Pulmonary Disease Research Articles

Functional impairment in COPD can be predicted using genomic-derived data

ObjectiveReduced functional capacity and muscle weakness are two major contributors to functional impairment in chronic obstructive pulmonary disease (COPD). The underlying causes of functional impairment are poorly understood and, therefore,...

Establishment of Scoring to Predict Severe Complication After Pyogenic Spondylodiscitis Surgery.

Retrospective cohort study using prospective database. This study aimed to establish a risk-scoring system for predicting severe complications after pyogenic spondylodiscitis surgery. Pyogenic spondylodiscitis surgery can cause severe complications. Grades III, IV, and V complications in the CD classification were defined as severe complications. A predictive scoring system for severe complications was developed using 7 risk factors identified from a cohort of 143 PS surgery patients from January 2013 to December 2017 described in a previous study. External validation used a separate cohort of 70 patients from 9 institutions identified from January 2018 to December 2021. This first study proposed a risk predictive scoring system for severe complications [updated Charlson comorbidity index (≥3), 2; chronic pulmonary disease, 3; diabetes, 1; Gram-negative bacteria, 3; pyogenic osteoarthritis, 3; preoperative white blood count (≥1.0×104/μL), 2; preoperative platelet count (≤2.4×105/μL), 2]. The scoring system could well predict severe complications [area under the receiver operating curve (AUROC) value of 0.851]. There was classification into 3 risk groups: low-moderate risk (≤4), high risk (5 or 6), and very high risk (≥7), further simplified by the scoring system. Complication rates were 5.2% (low-moderate), 40.1% (high), and 84.2% (very high). In addition, external validation showed a very good AUROC value of 0.820. We developed a simple, externally validated scoring system for predicting severe complications after pyogenic spondylodiscitis surgery that will be helpful for clinicians involved in informed consent and intensive care unit management of high-risk patients.

Combining Hyperpolarized 129Xe MR Imaging and Spectroscopy to Non-Invasively Estimate Pulmonary Vascular Resistance.

Hyperpolarized 129Xe MRI/MRS enables quantitative mapping of function in lung airspaces, membrane tissue, and red blood cells (RBCs) within the pulmonary capillaries. The RBC signal also exhibits cardiogenic oscillations that are reduced in pre-capillary pulmonary hypertension (PH). This effect is obscured in patients with concomitant defects in transfer from airspaces to RBCs, which increase RBC oscillation amplitudes. Here, we provide a framework for interpreting RBC oscillations and show their relationship to pulsatile blood flow, capillary blood volume, capillary compliance, and impedance of the capillary and venous circulation. This framework was first applied to characterize RBC oscillations in a cohort of subjects with pulmonary disease but no known PH (n=129). 129Xe MRI of RBC transfer was used to estimate capillary blood volume, and as it decreased, RBC oscillations sharply increased (r2adj=0.53), consistent with model predictions. Model-derived fit parameters were then used to estimate the distribution of pulmonary vascular resistance (PVR) across arterial, capillary, and venous circulation, and to correct oscillations for RBC transfer defects. 70% of PVR was estimated to arise from pulmonary arteries, 11% from capillaries, and 19% from veins. When tested in a second cohort of subjects who underwent 129Xe MRI/MRS and right heart catheterization (n=40), oscillations corrected for capillary blood volume correlated moderately with PVR (r2=0.27, p=0.0014). For every 1.96 WU increase in PVR, corrected oscillations decreased by 1 absolute percentage point. This work demonstrates that, although 129Xe-RBC oscillations are only indirectly sensitive to pre-capillary obstruction, corrected oscillations below 7.5% were 100% specific for elevated PVR.

