Chron Respir Dis [JOURNAL]
Sun
200 papers
Physiotherapy assessment of breathlessness and disordered patterns of breathing: Defining a consensus on terminology and assessment.
Grillo LJ, Easton I, Schreuder FM … +5 more , Lewis A, Bloom CI, Hopkinson NS, Shannon H, Russell AM
Chron Respir Dis · 2025 · PMID 40085749 · Full text
Abnormal breathing patterns unexplained by pathophysiology are typically referred to using terms including chronic breathlessness syndrome or complex breathlessness. Often patients with these conditions are referred to p...
Abnormal breathing patterns unexplained by pathophysiology are typically referred to using terms including chronic breathlessness syndrome or complex breathlessness. Often patients with these conditions are referred to physiotherapy for an assessment of this breathlessness, where some are diagnosed with breathing pattern disorder (BrPD) or dysfunctional breathing (DB). The condition seen in physiotherapy occurs in at least 10% of the general population, increasing to 29-40% with coexisting conditions. Inconsistency in the nomenclature and physiotherapy assessment reduces recognition of the condition and hinders development in this area. To establish expert physiotherapists' consensus on terminology to describe this condition and provide guidance for its physiotherapy assessment. The opinions and experiences of ten respiratory physiotherapists, nine other clinicians (doctors, nurses, and speech and language therapists), and five patients diagnosed with BrPD were explored in focus groups or interviews regarding the terminology used and assessment experience. A second separate purposive sample of clinical expert physiotherapists ( = 11) took part in a nominal group technique (NGT) process to build consensus on the following questions: Question 1: What is your preferred term for this condition? Question 2: What are the most important assessment components to be included in all assessments? One focus group ( = 10) and 14 interviews were completed. Framework analysis of the data from focus groups and interviews was undertaken and these results were shared with the participants in the nominal group. Consensus (71%) for the term breathing pattern disorder (BrPD) was achieved and an assessment guide was created. With improved consistency in its description and assessment, the adoption of breathing pattern disorder may help to further develop clinical and research priorities in this area within physiotherapy services.
Educational needs of people with COPD or asthma entering pulmonary rehabilitation and their significant others: A cross-sectional study.
Muijsenberg AJ, Houben-Wilke S, Tatousek J … +3 more , Lacroix J, Spruit MA, Janssen DJ
Chron Respir Dis · 2025 · PMID 40067744 · Full text
This study aimed to identify educational needs of people with COPD or asthma referred for pulmonary rehabilitation and their significant others. In this cross-sectional study, information needs were assessed by the Lung...
This study aimed to identify educational needs of people with COPD or asthma referred for pulmonary rehabilitation and their significant others. In this cross-sectional study, information needs were assessed by the Lung Information Needs Questionnaire. Learning styles were assessed with a multiple-choice question (visual, aural, read/write and kinaesthetic - multiple choices were possible). Psychological profiles were assessed by an instrument distinguishing four profiles: fighter, analyst, optimist or sensitive. 121 patients (57% female; age: 65 ± 10 years; 81% COPD) and 67 significant others (55% female; age: 61 ± 12 years) were included. Patients and their significant others had a variety of information needs. Patients and their significant others mostly preferred the aural (39% and 49%, respectively) and read/write learning styles (31% and 36%, respectively) as unimodal learners. 49% of patients and 51% of significant others preferred more than one learning style. Most prevalent psychological profiles were optimist in patients (36%) and fighter in significant others (59%). The identified variety in educational needs among people with COPD or asthma and their significant others underlines the importance of addressing this diversity of individual needs in education. Learners should have the opportunity to choose among a variety of topics and have access to multiple learning styles. Furthermore, educational interventions should consider to incorporate different communication strategies.
Validation of a clinical prediction model for falls in community-dwelling older adults with COPD: A preliminary analysis.
Nguyen KT, Ellerton C, Wald J … +5 more , Raghavan N, Macedo LG, Brooks D, Goldstein R, Beauchamp MK
Chron Respir Dis · 2025 · PMID 39957244 · Full text
BACKGROUND: People with chronic obstructive pulmonary disease (COPD) are at a higher risk of falls. This preliminary study aims to externally validate a previously developed clinical prediction model for falls in communi...
