Therapeutic Advances in Respiratory Disease最新文献

{"title":"Combined medical-interventional approaches for the management of complex fungal balls: a case series as a viable alternative in non-surgical patients.","authors":"Elaine Dumoulin, Christina S Thornton, John H MacGregor, Alain Tremblay, Chrystal Chan, Paul R MacEachern, Margaret M Kelly, Ranjani Somayaji, Michael D Parkins, Christopher H Mody","doi":"10.1177/17534666241255203","DOIUrl":"10.1177/17534666241255203","url":null,"abstract":"<p><p>Intracavitary pulmonary aspergilloma is a persistent and life-threatening infection that carries a mortality rate of up to 15%. It occurs when Aspergillus species gain entry to an existing lung cavity. In the absence of definitive treatment, patients may succumb to severe complications such as massive hemoptysis, cachexia, or secondary infections. Aspergillomas often show limited response to antifungal medications, mainly due to insufficient drug concentrations within the cavities. Surgery is frequently the preferred treatment option, but it poses significant risks, and many individuals are ineligible due to underlying health issues. We present the most extensive non-surgical fungal ball cohort to date, managed using an innovative multimodal strategy that combines antifungal therapy before and after bronchoscopic debulking. This was a cross-sectional observational study. For those who cannot undergo surgery, our medical center has pioneered a multimodal approach to aspergilloma resection. This approach combines bronchoscopic endoscopy with antifungal therapy and has been applied successfully to more than 18 patients that are presented in this series. The median age of the cohort was 58 years (range: 32-73), with an equal sex distribution. The mean percent predicted FEV₁ was 65.3%. The mean follow-up duration was 3.6 years (range: 0.5-10 years). The cohort receiving antifungals systematically prior to debridement showed a reduction of the pre-existing cavity (40.38 mm <i>versus</i> 34.02 mm, <i>p</i> = 0.021). Across the 18 patients during the follow-up period, 94% remained recurrence-free (defined by symptoms and radiology). Our study fills a critical knowledge gap regarding the significance of initiating antifungal treatment before bronchoscopic debulking and presents a viable approach in these cases for which there is a current unmet therapeutic need.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241255203"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11119499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087788","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":"Baseline patient demographics for TETRIS: a prospective, noninterventional study to characterize the use of triple therapy for COPD in Germany.","authors":"Claus F Vogelmeier, Kai-Michael Beeh, Peter Kardos, Thomas Paulsson, Gernot Rohde, Henrik Watz, Chris Compton, Tharishini Mohan, Jing Claussen","doi":"10.1177/17534666241287621","DOIUrl":"10.1177/17534666241287621","url":null,"abstract":"<p><strong>Background: </strong>Evidence on how decisions regarding escalation to triple therapy and de- or re-escalation are taken and the rationale on which these decisions are based is currently limited in Germany.</p><p><strong>Objectives: </strong>The TETRIS study aims to elucidate influences on treatment decisions surrounding triple therapy in a real-world practice setting in Germany.</p><p><strong>Design: </strong>TETRIS is an ongoing, multicenter, prospective, observational cohort study recruiting patients with chronic obstructive pulmonary disease (COPD) with or without asthma who have already been treated with triple therapy for 2-48 weeks.</p><p><strong>Methods: </strong>For better representation of the treatment reality in Germany, patients are recruited from general practitioners and pulmonologists. Data are collected in two parts. Part 1 involves cross-sectional phenotyping of patients at enrollment. Part 2 involves a 2-year longitudinal follow-up period to monitor/document all visits by the patients during the 24-month observation period per routine clinical practice. Here, we report the demographic and baseline characteristics of 1213 eligible patients recruited to part 1 of the study.</p><p><strong>Results: </strong>The mean patient age was 66.4 years overall, and 29.3% (356/1213) of patients had no comorbidities. The mean CAT score was 19.4; the number of exacerbations and hospitalizations due to exacerbations in the past 3 years before starting triple therapy was 0.6 and 0.1, respectively. Dual bronchodilation with a long-acting muscarinic antagonist (LAMA) plus a long-acting β-2 agonist (LABA) was the most common therapy for COPD before initiation of triple therapy in 58.3% of patients.