Difference In Forced Expiratory Volume Research Articles

The effect of Lactobacillus reuteri on pulmonary function test and growth of cystic fibrosis patients.

Cystic fibrosis (CF) patients frequently experience gut microbiota dysbiosis. Probiotic supplementation is a potential therapeutic approach to modify gut microbiota and improve CF management through the gut-lung axis. The aim of this study was to investigate the effect of Lactobacillus reuteri supplementation on pulmonary function test, respiratory symptoms and growth in CF patients. A randomized, placebo-controlled clinical trial was carried out on 40 children with CF aged from 6 to 20 years. Participants were designated to receive either L. reuteri or placebo daily for 4 months. Pulmonary function tests, weight, height and body mass index (BMI) z-scores were measured pre and post treatment. The median baseline BMI of the patients was 16.28 kg m-2. A significant change in the probiotic group's BMI z-score after the study period was observed (P = 0.034) but not for weight and height z-scores (P > 0.05). After treatment, Pseudomonas aeruginosa grew in sputum cultures of seven in the placebo and one patient in the intervention group (P = 0.03) while at baseline it grew in the sputum of four patients in each group. There was no significant difference in forced expiratory volume in the first second, forced expiratory flow at 25-75% or forced vital capacity change between the two groups after the treatment period (P > 0.05). Additionally, no significant differences were found in pulmonary exacerbations, hospitalization frequencies or COVID-19 infection between the two groups during the study (P > 0.05). The results suggest that L. reuteri supplementation may impact the growth of severely malnourished CF patients. Furthermore, it may be concluded that this strain might reduce P. aeruginosa in the sputum culture of CF patients. © 2024 Society of Chemical Industry.

Comparison of a portable, pneumotach flow-sensor–based spirometer (Spirofy™) with the vitalograph alpha Touch™ spirometer in evaluating lung function in healthy individuals, asthmatics, and COPD patients—a randomized, crossover study

BackgroundSpirofy™ is India’s first portable, pneumotach flow-sensor-based digital spirometer developed to diagnose asthma and chronic obstructive pulmonary disease (COPD). In this study, we compared the performance of the Spirofy™ device with that of the Vitalograph Alpha Touch™ spirometer in measuring the lung capacities of healthy individuals, asthmatics, and COPD patients. We also assessed the inter-device variability between two Spirofy™ devices.MethodsIn a randomized, three-way crossover, open-label study, we measured the differences in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) between the Spirofy™ and Vitalograph Alpha Touch™ spirometers. A proportion of the FEV1/FVC ratio distribution of < 0.7 was used to compare the diagnostic accuracies of the Spirofy™ with Vitalograph™ Alpha Touch™ spirometers.ResultsNinety subjects participated in this study. The mean ± SD FVC values obtained from the Spirofy™ 1, Spirofy™ 2, and Vitalograph Alpha Touch™ devices were 2.60 ± 1.05 L, 2.64 ± 1.04 L, and 2.67 ± 1.04 L, respectively. The mean ± SD FEV1 values obtained from the Spirofy™ 1, Spirofy™ 2, and Vitalograph Alpha Touch™ devices were 1.87 ± 0.92 (L), 1.88 ± 0.92 (L), and 1.93 ± 0.93 (L), respectively. A significant positive correlation was found between the FVC and FEV1 values recorded by Vitalograph Alpha Touch™, Spirofy™ 1, and Spirofy™ 2. As compared to Vitalograph Alpha Touch™, the Spirofy™ device showed good sensitivity (97%), specificity (90%), and overall accuracy (93.3%) at an FEV1/FVC ratio < 0.7. No inter-device variability was observed between the two Spirofy™ devices.ConclusionSpirofy™ is a portable and easy-to-use device and is as accurate as the standard Vitalograph Alpha Touch™ spirometer for the diagnosis of COPD and asthma.Trial registrationCTRI/2021/09/036492 (Clinical Trials Registry - India)

Effect of acupoint catgut embedding combined with western medicine on patients with stable COPD: Acupoint catgut embedding treating stable COPD meta-analysis.

