Obstructive Lung Disease Research Articles

Association between humidity and respiratory health: the 2016–2018 Korea National Health and Nutrition Examination Survey

BackgroundAmbient humidity has a significant impact on respiratory health and influences disease and symptoms. However, large-scale studies are required to clarify its specific effects on lung function and respiratory symptoms. We examined the relationship between relative humidity (RH), lung function, and respiratory symptoms using data from the Korea National Health and Nutrition Examination Survey (KNHANES).MethodsIn this cross-sectional study, we analyzed data from KNHANES participants aged ≥ 40 years, collected between 2016 and 2018. Pulmonary function tests (PFTs) and health questionnaires were used to assess lung function and respiratory symptoms. Individual environmental data, including RH, were obtained from the Community Multiscale Air Quality model and linked to the participants’ addresses. Short-term (0–14 days), mid-term (30–180 days), and long-term (1–5 years) RH exposures were examined. Linear regression models were used to evaluate the associations between RH and PFTs. Univariate and multivariable logistic regression models were applied to assess the risk of lung function abnormalities and respiratory symptoms.ResultsIn total, 10,396 participants were included (mean age: 58.3 years, male: 43.6%). In multiple regression analysis, higher RH was negatively associated with the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio across various time lags, while FVC was positively correlated with long-term RH exposure. In multiple logistic analysis adjusted for clinical and environmental covariates, long-term higher RH exposure was associated with a lower risk of restrictive lung disease (odds ratio [OR] at 4-year moving average [MA]: 0.978, 95% confidence interval [CI]: 0.959–0.997), while mid-term RH exposure decreased the risk of chronic cough (OR at 90-day MA: 0.968, 95% CI: 0.948–0.987) and sputum production (OR at 90-day MA: 0.985, 95% CI: 0.969–1.001).ConclusionsHigher RH was negatively associated with lung function and increased the risk of obstructive lung disease, whereas mid-term RH exposure reduced the risk of chronic cough and sputum production.

Clinical Significance of Aspergillus Sensitisation in Chronic Pulmonary Aspergillosis.

Aspergillus sensitisation (AS) is seen in many patients with chronic pulmonary aspergillosis (CPA). However, the clinical relevance of AS in CPA remains unclear. In this study, we assess the clinical significance of AS in CPA. We retrospectively analysed the data of CPA subjects, defining AS as Aspergillus fumigatus-IgE ≥ 0.35 kUA/L. We excluded subjects with asthma, allergic bronchopulmonary aspergillosis, chronic obstructive pulmonary disease (COPD) and diffuse parenchymal lung diseases (DPLD). The primary objective was to compare the demographic and clinical characteristics, lung functions (via spirometry) and treatment outcomes in CPA subjects with or without AS. The secondary objective was to explore the association between AS and airflow obstruction on spirometry using multivariable logistic regression analysis. We included 232 CPA subjects (119 females, 113 males) with a mean ± SD age of 42.1 ± 13.7 years. AS was present in 92 (39.7%) CPA patients (CPA-AS group). CPA-AS patients had higher SGRQ total scores, a higher prevalence of fungal ball, more frequent airflow obstruction and experienced more CPA relapses during follow-up compared to those without AS. Airflow obstruction was seen in 77/232 (33.2%) CPA patients. On multivariable logistic regression analysis, we found AS, increasing age and chronic fibrosing pulmonary aspergillosis independently associated with airflow obstruction on spirometry after adjusting for sex and other CPA categories. The relapse-free survival was significantly shorter in the CPA-AS group than in the CPA group. AS is common in CPA and is independently associated with airflow obstruction. More studies are required to confirm our findings.

Distinct physiological, transcriptomic, and imaging characteristics of asthma-COPD overlap compared to asthma and COPD in smokers

