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Pediatric Pulmonology Nov 2023Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of...
INTRODUCTION
Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of underlying mechanisms. Preterm-born children with and without lung dysfunction and term controls were assessed using oscillometry before and after exercise, and after postexercise bronchodilation.
METHODS
Preterm-born children, born at gestation of 34 weeks or less, were classified into those with prematurity-associated obstructive lung disease (POLD; FEV < LLN, FEV /FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (pPRISm; FEV < LLN, FEV /FVC ≥ LLN) and compared to preterm (FEV ≥ LLN) and term controls (%predicted FEV > 90%). All children underwent cardiopulmonary exercise, and oscillometry assessment at baseline, postexercise, and after postexercise bronchodilator administration.
RESULTS
From 241 participants aged 7-12 years, complete data were available from 179: 15 children with POLD and 11 with pPRISm were compared with 93 preterm and 60 term controls. POLD group, when compared to both control groups, had impaired impedance, greater resistance, more negative (greater magnitude) reactance at low frequencies, and also had decreased compliance. pPRISm group demonstrated impaired reactance and compliance compared to term controls. No differences were noted between the preterm and term controls. Exercise had little impact on oscillometry values, but children with POLD had greatest improvements after postexercise bronchodilator administration, with decreased resistance and decreased magnitude of reactance, particularly at low frequencies.
CONCLUSION
Preterm-born children with obstructive airway disease had the greatest oscillometry impairments and the largest improvements after postexercise bronchodilator compared to control groups. Oscillometry can potentially be used to identify preterm-born children with lung disease to institute treatment.
Topics: Child; Female; Humans; Infant, Newborn; Bronchodilator Agents; Oscillometry; Forced Expiratory Volume; Premature Birth; Lung; Lung Diseases; Lung Diseases, Obstructive; Spirometry; Infant, Newborn, Diseases
PubMed: 37701982
DOI: 10.1002/ppul.26658 -
Complementary Therapies in Medicine Mar 2024To understand research advances and frontiers of acupuncture regulation on the autonomic nervous system (ANS) over the past decade through a bibliometric analysis. (Review)
Review
OBJECTIVE
To understand research advances and frontiers of acupuncture regulation on the autonomic nervous system (ANS) over the past decade through a bibliometric analysis.
METHODS
Publications related to acupuncture regulation on the ANS were retrieved from the Web of Science Core Collection (WoSCC) database. CiteSpace software was used to analyze the datasets and generate knowledge maps.
RESULTS
A total of 445 relevant publications published between 2013 and 2022 were included in this bibliometric analysis. The number of annual publications fluctuated from 2013 to 2016 but increased gradually from 2016 to 2022. China produced the highest number of publications, while the USA established the most extensive cooperation relationships. China Academy of Chinese Medical Science was the most productive institution. Chen Jiande D.Z. was the most prolific author and Rong Peijing holds the most extensive cooperation network. Han Jisheng was the most co-cited author. Relevant research involved mechanism exploration and clinical efficacy research, and "anti-inflammatory effect" was the most active research topic, especially cholinergic anti-inflammatory mechanisms. The most cited references mainly focused on inflammation. Gastrointestinal and cardiovascular disorders were the most active medical conditions studied in this field.
CONCLUSIONS
Research related to acupuncture regulation on the ANS mainly focused on anti-inflammation, and regulating gastrointestinal and cardiovascular function over the past decade. However, the mechanisms of the autonomic effects of acupuncture need further investigation. High-quality clinical studies are required to determine the optimal parameters of acupuncture for clinical application.
