Multidisciplinary Respiratory Medicine最新文献

{"title":"SARS-CoV-2 viral load dynamics in immunocompromised critically ill patients on remdesivir treatment","authors":"T. Lahmer, J. Erber, R. Schmid, J. Schneider, C. Spinner, P. Luppa, F. Sörgel, M. Kinzig, S. Rasch","doi":"10.4081/mrm.2022.825","DOIUrl":"https://doi.org/10.4081/mrm.2022.825","url":null,"abstract":"The relationship between SARS-CoV-2 quantitative viral load and risk of disease progression, morbidity such as long- COVID or mortality in immunosuppressed, remains largely undefined in COVID-19 patients. Critically ill immunosuppressed patients potentially benefit from remdesivir treatment because of the prolonged course of their infection. Four critically ill immunocompromised patients and the impact of remdesivir on viral dynamics in lower respiratory samples were studied. Bronchoalveolar lavage (BAL) samples were assessed to measure SARS-CoV-2 quantitative viral load using real-time PCR. Corresponding plasma levels of remdesivir and its metabolite GS-441524 were determined. Mean virus load of 39.74 x 107 geq/ml (±33.25 x 107 geq/ml) on day 1 dropped significantly (p<0.008) to 3.54 x 106 geq/ml (±6.93 x 106 geq/ml) on day 3 and to 1.4 x 105 geq/ml (±2.35 x 105 geq/ml) on day 5 of remdesivir treatment. Mean virus load dropped below <1% between day 1 and 5 of remdesivir treatment. Parent prodrug remdesivir and also GS441524 metabolite levels of antiviral activity in our patients were far in excess of EC 50. Our data present that remdesivir treatment potentially reduces the SARS-CoV-2 viral load in immunosuppressed critically ill patients. However, the implication of viral load reduction on morbidity and mortality needs further investigation.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43145162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician’s attitudes on pulmonary rehabilitation following COVID-19: a brief perspective from a developing country","authors":"I. Chérrez-Ojeda, E. Vanegas, M. Félix, M. J. Farfán Bajaña, A. Sarfraz, Z. Sarfraz, Genesis Camacho, A. Barrios-Ruiz, Jack Michel","doi":"10.4081/mrm.2022.837","DOIUrl":"https://doi.org/10.4081/mrm.2022.837","url":null,"abstract":"Despite the uncertainty about the follow up of COVID-19 survivors, there is a growing body of evidence supporting specific interventions including pulmonary rehabilitation, which may lead to a reduced hospital stay and improved overall respiratory function. The aim of this short report was to assess the attitudes toward pulmonary rehabilitation following COVID-19 among Ecuadorian physicians. A cross-sectional study was conducted, in which a 5-question survey was used to assess the level of agreement to specific statements with a 5-point Likert scale. Out of the 282 participants, 48.2% (n=136) were male, with a mean of 12.6 (SD=11.3) years of experience. More than half of physicians (63.8%, n=180; χ2(2) = 139.224, p=0.000) considered that diagnosis and treatment of patients with sub-acute and chronic COVID-19 pulmonary sequelae is not clear. Additionally, 94.3% (n=266; χ2(2) = 497.331, p=0.000) agreed that pulmonary rehabilitation must be considered as a relevant strategy in long-term care following an acute infection, with 92.6% (n=261; χ2(2) = 449.772, p=0.000) stating it will improve the likelihood of survival and return to baseline health. In conclusion, we found that considerable majority of physicians held positive attitudes to the role of pulmonary rehabilitation and considered it as a relevant strategy in long-term care following COVID-19. However, most of them also conveyed that the diagnosis and treatment of chronic pulmonary sequalae is unclear, and that guidelines for assessing pulmonary function should be established.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42299932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memory of Prof. Carlo Grassi","authors":"L. Casali, Stefano Nardini","doi":"10.4081/mrm.2022.836","DOIUrl":"https://doi.org/10.4081/mrm.2022.836","url":null,"abstract":"On January 4th, 2022 Professor Carlo Grassi died at home in Milan, at the age of 95 years...","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48501084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures.","authors":"Panayiotis Kouis,&nbsp;Maria G Kakkoura,&nbsp;Stavria Artemis Elia,&nbsp;Phivos Ioannou,&nbsp;Pinelopi Anagnostopoulou,&nbsp;Louiza Potamiti,&nbsp;Maria A Loizidou,&nbsp;Mihalis I Panayiotidis,&nbsp;Kyriacos Kyriacou,&nbsp;Andreas Hadjisavvas,&nbsp;Panayiotis K Yiallouros","doi":"10.4081/mrm.2022.881","DOIUrl":"https://doi.org/10.4081/mrm.2022.881","url":null,"abstract":"<p><strong>Background: </strong>Primary ciliary dyskinesia (PCD) is a congenital disorder characterized by chronic respiratory morbidity. To date, there is no information on PCD-specific preference-based quality of life measures such as health utilities (HU). We cross-sectionally assessed HU in adult PCD patients and explored relationships with genotype, phenotype and quality of life (QOL)-PCD scales.</p><p><strong>Methods: </strong>Diagnostic testing was performed according to international guidelines, while participants completed the visual analog scale (VAS), time trade off (TTO), standard gamble (SG), and EuroQol 5 dimensions (EQ5D) HU instruments, as well as the QOL-PCD questionnaire. Hierarchical regression was used to identify the QOL-PCD scales that are most predictive of HU.</p><p><strong>Results: </strong>Among 31 patients, median HU are 0.75 (VAS), 0.86 (EQ5D), 0.91 (TTO) and 0.99 (SG). The underlying genotype is not associated with HU measures. VAS and EQ5D are associated with lung function, while TTO and SG values are not sensitive to any of the examined factors. Among the QOL-PCD scales, physical functioning and lower respiratory symptoms explained much of VAS (R²= 0.419) and EQ5D (R²= 0.538) variability.</p><p><strong>Conclusions: </strong>Our study demonstrates that HU elicitation in PCD is feasible using both direct and indirect methods. Overall, HU scores are relatively high among adult patients, with higher scores observed in SG and TTO, followed by EQ5D and VAS. VAS and EQ5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"17 ","pages":"881"},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/db/mrm-17-1-881.PMC9830407.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10581903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term benefits of a new oral appliance on adult snoring: a trend analysis","authors":"J. Chiang, Yen-Chang Lin, Hsiao-Chen Yu, Chih-Ming Lu, Yee-Hsin Kao","doi":"10.4081/mrm.2022.824","DOIUrl":"https://doi.org/10.4081/mrm.2022.824","url":null,"abstract":"Background Snoring constitutes a worldwide public health concern that may be associated with daytime fatigue, endothelial dysfunction, vascular injury, stroke, cardiovascular diseases, and diabetes among female patients. This study explored the effects of the so-called Lin Oral Appliance (LOA) on Taiwanese adults’ snoring rates. Methods A time series analysis was conducted to examine the associations between LOAs’ tongue compressors of different lengths, and snoring rates were calculated using the SnoreClock app. The LOA comprises 2 components: custom- made dental braces and tongue compressors of adjustable lengths; different versions had different-length compressors. Results Our multiple linear regression time-series model revealed the effects of the LOA on snoring rates. The results indicated the following: i) LOA tongue compressor lengths of 1 and 2.5 cm (LOA-1 and LOA-2.5, respectively) were associated with reduced snoring rates; ii) sleep durations of 5.5-7.5 h and daytime sleepiness were associated with increased snoring rates; and iii) among participants with snoring rates above 10%, the snoring rates observed 1-7 days before a given day constituted a significant factor influencing snoring rates on the given day. Conclusions We discovered that the LOA could reduce snoring rates and that the 2.5-cm compressor length in the LOA produced the best results.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47781490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for Herpes simplex virus (HSV) and Cytomegalovirus (CMV) infections in critically-ill COVID-19 patients","authors":"K. Fuest, J. Erber, Wiebke Berg-Johnson, M. Heim, D. Hoffmann, B. Kapfer, Silja Kriescher, B. Ulm, R. Schmid, S. Rasch, T. Lahmer","doi":"10.4081/mrm.2022.815","DOIUrl":"https://doi.org/10.4081/mrm.2022.815","url":null,"abstract":"Background To assess the prevalence of Herpes simplex and Cytomegalovirus infection in respiratory samples of critically-ill COVID-19 patients, its role in outcome and mortality and the influence of dexamethasone treatment in the early stage of SARS-CoV-2 infection. Methods All mechanically ventilated COVID-19 patients treated on ICU between March 2020 and January 2021 were included. Respiratory specimens were tested for Herpes simplex virus (HSV) type 1, 2 and Cytomegalovirus (CMV) by quantitative real-time PCR. Clinical parameters were compared in the cohorts with and without HSV-1- infection. Results 134 patients with a median age of 72.5 years (73.0% male, n=98) were included. HSV-1 reactivation occurred in 61 patients (45.5%), after median 9 (7-13) days of mechanical ventilation. The main factor for reactivation was length of stay on ICU (24 days vs 13 days, p<0.001) and duration of mechanical ventilation (417 vs 214 hours, p<0.001). Treatment with dexamethasone and a history of immunosuppression did not associate with HSV-infection in the univariate analysis (39 vs 41, p=0.462 and 27.9% vs 23.3%, p=0.561, respectively). Both ICU and hospital mortality were not significantly different in the cohorts with and without HSV-infection (57.4% vs 45.2%, p=0.219). Conclusions Our study shows a high prevalence of HSV-infection in critically-ill COVID-19 patients which was unexpectedly higher than the prevalence of CMV-infections and unrelated to dexamethasone treatment. The main risk factors for HSV and CMV in the studied cohorts were the length of ICU stay and duration of mechanical ventilation. Therefore, we recommend routine monitoring of critically ill COVID-19 patients for these viral co-infections and consider treatment in those patients.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44817211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nebivolol: an effective option against long-lasting dyspnoea following COVID-19 pneumonia - a pivotal double-blind, cross-over controlled study.","authors":"Roberto W Dal Negro,&nbsp;Paola Turco,&nbsp;Massimiliano Povero","doi":"10.4081/mrm.2022.886","DOIUrl":"https://doi.org/10.4081/mrm.2022.886","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pulmonary microvascular occlusions can aggravate SARS-CoV-2 pneumonia and result in a variable decrease in capillary blood volume (Vc). Dyspnoea may persist for several weeks after hospital discharge in many patients who have \"radiologically recovered\" from COVID-19 pneumonia. Dyspnoea is frequently \"unexplained\" in these cases because abnormalities in lung vasculature are understudied. Furthermore, even when they are identified, therapeutic options are still lacking in clinical practice, with nitric oxide (NO) supplementation being used only for severe respiratory failure in the hospital setting. Nebivolol is the only selective β&lt;sup&gt;1&lt;/sup&gt; adrenoceptor antagonist capable of inducing nitric oxide-mediated vasodilation by stimulating endothelial NO synthase &lt;i&gt;via&lt;/i&gt; β&lt;sub&gt;3&lt;/sub&gt; agonism. The purpose of this study was to compare the effect of nebivolol &lt;i&gt;versus&lt;/i&gt; placebo in patients who had low Vc and complained of dyspnoea for several weeks after COVID-19 pneumonia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients of both genders, aged ≥18 years, non-smokers, who had a CT scan that revealed no COVID-related parenchymal lesions but still complaining of dyspnoea 12-16 weeks after hospital discharge, were recruited. Spirometrical volumes, blood haemoglobin, SpO&lt;sub&gt;2&lt;/sub&gt;, simultaneous diffusing capacity for carbon monoxide (CO) and NO (DL&lt;sub&gt;CO&lt;/sub&gt; and DL&lt;sub&gt;NO&lt;/sub&gt;, respectively), DL&lt;sub&gt;NO&lt;/sub&gt;/DL&lt;sub&gt;CO&lt;/sub&gt; ratio, Vc and exhaled NO (eNO) were measured together with their dyspnoea score (DS), heart frequency (HF), and blood arterial pressure (BAP). Data were collected before and one week after both placebo (P) and nebivolol (N) (2.5 mg od) double-blind cross-over administered at a two-week interval. Data were statistically compared, and p&lt;0.05 assumed as statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight patients (3 males) were investigated. In baseline, their mean DS was 2.5±0.6 SD, despite the normality of lung volumes. DL&lt;sub&gt;CO&lt;/sub&gt; and DL&lt;sub&gt;NO&lt;/sub&gt; mean values were lower than predicted, while mean DL&lt;sub&gt;NO&lt;/sub&gt;/DL&lt;sub&gt;CO&lt;/sub&gt; ratio was higher. Mean Vc proved substantially reduced. Placebo did not modify any variable (all p=ns) while N improved DLco and Vc significantly (+8.5%, p&lt;0.04 and +17.7%, p&lt;0.003, respectively). eNO also was significantly increased (+17.6%, p&lt;0.002). Only N lowered the dyspnoea score (-76%, p&lt;0.001). Systolic and diastolic BAP were slightly lowered (-7.5%, p&lt;0.02 and -5.1%, p&lt;0.04, respectively), together with HF (-16.8%, p&lt;0.03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The simultaneous assessment of DL&lt;sub&gt;NO&lt;/sub&gt;, DL&lt;sub&gt;CO&lt;/sub&gt;, DL&lt;sub&gt;NO&lt;/sub&gt;/DL&lt;sub&gt;CO&lt;/sub&gt; ratio, and Vc confirmed that long-lasting dyspnoea is related to hidden abnormalities in the lung capillary vasculature. These abnormalities can persist even after the complete resolution of parenchymal lesions regardless of the normality of lung volumes. Nebivolol, but not placebo, improves DS and Vc","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"17 ","pages":"886"},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/e8/mrm-17-1-886.PMC9830396.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10528022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saudi Arabian real-life experience with biologic therapy in severe asthma.","authors":"Safwat Eldaboussi, Ahmed Qabil, Ahmed Lotfi, Amgad Awad, Eman Abdel Salam, Abdullah Alkhamis, Usama E Abuelhassan","doi":"10.4081/mrm.2021.807","DOIUrl":"10.4081/mrm.2021.807","url":null,"abstract":"<p><strong>Background: </strong>Severe asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.</p><p><strong>Methods: </strong>This multicenter observational study enrolled a cohort of 97 patients from March 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV₁ before and during biologic therapy.</p><p><strong>Results: </strong>Ninety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV₁ improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.</p><p><strong>Conclusions: </strong>Biologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"807"},"PeriodicalIF":2.3,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/f3/mrm-16-1-807.PMC8743612.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39962756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological profiles of tracheostomy patients: a single-center experience.","authors":"Abdulaziz Alrabiah,&nbsp;Khaled Alhussinan,&nbsp;Mohammed Alyousef,&nbsp;Ahmed Alsayed,&nbsp;Abdullah Aljasser,&nbsp;Shatha Alduraywish,&nbsp;Ahmed Alammar","doi":"10.4081/mrm.2021.811","DOIUrl":"https://doi.org/10.4081/mrm.2021.811","url":null,"abstract":"<p><strong>Background: </strong>This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year.</p><p><strong>Methods: </strong>A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter.</p><p><strong>Results: </strong>Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated <i>Pseudomonas aeruginosa</i>, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, <i>P. aeruginosa</i> was the most common (35%), followed by methicillin-resistant <i>Staphylococcus aureus</i> (MRSA; 23.5%).</p><p><strong>Conclusions: </strong>The most common post-tracheostomy microorganism was <i>P. aeruginosa</i>. MRSA showed a strong association with tracheostomy for obstructive indications.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"811"},"PeriodicalIF":2.3,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/18/mrm-16-1-811.PMC8743611.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39962757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standard spirometry to assess emphysema in patients with chronic obstructive pulmonary disease: the Emphysema Severity Index (ESI).","authors":"Roberto W Dal Negro, Matteo Paoletti, Massimo Pistolesi","doi":"10.4081/mrm.2021.805","DOIUrl":"10.4081/mrm.2021.805","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a generic term identifying a condition characterized by variable changes in peripheral airways and lung parenchyma. Standard spirometry cannot discriminate the relative role of conductive airways inflammatory changes from destructive parenchymal emphysema changes. The aim of this study was to quantify the emphysema component in COPD by a simple parameter (the Emphysema Severity Index - ESI), previously proved to reflect CT-assessed emphysema.</p><p><strong>Methods: </strong>ESI was obtained by fitting the descending limb of MEFV curves by a fully automated procedure providing a 0 to 10 score of emphysema severity. ESI was computed in COPD patients enrolled in the CLIMA Study.</p><p><strong>Results: </strong>The vast majority of ESI values ranged from 0 to 4, compatible with no-to-mild/moderate emphysema component. A limited proportion of patients showed ESI values >4, compatible with severe-to-very severe emphysema. ESI values were greatly dispersed within each GOLD class indicating that GOLD classification cannot discriminate emphysema and conductive airways changes in patients with similar airflow limitation. ESI and diffusing capacity (DL_CO) were significantly correlated (p<0.001). However, the great dispersion in their correlation suggests that ESI and DL_CO reflect partially different anatomo-functional determinants in COPD.</p><p><strong>Conclusions: </strong>Airflow limitation has heterogenous determinants in COPD. Inflammatory and destructive changes may combine in CT densitometric alterations that cannot be detected by standard spirometry. ESI computation from spirometric data helps to define the prevailing pathogenetic mechanism underlying the measured airflow limitation. ESI could be a reliable advancement to select large samples of patients in clinical or epidemiological trials, and to compare different pharmacological treatments.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"805"},"PeriodicalIF":2.3,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/a6/mrm-16-1-805.PMC8672489.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39889969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}