Although bronchodilators and glucocorticoids can reduce the symptoms of cough and asthma to a certain extent, the adverse drug reactions and recurrence after recovery still trouble clinicians. Acupoint catgut embedding is effective in preventing and treating acute recurrence and deterioration of COPD, but its clinical efficacy remains controversial. Therefore, this study evaluated the clinical efficacy and safety of acupoint catgut embedding combined with conventional Western medicine for COPD through meta-analysis. Pubmed, the Cochrane Library, Web of Science, Sinomed, China Knowledge Network, VIP, and Wanfang databases were searched, with a time frame from database creation to November 2022. Meta-analysis was performed with Revman 5.3. Publication bias was assessed by Stata 15.0. Seventeen studies were listed, with a total sample size of 1516 cases. Meta-analysis showed that compared with conventional western medicine, acupoint catgut embedding combined with conventional western medicine could effectively improve the total effective rate of clinical symptoms of stable COPD [RR = 1.21, 95%CI (1.13, 1.29), P < .00001], forced expiratory volume in 1 second (FEV1) [mean difference (MD) = 0.04, 95%CI (0.00, 0.09), P = .04],the percentage of forced expiratory volume in 1 second predicted value [MD = 1.13, 95%CI (0.38,1.88), P = .003], acute exacerbation of chronic obstructive pulmonary disease [MD = -0.73, 95%CI (-1.04, -0.42), P < .00001], COPD assessment test score [MD = -2.39, 95%CI (-3.65, -1.13), P = .0002], the improved medical research council respiratory questionnaire score (mMRC score) [MD = -0.15, 95%CI (-0.29, -0.02),P = .03], 6-minute walk distance [MD = 28.16, 95%CI (17.31, 39.00), P < .00001], the production of inflammatory factor interleukin-8 [MD = -9.65, 95%CI (-10.44, -8.86), P < .00001], but the adverse event rate was comparable[RR = 1.39, 95%CI (0.28,6.91), P = .69]. However, there was no significant difference in forced expiratory volume in 1 second/forced vital capacity and TNF-α between the acupoint catgut embedding combined group and the conventional western medication group. Harbord test showed no significant publication bias. The clinical efficacy of acupoint catgut embedding combined with conventional western medicine for stable COPD is better than that of conventional western medicine, and the safety may be equivalent to that of conventional western medicine, which has the value of further research exploration.

Application of Precision Nursing Based on Multidisciplinary Collaboration Model in Older Patients Undergoing Thoracoscopic Surgery for Lung Cancer

To examine the application effect of precision nursing strategies based on multidisciplinary collaboration model in older patients undergoing thoracoscopic surgery for lung cancer. A total of 100 patients who were admitted to our hospital for thoracoscopic surgery for lung cancer between July 2022 and March 2023 were prospectively enrolled for the study. They were assigned, with a random number table, to two groups, a control group receiving routine nursing care and an experimental group receiving nursing care based on multidisciplinary collaborative precision nursing strategies. Their lung function, anxiety and depression scores, and quality of life were assessed at three points of time, including upon admission, one week after surgery, and one month after surgery, and comparison was made between the two groups. There were significant differences in forced expiratory volume in one second (FEV1) at the three time points ( F=156.787, P<0.001) and the ratio of FEV1 to forced vital capacity (FVC) (FEV1/FVC%) at the three time points ( F=25.587, P<0.001) between two groups. There were significant difference between the findings for FEV1, FEV1/FVC%, FVC, and maximum voluntary ventilation (MVV) indexes at 1 week and those at 1 month after surgery in the experimental group ( P<0.05). After the surgery, the pulmonary function of the experimental group was better than that of the control group. The anxiety and depression scores of the experimental group were lower than those of the control group, with the difference being statistically significant ( P<0.05), which suggested that the experimental group showed improvement in anxiety and depression in comparison with the control group. Regarding the quality of life, there were significant differences between the two groups in the scores for the functional dimension ( F=109.798, P<0.001), the symptom dimension ( F=106.936, P<0.001), other items ( F=78.798, P<0.001), and overall health dimensions ( F=174.307, P<0.001). At 1 week and 1 month after surgery, the experimental group had higher scores for the functional dimension and lower scores for the symptom dimension than the control group did, with the differences being statistically significant ( P<0.05). The overall health status of the experimental group was better than that of the control group. Precision nursing strategies based on multidisciplinary collaboration model can effectively help improve the lung function, the mood, and the quality of life of patients in the short term, showing considerable promise for wide clinical application.

Factors related to fixedness after transbronchial fiducial marker placement for image-guided proton therapy: A retrospective study

BackgroundThe usefulness of transbronchially inserted gold fiducial markers has been reported in radiation therapy and proton therapy for mobile lesions, such as lung tumors. However, there is occasional dropout of inserted markers. This retrospective study investigated the factors related to dropout of markers inserted for image-guided proton therapy (IGPT). MethodsBetween June 2013 and October 2021, 535 markers were inserted in 171 patients with lung tumors. We investigated whether marker dropout was affected by the location of marker insertion, distance between the marker and the chest wall (DMC), and difference in forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). Marker dropout from the time of planning computed tomography (CT) to follow-up CT was also evaluated. ResultsOf the 535 inserted markers, 417 were confirmed on planning CT and 356 on follow-up CT after IGPT. Multivariate analysis revealed that marker insertion into the upper lobe and FEV1/FVC ≥70% were factors associated with total marker dropout. Marker dropout between planning CT and follow-up CT was associated with DMC, FEV1/FVC ≥70%, and planning CT performed within 4 days of marker insertion. ConclusionsMarker dropout can be minimized by inserting markers more peripherally, by considering the planned insertion location, and FEV1/FVC. Additionally, planning CT should be scheduled at least 5 days after marker insertion.

