Núñez-Cortés R, Cruz-Montecinos C, Martinez-Arnau F
… +6 more, Torres-Castro R, Zamora-Risco E, Pérez-Alenda S, Andersen LL, Calatayud J, Arana E
Chron Respir Dis
· 2022 · PMID 35957593
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INTRODUCTION: After hospitalization, early detection of musculoskeletal sequelae might help healthcare professionals to improve and individualize treatment, accelerating recovery after COVID-19. The objective was to dete...INTRODUCTION: After hospitalization, early detection of musculoskeletal sequelae might help healthcare professionals to improve and individualize treatment, accelerating recovery after COVID-19. The objective was to determine the association between the 30s sit-to-stand muscle power (30s-STS) and cross-sectional area of the chest muscles (pectoralis) in COVID-19 survivors. METHOD: This cross-sectional study collected routine data from COVID-19 survivors one month after hospitalization: 1) a chest computed tomography (CT) scan and 2) a functional capacity test (30s-STS). The pectoralis muscle area (PMA) was measured from axial CT images. For each gender, patients were categorized into tertiles based on PMA. The 30s-STS was performed to determine the leg extension power. The allometric and relative STS power were calculated as absolute 30s-STS power normalized to height squared and body mass. The two-way ANOVA was used to compare the gender-stratified tertiles of 30s-STS power variants. RESULTS: Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years, 30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant differences between the PMA tertiles in absolute STS power ( = .002) and allometric STS power ( = .001). There were no significant gender x PMA tertile interactions (all variables > .05). The high tertile of PMA showed a higher allometric STS power compared to the low and middle tertile, = .002 and = .004, respectively. Absolute STS power and allometric STS power had a moderate correlation with the PMA, r = 0.519 ( < .001) and r = 0.458 ( < .001) respectively. CONCLUSION: The 30s-STS power is associated with pectoralis muscle thickness in both male and female COVID-19 survivors. Thus, this test may indicate global muscle-wasting and may be used as a screening tool for lower extremity functional capacity in the early stages of rehabilitation planning in COVID-19 survivors.
Wang X, He H, Xu L
… +11 more, Chen C, Zhang J, Li N, Chen X, Jiang W, Li L, Wang L, Song Y, Xiao J, Zhang J, Hou D
Chron Respir Dis
· 2022 · PMID 35943965
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BACKGROUND: Active targeted case-finding is a cost-effective way to identify individuals with high-risk for early diagnosis and interventions of chronic obstructive pulmonary disease (COPD). A precise and practical COPD...BACKGROUND: Active targeted case-finding is a cost-effective way to identify individuals with high-risk for early diagnosis and interventions of chronic obstructive pulmonary disease (COPD). A precise and practical COPD screening instrument is needed in health care settings. METHODS: We created four statistical learning models to predict the risk of COPD using a multi-center randomized cross-sectional survey database ( = 5281). The minimal set of predictors and the best statistical learning model in identifying individuals with airway obstruction were selected to construct a new case-finding questionnaire. We validated its performance in a prospective cohort ( = 958) and compared it with three previously reported case-finding instruments. RESULTS: A set of seven predictors was selected from 643 variables, including age, morning productive cough, wheeze, years of smoking cessation, gender, job, and pack-year of smoking. In four statistical learning models, generalized additive model model had the highest area under curve (AUC) value both on the developing cross-sectional data set (AUC = 0.813) and the prospective validation data set (AUC = 0.880). Our questionnaire outperforms the other three tools on the cross-sectional validation data set. CONCLUSIONS: We developed a COPD case-finding questionnaire, which is an efficient and cost-effective tool for identifying high-risk population of COPD.