Comparing spirometry, impulse oscillometry with computed tomography for assessing small airway dysfunction in subjects with and without chronic obstructive pulmonary disease

BackgroundStudies on consistency among spirometry, impulse oscillometry (IOS), and histology for detecting small airway dysfunction (SAD) remain scarce. Considering invasiveness of lung histopathology, we aimed to compare spirometry and IOS with chest computed tomography (CT) for SAD detection, and evaluate clinical characteristics of subjects with SAD assessed by these three techniques.MethodsWe collected baseline data from the Early COPD (ECOPD) study. CT-defined SAD was defined as parametric response mapping quantifying SAD (PRMfSAD) ≥ 15%. Spirometry-defined SAD was defined as at least two of maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD was defined as peripheral airway resistance R5 − R20 > 0.07 kPa/L/s. The consistency of spirometry, IOS and CT for diagnosing SAD was assessed using Kappa coefficient. Correlations among the three techniques-measured small airway function parameters were assessed by Spearman correlation analysis.Results2055 subjects were included in the final analysis. There was low agreement in SAD assessment between spirometry and CT (Kappa = 0.126, 95% confidence interval [CI]: 0.106 to 0.146, p < 0.001), between IOS and CT (Kappa = 0.266, 95% CI: 0.219 to 0.313, p < 0.001), as well as among spirometry, IOS, and CT (Kappa = 0.056, 95% CI: 0.029 to 0.082, p < 0.001). The correlation was moderate (|r|: 0.5 to 0.7, p < 0.05) between spirometry and CT-measured small airway function parameters, and weak (|r|< 0.4, p < 0.05) between IOS and CT-measured small airway function parameters. Only spirometry-defined SAD group had more lower lung function (FEV1/FVC: adjusted difference=-10.7%, 95% CI: -13.5% to -7.8%, p < 0.001) and increased airway wall thickness (Pi 10: adjusted difference = 0.3 mm, 95% CI: 0 to 0.6 mm, p = 0.046) than only CT-defined SAD group. Only IOS-defined SAD group had better lung function (FEV1/FVC: adjusted difference = 3.9%, 95% CI: 1.9 to 5.8%, p < 0.001), less emphysema (inspiratory LAA− 950: adjusted difference=-2.1%, 95% CI:-3.1% to -1.1%, P < 0.001; PRMEmph: adjusted difference=-2.3%, 95% CI: -3.2% to -1.4%, p < 0.001), and thicker airway wall (Pi 10: adjusted difference = 0.2 mm, 95% CI: 0.1 mm to 0.4 mm, p = 0.005) than only CT-defined SAD group.ConclusionsThere was low consistency in the assessment of SAD between spirometry and CT, between IOS and CT, as well as among spirometry, IOS, and CT.Clinical trial numberNot applicable.

The relationship between fatigue levels and psychosocial adjustment in elderly individuals with chronic obstructive pulmonary disease: A descriptive study.

Chronic Obstructive Pulmonary Disease (COPD) is associated with physical limitations and significant social, psychological, and behavioral challenges. This study investigates the relationship between fatigue levels and psychosocial adjustment in COPD patients, considering their sociodemographic characteristics. A descriptive study was conducted with 160 COPD patients hospitalized in the Pulmonology Department of a university hospital. Data were collected via face-to-face interviews using a patient information form, the COPD and Asthma Fatigue Scale (CAFS), and the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR). Statistical analyses included Independent Sample t-test, One-Way ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis, with significance set at p < 0.05. The mean age of participants was 68.70 ± 9.41years; 71.9% were male, and 67.9% had COPD for over six years. Most participants (74.4%) reported limitations in daily living activities due to the disease, and 91.9% reported having social support. Mean scores were 58.03 ± 15.80 on the CAFS and 64.19 ± 6.41 on the PAIS-SR. Significant differences were observed in fatigue and psychosocial adjustment scores based on gender, social support, and disease impact on daily activities (p < 0.05). A weak positive correlation was found between fatigue levels and psychosocial adjustment (p < 0.05). COPD patients experience moderate-to-high fatigue levels and challenges in psychosocial adjustment, with fatigue negatively influencing adjustment. Interventions should focus on enhancing coping strategies, addressing psychosocial needs, and leveraging social support systems to improve patient outcomes.

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BackgroundOlder adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among...

Identification of patient demographic, clinical, and SARS-CoV-2 genomic factors associated with severe COVID-19 using supervised machine learning: a retrospective multicenter study

BackgroundDrivers of COVID-19 severity are multifactorial and include multidimensional and potentially interacting factors encompassing viral determinants and host-related factors (i.e., demographics, pre-existing conditions and/or genetics), thus complicating the prediction of clinical outcomes for different severe acute respiratory syndrome coronavirus (SARS-CoV-2) variants. Although millions of SARS-CoV-2 genomes have been publicly shared in global databases, linkages with detailed clinical data are scarce. Therefore, we aimed to establish a COVID-19 patient dataset with linked clinical and viral genomic data to then examine associations between SARS-CoV-2 genomic signatures and clinical disease phenotypes.MethodsA cohort of adult patients with laboratory confirmed SARS-CoV-2 from 11 participating healthcare institutions in the Greater Toronto Area (GTA) were recruited from March 2020 to April 2022. Supervised machine learning (ML) models were developed to predict hospitalization using SARS-CoV-2 lineage-specific genomic signatures, patient demographics, symptoms, and pre-existing comorbidities. The relative importance of these features was then evaluated.ResultsComplete clinical data and viral whole genome level information were obtained from 617 patients, 50.4% of whom were hospitalized. Notably, inpatients were older with a mean age of 66.67 years (SD ± 17.64 years), whereas outpatients had a mean age of 44.89 years (SD ± 16.00 years). SHapley Additive exPlanations (SHAP) analyses revealed that underlying vascular disease, underlying pulmonary disease, and fever were the most significant clinical features associated with hospitalization. In models built on the amino acid sequences of functional regions including spike, nucleocapsid, ORF3a, and ORF8 proteins, variants preceding the emergence of variants of concern (VOCs) or pre-VOC variants, were associated with hospitalization.ConclusionsViral genomic features have limited utility in predicting hospitalization across SARS-CoV-2 diversity. Combining clinical and viral genomic datasets provides perspective on patient specific and virus-related factors that impact COVID-19 disease severity. Overall, clinical features had greater discriminatory power than viral genomic features in predicting hospitalization.

Hearing loss and risk of major osteoporotic fracture: a population-based cohort study in the United Kingdom

SummaryUsing the UK Clinical Practice Research Datalink, our cohort study matched 237,297 individuals with hearing loss (HL) to 829,431 without HL. The study found an 8–10% higher risk of major osteoporotic fracture in individuals with HL compared to those without. Additionally, within the HL cohort, we identified risk factors for potential inclusion in fracture risk models.PurposeAssess association between hearing loss (HL) and major osteoporotic fracture (MOF; spine, wrist/forearm, shoulder/proximal humerus, hip) in individuals aged ≥ 60 years, and risk factors for MOF in individuals with HL.MethodsFrom the UK Clinical Practice Research Datalink, our cohort study matched individuals aged ≥ 60 years diagnosed with HL (READ/ICD-10 codes; 01January2001–31December2021; index event), without secondary osteoporosis causes, with up to five individuals without HL (birth, index year, sex, general practice). Incidence rates and Cox proportional hazard ratios (HL vs. no HL; stratified by low/high fracture risk) were calculated for MOF and hip fracture; multivariate logistic regression assessed risk factors for MOF and hip fracture (HL cohort).ResultsA total of 237,297 individuals with HL matched to 829,431 without HL, with a median age of 74 and 72 years, respectively. Compared with those without HL, individuals with HL had greater frailty (severe electronic frailty index, 5.9% vs. 2.7%), higher incidence of prior falls (14.1% vs. 10.6%), longer mean follow-up with higher incidence of MOF and hip fractures (5.1 vs. 4.4 years, 20.1 and 5.32 vs. 16.58 and 4.54 per 1000 person-years, respectively) and higher risk of MOF and hip fracture (adjusted HR, 1.10 and 1.08, respectively). Significant risk factors for MOF and hip fracture included age ≥ 70 years, fracture history, falls, osteoporosis diagnosis, chronic obstructive pulmonary disorder and cardiovascular disease (HL cohort).ConclusionIn individuals with HL, we observed an 8–10% higher risk of MOF and hip fracture versus individuals without HL and identified risk factors for potential inclusion in fracture risk models.

