Respiratory medicine最新文献

{"title":"Correlation of fractional exhaled nitric oxide (FeNO) and clinical outcomes in patients with chronic obstructive pulmonary disease: A prospective cohort study","authors":"Warangkana Keeratichananont ,&nbsp;Punchalee Kaenmuang ,&nbsp;Sarayut Lucien Geater ,&nbsp;Ratikorn Denyuk ,&nbsp;Chitsanupong Kanchanakanok","doi":"10.1016/j.rmed.2024.107682","DOIUrl":"10.1016/j.rmed.2024.107682","url":null,"abstract":"<div><h3>Background</h3><p>Fractional exhaled nitric oxide (FeNO) is an acceptable and noninvasive marker for defining eosinophilic airway inflammation. Further study is necessary to clarify the role of FeNO in patients with chronic obstructive pulmonary disease (COPD). This study aimed to determine the association between FeNO levels and clinical outcomes.</p></div><div><h3>Methods</h3><p>A prospective observational study was conducted at Songklanagarind Hospital from October 2020 to November 2022. FeNO testing and spirometry were performed at the initial visit and 12-month follow-up. Exacerbation, hospitalization, lung function decline, and all-cause mortality were analyzed to determine the association between FeNO levels and clinical outcomes.</p></div><div><h3>Results</h3><p>A total of 60 patients with COPD were enrolled, 88.3 % of whom were male, with a mean age of 71.3 ± 9.5 years. There were 18 patients (30 %) in the high FeNO group (≥25 ppb) and 42 patients (70 %) in the low (&lt;25 ppb) FeNO group. The mean blood eosinophil count (BEC) was significantly higher in the high FeNO group (<em>p</em> &lt; 0.001). After a 12-month follow-up period, high FeNO group had higher exacerbation events (HR of 1.26, 95 % confidence interval (CI), 1.10–1.97, <em>p</em>= 0.025). Hospitalization and mortality rates were significantly higher in the high FeNO group. Regardless of the inhaled corticosteroids used, patients with high BEC and FeNO levels tended to have a greater risk of exacerbation.</p></div><div><h3>Conclusion</h3><p>In patients with COPD, FeNO levels are strongly correlated with BEC. Poor clinical outcomes were reported in patients with high FeNO levels. FeNO may be a useful biomarker for predicting clinical outcomes in patients with COPD.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001562/pdfft?md5=c0d73ecd063908618779c7d6a281e6b4&pid=1-s2.0-S0954611124001562-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180530","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":"Application of the Lancet Commission COPD classification to COPD Cohort Population in South Korea","authors":"Hyonsoo Joo ,&nbsp;Hyoung Kyu Yoon ,&nbsp;Yong Il Hwang ,&nbsp;Sang Hyuk Kim ,&nbsp;Soo-Jung Um ,&nbsp;Won-Yeon Lee ,&nbsp;Ki-Suck Jung ,&nbsp;Kwang Ha Yoo ,&nbsp;Woo Jin Kim ,&nbsp;Chin Kook Rhee","doi":"10.1016/j.rmed.2024.107679","DOIUrl":"10.1016/j.rmed.2024.107679","url":null,"abstract":"<div><p>The Lancet Commissions on COPD recommended a new classification based on five main risk factors.</p><p>Patients with COPD were prospectively enrolled in a Korean COPD subgroup study cohort between April 2012 and June 2022. Patients were classified according to the etiologies (Type 1: Genetically determined (COPD-G), Type 2: Abnormal lung development (COPD-D), Type 3: Infections (COPD-I), Type 4: Cigarette smoking (COPD-C), Type 5: Biomass and pollution (COPD-P)).</p><p>The database enrolled 3476 patients. Among 3392 patients, 52 (2 %), 1339 (39 %), 2930 (86 %), and 2221 (65 %) were compatible with type 2 (COPD-D), 3 (COPD-I), 4 (COPD-C), and 5 (COPD-P), respectively. Most patients (71 %, 2405) had multiple risk factors contributing to their COPD. However, 93, 712, and 182 patients had only type 3 (COPD-I), 4 (COPD-C), and 5 (COPD-P), respectively. Type 3 (COPD-I) only patients were significantly younger, more often female, and had lower lung function. Both the rate and frequency of severe exacerbations were significantly higher in type 3 (COPD-I) only patients (p = 0.038 and p = 0.048, respectively). Compared with type 5 (COPD-P) only, type 3 (COPD-I) only was significantly associated with the risk of severe exacerbation (Odds ratio, 5.7 [95 % CI, 1.0–32.4]; P = 0.049, incident rate ratio, 8.7 [95 % CI, 1.7–44.0]; P = 0.009).