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Budden KF, Shukla SD, Bowerman KL, Vaughan A, Gellatly SL, Wood DLA, Lachner N, Idrees S, Rehman SF, Faiz A, Patel VK, Donovan C, Alemao CA, Shen S, Amorim N, Majumder R, Vanka KS, Mason J, Haw TJ, Tillet B, Fricker M, Keely S, Hansbro N, Belz GT, Horvat J, Ashhurst T, van Vreden C, McGuire H, Fazekas de St Groth B, King NJC, Crossett B, Cordwell SJ, Bonaguro L, Schultze JL, Hamilton-Williams EE, Mann E, Forster SC, Cooper MA, Segal LN, Chotirmall SH, Collins P, Bowman R, Fong KM, Yang IA, Wark PAB, Dennis PG, Hugenholtz P, Hansbro PM. Faecal microbial transfer and complex carbohydrates mediate protection against COPD. Gut 2024; 73:751-769. [PMID: 38331563 DOI: 10.1136/gutjnl-2023-330521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a major cause of global illness and death, most commonly caused by cigarette smoke. The mechanisms of pathogenesis remain poorly understood, limiting the development of effective therapies. The gastrointestinal microbiome has been implicated in chronic lung diseases via the gut-lung axis, but its role is unclear. DESIGN Using an in vivo mouse model of cigarette smoke (CS)-induced COPD and faecal microbial transfer (FMT), we characterised the faecal microbiota using metagenomics, proteomics and metabolomics. Findings were correlated with airway and systemic inflammation, lung and gut histopathology and lung function. Complex carbohydrates were assessed in mice using a high resistant starch diet, and in 16 patients with COPD using a randomised, double-blind, placebo-controlled pilot study of inulin supplementation. RESULTS FMT alleviated hallmark features of COPD (inflammation, alveolar destruction, impaired lung function), gastrointestinal pathology and systemic immune changes. Protective effects were additive to smoking cessation, and transfer of CS-associated microbiota after antibiotic-induced microbiome depletion was sufficient to increase lung inflammation while suppressing colonic immunity in the absence of CS exposure. Disease features correlated with the relative abundance of Muribaculaceae, Desulfovibrionaceae and Lachnospiraceae family members. Proteomics and metabolomics identified downregulation of glucose and starch metabolism in CS-associated microbiota, and supplementation of mice or human patients with complex carbohydrates improved disease outcomes. CONCLUSION The gut microbiome contributes to COPD pathogenesis and can be targeted therapeutically.
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Affiliation(s)
- Kurtis F Budden
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Kate L Bowerman
- School of Chemistry and Molecular Biosciences, Australian Centre for Ecogenomics, The University of Queensland, Brisbane, QLD, Australia
| | - Annalicia Vaughan
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Shaan L Gellatly
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - David L A Wood
- School of Chemistry and Molecular Biosciences, Australian Centre for Ecogenomics, The University of Queensland, Brisbane, QLD, Australia
| | - Nancy Lachner
- School of Chemistry and Molecular Biosciences, Australian Centre for Ecogenomics, The University of Queensland, Brisbane, QLD, Australia
| | - Sobia Idrees
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Saima Firdous Rehman
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Alen Faiz
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Vyoma K Patel
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Chantal Donovan
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Charlotte A Alemao
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sj Shen
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Nadia Amorim
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Rajib Majumder
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Kanth S Vanka
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jazz Mason
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Tatt Jhong Haw
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Bree Tillet
- Frazer Institute, University of Queensland, Woolloongabba, QLD, Australia
| | - Michael Fricker
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Simon Keely
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Nicole Hansbro
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Gabrielle T Belz
- Frazer Institute, University of Queensland, Woolloongabba, QLD, Australia
| | - Jay Horvat
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Thomas Ashhurst
- Sydney Cytometry, Charles Perkins Centre, Centenary Institute and The University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia
| | - Caryn van Vreden
- Sydney Cytometry, Charles Perkins Centre, Centenary Institute and The University of Sydney, Sydney, NSW, Australia
- Ramaciotti Facility for Human Systems Biology, Charles Perkins Centre and The University of Sydney, Sydney, NSW, Australia
| | - Helen McGuire
- Ramaciotti Facility for Human Systems Biology, Charles Perkins Centre and The University of Sydney, Sydney, NSW, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Facility for Human Systems Biology, Charles Perkins Centre and The University of Sydney, Sydney, NSW, Australia
| | - Nicholas J C King
- Sydney Cytometry, Charles Perkins Centre, Centenary Institute and The University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia
- Ramaciotti Facility for Human Systems Biology, Charles Perkins Centre and The University of Sydney, Sydney, NSW, Australia
- Discipline of Pathology, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Ben Crossett
- Sydney Mass Spectrometry, The University of Sydney, Sydney, NSW, Australia
| | - Stuart J Cordwell
- Sydney Mass Spectrometry, The University of Sydney, Sydney, NSW, Australia
- School of Life and Environmental Sciences, Charles Perkins Centre and The University of Sydney, Sydney, NSW, Australia
| | - Lorenzo Bonaguro
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany
| | - Joachim L Schultze
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Germany
- Genomics and Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany
- PRECISE Platform for Single Cell Genomics and Epigenomics, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) and the University of Bonn, Bonn, Germany
| | | | - Elizabeth Mann
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Samuel C Forster
- Centre for Innate Immunity and Infectious Diseases and Department of Molecular and Translational Science, Hudson Institute of Medical Research and Monash University, Melbourne, VIC, Australia
| | - Matthew A Cooper
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Leopoldo N Segal
- Division of Pulmonary and Critical Care Medicine, Laura and Isaac Perlmutter Cancer Center, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Translational Respiratory Research Laboratory, Singapore
| | - Peter Collins
- Mater Research Institute, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Dietetics & Food Services, Mater Hospital, Brisbane, QLD, Australia
| | - Rayleen Bowman
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Kwun M Fong
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Ian A Yang
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Paul G Dennis
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Philip Hugenholtz
- School of Chemistry and Molecular Biosciences, Australian Centre for Ecogenomics, The University of Queensland, Brisbane, QLD, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs and Immune Health Research Program, The University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
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Thomas D, McDonald VM, Stevens S, Baraket M, Hodge S, James A, Jenkins C, Marks GB, Peters M, Reynolds P, Upham JW, Yang IA, Gibson PG. Azithromycin Induced Asthma Remission in Adults With Persistent Uncontrolled Asthma: A Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial. Chest 2024:S0012-3692(24)00284-8. [PMID: 38431051 DOI: 10.1016/j.chest.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Asthma remission is a potential treatment goal. RESEARCH QUESTION Does adding azithromycin to standard therapy in patients with persistent uncontrolled asthma induce remission compared with placebo? STUDY DESIGN AND METHODS This secondary analysis used data from the AMAZES clinical trial-a double-blind placebo-controlled trial that evaluated the safety and efficacy of azithromycin on asthma exacerbations. The primary remission definition (referred to as clinical remission) was zero exacerbations and zero oral corticosteroids during the previous 6 months evaluated at 12 months and a 5-item Asthma Control Questionnaire score ≤ 1 at 12 months. Secondary remission definitions included clinical remission plus lung function criteria (postbronchodilator FEV1 ≥ 80% or postbronchodilator FEV1 ≤ 5% decline from baseline) and complete remission (sputum eosinophil count < 3% plus the aforementioned criteria). Sensitivity analyses explored the robustness of primary and secondary remission definitions. The predictors of clinical remission were identified. RESULTS A total of 335 participants (41.5% male; median age, 61.01 years; quartile 1-3, 51.03-68.73) who completed the 12-month treatment period were included in the analysis. Twelve months of treatment with azithromycin induced asthma remission in a subgroup of patients, and a significantly higher proportion in the azithromycin arm achieved both clinical remission (50.6% vs 38.9%; P = .032) and clinical remission plus lung function criteria (50.8% vs 37.1%; P = .029) compared with placebo, respectively. In addition, a higher proportion of the azithromycin group achieved complete remission (23% vs 13.7%; P = .058). Sensitivity analyses supported these findings. Baseline factors (eg, better asthma-related quality of life, absence of oral corticosteroid burst in the previous year) predicted the odds of achieving clinical remission. Azithromycin induced remission in both eosinophilic and noneosinophilic asthma. INTERPRETATION Adults with persistent symptomatic asthma achieved a higher remission rate when treated with azithromycin. Remission on treatment may be an achievable treatment target in moderate/severe asthma, and future studies should consider remission as an outcome measure.
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Affiliation(s)
- Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW, Australia.
| | - Vanessa M McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Sean Stevens
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW, Australia
| | - Melissa Baraket
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Sandra Hodge
- Lung Research Laboratory, Hanson Institute, Adelaide, SA, Australia; Lung Research, University of Adelaide and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Alan James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia
| | - Christine Jenkins
- Department of Thoracic Medicine, Concord Hospital, Concord, Australia; George Institute for Global Health, Sydney, NSW, Australia
| | - Guy B Marks
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Woolcock Institute of Medical Research, Glebe, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, Australia
| | - Paul Reynolds
- Lung Research, University of Adelaide and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Peter G Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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Thomas D, McDonald VM, Stevens S, Harvey ES, Baraket M, Bardin P, Bowden JJ, Bowler S, Chien J, Chung LP, Gillman A, Hew M, Hodge S, James A, Jenkins C, Katelaris CH, Katsoulotos GP, Langton D, Lee J, Marks G, Peters M, Radhakrishna N, Reynolds PN, Rimmer J, Sivakumaran P, Upham JW, Wark P, Yang IA, Gibson PG. Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients. Allergy 2024; 79:384-392. [PMID: 37632144 DOI: 10.1111/all.15867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Asthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission. METHODS This observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real-world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5-item Asthma Control Questionnaire (ACQ-5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post-bronchodilator FEV1 ≥80%) or stabilization (post-bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut-offs of ACQ-5/FEV1 scores. The predictors of clinical remission were identified. RESULTS 29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission. CONCLUSION Biologic treatment with mepolizumab or omalizumab for severe asthma-induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.
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Affiliation(s)
- Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
| | - Vanessa M McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sean Stevens
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
| | - Erin S Harvey
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Melissa Baraket
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Philip Bardin
- Lung and Sleep Medicine, Monash University and Medical Centre and Hudson Institute, Clayton, Victoria, Australia
| | - Jeffrey J Bowden
- Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
| | - Simon Bowler
- Department of Respiratory Medicine, Mater Hospital, Brisbane, Queensland, Australia
| | - Jimmy Chien
- Department of Sleep and Respiratory Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Li Ping Chung
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Andrew Gillman
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra Hodge
- Lung Research Laboratory, Hanson Institute, Adelaide, South Australia, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Lung Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Alan James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medcial School, The University of Western Australia, Perth, Western Australia, Australia
| | - Christine Jenkins
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
- Concord Clinical School, University of Sydney, Concord, New South Wales, Australia
| | - Constance H Katelaris
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Gregory P Katsoulotos
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- The University of Notre Dame, Sydney, Western Australia, Australia
- St George Specialist Centre, Kogarah, New South Wales, Australia
- St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia
| | - Joy Lee
- Austin Health, Melbourne, Victoria, Australia
| | - Guy Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
| | | | - Paul N Reynolds
- Department of Thoracic Medicine, Royal Adelaide Hospital, Lung Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
- St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - Pathmanathan Sivakumaran
- Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Wark
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Peter G Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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Stephens EKH, Guayco Sigcha J, Lopez-Loo K, Yang IA, Marshall HM, Fong KM. Biomarkers as a tool to reduce disparities in lung cancer screening and detection. Transl Lung Cancer Res 2024; 13:213-214. [PMID: 38404988 PMCID: PMC10891403 DOI: 10.21037/tlcr-2023-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Edward K. H. Stephens
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jazmin Guayco Sigcha
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kenneth Lopez-Loo
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A. Yang
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia
| | - Henry M. Marshall
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia
| | - Kwun M. Fong
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health District, Brisbane, Australia
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Wootton SL, Dale MT, Tian Y, King M, Alison JA, Chan ASL, Varnfield M, Yang IA, McKeough ZJ. User experience testing of the mobile pulmonary rehabilitation (m-PR™) app in people with chronic obstructive pulmonary disease. Digit Health 2024; 10:20552076241237381. [PMID: 38559582 PMCID: PMC10981254 DOI: 10.1177/20552076241237381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Mobile health (mHealth) technologies are emerging to support the delivery of pulmonary rehabilitation (PR). This study aimed to explore the ease of use, satisfaction and acceptability of an Australian mobile pulmonary rehabilitation app (m-PR™) in people with chronic obstructive pulmonary disease (COPD). Methods In this mixed methods observational study, participants with COPD were recruited following PR assessment. Participants were educated on m-PR™ which contained symptom monitoring, individualised exercise training with exercise videos, education videos, goal setting, health notifications and medication action plan. Participants used m-PR™ for 4-8 weeks. At baseline, participants were surveyed to assess level of technology engagement. At follow-up, participants completed the system usability survey (SUS), a satisfaction survey and a semi-structured interview. Results Fifteen participants (mean age 70 [SD 10] years, 53% female) completed the study. Technology usage was high with 73% (n = 11) self-rating their technology competence as good or very good. The SUS score of 71 (SD 16) demonstrated above average perceived usability of m-PR™. The satisfaction survey indicated that 67% (n = 10) enjoyed m-PR™ and 33% (n = 5) were neutral. Most participants found the different m-PR™ components somewhat easy or very easy to use (range 69-100%) and somewhat helpful or very helpful (range 76-100%). Interview responses revealed that m-PR™ elicited divergent feelings among participants, who reported both positive and negative feelings towards the app's features, the effort required to use it and data security. Conclusion The majority of participants found m-PR™ enjoyable, easy to use and helpful in managing their COPD. Further research is warranted to understand the effectiveness of mHealth to deliver PR.