The SHELTER Trial of Transplanting Hepatitis C Virus-Infected Lungs Into Uninfected Recipients.

This study is a single-arm trial of 10 lung transplants at a single center. Patients were included who were between 18 and 67 y of age and waitlisted for lung-only transplant. Patients were excluded who had evidence of liver disease. Primary outcome was HCV cure (sustained virologic response 12 wk after completing antiviral therapy). Recipients longitudinally reported QOL using the validated RAND-36 instrument. We also applied advanced methods to match HCV-RNA+ lung recipients to HCV-negative lung recipients in a 1:3 ratio at the same center. Between November 2018 and November 2020, 18 patients were consented and opted-in for HCV-RNA+ lung offers in the allocation system. After a median of 37 d (interquartile range [IQR], 6-373) from opt-in, 10 participants received double lung transplants. The median recipient age was 57 y (IQR, 44-67), and 7 recipients (70%) had chronic obstructive pulmonary disease. The median lung allocation score at transplant was 34.3 (IQR, 32.7-86.9). Posttransplant, 5 recipients developed primary graft dysfunction grade 3 on day 2 or 3, although none required extracorporeal membrane oxygenation. Nine patients received elbasvir/grazoprevir, whereas 1 patient received sofosbuvir/velpatasvir. All 10 patients were cured of HCV and survived to 1 y (versus 83% 1-y survival among matched comparators). No serious adverse events were found to be related to HCV or treatment. RAND-36 scores showed substantial improvement in physical QOL and some improvement in mental QOL. We also examined forced expiratory volume in 1 s-the most important lung function parameter after transplantation. We detected no clinically important differences in forced expiratory volume in 1 s between the HCV-RNA+ lung recipients versus matched comparators. SHELTER adds important evidence regarding the safety of transplanting HCV-RNA+ lungs into uninfected recipients and suggests QOL benefits.

Modeling of pulmonary deposition of agents of open and fixed dose triple combination therapies through two different low-resistance inhalers in COPD: a pilot study.

Inhalation therapy is a cornerstone of treating patients with chronic obstructive pulmonary disease (COPD). Inhaler devices might influence the effectiveness of inhalation therapy. We aimed to model and compare the deposition of acting agents of an open and a fixed dose combination (FDC) triple therapy and examine their repeatability. We recruited control subjects (Controls, n = 17) and patients with stable COPD (S-COPD, n = 13) and those during an acute exacerbation (AE-COPD, n = 12). Standard spirometry was followed by through-device inhalation maneuvers using a pressurized metered dose inhaler (pMDI) and a soft mist inhaler (SMI) to calculate deposition of fixed dose and open triple combination therapies by numerical modeling. Through-device inspiratory vital capacity (IVCd) and peak inspiratory flow (PIFd), as well as inhalation time (tin) and breath hold time (tbh) were used to calculate pulmonary (PD) and extrathoracic deposition (ETD) values. Deposition was calculated from two different inhalation maneuvers. There was no difference in forced expiratory volume in 1 s (FEV1) between patients (S-COPD: 42 ± 5% vs. AE-COPD: 35 ± 5% predicted). Spiriva® Respimat® showed significantly higher PD and lower ETD values in all COPD patients and Controls compared with the two pMDIs. For Foster® pMDI and Trimbow® pMDI similar PD were observed in Controls, while ETD between Controls and AE-COPD patients did significantly differ. There was no difference between COPD groups regarding the repeatability of calculated deposition values. Ranking the different inhalers by differences between the two deposition values calculated from separate maneuvers, Respimat® produced the smallest inter-measurement differences for PD. Our study is the first to model and compare PD using pMDIs and an SMI as triple combination in COPD. In conclusion, switching from FDC to open triple therapy in cases when adherence to devices is maintanined may contribute to better therapeutic effectiveness in individual cases using low resistance inhalers.

Effects of physical activity on lung function and quality of life in asthmatic children: An updated systematic review and meta-analysis.

The benefits of physical activity (PA) for asthmatic children were increasingly recognized, and as the design of studies on PA and asthma has become more refined in recent years, the latest evidence needed to be updated. We performed this meta-analysis to synthesize the evidence available from the last 10 years to update the effects of PA in asthmatic children. A systematic search was conducted in three databases, PubMed, Web of Science, and Cochrane Library. Randomized controlled trials were included, and two reviewers independently conducted the inclusion screening, data extraction, and bias assessment. A total of 9 studies were included in this review after 3,919 articles screened. PA significantly improved the forced vital capacity (FVC) (MD 7.62; 95% CI: 3.46 to 11.78; p < 0.001), and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) (MD 10.39; 95% CI: 2.96 to 17.82; p = 0.006) in lung function. There was no significant difference in forced expiratory volume in the first second (FEV1) (MD 3.17; 95% CI: -2.82 to 9.15; p = 0.30) and fractional exhaled nitric oxide (FeNO) (MD -1.74; 95% CI: -11.36 to 7.88; p = 0.72). Also, PA significantly improved the quality of life as assessed by the Pediatric Asthma Quality of Life Questionnaire (all items p < 0.05). This review suggested that PA could improve FVC, FEF25-75, and quality of life in asthmatic children, but there was insufficient evidence of improvement in FEV1 and airway inflammation. https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022338984.

Treating asthma patients with probiotics: a systematic review and meta-analysis.

To evaluate the role of probiotics in the treatment of asthma patients by meta-analysis. PubMed, Embase, The Cochrane Library, Web of Science, and other databases were searched by computer, and the relevant literature on the treatment of asthma by probiotics that met the inclusion criteria was screened by manual retrieval. Meta-analysis was performed using Revman 5.4 software and the combined effect was evaluated by odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI). a total of ten references were included, all of which were randomized controlled studies, and a total of 1,101 people were investigated. Fractional exhaled nitric oxide (FeNO) (MD = -7.17, 95 % CI: -12.81, -1.54), asthma symptom severity (MD = -0.07, 95 % CI: -0.10, -0.04), Childhood Asthma Control Test (CACT) (MD = 2.26, 95 % CI: 1.14, 3.39), and the number of acute episodes of asthma (OR = 0.30, 95 % CI: 0.19, 0.47) in the probiotics group were better than those in the control group. There was no significant difference in forced expiratory volume in the first second (FEV1) (MD = 0.11, 95 % CI: -0.05, 0.26) and FEV1/FVC (%) (MD = 0.32, 95 % CI: -1.48, 2.12). the use of probiotics in patients with asthma can improve lung inflammation and asthma symptoms, reduce the number of asthma attacks, and have no effect on lung function.

Validation of asthma management approach according to risk factors

Background Although studies show that most people successfully control their asthma, polls consistently show that this is not the case in real life. The present study aimed to validate assessment of asthma control using a risk stratification approach in comparison with global strategy for asthma management and prevention (GINA) guidelines with particular attention to high-risk group of asthmatic patients. Patients and methods This was a prospective interventional cohort trial that enrolled 30 patients with asthma in the outpatient department of Ain Shams University Hospital between January 2019 and January 2020. There were 10 female patients and 20 male patients, with a mean age of 51.43 ± 14.94 years. They were enrolled and randomly grouped 1: 1 into group A, which followed asthma risk stratification therapy (ARST), and group B, with the standard GINA approach, within 1-year follow-up period. Following visit 1 in a 2-week interval as a washout period, there were five consecutive visits on 3 months apart, and then visit 6 at the end of treatment at a 2-week interval. All patients were subjected to the Asthma Control Test Questionnaire for assessment of asthma control by GINA approach and to objective control assessments in ARST by Morisky Medication Adherence Scale-8 for adherence assessment, pulmonary function test for evaluation of annual decline of forced expiratory volume in the first second, and the annual rate of exacerbations. Results The results obtained from visits 1 to 6 showed nonstatistically significant differences in forced expiratory volume in the first second (75 vs. 81.82 ml, P=0.820) and in adherence scale (Morisky Medication Adherence Scale-8) on visits 2–5 (40 vs. 17, P=0465), or the rate of exacerbation (two exacerbations in each group), with no statistically significant differences (0 vs. 13.3%, P=0.143) in group A and group B, respectively. On the contrary, the assessment of severity tools in ARST was based on the level of sustainability of the asthma stepwise categorization among the duration therapy. Using ARST for the aims of control and severity assessments on the studied group, in comparison with the GINA assessment approach, there were highly significant statistical differences in numbers of controlled patients as well as numbers of patients with mild and moderate asthma for severity assessments (t=13.263, P=0.001 vs. t=22.941, P=0.0001, respectively). It could be concluded that applying the GINA approach on studied group A revealed underestimation of control and probably overestimation of asthma severity, or better called asthma stability. Conclusion ARST is noninferior to the GINA approach in the norms of asthma control when objectivity was measured, whereas the levels of sustainability or stability among the duration therapy for assessment of asthma severity were statistically overestimated when measured by GINA. These measures could help most patients with asthma, and there should be a concerted action for their implementation in epidemiological research.