BACKGROUND: People with chronic obstructive pulmonary disease (COPD) are at a higher risk of falls. This preliminary study aims to externally validate a previously developed clinical prediction model for falls in community-dwelling older adults with COPD. METHODS: This was a secondary analysis of a 12-month prospective cohort study. Older adults (≥60 years) with COPD, who reported a fall in the past year and/or had balance concerns, were tracked for 12-month future falls. Baseline predictors included 12-month history of ≥2 falls, total chronic conditions, and Timed Up and Go Dual-Task (TUG-DT) test scores. Model performance was assessed for discrimination (c-statistic), calibration (E:O, CITL, and calibration slope), and clinical value (decision curve analysis). RESULTS: The study included 89 participants (average age 73 ± 9 years; 83 females; FEV%predicted = 47%). Of these, 35 (39%) reported ≥1 future fall, totaling 89 falls. The model demonstrated acceptable discrimination (c-statistic = 0.62, CI [0.51,0.72]), and calibration (E:O = 1, CITL = 0, and a calibration slope = 1). Decision curve analysis showed greater clinical value when using the prediction model compared to screening for fall history alone. CONCLUSIONS: A 12-month history of ≥2 falls, higher total chronic conditions, and worse TUG-DT test scores, predicts falls in community-dwelling older adults with COPD. Larger studies are needed before clinical application.
Real-world disease burden, mortality, and healthcare resource utilization associated with bronchiectasis.
Shoaib S, Feliciano J, Dasenbrook EC … +5 more , Maynard J, Batchu L, Mohanty M, Lauterio M, Feld AJ
Chron Respir Dis · 2025 · PMID 39925084 · Full text
OBJECTIVES: To assess real-world survival and healthcare resource utilization (HCRU) in US patients with non-cystic fibrosis bronchiectasis (NCFBE). METHODS: This retrospective analysis, using data from the STATinMED RWD...
OBJECTIVES: To assess real-world survival and healthcare resource utilization (HCRU) in US patients with non-cystic fibrosis bronchiectasis (NCFBE). METHODS: This retrospective analysis, using data from the STATinMED RWD Insights database from Jan 2015-Oct 2022, included adults with NCFBE (from Jan 2015-Oct 2021) and non-NCFBE comparators (from Jan 2015-Aug 2020); baseline characteristics were balanced by inverse probability treatment weighting. Outcomes included survival through end of study. HCRU was assessed over 12 months. RESULTS: 117,718 patients with NCFBE and 306,678 comparators were included. Patients with NCFBE had a 77% higher risk of death than comparators (hazard ratio [HR] 1.77 [95% CI 1.74-1.80]). Risk of death was higher among patients aged ≥65 years (vs 18-34 years; HR 11.03 [95% CI 10.36-11.74]), among Black patients (vs White; HR 1.53 [95% CI 1.50-1.55]), and among patients with comorbid COPD (HR 1.42 [95% CI 1.40-1.44]). Patients with NCFBE incurred higher all-cause and respiratory-related HCRU than comparators for outpatient office, outpatient hospital, emergency department (ED), inpatient and respiratory-related pulmonologist visits (all < .0001); HCRU increased with exacerbations. CONCLUSIONS: Patients with NCFBE have high mortality burden and incur high HCRU, both of which are further increased with exacerbations. Prevention and delay of exacerbations are key areas for improvement of disease management.
Use of implementation science to qualitatively identify implementation determinants of COPD practice guidelines in primary care.
Raghavan D, Drummond KL, Sanders SA … +1 more , Kirchner J
Chron Respir Dis · 2025 · PMID 39911040 · Full text
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease with high morbidity and mortality. COPD guidelines (CPG) are greatly underutilized and studies attempting to improve this practice gap hav...
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease with high morbidity and mortality. COPD guidelines (CPG) are greatly underutilized and studies attempting to improve this practice gap have yielded inconsistent results. We hypothesize that using implementation science can provide a detailed understanding of these practice gaps and the reasons behind them. Since primary care (PC) manages the bulk of COPD patients, in this pilot study, we use principles of implementation science to systematically explore the reasons for this implementation gap in a PC setting. We used the Consolidated Framework of Implementation Science (CFIR), a determinant framework to design semi-structured interview guides to conduct multistakeholder interviews to explore the barriers and facilitators to four key COPD-CPG with known poor uptake: inhaler education, spirometry, pulmonary rehabilitation and COPD-specific patient education from patient and provider perspectives. Qualitative analysis was performed using rapid analysis. Seventeen respondents including both, patients and providers were interviewed. All these COPD-CPG were rated as 'highly important' suggesting that perceived importance alone is insufficient to bridge gaps in uptake. Respondents were least familiar with pulmonary rehabilitation. Physician time constraint was a significant reported barrier. There exist multilevel contextual barriers to each of these COPD-CPG. To increase uptake of COPD guidelines, implementation efforts that address multilevel barriers and promote collaborative care by use of non-physician resources are likely to have higher buy-in and greater chances for success.
Remote assessment of exercise capacity in adults with chronic respiratory disease: Safety, reliability and acceptability.
Cox NS, Dal Corso S, Burge AT … +3 more , Bondarenko J, Perryman J, Holland AE
Chron Respir Dis · 2025 · PMID 39881539 · Full text
OBJECTIVES: To assess the safety, reliability and acceptability of the modified incremental step test (MIST) supervised remotely via videoconferencing in adults with chronic respiratory disease. METHODS: Adults with chro...
OBJECTIVES: To assess the safety, reliability and acceptability of the modified incremental step test (MIST) supervised remotely via videoconferencing in adults with chronic respiratory disease. METHODS: Adults with chronic respiratory disease undertaking pulmonary rehabilitation were invited to undertake the MIST under two testing conditions: in-person supervision and remote supervision via video-conferencing. Test order was randomised. RESULTS: 38 participants ( = 18 Female; mean (SD) age 68 (10) years; 56% chronic obstructive pulmonary disease) undertook two MIST evaluations. There was excellent agreement between tests for total step count (ICC 0.93, 95%CI 0.86 to 0.96), despite higher counts with in-person supervision (MD 12 steps, 95%CI 1 to 24). There was very good agreement, and no difference between tests, for nadir oxygen saturation (ICC 0.797, 95%CI 0.643 to 0.889) and peak heart rate (ICC 0.782, 95%CI 0.620 to 0.880). Participant satisfaction with telehealth was high, and confidence was not different between testing conditions. There were no adverse events and remote testing was acceptable to participants. DISCUSSION: In this single centre cohort study MIST supervised remotely via video-conferencing was safe, reliable and acceptable to people with chronic respiratory disease.
The experience of adults with cystic fibrosis using long-term domiciliary non-invasive ventilation.
Choyce J, Hewison A, Swift A … +1 more , Whitehouse JL
Chron Respir Dis · 2025 · PMID 39876815 · Full text
The use of non-invasive ventilation (NIV) in patients with advanced cystic fibrosis (CF) has increased in recent years. Research evidence supports its clinical benefits, but less is known about the patients' experience o...
The use of non-invasive ventilation (NIV) in patients with advanced cystic fibrosis (CF) has increased in recent years. Research evidence supports its clinical benefits, but less is known about the patients' experience of its long-term use in a domiciliary setting. To investigate patients' lived experience of using long-term domiciliary NIV. Semi-structured, qualitative interviews were conducted with adults with CF using long-term domiciliary NIV for respiratory failure. The data collected were subject to thematic analysis. Nine adults (6 female), 5 of whom were awaiting lung transplantation, with a mean age of 39 years and mean FEV per cent predicted of 28%, were recruited. Data analysis revealed 2 themes: gratitude, and determination despite challenges. Patients identified some troubling side effects from NIV but were grateful for its symptomatic relief and were determined to continue using it to improve their quality of life. Participants reported experiences of NIV to be generally positive in terms of symptom relief and quality of life. These findings provide an initial insight into patients' experience of NIV and have the potential to help guide and improve care.
Ensifentrine in COPD patients taking long-acting bronchodilators: A pooled post-hoc analysis of the ENHANCE-1/2 studies.
Dransfield M, Marchetti N, Kalhan R … +5 more , Reyner D, Dixon AL, Rheault T, Rickard KA, Anzueto A
Chron Respir Dis · 2025 · PMID 39854278 · Full text
BACKGROUND: The efficacy and safety of ensifentrine, a novel PDE3/PDE4 inhibitor, were previously evaluated in the ENHANCE-1 (NCT04535986) and ENHANCE-2 (NCT04542057) trials. Here, we present a pooled post-hoc subgroup a...