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Affiliation(s)
- Sally L Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marita T Dale
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ye Tian
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Meredith King
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
| | - Jennifer A Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Allied Health, Sydney Local Health District, Camperdown,
Australia
| | - Andrew S L Chan
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Ian A Yang
- Faculty of Medicine, The Prince Charles Hospital and The University of Queensland, Brisbane, Australia
| | - Zoe J McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Patel N, Dahl K, O'Rourke R, Williamson A, Chatfield MD, Fong KM, Yang IA, Marshall HM. Vertebral CT attenuation outperforms standard clinical fracture risk prediction tools in detecting osteoporotic disease in lung cancer screening participants. Br J Radiol 2023; 96:20220992. [PMID: 37486625 PMCID: PMC10607405 DOI: 10.1259/bjr.20220992] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVES Compare accuracy of vertebral Hounsfield Unit (VHU) attenuation and FRAX and Garvan Fracture Risk Calculators in identifying low bone mineral density (BMD) and prevalent vertebral compression fractures (VF) in lung cancer screening (LCS) participants. METHODS Baseline CT scans from a single site of the International Lung Screen Trial were analysed. BMD was measured using VHU (of the most caudally imaged vertebra) and quantitative CT (QCT) (low BMD defined as <110 HU and <120 mg/cm3, respectively). Prevalent VF were classified semi-quantitatively. 10-year FRAX and Garvan fracture risks were calculated using dual energy X-ray absorptiometry (DXA) femoral neck T-score where available. Discrimination was assessed by area under receiver-operating characteristic curves (AUC). RESULTS 535 LCS participants were included; 41% had low VHU-BMD, 56% had low QCT-BMD and 10% had ≥1 VF with ≥25% vertebral height loss. VHU demonstrated 94% specificity and 70% sensitivity in identifying low QCT-BMD. VHU was superior to fracture risk tools in discriminating low QCT-BMD (AUC: VHU 0.94 vs FRAX 0.67, Garvan 0.64 [p < 0.05]). In 64 participants with recent DXA scans, VHU was superior to FRAXT-score and GarvanT-score in discriminating low QCT-BMD (AUC: VHU 0.99, FRAXT-score 0.71, GarvanT-score 0.71 [p < 0.05]). VHU was non-inferior to FRAXT-score and GarvanT-score in discriminating VF (AUC: VHU 0.65, FRAXT-score 0.53, GarvanT-score 0.61). CONCLUSIONS VHU outperforms clinical risk calculators in detecting low BMD and discriminates prevalent VF equally well as risk calculators with T-scores, yet is significantly simpler to perform. ADVANCES IN KNOWLEDGE VHU measurement could aid osteoporosis assessment in high-risk smokers undergoing LCS.
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Affiliation(s)
| | | | | | | | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Queensland, Australia
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Stephens EKH, Guayco Sigcha J, Lopez-Loo K, Yang IA, Marshall HM, Fong KM. Biomarkers of lung cancer for screening and in never-smokers-a narrative review. Transl Lung Cancer Res 2023; 12:2129-2145. [PMID: 38025810 PMCID: PMC10654441 DOI: 10.21037/tlcr-23-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Abstract
Background and Objective Lung cancer is the leading cause of cancer-related mortality worldwide, partially attributed to late-stage diagnoses. In order to mitigate this, lung cancer screening (LCS) of high-risk patients is performed using low dose computed tomography (CT) scans, however this method is burdened by high false-positive rates and radiation exposure for patients. Further, screening programs focus on individuals with heavy smoking histories, and as such, never-smokers who may otherwise be at risk of lung cancer are often overlooked. To resolve these limitations, biomarkers have been posited as potential supplements or replacements to low-dose CT, and as such, a large body of research in this area has been produced. However, comparatively little information exists on their clinical efficacy and how this compares to current LCS strategies. Methods Here we conduct a search and narrative review of current literature surrounding biomarkers of lung cancer to supplement LCS, and biomarkers of lung cancer in never-smokers (LCINS). Key Content and Findings Many potential biomarkers of lung cancer have been identified with varying levels of sensitivity, specificity, clinical efficacy, and supporting evidence. Of the markers identified, multi-target panels of circulating microRNAs, lipids, and metabolites are likely the most clinically efficacious markers to aid current screening programs, as these provide the highest sensitivity and specificity for lung cancer detection. However, circulating lipid and metabolite levels are known to vary in numerous systemic pathologies, highlighting the need for further validation in large cohort randomised studies. Conclusions Lung cancer biomarkers is a fast-expanding area of research and numerous biomarkers with potential clinical applications have been identified. However, in all cases the level of evidence supporting clinical efficacy is not yet at a level at which it can be translated to clinical practice. The priority now should be to validate existing candidate markers in appropriate clinical contexts and work to integrating these into clinical practice.
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Affiliation(s)
- Edward K. H. Stephens
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jazmin Guayco Sigcha
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kenneth Lopez-Loo
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A. Yang
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Henry M. Marshall
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Kwun M. Fong
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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8
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Ngo L, Lee XW, Elwashahy M, Arumugam P, Yang IA, Denman R, Haqqani H, Ranasinghe I. Freedom from atrial arrhythmia and other clinical outcomes at 5 years and beyond after catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2023; 9:447-458. [PMID: 37336617 PMCID: PMC10658515 DOI: 10.1093/ehjqcco/qcad037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/30/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/21/2023]
Abstract
AIMS Catheter ablation of atrial fibrillation (AF) is now a mainstream procedure although long-term outcomes are uncertain. We performed a systematic review and meta-analysis of procedural outcomes at 5 years and beyond. METHODS AND RESULTS We searched PubMed and Embase and after the screening, identified 73 studies (67 159 patients) reporting freedom from atrial arrhythmia, all-cause death, stroke, and major bleeding at ≥5 years after AF ablation. The pooled mean age was 59.7y, 71.5% male, 62.2% paroxysmal AF, and radiofrequency was used in 78.1% of studies. Pooled incidence of freedom from atrial arrhythmia at 5 years was 50.6% (95%CI 45.5-55.7%) after a single ablation and 69.7% [95%CI (confidence interval) 63.8-75.3%) after multiple procedures. The incidence was higher among patients with paroxysmal compared with non-paroxysmal AF after single (59.7% vs. 33.3%, p = 0.002) and multiple (80.8% vs. 60.6%, p < 0.001) ablations but was comparable between radiofrequency and cryoablation. Pooled incidences of other outcomes were 6.0% (95%CI 3.2-9.7%) for death, 2.4% (95%CI 1.4-3.7%) for stroke, and 1.2% (95%CI 0.8-2.0%) for major bleeding at 5 years. Beyond 5 years, freedom from arrhythmia recurrence remained largely stable (52.3% and 64.7% after single and multiple procedures at 10 years), while the risk of stroke and bleeding increased over time. CONCLUSION Nearly 70% of patients having multiple ablations remained free from atrial arrhythmia at 5 years, with the incidence slightly decreasing beyond this period. Risk of death, stroke, and major bleeding at 5 years were low but increased over time, emphasizing the importance of long-term thromboembolism prevention and bleeding risk management.
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Affiliation(s)
- Linh Ngo
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Xiang Wen Lee
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | | | - Pooja Arumugam
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
| | - Ian A Yang
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Russell Denman
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Haris Haqqani
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Isuru Ranasinghe
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
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Kung SC, Dixon O, Kentwell S, Vasireddy RS, Rodgers J, Ding Y, Rahman T, Tallis C, Yang IA, Mackintosh JA. Telomere biology disorder presenting acutely with pulmonary fibrosis and hepatopulmonary syndrome in a young adult male. Respirol Case Rep 2023; 11:e01182. [PMID: 37397566 PMCID: PMC10311130 DOI: 10.1002/rcr2.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
A 33-year-old man presented with acute dyspnoea and profound hypoxaemia, and had clubbing, greying of hair, orthodeoxia and fine inspiratory crackles. CT chest showed established pulmonary fibrosis in a usual interstitial pneumonia pattern. Additional investigations revealed a small patent foramen ovale, pancytopenia, and oesophageal varices and portal hypertensive gastropathy from liver cirrhosis. Telomere length testing demonstrated short telomeres (<1st percentile), confirming the diagnosis of a telomere biology disorder. An interstitial lung disease gene panel identified a pathogenic variant in TERT (c.1700C>T, p.(Thr567Met)) and a variant of uncertain significance in PARN (c.1159G>A, p.(Gly387Arg)). Combined lung and liver transplantation was deemed not suitable due to frailty and severe hepatopulmonary syndrome, and he died 56 days after presentation. Early recognition of the short telomere syndrome is important, and its multi-organ involvement poses challenges to management. Genetic screening may be important in younger patients with pulmonary fibrosis or in unexplained liver cirrhosis.
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Affiliation(s)
| | - Olivia Dixon
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Sarah Kentwell
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Raja S. Vasireddy
- Department of HaematologyThe Children's Hospital at Westmead, The Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Jonathan Rodgers
- Genetic Health QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Yuming Ding
- Gastroenterology and HepatologyThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Tony Rahman
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Gastroenterology and HepatologyThe Prince Charles HospitalBrisbaneQueenslandAustralia
| | - Caroline Tallis
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Ian A. Yang
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - John A. Mackintosh
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. A cross-sectional analysis of ambient fine particulate matter (PM 2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries. Environ Res 2023; 227:115734. [PMID: 36963710 DOI: 10.1016/j.envres.2023.115734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM2.5 exposure was 33.0 (±21.6) μg/m3. The adjusted model showed that a 10 μg/m3 increase in annual PM2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Arun Duggal Centre of Excellence for Research in Climate Change and Air Pollution, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW, 2050, Australia
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Wootton SL, Dale MT, Alison JA, Brown S, Rutherford H, Chan ASL, Varnfield M, Yang IA, Cunich M, Dennis S, McKeough ZJ. Mobile Health Pulmonary Rehabilitation Compared to a Center-Based Program for Cost-Effectiveness and Effects on Exercise Capacity, Health Status, and Quality of Life in People with Chronic Obstructive Pulmonary Disease: A Protocol for a Randomized Controlled Trial. Phys Ther 2023:7150682. [PMID: 37133445 DOI: 10.1093/ptj/pzad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE A comprehensive digitalized program is a novel way to improve access to pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). This study aims to determine if a home-based pulmonary rehabilitation program supported by mobile health (mHealth) technology is equivalent to center-based pulmonary rehabilitation in terms of improvements in exercise capacity and health status in people with COPD. METHODS This study is a prospective, multicenter, equivalence randomized controlled trial (RCT) with intention-to-treat analysis. A hundred participants with COPD will be recruited from 5 pulmonary rehabilitation programs. Following randomization, participants will be assigned in a concealed manner to receive either home-based pulmonary rehabilitation supported by mHealth or center-based pulmonary rehabilitation. Both programs will be 8 weeks and will include progressive exercise training, disease management education, self-management support, and supervision by a physical therapist. Co-primary outcome measures will be the 6-Minute Walk Test and the COPD Assessment Test. Secondary outcome measures will include the St George's Respiratory Questionnaire, the EuroQol 5 Dimension 5 Level, the modified Medical Research Council dyspnea scale, the 1-minute sit-to-stand test, the 5 times sit-to-stand test, the Hospital Anxiety and Depression Scale, daily physical activity levels, health care utilization, and costs. Outcomes will be measured at baseline and at the end of the intervention. Participant experience will be assessed through semistructured interviews at the end of the intervention. Utilization of health care and costs will also be measured again after 12 months. IMPACT This study will be the first rigorous RCT to examine the effects of a home-based pulmonary rehabilitation program supported by mHealth technology that includes comprehensive clinical outcome evaluation, assessment of daily physical activity, a health economic analysis, and qualitative analysis. If findings demonstrate that there is equivalence in clinical outcomes, that the mHealth program costs the least amount (and is thus cost-effective), and that the mHealth program is acceptable to participants, such programs should be widely implemented to improve access to pulmonary rehabilitation.
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Affiliation(s)
- Sally L Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marita T Dale
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer A Alison
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Allied Health, Sydney Local Health District, New South Wales, Australia
| | - Sarah Brown
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Physiotherapy, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
| | - Hannah Rutherford
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Directorate of Strategy, Innovation and Improvement, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew S L Chan
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marlien Varnfield
- Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Ian A Yang
- The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Michelle Cunich
- Boden Initiative, Charles Perkins Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Co-Lead, Implementation and Policy, Cardiovascular Initiative, The University of Sydney, Camperdown, NSW, Australia; Sydney Institute for Women, Children and their Families, Sydney Local Health District (SLHD); The ANZAC Research Institute, Concord Repatriation General Hospital, Concord, Australia; and Sydney Health Economics Collaborative, Sydney Local Health District, NSW, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- South West Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Zoe J McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Yang IA, Ferry OR, Clarke MS, Sim EH, Fong KM. Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2023; 3:CD002991. [PMID: 36971693 PMCID: PMC10042218 DOI: 10.1002/14651858.cd002991.pub4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND The role of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) has been the subject of much uncertainty. COPD clinical guidelines currently recommend selective use of ICS. ICS are not recommended as monotherapy for people with COPD, and are only given in combination with long-acting bronchodilators due to greater efficacy of combination therapy. Incorporating and critiquing newly published placebo-controlled trials into the monotherapy evidence base may help to resolve ongoing uncertainties and conflicting findings about their role in this population. OBJECTIVES To evaluate the benefits and harms of inhaled corticosteroids, used as monotherapy versus placebo, in people with stable COPD, in terms of objective and subjective outcomes. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was October 2022. SELECTION CRITERIA We included randomised trials comparing any dose of any type of ICS, given as monotherapy, with a placebo control in people with stable COPD. We excluded studies of less than 12 weeks' duration and studies of populations with known bronchial hyper-responsiveness (BHR) or bronchodilator reversibility. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our a priori primary outcomes were 1. exacerbations of COPD and 2. quality of life. Our secondary outcomes were 3. all-cause mortality, 4. lung function (rate of decline of forced expiratory volume in one second (FEV1)), 5. rescue bronchodilator use, 6. exercise capacity, 7. pneumonia and 8. adverse events including pneumonia. ]. We used GRADE to assess certainty of evidence. MAIN RESULTS Thirty-six primary studies with 23,139 participants met the inclusion criteria. Mean age ranged from 52 to 67 years, and females were 0% to 46% of participants. Studies recruited across the severities of COPD. Seventeen studies were of duration longer than three months and up to six months and 19 studies were of duration longer than six months. We judged the overall risk of bias as low. Long-term (more than six months) use of ICS as monotherapy reduced the mean rate of exacerbations in those studies where pooling of data was possible (generic inverse variance analysis: rate ratio 0.88 exacerbations per participant per year, 95% confidence interval (CI) 0.82 to 0.94; I2 = 48%, 5 studies, 10,097 participants; moderate-certainty evidence; pooled means analysis: mean difference (MD) -0.05 exacerbations per participant per year, 95% CI -0.07 to -0.02; I2 = 78%, 5 studies, 10,316 participants; moderate-certainty evidence). ICS slowed the rate of decline in quality of life, as measured by the St George's Respiratory Questionnaire (MD -1.22 units/year, 95% CI -1.83 to -0.60; I2 = 0%; 5 studies, 2507 participants; moderate-certainty evidence; minimal clinically importance difference 4 points). There was no evidence of a difference in all-cause mortality in people with COPD (odds ratio (OR) 0.94, 95% CI 0.84 to 1.07; I2 = 0%; 10 studies, 16,636 participants; moderate-certainty evidence). Long-term use of ICS reduced the rate of decline in FEV1 in people with COPD (generic inverse variance analysis: MD 6.31 mL/year benefit, 95% CI 1.76 to 10.85; I2 = 0%; 6 studies, 9829 participants; moderate-certainty evidence; pooled means analysis: 7.28 mL/year, 95% CI 3.21 to 11.35; I2 = 0%; 6 studies, 12,502 participants; moderate-certainty evidence). ADVERSE EVENTS in the long-term studies, the rate of pneumonia was increased in the ICS group, compared to placebo, in studies that reported pneumonia as an adverse event (OR 1.38, 95% CI 1.02 to 1.88; I2 = 55%; 9 studies, 14,831 participants; low-certainty evidence). There was an increased risk of oropharyngeal candidiasis (OR 2.66, 95% CI 1.91 to 3.68; 5547 participants) and hoarseness (OR 1.98, 95% CI 1.44 to 2.74; 3523 participants). The long-term studies that measured bone effects generally showed no major effect on fractures or bone mineral density over three years. We downgraded the certainty of evidence to moderate for imprecision and low for imprecision and inconsistency. AUTHORS' CONCLUSIONS This systematic review updates the evidence base for ICS monotherapy with newly published trials to aid the ongoing assessment of their role for people with COPD. Use of ICS alone for COPD likely results in a reduction of exacerbation rates of clinical relevance, probably results in a reduction in the rate of decline of FEV1 of uncertain clinical relevance and likely results in a small improvement in health-related quality of life not meeting the threshold for a minimally clinically important difference. These potential benefits should be weighed up against adverse events (likely to increase local oropharyngeal adverse effects and may increase the risk of pneumonia) and probably no reduction in mortality. Though not recommended as monotherapy, the probable benefits of ICS highlighted in this review support their continued consideration in combination with long-acting bronchodilators. Future research and evidence syntheses should be focused in that area.
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Affiliation(s)
- Ian A Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Olivia R Ferry
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Melissa S Clarke
- Redcliffe Hospital, Redcliffe, Australia
- North Lakes Health Precinct, North Lakes, Australia
- Caboolture Community and Oral Health, Caboolture, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Kwun M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. A cross-sectional analysis of long-term exposure to ambient air pollution and cognitive development in children aged 3-4 years living in 12 low- and middle-income countries. Environ Pollut 2023; 318:120916. [PMID: 36563987 DOI: 10.1016/j.envpol.2022.120916] [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] [Received: 04/19/2022] [Revised: 08/31/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Exposure to ambient air pollution may affect cognitive functioning and development in children. Unfortunately, there is little evidence available for low- and middle-income countries (LMICs), where air pollution levels are highest. We analysed the association between exposure to ambient fine particulate matter (≤2.5 μm [PM2.5]) and cognitive development indicators in a cross-sectional analysis of children (aged 3-4 years) in 12 LMICs. We linked Demographic and Health Survey data, conducted between 2011 and 2018, with global estimates of PM2.5 mass concentrations to examine annual average exposure to PM2.5 and cognitive development (literacy-numeracy and learning domains) in children. Cognitive development was assessed using the United Nations Children's Fund's early child development indicators administered to each child's mother. We used multivariable logistic regression models, adjusted for individual- and area-level covariates, and multi-pollutant models (including nitrogen dioxide and surface-level ozone). We assessed if sex and urban/rural status modified the association of PM2.5 with the outcome. We included 57,647 children, of whom, 9613 (13.3%) had indicators of cognitive delay. In the adjusted model, a 5 μg/m3 increase in annual all composition PM2.5 was associated with greater odds of cognitive delay (OR = 1.17; 95% CI: 1.13, 1.22). A 5 μg/m3 increase in anthropogenic PM2.5 was also associated with greater odds of cognitive delay (OR = 1.05; 95% CI: 1.00, 1.10). These results were robust to several sensitivity analyses, including multi-pollutant models. Interaction terms showed that urban-dwelling children had greater odds of cognitive delay than rural-dwelling children, while there was no significant difference by sex. Our findings suggest that annual average exposure to PM2.5 in young children was associated with adverse effects on cognitive development, which may have long-term consequences for educational attainment and health.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Arun Duggal Centre of Excellence for Research in Climate Change and Air Pollution, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
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14
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Lobb RJ, Visan KS, Wu LY, Norris EL, Hastie ML, Everitt S, Yang IA, Bowman RV, Siva S, Larsen JE, Gorman JJ, MacManus M, Leimgruber A, Fong KM, Möller A. An epithelial-to-mesenchymal transition induced extracellular vesicle prognostic signature in non-small cell lung cancer. Commun Biol 2023; 6:68. [PMID: 36653467 PMCID: PMC9849257 DOI: 10.1038/s42003-022-04350-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023] Open
Abstract
Despite significant therapeutic advances, lung cancer remains the leading cause of cancer-related death worldwide1. Non-small cell lung cancer (NSCLC) patients have a very poor overall five-year survival rate of only 10-20%. Currently, TNM staging is the gold standard for predicting overall survival and selecting optimal initial treatment options for NSCLC patients, including those with curable stages of disease. However, many patients with locoregionally-confined NSCLC relapse and die despite curative-intent interventions, indicating a need for intensified, individualised therapies. Epithelial-to-mesenchymal transition (EMT), the phenotypic depolarisation of epithelial cells to elongated, mesenchymal cells, is associated with metastatic and treatment-refractive cancer. We demonstrate here that EMT-induced protein changes in small extracellular vesicles are detectable in NSCLC patients and have prognostic significance. Overall, this work describes a novel prognostic biomarker signature that identifies potentially-curable NSCLC patients at risk of developing metastatic NSCLC, thereby enabling implementation of personalised treatment decisions.
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Affiliation(s)
- Richard J. Lobb
- grid.1049.c0000 0001 2294 1395Tumour Microenvironment Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD 4072 Australia
| | - Kekoolani S. Visan
- grid.1049.c0000 0001 2294 1395Tumour Microenvironment Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD 4072 Australia ,grid.10784.3a0000 0004 1937 0482Present Address: Department of Otorhinolaryngology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Li-Ying Wu
- grid.1049.c0000 0001 2294 1395Tumour Microenvironment Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia ,grid.1024.70000000089150953School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001 Australia
| | - Emma L. Norris
- grid.1049.c0000 0001 2294 1395Protein Discovery Centre, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia
| | - Marcus L. Hastie
- grid.1049.c0000 0001 2294 1395Protein Discovery Centre, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia
| | - Sarah Everitt
- grid.1055.10000000403978434Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia
| | - Ian A. Yang
- grid.1003.20000 0000 9320 7537UQ Thoracic Research Centre, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.415184.d0000 0004 0614 0266The Prince Charles Hospital, Brisbane, QLD 4032 Australia
| | - Rayleen V. Bowman
- grid.1003.20000 0000 9320 7537UQ Thoracic Research Centre, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.415184.d0000 0004 0614 0266The Prince Charles Hospital, Brisbane, QLD 4032 Australia
| | - Shankar Siva
- grid.1055.10000000403978434Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3000 Australia
| | - Jill E. Larsen
- grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD 4072 Australia ,grid.1049.c0000 0001 2294 1395Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia
| | - Jeffrey J. Gorman
- grid.1049.c0000 0001 2294 1395Protein Discovery Centre, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia
| | - Michael MacManus
- grid.1055.10000000403978434Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3000 Australia
| | | | - Kwun M. Fong
- grid.1003.20000 0000 9320 7537UQ Thoracic Research Centre, The University of Queensland, Brisbane, QLD 4072 Australia ,grid.415184.d0000 0004 0614 0266The Prince Charles Hospital, Brisbane, QLD 4032 Australia
| | - Andreas Möller
- grid.1049.c0000 0001 2294 1395Tumour Microenvironment Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD 4006 Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD 4072 Australia ,grid.1024.70000000089150953School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001 Australia ,grid.10784.3a0000 0004 1937 0482Present Address: Department of Otorhinolaryngology, Chinese University of Hong Kong, Shatin, Hong Kong
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15
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Sneath E, Tippett V, Bowman RV, Fong KM, Hazell W, Masel PJ, Bunting D, Watt K, Yang IA. The clinical journey of patients with a severe exacerbation of chronic obstructive pulmonary disease (COPD): from the ambulance to the emergency department to the hospital ward. J Thorac Dis 2022; 14:4601-4613. [PMID: 36647501 PMCID: PMC9840047 DOI: 10.21037/jtd-22-328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022]
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) are acute complications that often require emergency management by ambulance, emergency department (ED) and hospital services. Given the high mortality and morbidity of exacerbations, better understanding of the epidemiology of patients with COPD presenting to EDs is needed, as well as identification of predictive factors for adverse outcomes from exacerbations. Methods This retrospective observational study involved patients who presented to an ED in the state of Queensland and received either an ED or hospital diagnosis of COPD in 2015 and 2016. Administrative data from ambulance, ED, hospital and death registry databases were linked to provide a comprehensive picture of the emergency healthcare pathway for these patients. Results A total of 16,166 patients (49% female, 51% male) had 29,332 presentations to an ED in Queensland and received either an ED or hospital principal diagnosis of COPD during 2015 and 2016. These patients had a significant comorbidity burden with 54% having two or more comorbidities. Sixty-nine percent of ED presentations involved ambulance transport, and most of these (74%) involved administration of oxygen therapy and/or other medications by paramedics. Prehospital oxygen administration and ≥10 comorbidities were associated with >1 admission [odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1-1.5; OR 4.3, 95% CI: 3.1-5.8, respectively], greater than average lengths of stay (OR 1.5, 95% CI: 1.3-1.6; OR 22.1, 95% CI: 18.1-27.2) and mortality (OR 1.6, 95% CI: 1.5-1.8; OR 5.3, 95% CI: 4.2-6.8). Of the ambulance presentations, 90% were admitted or received ongoing care. Conclusions COPD places considerable burden on the emergency healthcare pathway including ambulances and EDs in Queensland. Patients with COPD most commonly present to the ED by ambulance and receive extensive pre-hospital management. These patients have significant comorbidity burden and experience high rates of admission and mortality. More research is required to investigate the emergency pathway to further identify reversible factors and enhance healthcare practice and policy for COPD management.
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Affiliation(s)
- Emily Sneath
- Faculty of Medicine, The University of Queensland, Queensland, Australia;,Department of Emergency Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Vivienne Tippett
- School of Clinical Sciences, Queensland University of Technology, Queensland, Australia
| | - Rayleen V. Bowman
- Faculty of Medicine, The University of Queensland, Queensland, Australia;,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Kwun M. Fong
- Faculty of Medicine, The University of Queensland, Queensland, Australia;,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Wayne Hazell
- Faculty of Medicine, The University of Queensland, Queensland, Australia;,Department of Emergency Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Philip J. Masel
- Faculty of Medicine, The University of Queensland, Queensland, Australia;,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Denise Bunting
- Information Support, Research & Evaluation, Queensland Ambulance Service, Queensland, Australia
| | - Kerrianne Watt
- Information Support, Research & Evaluation, Queensland Ambulance Service, Queensland, Australia
| | - Ian A. Yang
- Faculty of Medicine, The University of Queensland, Queensland, Australia;,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland, Australia
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16
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Marshall HM, Vemula M, Hay K, McCaul E, Passmore L, Yang IA, Bowman RV, Fong KM. Active screening for lung cancer increases smoking abstinence in Australia. Asia Pac J Clin Oncol 2022; 19:374-384. [DOI: 10.1111/ajco.13879] [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: 09/16/2021] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Henry M. Marshall
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Mounavi Vemula
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute HerstonQueenslandAustralia
| | - Elizabeth McCaul
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Linda Passmore
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Ian A. Yang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Rayleen V. Bowman
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Kwun M. Fong
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
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17
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Ahmed SM, Mishra GD, Moss KM, Mouly TA, Yang IA, Knibbs LD. Association between residential greenspace and health-related quality of life in children aged 0-12 years. Environ Res 2022; 214:113759. [PMID: 35753375 DOI: 10.1016/j.envres.2022.113759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Greenspaces generate several perceived health benefits, including an overall improvement in the quality of life. However, little is known about the effects of greenspaces through pregnancy and early childhood in promoting health-related quality of life (HRQoL) among children. METHOD Participants were from the Mothers and their Children's Health Study (MatCH), a 2016/17 sub-study of a national prospective study since 1996 known as the Australian Longitudinal Study on Women's Health (ALSWH). Mothers (n=3,048) self-reported on their three youngest children aged under 13 years (n=5,799, mean=7.0 years, s.d=3.2 years) using the Pediatric Quality of Life Inventory (PedsQL) to measure their HRQoL. Since 1996, annual exposure to green and non-green vegetation was measured using two remote sensing indicators: Normalized Difference Vegetation Index (NDVI) and fractional cover of non-photosynthetic vegetation (fNPV), respectively, for 100 m and 500 m buffer zone around maternal residential address. Multiple exposure windows were calculated including during pregnancy, the first year of life and child's lifetime exposure. Generalised estimating equations (GEE) models, adjusting for potential confounders, were used for analyses. RESULTS A 1 standard deviation increase in NDVI greenness within 500 m buffer around the home at early life and during childhood was positively associated with higher HRQoL in the total scores and psychological health summary scores in the crude model only. No association was found between fNPV (non-green vegetation) at 100 m and 500 m circular buffers and children's HRQoL. The overall findings from our models remained consistent based on a series of sensitivity analyses, including the impact of maternal residential mobility status and geocoding method on the effect estimates. CONCLUSION Our study revealed that surrounding residential greenspace was not associated with children's HRQoL. Further longitudinal studies are required to better understand the influence of greenspace at different periods of exposure on the health and wellbeing of children.