Laparoscopic fundoplication after lung transplantation does not appear to alter lung function trajectory

The primary aim of this study was to determine if allograft function in lung transplant (LTx) recipients improves or stabilizes after laparoscopic fundoplication (LF). The secondary aim was to examine the differences in forced expiratory volume in 1 second (FEV1) before and after LF for various subgroups to identify patients who obtained a superior respiratory outcome after LF, and potential predictive factors for this outcome. Retrospective analysis of consecutive LTx recipients undergoing LF at a single centre in Brisbane, Australia between 2004 and 2018. 149/431 proceeded to LF after clinical review and pH study. Regular pre- and post-fundoplication pulmonary function tests were collected from participants. Data were analyzed with linear mixed models, random intercept models, the Reliable Change Index (RCI), and graphical and visual analysis of the trajectory of FEV1. There was 100% follow-up. After Bonferroni adjustment for multiple comparison was performed, none of the models demonstrated statistical significance. The Reliable Change Index showed one patient had a significant improvement in lung function across that time period, while nine had a significant reduction. The rate of change before and after LF was similar for the 132/149 patients for whom the first and last pre- and post-LF FEV1 values were available. A subset of patients had a considerable reduction in their FEV1 in the peri-operative period (i.e., a large difference between the first measurement post-LF and the final measurement pre-LF). In the largest published cohort to date, LF performed in a high-volume center did not appear to alter the reduction in allograft function seen with time.

Appetite stimulants for people with cystic fibrosis.

Chronic loss of appetite in cystic fibrosis concerns both individuals and families. Appetite stimulants have been used to help cystic fibrosis patients with chronic anorexia attain optimal body mass index (BMI) and nutritional status. However, these may have adverse effects on clinical status. This is an updated version of the original review. To systematically search for and evaluate the evidence on the beneficial effects of appetite stimulants in the management of cystic fibrosis-related anorexia and synthesise reports of any side effects. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register and online trials registries; handsearched reference lists; and contacted local and international experts to identify relevant trials. Last search of the Cystic Fibrosis Trials Register: 23 May 2022. Last search of online trial registries: 10 May 2022. Randomised and quasi-randomised controlled trials of appetite stimulants compared to placebo, control, no treatment or different appetite stimulants, or to the same appetite stimulants at different doses or regimens for at least one month in adults and children with cystic fibrosis. Review authors independently extracted data and assessed risk of bias of the included trials. We used the GRADE approach to assess the certainty of the evidence and performed meta-analyses. We included four trials (70 participants) comparing appetite stimulants (cyproheptadine hydrochloride and megestrol acetate) to placebo; the numbers of adults or children within each trial were not always reported. We assessed the certainty of evidence as low due to the small number of participants, incomplete or selective outcome reporting, and unclear risk of selection bias. Regarding our primary outcomes, a meta-analysis of two trials (42 participants) showed that appetite stimulants may produce a larger increase in weight (kg) at three months (mean difference (MD) 1.25 kg, 95% confidence interval (Cl) 0.45 to 2.05), and one trial (17 participants) showed a similar result at six months (MD 3.80 kg, 95% CI 1.27 to 6.33) (both low-certainty evidence). Results also showed that weight z score may increase with appetite stimulants compared to placebo at three months (MD 0.61, 95% CI 0.29 to 0.93; 3 studies; 40 participants; P < 0.001) and at six months (MD0.74, 95% CI 0.26 to 1.22; 1 trial; 17 participants). There was no evidence of a difference in effect between cyproheptadine hydrochloride and megestrol acetate for either outcome. Only one trial (25 participants) reported analysable data for body composition (BMI), with results favouring cyproheptadine hydrochloride compared to placebo; a further trial (16 participants) narratively agreed with this result. All four trials reported on lung function at durations ranging from two to nine months. Considering analysable data, two trials (42 participants) found that appetite stimulants may make little or no difference in forced expiratory volume at one second (FEV1) % predicted at three months, and one trial (17 participants) found similar results at six months. Two further three-month trials narratively agreed with these results. Limited information was reported for secondary outcomes. Two trials (23 participants) reported results showing that appetite stimulants may increase appetite compared to placebo at three months (odds ratio 45.25, 95% CI 3.57 to 573.33; low-certainty evidence). Only one study reported on quality of life, finding that cyproheptadine reduced fatigue in two participants compared with none with placebo. One study (25 participants) found no difference in energy intake between appetite stimulant or placebo at three months. Insufficient reporting of adverse effects prevented a full determination of their impact. Two studies (33 participants) narratively reported similar requirements for additional antibiotics between appetite stimulants and placebo at three months. AUTHORS' CONCLUSIONS: At six months in adults and children, appetite stimulants improved only two of the outcomes of this review: weight (or weight z score) and subjectively reported appetite. Insufficient reporting of side effects prevented a full determination of their impact. Whilst the data may suggest the potential use of appetite stimulants in treating anorexia in adults and children with cystic fibrosis, this is based upon low-certainty evidence from a small number of trials, therefore firm conclusions cannot be drawn. Clinicians need to be aware of the potential adverse effects of appetite stimulants and actively monitor any individuals prescribed these medications accordingly. Research is required to determine meaningful surrogate measures for appetite and to define what constitutes quality weight gain. Future trials of appetite stimulants should use a validated measure of symptoms including a disease-specific instrument for measuring poor appetite. This review highlights the need for multicentred, adequately powered, and well-designed trials to evaluate agents to safely increase appetite in people with cystic fibrosis and to establish the optimal mode of treatment.

