Pulmonology最新文献

Background: Previous studies have shown that patients with chronic obstructive pulmonary disease (COPD) of severe or very severe airflow limitation have a reduced pectoralis muscle area (PMA), which is associated with mortality. However, whether patients with COPD of mild or moderate airflow limitation also have a reduced PMA remains unclear. Additionally, limited evidence is available regarding the associations between PMA and respiratory symptoms, lung function, computed tomography (CT) imaging, lung function decline, and exacerbations. Therefore, we conducted this study to evaluate the presence of PMA reduction in COPD and to clarify its associations with the referred variables.

Methods: This study was based on the subjects enrolled from July 2019 to December 2020 in the Early Chronic Obstructive Pulmonary Disease (ECOPD) study. Data including questionnaire, lung function, and CT imaging were collected. The PMA was quantified on full-inspiratory CT at the aortic arch level using predefined -50 and 90 Hounsfield unit attenuation ranges. Multivariate linear regression analyses were performed to assess the association between the PMA and airflow limitation severity, respiratory symptoms, lung function, emphysema, air trapping, and the annual decline in lung function. Cox proportional hazards analysis and Poisson regression analysis were used to evaluate the PMA and exacerbations after adjustment.

Results: We included 1352 subjects at baseline (667 with normal spirometry, 685 with spirometry-defined COPD). The PMA was monotonically lower with progressive airflow limitation severity of COPD after adjusting for confounders (vs. normal spirometry; Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1: β=-1.27, P=0.028; GOLD 2: β=-2.29, P<0.001; GOLD 3: β=-4.88, P<0.001; GOLD 4: β=-6.47, P=0.014). The PMA was negatively associated with the modified British Medical Research Council dyspnea scale (β=-0.005, P=0.026), COPD Assessment Test score (β=-0.06, P=0.001), emphysema (β=-0.07, P<0.001), and air trapping (β=-0.24, P<0.001) after adjustment. The PMA was positively associated with lung function (all P<0.05). Similar associations were discovered for the pectoralis major muscle area and pectoralis minor muscle area. After the 1-year follow-up, the PMA was associated with the annual decline in the post-bronchodilator forced expiratory volume in 1 s percent of predicted value (β=0.022, P=0.002) but not with the annual rate of exacerbations or the time to first exacerbation.

Conclusion: Patients with mild or moderate airflow limitation exhibit a reduced PMA. The PMA is associated with airflow limitation severity, respiratory symptoms, lung function, emphysema, and air trapping, suggesting that PMA measurement can assist with COPD assessment.

Introduction: Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD.

Methods: A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features).

Results: Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories 'Measuring and monitoring' and 'Support and Feedback' were present in all apps. Overall, the most implemented features were 'progress in visual format' (n = 13), 'advice on PA' (n = 14) and 'data in visual format' (n = 10). Only three apps included social features, and two included a web-based version of the app.

Conclusions: The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients' PA levels.

Nasal high flow (NHF) therapy is an established form of non invasive respiratory support used in acute and chronic care. Recently, a new high flow nasal cannula with asymmetric prongs was approved for clinical use. The clinical benefits of the new cannula have not yet been defined and no evidence are available on the use of asymmetric NHF support in patient with Chronic Obstructive Pulmonary Disease (COPD). We conducted a single-centre, prospective, physiologic, crossover, randomised study to investigate the effects on partial pressure of carbon dioxide (PaCO²) levels of two different nasal cannula ("asymmetric" vs "standard" nasal interface) in 20 COPD hypercapnic patients. All patients were recovering from an acute exacerbation that required hospitalisation and had persistent hypercapnia, despite having attained a stable pH. After enrolment, two 90-min trials with the asymmetric nasal high flow interface (Optiflow + Duet, Fisher & Paykel Healthcare Ltd., New Zealand) or the standard interface (Optiflow, Fisher & Paykel Healthcare Ltd., New Zealand) were randomly applied and a washout period of 60 min between the two treatments was performed for minimising the carryover effect. Study results suggested that the asymmetrical cannula did not significantly decrease PaCO² compared with the standard cannula. Similar performances were also observed in terms of diaphragm activity, dyspnoea and patient's comfort. Interestingly, asymmetric NHF cannula performed significantly better in reducing the dead space ventilation and increasing the ventilatory efficiency in more advanced COPD patients with more severe hypercapnia higher baseline PaCO² values (PaCO² ≥ 65 mmHg at baseline).   .

Background: Nasal high flow (NHF) has been proposed to sustain high intensity exercise in people with COPD, but we have a poor understanding of its physiological effects in this clinical setting.

Research question: What is the effect of NHF during exercise on dynamic respiratory muscle function and activation, cardiorespiratory parameters, endurance capacity, dyspnoea and leg fatigue as compared to control intervention.

Study design and methods: Randomized single-blind crossover trial including COPD patients. Two constant workload exercise testing were performed at 75% of peak power with NHF (30L/min, 34°C) or with control intervention. Pressure time product of the transdiaphragmatic pressure (PTPdi/min) and other physiological measurements were continuously monitored. Dyspnoea and lower limb fatigue were assessed using the 10-Borg scale.

Results: 14 patients with severe obstruction (median FEV1: 40 (IQR 28 to 52) %) were included. Their median age was 70 (IQR 57 to 72) years. At isotime, NHF had little to no effect on PTPdi/min (MD -15cmH2O.s/min, 95% CI -62 to 33) but increased tidal volume (MD 77mL, 95% CI 21 to 133). NHF also improved endurance capacity (MD 20s, 95% CI 2 to 40) and dyspnoea at isotime (MD -1.1, 95% CI -2.1 to -0.1). NHF had no or uncertain effect on other outcomes.

Conclusion: NHF has little to no effect on dynamic respiratory muscle function and activation but improves Vt. It leads to a trivially small increase in endurance capacity but a worthwhile improvement in dyspnoea. NHF may be beneficial for individuals experiencing critical inspiratory constraints and significant dyspnoea.

Fibrotic hypersensitivity pneumonitis (f-HP) is an interstitial lung disease in which various antigens in susceptible individuals may play a pathogenetic role. This study evaluates the role of transbronchial lung cryobiopsy (TBLC) and bronchoalveolar lavage (BAL) in identifying a UIP-like pattern and its association with fibrosis progression. We conducted a multicentre retrospective cohort study of patients diagnosed with f-HP who underwent BAL and TBLC between 2011 and 2023. A UIP-like pattern was defined by the presence of (A) patchy fibrosis and fibroblastic foci or (B) honeycombing ± (A). We investigated BAL's role in predicting UIP-like patterns within a clinical-radiological-serological framework, examining disease progression in these patients using spirometry and mortality data. A total of 195 patients were enrolled, 59 (30%) of whom exhibited a UIP-like pattern. These patients showed greater lung function decline, lower BAL lymphocytosis (14.4% vs. 37.4%, p < 0.001), higher nintedanib prescription (35% vs. 14%, p < 0.001), and higher 10-year mortality (HR 2.8, 95% CI 1.3-5.8, p = 0.004). f-HP patients with a UIP-like pattern exhibit worse clinical outcomes and higher mortality. In cases of low BAL lymphocytosis with a high pre-test clinical suspicion of f-HP, lung biopsy may not be necessary as it increases the likelihood of identifying a UIP-like pattern.

Introduction and objectives: Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD.

Materials and methods: A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only.

Results: We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic.

Conclusions: Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.

Background: Pre-chronic obstructive pulmonary disease (COPD) indicators are associated with COPD development, but their associations with lung function decline in persons without COPD and their longitudinal transitions remain uncertain.

Methods: In this prospective cohort study, 3526 subjects without COPD from the 2014-2015 national COPD surveillance in China were investigated for a second time during 2018-2020. Four potential pre-COPD indicators at baseline were chronic bronchitis, preserved ratio impaired spirometry (PRISm), low peak expiratory flow (PEF), and spirometric small airway dysfunction (sSAD). To include the incident COPD subjects in the lung function decline analysis for consistent indicators, forced expiratory volume in 1 s (FEV₁) <80% predicted was used instead of PRISm. Lung function outcomes were the declines in post-bronchodilator FEV₁, forced vital capacity (FVC), and FEV₁/FVC.

Results: Subjects with initial chronic bronchitis had faster declines in FEV₁ and FVC compared with those without initial chronic bronchitis among smokers. Consistent chronic bronchitis was associated with faster declines in FEV₁ and FVC among non-smokers. Consistent sSAD was associated with faster declines in FEV₁/FVC among smokers and non-smokers. Consistent FEV₁ <80% predicted and consistent low PEF were associated with a faster decline in FEV₁/FVC among smokers. Incident COPD developed from sSAD in almost half of the cases.

Conclusions: Initial chronic bronchitis and consistent FEV₁ <80% predicted, sSAD, and low PEF are associated with excessive lung function decline among smokers, while consistent chronic bronchitis and sSAD are associated with excessive lung function decline among non-smokers. Initial sSAD accounts for a larger proportion of incident COPD than initial chronic bronchitis, PRISm, and low PEF.