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Affiliation(s)
- Salma M Ahmed
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Katrina M Moss
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Tafzila A Mouly
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, New South Wales, Australia; Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
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18
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O’Farrell HE, Bowman RV, Fong KM, Yang IA. Plasma Extracellular Vesicle miRNA Profiles Distinguish Chronic Obstructive Pulmonary Disease Exacerbations and Disease Severity. Int J Chron Obstruct Pulmon Dis 2022; 17:2821-2833. [PMID: 36381992 PMCID: PMC9642085 DOI: 10.2147/copd.s379774] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Molecular biomarkers for chronic obstructive pulmonary disease (COPD) severity have been difficult to identify. We aimed to assess extracellular vesicle miRNAs’ potential as a blood biomarker in discriminating disease severity in participants with COPD. Patients and Methods Plasma extracellular vesicles (EVs) were obtained from two COPD cohorts (n = 20 during an exacerbation event, n = 20 during stable state), with varying disease severity (GOLD stages). The miRCURY LNA miRNA Serum/Plasma assay, specific to 179 targets, was used to evaluate EV miRNA expression. The miRNAs that were significantly dysregulated were further assessed for discriminatory power using ROC curve analysis, as well as their role in relevant biological pathways. Results One miRNA was significantly dysregulated between moderate GOLD participants compared to severe/very severe GOLD participants, with an AUC of 0.798, p = 0.01 for miR-374b-5p. Five miRNAs were significantly dysregulated between exacerbating and stable COPD participants, with miR-223-3p resulting in the highest AUC (0.755, p = 0.006) for a single miRNA, with a combination of three miRNAs (miR-92b-3p, miR-374a-5p and miR-106b-3p) providing the highest discriminatory power (AUC 0.820, p = 0.001). The “cytokine–cytokine receptor interaction” (hsa04060 pathway) was the most significant KEGG pathway enriched for three out of the five miRNAs associated with COPD exacerbations. Conclusion This initial small-scale study suggests that the bioactive cargo (miRNAs) in plasma EVs holds specific biological information for the severity of airflow obstruction and COPD exacerbations, warranting further investigation.
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Affiliation(s)
- Hannah E O’Farrell
- Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
- Correspondence: Hannah E O’Farrell, Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia, Tel +61 07 3139 4110, Email
| | - Rayleen V Bowman
- Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
| | - Kwun M Fong
- Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
| | - Ian A Yang
- Faculty of Medicine, the University of Queensland, Brisbane, QLD, Australia
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19
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Dabscheck E, George J, Hermann K, McDonald CF, McDonald VM, McNamara R, O’Brien M, Smith B, Zwar NA, Yang IA. COPD‐X
Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update. Med J Aust 2022; 217:415-423. [DOI: 10.5694/mja2.51708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Johnson George
- Centre for Medicine Use and Safety Monash University Melbourne VIC
| | | | | | | | - Renae McNamara
- Prince of Wales Hospital and Community Health Services Sydney NSW
| | | | | | | | - Ian A Yang
- University of Queensland Brisbane QLD
- Prince Charles Hospital Brisbane QLD
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20
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Olive GN, Yang IA, Marshall H, Bowman RV, Fong KM. More than meets the eye. Eur Respir J 2022; 60:60/3/2200763. [PMID: 36109046 DOI: 10.1183/13993003.00763-2022] [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: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Gerard N Olive
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A Yang
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Henry Marshall
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Rayleen V Bowman
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kwun M Fong
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia .,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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21
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Ahmed SM, Knibbs LD, Moss KM, Mouly TA, Yang IA, Mishra GD. Residential greenspace and early childhood development and academic performance: A longitudinal analysis of Australian children aged 4-12 years. Sci Total Environ 2022; 833:155214. [PMID: 35421455 DOI: 10.1016/j.scitotenv.2022.155214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Exposure to greenspaces has beneficial effects on children's mental health and development. This study explores the association between residential exposure to greenspace and early childhood development and academic outcomes. METHODS Children were from Mothers and their Children's Health (MatCH) study, a sub-study of the Australian Longitudinal Study on Women's Health. We obtained data on early childhood development from the Australian Early Development Census (AEDC), a population-wide census data (n = 936 children, mean age: 5.3, SD: 0.5 years). Academic performance relative to the national minimum standard (NMS) (i.e., in reading, writing, grammar and punctuation, spelling, and numeracy) of children with Year 3 and 5 data were from the 'National Assessment Program - Literacy and Numeracy' (NAPLAN) (n = 1679 children). Annual exposure to green and non-green vegetation was measured using the Normalized Difference Vegetation Index (NDVI) and fractional cover of non-photosynthetic vegetation (fNPV), respectively, within 100 m and 500 m buffer zone of maternal residential address. We calculated greenspace exposure at the year of test and average exposure throughout childhood. Greenspace exposures were standardised and odds ratio (ORs) with 95% confidence intervals (95% CI) were estimated using generalised estimating equation models, adjusting for potential confounders. RESULTS Exposure to fNPV within 500 m buffer of homes at the year of test and during child's lifetime was associated with academic scores below/at NMS at Year 3 (baseline) and Year 5 (follow-up) for the domains of reading, writing, and grammar and punctuation. Surrounding residential greenness was not significantly associated with NAPLAN scores. No association was found between residential greenspace and developmental vulnerability on one or more AEDC domains across both exposure windows. CONCLUSION Our study revealed that long-term and short-term exposure to non-green vegetation around homes is linked to poor academic performance in children. Further research on fNPV is required to verify these findings, with additional longitudinal studies.
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Affiliation(s)
- Salma M Ahmed
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, New South Wales, Australia; Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Katrina M Moss
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Tafzila A Mouly
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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22
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Ngo L, Woodman R, Denman R, Walters TE, Yang IA, Ranasinghe I. Longitudinal risk of death, hospitalizations for atrial fibrillation, and cardiovascular events following catheter ablation of atrial fibrillation: a cohort study. Eur Heart J Qual Care Clin Outcomes 2022; 9:150-160. [PMID: 35700131 PMCID: PMC9972809 DOI: 10.1093/ehjqcco/qcac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022]
Abstract
AIMS Population studies reporting contemporary long-term outcomes following catheter ablation of atrial fibrillation (AF) are sparse.We evaluated long-term clinical outcomes following AF ablation and examined variation in outcomes by age, sex, and the presence of heart failure. METHODS AND RESULTS We identified 30 601 unique patients (mean age 62.7 ± 11.8 years, 30.0% female) undergoing AF ablation from 2008 to 2017 in Australia and New Zealand using nationwide hospitalization data. The primary outcomes were all-cause mortality and rehospitalizations for AF or flutter, repeat AF ablation, and cardioversion. Secondary outcomes were rehospitalizations for other cardiovascular events. During 124 858.7 person-years of follow-up, 1900 patients died (incidence rate 1.5/100 person-years) with a survival probability of 93.0% (95% confidence interval (CI) 92.6-93.4%) by 5 years and 84.0% (95% CI 82.4-85.5%) by 10 years. Rehospitalizations for AF or flutter (13.3/100 person-years), repeat ablation (5.9/100 person-years), and cardioversion (4.5/100 person-years) were common, with respective cumulative incidence of 49.4% (95% CI 48.4-50.4%), 28.1% (95% CI 27.2-29.0%), and 24.4% (95% CI 21.5-27.5%) at 10 years post-ablation. Rehospitalizations for stroke (0.7/100 person-years), heart failure (1.1/100 person-years), acute myocardial infarction (0.4/100 person-years), syncope (0.6/100 person-years), other arrhythmias (2.5/100 person-years), and new cardiac device implantation (2.0/100 person-years) occurred less frequently. Elderly patients and those with comorbid heart failure had worse survival but were less likely to undergo repeat ablation, while long-term outcomes were comparable between the sexes. CONCLUSION Patients undergoing AF ablations had good long-term survival, a low incidence of rehospitalizations for stroke or heart failure, and about half remained free of rehospitalizations for AF or flutter, including for repeat AF ablation, or cardioversion.
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Affiliation(s)
- Linh Ngo
- Corresponding author. Tel: +61 731396958,
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Bedford Park, 5042, SA, Australia
| | - Russell Denman
- Department of Cardiology, The Prince Charles Hospital, Chermside, 4032, QLD, Australia
| | - Tomos E Walters
- Cardiology, St Vincent's Private Hospital Northside, Chermside, 4032, QLD, Australia
| | - Ian A Yang
- Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Northside Clinical Unit, The Prince Charles Hospital, Chermside, 4032, QLD, Australia,Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, 4032, QLD, Australia
| | - Isuru Ranasinghe
- Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Northside Clinical Unit, The Prince Charles Hospital, Chermside, 4032, QLD, Australia,Department of Cardiology, The Prince Charles Hospital, Chermside, 4032, QLD, Australia
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Yang IA, Jenkins CR, Salvi SS. Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment. Lancet Respir Med 2022; 10:497-511. [PMID: 35427530 DOI: 10.1016/s2213-2600(21)00506-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) was traditionally thought to be caused by tobacco smoking. However, recognition of the importance of non-smoking-related risk factors for COPD has increased over the past decade, with evidence on the burden, risk factors, and clinical presentations of COPD in never-smokers. About half of all COPD cases worldwide are due to non-tobacco-related risk factors, which vary by geographical region. These factors include air pollution, occupational exposures, poorly controlled asthma, environmental tobacco smoke, infectious diseases, and low socioeconomic status. Impaired lung growth during childhood, caused by a range of early-life exposures, is associated with an increased risk of COPD. Potential mechanisms for the pathogenesis of COPD in never-smokers include inflammation, oxidative stress, airway remodelling, and accelerated lung ageing. Compared with smokers who develop COPD, never-smokers with COPD have relatively mild chronic respiratory symptoms, little or no emphysema, milder airflow limitation, and fewer comorbidities; however, exacerbations can still be frequent. Further research-including epidemiological, translational, clinical, and implementation studies-is needed to address gaps in understanding and to advance potential solutions to reduce the burden of COPD in never-smokers.
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Affiliation(s)
- Ian A Yang
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Health, Brisbane, QLD, Australia.
| | - Christine R Jenkins
- Respiratory Group, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Thoracic Medicine, Concord General Hospital, Sydney, NSW, Australia; Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Sundeep S Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, Maharashtra, India; Faculty of Health Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India
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24
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Issac H, Keijzers G, Yang IA, Lea J, Taylor M, Moloney C. Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study. Int J Chron Obstruct Pulmon Dis 2022; 17:1089-1106. [PMID: 35573657 PMCID: PMC9091474 DOI: 10.2147/copd.s358254] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
- Correspondence: Hancy Issac, School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia, Email
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Ian A Yang
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
- College of Health and Biomedicine, Nursing and Midwifery, Victoria University, Melbourne, VIC, Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. Ambient air pollution and acute respiratory infection in children aged under 5 years living in 35 developing countries. Environ Int 2022; 159:107019. [PMID: 34875446 DOI: 10.1016/j.envint.2021.107019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 09/14/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evidence from developed countries suggests that fine particulate matter (≤2.5 µm [PM2.5]) contributes to childhood respiratory morbidity and mortality. However, few analyses have focused on resource-limited settings, where much of this burden occurs. We aimed to investigate the cross-sectional associations between annual average exposure to ambient PM2.5 and acute respiratory infection (ARI) in children aged <5 years living in low- and middle-income countries (LMICs). METHODS We combined Demographic and Health Survey (DHS) data from 35 countries with gridded global estimates of annual PM2.5 mass concentrations. We analysed the association between PM2.5 and maternal-reported ARI in the two weeks preceding the survey among children aged <5 years living in 35 LMICs. We used multivariable logistic regression models that adjusted for child, maternal, household and cluster-level factors. We also fitted multi-pollutant models (adjusted for nitrogen dioxide [NO2] and surface-level ozone [O3]), among other sensitivity analyses. We assessed whether the associations between PM2.5 and ARI were modified by sex, age and place of residence. RESULTS The analysis comprised 573,950 children, among whom the prevalence of ARI was 22,506 (3.92%). The mean (±SD) estimated annual concentration of PM2.5 to which children were exposed was 48.2 (±31.0) µg/m3. The 5th and 95th percentiles of PM2.5 were 9.8 µg/m3 and 110.9 µg/m3, respectively. A 10 µg/m3 increase in PM2.5 was associated with greater odds of having an ARI (OR: 1.06; 95% CI: 1.05-1.07). The association between PM2.5 and ARI was robust to adjustment for NO2 and O3. We observed evidence of effect modification by sex, age and place of residence, suggesting greater effects of PM2.5 on ARI in boys, in younger children, and in children living in rural areas. CONCLUSIONS Annual average ambient PM2.5, as an indicator for long-term exposure, was associated with greater odds of maternal-reported ARI in children aged <5 years living in 35 LMICs. Longitudinal studies in LMICs are required to corroborate our cross-sectional findings, to further elucidate the extent to which lowering PM2.5 may have a role in the global challenge of reducing ARI-related morbidity and mortality in children.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Centre of Excellence for Research on Clean Air, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Corvallis, OR, USA
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
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26
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Ahmed SM, Mishra GD, Moss KM, Yang IA, Lycett K, Knibbs LD. Maternal and Childhood Ambient Air Pollution Exposure and Mental Health Symptoms and Psychomotor Development in Children: An Australian Population-Based Longitudinal Study. Environ Int 2022; 158:107003. [PMID: 34991263 DOI: 10.1016/j.envint.2021.107003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 07/19/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Accumulating evidence indicates early life exposure to air pollution, a suspected neurotoxicant, is negatively associated with children's neurodevelopment. OBJECTIVES To explore the role of multiple exposure periods to ambient particulate matter with diameter <2.5 μm (PM2.5) and nitrogen dioxide (NO2) on emotion and behaviour, and early development in children <13 years. METHODS We used data from Mothers and their Children's Health (MatCH) study, a 2016/17 sub-study from a prospective longitudinal study, the Australian Longitudinal Study on Women's Health. Annual PM2.5 and NO2 estimates since 1996 were obtained from a land-use regression model. Maternal residential proximity to roadways were used as a proxy measure of exposure to traffic-related air pollution. Child outcomes were maternal-rated emotional and behavioural problems (Strengths and Difficulties Questionnaire; SDQ, aged 2-12 years, n = 5471 children) and developmental delay in communication and gross motor skills (Ages and Stages Questionnaire; ASQ, aged 1-66 months, n = 1265 children). Defined exposure periods were early life exposure ('during pregnancy' and 'first year of life') and 'children's lifetime exposure'. Ambient air pollution was divided into tertiles and logistic regression was performed to estimate odds ratio (OR) for each child outcome, adjusting for potential confounders. RESULTS Children exposed to moderate and high PM2.5 exposure, compared to low exposure, across all periods, had higher odds of emotional and behavioural problems, and gross motor delay. Children's lifetime exposure to moderate levels of PM2.5 (5.9-7.1 µg/m3) was associated with 1.27 (95% confidence interval 1.03, 1.57) fold higher odds of emotional/behavioural problems. Similar associations were found for moderate PM2.5 levels at 'first year of life' in a two-pollutant model only (OR: 1.30; 1.05, 1.60). However, there was insufficient evidence to suggest that NO2 exposure or living within 200 m of major roads was associated with emotional and behaviour problems or developmental delay across any exposure periods. CONCLUSION We found isolated evidence that early life and childhood exposure to PM2.5 may be associated with emotional and behavioural problems and delays in gross motor skills, but most associations were null. Due to the limited number of longitudinal studies on low-exposure settings, further studies with more temporally refined exposure assessment are warranted.
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Affiliation(s)
- Salma M Ahmed
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Katrina M Moss
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, and Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland Australia
| | - Kate Lycett
- Centre for Social & Early Emotional Development, School of Psychology, Deakin University, Burwood, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, New South Wales, Australia
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27
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Yang IA, McDonald CF, Francis JJ. Behaviour change: The key to implementing evidence on COPD prevention, diagnosis and management. Respirology 2021; 26:1021-1023. [PMID: 34595794 DOI: 10.1111/resp.14160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Ian A Yang
- The Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine F McDonald
- Austin Hospital, Institute for Breathing and Sleep, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jill J Francis
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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28
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O'Farrell HE, Brown R, Brown Z, Milijevic B, Ristovski ZD, Bowman RV, Fong KM, Vaughan A, Yang IA. E-cigarettes induce toxicity comparable to tobacco cigarettes in airway epithelium from patients with COPD. Toxicol In Vitro 2021; 75:105204. [PMID: 34186184 DOI: 10.1016/j.tiv.2021.105204] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The health effects of e-cigarettes in patients with pre-existing lung disease are unknown. The aim of this study was to investigate whether aerosols from a fourth-generation e-cigarette produces similar in-vitro cytotoxic, DNA damage and inflammatory effects on bronchial epithelial cells (BECs) from patients with COPD, as cigarette smoke. METHODS BECs from patients with COPD who underwent surgery for lung cancer and comparator (immortalised 16HBE) cells were grown at air liquid interface (ALI). BECs were exposed to aerosols from a JUUL® e-cigarette (Virginia Tobacco and Menthol pods at 5% nicotine strength) or reference 3R4F cigarette for 30 min at ALI. Cell cytotoxicity, DNA damage and inflammation were measured. RESULTS In response to the Virginia Tobacco and Menthol flavoured e-cigarette aerosols, COPD BECs showed comparable LDH release (cell cytotoxicity, p = 0.59, p = 0.67 respectively), DNA damage (p = 0.41, p = 0.51) and inflammation (IL-8, p = 0.20, p = 0.89 and IL-6, p = 0.24, p = 0.93), to cigarette smoke. 16HBE cells also showed comparable cellular responses to cigarette smoke. CONCLUSION In airway cells from patients with COPD, aerosols from a fourth-generation e-cigarette were associated with similar toxicity to cigarette smoke. These results have potential implications for the safety of e-cigarette use in patients with lung disease.
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Affiliation(s)
- Hannah E O'Farrell
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Reece Brown
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zac Brown
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Branka Milijevic
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zoran D Ristovski
- ILAQH, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rayleen V Bowman
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Annalicia Vaughan
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ian A Yang
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
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Martin A, Hancox RJ, Chang CL, Beasley R, Wrobel J, McDonald V, Dobler CC, Yang IA, Farah CS, Cochrane B, Hillis GS, Scowcroft CP, Aggarwal A, Di Tanna GL, Balicki G, Galgey S, Jenkins C. Preventing adverse cardiac events (PACE) in chronic obstructive pulmonary disease (COPD): study protocol for a double-blind, placebo controlled, randomised controlled trial of bisoprolol in COPD. BMJ Open 2021; 11:e053446. [PMID: 34452971 PMCID: PMC8404458 DOI: 10.1136/bmjopen-2021-053446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Heart disease in chronic obstructive pulmonary disease (COPD) is a common but neglected comorbidity. Patients with COPD are frequently excluded from clinical trials of treatments aimed at reducing cardiac morbidity and mortality, which has led to undertreatment of cardiovascular disease in patients with COPD. A particular concern in COPD is the underuse of beta (β)-blockers. There is observational evidence that cardioselective β-blockers are safe and may even reduce mortality risk in COPD, although some evidence is conflicting. There is an urgent need to answer the research question: Are cardioselective β-blockers safe and of benefit in people with moderately severe COPD? The proposed study will investigate whether cardioselective β-blocker treatment in patients with COPD reduces mortality and cardiac and respiratory morbidity. METHODS AND ANALYSES This is a double-blind, randomised controlled trial to be conducted in approximately 26 sites in Australia, New Zealand, India, Sri Lanka and other countries as required. Participants with COPD will be randomised to either bisoprolol once daily (range 1.25-5 mg, dependent on tolerated dose) or matched placebo, in addition to receiving usual care for their COPD over the study duration of 24 months.The study will enrol 1164 participants with moderate to severe COPD, aged 40-85 years. Participants will be symptomatic from their COPD and have a postbronchodilator forced expiratory volume in 1 s (FEV1) ≥30% and ≤70% predicted and a history of at least one exacerbation requiring systemic corticosteroids, antibiotics or both in the prior 24 months. ETHICS AND DISSEMINATION The study protocol has been approved by the Sydney Local Health District Human Research Ethics Committee at The Concord Repatriation General Hospital. TRIAL REGISTRATION NUMBERS NCT03917914; CTRI/2020/08/027322.
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Affiliation(s)
- Allison Martin
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Jeremy Wrobel
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Vanessa McDonald
- University of Newcastle, Callaghan, New South Wales, Australia
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Claudia C Dobler
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ian A Yang
- The Prince Charles Hospital, Chermside, Queensland, Australia
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Claude S Farah
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Belinda Cochrane
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
- Western Sydney University, Penrith, NSW, Australia
| | - Graham S Hillis
- Royal Perth Hospital, Perth, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | | | - Ashutosh Aggarwal
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Balicki
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Shane Galgey
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Christine Jenkins
- The George Institute for Global Health, Newtown, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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30
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McInerney-Leo AM, Chew HY, Inglis PL, Leo PJ, Joseph SR, Cooper CL, Okano S, Hassall T, Anderson L, Bowman RV, Gattas M, Harris JE, Marshall MS, Shaw JG, Wheeler L, Yang IA, Brown MA, Fong KM, Simpson F, Duncan EL. Germline ERBB3 mutation in familial non-small cell lung carcinoma: Expanding ErbB's role in oncogenesis. Hum Mol Genet 2021; 30:2393-2401. [PMID: 34274969 PMCID: PMC8643496 DOI: 10.1093/hmg/ddab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/12/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Lung cancer is the commonest cause of cancer deaths worldwide. Although strongly associated with smoking, predisposition to lung cancer is also heritable, with multiple common risk variants identified. Rarely, dominantly inherited non-small-cell lung cancer (NSCLC) has been reported due to somatic mutations in EGFR/ErbB1 and ERBB2. Germline exome sequencing was performed in a multi-generation family with autosomal dominant NSCLC, including an affected child. Tumour samples were also sequenced. Full-length wild-type (wtErbB3) and mutant ERBB3 (mutErbB3) constructs were transfected into HeLa cells. Protein expression, stability, and subcellular localization were assessed, and cellular proliferation, pAkt/Akt and pERK levels determined. A novel germline variant in ERBB3 (c.1946 T > G: p.Iso649Arg), coding for receptor tyrosine-protein kinase erbB-3 (ErbB3), was identified, with appropriate segregation. There was no loss-of-heterozygosity in tumour samples. Both wtErbB3 and mutErbB3 were stably expressed. MutErbB3-transfected cells demonstrated an increased ratio of the 80 kDa form (which enhances proliferation) compared with the full-length (180 kDa) form. MutErbB3 and wtErbB3 had similar punctate cytoplasmic localization pre- and post-epidermal growth factor stimulation; however, epidermal growth factor receptor (EGFR) levels decreased faster post-stimulation in mutErbB3-transfected cells, suggesting more rapid processing of the mutErbB3/EGFR heterodimer. Cellular proliferation was increased in mutErbB3-transfected cells compared with wtErbB3 transfection. MutErbB3-transfected cells also showed decreased pAkt/tAkt ratios and increased pERK/tERK 30 min post-stimulation compared with wtErbB3 transfection, demonstrating altered signalling pathway activation. Cumulatively, these results support this mutation as tumorogenic. This is the first reported family with a germline ERBB3 mutation causing heritable NSCLC, furthering understanding of the ErbB family pathway in oncogenesis.
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Affiliation(s)
- Aideen M McInerney-Leo
- The Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102
| | - Hui Yi Chew
- The Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102
| | - Po-Ling Inglis
- Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029
| | - Paul J Leo
- Australian Translational Genomics Centre, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102
| | - Shannon R Joseph
- The Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102
| | - Caroline L Cooper
- Department of Anatomical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane.,UQTRC, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006
| | - Satomi Okano
- The Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102
| | - Tim Hassall
- Queensland Children's Hospital, South Brisbane, QLD, 4101
| | - Lisa Anderson
- Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029
| | - Rayleen V Bowman
- UQTRC, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006.,Department of Thoracic Medicine, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032
| | - Michael Gattas
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4029
| | - Jessica E Harris
- Australian Translational Genomics Centre, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102
| | - Mhairi S Marshall
- Australian Translational Genomics Centre, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102
| | - Janet G Shaw
- UQTRC, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006.,Department of Thoracic Medicine, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032
| | - Lawrie Wheeler
- Australian Translational Genomics Centre, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102
| | - Ian A Yang
- UQTRC, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006.,Department of Thoracic Medicine, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032
| | - Matthew A Brown
- Australian Translational Genomics Centre, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102.,Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's College London NIHR Biomedical Research Centre, King's College London, United Kingdom
| | - Kwun M Fong
- UQTRC, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006.,Department of Thoracic Medicine, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032
| | - Fiona Simpson
- The Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102
| | - Emma L Duncan
- Australian Translational Genomics Centre, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT), Translational Research Institute, 37 Kent St, Woolloongabba, QLD, 4102.,UQTRC, Faculty of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006.,Department of Twin Research and Genetic Epidemiology, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
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Niessen NM, Gibson PG, Baines KJ, Barker D, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, Jenkins C, Peters MJ, Marks GB, Baraket M, Simpson JL, Fricker M. Sputum TNF markers are increased in neutrophilic and severe asthma and are reduced by azithromycin treatment. Allergy 2021; 76:2090-2101. [PMID: 33569770 DOI: 10.1111/all.14768] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The AMAZES randomized controlled trial demonstrated that long-term low-dose azithromycin treatment reduces exacerbations of poorly controlled asthma, but the therapeutic mechanisms remain unclear. Dysregulation of the inflammatory tumour necrosis factor (TNF) pathway is implicated in asthma and could be suppressed by azithromycin. We aimed to determine the inflammatory and clinical associations of soluble TNF signalling proteins (TNF receptors [TNFR] 1 and 2, TNF) in sputum and serum, and to test the effect of 48 weeks of azithromycin vs placebo on TNF markers. METHODS Sputum supernatant and serum TNFR1, TNFR2 (n = 142; 75 azithromycin-treated, 67 placebo-treated) and TNF (n = 48; 22 azithromycin-treated, 26 placebo-treated) were measured by ELISA in an AMAZES trial sub-population at baseline and end of treatment. Baseline levels were compared between sputum inflammatory phenotypes, severe/non-severe asthma and frequent/non-frequent exacerbators. Effect of azithromycin on markers was tested using linear mixed models. RESULTS Baseline sputum TNFR1 and TNFR2 were significantly increased in neutrophilic vs non-neutrophilic asthma phenotypes, while serum markers did not differ. Sputum TNFR1 and TNFR2 were increased in severe asthma and correlated with poorer lung function, worse asthma control and increasing age. Serum TNFR1 was also increased in severe asthma. Sputum and serum TNFR2 were increased in frequent exacerbators. Azithromycin treatment significantly reduced sputum TNFR2 and TNF relative to placebo, specifically in non-eosinophilic participants. CONCLUSIONS We demonstrate dysregulation of TNF markers, particularly in the airways, that relates to clinically important phenotypes of asthma including neutrophilic and severe asthma. Suppression of dysregulated TNF signalling by azithromycin could contribute to its therapeutic mechanism.
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Affiliation(s)
- Natalie M. Niessen
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- National Health and Medical Research Council Centre for Excellence in Severe Asthma Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
| | - Peter G. Gibson
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- National Health and Medical Research Council Centre for Excellence in Severe Asthma Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
- Department of Respiratory and Sleep Medicine John Hunter Hospital Newcastle NSW Australia
| | - Katherine J. Baines
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
| | - Daniel Barker
- Hunter Medical Research Institute Newcastle NSW Australia
| | - Ian A. Yang
- Faculty of Medicine Department of Thoracic Medicine The Prince Charles Hospital The University of Queensland Brisbane Qld Australia
| | - John W. Upham
- Diamantina Institute The University of Queensland Brisbane Qld Australia
- Department of Respiratory Medicine Princess Alexandra Hospital Brisbane Qld Australia
| | - Paul N. Reynolds
- Department of Thoracic Medicine Royal Adelaide Hospital Adelaide SA Australia
- Lung Research Laboratory Hanson Institute Adelaide SA Australia
- School of Medicine University of Adelaide Adelaide SA Australia
| | - Sandra Hodge
- Department of Thoracic Medicine Royal Adelaide Hospital Adelaide SA Australia
- Lung Research Laboratory Hanson Institute Adelaide SA Australia
- School of Medicine University of Adelaide Adelaide SA Australia
| | - Alan L. James
- Department of Pulmonary Physiology and Sleep Medicine Sir Charles Gairdner Hospital Perth WA Australia
- Medical School The University of Western Australia Perth WA Australia
| | - Christine Jenkins
- Respiratory Trials The George Institute for Global Health Sydney NSW Australia
- Department of Thoracic Medicine Concord General Hospital Sydney NSW Australia
| | - Matthew J. Peters
- Department of Thoracic Medicine Concord General Hospital Sydney NSW Australia
- Faculty of Medicine and Health Sciences Macquarie University Sydney NSW Australia
| | - Guy B. Marks
- Woolcock Institute of Medical Research Sydney NSW Australia
- South Western Sydney Clinical School University of New South Wales Sydney NSW Australia
| | - Melissa Baraket
- Medicine Faculty Respiratory Medicine Department and Ingham Institute Liverpool Hospital University of New South Wales Sydney NSW Australia
| | - Jodie L. Simpson
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
- Department of Respiratory and Sleep Medicine John Hunter Hospital Newcastle NSW Australia
| | - Michael Fricker
- Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs School of Medicine and Public Health The University of Newcastle Newcastle NSW Australia
- National Health and Medical Research Council Centre for Excellence in Severe Asthma Newcastle NSW Australia
- Hunter Medical Research Institute Newcastle NSW Australia
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32
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Parris BA, Leong S, Marshall H, Yang IA, Bowman RV, Fong KM. Postoperative adjuvant EGFR-TKIs for resected EGFR-mutant NSCLC-opportunities and obstacles. Ann Transl Med 2021; 9:586. [PMID: 33987284 PMCID: PMC8105855 DOI: 10.21037/atm-2020-133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/22/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Brielle A. Parris
- University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Brisbane, Australia
| | - Steven Leong
- University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Henry Marshall
- University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Ian A. Yang
- University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Rayleen V. Bowman
- University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Kwun M. Fong
- University of Queensland Thoracic Research Centre at The Prince Charles Hospital, Brisbane, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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33
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Philip J, Collins A, Smallwood N, Chang YK, Mo L, Yang IA, Corte T, McDonald CF, Hui D. Referral criteria to palliative care for patients with respiratory disease: a systematic review. Eur Respir J 2021; 58:13993003.04307-2020. [PMID: 33737407 DOI: 10.1183/13993003.04307-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Advanced non-malignant respiratory diseases are associated with significant patient morbidity, yet access to palliative care occurs late, if at all. AIM To examine referral criteria for palliative care among patients with advanced non-malignant respiratory disease, with a view to developing a standardised set of referral criteria. DESIGN Systematic review of all studies reporting on referral criteria to palliative care in advanced non-malignant respiratory disease, with a focus on chronic obstructive pulmonary disease and interstitial lung disease. DATA SOURCES A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using electronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed). RESULTS Searches yielded 2052 unique titles, which were screened for eligibility resulting in 62 studies addressing referral criteria to palliative care in advanced non-malignant respiratory disease. Of 18 categories put forward for referral to palliative care, the most commonly discussed factors were hospital use (69% of papers), indicators of poor respiratory status (47%), physical and emotional symptoms (37%), functional decline (29%), need for advanced respiratory therapies (27%), and disease progression (26%). CONCLUSION Clinicians consider referral to specialist palliative care for a wide range of disease- and needs-based criteria. Our findings highlight the need to standardise palliative care access by developing consensus referral criteria for patients with advanced non-malignant respiratory illnesses.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Parkville, Australia .,Palliative Care Service, St Vincent's Hospital, Fitzroy, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Natasha Smallwood
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA.,The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tamera Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, National Health and Medical Research Council, New South Wales, Australia
| | - Christine F McDonald
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
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34
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Alemao CA, Budden KF, Gomez HM, Rehman SF, Marshall JE, Shukla SD, Donovan C, Forster SC, Yang IA, Keely S, Mann ER, El Omar EM, Belz GT, Hansbro PM. Impact of diet and the bacterial microbiome on the mucous barrier and immune disorders. Allergy 2021; 76:714-734. [PMID: 32762040 DOI: 10.1111/all.14548] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/10/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
The prevalence of chronic immune and metabolic disorders is increasing rapidly. In particular, inflammatory bowel diseases, obesity, diabetes, asthma and chronic obstructive pulmonary disease have become major healthcare and economic burdens worldwide. Recent advances in microbiome research have led to significant discoveries of associative links between alterations in the microbiome and health, as well as these chronic supposedly noncommunicable, immune/metabolic disorders. Importantly, the interplay between diet, microbiome and the mucous barrier in these diseases has gained significant attention. Diet modulates the mucous barrier via alterations in gut microbiota, resulting in either disease onset/exacerbation due to a "poor" diet or protection against disease with a "healthy" diet. In addition, many mucosa-associated disorders possess a specific gut microbiome fingerprint associated with the composition of the mucous barrier, which is further influenced by host-microbiome and inter-microbial interactions, dietary choices, microbe immigration and antimicrobials. Our review focuses on the interactions of diet (macronutrients and micronutrients), gut microbiota and mucous barriers (gastrointestinal and respiratory tract) and their importance in the onset and/or progression of major immune/metabolic disorders. We also highlight the key mechanisms that could be targeted therapeutically to prevent and/or treat these disorders.
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Affiliation(s)
- Charlotte A. Alemao
- Priority Research Centre for Healthy Lungs Hunter Medical Research Institute New Lambton, Newcastle NSW Australia
- The University of Newcastle Newcastle NSW Australia
| | - Kurtis F. Budden
- Priority Research Centre for Healthy Lungs Hunter Medical Research Institute New Lambton, Newcastle NSW Australia
- The University of Newcastle Newcastle NSW Australia
| | - Henry M. Gomez
- Priority Research Centre for Healthy Lungs Hunter Medical Research Institute New Lambton, Newcastle NSW Australia
- The University of Newcastle Newcastle NSW Australia
| | - Saima F. Rehman
- Priority Research Centre for Healthy Lungs Hunter Medical Research Institute New Lambton, Newcastle NSW Australia
- The University of Newcastle Newcastle NSW Australia
| | - Jacqueline E. Marshall
- Faculty of Science Centre for Inflammation Centenary Institute University of Technology Sydney Sydney NSW Australia
| | - Shakti D. Shukla
- Priority Research Centre for Healthy Lungs Hunter Medical Research Institute New Lambton, Newcastle NSW Australia
- The University of Newcastle Newcastle NSW Australia
| | - Chantal Donovan
- Faculty of Science Centre for Inflammation Centenary Institute University of Technology Sydney Sydney NSW Australia
| | - Samuel C. Forster
- Department of Molecular and Translational Sciences Hudson Institute of Medical Research Centre for Innate Immunity and Infectious Diseases Monash University Clayton VIC Australia
| | - Ian A. Yang
- Thoracic Program The Prince Charles Hospital Metro North Hospital and Health Service Brisbane QLD Australia
- Faculty of Medicine UQ Thoracic Research Centre The University of Queensland Brisbane QLD Australia
| | - Simon Keely
- Hunter Medical Research Institute Priority Research Centre for Digestive Health and Neurogastroenterology University of Newcastle New Lambton Heights NSW Australia
| | - Elizabeth R. Mann
- Lydia Becker Institute of Immunology and Inflammation University of Manchester Manchester UK
- Faculty of Biology Medicine and Health Manchester Collaborative Centre for Inflammation Research Manchester Academic Health Science Centre University of Manchester Manchester UK
| | - Emad M. El Omar
- St George & Sutherland Clinical School Microbiome Research Centre University of New South Wales Sydney NSW Australia
| | - Gabrielle T. Belz
- Diamantina Institute University of Queensland Woolloongabba QLD Australia
- Department of Medical Biology Walter and Eliza Hall Institute of Medical Research University of Melbourne Parkville VIC Australia
| | - Philip M. Hansbro
- Priority Research Centre for Healthy Lungs Hunter Medical Research Institute New Lambton, Newcastle NSW Australia
- The University of Newcastle Newcastle NSW Australia
- Faculty of Science Centre for Inflammation Centenary Institute University of Technology Sydney Sydney NSW Australia
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35
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O'Neill C, Gibson PG, Heaney LG, Upham JW, Yang IA, Reynolds PN, Hodge S, Jenkins CR, Peters M, Marks GB, James AL, Simpson JL. The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma. Eur Respir J 2021; 57:13993003.02436-2020. [PMID: 33008933 DOI: 10.1183/13993003.02436-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/13/2020] [Indexed: 11/05/2022]
Abstract
Add-on azithromycin (AZM) results in a significant reduction in exacerbations among adults with persistent uncontrolled asthma. The aim of this study was to assess the cost-effectiveness of add-on AZM in terms of healthcare and societal costs.The AMAZES trial randomly assigned 420 participants to AZM or placebo. Healthcare use and asthma exacerbations were measured during the treatment period. Healthcare use included all prescribed medicine and healthcare contacts. Costs of antimicrobial resistance (AMR) were estimated based on overall consumption and published estimates of costs. The value of an avoided exacerbation was based on published references. Differences in cost between the two groups were related to differences in exacerbations in a series of net monetary benefit estimates. Societal costs included lost productivity, over the counter medicines, steroid induced morbidity and AMR costs.Add-on AZM resulted in a reduction in healthcare costs (mean (95% CI)) including nights in hospital (AUD 433.70 (AUD 48.59-818.81) or EUR 260.22 (EUR 29.15-491.29)), unplanned healthcare visits (AUD 20.25 (AUD 5.23-35.27) or EUR 12.15 (EUR 3.14-21.16)), antibiotic costs (AUD 14.88 (AUD 7.55-22.21) or EUR 8.93 (EUR 4.53-13.33)) and oral corticosteroid costs (AUD 4.73 (AUD 0.82-8.64) or EUR 2.84 (EUR 0.49-5.18)); all p<0.05. Overall healthcare and societal costs were lower (AUD 77.30 (EUR 46.38) and AUD 256.22 (EUR 153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD 2072.30 (95% CI AUD 1348.55-2805.23) or (EUR 1243.38 (EUR 809.13-1683.14) assuming a willingness to pay per exacerbation avoided of AUD 2651 (EUR 1590.60). Irrespective of the sensitivity analysis applied, the net monetary benefit for total, moderate and severe exacerbations remained positive and significant.Add-on AZM therapy in poorly controlled asthma was a cost-effective therapy. Costs associated with AMR did not influence estimated cost-effectiveness.
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Affiliation(s)
- Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, Hunter New England Area Health Service, John Hunter Hospital, Newcastle, NSW Australia
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - John W Upham
- Faculty of Medicine, The University of Queensland, St Lucia, Australia.,Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, St Lucia, Australia.,Dept of Thoracic Medicine, The Prince Charles Hospital, Chermside, Australia
| | - Paul N Reynolds
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Sandra Hodge
- Dept of Thoracic Medicine, Lung Research Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Christine R Jenkins
- Respiratory Trials, The George Institute for Global Health, Sydney, Australia.,Dept of Thoracic Medicine, Concord General Hospital, Sydney, Australia
| | - Matthew Peters
- Dept of Thoracic Medicine, Concord General Hospital, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Alan L James
- Medical School, University of Western Australia, Crawley, Australia.,Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia.,Dept of Respiratory and Sleep Medicine, Hunter New England Area Health Service, John Hunter Hospital, Newcastle, NSW Australia
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36
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Odo DB, Yang IA, Knibbs LD. A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys. Int J Environ Res Public Health 2021; 18:1411. [PMID: 33546363 PMCID: PMC7913474 DOI: 10.3390/ijerph18041411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
The domestic combustion of polluting fuels is associated with an estimated 3 million premature deaths each year and contributes to climate change. In many low- and middle-income countries (LMICs), valid and representative estimates of people exposed to household air pollution (HAP) are scarce. The Demographic and Health Survey (DHS) is an important and consistent source of data on household fuel use for cooking and has facilitated studies of health effects. However, the body of research based on DHS data has not been systematically identified, nor its strengths and limitations critically assessed as a whole. We aimed to systematically review epidemiological studies using DHS data that considered cooking fuel type as the main exposure, including the assessment of the extent and key drivers of bias. Following PRISMA guidelines, we searched PubMed, Web of Science, Scopus and the DHS publication portal. We assessed the quality and risk of bias (RoB) of studies using a novel tool. Of 2748 records remaining after removing duplicates, 63 were read in full. A total of 45 out of 63 studies were included in our review, spanning 11 different health outcomes and representing 50 unique analyses. In total, 41 of 45 (91%) studies analysed health outcomes in children <5 years of age, including respiratory infections (n = 17), death (all-cause) (n = 14), low birthweight (n = 5), stunting and anaemia (n = 5). Inconsistencies were observed between studies in how cooking fuels were classified into relatively high- and low-polluting. Overall, 36/50 (80%) studies reported statistically significant adverse associations between polluting fuels and health outcomes. In total, 18/50 (36%) of the analyses were scored as having moderate RoB, while 16/50 (32%) analyses were scored as having serious or critical RoB. Although HAP exposure assessment is not the main focus of the DHS, it is the main, often only, source of information in many LMICs. An appreciable proportion of studies using it to analyse the association between cooking fuel use and health have potential for high RoB, mostly related to confounder control, exposure assessment and misclassification, and outcome ascertainment. Based on our findings, we provide some suggestions for ways in which revising the information collected by the DHS could make it even more amenable to studies of household fuel use and health, and reduce the RoB, without being onerous to collect and analyse.
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Affiliation(s)
- Daniel B. Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- College of Health Sciences, Arsi University, Oromia, Asella P.O. Box 193, Ethiopia
| | - Ian A. Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, QLD 4032, Australia;
- UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane QLD 4032, Australia
| | - Luke D. Knibbs
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
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37
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Shukla SD, Taylor SL, Gibson PG, Barker D, Upham JW, Yang IA, Reynolds PN, Hodge S, James AL, Rogers GB, Simpson JL. Add-on azithromycin reduces sputum cytokines in non-eosinophilic asthma: an AMAZES substudy. Thorax 2021; 76:733-736. [PMID: 33414242 DOI: 10.1136/thoraxjnl-2020-216331] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
Add-on azithromycin (AZM) significantly reduces exacerbations in poorly controlled asthma irrespective of disease phenotype. In a predefined substudy of the original AMAZES protocol (500 mg, three times a week for 48 weeks), we report that AZM treatment reduces key sputum inflammatory proteins (interleukin (IL)-6, IL-1β and extracellular DNA), which is more evident in non-eosinophilic asthma (NEA). Moreover, AZM reduced Haemophilus influenzae load only in NEA. Our data support the anti-inflammatory effects of AZM in poorly controlled asthma. Prospective studies are required to identify patients that derive greatest benefit from AZM add-on therapy.
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Affiliation(s)
- Shakti D Shukla
- Faculty of Health and Medicine, The University of Newcastle Priority Research Centre for Asthma and Respiratory Disease, Newcastle, New South Wales, Australia
| | - Steven L Taylor
- Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,SAHMRI Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter G Gibson
- Faculty of Health and Medicine, The University of Newcastle Priority Research Centre for Asthma and Respiratory Disease, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Daniel Barker
- Faculty of Health and Medicine, The University of Newcastle Priority Research Centre for Asthma and Respiratory Disease, Newcastle, New South Wales, Australia
| | - John W Upham
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Ian A Yang
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Paul N Reynolds
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sandra Hodge
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medicine School, University of Western Australia, Crawley, WA, Australia
| | - Geraint B Rogers
- Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,SAHMRI Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jodie L Simpson
- Faculty of Health and Medicine, The University of Newcastle Priority Research Centre for Asthma and Respiratory Disease, Newcastle, New South Wales, Australia .,Hunter Medical Research Institute, Newcastle, NSW, Australia
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38
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Burke JP, Eastment JG, Bowman RV, Fong KM, Yang IA. Glycopyrronium bromide for chronic obstructive pulmonary disease. Hippokratia 2020. [DOI: 10.1002/14651858.cd010798.pub2] [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] [Indexed: 11/12/2022]
Affiliation(s)
- Joseph P Burke
- School of Medicine; The University of Queensland; Brisbane Australia
| | | | - Rayleen V Bowman
- Department of Thoracic Medicine; The Prince Charles Hospital; Brisbane Australia
- UQ Thoracic Research Centre, School of Medicine; The University of Queensland; Brisbane Australia
| | - Kwun M Fong
- Department of Thoracic Medicine; The Prince Charles Hospital; Brisbane Australia
- Thoracic Medicine Program; The Prince Charles Hospital; Brisbane Australia
| | - Ian A Yang
- Department of Thoracic Medicine; The Prince Charles Hospital; Brisbane Australia
- UQ Thoracic Research Centre, School of Medicine; The University of Queensland; Brisbane Australia
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39
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Bowerman KL, Rehman SF, Vaughan A, Lachner N, Budden KF, Kim RY, Wood DLA, Gellatly SL, Shukla SD, Wood LG, Yang IA, Wark PA, Hugenholtz P, Hansbro PM. Disease-associated gut microbiome and metabolome changes in patients with chronic obstructive pulmonary disease. Nat Commun 2020; 11:5886. [PMID: 33208745 PMCID: PMC7676259 DOI: 10.1038/s41467-020-19701-0] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third commonest cause of death globally, and manifests as a progressive inflammatory lung disease with no curative treatment. The lung microbiome contributes to COPD progression, but the function of the gut microbiome remains unclear. Here we examine the faecal microbiome and metabolome of COPD patients and healthy controls, finding 146 bacterial species differing between the two groups. Several species, including Streptococcus sp000187445, Streptococcus vestibularis and multiple members of the family Lachnospiraceae, also correlate with reduced lung function. Untargeted metabolomics identifies a COPD signature comprising 46% lipid, 20% xenobiotic and 20% amino acid related metabolites. Furthermore, we describe a disease-associated network connecting Streptococcus parasanguinis_B with COPD-associated metabolites, including N-acetylglutamate and its analogue N-carbamoylglutamate. While correlative, our results suggest that the faecal microbiome and metabolome of COPD patients are distinct from those of healthy individuals, and may thus aid in the search for biomarkers for COPD. Chronic obstructive pulmonary disease (COPD) is a progressing disease, with lung but not gut microbiota implicated in its etiology. Here the authors compare the stool from patients with COPD and healthy controls to find specific gut bacteria and metabolites associated with active disease, thereby hinting at a potential role for the gut microbiome in COPD.
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Affiliation(s)
- Kate L Bowerman
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Saima Firdous Rehman
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia
| | - Annalicia Vaughan
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, and Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nancy Lachner
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Kurtis F Budden
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia
| | - Richard Y Kim
- Centre for Inflammation, Centenary Institute & University of Technology Sydney, School of Life Sciences, Faculty of Science, Sydney, NSW, Australia
| | - David L A Wood
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Shaan L Gellatly
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia
| | - Shakti D Shukla
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia
| | - Ian A Yang
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, and Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Peter A Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia
| | - Philip Hugenholtz
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, and The University of Newcastle, Newcastle, NSW, Australia. .,Centre for Inflammation, Centenary Institute & University of Technology Sydney, School of Life Sciences, Faculty of Science, Sydney, NSW, Australia.
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Ding H, Chen SH, Edwards I, Jayasena R, Doecke J, Layland J, Yang IA, Maiorana A. Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis. J Med Internet Res 2020; 22:e20032. [PMID: 33185554 PMCID: PMC7695537 DOI: 10.2196/20032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/08/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. OBJECTIVE The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. METHODS We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). RESULTS We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07). CONCLUSIONS Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.
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Affiliation(s)
- Hang Ding
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
- The Australian e-Health Research Centre, Commonwealth Scientific & Industrial Research Organisation, Brisbane, Australia
- Prince Charles Hospital - Northside Clinic Unit School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sheau Huey Chen
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Iain Edwards
- Department of Community Health, Peninsula Health, Melbourne, Australia
| | - Rajiv Jayasena
- The Australian e-Health Research Centre, Commonwealth Scientific & Industrial Research Organisation, Melbourne, Australia
| | - James Doecke
- The Australian e-Health Research Centre, Commonwealth Scientific & Industrial Research Organisation, Melbourne, Australia
| | - Jamie Layland
- Department of Cardiology, Peninsula Health, Melbourne, Australia
- Peninsula Clinical School, Monash University, Melbourne, Australia
| | - Ian A Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia
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Paudel KR, Dharwal V, Patel VK, Galvao I, Wadhwa R, Malyla V, Shen SS, Budden KF, Hansbro NG, Vaughan A, Yang IA, Kohonen-Corish MRJ, Bebawy M, Dua K, Hansbro PM. Role of Lung Microbiome in Innate Immune Response Associated With Chronic Lung Diseases. Front Med (Lausanne) 2020; 7:554. [PMID: 33043031 PMCID: PMC7530186 DOI: 10.3389/fmed.2020.00554] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022] Open
Abstract
Respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), lung fibrosis, and lung cancer, pose a huge socio-economic burden on society and are one of the leading causes of death worldwide. In the past, culture-dependent techniques could not detect bacteria in the lungs, therefore the lungs were considered a sterile environment. However, the development of culture-independent techniques, particularly 16S rRNA sequencing, allowed for the detection of commensal microbes in the lung and with further investigation, their roles in disease have since emerged. In healthy individuals, the predominant commensal microbes are of phylum Firmicutes and Bacteroidetes, including those of the genera Veillonella and Prevotella. In contrast, pathogenic microbes (Haemophilus, Streptococcus, Klebsiella, Pseudomonas) are often associated with lung diseases. There is growing evidence that microbial metabolites, structural components, and toxins from pathogenic and opportunistic bacteria have the capacity to stimulate both innate and adaptive immune responses, and therefore can contribute to the pathogenesis of lung diseases. Here we review the multiple mechanisms that are altered by pathogenic microbiomes in asthma, COPD, lung cancer, and lung fibrosis. Furthermore, we focus on the recent exciting advancements in therapies that can be used to restore altered microbiomes in the lungs.
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Affiliation(s)
- Keshav Raj Paudel
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Vivek Dharwal
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Vyoma K Patel
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Izabela Galvao
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Ridhima Wadhwa
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Vamshikrishna Malyla
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sj Sijie Shen
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Kurtis F Budden
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicole G Hansbro
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Annalicia Vaughan
- Faculty of Medicine, Thoracic Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ian A Yang
- Faculty of Medicine, Thoracic Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Maija R J Kohonen-Corish
- Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mary Bebawy
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kamal Dua
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
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Affiliation(s)
- Eli Dabscheck
- Alfred Hospital, Monash University Melbourne VIC Australia
| | - Christine F. McDonald
- Austin Hospital, Institute for Breathing and Sleep University of Melbourne Melbourne VIC Australia
| | - Ian A. Yang
- The Prince Charles Hospital The University of Queensland Brisbane QLD Australia
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Donovan C, Liu G, Shen S, Marshall JE, Kim RY, Alemao CA, Budden KF, Choi JP, Kohonen-Corish M, El-Omar EM, Yang IA, Hansbro PM. The role of the microbiome and the NLRP3 inflammasome in the gut and lung. J Leukoc Biol 2020; 108:925-935. [PMID: 33405294 DOI: 10.1002/jlb.3mr0720-472rr] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022] Open
Abstract
The nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family, pyrin domain-containing protein 3 (NLRP3) inflammasome, is one of the most well-characterized inflammasomes, activated by pathogen-associated molecular patterns and damage-associated molecular patterns, including from commensal or pathogenic bacterial and viral infections. The NLRP3 inflammasome promotes inflammatory cell recruitment and regulates immune responses in tissues such as the gastrointestinal tract and the lung, and is involved in many diseases that affect the gut and lung. Recently, the microbiome in the gut and the lung, and the crosstalk between these organs (gut-lung axis), has been identified as a potential mechanism that may influence disease in a bidirectional manner. In this review, we focus on themes presented in this area at the 2019 World Congress on Inflammation. We discuss recent evidence on how the microbiome can affect NLRP3 inflammasome responses in the gut and lung, the role of this inflammasome in regulating gut and lung inflammation in disease, and its potential role in the gut-lung axis. We highlight the exponential increase in our understanding of the NLRP3 inflammasome due to the synthesis of the NLRP3 inflammasome inhibitor, MCC950, and propose future studies that may further elucidate the roles of the NLRP3 inflammasome in gut and lung diseases.
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Affiliation(s)
- Chantal Donovan
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gang Liu
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia
| | - Sj Shen
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia
| | - Jacqueline E Marshall
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia
| | - Richard Y Kim
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Charlotte A Alemao
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kurtis F Budden
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jaesung P Choi
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia
| | - Maija Kohonen-Corish
- Woolcock Institute of Medical Research and Faculty of Science, University of Technology Sydney, Garvan Institute of Medical Research and St George and Sutherland Clinical School, University of New South Wales, Kogarah, New South Wales, Australia
| | - Emad M El-Omar
- Microbiome Research Centre, St George and Sutherland Clinical School, University of New South Wales, Kogarah, New South Wales, Australia
| | - Ian A Yang
- The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, Sydney, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in Australia. Recently there have been unparalleled advances in the screening and management of lung cancer. OBJECTIVE The aim of this article is to discuss diagnosis and management of lung cancer, including advances that are likely to translate into future practice. DISCUSSION Screening with low-dose computed tomography scans has proven to be effective for detecting early curable disease, reducing mortality by ≥20% in randomised controlled trials. Implementation trials are underway within Australia and overseas, and a Commonwealth Inquiry is ongoing. Breath and blood biomarkers are less invasive alternatives that show potential but remain under investigation. Early diagnosis of lung cancer is key to improving survival - this includes familiarity with nodule screening recommendations and facilitating access to early tissue diagnosis via transthoracic needle aspiration or bronchoscopy. Treatment decisions can then be guided by staging with scans, molecular testing and multidisciplinary team consideration in the frame of patient factors/preferences. The therapeutic armamentarium is boosted by an increasing range of effective therapies including modern surgical and radiation techniques, and systemic treatments including targeted therapies and immunotherapy.
