Dimitrios Megaritis, Carlos Echevarria, Ioannis Vogiatzis
{"title":"Respiratory and locomotor muscle blood flow measurements using near-infrared spectroscopy and indocyanine green dye in health and disease.","authors":"Dimitrios Megaritis, Carlos Echevarria, Ioannis Vogiatzis","doi":"10.1177/14799731241246802","DOIUrl":"10.1177/14799731241246802","url":null,"abstract":"<p><p>Measuring respiratory and locomotor muscle blood flow during exercise is pivotal for understanding the factors limiting exercise tolerance in health and disease. Traditional methods to measure muscle blood flow present limitations for exercise testing. This article reviews a method utilising near-infrared spectroscopy (NIRS) in combination with the light-absorbing tracer indocyanine green dye (ICG) to simultaneously assess respiratory and locomotor muscle blood flow during exercise in health and disease. NIRS provides high spatiotemporal resolution and can detect chromophore concentrations. Intravenously administered ICG binds to albumin and undergoes rapid metabolism, making it suitable for repeated measurements. NIRS-ICG allows calculation of local muscle blood flow based on the rate of ICG accumulation in the muscle over time. Studies presented in this review provide evidence of the technical and clinical validity of the NIRS-ICG method in quantifying respiratory and locomotor muscle blood flow. Over the past decade, use of this method during exercise has provided insights into respiratory and locomotor muscle blood flow competition theory and the effect of ergogenic aids and pharmacological agents on local muscle blood flow distribution in COPD. Originally, arterial blood sampling was required via a photodensitometer, though the method has subsequently been adapted to provide a local muscle blood flow index using venous cannulation. In summary, the significance of the NIRS-ICG method is that it provides a minimally invasive tool to simultaneously assess respiratory and locomotor muscle blood flow at rest and during exercise in health and disease to better appreciate the impact of ergogenic aids or pharmacological treatments.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"21 ","pages":"14799731241246802"},"PeriodicalIF":3.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paulien Mellaerts, Heleen Demeyer, Astrid Blondeel, Tim Vanhoutte, Sofie Breuls, Marieke Wuyts, Iris Coosemans, Lode Claes, Nele Vandenbergh, Kaat Beckers, Lucas Vanden Bossche, Dimitri Stylemans, Wim Janssens, Stephanie Everaerts, Thierry Troosters
{"title":"The one-minute sit-to-stand test: A practical tool for assessing functional exercise capacity in patients with COPD in routine clinical practice.","authors":"Paulien Mellaerts, Heleen Demeyer, Astrid Blondeel, Tim Vanhoutte, Sofie Breuls, Marieke Wuyts, Iris Coosemans, Lode Claes, Nele Vandenbergh, Kaat Beckers, Lucas Vanden Bossche, Dimitri Stylemans, Wim Janssens, Stephanie Everaerts, Thierry Troosters","doi":"10.1177/14799731241291530","DOIUrl":"10.1177/14799731241291530","url":null,"abstract":"<p><p><b>Background:</b> Chronic obstructive pulmonary disease (COPD) is associated with a reduced exercise capacity. Although several field tests for exercise capacity have been modified for non-standard settings, i.e. outside the hospital clinic or pulmonary rehabilitation center, their uptake remains limited. <b>Objectives:</b> To assess the test-retest reliability, constuct validity and responsiveness of the one-minute sit-to-stand test (1'STST) adopted in clinical practice among patients with COPD and to confirm the earlier established minimal important difference (MID) of three repetitions. <b>Methods:</b> Patients with COPD performed two 1'STSTs, two 6-minute walk tests (6MWT), an isometric quadriceps force (QF) measurement, a cardiopulmonary exercise test (CPET), and a seven-day physical activity (PA) measurement before and after three months of pulmonary rehabilitation (PR). An Intraclass Correlation Coefficient (ICC) evaluated the agreement between two 1'STSTs. Pearson Correlation examined the association between the 1'STST and other physical measurements, and their changes following PR. A receiver operating characteristic (ROC) curve was constructed using a 30-meter increment in the 6MWT as cut-off to identify responders. <b>Results:</b> The 1'STST demonstrated good reliability (Δ0.9 ± 4.0 repetitions, <i>p</i> = .13; ICC = 0.79). The 1'STST was moderately correlated with the 6MWT (r = 0.57, <i>p</i> < .0001), VO<sub>2</sub>max (r = 0.50, <i>p</i> = .0006) and maximal work rate (r = 0.52, <i>p</i> = .0003). Weak correlations were observed with QF (r = 0.33, <i>p</i> = .03) and step count (r = 0.38, <i>p</i> = .013). The 1'STST improved after PR (∆ = 3.6 ± 6.4 repetitions, <i>p</i> = .0013) and changes correlated moderately with changes in the 6MWT (r = 0.57, <i>p</i> = .002), QF (r = 0.48, <i>p</i> = .003) and VO<sub>2</sub>max (r = 0.41, <i>p</i> = .014). A cut-off of three repetitions demonstrated a 71% accuracy in identifying responders to a rehabilitation program. <b>Conclusion:</b> The 1'STST is a valuable alternative to evaluate exercise capacity in patients with COPD when more expensive and time-consuming tests are unavailable.