The clinical and pathological features of asthma and chronic obstructive pulmonary disease (COPD) can converge in smokers and elderly individuals as asthma-COPD overlap (ACO). This overlap challenges the diagnosis and treatment of the distinct aetiologies underlying these conditions. We analysed 2453 smokers (≥10 pack-years), aged 45-80 years, from the Genetic Epidemiology of COPD (COPDGene) Study, stratified as Control, Asthma, COPD, and ACO based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. A comprehensive assessment was performed, encompassing symptomatology, pulmonary function tests (PFTs), complete blood counts (CBCs), bulk RNA sequencing (RNA-seq), and high-resolution quantitative computed tomography (QCT) imaging to evaluate clinical impact, lung function, systemic inflammation, and structural alterations contributing to disease progression across respiratory phenotypes. Differential expression (DE) analysis was performed using whole blood RNA-seq (BH-corrected FDR < 0.01), followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Group differences were assessed using the Mann-Whitney U-test (MWU) or Chi-squared test (χ2), with Bonferroni correction applied for multiple comparisons. Multivariate linear regression models were used to adjust the associations between disease status and specific clinical outcomes for confounders, with one-way ANOVA and Tukey's Honest Significant Difference (HSD) post-hoc test applied for pairwise comparisons. Our analysis aimed to delineate the extent and variability of clinical features among disease phenotypes to guide targeted therapeutic strategies. Our study highlights distinct yet overlapping profiles across ACO, asthma, and COPD. We effectively isolated disease-specific mechanisms by comparing each phenotype to smoking controls (GOLD 0) while accounting for baseline smoking-related inflammation. ACO exhibited the most severe symptom burden, with significantly higher COPD Assessment Test (CAT) score (18.32, 95% CI: [17.02, 19.63], P<0.0001) and Modified Medical Research Council (mMRC) Dyspnea score (2.14, 95% CI: [1.92, 2.35], P<0.0001) compared to COPD and asthma. ACO also displayed reduced lung capacity (forced expiratory volume in 1s [FEV1]: 52.5%, 95% CI: [50.08, 54.93], P<0.0001) and airflow limitation (FEV1/forced vital capacity [FVC]: 0.55, 95% CI: [0.5471, 0.5546], P<0.0001), closely resembling COPD but significantly worse than asthma. The inflammatory profile of ACO exhibited a mixed response, featuring elevated neutrophil counts (4.57K/μL, 95% CI: [4.28, 4.86], P<0.0001) and eosinophil levels (0.22K/μL, 95% CI: [0.20, 0.25], P<0.01), contrasting with the predominantly neutrophilic inflammation in COPD and the absence of systemic inflammation in asthma. Structurally, ACO demonstrated significant airway remodelling (Pi10: 2.87, 95% CI: [2.83, 2.91], P<0.0001), intermediate emphysema (5.66%, 95% CI: [4.72, 6.60], P<0.0001), and moderate small airway disease (parametric response mapping for functional small airway disease [PRMfSAD]: 22.94%, 95% CI: [21.53, 24.34], P<0.0001), reflecting features of both asthma and COPD. COPD was characterised by more extensive emphysema (8.9%, 95% CI: [8.34, 9.45], P<0.0001), small airway disease (PRMfSAD: 27.09%, 95% CI: [26.51, 27.66], P<0.0001), and gas trapping (37.34%, 95% CI: [36.33, 38.35], P<0.0001), alongside moderate airway remodelling. At a molecular level, DE analysis revealed enrichment of the Hypoxia-Inducible Factor 1 (HIF-1) pathway in ACO, highlighting unique hypoxia-driven metabolic adaptations, while COPD was associated with neutrophil extracellular trap (NET) formation and necroptosis. In contrast, asthma exhibited significant airway remodelling (Pi10: 2.09, 95% CI: [2.05, 2.13], P<0.0001), minimal parenchymal damage, and no systemic gene expression changes. Collectively, our findings underscore the lung function impairments, systemic inflammation, molecular mechanisms, and structural correlates distinguishing ACO from COPD and asthma, emphasising the need for precise clinical management and the potential for novel therapeutic interventions. This work was supported by National Heart, Lung, and Blood Institute (NHLBI) grants U01 HL089897 and U01 HL089856, as well as by National Institutes of Health (NIH) contract 75N92023D00011. Additional support was provided by grants R01 HL166231 (C.P.H.) and K01 HL157613 (A.S.).

Association of Comorbidity Duration with the Occurrence and Prognosis of Steatotic Liver Disease.