Relationship Between RNF213 p.R4810K and Echocardiographic Findings in Patients with Cerebrovascular Diseases: A Multicenter Prospective Cohort Study.

RING finger protein 213 (RNF213) p.R4810K is an established risk factor for moyamoya disease and intracranial artery stenosis in East Asian people. Recent evidence suggests its potential association with extracranial cardiovascular diseases, including pulmonary hypertension. We hypothesized that insidious abnormal cardiac functions are detected in RNF213 p.R4810K carriers with cerebrovascular diseases. We investigated patients registered in the National Cerebral and Cardiovascular Center Genome Registry between May 2017 and August 2021 who underwent echocardiography. All patients had cerebrovascular diseases. Patients with a medical history of chronic heart or pulmonary diseases were excluded. RNF213 p.R4810K was genotyped in all the patients. Of 2089 patients registered in the registry, 71 carriers and 1241 noncarriers were eligible for our analyses. The carriage of RNF213 p.R4810K emerged as a significant predictor for longer right ventricular outflow tract acceleration time in multivariable linear regression analysis (β=8.33 [95% CI, 0.92-15.74]; P=0.028). Additionally, the carriers showed increased odds of having right ventricular outflow tract acceleration time values ≥150 milliseconds (odds ratio, 2.22 [95% CI, 1.18-4.18]; P=0.014) in multivariable logistic regression analysis. A longer right ventricular outflow tract acceleration time may reflect an increased pulmonary vascular bed induced by abnormal vascular collateral networks and dilation of capillary vessels in peripheral pulmonary arteries in the preclinical stage of RNF213-related pulmonary hypertension. Thus, the right ventricular outflow tract acceleration time marker in RNF213 p.R4810K carriers suggests a biphasic course from the presymptomatic to symptomatic phase. Furthermore, vascular neurologists should carefully examine multiple organs because RNF213-related vasculopathy covers systemic cardiovascular diseases. URL: https://www.umin.ac.jp; Unique identifier: UMIN000050750.

Antioxidant-Rich Functional Foods and Exercise: Unlocking Metabolic Health Through Nrf2 and Related Pathways

This article reviews the synergistic effects of antioxidant-enriched functional foods and exercise in improving metabolic health, focusing on the underlying molecular mechanisms. The review incorporates evidence from PubMed, SCOPUS, Web of Science, PsycINFO, and reference lists of relevant reviews up to 20 December 2024, highlighting the central role of the Nrf2 pathway. As a critical regulator of oxidative stress and metabolic adaptation, Nrf2 mediates the benefits of these interventions. This article presents an innovative approach to understanding the role of Nrf2 in the regulation of oxidative stress and inflammation, highlighting its potential in the prevention and treatment of various diseases, including cancer, neurodegenerative disorders, cardiovascular and pulmonary diseases, diabetes, inflammatory conditions, ageing, and infections such as COVID-19. The novelty of this study is to investigate the synergistic effects of bioactive compounds found in functional foods (such as polyphenols, flavonoids, and vitamins) and exercise-induced oxidative stress on the activation of the Nrf2 pathway. This combined approach reveals their potential to improve insulin sensitivity and lipid metabolism and reduce inflammation, offering a promising strategy for the management of chronic diseases. However, there are significant gaps in current research, particularly regarding the molecular mechanisms underlying the interaction between diet, physical activity, and Nrf2 activation, as well as their long-term effects in different populations, including those with chronic diseases. In addition, the interactions between Nrf2 and other critical signalling pathways, including AMPK, NF-κB, and PI3K/Akt, and their collective contributions to metabolic health are explored. Furthermore, novel biomarkers are presented to assess the impact of these synergistic strategies, such as the NAD+/NADH ratio, the GSH ratio, and markers of mitochondrial health. The findings provide valuable insights into how the integration of an antioxidant-rich diet and regular exercise can improve metabolic health by activating Nrf2 and related molecular pathways and represent promising strategies for the prevention and treatment of metabolic disorders. Further studies are needed to fully understand the therapeutic potential of these interventions in diseases related to oxidative stress, such as cardiovascular disease, neurodegenerative disease, diabetes, and cancer.

Late onset congenital central hypoventilation syndrome in a child with Down syndrome

Congenital central hypoventilation syndrome (CCHS), also known as Ondine syndrome, is a rare genetic disorder characterized by alveolar hypoventilation and dysregulation of the autonomic nervous system. Late onset congenital central hypoventilation syndrome (LOCCHS) has been infrequently reported, particularly in patients with Down syndrome. This case report presents an 8-year-old girl with Down syndrome who developed late onset CCHS. Clinical assessments, laboratory tests, and imaging studies were performed to evaluate her condition. The patient exhibited severe respiratory acidosis and hypoxemia, necessitating intubation and mechanical ventilation. Despite multiple extubation attempts, the patient demonstrated no spontaneous breathing. The diagnosis of LOCCHS was considered after excluding other conditions. Unfortunately, the child expired within 24 hours following extubation. LOCCHS should be contemplated in children with unexplained hypoventilation who are challenging to extubate, particularly in the absence of underlying neurological, pulmonary, or cardiac diseases.

Research Trends of Traditional Chinese Medicine Therapies on Chronic Obstructive Pulmonary Disease: A Bibliometric Analysis.

Traditional Chinese Medicine (TCM) therapies have shown great improvement in chronic obstructive pulmonary disease (COPD) patients, yet no bibliometric analysis on TCM therapies for COPD exists. A comprehensive literature search was conducted on TCM therapies for COPD within the past decade, utilizing the Web of Science (WOS) Core Collection and China National Knowledge Infrastructure (CNKI) databases. To analyze collaborative patterns among countries/regions, institutions, and authors, as well as identify influential references and emerging research trends, CiteSpace and VOSviewer software were employed. The dataset comprised 625 articles from WOS and 5,641 from CNKI, revealing a consistent growth in COPD-related TCM research over the past 10 years. China emerged as the leading contributor, with a predominant focus on TCM Universities. The American Journal of Respiratory and Critical Care Medicine was the most cited journal, while Medicine published the highest number of articles. Li, JS was the most prolific author, and Barnes, PJ was the most frequently cited researcher. Key studies by Leung RWM: Eur Respir J. 2013;41(5):1051-7, Li SY: BMC Complement Altern Med. 2012;12:197, and Polkey MI: Chest. 2018;153(5):1116-24 garnered significant attention. Keyword analysis highlighted the prominence of Tai Chi, Chinese herbal medicine, acupoint sticking, acupuncture, lung function, quality of life, and inflammation as core research themes. Research on TCM therapies for COPD has gained growing attention over the past decade. Among the most commonly studied TCM interventions are Tai Chi, Chinese herbal medicine, acupoint sticking, and acupuncture. Lung function, quality of life, and inflammation have emerged as key areas of investigation and are likely to remain focal points for future research endeavors.