A Single Center Experience of Super-Responders Among Severe Asthma Patients Receiving Treatment with Mepolizumab.

OBJECTIVE:Anecdotal reports among clinicians treating severe asthma patients with novel add-on treatments such as mepolizumab suggest that a fraction of these patients may experience a much more dramatic benefit from these agents than reported in large, randomized controlled studies. Although these patients have been referred to as super-responders in some studies, currently, there is no consensus regarding the nomenclature. Therefore, our aim was to assess the real-life data among patients receiving mepolizumab treatment due to severe eosinophilic asthma, in an effort to determine potential clinical and laboratory differences between super-responders and other group of patients.MATERIAL AND METHODS:Data from adult patients who received at least four doses of mepolizumab due to persistent severe asthma between Janury 1, 2020, and December 31, 2021, in a Tertiary Allergy Clinic were evaluated in a retrospective manner.Results:A total of 57 patients with severe asthma receiving mepolizumab treatment were included [female: 38, male: 19]. At 4th- and 12th-month after initiation of mepolizumab treatment, significant differences in forced expiratory volume in 1 second, forced vital capacity, forced expiratory volume in 1 second/forced vital capacity, blood eosinophil count, and serum immunoglobulin E level were detected as compared to baseline (P < .001, P < 0.001, P = .027, P < .001, and P = .035). Also, at the 12th-month of treatment with mepolizumab, there were significant differences compared to baseline in asthma control test scores, number of asthma exacerbations, non-planned emergency room visits, hospitalizations, and daily need for oral corticosteroids (P < .001, for all parameters). Also, there was not a statistically significant difference between super-responders and responders groups in regard to age, gender, duration of disease, duration of mepolizumab treatment, allergen sensitivities, and comorbid conditions (chronic rhinosinusitis, nasal polyps, and aspirin sensitivity).Conclusion:Our results suggest that mepolizumab may be an effective therapeutic option in patients with severe asthma. On the other hand, patients who were considered to be super-responders to mepolizumab treatment were not significantly different from the remaining group of patients (responders). Obviously, further studies are warranted to better define the super-responders among patients with severe asthma who receive mepolizumab treatment.

Impact of Patient-Specific Aminoglycoside Monitoring for Treatment of Pediatric Cystic Fibrosis Pulmonary Exacerbations.

Aminoglycosides are frequently used for empiric and definitive treatment of cystic fibrosis (CF) pulmonary exacerbations. Various methods have been described for aminoglycoside therapeutic drug monitoring. The objective of this study is to evaluate the effect of patient-specific pharmacokinetic calculations for aminoglycosides used to treat CF pulmonary exacerbations. Ambidirectional cohort study of patients admitted to a children's hospital from June 1, 2018, through February 28, 2019, and June 1, 2019, through February 8, 2021. The primary outcome was the occurrence of dosing changes after analysis of initial serum concentrations in either group. Secondary outcomes included occurrence of nephrotoxicity, duration of antibiotics, and length of stay. Twenty-four patients (75%) in the intervention group versus zero in the control group required dosing adjustments after initial analysis of serum concentrations were completed (p < 0.001). There was not a statistically significant between-group difference for duration of antibiotics in days (median, 14 vs 13.5; Z, 1.07; p = 0.29) or length of stay (median, 11 vs 11; Z, -0.31; p = 0.76). There was also not a statistically significant between-group difference in forced expiratory volume in one second (FEV1) change from admission to discharge (11.4% vs 13.9%; t, 0.61; Degrees of Freedom, 39; p = 0.55). Two patients (6.25%) in the intervention group experienced nephrotoxicity compared with zero patients in the control group (risk difference, 6.25%; 95% CI, -2.14 to 14.64; number needed to harm, 16). Patient-specific pharmacokinetic monitoring led to significantly more dosing changes and was associated with similar patient outcomes as trough-only monitoring. Further studies are needed to identify methods to optimize aminoglycoside dosing and monitoring for these patients with the goal of reducing toxicities while maximizing efficacy.