Topics: Humans; Acupuncture Therapy; Autonomic Nervous System; Bibliometrics; Medicine, East Asian Traditional; Anti-Inflammatory Agents
PubMed: 38081432
DOI: 10.1016/j.ctim.2023.103009 -
Pulmonology Dec 2023In this review, we present the effects of lung hyperinflation on the cardiovascular system (CVS) and the beneficial outcomes of different deflation treatment modalities.... (Review)
Review
In this review, we present the effects of lung hyperinflation on the cardiovascular system (CVS) and the beneficial outcomes of different deflation treatment modalities. We discuss the effects of long-acting bronchodilator drugs, medical and surgical lung volume reduction on the performance of the CVS. Although there is a small number of studies investigating lung deflation and the CVS, the short-term improvement in heart function was clearly demonstrated. However, more studies, with longer duration, are needed to verify these significant beneficial effects of deflation of the lungs on the CVS. Dynamic hyperinflation during exercise could be a research model to investigate further the effects of lung hyperinflation and/or deflation on the CVS.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Cardiologists; Pulmonologists; Lung; Bronchodilator Agents
PubMed: 37031001
DOI: 10.1016/j.pulmoe.2023.02.011 -
International Journal of Chronic... 2023There is limited literature regarding real-world treatment patterns of patients with COPD, particularly since the introduction of once-daily single-inhaler triple...
Real-World Treatment Patterns and Switching Following Moderate/Severe Chronic Obstructive Pulmonary Disease Exacerbation in Patients with Commercial or Medicare Insurance in the United States.
PURPOSE
There is limited literature regarding real-world treatment patterns of patients with COPD, particularly since the introduction of once-daily single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol in 2017. Here, we evaluated treatment patterns of patients with COPD before and after a COPD exacerbation.
PATIENTS AND METHODS
Retrospective, descriptive study using medical and pharmacy claims data and enrollment information from the Optum Clinformatics Data Mart database. Patients aged ≥40 years with ≥1 COPD exacerbation on or after September 18, 2017 were included. The index date was the last day of the first COPD exacerbation (ie day of visit for a moderate exacerbation or discharge date for a severe exacerbation). The baseline period was 12 months prior to index and the follow-up period (≥3 months) spanned from index until the earliest of health plan disenrollment, end of data availability (September 30, 2020), or death. Treatment patterns were evaluated during baseline and follow-up, with a focus on medication switching in the 90 days pre- and post-index.
RESULTS
COPD exacerbations were identified in 307,727 patients (125,942 severe; 181,785 moderate). Mean age at index was 72.8 years; 56.3% were female. Before and after first exacerbation, 37.7% and 48.2% of patients used ≥1 controller medication, respectively. In the 90 days pre-index, ICS, LABA, and LAMA medications were used by 27.5% of patients. Of these users, 64.3% remained on the same medication class, 21.7% discontinued, and 14.1% switched medication in the 90 days post-index. Among switchers, 44.0% switched to triple therapy. Most common switches were ICS/LABA to ICS/LABA/LAMA (20.7%) and LAMA to ICS/LABA/LAMA (16.4%).
CONCLUSION
Many COPD exacerbations occur among patients not on controller medications. Although the percentage of patients receiving a controller medication increased following a first exacerbation, it remained below 50%. Of patients receiving controller medications pre-exacerbation, only a small proportion escalated to triple therapy post-exacerbation.
Topics: Humans; Aged; Female; United States; Male; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Administration, Inhalation; Medicare; Adrenergic beta-2 Receptor Agonists; Disease Progression; Fluticasone; Bronchodilator Agents; Muscarinic Antagonists; Adrenal Cortex Hormones
PubMed: 37521022
DOI: 10.2147/COPD.S398816 -
Cephalalgia : An International Journal... Mar 2024Hemicrania continua (HC) and paroxysmal hemicrania (PH) belong to a group of primary headache disorders called trigeminal autonomic cephalalgias. One of the diagnostic...
BACKGROUND
Hemicrania continua (HC) and paroxysmal hemicrania (PH) belong to a group of primary headache disorders called trigeminal autonomic cephalalgias. One of the diagnostic criteria for both HC and PH is the absolute response to the therapeutic dose of indomethacin. However, indomethacin is discontinued in many patients as a result of intolerance to its side effects. Melatonin, a pineal hormone, which shares similar chemical structure to indomethacin, has been reported to have some efficacy for HC in previous case reports and series. To our knowledge, there is no literature regarding the use of melatonin in PH. We aimed to describe the clinical use of melatonin in the preventive management of HC and PH.
METHODS
Patient level data were extracted as an audit from routinely collected clinical records in consecutive patients seen in outpatient neurology clinic at King's College Hospital, London, UK, from September 2014 to April 2023. Our cohort of patients were identified through a search using the keywords: hemicrania continua, paroxysmal hemicrania, melatonin and indomethacin. Descriptive statistics including absolute and relative frequencies, mean ± SD, median and interquartile range (IQR) were used.