Steatotic liver disease (SLD) interacts with various comorbidities, impacting outcomes, yet little is known about the duration of comorbidities in SLD occurrence and mortality. We investigated this relationship, focusing on disease predictors and mortality rates. Analyzing 2010 and 2015 Korea National Health and Nutrition Examination Survey data for patients aged ≥ 20, we categorized ten comorbidities (hypertension [HTN], diabetes mellitus [DM], dyslipidemia, stroke, myocardial infarction [MI], angina pectoris, asthma, chronic obstructive lung disease [COPD], chronic kidney disease [CKD], and depression) by duration. Association rule mining and logistic regression analyzed the association between SLD occurrence and comorbidity duration, while Cox regression assessed survival. The analysis included 2,757 SLD and 9,505 non-SLD cases. Association rule mining showed that the shorter duration of DM and dyslipidemia and the longer duration of HTN comprised the top-ranked component for presence of SLD. DM with a duration ≤ 1year showed higher risk of SLD than longer periods (odds ratio, 11.53), while the duration of cardiovascular disease, lung disease, or CKD was not significantly associated with the presence of SLD. In terms of prognosis, multivariate Cox regression showed that longer HTN and DM durations were significantly associated with increased hazard ratio (HR) beyond 10years (HR, 2.22 and 2.11, respectively). Cardiovascular disease duration ≤ 5years and lung disease duration > 5years showed statistical significance (HR 2.49and 2.38, respectively). Duration of comorbidities should be considered for comprehensive SLD risk stratification, for both the identification of SLD and the assessment of their prognosis after detection.

Risk factors for prolonged hospitalization as a marker for difficult-to-manage exacerbations of chronic obstructive lung disease (COPD): the DiMECO Study

BackgroundExacerbation is an independent risk factor for chronic obstructive pulmonary disease (COPD)-related morbidity and mortality. Despite optimal care, there may be risk factors that lead to difficulties in managing exacerbations that may be associated with prolongation of length of hospital stay (LOS).MethodsThis is a multicenter prospective observational study of COPD patients hospitalized with exacerbations. Prolonged LOS was calculated according to the 50th percentile and defined as ≥ 9 days. Potentially predicting factors of LOS were stratified into 4 pillars as patient-related, disease and exacerbation-related, treatment-related and, hospital utility-related. These categories were systematically documented throughout the duration of the hospitalization.ResultsA total of 434 patients, 361 males and 73 females, with a mean age of 69.2 ± 9.3 years, were included in the study. Variables of each pillar were tested with univariate analysis to identify potential risk factors for prolonged LOS. Subsequently significant factors excluding factors associated with hospital utility were tested with multivariate logistic regression analysis for detecting potential associated factors for difficult-to-manage COPD exacerbation. Biomass exposure, past history of non-invasive mechanical ventilation (NIMV), low bicarbonate levels at admission, antibiotic switching, need for theophylline, increasing oxygen requirement, need for in-hospital non-invasive mechanical ventilation, nutritional support and physiotherapy were found as defining factors.ConclusionsThe DiMECO study can help to identify COPD exacerbators who are at risk for prolonged hospitalizations that may associate with difficult-to-manage COPD exacerbations. Difficult to manage COPD exacerbation may serve as a provocative framework, underscoring the necessity for a better understanding of the multifaceted approaches to the management of COPD exacerbations. This conceptualization warrants further investigation across diverse clinical settings to validate its applicability and efficacy.

COPD Risk Phenotypes in Older Smokers: Evaluation in GLI- and GOLD-Defined Respiratory Impairment

PurposeIn aging populations, the Global Initiative for Obstructive Lung Disease (GOLD) spirometry threshold may misclassify normal spirometry as airflow limitation. The Global Lung Initiative (GLI) method provides age-adjusted criteria. We investigated how the use of GOLD or GLI thresholds in an algorithm affects the classification of elderly smokers into COPD risk phenotypes.MethodsUsing a modified COPDGene algorithm, including exposure, symptoms, and abnormal spirometry, 200 smokers aged 60 years and older were classified into 4 mutually exclusive phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms, normal spirometry; possible COPD), Phenotype C (no symptoms, abnormal spirometry; possible COPD), and Phenotype D (symptoms, abnormal spirometry; probable COPD). Abnormal spirometry was defined according to the GOLD or GLI criteria. A comparison was made between the GOLD- and GLI-defined phenotypes.ResultsUsing GLI criteria/cut-offs, 18.5% (n = 37) had phenotype A (no COPD), 42% (n = 84) had phenotype B (possible COPD), 7.5% (n = 15) had phenotype C (possible COPD), and 32% (n = 64) had phenotype D (probable COPD). Using GOLD criteria cut-offs, 14.5% (n-29) had phenotype A (no COPD); 31% (n = 62) had phenotype B, 11.5% (n = 23) had phenotype C (probable COPD), and 43% (n = 86) had phenotype D (probable COPD). Eight smokers with GOLD phenotype C were reclassified as GLI phenotype A, while 22 with GOLD phenotype D were reclassified as GLI phenotype B. Smokers identified as ‟probable COPD” by GOLD alone (potential false positives) had better spirometry results than those identified as ‟probable COPD” by both GOLD and GLI.ConclusionThe use of the GOLD threshold in an algorithm resulted in older smokers being classified into more severe COPD risk phenotypes compared to the GLI threshold. This suggests that GOLD may misclassify smokers with less affected phenotypes as having respiratory impairment, potentially leading to unnecessary and harmful treatments.

Susceptibility to and severity of SARS-CoV-2 infection according to prescription drug use-an observational study of 46,506 Danish healthcare workers.

It is not well investigated whether exposure to specific drug classes is associated with COVID-19. We investigated the risk of SARS-CoV-2 infection and severe COVID-19 among healthcare workers according to prescription drug use. We conducted an observational study among Danish healthcare workers. SARS-CoV-2 positivity was defined as a positive PCR/ELISA test throughout 2020 and severe COVID-19 as any above 48-hour hospitalization within 14 days after infection. Patient characteristics came from online surveys while data on SARS-CoV-2, drugs and hospitalizations came from Danish Health Registers. Infected individuals were matched with uninfected controls based on age, sex, and chronic diseases. Drug exposure was defined as any prescription redemption in the past six and one month(s) before infection for each drug class. Models assessing the risk of infection (conditional logistic regression) and severe COVID-19 (logistic regressions) versus drug usage were adjusted for BMI, smoking, alcohol, education, region, and patient contact when possible. We matched 5,710 SARS-CoV-2-infected cases with 57,021 controls. The odds of infection were reduced by calcium channel blocker (adjusted odds ratio (aOR) 0.81, 95% Confidence Interval (CI): 0.66-1.00) and vasoprotective drug (aOR 0.77, CI: 0.62-0.95) usage during the six months before infection compared to no usage. Exposure to antibacterials in the past month increased the odds of infection (aOR 1.27, CI: 1.09-1.48). Among infected participants, the odds of severe COVID-19 were higher with usage of almost any investigated drug, especially, diuretics (crude odds radio (OR) 4.82, CI:2.15-10.83), obstructive airway disease drugs (OR 4.49, CI: 2.49-8.08), and antibacterials (OR 2.74 CI:1.62-4.61). In conclusion, antibacterials were associated with more SARS-CoV-2 infections and calcium channel blockers with less. Once infected, users of prescription drugs had higher odds of developing severe COVID-19. These findings suggest a need for studies to clarify interactions between specific drug groups, behaviour, known risk factors, and disease susceptibility/severity.

Sex-specific association of total mineral intake with pulmonary function in middle-aged and older adults with chronic obstructive pulmonary disease

The objective of this study is to assess the impact of dietary intake and supplementation of total magnesium, iron, zinc and selenium on pulmonary function in middle-aged to elderly individuals diagnosed with chronic obstructive pulmonary disease (COPD). This study utilized publicly available data from NHANES, focusing on the 2007–2012 cycles to include participants aged 50 and above with COPD. The definition of COPD followed the 2024 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Dietary mineral intake was assessed through two 24-h dietary recall surveys. Pulmonary function assessments included parameters such as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), forced mid-expiratory flow (FEF 25–75%), and peak expiratory flow (PEF). Sex-specific associations of total magnesium, iron, zinc, and selenium intakes with pulmonary function parameters were assessed using multivariable regression models adjusted by potential covariates. The study sample had a mean age of 64.56 ± 8.26 years, with 35% being female. The median intakes of total magnesium, iron, zinc, and selenium for males were 312.8 mg, 15.6 mg, 14.4 mg, and 127.9 mcg, respectively, while for females, they were 257.5 mg, 12.8 mg, 11.4 mg, and 96.2 mcg. In males, higher total magnesium and iron intake were significantly associated with increased FEV1, FVC, and PEF (P < 0.05), while in females, only total zinc intake showed a positive association with PEF (P < 0.05). Participants meeting the recommended dietary allowance for total magnesium also exhibited significantly better lung function outcomes in both sexes. This study highlights the importance of adequate dietary mineral intake in managing pulmonary health among COPD patients. Enhancing mineral consumption, particularly magnesium, and iron, may be a viable strategy for improving lung function and overall health in this population, especially in men.