BACKGROUND: The efficacy and safety of ensifentrine, a novel PDE3/PDE4 inhibitor, were previously evaluated in the ENHANCE-1 (NCT04535986) and ENHANCE-2 (NCT04542057) trials. Here, we present a pooled post-hoc subgroup analysis of patients according to background chronic obstructive pulmonary disease (COPD) maintenance medication regimens. OBJECTIVE: This analysis aimed to explore the efficacy and safety of ensifentrine in patients receiving long-acting muscarinic antagonists (LAMA) or long-acting beta-agonists with inhaled corticosteroids (LABA + ICS). METHODS: Eligible patients had moderate to severe COPD, were aged 40-80 years, and were symptomatic at randomization. Patients were randomized 5:3, receiving twice-daily ensifentrine 3 mg or placebo via standard jet nebulizer over 24 weeks. RESULTS: The pooled post-hoc analysis included 485 LAMA patients and 272 LABA + ICS patients. Ensifentrine showed lung function improvement over placebo at week 12, including average FEV AUC in the LAMA (placebo-corrected least squares mean change from baseline [LSMC], 92 mL; 95% CI, 54, 131; < 0.001) and LABA + ICS subgroups (LSMC, 74 mL; 95% CI, 27, 121; = 0.002). Ensifentrine reduced the rate and risk of exacerbations in both LAMA (48% and 50%, respectively) and LABA + ICS (51% and 56%, respectively) subgroups. Ensifentrine-treated patients reported improvement in symptoms and quality of life over 24 weeks. The safety profile of ensifentrine in each subgroup was similar to the profile in the pooled modified intention-to-treat population. CONCLUSIONS: Nebulized ensifentrine offers a novel non-steroidal anti-inflammatory and bronchodilator treatment added to existing LAMA or LABA + ICS treatment options in patients with moderate to severe, symptomatic COPD.
Prevalence and characteristics of adults with preserved ratio impaired spirometry (PRISm): Data from the BOLD Australia study.
Zhou Y, Ampon MR, Abramson MJ … +7 more , James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG
Chron Respir Dis · 2025 · PMID 39844530 · Full text
Individuals with Preserved Ratio Impaired Spirometry (PRISm), defined as FEV/FVC ≥0.7 and FEV1 <80% predicted, are at higher risk of developing COPD. However, data for Australian adults are limited. We aimed to describe...
Individuals with Preserved Ratio Impaired Spirometry (PRISm), defined as FEV/FVC ≥0.7 and FEV1 <80% predicted, are at higher risk of developing COPD. However, data for Australian adults are limited. We aimed to describe prevalence of PRISm and its relationship with clinical characteristics in Australia. Data from the Burden of Lung Disease (BOLD) Australia study of randomly selected adults aged ≥40 years from six sites was classified into airflow limitation, PRISm, or normal spirometry groups. Demographic, clinical characteristics, and lung function were compared between groups. Of the study sample ( = 3518), 387 (11%) had PRISm, 549 (15.6%) had airflow limitation, and 2582 (73.4%) had normal spirometry. PRISm was more common in Indigenous Australian adults. Adults with PRISm had more frequent respiratory symptoms, more comorbidities, greater health burden and poorer quality of life than those with normal spirometry. Pre- and post-bronchodilator FEV and FVC were lower in adults with PRISm than those with airflow limitation. Adults with PRISm were less likely to use respiratory medicine than those with airflow limitation (OR = 0.56, 95% CI 0.38-0.81). PRISm was present in 11% of adults in this study and they had similar respiratory symptoms and health burden as adults with airflow limitation.
Is videoconference pulmonary rehabilitation associated with improvements in knowledge in people living with COPD? A propensity-matched service-evaluation.
Cheung CY, Yam WS, Palmer MD … +4 more , Clarke S, Dc Man W, J Roberts N, M Nolan C
Chron Respir Dis · 2025 · PMID 39840462 · Full text
Pulmonary rehabilitation (PR) services are increasingly using alternative programme delivery modes, for example telerehabilitation strategies including videoconferencing, to improve patient choice and accessibility. Alth...
Pulmonary rehabilitation (PR) services are increasingly using alternative programme delivery modes, for example telerehabilitation strategies including videoconferencing, to improve patient choice and accessibility. Although telerehabilitation results in improvements in core outcomes, the effect on knowledge attainment is not known. To observe the real-world responses of patients choosing to undergo videoconference PR to a matched control group choosing to undergo in-person PR, in terms of knowledge attainment. Using propensity score matching, 25 people with COPD who completed videoconference PR were matched 1:1 with a control group of 25 people with COPD who completed in-person PR. Knowledge attainment was measured using the Lung Information Needs Questionnaire (LINQ). There was a statistically and clinically significant improvement in LINQ score in both groups (mean (95%CI): videoconference -3.2 (-4.7 to -1.6); in-person -3.0 (-4.5 to -1.4)), with no significant between-group difference (mean (95%CI): 0.2 (-2.0 to -2.4)). 76% and 80% of participants achieved the minimal important difference of the LINQ in the videoconference and in-person PR groups respectively. In conclusion, this real-world service evaluation indicates that videoconference PR may be associated with similar improvements in knowledge attainment as in-person PR, but this requires corroboration due to the small sample size.