RESULTS
Fifty-six HC patients were included with a mean ± SD age of 52 ± 16 years; 43 of 56 (77%) patients were female. Melatonin was taken by 23 (41%) patients. Of these 23 patients, 19 (83%) stopped indomethacin because of different side effects. The doses of melatonin used ranged from 0.5 mg to 21 mg, with a median dose of 10 mg (IQR = 6-13 mg). Fourteen (61%) patients reported positive relief for headache, whereas the remaining nine (39%) patients reported no headache preventive effect. None of the patients reported that they were completely pain free. Two patients continued indomethacin and melatonin concurrently for better symptom relief. Eight patients continued melatonin as the single preventive treatment. Side effects from melatonin were rare. Twenty-two PH patients were included with mean ± SD age of 50 ± 17 years; 17 of 22 (77%) patients were female. Melatonin was given to six (27%) patients. The median dose of melatonin used was 8 mg (IQR = 6-10 mg). Three (50%) patients responded to melatonin treatment. One of them used melatonin as adjunctive treatment with indomethacin.
CONCLUSIONS
Melatonin showed some efficacy in the treatment of HC and PH with a well-tolerated side effect profile. It does not have the same absolute responsiveness as indomethacin, at the doses used, although it does offer a well-tolerated option that can have significant ameliorating effects in a substantial cohort of patients.
Topics: Humans; Female; Adult; Middle Aged; Aged; Male; Melatonin; Paroxysmal Hemicrania; Indomethacin; Headache; Trigeminal Autonomic Cephalalgias; Vascular Headaches; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 38518183
DOI: 10.1177/03331024231226196 -
Journal of Clinical Medicine Feb 2024The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to... (Review)
Review
The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to optimize mechanical ventilation, prevent spontaneous respiratory efforts, reduce the work of breathing and oxygen consumption, and avoid patient-ventilator asynchrony. In patients with acute respiratory distress syndrome (ARDS), NMBAs reduce the risk of barotrauma and improve oxygenation. Nevertheless, current guidelines and evidence are contrasting regarding the routine use of NMBAs. In status asthmaticus and acute exacerbation of chronic obstructive pulmonary disease, NMBAs are used in specific conditions to ameliorate patient-ventilator synchronism and oxygenation, although their routine use is controversial. Indeed, the use of NMBAs has decreased over the last decade due to potential adverse effects, such as immobilization, venous thrombosis, patient awareness during paralysis, development of critical illness myopathy, autonomic interactions, ICU-acquired weakness, and residual paralysis after cessation of NMBAs use. The aim of this review is to highlight current knowledge and synthesize the evidence for the effects of NMBAs for critically ill patients with lung diseases, focusing on patient-ventilator asynchrony, ARDS, status asthmaticus, and chronic obstructive pulmonary disease.
PubMed: 38398494
DOI: 10.3390/jcm13041182 -
The American Journal of Managed Care Feb 2024For patients with asthma who remain symptomatic on a medium-dose inhaled corticosteroid/long-acting β2 agonist, addition of a long-acting muscarinic antagonist as a...
OBJECTIVES
For patients with asthma who remain symptomatic on a medium-dose inhaled corticosteroid/long-acting β2 agonist, addition of a long-acting muscarinic antagonist as a supplementary controller is a recommended option. However, real-world data on the characteristics and treatment patterns of these patients are limited. This study described the demographics and clinical characteristics of new users of single- or multiple-inhaler triple therapy and treatment patterns preceding triple-therapy initiation.
STUDY DESIGN
This retrospective cohort study used medical and pharmacy claims data from the IQVIA PharMetrics Plus database.
METHODS
The study population comprised adults with asthma with or without chronic obstructive pulmonary disease (COPD) initiating triple therapy with single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; 100/62.5/25 μg) or multiple-inhaler triple therapy (MITT) between September 18, 2017, and September 30, 2019. Demographics, clinical characteristics, and treatment patterns in the 12 months preceding triple-therapy initiation were described (baseline period).
RESULTS
A total of 12,395 patients were included. Among FF/UMEC/VI initiators with asthma (n = 1301), the mean age was 49.0 years and 59.3% were women. During the baseline period, 81.5% of patients used controller therapy, 94.7% used rescue medications, and 42.0% reported at least 1 asthma-related exacerbation; the annual mean exacerbation rate was 0.96. Similar trends were observed among patients with asthma initiating MITT and patients with comorbid asthma-COPD initiating FF/UMEC/VI or MITT.
CONCLUSION
In real-world practice, triple therapy is often utilized following other asthma controller medication use. High disease burden, as evidenced by substantial use of rescue medications and continued asthma-related exacerbations, suggests that patients may not have achieved adequate asthma control prior to triple-therapy initiation.
Topics: Adult; Humans; Female; Middle Aged; Male; Bronchodilator Agents; Retrospective Studies; Administration, Inhalation; Asthma; Pulmonary Disease, Chronic Obstructive; Fluticasone; Muscarinic Antagonists; Drug Combinations
PubMed: 38381542
DOI: 10.37765/ajmc.2024.89494 -
Respirology (Carlton, Vic.) Dec 2023
Topics: Humans; Bronchodilator Agents; Fluticasone-Salmeterol Drug Combination; Lung; Pulmonary Disease, Chronic Obstructive; Administration, Inhalation; Drug Combinations; Androstadienes; Double-Blind Method; Fluticasone
PubMed: 37879756
DOI: 10.1111/resp.14612 -
The Journal of Allergy and Clinical... Feb 2024Digital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence, and short-acting β-agonist overuse.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Digital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence, and short-acting β-agonist overuse. The maintenance and reliever Digihaler System (DS) comprises 2 Digihaler inhalers (fluticasone propionate/salmeterol and albuterol) with an associated patient App and web-based Dashboard. Clinicians can review patients' inhaler use and Digihaler inhalation parameter data to support clinical decision-making.
OBJECTIVE
CONNECT2 evaluated asthma control in participants using the DS versus standard-of-care (SoC) maintenance and reliever inhalers.
METHODS
Participants (13 years or older) with uncontrolled asthma (Asthma Control Test [ACT] score <19) were randomized 4:3 (open-label) to the DS (n = 210) or SoC (n = 181) for 24 weeks. The primary endpoint was the proportion of patients achieving well-controlled asthma (ie, an ACT score ≥20 or increase from baseline of ≥3 units at week 24).
RESULTS
There was an 88.7% probability that participants using the DS would have greater odds of achieving improvement in asthma control compared with SoC after 24 weeks. The mean odds ratio (95% credible interval) for DS versus SoC was 1.35 (0.846-2.038), indicating a 35% higher odds of improved asthma control with the DS. The DS group had more clinician-participant interactions versus SoC, mainly addressing a poor inhaler technique. DS participants' maintenance treatment adherence was good (month 1: 79.2%; month 6: 68.6%); reliever use decreased by 38.2% versus baseline. App and Dashboard usability was rated "good."
CONCLUSION
The positive results in asthma control in this study after 24 weeks demonstrate the effectiveness of the DS in asthma management.
Topics: Humans; Budesonide; Formoterol Fumarate; Ethanolamines; Anti-Asthmatic Agents; Drug Combinations; Asthma; Albuterol; Administration, Inhalation; Bronchodilator Agents
PubMed: 38040117
DOI: 10.1016/j.jaip.2023.11.037 -
European Journal of Clinical... Nov 2023Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT) antagonists are often ineffective, while also conferring a risk of... (Review)
Review Meta-Analysis
PURPOSE
Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT antagonists for the treatment of nausea across all clinical settings.
METHODS
MEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE.
RESULTS
From 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD - 20.06; 95% CI - 26.26, - 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT antagonist. The overall GRADE assessment of evidence quality ranged from very low to low.
CONCLUSION
IPA may provide rapid, effective relief of nausea when compared with 5-HT antagonists.
Topics: Humans; Serotonin; 2-Propanol; Nausea; Antiemetics; Serotonin 5-HT3 Receptor Antagonists
PubMed: 37704796
DOI: 10.1007/s00228-023-03560-x