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Macdonald DM, Palzer EF, Abbasi A, Baldomero AK, Bhatt SP, Casaburi R, Connett JE, Dransfield MT, Gaeckle NT, Mkorombindo T, Rossiter HB, Stringer WW, Tiller NB, Wendt CH, Zhao D, Kunisaki KM. Chronotropic index during 6-minute walk and acute respiratory events in COPDGene. Respir Med 2022; 194:106775. [PMID: 35203009 PMCID: PMC8932051 DOI: 10.1016/j.rmed.2022.106775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lower heart rate (HR) increases during exercise and slower HR recovery (HRR) after exercise are markers of worse autonomic function that may be associated with risk of acute respiratory events (ARE). METHODS Data from 6-min walk testing (6MWT) in COPDGene were used to calculate the chronotropic index (CI) [(HR immediately post 6MWT - resting HR)/((220 - age) - resting HR)] and HRR at 1 min after 6MWT completion. We used zero-inflated negative binomial regression to test associations of CI and HRR with rates of any ARE (requiring steroids and/or antibiotics) and severe ARE (requiring emergency department visit or hospitalization), among all participants and in spirometry subgroups (normal, chronic obstructive pulmonary disease [COPD], and preserved ratio with impaired spirometry). RESULTS Among 4,484 participants, mean follow-up time was 4.1 years, and 1,966 had COPD. Among all participants, CI-6MWT was not associated with rate of any ARE [adjusted incidence rate ratio (aIRR) 0.98 (0.95-1.01)], but higher CI-6MWT was associated with lower rate of severe ARE [0.95 (0.92-0.99)]. Higher HRR was associated with a lower rate of both any ARE [0.97 (0.95-0.99)] and severe ARE [0.95 (0.92-0.98)]. Results were similar in the COPD spirometry subgroup. CONCLUSION Heart rate measures derived from 6MWT tests may have utility in predicting risk of acute respiratory events and COPD exacerbations.
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Affiliation(s)
- David M Macdonald
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA.
| | - Elise F Palzer
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Asghar Abbasi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Arianne K Baldomero
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Surya P Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Casaburi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - John E Connett
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathaniel T Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | | | - Harry B Rossiter
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - William W Stringer
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicholas B Tiller
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chris H Wendt
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China
| | - Ken M Kunisaki
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
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Gaeckle NT, Lee J, Park Y, Kreykes G, Evans MD, Hogan CJ. Aerosol Generation from the Respiratory Tract with Various Modes of Oxygen Delivery. Am J Respir Crit Care Med 2020; 202:1115-1124. [PMID: 32822208 PMCID: PMC7560792 DOI: 10.1164/rccm.202006-2309oc] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Rationale: Aerosol generation with modes of oxygen therapy such as high-flow nasal cannula and noninvasive positive-pressure ventilation is a concern for healthcare workers during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The amount of aerosol generation from the respiratory tract with these various oxygen modalities is unknown.Objectives: To measure the size and number concentration of particles and droplets generated from the respiratory tract of humans exposed to various oxygen delivery modalities.Methods: Ten healthy participants with no active pulmonary disease were enrolled. Oxygen modalities tested included nonhumidified nasal cannula, face mask, heated and humidified high-flow nasal cannula, and noninvasive positive-pressure ventilation. Aerosol generation was measured with each oxygen mode while participants performed maneuvers of normal breathing, talking, deep breathing, and coughing. Testing was conducted in a negative-pressure room. Particles with a diameter between 0.37 and 20 μm were measured using an aerodynamic particle spectrometer.Measurements and Main Results: Median particle concentration ranged from 0.041 to 0.168 particles/cm3. Median diameter ranged from 1.01 to 1.53 μm. Cough significantly increased the number of particles measured. Measured aerosol concentration did not significantly increase with the use of either humidified high-flow nasal cannula or noninvasive positive-pressure ventilation. This was the case during normal breathing, talking, deep breathing, and coughing.Conclusions: Oxygen delivery modalities of humidified high-flow nasal cannula and noninvasive positive-pressure ventilation do not increase aerosol generation from the respiratory tract in healthy human participants with no active pulmonary disease measured in a negative-pressure room.
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Affiliation(s)
- Nathaniel T. Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine
| | | | | | - Gean Kreykes
- Department of Respiratory Care, M Health Fairview, Minneapolis, Minnesota
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; and
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Baldomero AK, Wendt CH, Petersen A, Gaeckle NT, Han MK, Kunisaki KM. Impact of gastroesophageal reflux on longitudinal lung function and quantitative computed tomography in the COPDGene cohort. Respir Res 2020; 21:203. [PMID: 32746820 PMCID: PMC7397645 DOI: 10.1186/s12931-020-01469-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/24/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale Gastroesophageal reflux disease (GERD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and has been associated with increased risk of acute exacerbations, hospitalization, emergency room visits, costs, and quality-of-life impairment. However, it remains unclear whether GERD contributes to the progression of COPD as measured by lung function or computed tomography. Objective To determine the impact of GERD on longitudinal changes in lung function and radiographic lung disease in the COPDGene cohort. Methods We evaluated 5728 participants in the COPDGene cohort who completed Phase I (baseline) and Phase II (5-year follow-up) visits. GERD status was based on participant-reported physician diagnoses. We evaluated associations between GERD and annualized changes in lung function [forced expired volume in 1 s (FEV1) and forced vital capacity (FVC)] and quantitative computed tomography (QCT) metrics of airway disease and emphysema using multivariable regression models. These associations were further evaluated in the setting of GERD treatment with proton-pump inhibitors (PPI) and/or histamine-receptor 2 blockers (H2 blockers). Results GERD was reported by 2101 (36.7%) participants at either Phase I and/or Phase II. GERD was not associated with significant differences in slopes of FEV1 (difference of − 2.53 mL/year; 95% confidence interval (CI), − 5.43 to 0.37) or FVC (difference of − 3.05 mL/year; 95% CI, − 7.29 to 1.19), but the odds of rapid FEV1 decline of ≥40 mL/year was higher in those with GERD (adjusted odds ratio (OR) 1.20; 95%CI, 1.07 to 1.35). Participants with GERD had increased progression of QCT-measured air trapping (0.159%/year; 95% CI, 0.054 to 0.264), but not other QCT metrics such as airway wall area/thickness or emphysema. Among those with GERD, use of PPI and/or H2 blockers was associated with faster decline in FEV1 (difference of − 6.61 mL/year; 95% CI, − 11.9 to − 1.36) and FVC (difference of − 9.26 mL/year; 95% CI, − 17.2 to − 1.28). Conclusions GERD was associated with faster COPD disease progression as measured by rapid FEV1 decline and QCT-measured air trapping, but not by slopes of lung function. The magnitude of the differences was clinically small, but given the high prevalence of GERD, further investigation is warranted to understand the potential disease-modifying role of GERD in COPD pathogenesis and progression. Clinical trials registration NCT00608764.
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Affiliation(s)
- Arianne K Baldomero
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, One Veterans Drive, Mailstop: Pulmonary 111N, Minneapolis, MN, 55417, USA. .,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Chris H Wendt
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, One Veterans Drive, Mailstop: Pulmonary 111N, Minneapolis, MN, 55417, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Nathaniel T Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ken M Kunisaki
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, One Veterans Drive, Mailstop: Pulmonary 111N, Minneapolis, MN, 55417, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
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Gaeckle NT, Pragman AA, Pendleton KM, Baldomero AK, Criner GJ. The Oral-Lung Axis: The Impact of Oral Health on Lung Health. Respir Care 2020; 65:1211-1220. [PMID: 32156792 DOI: 10.4187/respcare.07332] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Poor oral health has long been recognized as a clinical risk factor for developing lung infections. Recent data using culture-independent techniques assessing the microbiome in healthy subjects have demonstrated that chronic microaspiration establishes a very similar microbial community between the mouth and lung, suggesting these 2 anatomic regions are closely intertwined. Dental disease is driven and aided by a dysbiosis in the oral microbiome, and evidence is mounting that implicates the microbiome in a variety of lung diseases including asthma, COPD, pulmonary fibrosis, and pneumonia. This review describes common dental conditions and potential mechanisms by which poor oral health may contribute to lung disease. We also review the current literature drawing associations between poor oral health and lung disease.
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Affiliation(s)
- Nathaniel T Gaeckle
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Alexa A Pragman
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,Division of Infectious Disease, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kathryn M Pendleton
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Arianne K Baldomero
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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Gaeckle NT, Heyman B, Criner AJ, Criner GJ. Markers of Dental Health Correlate with Daily Respiratory Symptoms in COPD. Chronic Obstr Pulm Dis 2018; 5:97-105. [PMID: 30374447 PMCID: PMC6190520 DOI: 10.15326/jcopdf.5.2.2017.0159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/22/2022]
Abstract
Background: Poor dental health occurs in patients with chronic obstructive pulmonary disease (COPD); some evidence suggests that it may correlate with lower forced expiratory volume in 1 second (FEV1) and 6-minute walk distance, and an increased rate of exacerbations. However, there is no data that examines how dental health may impact the daily respiratory symptoms that COPD patients experience. We prospectively studied indices of dental health and hygiene in patients with COPD and determined their impact on daily respiratory symptoms. Methods: A total of 20 individuals with COPD (median [interquartile range (IQR)] % FEV1 37 [29-43]) and 10 healthy control individuals with no lung disease were recruited. Dental questionnaires, spirometry, and a dental examination were administered on their initial visit. COPD participants were given an electronic COPD daily diary to document peak expiratory flow and the presence and magnitude of daily breathlessness, cough, sputum production, and wheeze. Results: Compared to healthy controls, COPD participants had less teeth (median 16.5 versus 28, p=0.0001), a trend to a higher plaque index (median 2.2 versus 1.7, p=0.15), and worse oral health-related quality of life (median Oral Health Impact Profile score 12.0 versus 4.5, p=0.02). A greater number of teeth correlated with higher percentage of days with cough (r=0.48, p<0.05) and wheeze (r=0.47, p<0.05). Conclusion: Individuals with severe COPD have poor oral hygiene and oral health-related quality of life. In the setting of poor dentition, a greater number of teeth correlates with more daily respiratory symptoms. More teeth may create a larger reservoir for inflammatory proteins and pathogenic bacteria to be aspirated into the airways.
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Affiliation(s)
- Nathaniel T Gaeckle
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Brooke Heyman
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Andrew J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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