</p><p>Many patients were affected by multiple factors. Therefore, it is important to consider not only smoking history, but also other potential risk factors when evaluating patients with COPD. Further research is needed to explore the implications of this new COPD classification system for clinical practice and treatment strategies.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001537/pdfft?md5=13bd89eb64b3379c34e17bf8dae204b6&pid=1-s2.0-S0954611124001537-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130638","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":"Clinical trial attitudes among individuals with Alpha-1 antitrypsin deficiency","authors":"Kristen E. Holm ,&nbsp;Robert A. Sandhaus ,&nbsp;Sheri Allison ,&nbsp;Charlie Strange","doi":"10.1016/j.rmed.2024.107676","DOIUrl":"10.1016/j.rmed.2024.107676","url":null,"abstract":"<div><h3>Purpose</h3><p>This study examined characteristics of clinical trials that influence interest in participation among individuals with alpha-1 antitrypsin deficiency (AATD).</p></div><div><h3>Procedures</h3><p>A cross-sectional survey was completed by individuals with AATD. Thirty-four items described characteristics of clinical trials, which were rated from 1 (would not participate) to 5 (highly interested in participating). Logistic regression was used to compare participants with high interest in trials (defined as scores of 4 or 5 on ≥50 % of responses) to all remaining participants.</p></div><div><h3>Results</h3><p>Data were provided by 1664 participants (91.6 % with lung disease, 16.3 % with liver disease, 14.9 % with lung and liver disease). Nearly one-third (31.8 %) indicated that they would not participate in a trial if there was a chance of getting a placebo. If the trial included three liver biopsies, 53.3 % would not participate. More than two-thirds (69.8 %) of participants who were using augmentation therapy would not participate in a trial that required twelve months off therapy. Individuals with two or more exacerbations in the prior year were more likely to have high interest in trials (OR = 1.4, 95 % CI = 1.1–1.7, p = 0.009). In addition, individuals with a score of 10 or higher on the COPD Assessment Test were more likely to have high interest (OR = 1.4, 95 % CI = 1.1–1.8, p = 0.010).</p></div><div><h3>Conclusions</h3><p>A sizeable percentage of participants indicated that they would not participate in clinical trials that include a placebo, involve multiple liver biopsies, or involve discontinuing augmentation therapy. Individuals who are more affected by AATD have more interest in trial participation than individuals who are less affected.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001501/pdfft?md5=39870f10b7a5e2030dd9335ac5f53171&pid=1-s2.0-S0954611124001501-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141135829","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":"Expert consensus on oral corticosteroids stewardship for the treatment of severe asthma in the Middle East and Africa","authors":"Mona Al-Ahmad ,&nbsp;Ashraf Al Zaabi ,&nbsp;Ashraf Madkour ,&nbsp;Haider Abdulhameed Alqaraghuli ,&nbsp;Hajar Al Hayaan ,&nbsp;Hassan Mobayed ,&nbsp;Majdy Idrees ,&nbsp;Nasser Al busaidi ,&nbsp;Salah Zeineldine","doi":"10.1016/j.rmed.2024.107674","DOIUrl":"10.1016/j.rmed.2024.107674","url":null,"abstract":"<div><p>In the Middle East and Africa (MEA) region, overuse of oral corticosteroids (OCS) for asthma management, both as burst and maintenance therapy, poses a significant challenge. Gaps in knowledge regarding the need to taper OCS in patients with severe asthma and the use of OCS in comorbid conditions have been noted. OCS stewardship can help attain optimal and effective OCS tapering along with reducing OCS overuse and over-reliance. In this paper, we discuss current practices regarding the use of OCS in asthma, globally and in the MEA region. Expert recommendations for achieving OCS stewardship in the MEA region have also been presented. Regional experts recommend increasing awareness among patients about the consequences of OCS overuse, engaging community pharmacists, and educating primary healthcare professionals about the benefits of prompt appropriate referral. Innovative local referral tools like ReferID can be utilized to refer patients with asthma to specialist care. The experts also endorse a multidisciplinary team approach and accelerating access to newer medicines like biologics to implement OCS stewardship and optimize asthma care in the MEA region.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001483/pdfft?md5=03033d4e63e410c2d46acc92029cb805&pid=1-s2.0-S0954611124001483-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088373","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":"Development of a predictive score to discriminate community acquired pneumonia with underlying lung cancer: A retrospective case – control study","authors":"João Barbosa-Martins ,&nbsp;Joana Mendonça ,&nbsp;Nuno Carvalho ,&nbsp;Carolina Carvalho ,&nbsp;Gustavo Soutinho ,&nbsp;Helena Sarmento ,&nbsp;Camila Coutinho ,&nbsp;Jorge Cotter","doi":"10.1016/j.rmed.2024.107675","DOIUrl":"10.1016/j.rmed.2024.107675","url":null,"abstract":"<div><h3>Background</h3><p>A pneumonic infiltrate might hide an occult lung cancer (LC). This awareness depends on each clinician personal experience, turning definitive LC diagnosis challenging and possibly delayed. In this study we aimed to develop a clinical score to better identify those cases.</p></div><div><h3>Materials and methods</h3><p>We conducted a retrospective case–control study, including previously undiagnosed LC patients admitted in our institution, with a presumptive suspicious of community acquired pneumonia (CAP). Cases were compared with random CAP inpatient controls, using a matched 2:1 ratio. Demographic, clinical, and laboratorial variables were assessed for a possible association with the presence of a CAP with underlying LC (CAP–uLC).</p></div><div><h3>Results</h3><p>Among 535 hospitalized LC patients, 43 cases had a presentation compatible with CAP and were compared with 86 CAP controls. A scoring system was built using 6 independent variables, which positively correlated with CAP–uLC: smoking history (OR: 8.3 [1.9–36.2]; p = 0.005); absence of fever (6.5 [2.0–21.5]; p = 0.002); sputum with blood (5.9 [1.2–29.9]; p = 0.033); platelet count ≥ 232x10³/μL (5.8 [1.6–20.6]; p = 0.006); putative alternative diagnosis than CAP (4.6 [1.5–14.7]; p = 0.009); and duration of symptoms ≥ 10 days (3.7 [1.1–13.0]; p = 0.037). Our score presented an AUC of 0.910 (95 % CI, 0.852–0.967; p &lt; 0.001), a sensitivity of 88.1 % and specificity of 84.7 %, in predicting the risk of presenting a CAP–uLC, when set to a cutoff of 18.</p></div><div><h3>Conclusion</h3><p>We propose a novel risk score aimed to aid clinicians identifying patients with CAP–uLC in the acute setting, possibly prompting early LC diagnosis.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088371","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":"Empowering caregivers of children with bronchiolitis obliterans: The effectiveness of an internet-based follow-up platform","authors":"Huayan Liu ,&nbsp;Qingqing Song ,&nbsp;Min Yi ,&nbsp;Xiaoyan Tan ,&nbsp;Yanping Chen ,&nbsp;Jianhui Xie ,&nbsp;Xuandong Wei ,&nbsp;Hongtao Chen ,&nbsp;Lina Zhong ,&nbsp;Xia Wu ,&nbsp;Kewei Wang","doi":"10.1016/j.rmed.2024.107673","DOIUrl":"10.1016/j.rmed.2024.107673","url":null,"abstract":"<div><h3>Objective</h3><p>Limited evidence on home care and need for long-term individualized follow-up highlight the importance of developing an Internet-based follow-up platform to support caregivers of children with Bronchiolitis Obliterans (BO). This Study aims to explore and test the potential benefits of this platform by comparing family management, medication compliance and clinical systems.</p></div><div><h3>Study design and methods</h3><p>A two-arm, single-blind randomized controlled trial was conducted on 168 children with BO and their families from January 2022 to October 2022. Families were randomly divided into Internet-based follow-up group and conventional follow-up group with a ratio of 1:1. Scores of family management measures (FaMM), 8-item of Morisky Medication Adherence (8-MMAS) and BO clinical symptoms of both groups were collected at three points of time: the day of discharge (T1), 3 months after discharge (T2), and 6 months after discharge (T3). The changes of each group due to intervention were compared by repeated-measures ANOVA.</p></div><div><h3>Results</h3><p>90 families completed the trial, including 48 in the Internet-based follow-up group and 42 in the conventional follow-up group. The results showed a significant difference in the group-by-time interaction on the scores of Child's Daily Life, Condition Management Ability and Parental Mutuality (<em>p</em> &lt; 0.05). No group-by-time effect was found on the scores of View of Condition Impact and Family Life Difficulty. Scores of BO clinical symptoms and MMAS-8 showed intra-group, inter-group, and group-by-time effects.</p></div><div><h3>Conclusions</h3><p>The Internet-based follow-up platform can empower caregivers in enhancing effective family management, improving medication compliance in children with BO, and relieving patients’ clinical symptoms.</p></div><div><h3>Trial registration</h3><p>Chinese Clinical Trials Registry of ChiCTR2200065121 (04/28/2022).</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065560","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":"Sexual activity and respiratory disease: A systematic review","authors":"Joan B. Soriano ,&nbsp;Francesca Polverino","doi":"10.1016/j.rmed.2024.107665","DOIUrl":"10.1016/j.rmed.2024.107665","url":null,"abstract":"<div><h3>Context</h3><p>Sex and gender are related concepts, but they have distinct meanings and implications. Respiratory diseases are a major driver of morbi-mortality. It is frequent that respirologists, primary care doctors, or other specialists, when dealing with respiratory patients, and aiming for a holistic management of their patients, they all skip any question or matter associated with sexual activity or behavior.</p></div><div><h3>Objectives</h3><p>To review how sexual activity is explored in respiratory patients.</p></div><div><h3>Methods</h3><p>To conduct this review, we endorse PRISMA guidance for reporting systematic reviews, and also the sex and gender equity in research (SAGER) guidelines.</p></div><div><h3>Results</h3><p>Compared to other conditions such as heart disease, mental disorders, Alzheimer's, or even COVID-19, to date there is no review focused on sexual activity and respiratory health and disease. Asthma, COPD and other respiratory patients can have their sexual activity and behaviors affected by their disease, but also limitations in sex might be the sentinel event of an incident respiratory disease. Asking on sexual desire and related sex issues should not be considered taboo in any respiratory consultation. Importantly, any marketed stereotypes on cigarettes after any sexual activity should be counteracted. Many clinical trials of respiratory drugs keep recruiting few or no women, so research on women's sexual desire and satisfaction lags behind that of men's. By using the available objective tools and validated questionnaires summarized in this review, these important domains of respiratory patients and their partners can be properly identified and managed.</p></div><div><h3>Conclusions</h3><p>Sexual activity, depending on age and individual specific conditions, is a fundamental driver of overall health, and therefore of lung health.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0954611124001392/pdfft?md5=b33d05340f8e2bd01e426083b4dbcc2f&pid=1-s2.0-S0954611124001392-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070997","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":"The risk of secondary spontaneous pneumothorax in patients with chronic obstructive pulmonary disease in Taiwan","authors":"Kuang-Ming Liao ,&nbsp;Chong-Chi Chiu ,&nbsp;Hsueh-Yi Lu","doi":"10.1016/j.rmed.2024.107672","DOIUrl":"10.1016/j.rmed.2024.107672","url":null,"abstract":"<div><h3>Introduction</h3><p>Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group.</p></div><div><h3>Methods</h3><p>In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls.</p></div><div><h3>Results</h3><p>We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities.</p></div><div><h3>Conclusion</h3><p>Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP.</p","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141039405","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":"Frailty and in-hospital mortality in older patients with acute exacerbation of COPD: A real-world prospective cohort study","authors":"Li Li ,&nbsp;Lei Wang ,&nbsp;Li Zhang ,&nbsp;Chongyang Zhao ,&nbsp;Qin Wang ,&nbsp;Ying Liu ,&nbsp;Lei Liu ,&nbsp;Gaiping Cheng ,&nbsp;Lishan Yuan ,&nbsp;Min Feng ,&nbsp;Gang Wang ,&nbsp;Deying Kang ,&nbsp;Xin Zhang","doi":"10.1016/j.rmed.2024.107663","DOIUrl":"10.1016/j.rmed.2024.107663","url":null,"abstract":"<div><h3>Background</h3><p>Few evidence exists for the effect of frailty on the patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).</p></div><div><h3>Objective</h3><p>We explored the link between frailty and in-hospital death in AECOPD, and whether laboratory indicators mediate this association.</p></div><div><h3>Methods</h3><p>This was a real-world prospective cohort study including older patients with AECOPD, consisting of two cohorts: a training set (n = 1356) and a validation set (n = 478). The independent prognostic factors, including frail status, were determined by multivariate logistic regression analysis. The relationship between frailty and in-hospital mortality was estimated by multivariable Cox regression. A nomogram was developed to provide clinicians with a quantitative tool to predict the risk of in-hospital death. Mediation analyses for frailty and in-hospital death were conducted.</p></div><div><h3>Results</h3><p>The training set included 1356 patients (aged 86.7 ± 6.6 years), and 25.0 % of them were frail. A nomogram model was created, including ten independent variables: age, sex, frailty, COPD grades, severity of exacerbation, mean arterial pressure (MAP), Charlson Comorbidity Index (CCI), Interleukin-6 (IL-6), albumin, and troponin T (TPN-T). The area under the receiver operating characteristic curve (ROCs) was 0.862 and 0.845 for the training set and validation set, respectively. Patients with frailty had a higher risk of in-hospital death than those without frailty (HR,1.83, 95%CI: 1.14, 2.94; p = 0.013). Furthermore, CRP and albumin mediated the associations between frailty and in-hospital death.</p></div><div><h3>Conclusions</h3><p>Frailty may be an adverse prognostic factor for older patients admitted with AECOPD. CRP and albumin may be part of the immunoinflammatory mechanism between frailty and in-hospital death.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056299","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":"Long-term therapy with CFTR modulators consistently improves glucose metabolism in adolescents and adults with cystic fibrosis","authors":"Amitay Cohen ,&nbsp;Alon Mass ,&nbsp;Joel Reiter ,&nbsp;David Haim Zangen ,&nbsp;Malena Cohen-Cymberknoh","doi":"10.1016/j.rmed.2024.107664","DOIUrl":"10.1016/j.rmed.2024.107664","url":null,"abstract":"<div><h3>Background</h3><p>Impaired glycemic control and the subsequent development of Cystic fibrosis Related Diabetes (CFRD) are prevalent complications, affecting up to 50 % of adults with cystic fibrosis (CF). CFTR modulator (CFTRm) therapies improve pulmonary functions, reduce exacerbation rates, increase survival in people with CF (pwCF) and appear to have a positive effect on extrapulmonary manifestations, such as nutritional state, improvements in upper respiratory symptoms, and quality of life. Initial findings indicate that CFTRm may have a positive impact on short-term glycemic control; however, long-term effects remain uncertain at present.</p></div><div><h3>Methods</h3><p>In this retrospective study, data were collected and analyzed on 15 pwCF, ages 13–37 years, started on CFTRm therapy. Oral Glucose Tolerance Test (OGTT) results were compared pre- and post-CFTRm therapy.</p></div><div><h3>Results</h3><p>The 120-min OGTT value decreased from 159.7 mg/dL to 130.4 mg/dL post-CFTRm (p = 0.047). The average time elapsed between the two OGTTs was 49.87 months (ranging 9–157 months, median 38 months). Glycemic status improved in six pwCF (two CFRD to normal (NGT)/indeterminate (INDET) glucose tolerance; two impaired glucose tolerance (IGT) to INDET; two INDET to NGT) and worsened in one (IGT to CFRD). Six pwCF and NGT remained stable with no changes in glycemic status throughout the follow-up period.</p></div><div><h3>Conclusions</h3><p>CFTRm therapy may decelerate the glycemic control deterioration in pwCF over an extended period. These findings indicate the need for periodic OGTTs following the initiation of CFTRm therapy to appropriately adjust insulin requirements and prevent hypoglycemia. Further larger cohorts are required to authenticate and substantiate these findings.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957716","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}