Chron Respir Dis
· 2022 · PMID 35938497
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INTRODUCTION: Specialist management of asthma has been shown to associate with socioeconomic status (SES). However, little is known about the influence of SES on care burden in universal healthcare settings. METHODS: Pat...INTRODUCTION: Specialist management of asthma has been shown to associate with socioeconomic status (SES). However, little is known about the influence of SES on care burden in universal healthcare settings. METHODS: Patients aged 18-45 years using inhaled corticosteroids (ICS) were followed in national databases. Impact of asthma was investigated using negative binomial regression adjusted for age, sex, comorbidity, and GINA 2020 Step. Uncontrolled asthma was defined as >600 annual SABA puffs, ≥2 prednisolone courses and/or ≥1 hospitalization. RESULTS: A total of 60,534 (55% female, median age 33 (IQR 25-39)) patients were followed for 10.1 years (IQR 5.2-14.3)). Uncontrolled asthma resulted in 6.5 and 0.51 additional annual contacts to primary care and pulmonologists, respectively.Unscheduled and primary care burden was dependent on SES, increasing with rural residence, lower education, income and receiving welfare. Differences in planned respiratory care were slight, only seen among divorced, low income- or welfare recipients. Lower SES was consistently associated with an increased utilization of SABA and prednisolone. No dose-response relationship between ICS use and SES could be identified. CONCLUSION: Lower SES in asthma is a risk factor for a predominance of unscheduled care and adverse outcomes, warranting further attention to patients' background when assessing asthma care.
Fujita K, Ohkubo H, Nakano A
… +12 more, Mori Y, Fukumitsu K, Fukuda S, Kanemitsu Y, Uemura T, Tajiri T, Maeno K, Ito Y, Oguri T, Ozawa Y, Murase T, Niimi A
Chron Respir Dis
· 2022 · PMID 35930440
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OBJECTIVES: Sarcopenia is a syndrome characterized by reduced muscle mass and function. It is well-recognized as a complication in chronic diseases such as chronic obstructive pulmonary disease. However, little is known...OBJECTIVES: Sarcopenia is a syndrome characterized by reduced muscle mass and function. It is well-recognized as a complication in chronic diseases such as chronic obstructive pulmonary disease. However, little is known about sarcopenia in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to investigate the clinical characteristics of sarcopenia and the association between quality of life and sarcopenia in patients with IPF. METHODS: In this pilot cross-sectional study, 56 Japanese outpatients with IPF (49 men) were enrolled prospectively. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia 2019. Its associations with clinical parameters including age, pulmonary functions, physical performance, and patient-reported outcomes (PROs) were examined. RESULTS: The frequency of sarcopenia was 39.3% ( = 22) in this cohort. There were significant differences in St George's Respiratory Questionnaire ( = .005), modified Medical Research Council score ( = .004), and Hospital and Anxiety Depression Scale depression score ( = .030) between the sarcopenic and non-sarcopenic groups. On multivariate regression analysis, 6-min walk distance (6MWD) was an independent factor associated with sarcopenia (odds ratio 1.241, 95% confidence interval 1.016-1.515, = .034). CONCLUSION: Sarcopenia was associated with PROs and physical performance in patients with IPF.
Gerlis C, Barradell A, Gardiner NY
… +4 more, Chaplin E, Goddard A, Singh SJ, Daynes E
Chron Respir Dis
· 2022 · PMID 35850558
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INTRODUCTION: There are early data to suggest that a rehabilitation programme can help with on-going symptoms of COVID-19, including breathlessness, exercise limitation and fatigue. As yet, there are no published data to...INTRODUCTION: There are early data to suggest that a rehabilitation programme can help with on-going symptoms of COVID-19, including breathlessness, exercise limitation and fatigue. As yet, there are no published data to understand patients' perceived acceptability of a rehabilitation programme for COVID-19. METHODS: 2 focus groups ( = 9) and 4 one to one interviews were conducted with participants who attended a rehabilitation program following COVID-19. Interviews were analysed using reflexive thematic analysis with an inductive approach. RESULTS: Two overarching themes were generated from the data. The first, The Recovery Journey is sub-divided into five sub-themes of Expectations, Individual and Varied Journeys, Mental and Physical Improvements, Self-values and The Journey Continues. The second overarching theme, The Rehabilitation boat contains five subthemes: Programme Delivery, Safe and Supportive, Validation and Assurance, Shared Reflections and Education. CONCLUSION: A rehabilitation programme for post COVID-19 symptoms was considered to be acceptable and viewed positively in terms of improving physical and mental symptoms. The opportunity to share the experience with others in the same boat was highly valued in the context of an unexpected and potentially lonely COVID-19 recovery.
