazil.

Sugarcane yield gap analysis in Brazil - A multi-model approach for determining magnitudes and causes

Brazil is the largest sugarcane producer in the world playing a pivotal role on global ethanol production. The sugarcane yield levels across the producing regions of the country vary substantially, resulting in yield gaps of different magnitudes, which represent a huge opportunity for increasing sugarcane and ethanol production. According to that, the present study aimed to investigate the sugarcane yield gap in Brazil, their magnitude and causes (water deficit or crop management), considering a multi-model approach. Three different sugarcane simulation models, FAO-Agroecological Zone, DSSAT/CANEGRO and APSIM-Sugarcane, properly calibrated and validated for sugarcane in Brazil, were used to estimate potential and water-limited yields and yield gaps for 30 locations across the country. The average of total yield gap for the 30 locations was 124 t ha^-1. The main proportion of the total yield gap was caused by water deficit (about 89 t ha^-1, representing 73% of the total), followed by sub-optimal crop management (about 35 t ha^-1, representing 27% of the total). The highest yield gap by water deficit was found in the Northeastern region, whereas São Paulo State showed the lowest yield gap by crop management. The main causes of yield gap by crop management are possibly related to the production system based on long-term monoculture and soil compaction due to intense crop mechanization in recent years. Reducing sugarcane yield gap caused by crop management by 20 to 100% would allow to diminish the cultivated area with this crop, respectively, from 9 to 32%. Possible solutions to mitigate the yield gaps, such as use of irrigation, adoption of drought tolerant cultivars, better traffic control, periodical crop rotation, among others, were also discussed.

The application of antimicrobial photodynamic therapy (aPDT) in dentistry: a critical review

In recent years there have been an increasing number of in vitro and in vivo studies that show positive results regarding antimicrobial photodynamic therapy (aPDT) used in dentistry. These include applications in periodontics, endodontics, and mucosal infections caused by bacteria present as biofilms. Antimicrobial photodynamic therapy is a therapy based on the combination of a non-toxic photosensitizer (PS) and appropriate wavelength visible light, which in the presence of oxygen is activated to produce reactive oxygen species (ROS). ROS induce a series of photochemical and biological events that cause irreversible damage leading to the death of microorganisms. Many light-absorbing dyes have been mentioned as potential PS for aPDT and different wavelengths have been tested. However, there is no consensus on a standard protocol yet. Thus, the goal of this review was to summarize the results of research on aPDT in dentistry using the PubMed database focusing on recent studies of the effectiveness aPDT in decreasing microorganisms and microbial biofilms, and also to describe aPDT effects, mechanisms of action and applications.

Acute inhibition of nitric oxide synthesis induces anxiolysis in the plus maze test

The involvement of nitric oxide (NO) in anxiety was investigated in rats, using the elevated plus maze test. Acute, but not chronic, systemic treatment with N omega-nitro-L-arginine methyl ester (L-NAME, 10 and 60 mg.kg-1), an inhibitor of NO synthase, increased the time spent by the rats in the open arms. Both the acute and chronic treatments with L-NAME inhibited NO synthase in endothelial cells and in the central nervous system, as shown by the increase in mean arterial pressure and decreased NO synthase activity in brain tissue. Chronic treatment with L-NAME also decreased the serum nitrate levels. The anxiolysis induced by acute L-NAME treatment is unlikely to be due to hypertension, since two-kidney one-clip hypertension in non-L-NAME-treated rats failed to significantly change exploratory behaviour in the elevated plus maze. These results indicate that acute inhibition of NO synthesis decreases anxiety in rats.

Short-term sucralfate administration alters potassium diclofenac absorption in healthy male volunteers

AIMS

Since patients who regularly take NSAIDS may use sucralfate because of its cytoprotective properties, we examined the influence of this compound on the pharmacokinetics of diclofenac.

METHODS

Potassium diclofenac (105 mg) was administered orally to eighteen healthy male volunteers with or without a 5-day pre-treatment with sucralfate (2000 mg twice daily). Blood samples were collected at intervals post-dose and serum concentrations of diclofenac were determined by reverse-phase h.p.l.c.

RESULTS

Pre-treatment with sucralfate significantly decreased both the AUC(0,8 h) [2265 ng h ml-1 (geometric mean) (range 1815-2827) vs 1821 ng h ml-1 (1295-2562)] and the Cmax [1135 ng ml-1 (geometric mean) (range 898-1436) 701 ng ml-1 (501-981)] with no significant delay in absorption [tmax 1.0 h (median) (range 0.5-2.0) vs 1.0 h (0.5-4.0)].

CONCLUSIONS

The short-term treatment of healthy male volunteers with sucralfate decreases potassium diclofenac bioavailability. These findings suggest that either an appropriate increase in the diclofenac intake or the use of another gastric mucosa protector must be adopted.

Short-term sucralfate administration does not alter the absorption of metronidazole in healthy male volunteers

BACKGROUND

An oral triple therapy using sucralfate instead of a bismuth to eradicate Helicobacter pylori has yielded worse results than those obtained with conventional oral triple therapies. To date, the effect of sucralfate on the pharmacokinetics of nitroimidazolic compounds used in triple therapy such as with metronidazole is unknown. The aim of this study was to investigate the effect of a 5-day administration period of sucralfate (2 g b.i.d.) on metronidazole pharmacokinetics.

METHODS

Fourteen healthy male volunteers were selected. The study had an open randomized 2-period crossover design with a 14-day washout period between the phases. The plasma concentration of metronidazole and its hydroxy-metabolite were measured by reverse-phase HPLC with ultraviolet detection.

RESULTS

No statistically significant difference was observed in any of the pharmacokinetic parameters studied in the absence and presence of sucralfate.

CONCLUSION

Our results clearly indicate that short-term treatment with sucralfate in healthy volunteers does not alter the extent or the rate of metronidazole absorption, and does not affect metronidazole clearance.

Influence of gastric acid secretion blockade and food intake on the bioavailability of a potassium diclofenac suspension in healthy male volunteers

The bioavailability of a single dose of a potassium diclofenac (KDIC) suspension (Flogan, Merck, 7ml, 105 mg) was studied in 13 healthy male volunteers in the fasting state (placebo phase, PLA), after gastric acid secretion blockade (subacute pretreatment with omeprazole, OME phase) and after food intake (FOOD phase). A 14-day washout period between phases was adopted. Serum samples were obtained over a 24 hour interval and the diclofenac concentrations were determined by high pressure liquid chromatography with ultraviolet detection. From the serum diclofenac concentration vs time curves, the AUC[0-infinity] (area under the concentration vs time curves from 0 to infinity), Cmax (maximum achieved concentration), tmax (time to achieve Cmax), Ke (terminal first order elimination constant), half-life values (t1/2) and AUC[0-infinity]/t1/2 ratio as an index of diclofenac clearance, were obtained. All these variables were analyzed using both parametric and non-parametric statistics. In the presence of food, KDIC absorption was delayed (as shown by lower Cmax and greater tmax values) and decreased (as shown by lower AUC[0-infinity] values), and the serum diclofenac concentration vs time curves showed a biphasic pattern. Omeprazole pretreatment did not change the absorption parameters. Both of these treatments altered the diclofenac clearance, as assessed by the AUC[0-infinity]/t1/2, t1/2 and Ke values, although the changes were not considered to be clinically significant, because of the wide therapeutic range for diclofenac. The delay in the rate of diclofenac absorption produced by food intake was not due to an increase in the gastric pH, and could be of particular importance when rapid analgesia is desired.