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Kaul B, Lee JS, Petersen LA, McCulloch C, Rosas IO, Bandi VD, Zhang N, DeDent AM, Collard HR, Whooley MA. Disparities in Antifibrotic Medication Utilization Among Veterans With Idiopathic Pulmonary Fibrosis. Chest 2023; 164:441-449. [PMID: 36801465 PMCID: PMC10410245 DOI: 10.1016/j.chest.2023.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/11/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Two antifibrotic medications, pirfenidone and nintedanib, are approved for the treatment of idiopathic pulmonary fibrosis (IPF). Little is known about their real-world adoption. RESEARCH QUESTION What are the real-world antifibrotic utilization rates and factors associated with uptake among a national cohort of veterans with IPF? STUDY DESIGN AND METHODS This study identified veterans with IPF who received care either provided by the Veterans Affairs (VA) Healthcare System or non-VA care paid for by the VA. Patients who had filled at least one antifibrotic prescription through the VA pharmacy or Medicare Part D between October 15, 2014, and December 31, 2019, were identified. Hierarchical logistic regression models were used to examine factors associated with antifibrotic uptake, accounting for comorbidities, facility clustering, and follow-up time. Fine-Gray models were used to evaluate antifibrotic use by demographic factors, accounting for the competing risk of death. RESULTS Among 14,792 veterans with IPF, 17% received antifibrotics. There were significant disparities in adoption, with lower uptake associated with female sex (adjusted OR, 0.41; 95% CI, 0.27-0.63; P < .001), Black race (adjusted OR, 0.60; 95% CI, 0.49-0.73; P < .001), and rural residence (adjusted OR, 0.88; 95% CI, 0.80-0.97; P = .012). Veterans who received their index diagnosis of IPF outside the VA were less likely to receive antifibrotic therapy (adjusted OR, 0.15; 95% CI, 0.10-0.22; P < .001). INTERPRETATION This study is the first to evaluate the real-world adoption of antifibrotic medications among veterans with IPF. Overall uptake was low, and there were significant disparities in use. Interventions to address these issues deserve further investigation.
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Affiliation(s)
- Bhavika Kaul
- Department of Medicine, University of California San Francisco, San Francisco, CA; Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Joyce S Lee
- Department of Medicine, University of Colorado, Aurora, CO
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, TX; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Venkata D Bandi
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ning Zhang
- Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Alison M DeDent
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Harold R Collard
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Mary A Whooley
- Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA
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Ayyala U, Raheem S, Triozzi JL, Hunter A, Welch E, Bujarski S, Kao C, Pandit L, Velamuri K, Bandi VD. Implementation of a Virtual Huddle to Support Patient Care During the COVID-19 Pandemic. Fed Pract 2022; 39:e0310. [PMID: 36425807 PMCID: PMC9652024 DOI: 10.12788/fp.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND During a surge of COVID-19 cases, the volume of acute care patients with hypoxemic respiratory failure placed a high burden of responsibility on internal medicine, pulmonary and critical care medicine, and clinical pharmacy services. OBSERVATIONS We describe the COVID-19 Tele-Huddle Program, a novel approach to communication between key stakeholders in COVID-19 patient care through a daily video conferencing huddle. The program was implemented during a 4-week surge in COVID-19 cases at a large, academic medical center in Houston, Texas. Data collected during the COVID-19 Tele-Huddle Program included the type and number of interventions implemented, number of patients discussed, and COVID-19 therapies provided. In addition, hospital medicine team members completed a user-experience survey. CONCLUSIONS A multidisciplinary consultation service using video conferencing can support the care of patients with high disease severity without overwhelming existing inpatient medical, intensive care, and pharmacy services.