Impact of body mass index on omalizumab response in adults with moderate-to-severe allergic asthma

BackgroundEffectiveness of asthma treatment, including biologics, may be different in patients with higher body mass index (BMI). ObjectiveTo evaluate response to omalizumab (dosed by serum immunoglobulin E level and weight) by BMI category. MethodsPooled data from 2 randomized, double-blind, placebo-controlled studies of adults with moderate-to-severe allergic asthma were analyzed by BMI category (<25 kg/m2 [normal or underweight], n = 397; 25 to <30 kg/m2 [overweight], n = 330; ≥ 30 kg/m2 [obese], n = 268). Placebo-adjusted exacerbation rate reductions were evaluated by Poisson regression modeling. Changes from baseline in forced expiratory volume in 1 second, beclomethasone dipropionate (BDP) dose, Total Asthma Symptom Score, and Asthma Quality of Life Questionnaire were evaluated by analysis of covariance. ResultsGreater placebo-adjusted exacerbation rate reductions (95% confidence interval) were observed with increasing BMI (normal or underweight, −37.4% [−69.0% to 26.8%]; overweight, −52.7% [−78.4% to 3.7%]; obese, −71.9% [−86.9% to −39.5%]). There were no differences in forced expiratory volume in 1 second improvement between BMI categories at week 16 (normal or underweight, 76.2 [5.3-147.1] mL; overweight, 98.1 [13.9-182.4] mL; obese, 69.1 [−18.9 to 157.2] mL). No differences in BDP dose reduction (µg) were noted between BMI categories (normal or underweight, 23.0 [15.7-30.3]; overweight, 22.5 [13.5-31.5]; obese, 16.6 [5.8-27.3]). Fewer patients in the higher BMI categories eliminated BDP use. There were trends for smaller improvements with higher BMI in Total Asthma Symptom Score (normal/underweight, −0.52 [−0.82 to −0.22]; overweight, −0.50 [−0.80 to −0.20]; obese, −0.39 [−0.77 to 0.00]) and Asthma Quality of Life Questionnaire (normal or underweight, 0.34 [0.16-0.52]; overweight, 0.34 [0.13-0.55]; obese, 0.15 [−0.08 to 0.39]). ConclusionOmalizumab provides benefit to patients with moderate-to-severe allergic asthma, regardless of BMI. Trial RegistrationStudies 008/009 were conducted before clinical trial registration was required, and therefore clinical trial registration numbers are not available.

Efficacy Analysis of Levofloxacin Combined with Cefoperazone/Sulbactam Sodium in the Treatment of Adult Bronchiectasis Complicated with Infection

Objective: To investigate the efficacy of levofloxacin combined with cefoperazone/ sulbactam sodium in the treatment of bronchiectasis complicated with infection in adults and its effect on lung function. Methods About 200 patients with bronchiectasis and infection from May 2019 to July 2022 in Jintan First People's Hospital of Changzhou City, Jiangsu Province were selected and divided into 2 groups (100 cases in each group) according to the treatment plan. The control group received cefoperazone /sulbactam sodium treatment, the observation group was treated with levofloxacin on the basis of the above. The evaluation was conducted by comparing the time of improvement of clinical symptoms, the decrease of inflammatory indicators, and the improvement of lung function indicators. Results After treatment, the overall effectiveness rate of the observation group was 93%, and the control group was 78%, which was significantly different (P<0.05), cough and sputum production, body temperature recovery and hemoptysis stop time were all earlier than those in the control group (P<0.05). Prior to treatment, there was no significant difference in neutrophil values (GRAN), white blood cell count (WBC), and hypersensitive C-reactive protein (CRP) between the two groups (P>0.05). After treatment, the GRAN, WBC and CRP of the control group were significantly higher than those in the observation group (P<0.05); there was no significant difference in forced expiratory volume (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC between the two groups before treatment (P>0.05), After treatment, the FVC, FEV1, FEV1/FVC values in the observation group were significantly higher than those in the control group (P<0.05). Conclusion The application of levofloxacin combined with cefoperazone/sulbactam sodium can effectively improve the clinical symptoms, inflammation level and pulmonary function indexes of adult bronchiectasis complicated with infection.

