European Respiratory Review最新文献

{"title":"Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat?","authors":"Diego Poddighe, Marine Van Hollebeke, Antenor Rodrigues, Greet Hermans, Dries Testelmans, Alexandros Kalkanis, Beatrix Clerckx, Ghislaine Gayan-Ramirez, Rik Gosselink, Daniel Langer","doi":"10.1183/16000617.0150-2024","DOIUrl":"10.1183/16000617.0150-2024","url":null,"abstract":"<p><p>Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. Respiratory muscle dysfunction can contribute to the onset of respiratory failure and may also worsen due to interventions aimed at treatment. Evaluating respiratory muscle function is particularly valuable for diagnosing, phenotyping and assessing treatment efficacy in these patients. This review outlines established methods, such as measuring respiratory pressures, and explores novel techniques, including respiratory muscle neurophysiology assessments using electromyography and imaging with ultrasound.Additionally, we review various treatment strategies designed to support and alleviate the burden on overworked respiratory muscles or to enhance their capacity through training interventions. These strategies range from invasive and noninvasive mechanical ventilation approaches to specialised respiratory muscle training programmes. By summarising both established techniques and recent methodological advancements, this review aims to provide a comprehensive overview of the tools available in clinical practice for evaluating and treating respiratory muscle dysfunction. Our goal is to present a clear understanding of the current capabilities and limitations of these diagnostic and therapeutic approaches. Integrating advanced diagnostic methods and innovative treatment strategies should help improve patient management and outcomes. This comprehensive review serves as a resource for clinicians, equipping them with the necessary knowledge to effectively diagnose and treat respiratory muscle dysfunction in both acute and chronic respiratory failure scenarios.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia in interstitial lung disease.","authors":"Robert Sheehy, Samuel McCormack, Caitlin Fermoyle, Tamera Corte","doi":"10.1183/16000617.0126-2024","DOIUrl":"10.1183/16000617.0126-2024","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung disease (ILD) encompasses a heterogeneous group of chronic lung conditions with considerable variability in prognosis and response to treatment. People with reduced muscle mass and function, known as sarcopenia, have a higher risk of mortality and adverse clinical outcomes both in the general population and in other chronic disease states. The importance of sarcopenia across the spectrum of patients with ILD is not well established.</p><p><strong>Objectives: </strong>In this narrative review, we explore the prevalence and clinical implications of sarcopenia in patients with ILD, evaluate the optimal methods to diagnose sarcopenia in this patient population and review treatment interventions.</p><p><strong>Findings: </strong>Almost one third of patients with chronic forms of ILD have evidence of sarcopenia. Sarcopenia is associated with adverse clinical outcomes and increased risk of mortality in select populations with ILD. Screening tests such as the SARC-F (strength, assistance walking, rise from a chair, climb stairs, falls) questionnaire and clinical assessment tools (including grip strength dynamometry) are well validated. Medical imaging modalities, including computed tomography, are hampered by lack of a gold standard and normative values, but have been used in patients with ILD in acute care and research settings. If sarcopenia is identified, multidimensional interventions such as pulmonary rehabilitation are beneficial.</p><p><strong>Conclusion: </strong>Sarcopenia is common in patients with ILD and is associated with poorer outcomes. Accordingly, if identified, targeted interventions should be considered. Validated diagnostic criteria exist, but the optimal use of medical imaging techniques in this patient cohort remains an area of uncertainty.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital remote maintenance inhaler adherence interventions in COPD: a systematic review and meta-analysis.","authors":"Hnin Aung, Ronnie Tan, Cara Flynn, Pip Divall, Adam Wright, Anna Murphy, Dominick Shaw, Tom J C Ward, Neil J Greening","doi":"10.1183/16000617.0136-2024","DOIUrl":"10.1183/16000617.0136-2024","url":null,"abstract":"<p><strong>Introduction: </strong>Sub-optimal inhaler adherence undermines the efficacy of pharmacotherapy in COPD. Digitalised care pathways are increasingly used to improve inhaler-use behaviour remotely. This review investigated the feasibility and impact of remote electronic inhaler adherence monitoring (EIM) and intervention platforms on clinical outcomes in COPD.</p><p><strong>Methods: </strong>A literature search was conducted and studies investigating maintenance inhaler use among people with COPD using digital technology were selected. Pairwise and proportional meta-analyses were employed with heterogeneity assessed using I² statistics. When meta-analysis was not feasible, a narrative synthesis of outcomes was conducted.</p><p><strong>Results: </strong>We included 10 studies including 1432 people with COPD whose maintenance inhaler usage was supported by digital inhalers and apps featuring audiovisual reminders and educational content with or without engagement with healthcare providers (HCPs). Inhaler adherence rate (AR) varied with calculation methods, but an overall suboptimal adherence was observed among people with COPD. HCP-led adherence interventions alongside EIM improved mean AR by 18% (95% CI 9-27) <i>versus</i> passive EIM only. Enhanced AR may reduce COPD-related healthcare utilisation with little impact on health-related quality of life and exacerbation rate. Despite encountering technical issues among 14% (95% CI 5-23%) of participants, 85% (95% CI 76-94%) found digital platforms convenient to use, while 91% (95% CI 79-100%) perceived inhaler reminders as helpful.</p><p><strong>Conclusion: </strong>Digitalised interventions can enhance maintenance inhaler adherence in COPD but their overall effect on clinical outcomes remains uncertain. Further work is required to tailor interventions to individuals' adherence behaviour and investigate their longer-term impact.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway epithelium in lung transplantation: a potential actor for post-transplant complications?","authors":"Jules Milesi, Delphine Gras, Pascal Chanez, Benjamin Coiffard","doi":"10.1183/16000617.0093-2024","DOIUrl":"10.1183/16000617.0093-2024","url":null,"abstract":"<p><p>Lung transplantation, a critical intervention for end-stage lung diseases, is frequently challenged by post-transplant complications. Indeed, primary graft dysfunction, anastomotic complications, infections and acute and chronic rejections pose significant hurdles in lung transplantation. While evidence regarding the role of airway epithelium after lung transplantation is still emerging, its importance is becoming increasingly recognised. This review looks at the complex involvement of airway epithelium in various post-transplant complications, while emphasising the utility of airway epithelial culture as a research model. In summary, by elucidating the involvement of airway epithelium in each post-transplant complication and explaining these intricate processes, the review aims to guide specific future research efforts and therapeutic strategies aimed at improving lung transplant outcomes and enhancing patient care.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting of pre-existing multiple long-term conditions in physical rehabilitation for long COVID: a scoping review.","authors":"Lucy Gardiner, Hannah M L Young, Holly Drover, Emily Morgan-Selvaratnam, Michael Natt, Nikki Smith, Enya Daynes, Mark W Orme, Rod S Taylor, Sally J Singh, Rachael A Evans","doi":"10.1183/16000617.0123-2024","DOIUrl":"10.1183/16000617.0123-2024","url":null,"abstract":"<p><strong>Background: </strong>Physical rehabilitation may improve health and wellbeing outcomes for some adults living with long COVID. However, individuals living with pre-existing multiple long-term conditions (MLTCs) and long COVID may have additional rehabilitation challenges. This scoping review aims to identify the available evidence describing physical rehabilitation interventions for adults living with long COVID, to systematically map the reporting of pre-existing MLTCs, and to describe the characteristics of physical rehabilitation interventions used in adults with both pre-existing long-term conditions (LTCs) and long COVID.</p><p><strong>Methods: </strong>MEDLINE, CINAHL, Scopus, APA PsycInfo, medRxiv, OpenGrey and MedNar were searched from January 2020 to July 2023. Eligibility criteria included adults with long COVID, rehabilitation interventions including a physical component in any setting and any study design investigating interventions or intervention content except case series/reports.</p><p><strong>Results: </strong>Of 5326 unique records, 50 articles met the inclusion criteria, of which 25 (50%) made reference to pre-existing LTCs. These articles included four protocols and one consensus statement. Four of the remaining 20 studies (20%) reported the number of pre-existing LTCs, enabling the differentiation of individuals with MLTCs. One study reported outcomes of individuals with MLTCs separately to those without. The interventions described (k=24) typically consisted of combined aerobic and strength exercises (k=17 (71%)) in an outpatient setting (k=13 (54%)).</p><p><strong>Conclusions: </strong>There is limited and inconsistent reporting of the presence of MLTCs in studies of physical rehabilitation for adults with long COVID. Clarity and consistency of reporting of MLTCs is required to enable evaluation and adaptation of interventions to improve health and wellbeing for this population.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating asthma care guidelines into primary care electronic medical records: a review focused on Canadian knowledge translation tools.","authors":"Matheson McFarlane, Alison Morra, M Diane Lougheed","doi":"10.1183/16000617.0247-2023","DOIUrl":"10.1183/16000617.0247-2023","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is one of the most common chronic respiratory diseases globally. Despite national and international asthma care guidelines, gaps persist in primary care. Knowledge translation (KT) electronic tools (eTools) exist aiming to address these gaps, but their impact on practice patterns and patient outcomes is variable. We aimed to conduct a nonsystematic review of the literature for key asthma care gaps and identify limitations and future directions of KT eTools optimised for use in electronic medical records (EMRs).</p><p><strong>Methods: </strong>The database OVID Medline was searched (1999-2024) using keywords such as asthma, KT, primary healthcare and EMRs. Primary research articles, systematic reviews and published international/national guidelines were included. Findings were interpreted within the knowledge-to-action framework.</p><p><strong>Results: </strong>Key asthma care gaps in primary care include under-recognition of suboptimal control, underutilisation of pulmonary function tests, barriers to care delivery, provider attitudes/beliefs, limited access to asthma education and referral to asthma specialists. Various KT eTools have been validated, many with optimisation for use in EMRs. KT eTools within EMRs have been a recent focus, including asthma management systems, decision support algorithms, data standards initiatives and asthma case definition validation for EMRs.</p><p><strong>Conclusions: </strong>The knowledge-to-action cycle is a valuable framework for developing and implementing novel KT tools. Future research should integrate end-users into the process of KT tool development to improve the perceived utility of these tools. Additionally, the priorities of primary care physicians should be considered in future KT tool research to improve end-user uptake and overall asthma management practices.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thank you from the Chief Editor (2022-2024).","authors":"Renata L Riha","doi":"10.1183/16000617.0234-2024","DOIUrl":"10.1183/16000617.0234-2024","url":null,"abstract":"","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of body mass index on mortality in COPD: an updated dose-response meta-analysis.","authors":"Eric Daniel Tenda, Joshua Henrina, Andry Setiadharma, Immanuel Felix, Mira Yulianti, Ceva Wicaksono Pitoyo, Sze Shyang Kho, Melvin Chee Kiang Tay, Dyah S Purnamasari, Czeresna Heriawan Soejono, Siti Setiati","doi":"10.1183/16000617.0261-2023","DOIUrl":"10.1183/16000617.0261-2023","url":null,"abstract":"<p><strong>Background and objective: </strong>The obesity paradox is a well-established clinical conundrum in COPD patients. This study aimed to provide an updated analysis of the relationship between body mass index (BMI) and mortality in this population.</p><p><strong>Methods: </strong>A systematic search was conducted through Embase, PubMed, and Web of Science. International BMI cut-offs were employed to define underweight, overweight and obesity. The primary outcome was all-cause mortality, and the secondary outcome was respiratory and cardiovascular mortality.</p><p><strong>Results: </strong>120 studies encompassed a total of 1 053 272 patients. Underweight status was associated with an increased risk of mortality, while overweight and obesity were linked to a reduced risk of mortality. A nonlinear U-shaped relationship was observed between BMI and all-cause mortality, respiratory mortality and cardiovascular mortality. Notably, an inflection point was identified at BMI 28.75 kg·m^-2 (relative risk 0.83, 95% CI 0.80-0.86), 30.25 kg·m^-2 (relative risk 0.51, 95% CI 0.40-0.65) and 27.5 kg·m^-2 (relative risk 0.76, 95% CI 0.64-0.91) for all-cause, respiratory and cardiovascular mortality, respectively, and beyond which the protective effect began to diminish.</p><p><strong>Conclusion: </strong>This study augments the existing body of evidence by confirming a U-shaped relationship between BMI and mortality in COPD patients. It underscores the heightened influence of BMI on respiratory and cardiovascular mortality compared to all-cause mortality. The protective effect of BMI was lost when BMI values exceeded 35.25 kg·m^-2, 35 kg·m^-2 and 31 kg·m^-2 for all-cause, respiratory and cardiovascular mortality, respectively.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil dynamics in pulmonary fibrosis: pathophysiological and therapeutic perspectives.","authors":"Louise Elizabeth Crowley, Robert Andrew Stockley, David Richard Thickett, Davinder Dosanjh, Aaron Scott, Dhruv Parekh","doi":"10.1183/16000617.0139-2024","DOIUrl":"10.1183/16000617.0139-2024","url":null,"abstract":"<p><p>The shared pathobiological mechanisms driving progressive fibrosis in interstitial lung diseases (ILDs) remain unclear. Neutrophils, the most common immune cells in the human body, contain an extensive array of proteinases that are important for cell function, including tissue repair and remodelling. Increasing observational studies have reported elevated neutrophil counts in the respiratory tract and circulation of patients with ILD and suggest a role as a biomarker of disease severity. Neutrophils and their contents (including the formation of neutrophil extracellular traps (NETs)) are present in fibrotic lung tissue. Proteinases and NETs may drive fibrogenesis in animal and <i>in vitro</i> models and may impact transforming growth factor-β1 activation. However, the effect of neutrophil action, whether reparative or pathologically destructive to the delicate lung architecture, has yet to be determined. This review aims to summarise the current literature surrounding the potential role of the neutrophil as a biomarker and contributor to the pathogenesis of ILD. There is currently a paucity of treatment options in ILD driven by the knowledge gap underlying the overall disease mechanisms. This review concludes that neutrophils warrant further evaluation as manipulation of recruitment and function could provide a novel and much needed therapeutic strategy.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting paediatric asthma exacerbations with machine learning: a systematic review with meta-analysis.","authors":"Martina Votto, Annalisa De Silvestri, Lorenzo Postiglione, Maria De Filippo, Sara Manti, Stefania La Grutta, Gian Luigi Marseglia, Amelia Licari","doi":"10.1183/16000617.0118-2024","DOIUrl":"10.1183/16000617.0118-2024","url":null,"abstract":"<p><strong>Background: </strong>Asthma exacerbations in children pose a significant burden on healthcare systems and families. While traditional risk assessment tools exist, artificial intelligence (AI) offers the potential for enhanced prediction models.</p><p><strong>Objective: </strong>This study aims to systematically evaluate and quantify the performance of machine learning (ML) algorithms in predicting the risk of hospitalisation and emergency department (ED) admission for acute asthma exacerbations in children.</p><p><strong>Methods: </strong>We performed a systematic review with meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias and applicability for eligible studies was assessed according to the prediction model study risk of bias assessment tool (PROBAST). The protocol of our systematic review was registered in the International Prospective Register of Systematic Reviews.</p><p><strong>Results: </strong>Our meta-analysis included seven articles encompassing a total of 17 ML-based prediction models. We found a pooled area under the curve (AUC) of 0.67 (95% CI 0.61-0.73; I²=99%; p<0.0001 for heterogeneity) for models predicting ED admission, indicating moderate accuracy. Notably, models predicting child hospitalisation demonstrated a higher pooled AUC of 0.79 (95% CI 0.76-0.82; I²=95%; p<0.0001 for heterogeneity), suggesting good discriminatory power.</p><p><strong>Conclusion: </strong>This study provides the most comprehensive assessment of AI-based algorithms in predicting paediatric asthma exacerbations to date. While these models show promise and ML-based hospitalisation prediction models, in particular, demonstrate good accuracy, further external validation is needed before these models can be reliably implemented in real-life clinical practice.</p>","PeriodicalId":12166,"journal":{"name":"European Respiratory Review","volume":"33 174","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}