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"21 ","pages":"14799731241291530"},"PeriodicalIF":3.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute severe asthma and its predictors of mortality in rural Southwestern Nigeria: a-five year retrospective observational study.","authors":"Azeez Oyemomi Ibrahim, Shuaib Kayode Aremu, Babatunde Adeola Afolabi, Gbadebo Oladimeji Ajani, Fasanmi Tolulope Kolawole, OlufunmilayoAdenike Oguntoye","doi":"10.1177/14799731221151183","DOIUrl":"https://doi.org/10.1177/14799731221151183","url":null,"abstract":"<p><strong>Objectives: </strong>There is an observed paucity of data regarding the predictors of asthma mortality in Nigeria. This study aimed to ascertain the clinical presentations and predictors of acute severe asthma mortality in rural Southwestern Nigeria.</p><p><strong>Methods: </strong>A retrospective observational study using a data form and a standardized questionnaire was used to review the 124 patients admitted at Emergency Department between January 2015 and December 2019. The data were analyzed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Binary logistic regression analysis was used to determine the predictors of asthma mortality and a <i>p</i>-value <.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 124 patients were studied. The acute severe asthma mortality was 4.8% and its predictors were older age (Crude odds Ratio (COR), 14.857; 95% CI: 2.489-88.696, <i>p</i> < .001), Tobacco smoking (COR, 6.741; 95% CI: 1.170-38.826, <i>p</i> = .016), more than three co-morbidities (COR, 2.750; 95% CI: 1.147-26.454, <i>p</i> = 0.012), diabetes mellitus (COR, 13.750; 95% CI: 2.380-79.433, <i>p</i> < .001), Human Immunodeficiency virus (COR, 117.000; 95% CI: 9.257-1479.756, <i>p</i> < .001), ≥2 days before presentation (COR, 7.440; 95% CI: 1.288-42.980, <i>p</i> = .039), and Short-acting-B2-agonists overuse (COR, 7.041; 95% CI: 1.005-62.165, <i>p</i> = .044).</p><p><strong>Conclusion: </strong>The mortality rate was 4.8% and its predictors were older age patients, tobacco smoking, multiple co-morbidities, diabetes mellitus, HIV, SP02 <90%, delay presentation, and Short-acting-B2-agonists over use, The study showed that there is high prevalence of asthma mortality in rural Southwestern Nigeria. The findings may be used to plan for asthma preventions and control programs in rural settings, and may also provide an impetus for prospective research on these outcomes.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731221151183"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/38/aa/10.1177_14799731221151183.PMC9869197.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10646020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wafa B Khan, Harry M Gallagher, Dilip Jayasimhan, Michael Dray, Catherina L Chang
{"title":"The impact of bronchoalveolar lavage on the diagnosis of undifferentiated interstitial lung disease alongside a multidisciplinary discussion.","authors":"Wafa B Khan, Harry M Gallagher, Dilip Jayasimhan, Michael Dray, Catherina L Chang","doi":"10.1177/14799731231196581","DOIUrl":"10.1177/14799731231196581","url":null,"abstract":"<p><strong>Background and objective: </strong>Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD.</p><p><strong>Methods: </strong>Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic.</p><p><strong>Results: </strong>36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47-0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624-0.935), in step 3 κ = 0.776 (95% CI 0.614-0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD.</p><p><strong>Conclusion: </strong>We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231196581"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/39/10.1177_14799731231196581.PMC10434757.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10400412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yijun Zhou, Maria R Ampon, Michael J Abramson, Alan L James, Graeme P Maguire, Richard Wood-Baker, David P Johns, Guy B Marks, Helen K Reddel, Brett G Toelle
{"title":"Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study.","authors":"Yijun Zhou, Maria R Ampon, Michael J Abramson, Alan L James, Graeme P Maguire, Richard Wood-Baker, David P Johns, Guy B Marks, Helen K Reddel, Brett G Toelle","doi":"10.1177/14799731231221820","DOIUrl":"10.1177/14799731231221820","url":null,"abstract":"<p><strong>Background: </strong>Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults.</p><p><strong>Method: </strong>The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2).</p><p><strong>Results: </strong>Among all respondents (<i>n</i> = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV<sub>1</sub> below 80% predicted, or FEV<sub>1</sub>/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively).</p><p><strong>Conclusions: </strong>Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231221820"},"PeriodicalIF":3.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kim van der Braak, Joshua Wald, Catherine M Tansey, Thais Paes, Maria Sedeno, Anne-Marie Selzler, Michael K Stickland, Jean Bourbeau, Tania Janaudis-Ferreira
{"title":"Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study.","authors":"Kim van der Braak, Joshua Wald, Catherine M Tansey, Thais Paes, Maria Sedeno, Anne-Marie Selzler, Michael K Stickland, Jean Bourbeau, Tania Janaudis-Ferreira","doi":"10.1177/14799731231179105","DOIUrl":"10.1177/14799731231179105","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre.</p><p><strong>Methods: </strong>Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance<i>.</i></p><p><strong>Results: </strong><i>Reach</i>: 70-75% of referred patients agreed to a PR program (<i>n</i> = 26). <i>Effectiveness</i>: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. <i>Adoption</i>: All healthcare professionals (HCPs) involved in PR (<i>n</i> = 8) participated. <i>Implementation</i>: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). <i>Maintenance</i>: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program.</p><p><strong>Conclusions: </strong>The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231179105"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/8b/10.1177_14799731231179105.PMC10363903.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9870357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dawei Chen, Caimei Chen, Pan Zhang, Feng Zhang, Hao Zhang, Qing Sun, Jian Sun, Yan Tan, Binbin Pan, Xin Wan
{"title":"The arrival ward requiring help by wheelchair or medical cart, arterial oxygenation index, age, albumin and neutrophil count score: Predicting in-hospital mortality in Chinese patients with acute exacerbations of chronic obstructive pulmonary disease.","authors":"Dawei Chen, Caimei Chen, Pan Zhang, Feng Zhang, Hao Zhang, Qing Sun, Jian Sun, Yan Tan, Binbin Pan, Xin Wan","doi":"10.1177/14799731231197226","DOIUrl":"10.1177/14799731231197226","url":null,"abstract":"<p><strong>Background: </strong>In this study, we will derive and validate a prognostic tool to predict in-hospital death based on Chinese acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.</p><p><strong>Methods: </strong>Independent predictors of in-hospital death were identified by logistic regression analysis and incorporated into a clinical prediction tool.</p><p><strong>Results: </strong>The clinical prediction model was developed with data from 1121 patients and validated with data from 245 patients. The five predictors of in-hospital death from the development cohort (Arrival ward requiring help by wheelchair or medical cart, Arterial oxygenation index, Age, Albumin and Neutrophil count) were combined to form the AAAAN Score. The AAAAN Score achieved good discrimination (AUC = 0.85, 95% CI 0.81-0.89) and calibration (Hosmer-Lemeshow chi-square value was 3.33, <i>p</i> = 0.65). The AAAAN Score, which underwent internal bootstrap validation, also showed excellent discrimination for mortality (AUC = 0.85, 95% CI 0.81 to 0.89) and performed more strongly than other clinical prediction tools. Patients were categorized into 3 risk groups based on the scores: low risk (0-2 points, 0.7% in-hospital mortality), intermediate risk (3-4 points, 4.1% in-hospital mortality), and high risk (5-7 points, 23.4% in-hospital mortality). Predictive performance was confirmed by external validation.</p><p><strong>Conclusions: </strong>The AAAAN Score is a prognostic tool to predict in-hospital death in Chinese AECOPD patients.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231197226"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/8d/10.1177_14799731231197226.PMC10448383.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diana Zanolari, Daniela Händler-Schuster, Christian Clarenbach, Gabriela Schmid-Mohler
{"title":"A qualitative study of the sources of chronic obstructive pulmonary disease-related emotional distress.","authors":"Diana Zanolari, Daniela Händler-Schuster, Christian Clarenbach, Gabriela Schmid-Mohler","doi":"10.1177/14799731231163873","DOIUrl":"https://doi.org/10.1177/14799731231163873","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to identify the sources of illness-related emotional distress from the perspective of individuals living with mild to severe chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>A qualitative study design with purposive sampling was applied at a Swiss University Hospital. Eleven interviews were conducted with individuals who suffered from COPD. To analyze data, framework analysis was used, guided by the recently presented model of illness-related emotional distress.</p><p><strong>Results: </strong>Six main sources for COPD-related emotional distress were identified: physical symptoms, treatment, restricted mobility, restricted social participation, unpredictability of disease course and COPD as stigmatizing disease. Additionally, life events, multimorbidity and living situation were found to be sources of non-COPD-related distress. Negative emotions ranged from anger, sadness, and frustration to desperation giving rise to the desire to die. Although most patients experience emotional distress regardless of the severity of COPD, the sources of distress appear to have an individual manifestation.</p><p><strong>Discussion: </strong>There is a need for a careful assessment of emotional distress among patients with COPD at all stages of the disease to provide patient-tailored interventions.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231163873"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10009049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9167508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edward M Kerwin, Paul W Jones, Leif H Bjermer, François Maltais, Isabelle H Boucot, Ian P Naya, David A Lipson, Chris Compton, Lee Tombs, Claus F Vogelmeier
{"title":"How can the findings of the EMAX trial on long-acting bronchodilation in chronic obstructive pulmonary disease be applied in the primary care setting?","authors":"Edward M Kerwin, Paul W Jones, Leif H Bjermer, François Maltais, Isabelle H Boucot, Ian P Naya, David A Lipson, Chris Compton, Lee Tombs, Claus F Vogelmeier","doi":"10.1177/14799731231202257","DOIUrl":"10.1177/14799731231202257","url":null,"abstract":"<p><p>This review addresses outstanding questions regarding initial pharmacological management of chronic obstructive pulmonary disease (COPD). Optimizing initial treatment improves clinical outcomes in symptomatic patients, including those with low exacerbation risk. Long-acting muscarinic antagonist/long-acting β<sub>2</sub>-agonist (LAMA/LABA) dual therapy improves lung function versus LAMA or LABA monotherapy, although other treatment benefits have been less consistently observed. The benefits of dual bronchodilation in symptomatic patients with COPD at low exacerbation risk, and its duration of efficacy and cost effectiveness in this population, are not yet fully established. Questions remain on the impact of baseline symptom severity, prior treatment, degree of reversibility to bronchodilators, and smoking status on responses to dual bronchodilator treatment. Using evidence from EMAX (NCT03034915), a 6-month trial comparing the LAMA/LABA combination umeclidinium/vilanterol with umeclidinium and salmeterol monotherapy in symptomatic patients with COPD at low exacerbation risk who were inhaled corticosteroid-naïve, we describe how these findings can be applied in primary care.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231202257"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41102651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Weber, Ilena Müller, Annina E Büchi, Sabina A Guler
{"title":"Prevalence and assessment of frailty in interstitial lung disease - a systematic review and meta-analysis.","authors":"Angela Weber, Ilena Müller, Annina E Büchi, Sabina A Guler","doi":"10.1177/14799731231196582","DOIUrl":"10.1177/14799731231196582","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a multisystem dysregulation that challenges homeostasis and increases vulnerability towards stressors. In patients with interstitial lung diseases (ILD) frailty is associated with poorer lung function, greater physical impairment, and higher symptom burden. Our understanding of the prevalence of frailty in ILD and consequently its impact on the ILD population is limited.</p><p><strong>Objective and methods: </strong>We aimed to systematically review frailty assessment tools and to determine frailty prevalence across different ILD cohorts. Meta-analyses were used to calculate the pooled prevalence of frailty in the ILD population.</p><p><strong>Results: </strong>We identified 26 studies (15 full-texts, 11 conference abstracts) including a total of 4614 patients with ILD. The most commonly used frailty assessment tools were the Fried Frailty Phenotype (FFP), the Short Physical Performance Battery (SPPB), and the cumulative Frailty Index (FI). Data allowed for meta-analyses of FFP and SPPB prevalence. The pooled prevalence of frailty was 35% (95% CI 25%-45%) by FFP, and 19% (95% CI 12%-28%) by SPPB.</p><p><strong>Conclusions: </strong>Frailty is common in ILD, with considerable variability of frailty prevalence depending on the frailty assessment tool used. These findings highlight the importance of frailty in ILD and the need for a standardized approach to frailty assessment in this population.</p>","PeriodicalId":10217,"journal":{"name":"Chronic Respiratory Disease","volume":"20 ","pages":"14799731231196582"},"PeriodicalIF":4.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/db/10.1177_14799731231196582.PMC10521296.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41123975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}