Pulmonary rehabilitation healthcare professionals understanding and experiences of the protected characteristics of service users: A qualitative analysis.
Drover H, Singh SJ, Orme MW … +1 more , Daynes E
Chron Respir Dis · 2025 · PMID 39809593 · Full text
BACKGROUND: Health inequalities can affect access and uptake to pulmonary rehabilitation (PR). An individual's protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy an...
BACKGROUND: Health inequalities can affect access and uptake to pulmonary rehabilitation (PR). An individual's protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation) may contribute to health inequalities. Healthcare professionals (HCPs) experiences of the inclusivity and representativeness of PR services and knowledge of protected characteristics are unknown, however are vital for the identification and resolution of health inequalities. This qualitative study explored HCPs understanding of protected characteristics and their perception of the inclusivity, representativeness and equitable benefit of their PR services. METHODS: Semi-structured qualitative interviews were conducted in person or via videoconferencing with HCPs involved in PR from two healthcare providers. Interviews were analysed using reflexive thematic analysis. RESULTS: 12 interviews were conducted with physiotherapists ( = 6), occupational therapists ( = 2), nurses ( = 2) and exercise physiologists ( = 2). Participants had a median (IRQ) age of 43 (13) and 75% ( = 9) were female. Four themes were generated. 1: 'I don't really know as much as I should' [about protected characteristics]; 2: It's uncomfortable collecting protected characteristics…; 3: 'I don't think [service users] are as representative as they could be'; 4: A conventional rehabilitation programme does not meet the needs of all. CONCLUSIONS: This study highlighted several challenges in HCPs understanding of protected characteristics and the representativeness of PR that must be addressed to ensure equity. Strategies, to understand barriers in accessing PR that limit representativeness should be explored.
Active cycle of breathing technique versus oscillating positive expiratory pressure therapy: Effect on lung function in children with primary ciliary dyskinesia; A feasibility study.
Fashho B, Rumman N, Lucas J … +1 more , Halaweh H
Chron Respir Dis · 2025 · PMID 39805566 · Full text
Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder requiring airway clearance techniques for mucus removal. We aimed to evaluate the feasibility and the effect of the active cycle of breathing technique (ACBT) v...
Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder requiring airway clearance techniques for mucus removal. We aimed to evaluate the feasibility and the effect of the active cycle of breathing technique (ACBT) versus oscillating positive expiratory pressure therapy (OPEP) in improving lung function and functional exercise capacity among children with PCD in Palestine. 32 PCD children (6-18 years) were included in a 12-week home-based feasibility study. They were assigned randomly into two groups: ACBT and OPEP. Data collection included spirometry measurements, and the six-minute walk test (6MWT). After 12 weeks of regular airway clearance techniques (ACT), the FEV, MEF, and the 6MWT demonstrated statistically significant differences ( = .02, = .04, and = .05 respectively) between the two groups, in favor of the OPEP group with the effect size of Cohen's d (0.86, 0.76, and 0.71) respectively. However, there was no significant difference ( > .05) between the two groups in FVC and FEV/FVC. Additionally, only in the OPEP group, significant differences were recorded between pre and post-tests for FEV1 and 6MWT ( < .05). The randomized study design comparing ACBT and OPEP was feasible and acceptable to patients. OPEP demonstrates potential for managing respiratory health; however, treatments should be individualized to address each patient's specific needs. Further research with larger cohorts is needed to assess the effectiveness of both methods.
Tracheal mucosal keratosis: Case discussion and literature review.
Kong W, Zhao L, Chen G … +4 more , Huang C, Gu W, Jie H, Yi L
Chron Respir Dis · 2025 · PMID 39752434 · Full text
A 57-year-old female presented with a chief complaint of cough, with productive yellow sputum particularly severe in the morning. Bronchoscopy revealed inflammatory changes in both main bronchi, with abundant white purul...
A 57-year-old female presented with a chief complaint of cough, with productive yellow sputum particularly severe in the morning. Bronchoscopy revealed inflammatory changes in both main bronchi, with abundant white purulent secretions and necrotic material adhering to the luminal surface. Histopathological examination showed chronic inflammatory changes in the mucosal tissue, with mild hyperplasia of the local squamous epithelium and evidence of keratinization in the surrounding area, consistent with a diagnosis of tracheal mucosal keratosis. The patient was treated with anti-infection therapy, combined with symptomatic supportive treatments such as cough suppression, expectorants, and bronchodilation, resulting in an improvement of symptoms. Analysis of previous literature revealed that although this condition lacks specific clinical manifestations and signs, it exhibits a typical pattern of tracheal wall lesions, and bronchoscopy and histopathological examination have high diagnostic value for this disease. Due to impaired airway mucosal barrier function, the patient is prone to bacterial infection or colonization in the airways. Symptomatic supportive treatment based on the actual condition can effectively alleviate the patient's clinical symptoms. Currently, there is no definitive curative treatment for tracheal mucosal keratosis. However, treatments such as high-frequency electrocautery, carbon dioxide cryotherapy, and repeated lavage with epidermal growth factors may be helpful in curing this condition.
Eosinopenia in bronchiectasis: A novel biomarker for morbidity and mortality.
Izhakian S, Yehezkely R, Frajman A … +7 more , Mekiten O, Hadar O, Rockland A, Malka L, Freidkin L, Rosengarten D, Kramer MR
Chron Respir Dis · 2025 · PMID 39749821 · Full text
BACKGROUND: The paradigm of bronchiectasis is shifting away from its exclusive characterization as a neutrophilic condition. Patients with bronchiectasis and high eosinophil levels have been found to have a specific phen...
BACKGROUND: The paradigm of bronchiectasis is shifting away from its exclusive characterization as a neutrophilic condition. Patients with bronchiectasis and high eosinophil levels have been found to have a specific phenotype, but the clinical effect of eosinopenia remains unclear. METHOD: A retrospective, single-center, observational study was conducted at a tertiary medical center. Adult patients under follow-up for bronchiectasis from January 2007 to August 2020 were categorized by blood eosinophil count (BEC) as follows: eosinopenia (<100 cells/µL), normal (100-299 cells/µL), and eosinophilia (≥300 cells/µL). Data on the first hospitalization due to exacerbation and the community exacerbation rate in the first year of follow-up were analyzed. Mortality rates were assessed up to the end of follow-up on September 1, 2023. RESULTS: The cohort included 724 patients (100%), 61% female ( = 442), of mean age 61 ± 16 years. The median follow-up period was 7.5 years (IQR: 5.1-10.8). Eosinopenia was found in 14.7% ( = 107), normal BEC in 56.6% ( = 417), and eosinophilia in 28.7% ( = 200). Patients with eosinopenia had a higher hazard ratio for first hospitalization than the normal-count group (1.71, 95% CI 1.11-2.64, = .01) and the highest mean exacerbation rate ( = .04). On multivariate analysis, eosinopenia was significantly associated with higher mortality (HR 2.15, 95% CI 1.42-3.24, < .001) after adjusting for age and sex. CONCLUSION: Eosinopenia in bronchiectasis emerged as a potential biomarker for adverse outcomes. Further study of its role in disease behavior may provide insights for the development of therapeutic strategies.
Estimation of the health economic benefit of widening pulmonary rehabilitation uptake and completion.
Steiner M, Mahon J, Fuld J … +1 more , Hex N
Chron Respir Dis · 2024 · PMID 39648047 · Full text
Increasing uptake and completion of Pulmonary Rehabilitation in people with COPD has the potential to deliver health benefit and reduce health inequalities. We have quantified the cost-effectiveness of enhancing PR acces...
Increasing uptake and completion of Pulmonary Rehabilitation in people with COPD has the potential to deliver health benefit and reduce health inequalities. We have quantified the cost-effectiveness of enhancing PR access and completion by reviewing the cost-effectiveness literature for PR in COPD. A literature review identified studies that provided cost-effectiveness evidence for PR compared to no PR. The key metrics of interest were healthcare resource use and cost savings, and quality adjusted life year (QALY) gains. Healthcare resource use data were valued using the UK NHS National Tariff 2022/23. From the literature search we identified the QALY gain resulting from completion of PR. The value of the QALY gain resulting from PR completion was calculated using the standard willingness-to-pay threshold of £20,000 considered by the UK National Institute for Health and care Excellence (NICE). We estimated a QALY gain resulting from completion of PR of 0.065 and value of the QALY gain was therefore calculated to be £1300 per person completing PR. We estimated the 12 month reduction in hospitalisation following completion of PR to be 8.2% giving a total cost reduction per patient of £245. We therefore calculated that up to £1545 could be spent per person with COPD to deliver PR cost-effectively. Our analysis provides commissioners with the information they need to make informed decisions about planning and provision of PR. The data allows estimation of additional resources that could be deployed in addressing inequitable access to PR among disadvantaged and underserved populations whilst retaining cost effectiveness of the intervention.
Routine pulmonary lung function tests: Interpretative strategies and challenges.
Barkous B, Briki C, Boubakri S … +4 more , Abdesslem M, Ben Abbes N, Ben Hmid W, Ben Saad H
Chron Respir Dis · 2024 · PMID 39644209 · Full text
The diagnosis and management of common chronic respiratory diseases depend on various parameters obtained from pulmonary function tests (PFTs), such as spirometry, plethysmography, and carbon monoxide diffusion capacity...
The diagnosis and management of common chronic respiratory diseases depend on various parameters obtained from pulmonary function tests (PFTs), such as spirometry, plethysmography, and carbon monoxide diffusion capacity (DLCO). These tests are interpreted following guidelines established by reputable scientific societies like the European Respiratory Society and the American Thoracic Society (ERS/ATS). This review aimed to offer a comprehensive framework for interpreting PFTs, incorporating the latest ERS/ATS update (i.e.; 2022), and to briefly explore some complex cases to shed light on their implications for understanding PFTs. The ERS/ATS update outlines a systematic approach to interpreting PFT results, which involves several steps. Initially, results are compared to those of a healthy reference population to determine normal, low, or high parameters. Then, potential ventilatory impairments (VIs), such as obstructive or restrictive VIs, are identified, which could indicate specific chronic respiratory or extra-respiratory diseases. The severity of identified VIs or reductions in DLCO is then assessed. If bronchodilator testing is performed, its response is evaluated. Lastly, any significant changes in PFT parameters over time are noted by comparing current results with previous ones, if available. Despite the clarity provided by the ERS/ATS update, certain uncertainties persist and require clarification, such as the identification of new patterns (e.g.; non-obstructive abnormal spirometry, isolated low forced expiratory volume in 1 s), and classifications of mixed VI or lung hyperinflation in terms of functional severity. This review is a comprehensive framework for interpreting PFTs. Since some issues pose uncertainty in clinical practice, it would be beneficial to the ERS/ATS to reconcile some inconsistencies and provide clearer guidance on different classifications and VIs.
Fidelity of a home-based pulmonary rehabilitation program in people with COPD referred from primary care.
Dal Corso S, Holland AE, George J … +6 more , Abramson MJ, Russell G, Zwar N, Bonevski B, Perryman J, Cox NS
Chron Respir Dis · 2024 · PMID 39631437 · Full text
Pulmonary rehabilitation (PR) is highly effective but underutilised. Pathways to home-based PR (HBPR) from general practice could improve utilisation, but program fidelity in this setting is unknown. This study aimed to...
Pulmonary rehabilitation (PR) is highly effective but underutilised. Pathways to home-based PR (HBPR) from general practice could improve utilisation, but program fidelity in this setting is unknown. This study aimed to explore the fidelity of HBPR in people referred from general practice. Secondary analysis of intervention-group data from two-arm cluster RCT (RADICALS-interdisciplinary intervention for people with COPD including smoking cessation support, home medicine reviews and 8-weeks HBPR). HBPR fidelity assessed by the extent to which exercise training was prescribed according to protocol. Completion of HBPR and contributing factors were determined. 107 participants (68% of intervention group) were referred to HBPR, with = 75 (70%) commencing the program (mean age 68 years, FEV 65% predicted, median mMRC 1). Aerobic training was prescribed according to protocol for 74% of participants in week one, and on average 89% of participants in weeks 2-8. Resistance training was prescribed according to protocol for 98% and 88% of participants (Week 1 and Weeks 2-8, respectively). Rehabilitation completers ( = 57, 76%) were 26 times more likely to have attended the Week 2 phone call (95% CI 2-352). Clinically meaningful improvements were achieved in health-related quality of life (SGRQ) and health status (CAT) following rehabilitation. PR program fidelity can be maintained when delivering HBPR to people with COPD referred directly from general practice. Early engagement with PR may be key to supporting rehabilitation completion.
Antifibrotic drug treatment of patients with idiopathic pulmonary fibrosis in Sweden: A registry-based observational study.
Carlson L, Kalafatis D, Pesonen I … +2 more , Magnusson JM, Skold M
Chron Respir Dis · 2024 · PMID 39532288 · Full text
OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive fibrosis of the lung parenchyma, resulting in respiratory failure. This study analysed differences in patient characteristics and antifibrot...
OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive fibrosis of the lung parenchyma, resulting in respiratory failure. This study analysed differences in patient characteristics and antifibrotic treatment strategies during the first years after IPF diagnosis. METHODS: Data from patients with IPF was extracted from the Swedish IPF registry. Patients were defined as treated (either as fully- or reduced treated) or non-treated with antifibrotic drugs. Differences in clinical parameters and side effects were defined. RESULTS: Among 532 patients, 371 received treatment with antifibrotic drugs. Treated patients were younger, had worse lung function, higher body mass index (BMI), higher Gender-Age-Physiology stage, and were more often on oxygen treatment. Non-treated patients displayed a stable BMI, whereas patients treated with antifibrotics declined in BMI during follow-up. More than half (56%) of treated patients had reduced antifibrotic treatment. Sixty per cent reported side effects, with diarrhoea, nausea, and skin rash as the most common. CONCLUSIONS: Patients prescribed antifibrotic treatment had more advanced disease compared to patients not prescribed antifibrotics. A considerable proportion of the patients had reduced treatment, probably due to more side effects in this group. This indicates that individuals starting treatment at IPF diagnosis are considered to be in greater need of antifibrotic drug treatment by the prescriber, compared to individuals with less severe disease.
Functional status following pulmonary rehabilitation in people with interstitial lung disease: A systematic review and meta-analysis.
Rodrigues G, Santos R, Pinto R … +2 more , Oliveira A, Marques A
Chron Respir Dis · 2024 · PMID 39440394 · Full text
BACKGROUND: Individuals with interstitial lung disease (ILD) often experience worsening symptoms and activity avoidance. Limited data exists on outcome measures for assessing functional status (capacity and performance),...
BACKGROUND: Individuals with interstitial lung disease (ILD) often experience worsening symptoms and activity avoidance. Limited data exists on outcome measures for assessing functional status (capacity and performance), as well as on the effectiveness of pulmonary rehabilitation (PR) in improving these outcomes in ILD. AIM: This review aimed to systematically assess the effects of PR on both functional capacity and performance in individuals with ILD. METHODS: Randomised controlled trials involving pulmonary rehabilitation (PR) in adults with ILD, which included at least an exercise training component and education and/or psychosocial support, were included. Risk of bias and quality of evidence were assessed. Mean changes from baseline and standard deviations were retrieved for each group, and a random-effects model was applied. RESULTS: Eight studies were included, mostly involving individuals with idiopathic pulmonary fibrosis ( = 5). PR duration ranged from 3 to 26 weeks. Seven studies used the 6MWT to evaluate functional capacity and one also used the 30-s STS. Two studies assessed functional performance, measuring time spent in moderate physical activity with the SenseWear Armband, number of steps per day with the same device, and energy expenditure in MET-min using the international physical activity questionnaire. PR improved functional capacity (6MWT-MD 45.82 m, 95%CI [26.14; 65.50], I = 71.54%, < .001; 30-s STS- PR: 3.7 ± 2.6 reps; control group: -0.4 ± 2.5 reps, < .001) compared to usual care. Only self-reported physical activity levels increased after PR (PR: 51.4 ± 57.7MET-min; control group: 20.9 ± 37.2MET-min, = .03). CONCLUSION: PR is effective at improving functional capacity; however, functional performance is often overlooked, resulting in limited and inconclusive findings.
Smoking-related interstitial lung disease: A narrative review.
Casal A, Suárez-Antelo J, Riveiro V … +4 more , Ferreiro L, Rodríguez-Núñez N, Toubes ME, Valdés L
Chron Respir Dis · 2024 · PMID 39423337 · Full text
Although smoking-related interstitial lung diseases (SR-ILD) are a relatively rare group of entities, they are a relevant public health problem of growing importance, both because they affect young adults and because of...
Although smoking-related interstitial lung diseases (SR-ILD) are a relatively rare group of entities, they are a relevant public health problem of growing importance, both because they affect young adults and because of their increasing prevalence in recent years due to increased tobacco consumption. In patients who smoke and have non-specific respiratory symptoms, SR-ILD should be ruled out, a term that encompasses a group of different entities in which the basis for diagnosis is the smoking history together with compatible respiratory functional findings, radiology and/or histology. An association has been established between tobacco smoke and a group of diseases that include respiratory bronchiolitis-associated interstitial lung disease (2%-3% of all ILD), desquamative interstitial pneumonia (<1%), Langerhans cell histiocytosis (3%-5%) and acute eosinophilic pneumonia. Smoking is considered a risk factor for idiopathic pulmonary fibrosis which has also been called combined fibroemphysema (5%-10% of all ILD); however, the role and impact of smoking in its development, remains to be determined. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features. In the absence of robust scientific evidence on its management, smoking cessation is the first measure to be taken into account. Although most diseases have a benign clinical course after smoking cessation, some cases may progress to chronic respiratory failure.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe