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Kaenmuang P, Navasakulpong A, Geater SL, Densrisereekul S, Juthong S. Blood Eosinophil Count Stability and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease in a High Endemic Area of Parasitic Infection: A Prospective Study. Chronic Obstr Pulm Dis 2024. [PMID: 38575373 DOI: 10.15326/jcopdf.2023.0492] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background The blood eosinophil count (BEC) is an effective biomarker for predicting inhaled corticosteroid responsiveness in patients with chronic obstructive pulmonary disease (COPD). Methods A 12-month prospective observational study was conducted in patients with COPD. BEC was measured at enrolment, and after 6 and 12 months. Patients were classified into three groups according to their baseline BEC: <100, 100 - 299, and ≥300 cells/µL. We aimed to describe the patterns of blood eosinophil stability in patients with stable COPD and compare the exacerbation rates and other clinical outcomes at 6 and 12 months. Results A total of 252 patients with COPD were included. The <100, 100 - 299, and ≥ 300 cells/μL groups consisted of 14.7, 38.9, and 46.4% of patients, respectively. BEC stability was highest (85%) in the ≥300 cells/μL group for both durations. The lowest stability was observed in the <100 cells/μL group at 57 and 46% after 6 and 12 months, respectively. The persistent ≥ 300 cells/μL group had a higher incidence of moderate-to-severe exacerbation (IRR 2.44, 95% confidence interval (CI): 1.13-5.27, p value 0.023, as well as severe exacerbation (IRR 2.19, 95%CI: 1.39-3.45, p value 0.001). Other patient-reported outcomes did not differ significantly between groups. Conclusion Blood eosinophil levels had good stability in patients with COPD with BEC ≥300 cells/µL and was associated with a high risk of exacerbation in the persistent ≥300 cells/μL group. The variability of BEC was higher in patients with COPD with BEC <300 cells/µL.
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Affiliation(s)
- Punchalee Kaenmuang
- Division of Internal Medicine, Respiratory and Respiratory Critical Care Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Asma Navasakulpong
- Division of Internal Medicine, Respiratory and Respiratory Critical Care Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sarayut Lucien Geater
- Division of Internal Medicine, Respiratory and Respiratory Critical Care Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sirikorn Densrisereekul
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Siwasak Juthong
- Division of Internal Medicine, Respiratory and Respiratory Critical Care Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Boonsong T, Nakwan N, Chareonlap C, Kaenmuang P, Kanjanapradit K, Chang A. A 51-Year-Old Woman With Progressive Dyspnea and Diffuse Bilateral Pulmonary Nodules. Chest 2023; 164:e147-e150. [PMID: 37945197 DOI: 10.1016/j.chest.2023.06.003] [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: 04/14/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 11/12/2023] Open
Abstract
CASE PRESENTATION A 51-year-old woman was referred to our hospital with progressive dyspnea on exertion for 2 months after COVID-19 vaccination (ChAdOx1-S [recombinant] vaccine). She did not have a cough, fever, hemoptysis, weight loss, or night sweats. She had no history of arthritis, rash, photosensitivity, or other signs of autoimmune disease. Chest radiograph revealed diffuse ground-glass opacities and bilateral pulmonary nodules. She denied any history of smoking, contact with individuals infected with TB, relevant hobbies, or exposure to domestic animals. She had no relevant medical history, was previously healthy, and worked as a chef.
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Affiliation(s)
- Thitaya Boonsong
- Division of Pulmonology, Department of Internal Medicine, Songkhla, Thailand
| | - Narongwit Nakwan
- Division of Pulmonology, Department of Internal Medicine, Songkhla, Thailand
| | - Cheep Chareonlap
- Department of Anatomical Pathology, Hatyai Hospital, Songkhla, Thailand
| | - Punchalee Kaenmuang
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Songkhla, Thailand
| | - Kanet Kanjanapradit
- Division of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.
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Kaenmuang P, Keeratichananont W, Geater SL, Chantamanee N, Srikaew P. Prevalence, predictors, dynamic bone change, and treatment efficacy of osteoporosis among chronic obstructive pulmonary disease patients: a prospective cohort study. Front Med (Lausanne) 2023; 10:1214277. [PMID: 37614952 PMCID: PMC10442549 DOI: 10.3389/fmed.2023.1214277] [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: 04/29/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Osteoporosis is a silent chronic obstructive pulmonary disease (COPD) comorbidity that is often under-detected. We aimed to study the prevalence and potential predictors of osteoporosis in COPD. Dynamic changes in bone mass density (BMD) and treatment efficacy of bisphosphonate were also assessed. Methods This prospective cohort study included COPD patients between January 2017 and January 2019. Demographics data, spirometric parameters, and C-reactive protein (CRP) were collected. Bone mineral density (BMD) at the lumbar spine (L2-4) and both femoral necks were measured after enrollment and the 12-month follow-up. Participants were categorized into three groups per the baseline BMD T-score: normal (≥ - 1.0), osteopenia (between -1.0 and - 2.5), and osteoporosis (≤ - 2.5). In the osteoporosis group, alendronate 70 mg/week with vitamin D and calcium was prescribed. Results In total, 108 COPD patients were enrolled. The prevalence of osteoporosis and osteopenia were 31.5 and 32.4%, respectively. Advanced age, lower body mass index (BMI), history of exacerbation in the previous year, and high CRP levels were significant predictors of osteoporosis. After 12 months, 35.3% in the osteoporosis group reported new vertebral and femoral fractures, compared to none in the non-osteoporosis group (p < 0.001). In the normal BMD and osteopenia groups showed a further decline in BMD after 12-month. Conversely, the osteoporosis group showed a statistically significant improvement in BMD after anti-resorptive treatment (p < 0.001). Conclusion The prevalence of osteoporosis was high in Thai COPD patients. Advanced age, lower BMI, history of exacerbation, and high CRP levels were potential predictors. A rapid decline in BMD was observed in COPD patients without treatment.
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Affiliation(s)
- Punchalee Kaenmuang
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Warangkana Keeratichananont
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sarayut Lucien Geater
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Nicha Chantamanee
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Piyaporn Srikaew
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Keeratichananont W, Kaenmuang P, Geater SL, Manoret P, Thanapattaraborisuth B. Prevalence, associated factors, and clinical consequences of metabolic syndrome in chronic obstructive pulmonary disease patients: a 5-year prospective observational study. Ther Adv Respir Dis 2023; 17:17534666231167342. [PMID: 37086118 PMCID: PMC10126686 DOI: 10.1177/17534666231167342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by multiple systemic comorbidities, not only airflow limitation. Metabolic syndrome (MetS) is a common comorbidity. Patients with COPD have a higher risk of MetS than do healthy individuals. OBJECTIVES We aimed to investigate the prevalence of and explore the factors associated with MetS in Thai COPD patients and to assess the clinical consequences of MetS after a 5-year follow-up period. METHODS A prospective observational study was conducted in patients with stable COPD at Songklanagarind Hospital between June 2015 and November 2019. MetS was defined according to the International Diabetes Federation 2005 criteria. The patients were followed-up for 5 years. The prevalence, associated factors, and consequences of MetS were analyzed. RESULTS A total of 115 patients with COPD were enrolled, of whom 95.3% were male. The overall prevalence of MetS was 37.4% (43 patients). Chronic bronchitis and high C-reactive protein (CRP) levels were independently and significantly associated with MetS in patients with COPD (p = 0.036 and 0.044, respectively). After following patients for 5 years, the incidence of cardiovascular disease and stroke, exacerbation rate, and mortality rate were significantly higher in the COPD with MetS group [relative risk (RR) = 15.36, 95% confidence interval (CI) = (2.13-110.67), RR = 45.43, 95% CI = (4.61-447.07), RR = 1.94, 95% CI = (1.40-2.70), and RR = 48.01, 95% CI = (1.12-2049.43), respectively]. CONCLUSION The prevalence of MetS is high in patients with COPD. Chronic bronchitis and high CRP levels are associated with MetS in COPD. The incidence of clinical consequences was significantly higher in patients with COPD and MetS after a 5-year follow-up. Screening for MetS is strongly recommended for all patients with COPD.
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Affiliation(s)
- Warangkana Keeratichananont
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Punchalee Kaenmuang
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Sarayut Lucien Geater
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Premanan Manoret
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Kaenmuang P, Navasakulpong A. Efficacy of whole lung lavage in pulmonary alveolar proteinosis: a 20-year experience at a reference center in Thailand. J Thorac Dis 2021; 13:3539-3548. [PMID: 34277049 PMCID: PMC8264701 DOI: 10.21037/jtd-20-3308] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
Background Pulmonary alveolar proteinosis (PAP) is a rare lung syndrome. The current standard treatment is whole lung lavage (WLL). We reviewed PAP cases treated with WLL during a 243-month period. The primary objective was to describe the efficacy of WLL. We compared chest imaging resolution and pulmonary function tests (PaO2 and DLCO) before the first and after the last WLL. The secondary objectives were to compare mMRC dyspnea scores, other lung function parameters, and complications of WLL. Methods We retrospectively reviewed PAP patients from 1 January 2000 to 31 March 2020. Demographic data, pulmonary function tests, and the efficacy of WLL were collected from the electronic medical database and analyzed by descriptive analysis. Differences in data used the student t-test to compare parameters pre- and post-WLL. Results A total of 19 PAP patients and 50 WLL procedures were included. Eleven patients (57.9%) were females and the mean age was 51.5±11.7 years. Dyspnea (100%) and cough (94.7%) were the two leading symptoms. The most common indication for WLL was progressive dyspnea. There were significant improvements in SpO2 from 86% to 94% (P<0.001), PaO2 from 49.3 to 66.1 (P<0.001), DLCO from 31.8% to 52.5% predicted (P=0.013), and the mMRC dyspnea score from 3 to 2 (P<0.001) without major complications. Conclusions WLL is an effective standard treatment for PAP cases. It is safe and can be used as a primary treatment in case of inhaled anti GM-CSF is not available.
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Affiliation(s)
- Punchalee Kaenmuang
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkhla University, Hat Yai, Thailand
| | - Asma Navasakulpong
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkhla University, Hat Yai, Thailand
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Kaenmuang P, Navasakulpong A. Clinical characteristics of anti-MDA5 antibody-positive interstitial lung disease. Respirol Case Rep 2021; 9:e00701. [PMID: 33343905 PMCID: PMC7734424 DOI: 10.1002/rcr2.701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022] Open
Abstract
Clinically amyopathic dermatomyositis (CADM) with anti-melanoma differentiation-associated gene 5 antibody is associated with rapidly progressive interstitial lung disease (RP-ILD) which results in up to 50% mortality, especially within six months of diagnosis. However, limited data are available on this disease. This is the first case series of six patients in Thailand diagnosed with CADM with ILD. All patients presented with respiratory symptoms, such as progressive dyspnoea, dyspnoea on exertion, or cough. High-resolution computed tomography of the chest showed predominantly subpleural and peripheral consolidation in both lower lungs. Four patients had RP-ILD and three of the RP-ILD patients died within seven weeks of diagnosis. These cases illustrate the clinical characteristics, chest imaging, treatments, and clinical outcomes of the patients diagnosed with CADM and ILD.
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Affiliation(s)
- Punchalee Kaenmuang
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of MedicinePrince of Songkhla UniversityHat YaiThailand
| | - Asma Navasakulpong
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of MedicinePrince of Songkhla UniversityHat YaiThailand
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Juthong S, Kaenmuang P. Association between blood eosinophils with exacerbation and patient-reported outcomes in chronic obstructive pulmonary disease patients in an endemic area for parasitic infections: a prospective study. J Thorac Dis 2020; 12:4868-4876. [PMID: 33145060 PMCID: PMC7578515 DOI: 10.21037/jtd-19-4101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/06/2022]
Abstract
Background Eosinophilic chronic obstructive pulmonary disease (COPD) patients have eosinophilic airway inflammation. No prospective study has reported blood eosinophil counts in an endemic area for parasitic infection. The primary objective was to compare exacerbation rates. The secondary objectives were patient-reported outcomes between eosinophilic and non-eosinophilic COPD. Methods A prospective study was conducted in COPD patients for 52 weeks. COPD was diagnosed according to GOLD criteria. Blood eosinophil counts were recorded at study entry. Exacerbations were recorded during the entire study period whereas COPD Assessment Test (CAT) and spirometry were recorded at 12 months. The eosinophilic and non-eosinophilic groups were defined by blood eosinophil counts ≥300 and <300 cells/µL, respectively. Results A total of 145 COPD patients were included. Fifty-eight (40%) and 87 (60%) patients were eosinophilic and non-eosinophilic COPD and the median [interquartile range (IQR)] eosinophil counts were 481 [378.5, 675] and 149 [101.2, 208] cells/µL, respectively. The median (IQR) annual exacerbation rates were 3 [2, 4] and 2 [2, 2.5] times/year in the eosinophilic and non-eosinophilic groups, respectively (P=0.024). The eosinophilic group had higher admissions (P=0.007) but lower mortality (P=0.041). The patient-reported outcomes were not statistically significantly different between the two groups. Eosinophil counts ≥300 cells/µL identified exacerbation in COPD patients with sensitivity and specificity of 0.71 and 0.64, respectively. Conclusions COPD patients with blood eosinophil counts ≥300 cells/µL had more exacerbations and admissions but lower mortality than the non-eosinophilic patients. Blood eosinophil count is an effective biomarker to predict exacerbation risk in endemic parasitic areas. Trial registration NCT04123028 at ClinicalTrials.gov.
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Affiliation(s)
- Siwasak Juthong
- Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Punchalee Kaenmuang
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Kaenmuang P, Navasakulpong A. Short-Term Lung Function Changes and Predictors of Progressive Systemic Sclerosis-Related Interstitial Lung Disease. Tuberc Respir Dis (Seoul) 2020; 83:312-320. [PMID: 32668825 PMCID: PMC7515676 DOI: 10.4046/trd.2020.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/27/2020] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) involves multiple organ systems and has the highest mortality among connective tissue diseases. Interstitial lung disease is the most common cause of death among SSc patients and requires closer studies and follow-ups. This study aimed to identify lung function changes and predictors of progressive disease in systemic sclerosis-related interstitial lung disease (SSc-ILD). METHODS A retrospective study extracted SSc patients from an electronic database January 2002-July 2019. Eligible cases were SSc patients >age 15 diagnosed with SSc-ILD. Factors associated with progressive disease were analyzed by univariate and multivariate logistic regression analyses. RESULTS Seventy-eight SSc-ILD cases were enrolled. Sixty-five patients (83.3%) were female, with mean age of 44.7±14.4, and 50 (64.1%) were diffuse type SSc-ILD. Most SSc-ILD patients had crackles (75.6%) and dyspnea on exertion (71.8%), and 19.2% of the SSc-ILD patients had no abnormal respiratory symptoms but had abnormal chest radiographic findings. The most common diagnosis of SSc-ILD patients was non-specific interstitial pneumonia (43.6%). The lung function values of diffusing capacity of the lung for carbon monoxide (DLCO) and DLCO per unit alveolar volume declined in progressive SSc-ILD during a 12-month follow-up. Male and no previous aspirin treatment were the two significant predictive factors of progressive SSc-ILD with adjusted odds ratios of 5.72 and 4.99, respectively. CONCLUSION This present study showed that short-term lung function had declined during the 12-month follow-up in progressive SSc-ILD. The predictive factors in progressive SSc-ILD were male sex and no previous aspirin treatment. Close follow-up of the pulmonary function tests is necessary for early detection of progressive disease.
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Affiliation(s)
- Punchalee Kaenmuang
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Thailand
| | - Asma Navasakulpong
- Respiratory and Respiratory Critical Care Medicine Unit, Division of Internal Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Thailand
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