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Affiliation(s)
- Rachel McLellan
- MBBS, FRACP (Gen Med), Associate Lecturer of the School of Clinical Medicine, UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Qld; Registrar, Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Qld
| | - Henry Marshall
- MBBS, PhD, FRACP (Thor Med), Senior Lecturer and Clinical Academic Fellow, UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Qld; Thoracic Physician, Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Qld
| | - Annette Dent
- BAppSc (Med Tech), PhD, Director, Respiratory Investigations, Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Qld
| | - Rayleen V Bowman
- MBBS, PhD, FRACP (Thor Med), Associate Professor, UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Qld; Thoracic Physician, Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Qld
| | - Ian A Yang
- MBBS (Hons), PhD, FRACP (Thor Med), FAPSR, FThorSoc, Grad Dip Clin Epid, Professor, Medicine and Head UQ Northside Clinical Unit, UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Qld; Thoracic Physician and Director, Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Qld
| | - Kwun M Fong
- MBBS, PhD, FRACP (Thor Med), Professor, Medicine, UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Qld; Thoracic Physician and Head of Pulmonary Malignancy Services, Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Qld
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Oey H, Daniels M, Relan V, Chee TM, Davidson MR, Yang IA, Ellis JJ, Fong KM, Krause L, Bowman RV. Whole-genome sequencing of human malignant mesothelioma tumours and cell lines. Carcinogenesis 2020; 40:724-734. [PMID: 31038674 DOI: 10.1093/carcin/bgz066] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/31/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022] Open
Abstract
Pleural mesothelioma is a cancer of serosal surfaces caused by environmental exposure to asbestos. Clinical outcome remains poor and while trials of new treatments are ongoing it remains an understudied cancer. Mesothelioma cell lines can readily be grown from primary tumour and from tumour cells shed into pleural effusion with the latter representing a particularly valuable source of DNA in clinical settings, procurable without the need for additional invasive procedures. However, it is not well understood how accurately patient-derived cultured tumour cells represent the molecular characteristics of their primary tumour. We used whole-genome sequencing of primary tumour and matched cultured cells to comprehensively characterize mutations and structural alterations. Most cases had complex rearranged genomes with evidence of chromoanagenesis and rearrangements reminiscent of chromoplexy. Many of the identified driver mutations were structural, indicating that mesothelioma is often caused by structural alterations and catastrophic genomic events, rather than point mutations. Because the majority of genomic changes detected in tumours were also displayed by the genomes of cultured tumour cells, we conclude that low-passage cultured tumour cells are generally suitable for molecular characterization of mesothelioma and may be particularly useful where tissue samples with high tumour cell content are not available. However, the subclonal compositions of the cell lines did not fully recapitulate the subclonal diversity of the primary tumours. Furthermore, longitudinal acquisition of major alterations in subclonal cell populations was observed after long-term passaging. These two factors define limitations of tumour-derived cell lines as genomic substrate for clinical purposes.
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Affiliation(s)
- Harald Oey
- Diamantina Institute, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Marissa Daniels
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Vandana Relan
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Tian Mun Chee
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Morgan R Davidson
- Department of Anatomical Pathology, The Prince Charles Hospital, Queensland, Australia
| | - Ian A Yang
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia
| | - Jonathan J Ellis
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology (QUT) at Translational Research Institute, Brisbane, Australia
| | - Kwun M Fong
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia
| | - Lutz Krause
- Diamantina Institute, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Australia
| | - Rayleen V Bowman
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia
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Cousins JL, Wood-Baker R, Wark PAB, Yang IA, Gibson PG, Hutchinson A, Sajkov D, Hiles SA, Samuel S, McDonald VM. Management of acute COPD exacerbations in Australia: do we follow the guidelines? ERJ Open Res 2020; 6:00270-2019. [PMID: 32337215 PMCID: PMC7167211 DOI: 10.1183/23120541.00270-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 01/30/2023] Open
Abstract
Objective We aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after. Methods A prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status. Results There were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged. Conclusion When compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care. A multisite audit of hospital admissions for patients experiencing #AECOPD in Australia highlighted important gaps in management when compared against national guidelines. Further focus on how we can improve guideline uptake by clinicians is needed.http://bit.ly/2VjGnHw
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Affiliation(s)
- Joyce L Cousins
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Avondale University College, Faculty of Nursing, Wahroonga, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Ian A Yang
- The Prince Charles Hospital and University of Queensland, Chermside, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute, Flinders University and Flinders Medical Centre, Bedford Park, Australia
| | - Sarah A Hiles
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sameh Samuel
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Vanessa M McDonald
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
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47
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Taylor SL, Leong LEX, Mobegi FM, Choo JM, Wesselingh S, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, Jenkins C, Peters MJ, Baraket M, Marks GB, Gibson PG, Rogers GB, Simpson JL. Long-Term Azithromycin Reduces Haemophilus influenzae and Increases Antibiotic Resistance in Severe Asthma. Am J Respir Crit Care Med 2020; 200:309-317. [PMID: 30875247 DOI: 10.1164/rccm.201809-1739oc] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: The macrolide antibiotic azithromycin reduces exacerbations in adults with persistent symptomatic asthma. However, owing to the pleotropic properties of macrolides, unintended bacteriological consequences such as augmented pathogen colonization or dissemination of antibiotic-resistant organisms can occur, calling into question the long-term safety of azithromycin maintenance therapy.Objectives: To assess the effects of azithromycin on the airway microbiota, pathogen abundance, and carriage of antibiotic resistance genes.Methods: 16S rRNA sequencing and quantitative PCR were performed to assess the effect of azithromycin on sputum microbiology from participants of the AMAZES (Asthma and Macrolides: The Azithromycin Efficacy and Safety) trial: a 48-week, double-blind, placebo-controlled trial of thrice-weekly 500 mg oral azithromycin in adults with persistent uncontrolled asthma. Pooled-template shotgun metagenomic sequencing, quantitative PCR, and isolate whole-genome sequencing were performed to assess antibiotic resistance.Measurements and Main Results: Paired sputum samples were available from 61 patients (n = 34 placebo, n = 27 azithromycin). Azithromycin did not affect bacterial load (P = 0.37) but did significantly decrease Faith's phylogenetic diversity (P = 0.026) and Haemophilus influenzae load (P < 0.0001). Azithromycin did not significantly affect levels of Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, or Moraxella catarrhalis. Of the 89 antibiotic resistance genes detected, five macrolide resistance genes and two tetracycline resistance genes were increased significantly.Conclusions: In patients with persistent uncontrolled asthma, azithromycin reduced airway H. influenzae load compared with placebo but did not change total bacterial load. Macrolide resistance increased, reflecting previous studies. These results highlight the need for studies assessing the efficacy of nonantibiotic macrolides as a long-term therapy for patients with persistent uncontrolled asthma.
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Affiliation(s)
- Steven L Taylor
- 1South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,2South Australian Health and Medical Research Institute Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Lex E X Leong
- 1South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,2South Australian Health and Medical Research Institute Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Fredrick M Mobegi
- 1South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,2South Australian Health and Medical Research Institute Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Jocelyn M Choo
- 1South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,2South Australian Health and Medical Research Institute Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Steve Wesselingh
- 1South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,2South Australian Health and Medical Research Institute Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ian A Yang
- 3Faculty of Medicine, The University of Queensland, St. Lucia, Queensland, Australia.,4Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - John W Upham
- 3Faculty of Medicine, The University of Queensland, St. Lucia, Queensland, Australia.,5Translational Research Institute, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Paul N Reynolds
- 6Department of Thoracic Medicine, Lung Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,7School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sandra Hodge
- 6Department of Thoracic Medicine, Lung Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,7School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alan L James
- 8Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,9School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Christine Jenkins
- 10Respiratory Trials, The George Institute for Global Health, New South Wales, Australia.,11Department of Thoracic Medicine, Concord General Hospital, New South Wales, Australia
| | - Matthew J Peters
- 11Department of Thoracic Medicine, Concord General Hospital, New South Wales, Australia.,12Australian School of Advanced Medicine, Macquarie University, New South Wales, Australia
| | - Melissa Baraket
- 13Respiratory Medicine Department and Ingham Institute, Liverpool Hospital, New South Wales, Australia.,14South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales Australia
| | - Guy B Marks
- 13Respiratory Medicine Department and Ingham Institute, Liverpool Hospital, New South Wales, Australia.,14South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales Australia.,15Woolcock Institute of Medical Research, Glebe, New South Wales, Australia; and
| | - Peter G Gibson
- 15Woolcock Institute of Medical Research, Glebe, New South Wales, Australia; and.,16Respiratory and Sleep Medicine, Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Geraint B Rogers
- 1South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,2South Australian Health and Medical Research Institute Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Jodie L Simpson
- 16Respiratory and Sleep Medicine, Priority Research Centre for Healthy Lungs, The University of Newcastle, Callaghan, New South Wales, Australia
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Dummer J, Dobler CC, Holmes M, Chambers D, Yang IA, Parkin L, Smith S, Wark P, Dev A, Hodge S, Dabscheck E, Gooi J, Samuel S, Knowles S, Holland AE. Diagnosis and treatment of lung disease associated with alpha one-antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25:321-335. [PMID: 32030868 PMCID: PMC7078913 DOI: 10.1111/resp.13774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/27/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022]
Abstract
AATD is a common inherited disorder associated with an increased risk of developing pulmonary emphysema and liver disease. Many people with AATD-associated pulmonary emphysema remain undiagnosed and therefore without access to care and counselling specific to the disease. AAT augmentation therapy is available and consists of i.v. infusions of exogenous AAT protein harvested from pooled blood products. Its clinical efficacy has been the subject of some debate and the use of AAT augmentation therapy was recently permitted by regulators in Australia and New Zealand, although treatment is not presently subsidized by the government in either country. The purpose of this position statement is to review the evidence for diagnosis and treatment of AATD-related lung disease with reference to the Australian and New Zealand population. The clinical efficacy and adverse events of AAT augmentation therapy were evaluated by a systematic review, and the GRADE process was employed to move from evidence to recommendation. Other sections address the wide range of issues to be considered in the care of the individual with AATD-related lung disease: when and how to test for AATD, changing diagnostic techniques, monitoring of progression, disease in heterozygous AATD and pharmacological and non-pharmacological therapy including surgical options for severe disease. Consideration is also given to broader issues in AATD that respiratory healthcare staff may encounter: genetic counselling, patient support groups, monitoring for liver disease and the need to establish national registries for people with AATD in Australia and New Zealand.
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Affiliation(s)
- Jack Dummer
- Department of Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Claudia C. Dobler
- Institute for Evidence‐Based HealthcareBond University and Gold Coast University HospitalGold CoastQLDAustralia
- Department of Respiratory MedicineLiverpool HospitalSydneyNSWAustralia
| | - Mark Holmes
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSAAustralia
- Faculty of MedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Daniel Chambers
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- Queensland Lung Transplant ProgramThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Ian A. Yang
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- Department of Thoracic MedicineThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Lianne Parkin
- Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Sheree Smith
- School of Nursing and MidwiferyWestern Sydney UniversitySydneyNSWAustralia
| | - Peter Wark
- Centre for Healthy LungsUniversity of NewcastleNewcastleNSWAustralia
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNew LambtonNSWAustralia
| | - Anouk Dev
- Department of GastroenterologyMonash HealthMelbourneVICAustralia
| | - Sandra Hodge
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSAAustralia
- Faculty of MedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Eli Dabscheck
- Department of Respiratory MedicineAlfred HospitalMelbourneVICAustralia
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Julian Gooi
- Department of Cardiothoracic SurgeryAlfred HospitalMelbourneVICAustralia
| | - Sameh Samuel
- Department of Respiratory MedicineWollongong HospitalWollongongNSWAustralia
- School of Medicine, University of WollongongWollongongNSWAustralia
| | | | - Anne E. Holland
- Department of Allergy, Immunology and Respiratory Medicine, Central Clinical SchoolMonash UniversityMelbourneVICAustralia
- Department of PhysiotherapyAlfred HealthMelbourneVICAustralia
- Institute for Breathing and SleepMelbourneVICAustralia
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49
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Mackintosh JA, Marshall HM, Slaughter R, Reddy T, Yang IA, Bowman RV, Fong KM. Interstitial lung abnormalities in the Queensland Lung Cancer Screening Study: prevalence and progression over 2 years of surveillance. Intern Med J 2020; 49:843-849. [PMID: 30350396 DOI: 10.1111/imj.14148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND We report the prevalence and progression of incidentally detected interstitial lung abnormalities (ILA) in the Queensland Lung Cancer Screening Study cohort. METHODS About 256 volunteers aged 60-74, with ≥30 pack years smoking history and forced expiratory volume in 1 s (FEV1) ≥50% predicted underwent low-dose computed tomography (CT) chest screening. Electronic search of baseline (T0) and 2-year follow-up (T2) CT reports identified candidate cases using Fleischner Society interstitial terminology. Candidate CT were reviewed in a randomised order by two experienced radiologists and a senior respiratory medicine trainee blinded to the existing reports. Scans were evaluated for the presence and extent of ILA using an in-house score, and graded for progression. RESULTS ILA were detected in 20/256 baseline cases (7.8%) with no incident cases detected at T2 surveillance imaging. Of these 20 cases, 9 (45%) had reticulation, 18 (90%) had ground glass change, 1 had traction bronchiectasis and 1 had randomly distributed nodularity. Seven cases with ground glass changes also had areas of reticulation, and only two had reticulation alone. All ILA were graded as minor except for traction bronchiectasis, which was moderate. Only one case progressed on T2 imaging. ILA were associated with the presence of auscultatory crackles (50% vs 11.6%, P = 0.001) and a lesser degree of emphysema (mean % volumetric emphysema 6.7% vs 9.8%, P = 0.009). No relationship was observed between baseline and serial lung function parameters. CONCLUSION ILA are frequent incidental findings in lung cancer screening. In the majority of cases these abnormalities do not appear to change significantly over a 2-year period of surveillance.
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Affiliation(s)
- John A Mackintosh
- University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Henry M Marshall
- University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Richard Slaughter
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Taryn Reddy
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Ian A Yang
- University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Rayleen V Bowman
- University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kwun M Fong
- University of Queensland Thoracic Research Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
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50
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Fong KM, Hughes BGM, Lwin Z, Yang IA. EGFR mutations in lung cancer: not all equal in the eyes of the immune system? Ann Transl Med 2020; 7:S326. [PMID: 32016044 DOI: 10.21037/atm.2019.09.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kwun M Fong
- Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.,University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Brett G M Hughes
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Cancer Care Services, The Prince Charles Hospital, Queensland, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Zarnie Lwin
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Cancer Care Services, The Prince Charles Hospital, Queensland, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Ian A Yang
- Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.,University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
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