American journal of respiratory and critical care medicine最新文献

{"title":"Low-Dose Morphine Does Not Cause Sleepiness in Chronic Obstructive Pulmonary Disease: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Thomas J Altree, Barbara Toson, Kelly A Loffler, Magnus Ekström, David C Currow, Danny J Eckert","doi":"10.1164/rccm.202310-1780OC","DOIUrl":"10.1164/rccm.202310-1780OC","url":null,"abstract":"<p><p><b>Rationale:</b> Regular, low-dose, sustained-release morphine is frequently prescribed for persistent breathlessness in chronic obstructive pulmonary disease (COPD). However, effects on daytime sleepiness, perceived sleep quality, and daytime function have not been rigorously investigated. <b>Objectives:</b> We sought to determine the effects of regular, low-dose, sustained-release morphine on sleep parameters in COPD. <b>Methods:</b> We conducted prespecified secondary analyses of validated sleep questionnaire data from a randomized trial of daily, low-dose, sustained-release morphine versus placebo over 4 weeks commencing at 8 or 16 mg/d with blinded up-titration over 2 weeks to a maximum of 32 mg/d. Primary outcomes for these analyses were Week-1 Epworth Sleepiness Scale (ESS) and Karolinska Sleepiness Scale (KSS) scores on morphine versus placebo. Secondary outcomes included Leeds Sleep Evaluation Questionnaire scores (end of Weeks 1 and 4), KSS and ESS scores beyond Week 1, and associations between breathlessness, morphine, and questionnaire scores. <b>Measurements and Main Results:</b> One hundred fifty-six people were randomized. Week-1 sleepiness scores were not different on morphine versus placebo (ΔESS [95% confidence interval] versus placebo: 8-mg group, -0.59 [-1.99, 0.81], <i>P</i> = 0.41; 16-mg group, -0.72 [-2.33, 0.9], <i>P</i> = 0.38; ΔKSS vs. placebo, 8-mg group: 0.11 [-0.7, 0.9], <i>P</i> = 0.78; 16-mg group, -0.41 [-1.31, 0.49], <i>P</i> = 0.37). This neutral effect persisted at later time points. In addition, participants who reported reduced breathlessness with morphine at 4 weeks also showed improvement in LSEQ domain scores including perceived sleep quality and daytime function. <b>Conclusions:</b> Regular, low-dose morphine does not worsen sleepiness when used for breathlessness in COPD. Individual improvements in breathlessness with morphine may be related to improvements in sleep. Clinical trial registered with www.clinicaltrials.gov (NCT02720822).</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140108760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of Potential Breath Biomarkers for Asthma: A Step Forward Toward the Clinical Implementation of Breath Analysis.","authors":"Rosa A Sola-Martínez, Alice M Turner, Teresa de Diego Puente","doi":"10.1164/rccm.202405-1033ED","DOIUrl":"10.1164/rccm.202405-1033ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcoidosis Immunodiagnostic Test Detects IgG Antibodies against Unique Antigenic Epitopes.","authors":"Lobelia Samavati, Jaya Talreja, Changya Peng","doi":"10.1164/rccm.202406-1235LE","DOIUrl":"10.1164/rccm.202406-1235LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Yoshihiro and Taito: True Effect of Fludrocortisone for Septic Shock: Baseline Risk and Transitivity Concerns.","authors":"Bijan Teja","doi":"10.1164/rccm.202407-1437LE","DOIUrl":"10.1164/rccm.202407-1437LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Realistic Longitudinal Monitoring of Structure-Function in Smokers.","authors":"Sylvia Verbanck, Eef Vanderhelst","doi":"10.1164/rccm.202405-1071LE","DOIUrl":"10.1164/rccm.202405-1071LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Verbanck and Vanderhelst: Toward Realistic Longitudinal Monitoring of Structure?Function in Smokers.","authors":"Andrew I Ritchie, Eric A Hoffman, James P Allinson, Jadwiga A Wedzicha","doi":"10.1164/rccm.202407-1378LE","DOIUrl":"10.1164/rccm.202407-1378LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D Supplementation, Long-Term PM_2.5 Exposure, and Severe Asthma Exacerbations in Children with Low Vitamin D: A Post Hoc Analysis of a Double-Blind, Randomized, Placebo-Controlled Trial (VDKA).","authors":"Franziska J Rosser, Yueh-Ying Han, Erick Forno, Theresa W Guilbert, Leonard B Bacharier, Wanda Phipatanakul, Juan C Celedón","doi":"10.1164/rccm.202407-1353RL","DOIUrl":"https://doi.org/10.1164/rccm.202407-1353RL","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preacinar Arterial Dilation Mediates Outcomes of Quantitative Interstitial Abnormalities in the COPDGene Study.","authors":"Eileen M Harder, Pietro Nardelli, Carrie L Pistenmaa, Samuel Y Ash, Aparna Balasubramanian, Russell P Bowler, Mónica Iturrioz Campo, Alejandro A Diaz, Paul M Hassoun, Jane A Leopold, Fernando J Martinez, Steven D Nathan, Imre Noth, Anna J Podolanczuk, Rajan Saggar, Rúben San José Estépar, Oksana A Shlobin, Wei Wang, Aaron B Waxman, Rachel K Putman, George R Washko, Bina Choi, Raúl San José Estépar, Farbod N Rahaghi","doi":"10.1164/rccm.202312-2342OC","DOIUrl":"10.1164/rccm.202312-2342OC","url":null,"abstract":"<p><p><b>Rationale:</b> Quantitative interstitial abnormalities (QIAs) are a computed tomography (CT) measure of early parenchymal lung disease associated with worse clinical outcomes, including exercise capacity and symptoms. The presence of pulmonary vasculopathy in QIAs and its role in the QIA-outcome relationship is unknown. <b>Objectives:</b> To quantify radiographic pulmonary vasculopathy in QIAs and determine whether this vasculopathy mediates the QIA-outcome relationship. <b>Methods:</b> Ever-smokers with QIAs, outcomes, and pulmonary vascular mediator data were identified from the Genetic Epidemiology of COPD (COPDGene) study cohort. CT-based vascular mediators were right ventricle-to-left ventricle ratio, pulmonary artery-to-aorta ratio, and preacinar intraparenchymal arterial dilation (pulmonary artery volume, 5-20 mm² in cross-sectional area, normalized to total arterial volume). Outcomes were 6-minute walk distance and a modified Medical Council Research Council Dyspnea Scale score of 2 or higher. Adjusted causal mediation analyses were used to determine whether the pulmonary vasculature mediated the QIA effect on outcomes. Associations of preacinar arterial dilation with select plasma biomarkers of pulmonary vascular dysfunction were examined. <b>Measurements and Main Results:</b> Among 8,200 participants, QIA burden correlated positively with vascular damage measures, including preacinar arterial dilation. Preacinar arterial dilation mediated 79.6% of the detrimental impact of QIA on 6-minute walk distance (56.2-100%; <i>P</i> < 0.001). Pulmonary artery-to-aorta ratio was a weak mediator, and right ventricle-to-left ventricle ratio was a suppressor. Similar results were observed in the relationship between QIA and modified Medical Council Research Council dyspnea score. Preacinar arterial dilation correlated with increased pulmonary vascular dysfunction biomarker levels, including angiopoietin-2 and N-terminal brain natriuretic peptide. <b>Conclusions:</b> Parenchymal QIAs deleteriously impact outcomes primarily through pulmonary vasculopathy. Preacinar arterial dilation may be a novel marker of pulmonary vasculopathy in QIAs.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons about Low-Dose Morphine at the Intersection of Sleep and Breathlessness.","authors":"Nicolle Jasmin Domnik, Henry Klar Yaggi","doi":"10.1164/rccm.202404-0682ED","DOIUrl":"10.1164/rccm.202404-0682ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141282743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Searching for an Elusive Phantom - Targeting Estrogen in Pulmonary Hypertension.","authors":"Mark Toshner","doi":"10.1164/rccm.202405-1029ED","DOIUrl":"10.1164/rccm.202405-1029ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":19.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}