Respiratory and Cardiovascular Outcomes in Survivors of Extremely Preterm Birth at 19 Years

With improved neonatal intensive care, more children born before 26 weeks’ gestation (extremely preterm [EP]) survive to adulthood. What is the pulmonary status of these patients?A total of 123 19-year-olds born EP. A total of 64 age and sex matched subjects born at term served as controls.Subjects were interviewed regarding health status. Spirometry (with bronchodilator) and a standardized incremental shuttle walk test were performed. These studies were also compared with those done on the same participants when they were 11 years of age.Compared with the control group, the EP group was significantly impaired on all spirometric parameters. The difference in mean postbronchodilator forced vital capacity z score between EP and control subjects was −0.64 SD (95% confidence interval [CI]: −0.94 to −0.35), equivalent to 470 mL, and the mean difference in forced expiratory volume in 1 second z scores was −1.08 SD (95% CI: −1.40 to −0.77), equivalent to 600 mL. Bronchodilator reversibility (defined as a >12% change in forced expiratory volume in 1 second) was more common in the EP group (26.5%) than it was in the control group (6.3%; odds ratio: 5.39 [95% CI: 1.81 to 16.04]). Although the EP group was not more likely to have a clinical diagnosis of asthma by the participants usual clinician, as reported by the participant (41% versus 34%), those EP participants who had had neonatal bronchopulmonary dysplasia (BPD) were more likely to have this diagnosis than those EP participants who had not (49% versus 21%). Comparing spirometry at age 11 and age 19 revealed no evidence of “catch up” improvement in lung function. A clinically and statistically significant lower shuttle walk distance was observed in the EP group, compared with the control group (899 m [SD: 305] vs 1132 m [SD: 303]; P < .05), and in the EP group with BPD, compared with the EP group without BPD (862 m [SD: 304] vs 991 m [SD: 290]; P < .05).EP survivors have lower lung function and decreased exercise capacity, as compared with that of controls. EP survivors who had neonatal BPD had higher rates of reported physician-diagnosed asthma.When evaluating adults with asthma, it is appropriate to inquire about neonatal history, given these profound, long-term consequences on lung function and exercise capacity and be particularly attentive because the authors point out to “promotion of a healthy lifestyle, including, for example, physical activity, weight management, and tobacco avoidance.”

Effect of Adding Inhaled Corticosteroid to Long-Acting Muscarinic Antagonist/Long-Acting Beta-Agonist Therapy Among Patients With Chronic Obstructive Pulmonary Disease.

BackgroundThe role of inhaled corticosteroid (ICS) in chronic obstructive pulmonary disease (COPD) is unclear. Hence, this study aimed to evaluate the efficacy of ICS as an add-on to long-acting muscarinic antagonist (LAMA)/long-acting beta 2 agonist (LABA), which was assessed using the impulse oscillation system (IOS), in patients with COPD.MethodologyWe included patients with COPD whose treatment was changed from LAMA/LABA (≥four weeks) to ICS/LAMA/LABA between April 2019 and March 2021. To gain insight into the effect and safety of ICS-containing triple therapy for COPD, pulmonary function; Short-Form 36, St. George’s Respiratory Questionnaire, COPD Assessment Test, and modified Medical Research Council scores; and airway resistance assessed using the IOS from one week before LAMA/LABA was switched to ICS/LAMA/LABA therapy until more than eight but less than twelve weeks after switching were evaluated.ResultsIn total, 46 patients with COPD (mean age: 72.28 ± 7.81 years) were included in the study. None of the pulmonary function test parameters significantly changed from baseline values (mean difference in forced expiratory volume in one second [FEV1.0]: +0.032, P = 0.12; percentage FEV1.0 [FEV1.0%]/forced vital capacity [FVC]: −0.58, P = 0.42; and FVC: +0.087, P = 0.058). Meanwhile, the IOS showed that resonant frequency (mean difference from baseline: −2.12, P < 0.0001) and bodily pain scores in the St. George’s Respiratory Questionnaire (mean difference: −7.03, P = 0.031) significantly decreased.ConclusionsSwitching from LAMA/LABA to ICS/LAMA/LABA therapy reduces airway elasticity-to-inertial resistance ratios, which may lead to structural airway improvements in patients with COPD.

An intervention to support adherence to inhaled medication in adults with cystic fibrosis: the ACtiF research programme including RCT

An intervention to support adherence to inhaled medication in adults with cystic fibrosis: the ACtiF research programme including RCT

Personal protective equipment use during industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina 2014-2015.

Occupational activities related to industrial hog operation (IHO) worker lung function are not well defined. Therefore, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) use on IHOs. From 2014 to 2015, 103 IHO workers were enrolled and followed for 16 weeks. At each biweekly visit, work activities and PPE use were self-reported via questionnaire and lung function measurements were collected via spirometry. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data. Increasing years worked on an IHO were associated with diminished lung function, but baseline and longitudinal work activities were largely inconsistent in direction and magnitude. Unexpectedly, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in forced expiratory volume in the first second (FEV1 ) was estimated when workers wore PPE consistently (≥80% of the time at work) versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased. Similar to past studies, baseline estimates were likely obscured by healthy worker effect bias, but showed decrements in worker lung function as years of work increased. A challenge to disentangling the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to the work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE.