Pulmonary outcome in former preterm, very low birth weight children with bronchopulmonary dysplasia: a case-control follow-up at school age

OBJECTIVE

To assess and compare long-term pulmonary outcomes in former preterm-born, very low birth weight (VLBW) children with and without bronchopulmonary dysplasia (BPD) born in the surfactant era.

STUDY DESIGN

Pulmonary function tests (ie, spirometry, body plethysmography, and gas transfer testing) were performed in children with a history of VLBW and BPD (n = 28) and compared with a matched preterm-born VLBW control group (n = 28). Medical history was evaluated by questionnaire.

RESULTS

At time of follow-up (mean age, 9.5 years), respiratory symptoms (36% vs 8%) and receipt of asthma medication (21% vs 0%) were significantly more frequent in the preterm-born children with previous BPD than in those with no history of BPD. The children with a history of BPD had significantly lower values for forced expiratory volume in 1 second (z-score -1.27 vs -0.4; P = .008), forced vital capacity (z-score -1.39 vs -0.71 z-score; P = .022), and forced expiratory flow rate at 50% of forced vital capacity (z-score -2.21 vs -1.04; P = .048) compared with the preterm control group.

CONCLUSION

Preterm-born children with a history of BPD are significantly more likely to have lung function abnormalities, such as airway obstruction and respiratory symptoms, at school age compared with preterm-born children without BPD.

Probability of treatment following acute decline in lung function in children with cystic fibrosis is related to baseline pulmonary function

OBJECTIVE

To determine whether the association between high forced expiratory volume in 1 second (FEV1) and increased rate of decline in FEV1 in children with cystic fibrosis could be due to less frequent intervention after acute declines (sudden decline events) in FEV1.

STUDY DESIGN

Patients with cystic fibrosis aged 6-17 years enrolled in the Epidemiologic Study of Cystic Fibrosis were assessed for a sudden decline event, defined as a 10% relative decline in FEV1% predicted from an average of 3 consecutive stable baseline spirometries. The likelihood of therapeutic intervention within 14 days before and 56 days after this event was then related to their baseline FEV1% predicted age-specific decile using a logistic regression adjusting for age group (6-12 years, 13-17 years) and presence of Pseudomonas aeruginosa on respiratory culture.

RESULTS

A total of 10 888 patients had at least 1 sudden decline event in FEV1. Patients in the highest FEV1 decile were significantly less likely than those in the lowest decile to receive intravenous antibiotics (OR, 0.14; 95% CI, 0.11-0.18; P < .001) or be hospitalized (OR, 0.18; 95% CI, 0.14-0.23; P < .001) following decline.

CONCLUSIONS

Children and adolescents with high baseline lung function are less likely to receive a therapeutic intervention following an acute decline in FEV1, which may explain their greater rate of FEV1 decline.

Stimulated nitric oxide production and arginine deficiency in children with cystic fibrosis with nutritional failure

OBJECTIVE

To determine whether upregulated whole body de novo arginine synthesis and protein breakdown are present as a compensatory mechanism to meet the increased demand for arginine and nitric oxide (NO) production in pediatric patients with cystic fibrosis (CF) and nutritional failure.

STUDY DESIGN

In 16 children with CF, studied at the end of antibiotic treatment for a pulmonary exacerbation, and 17 healthy controls, whole body arginine, citrulline (Cit), and protein turnover were assessed by stable isotope methodology and de novo arginine synthesis, arginine clearance, NO synthesis, protein synthesis and breakdown, and net protein balance were calculated. The plasma isotopic enrichments and amino acid concentrations were measured by liquid chromatography-tandem mass spectrometry.

RESULTS

Increased arginine clearance was found in patients with CF (P < .001), whereas whole body NO production rate and plasma arginine levels were not different. Whole body arginine production (P < .001), de novo arginine synthesis, and protein breakdown and synthesis (P < .05) were increased in patients with CF, but net protein balance was comparable. Patients with CF with nutritional failure (n = 7) had significantly higher NO production (P < .05), de novo arginine synthesis, Cit production (P < .001), and plasma Cit concentration (P < .05) and lower plasma arginine concentration (P < .05) than those without nutritional failure (n = 9).

CONCLUSIONS

Nutritional failure in CF is associated with increased NO production. However, up-regulation of de novo arginine synthesis and Cit production was not sufficient to meet the increased arginine needs leading to arginine deficiency.

Early Post-Transplantation Spirometry Is Associated with the Development of Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Cell Transplantation

Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (allo-HCT) is often diagnosed at a late stage when lung dysfunction is severe and irreversible. Identifying patients early after transplantation may offer improved strategies for early detection that could avert the morbidity and mortality of BOS. This study aimed to determine whether a decline in lung function before and early after (days +80 to +100) allo-HCT are associated with a risk of BOS beyond 6 months post-transplantation. In a single-center cohort of 2941 allo-HCT recipients, 186 (6%) met National Institutes of Health criteria for BOS. Pretransplantation and post-transplantation day +80 spirometric parameters were analyzed as continuous variables and included in a multivariable model with other factors, including donor source, graft source, conditioning regimen, use of total body irradiation, and immunoglobulin levels. Pre-transplantation forced expiratory flow between 25% and 75% of maximum (FEF_25-75), day +80 forced expiratory volume in 1 second (FEV₁), and day +80 FEF_25-75 had the strongest associations with increased risk of BOS. Assessment of the multivariable model showed that a decline in day +80 FEF_25-75 added additional risk to the day +80 FEV₁ model (P = .03), whereas FEV₁ decline at day +80 added no additional risk to the day +80 FEF_25-75 model (P = .645). Moreover, day +80 FEF_25-75 conferred additional risk when considered with pretransplantation FEF_25-75. These results suggest that day +80 FEF_25-75 may be more important than FEV₁ in predicting the development of BOS. This study highlights the importance of obtaining early post-transplantation pulmonary function tests for the potential risk stratification of patients at risk for BOS.

Risk factors for depression in patients with chronic obstructive pulmonary disease

BACKGROUND

The prevalence of depression in patients with chronic obstructive pulmonary disease (COPD) ranges from 10% to 42%, but the diagnosis of depression in patients with COPD is often unrecognized and untreated. Unrecognized depression has major implications for compliance with medical treatment, prolonged lengths of stay, increased frequency of hospital admissions, and increased consultations with primary care physicians. Many studies have attempted to identify risk factors for progression, prognosis and response to therapy in patients with depression. However, few studies have examined the risk factors for depression in patients with COPD, and some results remain controversial.

AIM

To identify the potential risk factors to define patients with COPD who are at "high risk" of depression.

METHODS

The clinical data of 293 patients with COPD were reviewed from January 2017 to December 2018. The correlations between demographics, clinical characteristics and depression were analyzed. The risk factors for depression in patients with COPD were identified by multivariate logistic regression analysis. The cutoff value, sensitivity and specificity of the independent correlation factors were calculated with a receiver operating characteristic curve.

RESULTS

Of the 293 patients included, 65 (22.18%) individuals were identified to have depression. Significant differences were detected between patients with and without depression in terms of body mass index (BMI), forced expiratory volume in 1 s (FEV1), and COPD assessment test (CAT) score (all P < 0.05). Low BMI, low FEV1, and high CAT were independent risk factors for depression in patients with COPD and the cutoff values of BMI, FEV1, and CAT scores were 21.373 kg/m2, 0.855 L and 12.5, respectively.

CONCLUSION

Low BMI, low FEV1, and high CAT score were identified as independent risk factors for depression in patients with COPD.

Effects of influenza vaccination on clinical outcomes of chronic obstructive pulmonary disease: A systematic review and meta-analysis

PURPOSE

Influenza is a threat to patients with chronic obstructive pulmonary disease (COPD), influenza vaccination help to reduce incidence of influenza infection, however, whether it is beneficial to COPD patients in clinical outcomes lacks for evidence due to limited studies and participations.

METHODS

We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) and China Science and Technology Journal Database (CSTJ) to retrieve eligible studies regardless of study design published before August 2020, and conducted meta-analysis with odds ratio (OR) and mean difference (MD). The quality of included studies and pooled evidences were assessed. Narrative summaries were provided where data were insufficient for meta-analysis.

RESULTS

2831 COPD patients were included, the pooled results showed that influenza vaccination reduced the exacerbations (P = 0.0001) and trends of hospitalizations (P = 0.09) in COPD patients. Further subgroup analysis showed that the reduction of exacerbations and hospitalizations were significant in patients with FEV₁<50 % predicted (P = 0.01 and P < 0.0001 respectively), but not in those with FEV₁≥50 % predicted (P = 0.23 and P = 0.76 respectively). No significant effect of influenza vaccination on all-cause mortality was observed.

CONCLUSIONS

Our findings support a protective role of influenza vaccination in COPD patients, a yearly influenza vaccination should be strongly recommended for all COPD patients, especially those with severe airflow limitation, to reduce possible influenza infection, and thus associated exacerbations and hospitalizations.

Electronic home monitoring of children with cystic fibrosis to detect and treat acute pulmonary exacerbations and its effect on 1-year FEV1

BACKGROUND

We aimed to investigate the effect of the use of electronic home spirometry in children with cystic fibrosis (CF) on 1-year FEV1 (% predicted, pp) change.

METHODS

This is a randomised, one-year prospective study including children with CF between 6 and 18 years of age. Subjects were randomised into home spirometry group (HSG) and usual care group (UCG). Children in HSG performed two pulmonary function tests (PFT) per week. Data regarding acute pulmonary exacerbations (PEx) was obtained from patients' records. At baseline and 12th month, health related quality of life questionnaire for CF patients (CFQ-R) and lung clearance index (LCI) were performed.

RESULTS

Sixty children were recruited with a median (IQR) age of 13.3 (11.4-15.4) years. Absolute change in FEV1pp from baseline to 12th month as median (IQR) was +1% (-6.75-9.75) in HSG and -2.50% (-7.50-3.25) in UCG (p = 0.10). Sensitivity analysis including only adherent children in HSG (n = 22), yielded an increase of 5% (-3.50-12) in HSG and a decrease of 2.50% (-7.50-3.25) in UCG (p = 0.009). A total of 29 (96.7%) subjects in HSG and 23 (76.7%) in UCG had PEx (p = 0.05). Absolute change in median (IQR) LCI2.5 from baseline to the 12th month was -1.6 [-2.9-0] (p<0.001) in HSG and -1.5 [-2.8-(-0.6)] (p<0.001) in UCG (p = 0.94). There was a significant increase in the social domain of the CFQ-R in HSG (from 59.1 to 76.2, p = 0.01).

CONCLUSIONS

Electronic home monitoring of children with CF by spirometry may result in improvement in lung function.

Respiratory evaluation of the risk for postoperative pulmonary complications in patients who preoperatively consulted pulmonologists: Studying both patients who underwent and who precluded planned surgery

BACKGROUND

Due to advances in medicine, patients with pulmonary diseases have become candidates for surgery under general anesthesia. They often consult pulmonologists to assess their tolerability for surgery. The purpose of this study was to evaluate the significant characteristics responsible for postoperative pulmonary complications (PPCs) and the preclusion of the planned surgery.

METHODS

The clinical data of 462 consecutive patients who consulted at the Department of Respiratory Medicine before surgery under general anesthesia were used in this study. The relationship between the patient׳s characteristics and their outcomes were analyzed. The patients who were scheduled for lung resection were excluded.

RESULTS

Of the 386 patients who underwent planned surgery, 353 had no PPCs (Group A) and 33 developed PPCs (Group B). Planned surgery under general anesthesia was precluded in 31 patients due to respiratory problems (Group C). The significant predictors for PPCs consisted of a higher age, male gender, asthma, gastrointestinal surgery, cardiovascular surgery and a lower percentage of the predicted forced expiratory volume in 1 second (% predicted FEV₁). The significant factors associated with the preclusion of planned surgery included interstitial pneumonia (IP), dermatologic surgery and a lower % predicted FEV₁. The predicted probability of PPCs in Group C was significantly higher than that in Group A and lower than that in Group B (all p-values < 0.05).

CONCLUSION

The common clinical finding for predicting PPCs and encouraging the preclusion of the planned surgery under general anesthesia was a lower % predicted FEV₁.

Reduced Forced Expiratory Volume in 1 Second Percentage Predicted Is Associated With Diffuse Coronary Atherosclerosis in Hospitalized Patients Undergoing Coronary Angiography

BACKGROUND

Reduced forced expiratory volume in 1 second percentage (FEV1%) predicted is closely related to cardiovascular mortality. However, evidence regarding the correlation between FEV1% predicted and the severity of coronary atherosclerosis observed on coronary angiography is still limited. We aimed to explore whether a decline in FEV1% predicted was associated with diffuse coronary atherosclerosis in hospitalized patients.

METHODS

A cross-sectional study enrolling hospitalized patients with cardiovascular symptoms undergoing both coronary angiography and lung function testing was conducted. The correlation between FEV1% predicted and angiographic characteristics, including the number of diseased vessels, total number of coronary lesions and Gensini score was analyzed.

RESULTS

Eighty-five patients were included. Patients with ≥2-vessel disease had significantly lower FEV1% predicted than patients with <2-vessel disease (60.9% ± 19.7% versus 77.2% ± 19.7%, P < 0.001). FEV1% predicted was inversely related to the total number of coronary lesions (β = -0.029, P = 0.002) and Gensini score (β = -0.525, P = 0.006). FEV1% predicted was independently associated with ≥2-vessel disease (odds ratio = 0.961, P = 0.007), total number of coronary lesions (adjusted β = -0.039, P < 0.001) and Gensini score (adjusted β = -0.602, P = 0.005) after adjustment for other traditional cardiovascular risk factors. In the coronary artery disease subgroup, FEV1% predicted maintained an independent and negative relationship with ≥2-vessel disease, total number of coronary lesions and Gensini score.

CONCLUSIONS

Reduced FEV1% predicted was closely associated with multivessel coronary disease and diffuse coronary atherosclerosis in hospitalized patients undergoing coronary angiography.

Rapid FEV1 decline and the effects of both FEV1 and FVC on cardiovascular disease: A UK biobank cohort analysis

BACKGROUND

The relationship between lung function and cardiovascular disease (CVD) has emerged as a significant research focus in recent years, but studies on the effects of both forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) remain limited.

METHODS

Among 29,662 participants in the UK Biobank study free of CVD, rapid lung function decline was defined as the decline in either FEV1 (greatest quartile), FVC (greatest quartile), or both (when both FEV1 and FVC exceeded the greatest quartile). CVDs include coronary heart disease (CHD), arrhythmias, heart failure (HF), peripheral arterial disease (PAD), and other CVDs (including endocarditis, stroke, and myocardial diseases). Cox proportional hazards models were used to explore the associations between lung function and CVD incidence. Fine‒Gray models were used to account for the competing risk of death.

RESULTS

Among 29,662 participants in the UK Biobank study free of CVD, the adjusted hazard ratios (HRs) for FEV1 rapid decline were 1.150 (95% CI: 1.009-1.311) for CHD, 1.307 (95% CI: 1.167-1.465) for arrhythmias, 1.406 (95% CI: 1.084-1.822) for HF, 1.287 (95% CI: 1.047-1.582) for PAD, 1.170 (95% CI: 1.022-1.340) for other CVDs, and 1.216 (95% CI: 1.124-1.315) for composite CVD. The adjusted HRs for the impact of both rapid decreases in FEV1 and FVC were 1.386 (95% CI: 1.226-1.567) for arrhythmias, 1.390 (95% CI: 1.041-1.833) for HF, 1.222 (95% CI: 1.054-1.417) for other CVDs, and 1.230 (95% CI: 1.128-1.340) for composite CVD.

CONCLUSIONS

The rapid decline in FEV1 and the impact of both FEV1 and FVC are closely associated with the subsequent incidence of various CVDs and composite CVD.

Vocal cord dysfunction related to water-damaged buildings

BACKGROUND

Vocal cord dysfunction (VCD) is the intermittent paradoxical adduction of the vocal cords during respiration, resulting in variable upper airway obstruction. Exposure to damp indoor environments is associated with adverse respiratory health outcomes, including asthma, but its role in the development of VCD is not well described.

OBJECTIVE

We describe the spectrum of respiratory illness in occupants of 2 water-damaged office buildings.

METHODS

The National Institute for Occupational Safety and Health conducted a health hazard evaluation that included interviews with managers, a maintenance officer, a remediation specialist who had evaluated the 2 buildings, employees, and consulting physicians. In addition, medical records and reports of building evaluations were reviewed. Diagnostic evaluations for VCD had been conducted at the Asthma and Allergy Center of the Medical College of Wisconsin.

RESULTS

Two cases of VCD were temporally related to occupancy of water-damaged buildings. The patients experienced cough, chest tightness, dyspnea, wheezing, and hoarseness when in the buildings. Spirometry was normal. Methacholine challenge did not show bronchial hyperreactivity but did elicit symptoms of VCD and inspiratory flow-volume loop truncation. Direct laryngoscopy revealed vocal cord adduction during inspiration. Coworkers developed upper and lower respiratory symptoms; their diagnoses included sinusitis and asthma, consistent with recognized effects of exposure to indoor dampness. Building evaluations provided evidence of water damage and mold growth.

CONCLUSION

VCD can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms.