Respiratory medicine最新文献

{"title":"Unveiling the metabolic challenges in pulmonary arterial hypertension: Insights into thyroid, glycemic, lipid, and bone disorders","authors":"Odil Garrido Campos de Andrade , Luiz Claudio Gonçalves de Castro , Veronica Moreira Amado","doi":"10.1016/j.rmed.2024.107859","DOIUrl":"10.1016/j.rmed.2024.107859","url":null,"abstract":"<div><div>This study aimed to evaluate the prevalence of thyroid, glycemic, lipid and metabolic bone disorders among adult patients with pulmonary arterial hypertension (PAH).</div></div><div><h3>Methods</h3><div>This was an observational cross-sectional clinical study with patients with PAH, matched by sex and age with a control group without PAH. All individuals were enrolled into a clinical assessment, metabolic workup, thyroid ultrasound, and bone densitometry protocol.</div></div><div><h3>Results</h3><div>The PAH group included 35 participants (34 females, 46 ± 15.5 years), and the control group, 40 (39 females, 41.8 ± 13.1 years). There was no difference in body mass index (BMI) between PAH and control group (27.5 ± 5.9 and 26.9 ± 4.3 kg/m<sup>2</sup>, respectively, p = 0.63; 95 % CI: −1.8, 2.94), neither in physical activity time per week (60.3 ± 103.3 and 98.9 ± 137.6, respectively, p = 0.17; 95 % CI: −95.23, 18.06). Although there was no difference in the prevalence of insulin resistance between the PAH (51.4 %) and the control group (47.5 %), p = 0.74, patients with PAH had a higher median of glycated hemoglobin (A1c) than the control group (6.1 % and 5.57 %, respectively, p = 0.006; 95 % CI: −0.14, 1.22). PAH group presented lower mean total <strong>c</strong>holesterol (170.46 ± 35.51 mg/dL) and median LDL-cholesterol [105 (83–129) mg/dL, median (P25–P75)] levels than the control group [192.1 ± 34.44 mg/dL, p = 0.009; 95 % CI = −37.76, 5.52 and 121.6 (97–145) mg/dL, p = 0.012; 95 % CI: −34.08, 0.77, respectively]. It was found a higher prevalence of hypothyroidism (22.9 %) in PAH group than in control group (2.5 %), p = 0.007. We found hyperparathyroidism (HPT) among 8 patients of PAH group (23 %), but none in the control group. Considering bone mineral density disorders, 12 patients from PAH group presented low bone mass, osteopenia, or osteoporosis (34 %), and 8 individuals in the control group (20 %), p = 0.032, which represented a 2.13 higher relative risk for those conditions for the former group. The patients with HPT presented a higher creatinine level (0.98 ± 0.12 mg/dL) than the PAH patients with normal parathyroid hormone (0.76 ± 0.14 mg/dL), p = 0.0004; 95 % CI: 0.12, 0.33. The PAH group also presented lower total hip (-0.15 ± 1.25) and femoral neck (−0.14 ± 1.07) bone mineral density (BMD) Z-scores than the control group (0.50 ± 1.13, p = 0.021; 95 % CI: −0.18, −0.027 and 0.35 ± 0.94, p = 0.038; 95 % CI: −0.16, −0.01, respectively).</div></div><div><h3>Conclusion</h3><div>In this cohort, the findings of higher A1c levels, hypothyroidism prevalence, lower LDL and total cholesterol levels, and a higher prevalence of hyperparathyroidism, as well as lower total hip and femoral neck BMD Z-scores in the PAH group, compared to the control group and highlighting the dysregulation of various metabolic pathways in patients with HAP, suggesting the need for targeted interventions to enhance patient care. Additionally, they underscore","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"235 ","pages":"Article 107859"},"PeriodicalIF":3.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626486","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}

{"title":"Effect of continuous positive airway pressure on cardiometabolic risk factors in patients with obstructive sleep apnea: A systematic review and meta-analysis","authors":"Mengjiao Lv ,&nbsp;Jing Mao ,&nbsp;Saikun Wang ,&nbsp;Changyue Zhang ,&nbsp;Chunting Qian ,&nbsp;Ruiting Zhu ,&nbsp;Sikun Xiong ,&nbsp;Yong Zhang ,&nbsp;Lirong Guo","doi":"10.1016/j.rmed.2024.107852","DOIUrl":"10.1016/j.rmed.2024.107852","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiometabolic risk factors (CMRFs) play a crucial role in the occurrence and development of cardiovascular diseases. Obstructive sleep apnea (OSA) causes abnormalities of CMRFs. Continuous positive airway pressure (CPAP) is a widely used treatment for OSA. This systematic review and meta-analysis aimed to investigate the effect of CPAP on CMRFs in patients with OSA.