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Affiliation(s)
- Uma Ayyala
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | - Shazia Raheem
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | | | | | - Elwyn Welch
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | - Stephen Bujarski
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | - Christina Kao
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | - Lavannya Pandit
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | - Kanta Velamuri
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
| | - Venkata D. Bandi
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston,
Texas
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Agrawal R, Spiegelman AM, Bandi VD, Hirshkowitz M, Sharafkhaneh A. Obstructive sleep apnea in diabetic patients is associated with higher healthcare utilization. Sleep Breath 2022; 26:1817-1820. [DOI: 10.1007/s11325-021-02552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
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Zhou H, Park C, Poursina O, Zahiri M, Nguyen H, Ruiz IT, Nguyen CK, Bryant MS, Sharafkhaneh A, Bandi VD, Najafi B. Harnessing Digital Health to Objectively Assess Functional Performance in Veterans with Chronic Obstructive Pulmonary Disease. Gerontology 2022; 68:829-839. [PMID: 34844245 PMCID: PMC9148378 DOI: 10.1159/000520401] [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: 07/19/2021] [Accepted: 10/22/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION An early detection of impaired functional performance is critical to enhance symptom management for patients with chronic obstructive pulmonary disease (COPD). However, conventional functional measures based on walking assessments are often impractical for small clinics where the available space to administrate gait-based test is limited. This study examined the feasibility and effectiveness of an upper-extremity frailty meter (FM) in identifying digital measures of functional performance and assessing frailty in COPD patients. METHODS Forty-eight patients with COPD (age = 68.8 ± 8.5 years, body mass index [BMI] = 28.7 ± 5.8 kg/m2) and 49 controls (age = 70.0 ± 3.0 years, BMI = 28.7 ± 6.1 kg/m2) were recruited. All participants performed a 20-s repetitive elbow flexion-extension test using a wrist-worn FM sensor. Functional performance was quantified by FM metrics, including speed (slowness), range of motion (rigidity), power (weakness), flexion and extension time (slowness), as well as speed and power reduction (exhaustion). Conventional functional measures, including timed-up-and-go test, gait and balance tests, and 5 repetition sit-to-stand test, were also performed. RESULTS Compared to controls, COPD patients exhibited deteriorated performances in all conventional functional assessments (d = 0.64-1.26, p < 0.010) and all FM metrics (d = 0.45-1.54, p < 0.050). FM metrics had significant agreements with conventional assessment tools (|r| = 0.35-0.55, p ≤ 0.001). FM metrics efficiently identified COPD patients with pre-frailty and frailty (d = 0.82-2.12, p < 0.050). CONCLUSION This study proposes the feasibility of using a 20-s repetitive elbow flexion-extension test and wrist-worn sensor-derived frailty metrics as an alternative and practical solution to evaluate functional performance in COPD patients. Its simplicity and low risk for test administration may also facilitate its application for remote patient monitoring. Furthermore, in settings where the administration of walking test is impractical, for example, when ventilator support is needed or space is limited, FM may be used as an alternative solution. Future studies are encouraged to use the FM to quantitatively monitor the progressive decline in functional performance and quantify outcomes of rehabilitation interventions.
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Affiliation(s)
- He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA,Shenzhen Dengding Biopharma Co., Ltd., Shenzhen, Guangdong, China,Shenzhen Mass Medical Co., Ltd., Shenzhen, Guangdong, China
| | - Catherine Park
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Olia Poursina
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mohsen Zahiri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Hung Nguyen
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ilse Torres Ruiz
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christina K. Nguyen
- Telehealth Cardio-Pulmonary Rehabilitation program, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Mon S. Bryant
- Telehealth Cardio-Pulmonary Rehabilitation program, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Amir Sharafkhaneh
- Telehealth Cardio-Pulmonary Rehabilitation program, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas, USA,Pulmonary, Critical Medicine and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Venkata D Bandi
- Pulmonary, Critical Medicine and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Agrawal R, Jones MB, Spiegelman AM, Bandi VD, Hirshkowitz M, Sharafkhaneh A. Presence of obstructive sleep apnea is associated with higher future readmissions and outpatient visits-a nationwide administrative dataset study. Sleep Med 2021; 89:60-64. [PMID: 34906781 DOI: 10.1016/j.sleep.2021.10.034] [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: 05/03/2021] [Revised: 08/05/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital readmissions and outpatient visits contribute to the significant burden on healthcare systems. Obstructive sleep apnea (OSA) is a chronic medical condition that is associated with cardiovascular comorbidities and other chronic conditions. Inpatient and outpatient healthcare utilization rates in patients with OSA following hospitalization are unclear. METHODS This. retrospective case-control cohort study utilized a nationwide database to assess if OSA is associated with higher healthcare utilization post-hospitalization. We compared healthcare utilization among patients with OSA versus without OSA between 2009 and 2014 after matching for demographic variables, geographic location, hospital environment, reason for admission, and severity of illness during hospitalization. We measured future healthcare utilization by the number of ICU admissions, hospital admissions, emergency room visits, and outpatient visits after being discharged from the index hospitalization. RESULTS Two equal-sized cohorts comprised of 85,912 matched pairs were obtained. The OSA cohort demonstrated significantly higher rates of future ICU admissions, hospital admissions, emergency room visits, and outpatient visits. Matching for comorbid cardiovascular conditions continued to demonstrate higher healthcare utilization in the OSA group. Short-term outcomes during the index hospitalization were relatively similar between groups. CONCLUSIONS This retrospective database study demonstrated that OSA may be an independent marker of higher future healthcare utilization. On the other hand, the length of stay during the index hospitalization was not elevated. Prospective studies are needed to confirm these findings and investigate the impact of directing additional resources to inpatients with OSA.
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Affiliation(s)
- Ritwick Agrawal
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Melissa B Jones
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Venkata D Bandi
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Max Hirshkowitz
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amir Sharafkhaneh
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
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Agrawal R, Spiegelman AM, Bandi VD, Hirshkowitz M, Sharafkhaneh A. Healthcare utilization after elective surgery in patients with obstructive sleep apnea - analysis of a nationwide data set. Sleep Med 2021; 81:294-299. [PMID: 33744518 DOI: 10.1016/j.sleep.2021.02.044] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obstructive sleep apnea is prevalent among those undergoing elective surgery and likely introduces a risk of adverse outcomes. To understand its impact, we aimed to compare healthcare utilization in postsurgical patients with obstructive sleep apnea compared to controls matched on the surgical care environment. METHODS This is a retrospective case-control cohort study using a nationwide database. Among patients undergoing elective surgical procedures during 2009-2014, we compared patients with obstructive sleep apnea with those without obstructive sleep apnea. The two cohorts were matched based on age, sex, type of surgery, performing surgeon, the hospital where the procedure was performed, and various All-Patient-Refined Diagnosis-Related-Groups severity indices. The primary effect of interest was short-term healthcare utilization. We also compared long-term hospital admissions, intensive care unit admissions, emergency room visits and outpatient visits. RESULTS 47,719 subjects and controls were matched on a 1:1 basis. As the subjects were matched, the two groups did not differ on age, percent female, and various Diagnosis-Related-Groups severity indices. The obstructive sleep apnea group had more comorbid conditions and a higher Elixhauser index. Short-term healthcare utilization measured by the length of stay and mortality related to index procedure did not increase in the sleep apnea group. In hierarchical logistical regression analysis, the presence of sleep apnea predicted higher long-term health care utilization. CONCLUSIONS Our data suggests that the presence of sleep apnea was not associated with increased post elective surgical length of stay and mortality; however, the presence of obstructive sleep apnea was associated with long-term health care utilization.
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Affiliation(s)
- Ritwick Agrawal
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
| | | | - Venkata D Bandi
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Max Hirshkowitz
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amir Sharafkhaneh
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
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Bryant MS, Bandi VD, Nguyen CK, Lan C, Henson HK, Sharafkhaneh A. Telehealth Pulmonary Rehabilitation for Patients With Severe Chronic Obstructive Pulmonary Disease. Fed Pract 2019; 36:430-435. [PMID: 31571812 PMCID: PMC6752812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
For patients with chronic obstructive pulmonary disease, a home-based, interactive telehealth program can improve accessibility to pulmonary rehabilitation and reduce travel costs.
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Affiliation(s)
- Mon S Bryant
- is a Registered Physical Therapist; is a Registered Respiratory Therapist; , and are Physicians; all at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Mon Bryant is an Assistant Professor; Charles Lan and Helene Henson are Associate Professors; Venkata Bandi and Amir Sharafkhaneh are Professors; all at Baylor College of Medicine in Houston
| | - Venkata D Bandi
- is a Registered Physical Therapist; is a Registered Respiratory Therapist; , and are Physicians; all at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Mon Bryant is an Assistant Professor; Charles Lan and Helene Henson are Associate Professors; Venkata Bandi and Amir Sharafkhaneh are Professors; all at Baylor College of Medicine in Houston
| | - Christina K Nguyen
- is a Registered Physical Therapist; is a Registered Respiratory Therapist; , and are Physicians; all at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Mon Bryant is an Assistant Professor; Charles Lan and Helene Henson are Associate Professors; Venkata Bandi and Amir Sharafkhaneh are Professors; all at Baylor College of Medicine in Houston
| | - Charlie Lan
- is a Registered Physical Therapist; is a Registered Respiratory Therapist; , and are Physicians; all at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Mon Bryant is an Assistant Professor; Charles Lan and Helene Henson are Associate Professors; Venkata Bandi and Amir Sharafkhaneh are Professors; all at Baylor College of Medicine in Houston
| | - Helene K Henson
- is a Registered Physical Therapist; is a Registered Respiratory Therapist; , and are Physicians; all at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Mon Bryant is an Assistant Professor; Charles Lan and Helene Henson are Associate Professors; Venkata Bandi and Amir Sharafkhaneh are Professors; all at Baylor College of Medicine in Houston
| | - Amir Sharafkhaneh
- is a Registered Physical Therapist; is a Registered Respiratory Therapist; , and are Physicians; all at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Mon Bryant is an Assistant Professor; Charles Lan and Helene Henson are Associate Professors; Venkata Bandi and Amir Sharafkhaneh are Professors; all at Baylor College of Medicine in Houston
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Guntupalli KK, Reddy RM, Loutfi RH, Alapat PM, Bandi VD, Hanania NA. Evaluation of obstructive lung disease with vibration response imaging. J Asthma 2009; 45:923-30. [PMID: 19085584 DOI: 10.1080/02770900802395496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As optimal treatment and prognosis differ between asthma and COPD, a new diagnostic approach to differentiating between the two disorders would be clinically desirable. We evaluated the utility of vibration response imaging in differentiating between asthma and COPD. Sixty-six subjects with asthma or COPD were recorded, before and after the administration of a short-acting bronchodilator, using a computerized lung sound analysis device. Gray-scale images of breath sound distribution in the lungs, quantitative data in breath sound graphs (timing, amplitude) and automatic crackle and wheeze detection programs were used to differentiate between asthma and COPD subjects. Imaging data were compared with the clinical diagnosis, made by the standard methods (medical history, physical examination, and spirometric indices). Blinded evaluation of images demonstrated a significantly higher rate of improvement in image dynamics, shape and overall improvement following bronchodilator in subjects with asthma compared with those with COPD. Quantitative data showed distinct patterns in timing and amplitude for these two pathologies. Combined analyses based on qualitative image evaluation and quantitative data demonstrated an overall 85% accuracy (84% for asthma, 86% for COPD) in differentiating between asthma and COPD. Combined qualitative and quantitative evaluations of lung sounds are quite sensitive in distinguishing between lung sound recordings of COPD and asthma individuals. Lung sound features of synchronization in timing and intensity provide objective data that may further differentiate these two airway disorders.
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Affiliation(s)
- Kalpalatha K Guntupalli
- Baylor College of Medicine, Ben Taub General Hospital, 1504 Taub Loop, Houston, Texas 77030, USA.
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Guntupalli KK, Alapat PM, Bandi VD, Kushnir I. Validation of automatic wheeze detection in patients with obstructed airways and in healthy subjects. J Asthma 2009; 45:903-7. [PMID: 19085580 DOI: 10.1080/02770900802386008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Computerized lung-sound analysis is a sensitive and quantitative method to identify wheezing by its typical pattern on spectral analysis. We evaluated the accuracy of the VRI, a multi-sensor, computer-based device with an automated technique of wheeze detection. The method was validated in 100 sound files from seven subjects with asthma or chronic obstructive pulmonary disease and seven healthy subjects by comparison of auscultation findings, examination of audio files, and computer detection of wheezes. Three blinded physicians identified 40 sound files with wheezes and 60 sound files without wheezes. Sensitivity and specificity were 83% and 85%, respectively. Negative predictive value and positive predictive value were 89% and 79%, respectively. Overall inter-rater agreement was 84%. False positive cases were found to contain sounds that simulate wheezes, such as background noises with high frequencies or strong noises from the throat that could be heard and identified without a stethoscope. The present findings demonstrate that the wheeze detection algorithm has good accuracy, sensitivity, specificity, negative predictive value and positive predictive value for wheeze detection in regional analyses with a single sensor and multiple sensors. Results are similar to those reported in the literature. The device is user-friendly, requires minimal patient effort, and, distinct from other devices, it provides a dynamic image of breath sound distribution with wheeze detection output in less than 1 minute.
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Affiliation(s)
- Kalpalatha K Guntupalli
- Baylor College of Medicine, Ben Taub General Hospital, 1504 Taub Loop, Houston, Texas 77030, USA.
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Abstract
Acute respiratory failure can be the result of a variety of clinical conditions, such as congestive heart failure, pneumonia, pulmonary embolism, exacerbation of obstructive lung diseases, and acute respiratory distress syndrome (ARDS). This article focuses on developments related to acute lung injury and ARDS and reviews epidemiology, pathogenesis and therapeutic advances with an emphasis on the obstetric population. A brief discussion of tocolytic-induced pulmonary edema, preeclampsia, venous air embolism, and aspiration-related ARDS is included. Management of pregnant women with ARDS is outlined.
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Affiliation(s)
- Venkata D Bandi
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Munnur U, Karnad DR, Suresh MS, Bandi VD, Lapsia V, Ramshesh P, Guntupalli KK. Critical Care Resource Utilization and Outcomes of Obstetric Patients in an American and an Indian Public Hospita. Chest 2003. [DOI: 10.1378/chest.124.4_meetingabstracts.183s-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Atmar RL, Guy E, Guntupalli KK, Zimmerman JL, Bandi VD, Baxter BD, Greenberg SB. Respiratory tract viral infections in inner-city asthmatic adults. Arch Intern Med 1998; 158:2453-9. [PMID: 9855383 DOI: 10.1001/archinte.158.22.2453] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Respiratory tract viral infections (RTVIs) have been identified frequently in association with asthma exacerbations in children, but few studies have shown similar rates of viral infections in adults with asthma. Further studies using newer diagnostic techniques to evaluate the frequency of RTVIs in adults with acute exacerbations of asthma need to be performed. METHODS Twenty-nine asthmatic adults were recruited from the pulmonary clinic of an urban county hospital and were followed up in a longitudinal cohort study for signs and symptoms of asthma and RTVI. One hundred twenty-two asthmatic adults presenting to the emergency department (ED) of the same hospital with acute symptoms of asthma underwent evaluation for RTVI in a cross-sectional prevalence study. In both studies, respiratory secretions and paired serum samples were collected from subjects with acute wheezing episodes and evaluated using virus culture, serologic testing, and reverse transcription-polymerase chain reaction (RT-PCR). RESULTS In the longitudinal cohort study, 138 respiratory illnesses, of which 87 were asthma exacerbations, were evaluated; 41% of all illnesses and 44% of asthma exacerbations were associated with an RTVI. In the ED study, 148 asthma exacerbations were evaluated; 55% were associated with an RTVI. An RTVI was identified in 21 (50%) of 42 of the subjects hospitalized in the ED study. Picornaviruses (rhinoviruses), coronaviruses, and influenza viruses were the most commonly identified causes of RTVI. Forty-six (60%) of the 77 picornavirus infections and 22 (71%) of the 31 coronavirus infections were identified only using RT-PCR. CONCLUSIONS Asthmatic exacerbations in adults are frequently associated with an RTVI. Identification of such infections often requires newer diagnostic methods, such as virus-specific RT-PCR. The high frequency of RTVIs identified in association with asthmatic exacerbations in adults from the inner city suggests that strategies for the prevention of RTVI should be targeted toward this population.
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Affiliation(s)
- R L Atmar
- Department of Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, Tex, 77030, USA
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