</p><p><strong>Conclusion: </strong>In this real-world setting in Germany, patients with COPD have a relatively low reported exacerbation rate but high symptom burden, and over 70% are multimorbid. Triple therapy is initiated in patients who are primarily highly symptomatic despite being on LAMA + LABA. Future prospective studies in patients with multimorbidity are warranted to better understand the treatment landscape across the disease spectrum.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/study/NCT04657211.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241287621"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508490","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 behavioral cough suppression therapy for refractory chronic cough or unexplained chronic cough: a meta-analysis of randomized controlled trials.","authors":"Baiyi Yi, Shengyuan Wang, Xianghuai Xu, Li Yu","doi":"10.1177/17534666241305952","DOIUrl":"10.1177/17534666241305952","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of behavioral cough suppression therapy (BCST) for refractory chronic cough (RCC) and unexplained chronic cough (UCC) remains unclear due to limited evidence from small-scale single-center studies.</p><p><strong>Objective: </strong>To compile and assess the quality of evidence from randomized controlled trials to evaluate the effectiveness of BCST.</p><p><strong>Design: </strong>This study included randomized controlled studies and self-controlled studies related to BCST involving adult patients with RCC or UCC.</p><p><strong>Data sources and methods: </strong>We conducted an extensive search of various English and Chinese databases (e.g., PubMed, CNKI, CBM, VIP, and Wanfang Data Journal Full-text Database) and the Clinical Trial Registration website up to April 2024. The selected studies underwent meta-analysis to investigate the impact of BCST on the patient's quality of life and cough frequency.</p><p><strong>Results: </strong>The included 12 studies showed that BCST significantly improved the Leicester Cough Questionnaire scores of the patients (MD = 4.50, 95% CI (4.03, 4.97), <i>p</i> < 0.001) compared to the simple verbal education group. In addition, a significant reduction in objective cough frequency was observed in patients compared to before BCST, with a statistically significant difference (MD = -8.06, 95% CI (-9.71, -6.41), <i>p</i> < 0.001). Other measures of cough symptoms, such as symptom scores, Visual Analog Scale (VAS) scores, and Cough Severity Index (CSI) also showed improvement.</p><p><strong>Conclusion: </strong>This meta-analysis revealed positive therapeutic effects of BCST in patients with RCC/UCC, potentially advancing its application in broader clinical settings.</p><p><strong>Trial registration: </strong>This study was registered on PROSPERO with the registration number <i>CRD42024530746.</i></p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241305952"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872964","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":"Diagnostic value of serum vascular endothelial growth factor-D in Korean patients with lymphangioleiomyomatosis.","authors":"Hee-Young Yoon, Su-Jin Moon, Song Yee Kim, Jong Sun Park, Sun Mi Choi, Hyung Koo Kang, Jin Woo Song","doi":"10.1177/17534666241272928","DOIUrl":"10.1177/17534666241272928","url":null,"abstract":"<p><strong>Background: </strong>Lymphangioleiomyomatosis (LAM) is a rare multisystemic disorder characterized by the proliferation of abnormal smooth muscle-like cells. Although serum vascular endothelial growth factor-D (VEGF-D) is currently used as a diagnostic biomarker for LAM, its diagnostic value in Korean patients is unclear.</p><p><strong>Objectives: </strong>To evaluate the diagnostic value of serum VEGF-D for LAM in Korean patients.</p><p><strong>Design: </strong>A multicenter prospective cohort study.</p><p><strong>Methods: </strong>Serum samples were prospectively collected from five medical institutions, from patients with LAM (<i>n</i> = 40) and controls (<i>n</i> = 24; healthy participants = 3, other cystic lung diseases = 13, idiopathic pulmonary fibrosis = 4, idiopathic nonspecific interstitial pneumonia = 4). Serum VEGF-D levels were measured using the enzyme-linked immunosorbent assay, and the diagnostic value was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>The mean age of patients with LAM was 44.5 years, and all were female (controls: 47.8 years; female: 70.8%, <i>p</i> < 0.001). The serum VEGF-D levels were significantly higher in patients with LAM than those in the control group (median: 708.9 pg/mL vs 325.3 pg/mL, <i>p</i> < 0.001). In the ROC curve analysis, serum VEGF-D levels showed good predicting performance for LAM diagnosis (area under the curve = 0.918) with an optimal cut-off value of 432.7 pg/mL (sensitivity = 85.0%, specificity = 87.5%). When 800 pg/mL was used as the cut-off value, the specificity of serum VEGF-D for LAM diagnosis increased to 100.0%.</p><p><strong>Conclusion: </strong>Our results suggest that serum VEGF-D may be a useful biomarker for diagnosing LAM in Korean patients, similar to previous reports.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241272928"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989000","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 effect of benralizumab on inflammation in severe asthma: a real-life analysis.","authors":"Dina Visca, Francesco Ardesi, Martina Zappa, Sarah Grossi, Patrizia Pignatti, Marco Vanetti, Laura Pini, Giovanni Sotgiu, Rosella Centis, Giovanni Battista Migliori, Antonio Spanevello","doi":"10.1177/17534666241304685","DOIUrl":"10.1177/17534666241304685","url":null,"abstract":"<p><strong>Background: </strong>Benralizumab is a monoclonal antibody treatment for severe eosinophilic asthma (SEA). Few studies investigated its role in airway inflammation and its correlation with lung function.</p><p><strong>Objectives: </strong>The aim of the present study is to assess its effect after 1 year of treatment, focusing on airway inflammation.</p><p><strong>Design: </strong>This is a retrospective observational study, in an Italian tertiary reference centre specialised in diagnosis and management of severe asthma patients.</p><p><strong>Methods: </strong>We conducted a monocentric retrospective study including SEA patients treated with benralizumab for 1 year. Clinical, functional and inflammatory data were collected at baseline, 6 (T6) and 12 (T12) months.</p><p><strong>Results: </strong>Twenty-two SEA patients on benralizumab were included. We observed a reduction in exacerbations rate and systemic steroid treatment (<i>p</i> < 0.0001) as well as an improvement in asthma control (<i>p</i> < 0.0001), health-related quality of life (<i>p</i> = 0.017) and lung function pre-BD FEV1 (L) (<i>p</i> = 0.02) and percentage (<i>p</i> = 0.004) and post-BD FEV1 (L) (<i>p</i> = 0.01) and percentage (<i>p</i> = 0.003) from baseline to T6 and T12. A reduction in sputum eosinophil percentage was observed at T6 and T12 (<i>p</i> < 0.005). We found a positive correlation between the variation of sputum eosinophils percentage and FEV1 (L) at T12 (rho = -0.79, <i>p</i> = 0.04). Moreover, the improvement of FEF_25%-75% from baseline to 6 (rho = -0.53, <i>p</i> = 0.03) and 12 (rho = -0.62, <i>p</i> = 0.01) months negatively correlated with the duration of asthma disease.In our cohort 12/22 patients were super-responders at T6 and 15/22 at T12. Furthermore, clinical remission was reached by 12/22, and all of them obtained blood and sputum eosinophils counts normalisation.</p><p><strong>Conclusion: </strong>Our data confirm that it is a rapid and effective treatment for SEA acting on clinical, functional, systemic and airway inflammatory outcomes. Our results highlight the role of induced sputum as a promising non-invasive technique to investigate pathophysiologic mechanisms in severe asthma treated with biologics. Finally, a negative correlation between small airway improvement and the duration of asthma may suggest that a prompt referral to asthma centres may delay lung function worsening. Additional studies are needed to investigate more in-depth the role of induced sputum in the management of asthma, response to treatment and remission.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241304685"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839688","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":"Albuterol-budesonide fixed-dose combination rescue inhaler for asthma: a plain language summary of the MANDALA study.","authors":"Alberto Papi, Bradley E Chipps, Richard Beasley, Reynold A Panettieri, Elliot Israel, Mark Cooper, Lynn Dunsire, Allison Jeynes-Ellis, Robert Rees, Frank C Albers, Christy Cappelletti","doi":"10.1177/17534666241232264","DOIUrl":"10.1177/17534666241232264","url":null,"abstract":"<p><p><b>What is this summary about?</b>This summary describes the results of a clinical study called MANDALA that was published in the <i>New England Journal of Medicine</i> in 2022. In the MANDALA study, researchers looked at a new asthma rescue inhaler that contains both <b>albuterol</b> and <b>budesonide</b> in a single inhaler (known as <b>albuterol-budesonide</b>, AIRSUPRA™). This summary describes the results for people aged 18 yearsand older who took part in the study.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241232264"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11067641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865865","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":"All-cause and cause-specific mortality by spirometric pattern and sex - a population-based cohort study.","authors":"Helena Backman, Sami Sawalha, Ulf Nilsson, Linnea Hedman, Caroline Stridsman, Lowie E G W Vanfleteren, Bright I Nwaru, Nikolai Stenfors, Eva Rönmark, Anne Lindberg","doi":"10.1177/17534666241232768","DOIUrl":"10.1177/17534666241232768","url":null,"abstract":"<p><strong>Background: </strong>Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated.</p><p><strong>Objectives: </strong>To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF).</p><p><strong>Design: </strong>Population-based prospective cohort study.</p><p><strong>Methods: </strong>Individuals with CAO [FEV₁/vital capacity (VC) < 0.70], RSP [FEV₁/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV₁/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years.</p><p><strong>Results: </strong>The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes.</p><p><strong>Conclusion: </strong>The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241232768"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094623","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":"Impression life with pulmonary hypertension: clinically relevant characteristics and quality of life among patients in Gansu, China.","authors":"Juxia Zhang, Yujie Wen, Yuhuan Yin, Yiyin Zhang, Rong Zhang, Xiaoli Zhang, Jianying Ye, Yuping Feng, Hongyan Meng","doi":"10.1177/17534666241246428","DOIUrl":"10.1177/17534666241246428","url":null,"abstract":"<p><strong>Background: </strong>The adverse effects of pulmonary arterial hypertension (PAH) on physical, emotional, and health-related quality of life (HRQoL) remain primarily unrecognized, especially in resource-limited settings.</p><p><strong>Objectives: </strong>This study aims to characterize the HRQoL of patients with PAH in this area and also identify the potential role of clinically relevant characteristics, including the 6-min walk distance test (6MWD), WHO-Functional Classification (WHO-FC), and mental health in the occurrence of lowering quality of life.</p><p><strong>Design: </strong>This was a cross-sectional observational study.</p><p><strong>Methods: </strong>Inpatients with PAH were chosen from a tertiary hospital located in Gansu province, China. All participants were interviewed face-by-face by using questionnaires, including items from the 36-Item Short Form Health Survey (SF-36), the self-rating anxiety scale, and the self-rating depression scale. Data on demographic and clinically relevant characteristics, including WHO-FC and 6MWD, were also collected by tracing medical recorders. Multiple linear regression analysis was used to determine the association between demographic, clinically relevant characteristics data, and physical component summary (PCS) or mental component summary (MCS) in SF-36.</p><p><strong>Results: </strong>Of the 152 participants, SF-36 differed significantly from Chinese norms in all eight domains, with role-physical (21.55 ± 9.87) less than one-third of the norm (88.79 ± 28.49). Multiple linear regression results showed that the factors with the greatest impact on PCS were anxiety scores (β = -0.22, <i>p</i> = 0.001), followed by WHO-FC (β = -0.16, <i>p</i> = 0.014) and 6MWD (β = 0.15, <i>p</i> = 0.036). The factors with the greatest impact on MCS were WHO-FC (β = -0.30, <i>p</i> < 0.001), followed by anxiety (β = -0.23, <i>p</i> = 0.001) and depression scores (β = -0.16, <i>p</i> = 0.013).</p><p><strong>Conclusion: </strong>HRQoL was substantially reduced among PAH patients in the resource-limited area, mainly the physiological functions. WHO-FC and anxiety scores were independently associated with both PCS and MCS in SF-36. Clinicians should make reasonable rehabilitation programs and plans for patients according to their cardiac function grade and the severity of clinical symptoms. In addition, psychological interventions should also be taken, especially for those with anxiety symptoms, so as to improve their HRQoL.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241246428"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11055475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861803","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":"Long-acting muscarinic antagonist and long-acting β₂-agonist combination for the treatment of maintenance therapy-naïve patients with chronic obstructive pulmonary disease: a narrative review.","authors":"Roland Buhl, Marc Miravitlles, Antonio Anzueto, Stephen Brunton","doi":"10.1177/17534666241279115","DOIUrl":"10.1177/17534666241279115","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Faster lung function impairment occurs earlier in the disease, particularly in mild-to-moderate COPD, highlighting the need for early and effective targeted interventions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 report recommends initial pharmacologic treatment with a long-acting muscarinic antagonist (LAMA) and long-acting β₂-agonist (LABA) combination in group B (0 or 1 moderate exacerbation not leading to hospitalization, modified Medical Research Council score of ⩾2, and COPD Assessment Test™ score of ⩾10) and E (⩾2 moderate exacerbations or ⩾1 exacerbation leading to hospitalization and blood eosinophil count <300 cells/µL) patients. In randomized controlled trials (RCTs), LAMA/LABA combination therapy improved lung function, St. George's Respiratory Questionnaire (SGRQ) total score, and Transitional Dyspnea Index (TDI) focal score and reduced the use of rescue medications, exacerbation risk, and risk of first clinically important deterioration (CID), compared with LAMA or LABA monotherapy. However, there is limited evidence regarding the efficacy and safety of LAMA/LABA combination therapy versus LAMA or LABA monotherapy in maintenance therapy-naïve patients. This review discusses the rationale for the early initiation of LAMA/LABA combination therapy in maintenance therapy-naïve patients with COPD. In post hoc analyses of pooled data from RCTs, compared with LAMA or LABA monotherapy, LAMA/LABA combination therapy improved lung function and quality of life and reduced COPD symptoms, risk of first moderate/severe exacerbation, risk of first CID, and use of rescue medication, with no new safety signals. In a real-world study, patients initiating LAMA/LABA had significantly reduced risk of COPD-related inpatient admissions and rate of on-treatment COPD-related inpatient admissions over 12 months than those initiating LAMA. Consequently, LAMA/LABA combination therapy could be considered the treatment of choice in maintenance therapy-naïve patients with COPD, as recommended by the GOLD 2024 report.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241279115"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354343","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":"Association between handgrip strength and small airway disease in patients with stable chronic obstructive pulmonary disease.","authors":"Thanapon Keawon, Narongkorn Saiphoklang","doi":"10.1177/17534666241281675","DOIUrl":"10.1177/17534666241281675","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is associated with airflow limitation resulting from a combination of small airway disease (SAD) and parenchymal destruction. Although various diagnostic methods for SAD exist, access to these tools can be limited.</p><p><strong>Objectives: </strong>This study aimed to explore the correlation between handgrip strength (HGS) and SAD in COPD patients.</p><p><strong>Design: </strong>Cross-sectional prospective study.</p><p><strong>Methods: </strong>HGS was measured using a hand dynamometer. SAD was evaluated using impulse oscillometry, with results reported as the difference between respiratory resistance at 5 and 20 Hz (R5-R20). SAD was defined as R5-R20 ⩾0.07 kPa/L/s. The receiver operator characteristic (ROC) curves, sensitivity, and specificity values were calculated to determine the optimal cutoff value of HGS for predicting SAD.</p><p><strong>Results: </strong>Sixty-four patients (90.6% male) were included. The average age was 72.1 ± 8.3 years, and body mass index was 23.4 ± 4.2 kg/m². FEV₁ was 71.6 ± 21.3%, and HGS was 30.2 ± 8.1 kg. R5-R20 was 0.11 ± 0.08 kPa/L/s. SAD was found in 64.1% of patients. A negative correlation between HGS and R5-R20 was observed (<i>r</i> = -0.332, <i>p</i> = 0.007). The best cutoff value for HGS in detecting SAD was determined to be 28.25 kg, with a sensitivity of 73.9%, specificity of 65.9%, and an area under ROC curve of 0.685 (95% CI 0.550-0.819, <i>p</i> = 0.015).</p><p><strong>Conclusion: </strong>SAD is common in COPD patients, and HGS is significantly negatively correlated with SAD. This tool might serve as an alternative or adjunctive assessment for small airway dysfunction in COPD patients.</p><p><strong>Registration: </strong>This study was registered with ClinicalTrials.gov with number NCT06223139.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241281675"},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378332","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}