Abnormal spirometry in individuals with a smoking history and no known obstructive lung disease: current understanding and clinical implications.

Recent recognition of the importance of abnormal spirometry without obstruction has generated interest in its epidemiology, risk factors, longitudinal outcomes, and clinical implications. Preserved ratio impaired spirometry (PRISm), defined as an forced expiratory volume in 1 s (FEV1)/ forced vital capacity (FVC) ≥0.7 with an FEV1 <80% predicted, has a high prevalence globally (2.4-16.7%) and is more common in individuals with metabolic comorbidities, smoking history, female sex, and higher BMI. PRISm is associated with increased respiratory symptoms and poor clinical outcomes such as increased all-cause mortality and cardiovascular events compared to normal spirometry. Longitudinal studies show substantial subsets of individuals with PRISm will transition to other spirometric categories, including progression to obstruction. Individuals with PRISm are heterogeneous; recent investigations have focused on subtyping PRISm based on spirometric features or pathobiologically-based phenotypes. PRISm is a common spirometric abnormality which is robustly associated with negative outcomes. However, current knowledge gaps with respect to heterogeneity, specific etiologies, and longitudinal progression preclude the development of universal evidence-based diagnostic and management strategies. At present, clinicians are advised to focus on risk factor modification (e.g., diabetes, obesity) and the identification of actionable traits (e.g. emphysema, interstitial lung abnormalities) among patients with PRISm.

Sustainability and choice of inhaled treatment for obstructive pulmonary diseases

Inhaled treatments are essential for obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, pressurized metered-dose inhalers (pMDI) use propellant gases, contributing to greenhouse gas (GHG) emissions and thereby to climate change. The use of dry powder inhalers (DPI) or soft mist inhalers (SMI) when clinically appropriate is a way to reduce these emissions. It is essential to confirm the diagnosis, promote adherence and therapeutic education, and support effective recycling policies and the development of less polluting treatments. In any case, the right inhaler is the one that suits the patient, is used correctly, and stabilizes of the respiratory condition.

Impact of the COVID-19 pandemic on the clinical features of patients with chronic obstructive pulmonary disease: an observational cross-sectional study.

The presence of chronic obstructive pulmonary disease (COPD) and COVID-19 infection is a detrimental combination for patients and can cause negative clinical consequences. The investigation aimed to compare sociodemographic and clinical parameters of COPD individuals hospitalized for exacerbations before and at the end of the COVID-19 pandemic. An observational cross-sectional study including 222 patients with COPD was conducted in two stages: a survey and assessment of clinical and laboratory data of patients hospitalized from September 2022 to March 2023 (n=98) and processing of the medical histories of patients with COPD who received hospital treatment in 2017 and 2018 (n=124). A comparative analysis of patients who received inpatient treatment for COPD showed that the frequency of patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) I was half as high after the COVID-19 pandemic, whereas the individuals with GOLD IV were more frequent during the same period (p<0.05). Multiple regression analysis proved the effects of smoking status and previous COVID-19 infection on the health status of patients with COPD according to COPD Assessment Test data (p<0.05). There was an increase in the frequency of comorbid pathologies in the post-COVID period: hypertension, coronary heart disease, gastrointestinal diseases, anemia (p<0.05), and other diseases. This study highlights the significant influence of the COVID-19 infection on people with COPD, which manifested as impaired lung function and an increased incidence of comorbidities.

Association of MYH10 with clinical variables in obstructive lung diseases

Association of MYH10 with clinical variables in obstructive lung diseases

OSTEOARTHRITIS AND METABOLIC SYNDROME: KEY ASPECTS OF PATIENT MANAGEMENT

Introduction: Osteoarthritis is a major health concern, and along with coronary heart disease and arterial hypertension, forms a triad of the most common diseases among the adult population. Osteoarthritis significantly reduces the quality of life, leads to disability, and increases mortality rates. Globally, nearly 240 million people suffer from osteoarthritis (about 10% of men and 18% of women over the age of 60). In terms of disease burden, osteoarthritis ranks: first in complications of the musculoskeletal system, second in the number of visits to family doctors, and third in cases of disability. Patients with osteoarthritis, particularly those with comorbid conditions and metabolic syndrome, face a high prevalence of cardiovascular diseases and an increased risk of premature death. Goal: to elucidate modern insights into the pathogenetic links between osteoarthritis and metabolic syndrome, and to justify new approaches to improving treatment for patients with this pathology. Materials and Methods: A literature search was conducted using scientific databases, employing methods of analysis, comparison, and generalization of information about the relationship between osteoarthritis and metabolic syndrome. The study was carried out at the Department of Family Medicine and Therapy at Poltava State Medical University, based in the Regional Rheumatology Center of M. V. Sklifosovskiy Poltava Regional. The study involved 40 patients, both outpatients and inpatients, including 26 women (65%) and 14 men (35%), aged 54-69 years, with primary osteoarthritis of X-ray stages I-II according to the Kellgren-Lawrence scale, in combination with metabolic syndrome. The control group consisted of 20 individuals. Results. A 12-month monitoring of this group of patient was conducted, revealing mild to moderate manifestations of metabolic syndrome along with polymorbid conditions such as chronic obstructive lung diseases and genitourinary system disorders. Most frequently, one, and rarely two, comorbid conditions were detected, along with one or two diseases unrelated to osteoarthritis. The most common progressive conditions observed were arterial hypertension, ischemic heart disease, heart failure, obesity, type 2 diabetes, and digestive system diseases. The primary goal in managing patients with osteoarthritis and metabolic syndrome is to significantly reduce cardiovascular risk and mortality. This involves developing a comprehensive concept of metabolic syndrome and osteoarthritis, identifying patients at high cardiovascular risk, and implementing preventive measures, including lifestyle modifications and the use of appropriate medications. Conclusions. The study revealed a significant clinical effect from the use of therapy that included coxibs in 78% of patients in the main group with osteoarthritis combined with metabolic syndrome. A positive outcome was observed in terms of pain reduction, a reduction in inpatient treatment duration by 2-3 days, and extended remission periods. For this category of patients, primary prevention should focus on weight loss, increased physical activity, and normalization of metabolic disorders.

Salbutamol attenuates arrhythmogenic effect of aminophylline in a hPSC-derived cardiac model

The combination of aminophylline and salbutamol is frequently used in clinical practice in the treatment of obstructive lung diseases. While the side effects (including arrhythmias) of the individual bronchodilator drugs were well described previously, the side effects of combined treatment are almost unknown. We aimed to study the arrhythmogenic potential of combined aminophylline and salbutamol treatment in vitro. For this purpose, we used the established atomic force microscopy (AFM) model coupled with cardiac organoids derived from human pluripotent stem cells (hPSC-CMs). We focused on the chronotropic, inotropic, and arrhythmogenic effects of salbutamol alone and aminophylline and salbutamol combined treatment. We used a method based on heart rate/beat rate variability (HRV/BRV) analysis to detect arrhythmic events in the hPSC-CM based AFM recordings. Salbutamol and aminophylline had a synergistic chronotropic and inotropic effect compared to the effects of monotherapy. Our main finding was that salbutamol reduced the arrhythmogenic effect of aminophylline, most likely mediated by endothelial nitric oxide synthase activated by beta-2 adrenergic receptors. These findings were replicated and confirmed using hPSC-CM derived from two cell lines (CCTL4 and CCTL12). Data suggest that salbutamol as an add-on therapy may not only deliver a bronchodilator effect but also increase the cardiovascular safety of aminophylline, as salbutamol reduces its arrhythmogenic potential.

Rehospitalization Rates and Mortality Factors of Chronic Respiratory Failure Patients Using Home-Based NIV Due to Chronic Obstructive and Restrictive Lung Diseases

Rehospitalization Rates and Mortality Factors of Chronic Respiratory Failure Patients Using Home-Based NIV Due to Chronic Obstructive and Restrictive Lung Diseases

Risk Factors for Cervical Hematoma After Thyroid Surgery at a Portuguese Hospital: A Retrospective Study.

Cervical hematoma post thyroid surgery is an uncommon but potentially life-threatening postoperative complication. Moreover, despite its low incidence, this complication has been a barrier to outpatient surgical care. Assessing postoperative complication rates and their risk factors can improve the safety and cost-effectiveness of these procedures, which is especially useful in promoting outpatient surgical care. This retrospective study included 198 patients who underwent thyroid surgery in the district of Viseu (Portugal)between January 2020 and December 2021. The sample was analyzed to determine the incidence of cervical hematoma post thyroid surgery and to identify possible medical and modifiable anesthetic risk factors related to hematoma. To determine the risk factors, the sample was divided into two groups: Group 1 included patients without postoperative cervical hematoma and Group 2 included patients with postoperative cervical hematoma Result: The incidence of postoperative cervical hematoma was 6.0%, slightly higher than previously reported in the literature.Univariate analysis identified two factors associated with post-surgical cervical hematoma in our sample: a medical history of obstructive lung disease and intraoperative administration of ketorolac. Several studies have reliably associated a history of chronic obstructive pulmonary disease (COPD) with airway reactivity, especially during an anesthetic emergency. The use of non-steroidal analgesics is widespread in intraoperative practice, and the literature consistently supports the safety of their administration in endocrine cervical surgical procedures. Our study revealed controversies related to this topic, and in our opinion,patients who received intraoperative ketorolac in our cohort tended to follow an opioid-free analgesia regimen, leading to more pain and discomfort post surgery. Discomfort and pain in the immediate postoperative period have been identified as potential risk factors for cervical hematoma. Patients with obstructive lung disease ​​​​​​should be carefully monitored after thyroid surgery and may not be suitable for an ambulatory thyroidectomy. The risk of postoperative bleeding and the benefits of intraoperative ketorolac administration should be balanced, particularly for high-risk patients like those with obstructive pulmonary disease.The establishment of standardized anesthetic protocols for thyroid surgery can enhance the safety and cost-effectiveness of procedures, helping to define feasible preoperative criteria for patient selection in outpatient care.

Flow Profiles Identify Sources of Poor Metered Dose Inhaler Technique: An Observational Study in Long-Term pMDI Users

BackgroundInhaled medications are commonly used as therapy for obstructive lung disease (OLD) yet poor technique from pressurized metered dose inhalers (pMDI) can severely limit drug delivery and therapeutic efficacy. A novel flow sensor has been developed to characterize inhalation flow profiles from pMDIs. Research QuestionAmong OLD subjects, flow profiles during pMDI inhalation maneuvers would expose poor patterns of pMDI use, which can be used to remediate pMDI technique. Study Design and MethodsA novel flow sensor was coupled to a placebo pMDI inhaler to characterize inhalation technique in 70 OLD participants from a pulmonary clinic. pMDI inhalation flow profiles generated actuation timing, mean inspiratory airflow (MIF) and inspired volume before and after visualizing these features. McNemar’s was used to characterize the impact of training on pMDI inhalation metrics. The post-actuation inspired volume was normalized to inspiratory capacity (IC). ResultsAmong participants with 17.4 (SD = 17.9) years of pMDI use, flow profiles uncovered mistimed actuations in 47.1% and poor inspiratory flow rates in 30.0% of subjects. After visualizing flow profiles, participants improved actuation timing (c2(1) =12.042, p < .001), mean inhaled volume (87.9 to 105.6% of IC, p<0.001) and the combined inhalation metrics (c2(1) =8.45, p = 0.003). InterpretationFlow profiles helped uncover and remediate specific defects in pMDI technique in the majority of chronic OLD users. Flow profiles from inhaled medications can be used to enhance drug delivery to the lung.

Non-local impact of distal airway constrictions on patterns of inhaled particle deposition.

Airway constriction and blockage in obstructive lung diseases cause ventilation heterogeneity and create barriers to effective drug deposition. Established computational particle-deposition models have not accounted for these impacts of disease. We present a new particle-deposition model that calculates ventilation based on the resistance of each airway, such that ventilation responds to airway constriction. The model incorporates distal airway constrictions representative of cystic fibrosis, allowing us to investigate the resulting impact on patterns of deposition. Unlike previous models, our model predicts how constrictions affect deposition in airways throughout the lungs, not just in the constricted airways. Deposition is reduced in airways directly distal and proximal to constrictions. When constrictions are clustered together, central-airways deposition can increase significantly in regions away from constrictions, but distal-airways deposition in those regions remains largely unchanged. We use our model to calculate lung clearance index (LCI), a clinical measure of ventilation heterogeneity, after applying constrictions of varying severities in one lobe. We find an increase in LCI coinciding with significantly reduced deposition in the affected lobe. Our results show how the model provides a framework for development of computational tools that capture the impacts of airway disease, which could significantly affect predictions of regional dosing.

PiSlope: A New CT Metric for Quantifying Airway Remodeling in Chronic Obstructive Pulmonary Disease.

Background Airway wall thickening is commonly quantified at chest CT with Pi10, the square root of the wall area of a hypothetical airway with a luminal perimeter of 10 mm. Although Pi10 has proven to be a useful construct, it assumes uniform thickening of all airways and considers only a single airway level in summarizing airway remodeling, limiting its accuracy. Purpose To evaluate PiSlope, a new metric for the quantification of airway wall thickening. Materials and Methods In this secondary analysis of data from a multicenter prospective study of individuals who currently smoke or formerly smoked as well as healthy volunteers who never smoked enrolled from January 2008 to June 2011 and followed up longitudinally until September 2022, chest CT images were analyzed section by section to quantify the luminal perimeter and airway wall thickness for each visible airway. Linear regression was used to calculate the slope of the luminal perimeter against wall thickness to determine the PiSlope. PiSlope was normalized by the individual's height squared. Multivariable regression was used to test the associations between airway metrics and respiratory outcomes. Results The mean age of the 8199 participants was 59.5 years ± 9.1 (SD), with 53% male and 67% White participants. With increasing disease severity (ie, Global Initiative for Chronic Obstructive Lung Disease stages 0-4), Pi10 increased (4.26 mm ± 0.23, 4.29 mm ± 0.21, 4.43 mm ± 0.26, 4.51 mm ± 0.28, and 4.53 mm ± 0.27, respectively) and PiSlope decreased (0.38 ± 0.10, 0.38 ± 0.10, 0.35 ± 0.11, 0.33 ± 0.10, and 0.31 ± 0.10) (trend test; both P < .001). Multivariable analyses revealed that PiSlope was associated with dyspnea, respiratory quality of life, 6-minute walk distance, exacerbations, lung function decline, and all-cause mortality, with and without Pi10 being included in the model. Conclusion The new metric PiSlope quantifies airway wall remodeling and shows associations with respiratory symptoms, quality of life, exacerbations, lung function decline, and all-cause mortality. Clinical trial registration no. NCT00608764 © RSNA, 2024 See also the editorial by Lynch in this issue.

Анализ возможностей метода оценки кривой «поток–объем» по изменению ее формы при обструкции бронхов

In case of obstructive disorders, the flow–volume curve has a concave shape, but this feature is not given due attention. Тhe analysis of the velocity indicators of the respiratory function (such as the peak expiratory flow (PEF) and forced expiratory flows (FEFs)) will significantly expand the diagnostic capabilities of the spirometry method. This paper aims to perform a comparative analysis of the diagnostic strength of the methods of the flow-volume curve assessment by the changes in its shape in patients with obstructive airway diseases to determine the most reliable one. The respiratory function of 540 patients was tested (234 are men (57 [36; 67] years) and 306 are women (59 [44; 69] years)), with the ratio of areas under the actual curve and the predicted curve calculated for each one, as well as the angle formed by the curve; the ratio of the actual FEF (henceforth referred to as FEF) to the predicted FEF, cut-off points to differentiate between obstructive diseases and health. On the basis of these results, we concluded whether the patient’s bronchi were blocked. The results were then compared to the Knudson reference equations, with the test’s operational characteristics calculated compared to the standard. The methods of assessing the angle β and the total concavity of the flow-volume curve have high diagnostic sensitivity (87.8% and 95.6% respectively). The assessment of the area under the curve (AEX-FV) has high diagnostic specificity (88.6%). The results obtained show sufficient diagnostic efficiency of the methods of flow-volume curve estimation by the changes in its shape. However, the use of these methods in isolation from the reference equations does not currently seem reasonable for clinical practice. It appears reasonable to use the reference equations and one of the methods of curve shape assessment together.