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Clinical and Experimental Allergy :... Nov 2023It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children.
BACKGROUND
It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children.
OBJECTIVE
We evaluated predictors for these two outcomes in a clinical cohort study.
METHODS
The Swiss Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children (5-16 years old) diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks.
RESULTS
At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline (e.g. ≥1 night wheeze/week OR: 3.2; 95% CI: 1.7-6), wheeze triggered by allergens (2.2; 1.4-3.3), colds (2.3; 1.4-3.6) and exercise (3.2; 2-5), a more intense treatment at baseline (2.4; 1.3-4.4 for Step 3 vs. 1), history of preschool (2.6; 1.5-4.4) and persistent wheeze (2; 1.4-3.2), and exposure to tobacco smoke (1.7; 1-2.6). Incident asthma attacks were associated with previous episodes of severe wheeze (2; 1.2-3.3) and asthma attacks (2.8; 1.6-5 for emergency care visits), younger age (0.8; 0.8-0.9 per 1 year) and non-Swiss origin (0.3; 0.2-0.5 for Swiss origin). Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks.
CONCLUSION
Children at risk of long-term suboptimal asthma control differ from those at risk of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes.
Topics: Child; Humans; Child, Preschool; Adolescent; Cohort Studies; Prospective Studies; Switzerland; Asthma; Allergens; Respiratory Sounds; Nitric Oxide
PubMed: 37658735
DOI: 10.1111/cea.14390 -
Archivos de Bronconeumologia Apr 2024Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms...
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently coexist, increasing the prevalence of both entities and impacting on symptoms and prognosis. CVD should be suspected in patients with COPD who have high/very high risk scores on validated scales, frequent exacerbations, precordial pain, disproportionate dyspnea, or palpitations. They should be referred to cardiology if they have palpitations of unknown cause or angina pain. COPD should be suspected in patients with CVD if they have recurrent bronchitis, cough and expectoration, or disproportionate dyspnea. They should be referred to a pulmonologist if they have rhonchi or wheezing, air trapping, emphysema, or signs of chronic bronchitis. Treatment of COPD in cardiovascular patients should include long-acting muscarinic receptor antagonists (LAMA) or long-acting beta-agonists (LABA) in low-risk or high-risk non-exacerbators, and LAMA/LABA/inhaled corticosteroids in exacerbators who are not controlled with bronchodilators. Cardioselective beta-blockers should be favored in patients with CVD, the long-term need for amiodarone should be assessed, and antiplatelet drugs should be maintained if indicated.
Topics: Humans; Cardiovascular Diseases; Administration, Inhalation; Muscarinic Antagonists; Pulmonary Disease, Chronic Obstructive; Drug Therapy, Combination; Adrenal Cortex Hormones; Dyspnea; Pain; Adrenergic beta-2 Receptor Agonists; Bronchodilator Agents
PubMed: 38383272
DOI: 10.1016/j.arbres.2024.01.013 -
The Journal of Allergy and Clinical... Sep 2023The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in...
BACKGROUND
The Global Initiative for Asthma and National Asthma Education and Prevention Program recently made paradigm-shifting recommendations regarding inhaler management in asthma. The Global Initiative for Asthma now recommends that combination inhaled corticosteroid (ICS)-formoterol inhalers replace short-acting β-agonists as the preferred reliever therapy at all steps of asthma management. Although the most recent guidelines of the National Asthma Education and Prevention Program did not review reliever ICS-formoterol usage in mild asthma, they similarly recommended single maintenance and reliever therapy (SMART) at steps 3 and 4 of asthma management. Despite these recommendations, many clinicians-particularly in the United States-are not prescribing new inhaler paradigms. Clinician-level reasons for this implementation gap remain largely unexplored.
OBJECTIVE
To gain an in-depth understanding of the facilitators and barriers to prescribing reliever ICS-formoterol inhalers and SMART in the United States.
METHODS
Community and academic primary care providers, pulmonologists, and allergists who reported regularly caring for adults with asthma were interviewed. Interviews were recorded, transcribed, qualitatively coded, and analyzed using the Consolidated Framework for Implementation Research. Interviews were continued until theme saturation.
RESULTS
Among 20 interviewed clinicians, only 6 clinicians described regularly prescribing ICS-formoterol inhalers as a reliever inhaler (either alone or within SMART). Significant barriers to new inhaler approaches included concerns surrounding a lack of Food and Drug Administration labeling for ICS-formoterol as a reliever therapy, a lack of awareness regarding a patient's formulary-preferred ICS-long-acting β-agonist choices, the high cost of combination inhalers, and time constraints. Facilitators to using new inhaler approaches included clinicians' beliefs that the latest inhaler recommendations are simpler and more congruent with real-world patients' behavior, and that a potential change in management strategy would offer a valuable opportunity for shared decision making.
CONCLUSIONS
Although new guidelines exist in asthma, many clinicians described significant barriers to using them including medicolegal issues, pharmaceutical formulary confusion, and high drug costs. Nonetheless, most clinicians believed that the latest inhaler approaches would be more intuitive for their patients and would offer an opportunity for patient-centered collaboration and care. Stakeholders may find these results useful in future attempts to increase the real-world adoption of recent asthma recommendations.
Topics: Adult; Humans; United States; Budesonide; Anti-Asthmatic Agents; Ethanolamines; Administration, Inhalation; Asthma; Budesonide, Formoterol Fumarate Drug Combination; Formoterol Fumarate; Nebulizers and Vaporizers; Adrenal Cortex Hormones; Drug Combinations
PubMed: 37245736
DOI: 10.1016/j.jaip.2023.05.023 -
The Laryngoscope Apr 2024The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to...
OBJECTIVE
The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR.
METHODS
Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician.
RESULTS
After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h.
CONCLUSION
A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR.
LEVEL OF EVIDENCE
5 Laryngoscope, 134:1614-1624, 2024.
Topics: Humans; Laryngopharyngeal Reflux; Larynx; Otolaryngologists; Electric Impedance; Surveys and Questionnaires; Esophageal pH Monitoring
PubMed: 37929860
DOI: 10.1002/lary.31134 -
Pneumologie (Stuttgart, Germany) Sep 2023Interstitial lung diseases are associated with high morbitity and mortality. Rapid diagnosis in a qualified center is necessary in order to provide the best possible...
Interstitial lung diseases are associated with high morbitity and mortality. Rapid diagnosis in a qualified center is necessary in order to provide the best possible treatment. However, geographic distance and organizational issues lead to unacceptable delays. To support pulmonologists in private practice, we have trialed a digital system that minimizes such delays. The "virtual ILD board" leads to a considerably faster diagnosis and is a helpful tool for pulmonologists in practice. Standardization increases patient safety by ensuring interdisciplinary assessment and thus makes a relevant contribution to the management and guideline-based care of interstitial lung diseases.
Topics: Humans; Pilot Projects; Lung Diseases, Interstitial
PubMed: 37696286
DOI: 10.1055/a-2113-0556 -
BMC Musculoskeletal Disorders Aug 2023The COVID-19 pandemic necessitated the reorganization of health services to cater to the needs of individuals affected by the virus.
BACKGROUND
The COVID-19 pandemic necessitated the reorganization of health services to cater to the needs of individuals affected by the virus.
OBJECTIVE
This study aimed to examine the association between musculoskeletal pain during and after SARS-CoV-2 infection and the utilization of health services among adults in southern Brazil. METHODS: A cross-sectional study was conducted with individuals aged 18 years and older, who were diagnosed with COVID-19 between December 2020 and March 2021. Questionnaires were electronically collected using tablets through the REDCap platform via phone calls. The health service utilization outcomes assessed included Primary Health Care, general practitioners, private emergency care, and specialized services. The exposure variable was the presence of musculoskeletal pain during and after SARS-CoV-2 infection in different regions, such as cervical, upper limbs, thoracic, lumbar, and lower limbs. Poisson regression analysis was employed to assess the relationship between health service utilization during and after SARS-CoV-2 infection and musculoskeletal pain during and after the infection with SARS-CoV-2 among adults in southern Brazil. Data were analyzed using the Stata 16.1 statistical package. RESULTS: A total of 2,919 individuals were interviewed. Overall, individuals with musculoskeletal pain were found to utilize health services approximately 15 percentage points higher when compared to those without musculoskeletal pain. In adjusted analysis, individuals who reported musculoskeletal pain during and after SARS-CoV-2 infection were up to twice as likely to use health services. Among them, the emergency care unit was the most frequently used service, particularly in those with pain in the lower limbs (RP=2.19, 95% CI 1.66-2.87) and thoracic region (RP=2.04, 95% CI 1.47-2.84). Notably, the highest magnitudes of association were observed with emergency care units, specialist doctors, and specialized services, especially neurologists, who were two to three times more likely to be sought, followed by pulmonologists. CONCLUSION: Health service utilization was significantly associated with musculoskeletal pain during and after SARS-CoV-2 infection. All regions, except for the cervical region, showed a correlation with the use of Primary Health Care. The thoracic region featured an association with pulmonologists and emergency room utilization. Additionally, health services like emergency care units, specialist doctors, and specialized services, including cardiologists and neurologists, were commonly utilized across all regions in southern Brazil.
Topics: Adult; Humans; Cross-Sectional Studies; Musculoskeletal Pain; Pandemics; COVID-19; SARS-CoV-2; Patient Acceptance of Health Care
PubMed: 37644443
DOI: 10.1186/s12891-023-06794-z -
Clinics in Chest Medicine Jun 2024The pericardium comprises a double-walled fibrous-serosal sac that encloses the heart. Reflections of the serosal layer form sinuses and recesses. With advances in... (Review)
Review
The pericardium comprises a double-walled fibrous-serosal sac that encloses the heart. Reflections of the serosal layer form sinuses and recesses. With advances in multidetector computed tomography (CT) technology, pericardial recesses are frequently detected with thin-section CT. Knowledge of pericardial anatomy on imaging is crucial to avoid misinterpretation of fluid-filled pericardial sinuses and recesses as adenopathy/pericardial metastasis or aortic dissection, which can impact patient management and treatment decisions. The authors offer a comprehensive review of pericardial anatomy and its variations observed on CT, potential pitfalls in image interpretation, and implications for the pulmonologist with respect to unnecessary diagnostic procedures or interventions.
Topics: Humans; Pericardium; Tomography, X-Ray Computed; Pulmonologists; Multidetector Computed Tomography
PubMed: 38816085
DOI: 10.1016/j.ccm.2024.02.002 -
Vaccine Dec 2023Influenza is associated with considerable respiratory morbidity and mortality. Healthcare authorities recommend immunization of all children as vaccinations protect...
INTRODUCTION
Influenza is associated with considerable respiratory morbidity and mortality. Healthcare authorities recommend immunization of all children as vaccinations protect vulnerable populations, minimize influenza triggered asthma attacks, and reduced the burden of respiratory illnesses during the SARS-CoV-2 pandemic. Medical professionals should counsel parents of children with chronic lung disease to receive annual influenza vaccinations as part of supportive care. We aimed to describe adherence to influenza vaccination in respiratory patients and identify potential reasons for non-vaccination.
METHODS
This study included questionnaires reviewing personal experience and beliefs regarding influenza vaccination, provided by parents of patients who visited the Pediatric Pulmonary Institute at Schneider Children's Medical Center with their children, during March-August 2021.
RESULTS
Of 198 parents who completed our questionnaire, 114 (57.3 %) vaccinated their children against influenza during that year. Average age was 6.9 ± 4.5 years. Demographic data were similar between the vaccinated and unvaccinated groups. Influenza vaccination rates differed significantly between parents who received an explanation from their primary physician and those who did not (65.4 % vs. 43.7 %, respectfully, p = 0.003), and parents who received explanations from a pulmonary specialist and those who did not (77.3 % vs. 48.8 %, respectively, p = 0.004). The combined recommendation of a primary physician and pulmonologist translated to a significantly higher vaccination rate among those who received such recommendations, as compared to those who did not (p < 0.001). Parents who believed in vaccine efficacy and safety were more likely to vaccinate their children (p < 0.001). Factors significantly affecting the decision of the parents to have their child vaccinated were their knowledge, beliefs, and conceptions about the vaccine.
CONCLUSIONS
Pediatric respiratory patients' influenza vaccination rate was 57 %. Major factors encouraging vaccination were correct parental knowledge and receiving recommendations from their primary physician\pulmonologist. This emphasizes the need for providing patients with information, by first explaining the vaccine's importance to physicians.
Topics: Humans; Child; Child, Preschool; Influenza, Human; Pandemics; COVID-19; SARS-CoV-2; Health Knowledge, Attitudes, Practice; Influenza Vaccines; Vaccination; Parents
PubMed: 37977938
DOI: 10.1016/j.vaccine.2023.11.026 -
The World Allergy Organization Journal Dec 2023For therapy of severe asthma 5 monoclonal antibodies have been available in Germany up to November 2022, but no clear rules exist on choice of initial therapy,...
BACKGROUND
For therapy of severe asthma 5 monoclonal antibodies have been available in Germany up to November 2022, but no clear rules exist on choice of initial therapy, assessment of response, and switch.
OBJECTIVE
To assess current practice on all aspects of biologic therapy by specialists in Germany.
METHODS
A questionnaire was created by specialists for severe asthma, which was tested and modified by further experts. We invited 119 pulmonologists of the German Asthma Net (GAN) to complete the survey and used SoSci Survey and SPSS for data collection and analysis.
RESULTS
Forty-seven pulmonologists took part in the survey with a median annual number of patients treated with biologics of 35, 55% worked in an outpatient practice, and 40% in a hospital. Exacerbations and oral steroid use were the most important factors for the decision to start a biologic therapy. Accordingly, these parameters were also the most relevant for assessment of response. Most participants considered type-2 inflammation biomarkers and comorbidities (foremost CRSwNP and AD) for choosing initial biologic. Asthma Control Test (ACT) was the most common instrument for assessing status of disease control. There was no consensus on thresholds for response of pulmonary function tests including FEV1, FVC, and RV. Eighty-five percent of participants distinguished between "responders", "partial responders" and "non-responders". Comorbidities played an important role for the decision to switch to another biologic, eg, when initial therapy had insufficient effectiveness on CRSwNP.
CONCLUSION
This study provides a detailed insight into current opinions and practice of biologic use in severe asthma in Germany.
PubMed: 38033455
DOI: 10.1016/j.waojou.2023.100844 -
Chest Jun 2024Acute pulmonary embolism (PE) is a common disease encountered by pulmonologists, cardiologists, and critical care physicians throughout the world. For patients with... (Review)
Review
TOPIC IMPORTANCE
Acute pulmonary embolism (PE) is a common disease encountered by pulmonologists, cardiologists, and critical care physicians throughout the world. For patients with high-risk acute PE (defined by systemic hypotension) and intermediate high-risk acute PE (defined by the absence of systemic hypotension, but the presence of numerous other concerning clinical and imaging features), intensive care often is necessary. Initial management strategies should focus on optimization of right ventricle (RV) function while decisions about advanced interventions are being considered.
REVIEW FINDINGS
We reviewed the existing literature of various vasoactive agents, IV fluids and diuretics, and pulmonary vasodilators in both animal models and human trials of acute PE. We also reviewed the potential complications of endotracheal intubation and positive pressure ventilation in acute PE. Finally, we reviewed the data of venoarterial extracorporeal membrane oxygenation (ECMO) use in acute PE. The above interventions are discussed in the context of the underlying pathophysiologic features of acute RV failure in acute PE with corresponding illustrations.
SUMMARY
Norepinephrine is a reasonable first choice for hemodynamic support with vasopressin as an adjunct. IV loop diuretics may be useful if evidence of RV dysfunction or volume overload is present. Fluids should be given only if concern exists for hypovolemia and absence of RV dilatation. Supplemental oxygen administration should be considered even without hypoxemia. Positive pressure ventilation should be avoided if possible. venoarterial ECMO cannulation should be implemented early if ongoing deterioration occurs despite these interventions.
PubMed: 38830402
DOI: 10.1016/j.chest.2024.04.032