Clinical profile of interstitial lung disease in children from Western India

Background: The epidemiology of interstitial lung disease in children (chILD) remains largely unknown, particularly in developing countries. This study aims to estimate the spectrum of ILD in children in India Methods: We retrospectively analysed data from consecutive subjects aged 0 to 18 years with interstitial lung diseases (ILD) recorded in the hospital registry at the Paediatric Respiratory Unit of Bai Jerbai Wadia Institute of Child Health from January 2018 to December 2023. We determined the proportion of each ILD subtype among children. Results: Out of 30 enrolled children, 60% were male. Symptoms began within the first year in 17 (56%) children, predominantly with a dry cough (77%) and dyspnea. Respiratory compromise signs were common, including tachypnea, tachycardia and hypoxemia, with 17% exhibiting clubbing. Chest X-rays showed reticular/reticulonodular patterns (63%) and HRCT revealed ground glass opacities (63%). Lung function tests indicated a restrictive pattern in 33%. Bronchoscopy aided in diagnosing pulmonary alveolar proteinosis, hypersensitive pneumonitis and diffuse alveolar hemorrhage. Genetic analysis (43% cases) identified surfactant protein disorder as the most common (13%). ILD subtypes included pulmonary hemosiderosis (23%), surfactant protein disorder, pulmonary alveolar proteinosis and Langerhans cell histiocytosis (each 13%). Conclusions: In Western India, Paediatric interstitial lung diseases exhibit a different pattern compared to adults. Pulmonary hemosiderosis spectrum, pulmonary alveolar proteinosis and surfactant protein disorder emerge as the predominant burdens among children.

O-15 CUTANEOUS SARCOIDOSIS PRESENTING AS ASYMPTOMATIC PTH-INDEPENDENT HYPERCALCEMIA

Abstract Introduction Sarcoidosis is a rare disease primarily affecting the pulmonary system in approximately 90% of cases. (1) Cutaneous involvement occurs in 20-35% of sarcoidosis patients and can present without systemic manifestations (2). The skin is the second most commonly affected organ after the lungs in sarcoidosis (3). Clinical Case We report a unique case of cutaneous sarcoidosis presenting with asymptomatic hypercalcemia. An 81-year-old White British woman with a medical history of type 2 diabetes mellitus, anemia, hypertension, and polymyalgia rheumatica (PMR) was managed for left leg cellulitis. Examination revealed a systolic murmur, clear chest, bilateral erythema, raised temperature, and pitting edema at the infection site. An admission chest x-ray showed a known large hiatus hernia. Routine blood tests revealed adjusted calcium levels of 3.52 mmol/L (2.20-2.60 mmol/L), and PTH levels were low at 0.9 pmol/L (1.6-6.9 pmol/L), indicating PTH-independent hypercalcemia. Further blood tests showed normal vitamin D (129nmol/L, n&amp;gt;50nmol/L), ACE levels (&amp;lt;5 IU/L), and thyroid funct,on tests (TSH 7.17mU/L, n0.30-4.20mU/L, T4 15.6pmol/L, n11.9-21.6pmol/L, TPO antibody&amp;lt;10IU/mL, n0-34). Myeloma screen (no monoclonal bands, Serum Kappa Free Light Chain:31.03 mg/L,n 3.30 - 19.40; Serum Lambda Free Light Chain:22.57 mg/L,n:5.71 - 26.30) and autoimmune screens (IgG:7.8 g/L,n:6.0 - 16.0; IgA:1.26 g/L,n:0.80 - 4.00; IgM*0.41 g/L,n:0.50 - 2.00) were negative. Elevated 1,25-dihydroxy vitamin D (calcitriol) was noted at 246 pmol/L. Occult malignancy was ruled out via normal CT chest, abdomen, and pelvis, gastroscopy with biopsy, and CT head scans. Initial PET CT results were reported as normal. Hypercalcemia management included intravenous fluids, zoledronic acid, denosumab, steroids, and cinacalcet. Subsequent detailed PET CT report revealed extensive moderate FDG uptake in the subcutaneous tissue of both arms. Physical examination identified subcutaneous nodules, and histology confirmed a florid dermal non-necrotizing granulomatous reaction, diagnosing extra-pulmonary cutaneous sarcoidosis. Interestingly, the patient had been on long-term prednisolone (10 mg) for PMR, recently reduced to 4 mg prior to admission. Her calcium levels normalized (2.57 mmol/L) after weaning off prednisolone. Conclusion Hypercalcemia in cutaneous sarcoidosis without pulmonary involvement is rare. Long-term follow-up is essential, as patients with cutaneous sarcoidosis may develop systemic involvement. She was referred to pulmonary and dermatology specialists for further evaluation.

BETA BLOCKER THERAPY IMPROVES RIGHT VENTRICULAR FUNCTIONS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a clinical condition with a high mortality and morbidity rate. Cardiac involvement is common in COPD patients. In this disease, beta-blocker (BB) treatment could not be used in sufficient doses most of the time since it is thought that this treatment may aggravate the disease. However, BB is the main drug therapy in patients with atherosclerotic heart disease. In this study, right ventricular (RV) functions were examined using speckle-tracking echocardiography in COPD patients under BB therapy. MATERIAL AND METHODS: Patients, who were followed up with the diagnosis of COPD, were involved in the study. Patients under BB treatment for three months or more were assigned to Group 1 and patients with similar demographic and clinical features to the control group by using propensity score matching (PSM) analysis. Baseline demographic and clinical features of patients were compared, and the effects of BB treatment were analyzed. RESULTS: After PSM analysis, right ventricular free-wall global strain (p &amp;lt;0.001), right ventricular global longitudinal strain (p &amp;lt;0.001), right ventricular right ventricular free-wall global strain rate (p: 0.001), and right ventricular global longitudinal strain rate (p: 0.005) were found to be significantly higher in Group 1. CONCLUSIONS: COPD and atherosclerosis have similar pathways such as inflammation and endothelial dysfunction, and the use of BB in COPD patients may have a positive effect on the improvement of right ventricular functions. This effect can be demonstrated by making use of the deformation analysis rather than conventional parameters.

Sensitivity and Specificity of the Yale Swallow Protocol in Recently Extubated Patients.

The purpose of this study was to determine the sensitivity and specificity of the Yale Swallow Protocol (YSP) in detecting aspiration in recently extubated patients. One hundred fifty-four participants referred for swallowing evaluation underwent the YSP and fiberoptic endoscopic evaluation of swallowing (FEES) in random order within 48 hr of extubation. The YSP included orientation questions, an oral motor exam, and a 3-oz water swallow test. Failure was defined as interrupted drinking or immediate cough after drinking. FEES exams were rated using the Penetration Aspiration Scale. Fisher's exact test and t test were used to test for association between failure on the YSP and participant factors (sex, age, reason for admission/intubation, duration of intubation, number of intubations, and time post-extubation of exam), aspiration on FEES and participant factors, and a false negative on the YSP and participant factors. Fifty-seven percent (88 of 154) failed the YSP. Fifty percent (77 of 154) of participants aspirated on at least one trial during the FEES. Sensitivity of the YSP was 75%, and specificity was 61%. Participants who failed the YSP were older (M = 61 years; p = .0030). More women failed the YSP than men (p = .0007). No patient factors were associated with aspiration on FEES. Participants admitted for respiratory etiologies (pneumonia, chronic obstructive pulmonary disease exacerbation) were most likely to have a false negative on the YSP (p = .02). False negatives were also more likely in participants with a size ≥ 8 of endotracheal tube (p = .03). The YSP has suboptimal sensitivity and specificity for detecting aspiration in recently extubated patients. More data are needed on predictors of false negatives in order to improve sensitivity and specificity in this critically ill patient population.

Diagnosis of chronic obstructive pulmonary disease (COPD) in older patients : Consensus statement of the Working Group on Pneumology in Older Patients.

Chronic obstructive pulmonary disease (COPD) is afrequent disease from which approximately 8% of individuals aged 40years and above suffer. The prevalence increases up to fivefold as age advances. Following an introduction including the etiology, measurement, characteristic features and classification of COPD, this article presents the consensus recommendations of the German Working Group on Pneumology in Older Patients. These include statements on the screening for frailty, dysphagia, malnutrition and cognitive impairment. The results are summarized with the final conclusion that adequate treatment of COPD can also slow the progression of cognitive decline and could potentially prevent or delay the onset of dementia.

Health-related quality of life across heart failure categories: associations with clinical characteristics and outcomes.

The study aims to examine characteristics and outcomes associated with health-related quality of life (HRQoL) in patients with heart failure (HF) with preserved, mildly reduced and reduced ejection fraction (EF) (HFpEF, HFmrEF and HFrEF). Data on HRQoL were collected in the Swedish Heart Failure Registry (SwedeHF; 2000-2021) using the EuroQoL 5-dimensional visual analogue scale (EQ 5D-vas). Baseline EQ 5D-vas scores were categorized as 'best' (76-100), 'good' (51-75), 'bad' (26-50) and 'worst' (0-25). Independent associations between patients' characteristics and EQ 5D-vas, as well as between EQ 5D-vas and outcomes were assessed. Of 40809 patients (median age 74years; 32% female), 29% were in the 'best', 41% in the 'good', 25% in the 'bad' and 5% in the 'worst' EQ 5D-vas categories, similarly distributed across all EF categories. Higher New York Heart Association (NYHA) class was strongly associated with lower EQ 5D-vas regardless of EF categories, followed by chronic obstructive pulmonary disease, smoking, body mass index, higher heart rate, anaemia, previous stroke, ischaemic heart disease, use of diuretics and living alone, whereas higher income, male sex, outpatient status and higher systolic blood pressure were inversely associated with lower EQ 5D-vas categories. Patients in the 'worst' EQ 5D-vas category as compared with the 'best' had the highest risk of all-cause death [adjusted hazard ratios 1.97, 95% confidence interval (CI) 1.64-2.37 in HFrEF, 1.77, 95% CI 1.30-2.40 in HFmrEF and 1.43 95% CI 1.02-2.00 in HFpEF]. Most patients were in the two highest EQ 5D-vas categories. Higher NYHA class had the strongest association with lower EQ 5D-vas categories, across all EF categories. Patients in the worst EQ 5D-vas category were at the highest risk of mortality.

Retrospective Cohort Study of Elderly Users of Single- or Multiple-Inhaler Triple Therapy for the Treatment of Asthma in the USA.

Escalation to single- or multiple-inhaler triple therapy (SITT; MITT) is a recommended option for patients with asthma who remain uncontrolled by medium-dose inhaled corticosteroid/long-acting β2-agonist; however, characterization of elderly users of triple therapy is limited. This real-world cohort study describes demographics and clinical characteristics of elderly patients with asthma with and without comorbid chronic obstructive pulmonary disease (COPD) who are new users of triple therapy, and asthma treatment patterns preceding triple therapy initiation. This retrospective cohort study used administrative claims data from the Optum Clinformatics Data Mart database. Eligible patients were ≥ 65years of age with asthma or with asthma and comorbid COPD who initiated either triple therapy with single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; 100/62.5/25μg) or MITT between September 18, 2017 and September 30, 2020. Demographics, clinical characteristics, healthcare resource utilization, healthcare costs, and asthma treatment patterns were described in the 12-month period before triple therapy initiation (baseline period). In total, 15,557 patients were included. Among FF/UMEC/VI initiators with asthma (N = 635) mean age was 73.3years and 66.6% were female. During the baseline period, > 75% of patients used controller therapy, > 92% used rescue medications, 27.9% experienced ≥ 1 asthma-related exacerbation, with mean annual exacerbation rate of 0.42, and mean all-cause healthcare costs were $23,407. Patients with asthma initiating MITT and patients with asthma and comorbid COPD initiating FF/UMEC/VI or MITT had similar characteristics, healthcare resource utilization, healthcare costs, and asthma treatment patterns to FF/UMEC/VI initiators with asthma. Triple therapy is often initiated following use of other asthma controller medications in real-world practice. Substantial rescue medication use and high disease and economic burden among this elderly patient population suggest that their asthma was not adequately controlled prior to triple therapy initiation. This retrospective study provides an early profile of elderly patients with asthma in the USA.

Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine.

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults. Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination. The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.