</div></div><div><h3>Methods</h3><div>A search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase was conducted to find randomized controlled trials up to December 3, 2023. The quality of the studies included was evaluated using the Cochrane Bias Risk Tool 2.0, and a meta-analysis was carried out using Stata15.1 software. The effect sizes for this meta-analysis were represented as the weighted mean difference (WMD) and 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>A total of 52 studies with 10,104 participants were analyzed. The results showed that CPAP significantly lowered systolic blood pressure (WMD: −2.04 mmHg; 95%CI: −3.56 to −0.51), diastolic blood pressure (WMD: −1.40 mmHg; 95%CI: −2.36 to −0.44), total cholesterol (WMD: −0.27 mmol/L; 95%CI: −0.51 to −0.04), triglycerides (WMD: −0.02 mmol/L; 95%CI: −0.03 to −0.01), and fasting blood glucose (WMD: −0.15 mmol/L; 95%CI: −0.16 to −0.13) in patients with OSA. However, there was no significant change in low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, waist circumference, or body mass index after CPAP.</div></div><div><h3>Conclusion</h3><div>In summary, this meta-analysis demonstrated that CPAP effectively reduced certain CMRFs in patients with OSA, offering new insights for cardiovascular disease prevention.</div></div><div><h3>Systematic review registration</h3><div>PROSPERO, identifier CRD42023456380.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"235 ","pages":"Article 107852"},"PeriodicalIF":3.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626363","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}

{"title":"Modification of asthma treatment efficacy by healthcare access: A reanalysis of AsthmaNet Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) clinical trial","authors":"Lizbeth F. Gómez ,&nbsp;Ellen Kinnee ,&nbsp;Joel D. Kaufman ,&nbsp;Michael T. Young ,&nbsp;Anne M. Fitzpatrick ,&nbsp;Wanda Phipatanakul ,&nbsp;David T. Mauger ,&nbsp;Leslie A. McClure ,&nbsp;Usama Bilal ,&nbsp;Fernando Holguin ,&nbsp;Jane E. Clougherty","doi":"10.1016/j.rmed.2024.107853","DOIUrl":"10.1016/j.rmed.2024.107853","url":null,"abstract":"<div><h3>Background</h3><div>While randomized controlled trials (RCTs) in asthma management are designed to balance known and unknown variables across treatment groups, including social and environmental co-exposures, it remains important to consider how these co-exposures influence disease progression and treatment outcomes. The importance of considering socio-environmental co-exposures in the context of asthma is twofold: 1) asthma disproportionately affects low-income urban communities, where air pollution and chronic stress are pervasive; and 2) despite the wide range of asthma treatments, inadequate disease control persists.</div></div><div><h3>Methods</h3><div>In the present ancillary study of the Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) RCT, we investigated how socio-environmental factors, such as air pollution exposure and healthcare access, modify the effect of inhaled corticosteroid (ICS) therapy in children with asthma. The original STICS RCT evaluated the efficacy and safety of increasing the dose of inhaled glucocorticoids from a baseline daily low dose to five times the daily dose for 7 days in school-age children with mild -to-moderate persistent asthma who began to have short-term loss of asthma control (Jackson et al., 2018 Mar 8) [1]. Our study adds onto those findings by incorporating residential level particulate matter 2.5 μg/m3 (PM2.5) and geographic health provider shortage areas (HPSA) as potential modifiers.</div></div><div><h3>Results</h3><div>Consistent with the main trial results, we did not find a difference in the number of exacerbations between treatment arms. However, we found the effect of receiving 5xICS, as compared with 1xICS on the time to prednisone was significantly different for children living in areas a shortage of health professionals (HR: 2.09; 95 % CI: 0.74, 5.95) than for children living in no shortage areas (HR: 0.40; 95 % CI: 0.21, 0.77).</div></div><div><h3>Conclusion</h3><div>This finding underscores the importance of considering environmental and social factors in asthma treatment.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> ID NCT02066129 <span><span>https://clinicaltrials.gov/study/NCT02066129</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107853"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604294","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":"Defining a phenotype of severe COPD patients who develop chronic hypercapnia","authors":"Renzo Boersma ,&nbsp;Jens T. Bakker ,&nbsp;Maaike de Vries ,&nbsp;Tim Raveling ,&nbsp;Dirk-Jan Slebos ,&nbsp;Peter J. Wijkstra ,&nbsp;Jorine E. Hartman ,&nbsp;Marieke L. Duiverman","doi":"10.1016/j.rmed.2024.107850","DOIUrl":"10.1016/j.rmed.2024.107850","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic hypercapnia, defined by elevated blood CO₂ levels, is a serious complication most prevalent in severe COPD. It negatively impacts quality of life, increases hospitalization rates, and elevates mortality risks. However, not all severe COPD patients develop chronic hypercapnia, and its underlying mechanisms remain unclear. Identifying clinical and pathophysiological predictors of hypercapnia is essential for tailored treatment strategies. This study investigates the relationship between hypercapnia and patient characteristics, lung function, and CT scan features to identify potential therapeutic targets.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 1526 COPD patients from three cohorts: a standard care cohort and two research cohorts (NCT04023409; NCT03053973). Data collected included demographic and clinical information, blood gases, lung function (FEV₁, FVC, TLC, RV, DLCOc), and high-resolution CT scans (lung volumes, air trapping, emphysema scores, airway wall thickness (Pi10), and diaphragm indices).</div></div><div><h3>Results</h3><div>Hypercapnia prevalence increased with COPD severity. Hypercapnic patients were older, more likely to smoke, and had more comorbidities. They exhibited lower FEV₁ and FVC, and higher RV/TLC ratios, with CT scans showing lower emphysema scores and greater Pi10. Multivariate analysis identified lower PaO₂, FEV₁% predicted, and emphysema scores, along with higher RV/TLC ratios and NT-proBNP levels, as independent predictors of PaCO₂, collectively explaining 46.3 % of the variance.</div></div><div><h3>Conclusion</h3><div>COPD patients with chronic hypercapnia are characterized by higher smoking rates, lower PaO₂ levels, poorer lung function, less emphysema, and increased airway pathology. These findings underscore the multifactorial nature of hypercapnia in COPD, highlighting the need for personalized therapeutic strategies targeting these factors to improve outcomes.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107850"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564812","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":"Endobronchial valve treatment improves chest-CT diaphragm configuration in COPD","authors":"Jens T. Bakker ,&nbsp;Jorine E. Hartman ,&nbsp;Karin Klooster ,&nbsp;Jean-Paul Charbonnier ,&nbsp;Michail Tsiaousis ,&nbsp;Rozemarijn Vliegenthart ,&nbsp;Dirk-Jan Slebos","doi":"10.1016/j.rmed.2024.107856","DOIUrl":"10.1016/j.rmed.2024.107856","url":null,"abstract":"<div><div>This study investigated the impact of bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) on diaphragm configuration. We successfully analyzed the diaphragm index using a newly developed quantitative computed tomography (QCT) tool before and after EBV treatment in forty patients with severe emphysema. We evaluated whether changes in the diaphragm index were associated with improvements in forced expiratory volume in 1 s (FEV₁), residual volume (RV), Saint Georges Respiratory Questionnaire (SGRQ), and 6-min walking distance (6MWD) using Spearman's rho. The EBV treatment influenced the diaphragm configuration only on the treated side, resulting in an increased diaphragm curvature. There were significant associations of relative diaphragm index changes on the treated lung side or the entire diaphragm with improvements in FEV₁ and 6MWD. These findings provide valuable insights into how EBV treatment affects the diaphragm in COPD patients.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107856"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626487","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":"Efficacy of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary disease and exercise pulmonary hypertension","authors":"Yutaro Naka ,&nbsp;Takumi Inami ,&nbsp;Kaori Takeuchi ,&nbsp;Hanako Kikuchi ,&nbsp;Ayumi Goda ,&nbsp;Masaharu Kataoka ,&nbsp;Takashi Kohno ,&nbsp;Kyoko Soejima ,&nbsp;Toru Satoh","doi":"10.1016/j.rmed.2024.107848","DOIUrl":"10.1016/j.rmed.2024.107848","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic disease (CTEPD) without pulmonary hypertension (PH) remains unknown. Exercise PH (Ex-PH) is associated with impaired exercise capacity, even when pulmonary hemodynamics are normal at rest. We hypothesized that patients with Ex-PH could be the candidates for BPA. This study aimed to determine the prevalence and clinical profiles of Ex-PH and the effect of BPA on oxygenation and Ex-PH in patients with CTEPD and mean pulmonary arterial pressure (mPAP) ≤ 20 mmHg.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 23 patients (median age 65 years) with CTEPD and mPAP ≤20 mmHg at rest who underwent cardiopulmonary exercise testing with right heart catheterization. Patients were divided into two groups: Ex-PH, defined by an mPAP/cardiac output (CO) slope (mPAP/CO slope) &gt; 3.0, and non-Ex-PH.</div></div><div><h3>Results</h3><div>Overall, 12 and 11 patients were identified as Ex-PH and non-Ex-PH groups, respectively. There were no significant differences in clinical parameters, including hemodynamics at rest, and blood gas analysis between Ex-PH and non-Ex-PH groups. Among 9 patients with Ex-PH, BPA improved World Health Organization-functional class and PaO₂ at rest and was associated with a decrease in the mPAP/CO slope. All 3 patients discontinued LTOT after BPA. There were no significant complications during each BPA session.</div></div><div><h3>Conclusions</h3><div>Ex-PH was common among patients with CTEPD without PH. BPA could improve symptoms, oxygenation, and exercising hemodynamics in patients with CTEPD and Ex-PH.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107848"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569361","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}

{"title":"Exploring sleep-related breathing disorders in pediatric obesity and Prader-Willi syndrome","authors":"Gintare Oboleviciene ,&nbsp;Laimute Vaideliene ,&nbsp;Valdone Miseviciene","doi":"10.1016/j.rmed.2024.107855","DOIUrl":"10.1016/j.rmed.2024.107855","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the differences of clinical and diagnostic features of sleep related breathing disorders (SRBDs) between children with PWS and obese children, considering obesity as a unifying risk factor for sleep apnea.</div></div><div><h3>Study design</h3><div>This retrospective cohort study included ≥2 years of age children who had obesity and genetically confirmed Prader-Willi syndrome (PWS) or were non-PWS obese children. Out of 267 children, 58 children met inclusion criteria. Clinical data and records of standard overnight polysomnography (PSG) were collected and compared between groups during the study.</div></div><div><h3>Results</h3><div>Obstructive sleep apnea (OSA) was identified in 97.2 % non-PWS obese children and 72.7 % PWS children (p = 0.072). Central sleep apnea (CSA) events were more commonly found in children with PWS (p = 0.035, OR 4.35, CI 95 % 1.05–18.03) as well as sleep-related hypoventilation (p = 0.016, OR 4.66, CI 95 % 1.26–17.34). Sleep efficiency was higher in PWS patients (p = 0.038). Sleep fragmentation was significantly associated with higher AHI only in non-PWS obese children (p = 0.027). In the PWS group patients, a moderate correlation was found between BMI and age (p = 0.025, r = 0.559, CI 95 % 0.087–0.826) as well as AHI and age (p = 0.003, r = 0.686, CI 95 % 0.232–0.895).</div></div><div><h3>Conclusions</h3><div>Non-PWS obese children, similar to those with PWS, exhibit a high risk of SRBDs. Although CSA and sleep-related hypoventilation may occur more frequently in patients with PWS, OSA remains the predominant disorder. Both patient groups are advised to undergo PSG due to the significant risk of SRBDs, particularly during adolescence.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107855"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604059","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}

{"title":"Epistaxis in COVID positive ICU patients, implications, and future interventions","authors":"Sarah Clark ,&nbsp;Kristin Sheehan ,&nbsp;Samantha Fabian ,&nbsp;Timothy Immelman ,&nbsp;Connie Liu ,&nbsp;John Clinger ,&nbsp;Peter Miller","doi":"10.1016/j.rmed.2024.107851","DOIUrl":"10.1016/j.rmed.2024.107851","url":null,"abstract":"<div><h3>Purpose</h3><div>Epistaxis in critically ill patients may prevent the use of non-invasive ventilation and impair nasal oxygen delivery. Since the onset of COVID-19, high-flow nasal oxygen has dramatically increased. There is a paucity of literature on characteristics of epistaxis in critically ill, COVID-19 positive patients. We aimed to establish the incidence of epistaxis and identify risk factors.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective observational study conducted at a large academic medical center. Chart review was performed on patients with an intensive care admission and COVID-19 diagnosis between January 2020 and May 2022. Data included epistaxis events, supplemental oxygen delivery and duration, anticoagulation, and antiplatelet therapies.</div></div><div><h3>Results</h3><div>932 patients met study criteria. Epistaxis incidence was 7.4 %. Of those with epistaxis, 78 % were administered supplemental oxygen. For each additional day on nasal oxygen, patients were at a 7.1 % higher risk for epistaxis (p &lt; .001). Most antiplatelet agents and therapeutic anticoagulation were not found to increase risk.</div></div><div><h3>Conclusions</h3><div>Nasal oxygen was a major risk factor for epistaxis in this population. Nasal hygiene is a standard regimen recommended by otolaryngologists for epistaxis. Protocolizing the inclusion of nasal hygiene measures may be an easy, inexpensive way to prevent epistaxis in this already unstable patient population.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107851"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569381","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}

{"title":"Understanding the acceptability of the changing model of care in cystic fibrosis","authors":"Michael Doumit ,&nbsp;Verity Pacey ,&nbsp;Adam Jaffe ,&nbsp;Kelly Gray","doi":"10.1016/j.rmed.2024.107847","DOIUrl":"10.1016/j.rmed.2024.107847","url":null,"abstract":"<div><h3>Background</h3><div>Cystic fibrosis (CF) outpatient care has evolved into a hybrid model, incorporating telehealth and face-to-face reviews. This study explores the acceptability of the hybrid model of care from the perspective of people with CF and parents of children with CF.</div></div><div><h3>Methods</h3><div>People with CF and parents of children with CF from eight Australian CF centres participated in semi-structured interviews. Maximum variation sampling sought participants from varied socioeconomic levels and geographical locations. The interview guide and thematic analysis utilised the Theoretical Framework of Acceptability (TFA) to explore domains of acceptability.</div></div><div><h3>Results</h3><div>Ten adults and 16 parents of children with CF were interviewed. The major themes from the interviews aligned with the TFA domains. These were [1]: life is easier with a hybrid model of care [2], hybrid care is effective but not comprehensive [3], hybrid care needs to adapt to individual needs [4], confidence in hybrid care is determined by internal and external factors [5], hybrid care is easy to engage in[6] accepting hybrid care involves compromising valued aspects of face-to-face care [7], hybrid care reduces infection risk and helps normalise life.</div></div><div><h3>Conclusion</h3><div>The addition of telehealth to the traditional model of CF care is acceptable overall. The level of acceptability is variable and is determined by the willingness to compromise valued aspects of face-to-face care to obtain the convenience, safety and normality that receiving part of care through telehealth allows. Therefore, the model should be personalised in consultation with people with CF and parents of children with CF.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107847"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552114","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}

{"title":"β-Blockers and Asthma: Surprising findings from the FAERS database","authors":"Mario Cazzola ,&nbsp;Josuel Ora ,&nbsp;Luigino Calzetta ,&nbsp;Paola Rogliani ,&nbsp;Maria Gabriella Matera","doi":"10.1016/j.rmed.2024.107849","DOIUrl":"10.1016/j.rmed.2024.107849","url":null,"abstract":"<div><h3>Introduction</h3><div>β-Blockers are essential for cardiovascular disease management but can induce respiratory issues, particularly with non-selective β-blockers. Their safety in asthmatic patients is debated.</div></div><div><h3>Objective</h3><div>This study investigates the link between different classes of β-blockers and the risk of asthma and asthma-like adverse events (AEs) using data from the Food and Drug Administration's Adverse Event Reporting System (FAERS).</div></div><div><h3>Methods</h3><div>β-Blockers were first reviewed according to European Society of Cardiology classification and then using the Vashistha and Kumar classification. The risk associated with different β-blocker classes was evaluated through disproportionality analysis using the reporting odds ratio (ROR).</div></div><div><h3>Results</h3><div>Among 251,145 AEs reported for β-blockers, 4104 were asthma-related. Selective β₁-blockers had a higher asthma risk signal (ROR: 1.15) compared to non-selective β-blockers (ROR: 0.90). α- and β-Blockers showed the lowest risk (ROR: 0.51). The Vashistha and Kumar classification detailed risk profiles for various β-blockers, highlighting differences even within the same class. Dual α- and β-blockers, hydrophilic, and lipophilic β-blockers posed lower asthma risks, while selective β₁-blockers had higher risks regardless of intrinsic sympathomimetic activity.</div></div><div><h3>Conclusion</h3><div>Although the signals detected by disproportionality analysis are only candidate risks, the risk stratification resulting from our analysis highlights the need for cautious β-blocker selection in asthmatic patients or those predisposed to asthma. Furthermore, despite the limitations associated with the FAERS data, the study reveals significant variability in risk among different β-blocker classes, crucial for clinical decisions and patient management. Drugs like esmolol, metoprolol, nebivolol, and nadolol may be safer for asthmatic patients, whereas betaxolol, bisoprolol, timolol, and propranolol should be avoided.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"234 ","pages":"Article 107849"},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569396","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}