Ye YP, Zhao H, Kang T
… +4 more, Zhao LH, Li N, Chen J, Peng XX
Chron Respir Dis
· 2022 · PMID 35830291
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OBJECTIVE: To explore the optimal cut-off value of serum procalcitonin (PCT) level in predicting bacterial infection in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MET...OBJECTIVE: To explore the optimal cut-off value of serum procalcitonin (PCT) level in predicting bacterial infection in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: 204 hospitalized patients with AECOPD were enrolled in this study. Their diagnoses and treatments followed routine protocols in Fu-Xing Hospital affiliated to Capital Medical University, Beijing, China. Extra blood samples were taken for serum PCT level testing and the results were blinded to the treating physicians. On discharge, clinical data were collected and the treating physicians made comprehensive analyses to determine whether the AECOPD were triggered by respiratory tract bacterial infection or non-bacterial causes according to the "new diagnostic criteria" defined in this study. In the AECOPD patients with bacterial infection, treating physicians decided whether they had bacterial pneumonia based on imaging studies. Receiver operating characteristic curve (ROC) was used to analyze the accuracy of serum PCT level in predicting bacterial infection. RESULTS: In the 173 AECOPD patients who did not have pneumonia, 115 had evidences of bacterial infection while 58 did not. The median PCT levels were 0.1(0.08, 0.18) ng/ml and 0.07 (0.05, 0.08) ng/ml for each group, which were statistically different. The proposed optimal cut-off value of serum PCT level in predicting bacterial infection was 0.08 ng/mL according to this study, with a sensitivity of 81%, specificity of 67% and area under the ROC curve (AUC) of 0.794. There were 31 AECOPD patients diagnosed with pneumonia, their median PCT level was 0.23 ng/mL. CONCLUSIONS: The serum PCT levels slightly increased in the majority of hospitalized patients with AECOPD compared with reference range. When PCT level was ≥0.08 ng/mL, AECOPD was more likely to be caused by bacterial infection. A significantly elevated PCT levels may indicate combination of AECOPD and bacterial pneumonia.
Fujita K, Ohkubo H, Nakano A
… +12 more, Takeda N, Fukumitsu K, Fukuda S, Kanemitsu Y, Uemura T, Tajiri T, Maeno K, Ito Y, Oguri T, Ozawa Y, Murase T, Niimi A
Chron Respir Dis
· 2022 · PMID 35792724
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OBJECTIVES: The peak expiratory flow rate (PEFR) is known to decrease in patients with sarcopenia. However, little is known about the clinical impact of the PEFR in idiopathic pulmonary fibrosis (IPF). This study aimed t...OBJECTIVES: The peak expiratory flow rate (PEFR) is known to decrease in patients with sarcopenia. However, little is known about the clinical impact of the PEFR in idiopathic pulmonary fibrosis (IPF). This study aimed to confirm whether a decrease in PEFR over 6 months was associated with survival in IPF patients. METHODS: Consecutive IPF patients who had been assessed at a single center were retrospectively analyzed. The relative decline in PEFR over 6 months was assessed. Survival analyses were performed by univariate and multivariate Cox proportional hazard models. RESULTS: A total of 61 eligible cases (average age 70 years) were examined, and 21 patients (34.4%) died. The univariate Cox regression analysis showed that the body mass index, baseline % predicted forced vital capacity (FVC), baseline % predicted PEFR, % predicted diffusion capacity for carbon monoxide (DL), relative decline in FVC, and relative decline in PEFR were prognostic factors. On multivariate analyses, relative decline in PEFR (hazard ratio [HR] 1.037, < .05) and baseline % predicted FVC (HR 0.932, < .001) were independent prognostic factors, whereas relative decline in FVC was not. CONCLUSION: A decrease in PEFR after 6 months may predict worse survival in patients with IPF.
Xiaoyan W, Yu X, Xiaoyan Y
… +3 more, Min L, Yanwei L, Huaping D
Chron Respir Dis
· 2022 · PMID 35724363
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BACKGROUND AND OBJECTIVE: Many bronchiectasis patients suffer dyspnea, decreased exercise tolerance, and low body mass index. Chest wall muscles play a special role in respiratory movement and make up parts of skeletal m...BACKGROUND AND OBJECTIVE: Many bronchiectasis patients suffer dyspnea, decreased exercise tolerance, and low body mass index. Chest wall muscles play a special role in respiratory movement and make up parts of skeletal muscles. This study aimed to examine the chest wall muscle thickness and their relationship with disease severity in bronchiectasis. METHODS: We retrospectively included 166 patients with bronchiectasis and 62 patients with pneumonia as comparators. The thickness of chest wall muscle as determined in chest CT, pulmonary function, and Bronchiectasis Severity Index (BSI) score were recorded. We compared the thickness of the chest wall muscle in two groups and assessed the relationships among chest wall muscle thickness, pulmonary function, and BSI score. RESULTS: Chest wall muscle thickness of the anterior midclavicular line and posterior exterior scapula were thinner in bronchiectasis patients than comparators both above the aortic arch level and at the aortic arch window level. Muscle thickness of the posterior interior scapula above the aortic arch level was significantly thinner in bronchiectasis patients. Chest wall muscle thickness at the anterior midclavicular line both the above aortic arch level and at the level of the aortic arch window were related to diffuse capacity in bronchiectasis patients. Anterior chest wall muscle thickness above the aortic arch was found to be a risk factor of disease severity. CONCLUSION: Anterior chest wall muscles in the upper and middle chest were thinner in bronchiectasis patients than in comparators, and had relationship with spirometry and diffuse compacity factors. We provide another method to conveniently assess bronchiectasis severity.
Clarke SY, Williams MT, Johnston KN
… +1 more, Lee AL
Chron Respir Dis
· 2022 · PMID 35698999
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BACKGROUND: Dyspnoea and pain are symptoms of chronic obstructive pulmonary disease (COPD). This review focused upon pain and dyspnoea during hospital admissions for acute exacerbations of COPD (AECOPD), with the aim of...BACKGROUND: Dyspnoea and pain are symptoms of chronic obstructive pulmonary disease (COPD). This review focused upon pain and dyspnoea during hospital admissions for acute exacerbations of COPD (AECOPD), with the aim of examining prevalence, assessment, clinical associations, and researcher-reported implications of these symptoms. METHODS: Four electronic databases were searched from inception to 31 May 2021. Full text versions of studies were assessed for methodological quality and data were extracted independently by two reviewers. Where data permitted, pooled prevalence of pain and dyspnoea were calculated by meta-analysis. RESULTS: Four studies were included. The pooled prevalence of pain and dyspnoea was 44% (95% confidence interval (CI) 35%-52%) and 91% (95% CI 87%-94%) respectively. An array of instruments with varying focal periods were reported (pain: six tools, dyspnoea: four tools). Associations and clinical implications between the two symptoms at the time of hospital admission were rarely reported. CONCLUSIONS: Few studies reported prevalence of pain and dyspnoea during an AECOPD. A greater understanding into the prevalence, intensity and associations of these symptoms during AECOPD could be furthered by use of standardised assessment tools with clearly defined focal periods.
Chron Respir Dis
· 2022 · PMID 35687527
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The COVID-19 pandemic has served to expose and amplify existing inequalities in chronic respiratory disease and the social determinants of health. In this article, we summarise evidence of existing disparities associated...The COVID-19 pandemic has served to expose and amplify existing inequalities in chronic respiratory disease and the social determinants of health. In this article, we summarise evidence of existing disparities associated with chronic obstructive pulmonary disease and pulmonary rehabilitation; highlighting limitations of existing data. To reduce health inequalities in pulmonary rehabilitation, there is a need to identify and target factors influencing fair access and personal agency to engage. With consideration of the influence of culture on beliefs, expectations and health behaviours, we propose a renewed approach toward progressively achieving health equity in pulmonary rehabilitation based on principles of cultural safety and adaptation. This is a key priority in improving the quality of life of people living with chronic respiratory disease. Building comprehensive pulmonary rehabilitation service delivery models based on an understanding of the holistic needs of the local population should be a priority for service providers and researchers.
Domínguez-Ortega J, Plaza V, Li VW
… +6 more, Fonseca E, Cea-Calvo L, Martin A, Sánchez-Jareño M, Brady JE, Schelfhout J
Chron Respir Dis
· 2022 · PMID 35620851
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BACKGROUND: Chronic cough (CC) represents a significant health burden. This study assessed the prevalence of CC (defined as per international guidelines as cough duration >8 weeks) in Spanish adults and compared characte...BACKGROUND: Chronic cough (CC) represents a significant health burden. This study assessed the prevalence of CC (defined as per international guidelines as cough duration >8 weeks) in Spanish adults and compared characteristics between CC and non-CC cohorts. METHODS: CC cohorts were compiled using data from adult respondents to the 2020 Spanish cross-sectional online National Health and Wellness Survey (NHWS). Using propensity scores, respondents experiencing CC during their lifetime and the previous 12 months were matched 3:1 to respondents without CC and their health characteristics were compared. The number of Spanish adults affected with CC was estimated using weighted CC prevalence. RESULTS: CC during their lifetime or the previous 12 months was experienced by 579 (8.2%) and 389 (5.5%) of 7074 NHWS respondents, of whom 233 (38.5%) and 171 (44.0%), respectively, had physician-diagnosed CC. Based on weighted prevalence rates, lifetime and 12-month CC were estimated to affect ≈3.3 million and ≈2.2 million Spanish adults, respectively. Relative to the non-CC cohort, the 12-month CC cohort consistently demonstrated poorer health status, poorer mental health, greater healthcare utilization, and lower productivity at work and home. CONCLUSION: This study contributes novel data regarding the prevalence of CC in Spain, suggests that CC is underdiagnosed, and reflects that CC and related comorbidities inflict a significant health burden in the affected population.
Benavides-Cordoba V, Barros-Poblete M, Vieira RP
… +3 more, Mazzucco G, Fregonezi G, Torres-Castro R
Chron Respir Dis
· 2022 · PMID 35616253
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INTRODUCTION: The Coronavirus disease (COVID-19) pandemic has significantly altered the provision of rehabilitation services, especially pulmonary rehabilitation (PR). Our objective was to assess the provision of PR serv...INTRODUCTION: The Coronavirus disease (COVID-19) pandemic has significantly altered the provision of rehabilitation services, especially pulmonary rehabilitation (PR). Our objective was to assess the provision of PR services in Latin America 18 months after the COVID-19 pandemic was declared. METHODS: A cross-sectional study that included professionals dedicated to PR in centres in Latin America was applied. Responses to an online questionnaire were collected from May to September 2021. The following data were included for the analysis: demographic data, evaluation strategies, program structure, PR intervention in post-COVID-19 patients, and perception of strategies therapies for the care of post-COVID-19 patients. The questionnaire was distributed in Spanish and Portuguese languages. RESULTS: Responses were received from 196 PR centres. Exercise tolerance was predominantly measured with the six-minute walk test. Less than 50% of the institutions evaluate quality of life, physical qualities, symptoms, and lung function. Most of the programmes have physiotherapists (90.8%), as well as pulmonologists (60%), and psychologists (35%), among other professionals. CONCLUSION: PR services in Latin America have adapted in their way to the requirements of the pandemic, and most continued to provide face-to-face services. It was identified that the application of the programs is heterogeneous both in evaluations and interventions.
Gonzalez-Garcia M, Aguirre-Franco CE, Vargas-Ramirez L
… +2 more, Barrero M, Torres-Duque CA
Chron Respir Dis
· 2022 · PMID 35603864
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BACKGROUND: Pulmonary hypertension (PH) is associated with decreased exercise tolerance in chronic obstructive pulmonary disease (COPD) patients, but in the altitude the response to exercise in those patients is unknown....BACKGROUND: Pulmonary hypertension (PH) is associated with decreased exercise tolerance in chronic obstructive pulmonary disease (COPD) patients, but in the altitude the response to exercise in those patients is unknown. Our objective was to compare exercise capacity, gas exchange and ventilatory alterations between COPD patients with PH (COPD-PH) and without PH (COPD-nonPH) residents at high altitude (2640 m). METHODS: One hundred thirty-two COPD-nonPH, 82 COPD-PH, and 47 controls were included. Dyspnea by Borg scale, oxygen consumption (VO), work rate (WR), ventilatory equivalents (VE/VCO), dead space to tidal volume ratio (V/V), alveolar-arterial oxygen tension gradient (AaPO), and arterial-end-tidal carbon dioxide pressure gradient (Pa-ETCO) were measurement during a cardiopulmonary exercise test. For comparison of variables between groups, Kruskal-Wallis or one-way ANOVA tests were used, and stepwise regression analysis to test the association between PH and exercise capacity. RESULTS: All COPD patients had a lower exercise capacity and higher PaCO, A-aPO and V/V than controls. The VO % predicted (61.3 ± 20.6 vs 75.3 ± 17.9; < 0.001) and WR % predicted (65.3 ± 17.9 vs 75.3 ± 17.9; < 0.001) were lower in COPD-PH than in COPD-nonPH. At peak exercise, dyspnea was higher in COPD-PH ( = 0.011). During exercise, in COPD-PH, the PaO was lower ( < 0.001), and AaPO ( < 0.001), Pa-ETCO ( = 0.033), VE/VCO ( = 0.019), and V/V ( = 0.007) were higher than in COPD-nonPH. In the multivariate analysis, PH was significantly associated with lower peak VO and WR ( < 0.001). CONCLUSION: In COPD patients residing at high altitude, the presence of PH was an independent factor related to the exercise capacity. Also, in COPD-PH patients there were more dyspnea and alterations in gas exchange during the exercise than in those without PH.
Martynowicz H, Wieczorek T, Macek P
… +7 more, Wojakowska A, Poręba R, Gać P, Mazur G, Skomro R, Smardz J, Więckiewicz M
Chron Respir Dis
· 2022 · PMID 35512250
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We aimed to evaluate and compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) in reducing the intensity of sleep bruxism (SB) in patients with obstructive sleep apnea...We aimed to evaluate and compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) in reducing the intensity of sleep bruxism (SB) in patients with obstructive sleep apnea (OSA). Forty-eight adults with OSA were subjected to single-night full polysomnography (PSG) in the Sleep Laboratory of the Wroclaw Medical University. The respiratory events and bruxism episodes were scored according to the standards of the American Academy of Sleep Medicine. The patients were assigned to the CPAP treatment or the MAD treatment in accordance to apnea-hypopnea index (AHI). The second PSG examination was conducted during the MAD or CPAP treatment to assess the effect of treatment on bruxism episode index (BEI) and AHI. The mean AHI and mean BEI in the study material were estimated to be 30.05 ± 15.39 and 5.10 ± 5.31, respectively. The bruxism parameters were significantly decreased in both the CPAP and MAD groups. Compared to the MAD, the CPAP treatment was more effective in reducing AHI; however, there was no significant difference in effectiveness of CPAP and MAD treatment in BEI reduction. Both CPAP and MAD treatments were effective against SB coexisting with OSA. Due to the application of these treatment options, the risk of OSA should be estimated in patients with SB.
Chron Respir Dis
· 2022 · PMID 35471849
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OBJECTIVE: Bronchiectasis is a heterogeneous disease with distinct phenotypes. The post-tuberculosis (post-TB) bronchiectasis phenotype is prevalent in many countries but is under-studied. Our aim was to identify distinc...OBJECTIVE: Bronchiectasis is a heterogeneous disease with distinct phenotypes. The post-tuberculosis (post-TB) bronchiectasis phenotype is prevalent in many countries but is under-studied. Our aim was to identify distinct phenotypic characteristics of post-TB bronchiectasis. METHODS: We recruited adults admitted between Jan 2010-Oct 2017 at Changi General Hospital, Singapore for bronchiectasis exacerbation. We collected demographics, symptoms, lung function, microbiology and FACED scores. Participants were followed-up until the next hospitalized exacerbation or end of study, whichever was sooner. Participants diagnosed by their attending respiratory specialist to have post-TB bronchiectasis were compared to those with bronchiectasis from other aetiologies. RESULTS: 148 participants were included with mean±standard deviation age 63 ± 9 years; 46 (31.1%) had post-TB bronchiectasis and 102 (68.9%) other aetiologies. Compared to other aetiologies, participants with post-TB bronchiectasis had significantly lower body mass index (BMI), more frequent presentation with haemoptysis, lower forced expiratory volume in one second (FEV), more frequent isolation of nontuberculous mycobacteria (NTM), and higher FACED scores indicating greater disease severity. Over a median follow-up of 21 months, post-TB bronchiectasis was associated with shorter time to next hospitalized exacerbation (49 vs 76 months, Log-Rank = .01). CONCLUSION: Post-TB bronchiectasis is a distinct entity with higher rates of haemoptysis and NTM isolation, more frequent exacerbations, and greater disease severity.
Veldhoen ES, Vercoelen F, Ros L
… +7 more, Verweij-van den Oudenrijn LP, Wösten-van Asperen RM, Hulzebos EH, Bartels B, Gaytant MA, van der Ent K, Ludo van der Pol W
Chron Respir Dis
· 2022 · PMID 35442817
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Air stacking (AS) and mechanical insufflation-exsufflation (MI-E) aim to increase cough efficacy by augmenting inspiratory lung volumes in patients with neuromuscular diseases (NMDs). We studied the short-term effect of...Air stacking (AS) and mechanical insufflation-exsufflation (MI-E) aim to increase cough efficacy by augmenting inspiratory lung volumes in patients with neuromuscular diseases (NMDs). We studied the short-term effect of AS and MI-E on lung function. We prospectively included NMD patients familiar with daily AS or MI-E use. Studied outcomes were forced vital capacity (FVC), forced expiratory volume in one second (FEV), and peak expiratory flow (PEF) prior to, immediately after, and up to 2 h after treatment. Paired sample T-test and Wilcoxon signed-rank test was used. Sixty-seven patients participated. We observed increased FVC and FEV immediately after AS with a mean difference of respectively 0.090 L (95% CI 0.045; 0.135, < .001) and 0.073 L (95% CI 0.017; 0.128, = .012). Increased FVC immediately after MI-E (mean difference 0.059 L (95% CI 0.010; 0.109, = .021) persisted 1 hour (mean difference 0.079 L (95% CI 0.034; 0.125, = .003). The effect of treatment was more pronounced in patients diagnosed with Spinal Muscular Atrophy, compared to patients with Duchenne muscular dystrophy. AS and MI-E improved FVC immediately after treatment, which persisted 1 h after MI-E. There is insufficient evidence that short-lasting increases in FVC would explain the possible beneficial effect of AS and MI-E.