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Collaro AJ, Foong R, Chang AB, Marchant JM, Blake TL, Cole JF, Pearson G, Hii R, Brown H, Chatfield MD, Hall G, McElrea MS. Which reference equation should we use for interpreting spirometry values for First Nations Australians? A cross-sectional study. Med J Aust 2024. [PMID: 38741358 DOI: 10.5694/mja2.52306] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/11/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To evaluate the suitability of the Global Lung Function Initiative (GLI)-2012 other/mixed and GLI-2022 global reference equations for evaluating the respiratory capacity of First Nations Australians. DESIGN, SETTING Cross-sectional study; analysis of spirometry data collected by three prospective studies in Queensland, the Northern Territory, and Western Australia between March 2015 and December 2022. PARTICIPANTS Opportunistically recruited First Nations participants in the Indigenous Respiratory Reference Values study (Queensland, Northern Territory; age, 3-25 years; 18 March 2015 - 24 November 2017), the Healthy Indigenous Lung Function Testing in Adults study (Queensland, Northern Territory; 18 years or older; 14 August 2019 - 15 December 2022) and the Many Healthy Lungs study (Western Australia; five years or older; 10 October 2018 - 7 November 2021). MAIN OUTCOME MEASURES Goodness of fit to spirometry data for each GLI reference equation, based on mean Z-score and its standard deviation, and proportions of participants with respiratory parameter values within 1.64 Z-scores of the mean value. RESULTS Acceptable and repeatable forced expiratory volume in the first second (FEV1) values were available for 2700 First Nations participants in the three trials; 1467 were classified as healthy and included in our analysis (1062 children, 405 adults). Their median age was 12 years (interquartile range, 9-19 years; range, 3-91 years), 768 (52%) were female, and 1013 were tested in rural or remote areas (69%). Acceptable and repeatable forced vital capacity (FVC) values were available for 1294 of the healthy participants (88%). The GLI-2012 other/mixed and GLI-2022 global equations provided good fits to the spirometry data; the race-neutral GLI-2022 global equation better accounted for the influence of ageing on FEV1 and FVC, and of height on FVC. Using the GLI-2012 other/mixed reference equation and after adjusting for age, sex, and height, mean FEV1 (estimated difference, -0.34; 95% confidence interval [CI], -0.46 to -0.22) and FVC Z-scores (estimated difference, -0.45; 95% CI, -0.59 to -0.32) were lower for rural or remote than for urban participants, but their mean FEV1/FVC Z-score was higher (estimated difference, 0.14; 95% CI, 0.03-0.25). CONCLUSION The normal spirometry values of healthy First Nations Australians may be substantially higher than previously reported. Until more spirometry data are available for people in urban areas, the race-neutral GLI-2022 global or the GLI-2012 other/mixed reference equations can be used when assessing the respiratory function of First Nations Australians.
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Affiliation(s)
- Andrew J Collaro
- Queensland Hospital and Health Service, Brisbane, QLD
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
| | - Rachel Foong
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA
- Telethon Kids Institute, University of Western Australia, Perth
| | - Anne B Chang
- Queensland Hospital and Health Service, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
| | - Julie M Marchant
- Queensland Hospital and Health Service, Brisbane, QLD
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
| | - Tamara L Blake
- Child Health Research Centre, University of Queensland, Brisbane, QLD
| | | | - Glenn Pearson
- Telethon Kids Institute, University of Western Australia, Perth
| | - Rebecca Hii
- Telethon Kids Institute, University of Western Australia, Perth
- St John of God Midland Public and Private Hospitals, Midland, WA
| | - Henry Brown
- Telethon Kids Institute, University of Western Australia, Perth
| | - Mark D Chatfield
- Child Health Research Centre, University of Queensland, Brisbane, QLD
| | - Graham Hall
- Telethon Kids Institute, University of Western Australia, Perth
| | - Margaret S McElrea
- Queensland Hospital and Health Service, Brisbane, QLD
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
- Menzies School of Health Research, Darwin, NT
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Howarth T, Gibbs C, Heraganahally SS, Abeyaratne A. Hospital admission rates and related outcomes among adult Aboriginal australians with bronchiectasis - a ten-year retrospective cohort study. BMC Pulm Med 2024; 24:118. [PMID: 38448862 PMCID: PMC10918854 DOI: 10.1186/s12890-024-02909-x] [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: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND This study assessed hospitalisation frequency and related clinical outcomes among adult Aboriginal Australians with bronchiectasis over a ten-year study period. METHOD This retrospective study included patients aged ≥ 18 years diagnosed with bronchiectasis between 2011 and 2020 in the Top End, Northern Territory of Australia. Hospital admissions restricted to respiratory conditions (International Classification of Diseases (ICD) code J) and relevant clinical parameters were assessed and compared between those with and without hospital admissions. RESULTS Of the 459 patients diagnosed to have bronchiectasis, 398 (87%) recorded at least one respiratory related (ICD-J code) hospitalisation during the 10-year window. In comparison to patients with a recorded hospitalisation against those without-hospitalised patients were older (median 57 vs 53 years), predominantly females (54 vs 46%), had lower body mass index (23 vs 26 kg/m2) and had greater concurrent presence of chronic obstructive pulmonary disease (COPD) (88 vs 47%), including demonstrating lower spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) (median FVC 49 vs 63% & FEV1 36 vs 55% respectively)). The total hospitalisations accounted for 3,123 admissions (median 4 per patient (IQR 2, 10)), at a median rate of 1 /year (IQR 0.5, 2.2) with a median length of 3 days (IQR 1, 6). Bronchiectasis along with COPD with lower respiratory tract infection (ICD code-J44) was the most common primary diagnosis code, accounting for 56% of presentations and 46% of days in hospital, which was also higher for patients using inhaled corticosteroids (81 vs 52%, p = 0.007). A total of 114 (29%) patients were recorded to have had an ICU admission, with a higher rate, including longer hospital stay among those patients with bronchiectasis and respiratory failure related presentations (32/35, 91%). In multivariate regression model, concurrent presence of COPD or asthma alongside bronchiectasis was associated with shorter times between subsequent hospitalisations (-423 days, p = 0.007 & -119 days, p = 0.02 respectively). CONCLUSION Hospitalisation rates among adult Aboriginal Australians with bronchiectasis are high. Future interventions are required to explore avenues to reduce the overall morbidity associated with bronchiectasis among Aboriginal Australians.
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Affiliation(s)
- Timothy Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Claire Gibbs
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, NT, Australia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia.
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, NT, Australia.
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia.
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Ivey MA, Smith SM, Benke G, Toelle BG, Hunter ML, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Abramson MJ. COPD in Never-Smokers: BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2024; 19:161-174. [PMID: 38249822 PMCID: PMC10800088 DOI: 10.2147/copd.s439307] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio Conclusion COPD was prevalent in this population of never-smokers aged 40 years and over. This finding highlights the significance of risk factors other than smoking in the development of COPD.
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Affiliation(s)
- Marsha A Ivey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sheree M Smith
- School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Brett G Toelle
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Michael L Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia
| | - Graeme P Maguire
- Curtin Medical School, Curtin University, Perth, WA, 6102, Australia
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Craig S, Delardes B, Nehme Z, Wilson C, Dalziel S, Nixon GM, Powell C, Graudins A, Babl FE. Acute paediatric asthma treatment in the prehospital setting: a retrospective observational study. BMJ Open 2023; 13:e073029. [PMID: 37349099 PMCID: PMC10314617 DOI: 10.1136/bmjopen-2023-073029] [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: 02/21/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES To describe the incidence of and patterns of 'escalated care' (care in addition to standard treatment with systemic corticosteroids and inhaled bronchodilators) for children receiving prehospital treatment for asthma. DESIGN Retrospective observational study. SETTING State-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population 6.5 million) PARTICIPANTS: Children aged 1-17 years and given a final diagnosis of asthma by the treating paramedics and/or treated with inhaled bronchodilators from 1 July 2019 to 30 June 2020. PRIMARY AND SECONDARY OUTCOME MEASURES We classified 'escalation of care' as parenteral administration of epinephrine, or provision of respiratory support. We compared clinical, demographic and treatments administered between those receiving and not receiving escalation of care. RESULTS Paramedics attended 1572 children with acute exacerbations of asthma during the 1 year study period. Of these, 22 (1.4%) had escalated care, all receiving parenteral epinephrine. Patients with escalated care were more likely to be older, had previously required hospital admission for asthma and had severe respiratory distress at initial assessment.Of 1307 children with respiratory status data available, at arrival to hospital, the respiratory status of children had improved overall (normal/mild respiratory distress at initial assessment 847 (64.8%), normal/mild respiratory distress at hospital arrival 1142 (87.4%), p<0.0001). CONCLUSIONS Most children with acute exacerbations of asthma did not receive escalated therapy during their pre-hospital treatment from ambulance paramedics. Most patients were treated with inhaled bronchodilators only and clinically improved by the time they arrived in hospital.
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Affiliation(s)
- Simon Craig
- Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Belinda Delardes
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Ziad Nehme
- Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Wilson
- Emergency Medicine Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Research Group, PREDICT Network, Melbourne, Victoria, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand
- Paediatrics and Surgery, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Gillian M Nixon
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Respiratory Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Colin Powell
- Department of Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
- Cardiff School of Health Sciences, Cardiff, UK
| | - Andis Graudins
- Dandenong Emergency Department, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Dandenong, Victoria, Australia
| | - Franz E Babl
- Emergency Medicine Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Melbourne, Victoria, Australia
- Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
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Xu J, Xu X, Jiang L, Dua K, Hansbro PM, Liu G. SARS-CoV-2 induces transcriptional signatures in human lung epithelial cells that promote lung fibrosis. Respir Res 2020; 21:182. [PMID: 32664949 PMCID: PMC7359430 DOI: 10.1186/s12931-020-01445-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [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: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS)-CoV-2-induced coronavirus disease-2019 (COVID-19) is a pandemic disease that affects > 2.8 million people worldwide, with numbers increasing dramatically daily. However, there is no specific treatment for COVID-19 and much remains unknown about this disease. Angiotensin-converting enzyme (ACE)2 is a cellular receptor of SARS-CoV-2. It is cleaved by type II transmembrane serine protease (TMPRSS)2 and disintegrin and metallopeptidase domain (ADAM)17 to assist viral entry into host cells. Clinically, SARS-CoV-2 infection may result in acute lung injury and lung fibrosis, but the underlying mechanisms of COVID-19 induced lung fibrosis are not fully understood. METHODS The networks of ACE2 and its interacting molecules were identified using bioinformatic methods. Their gene and protein expressions were measured in human epithelial cells after 24 h SARS-CoV-2 infection, or in existing datasets of lung fibrosis patients. RESULTS We confirmed the binding of SARS-CoV-2 and ACE2 by bioinformatic analysis. TMPRSS2, ADAM17, tissue inhibitor of metalloproteinase (TIMP)3, angiotensinogen (AGT), transformation growth factor beta (TGFB1), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF) A and fibronectin (FN) were interacted with ACE2, and the mRNA and protein of these molecules were expressed in lung epithelial cells. SARS-CoV-2 infection increased ACE2, TGFB1, CTGF and FN1 mRNA that were drivers of lung fibrosis. These changes were also found in lung tissues from lung fibrosis patients. CONCLUSIONS Therefore, SARS-CoV-2 binds with ACE2 and activates fibrosis-related genes and processes to induce lung fibrosis.
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Affiliation(s)
- Jincheng Xu
- School of Stomatology, Bengbu Medical College, Bengbu, 2033, Anhui, China
| | - Xiaoyue Xu
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, 233000, NSW, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Lina Jiang
- School of Stomatology, Bengbu Medical College, Bengbu, 2033, Anhui, China
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
- Centre for Inflammation, Centenary Institute, Camperdown, NSW, 2050, Australia
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute, Camperdown, NSW, 2050, Australia
- School of Life Science, Faculty of Science, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Gang Liu
- Centre for Inflammation, Centenary Institute, Camperdown, NSW, 2050, Australia.
- School of Life Science, Faculty of Science, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
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