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JMIR Formative Research Dec 2023Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the...
BACKGROUND
Asthma is one of the most common respiratory diseases, with an ever-growing health care burden. Remote patient monitoring (RPM) has gained increasing importance in the respiratory care area with the outbreak of the COVID-19 pandemic. In this pilot study, we introduced a novel platform that remotely monitors patients with chronic respiratory illnesses using Centers for Disease Control and Prevention guidelines to reduce hospitalizations and emergency department visits.
OBJECTIVE
This study aimed to understand patient and physician engagement with a new virtual care solution (KevaTalk app and Keva365 platform) and the value, for both patients and providers, of using an RPM tool. We assessed real-world use of the platform from both physician and patient perspectives and the impact of devices on engagement and monitoring.
METHODS
Participants with a history of moderate to severe persistent asthma, seen by a pulmonologist at a hospital, were included in this study. The inclusion criteria involved being aged ≥18 years and having access to an Android or iOS mobile device with internet. We provided patient questionnaires to assess the app's usefulness and evaluate its features. We monitored remote spirometry and oximetry data, app check-ins, alerts, and escalations during this study's time window. Data were reviewed daily and predetermined criteria were set to escalate for physician review based on the patient's symptoms and objective data.
RESULTS
Overall, 25 patients were included in this pilot. The mean age was 57 (SD 10.7) years and a majority (n=23, 92%) were female. A baseline questionnaire, which was used to rate the app, indicated that the ease of check-in and ease of modification to the patient's asthma plan were the 2 highest rated features. In total, 2066 check-ins (1550 green, 506 yellow, and 10 red check-ins) and 1155 spirometry sessions were recorded during this 3-month period. Further, 64% (14/22) and 91% (20/22) of patients were found to have peak flows in their red and yellow zones at least once, respectively. During the course of this study, 484 alerts were recorded and evaluated by the team, of which 37.2% (n=180) required an escalation to the physician; this included a transfer to a medical facility, change in respiratory medication, or further education.
CONCLUSIONS
In this pilot study, we demonstrated the feasibility of implementing a novel RPM platform in patients with asthma. Our platform showed high patient engagement and satisfaction and provided physicians with real-time subjective data to evaluate patients remotely that aids in clinical decision-making. The escalations prevented patients from having an exacerbation or flare up, which led to the prevention of an emergency department visit. Continuous monitoring of chronic disease has benefits over episodic monitoring. It allows for improved quality of life, better outcomes, and huge health care savings.
PubMed: 38153783
DOI: 10.2196/51065 -
Cureus Aug 2023Asthma is a prevalent chronic respiratory condition affecting a significant portion of women of reproductive age. While the impact of asthma on general health and... (Review)
Review
Asthma is a prevalent chronic respiratory condition affecting a significant portion of women of reproductive age. While the impact of asthma on general health and well-being has been extensively studied, its association with fertility challenges in women remains an area of growing concern. This review article explores the complexities surrounding fertility challenges in asthmatic women, specifically focusing on pregnancy loss, infertility, and the utilization of assisted reproductive technologies (ARTs). Various factors contribute to the heightened risk of pregnancy loss in asthmatic women, including the systemic inflammation associated with asthma, suboptimal asthma control, medication usage, and comorbidities. The review highlights the need for multidisciplinary management approaches to optimize asthma control before and during pregnancy, reducing the risk of adverse pregnancy outcomes. Furthermore, the review investigates the potential impact of asthma on female fertility and the underlying mechanisms involved. Asthma-related factors, such as chronic inflammation, altered hormonal balance, and medication effects, may disrupt the delicate reproductive processes, leading to infertility. It emphasizes the importance of comprehensive fertility evaluations and personalized treatment strategies for asthmatic women experiencing difficulties conceiving. Additionally, the article explores the utilization of ARTs, including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), in asthmatic women. It discusses the safety considerations and potential challenges associated with these techniques, such as the impact of asthma medications on oocyte quality, the effects of hormonal stimulation on asthma control, and the risk of exacerbations during the IVF process. The review underscores the importance of collaborative efforts among healthcare providers, including allergists, pulmonologists, obstetricians, and fertility specialists, to ensure optimal management of asthmatic women seeking to conceive. It emphasizes the significance of preconception counseling, meticulous asthma control, appropriate medication management, and individualized fertility treatments to enhance the reproductive outcomes in this population.
PubMed: 37692593
DOI: 10.7759/cureus.43104 -
Journal of Managed Care & Specialty... Aug 2023Nontuberculous mycobacterial lung disease (NTMLD) is a debilitating disease. Chronic obstructive pulmonary disease (COPD) is the leading comorbidity associated with...
Identifying potentially undiagnosed nontuberculous mycobacterial lung disease among patients with chronic obstructive pulmonary disease: Development of a predictive algorithm using claims data.
Nontuberculous mycobacterial lung disease (NTMLD) is a debilitating disease. Chronic obstructive pulmonary disease (COPD) is the leading comorbidity associated with NTMLD in the United States. Their similarities in symptoms and overlapping radiological findings may delay NTMLD diagnosis in patients with COPD. To develop a predictive model that identifies potentially undiagnosed NTMLD among patients with COPD. This retrospective cohort study developed a predictive model of NTMLD using US Medicare beneficiary claims data (2006 - 2017). Patients with COPD with NTMLD were matched 1:3 to patients with COPD without NTMLD by age, sex, and year of COPD diagnosis. The predictive model was developed using logistic regression modeling risk factors such as pulmonary symptoms, comorbidities, and health care resource utilization. The final model was based on model fit statistics and clinical inputs. Model performance was evaluated for both discrimination and generalizability with c-statistics and receiver operating characteristic curves. There were 3,756 patients with COPD with NTMLD identified and matched to 11,268 patients with COPD without NTMLD. A higher proportion of patients with COPD with NTMLD, compared with those with COPD without NTMLD, had claims for pulmonary symptoms and conditions, including hemoptysis (12.6% vs 1.4%), cough (63.4% vs 24.7%), dyspnea (72.5% vs 38.2%), pneumonia (59.2% vs 13.4%), chronic bronchitis (40.5% vs 16.3%), emphysema, (36.7% vs 11.1%), and lung cancer (15.7% vs 3.5%). A higher proportion of patients with COPD with NTMLD had pulmonologist and infectious disease (ID) specialist visits than patients with COPD without NTMLD (≥ 1 pulmonologist visit: 81.3% vs 23.6%, respectively; ≥ 1 ID visit: 28.3% vs 4.1%, respectively, < 0.0001). The final model consists of 10 risk factors (≥ 2 ID specialist visits; ≥ 4 pulmonologist visits; the presence of hemoptysis, cough, emphysema, pneumonia, tuberculosis, lung cancer, or idiopathic interstitial lung disease; and being underweight during a 1-year pre-NTMLD period) predicting NTMLD with high sensitivity and specificity (c-statistic, 0.9). The validation of the model on new testing data demonstrated similar discrimination and showed the model was able to predict NTMLD earlier than the receipt of the first diagnostic claim for NTMLD. This predictive algorithm uses a set of criteria comprising patterns of health care use, respiratory symptoms, and comorbidities to identify patients with COPD and possibly undiagnosed NTMLD with high sensitivity and specificity. It has potential application in raising timely clinical suspicion of patients with possibly undiagnosed NTMLD, thereby reducing the period of undiagnosed NTMLD. Dr Wang and Dr Hassan are employees of Insmed, Inc. Dr Chatterjee was an employee of Insmed, Inc, at the time of this study. Dr Marras is participating in multicenter clinical trials sponsored by Insmed, Inc, has consulted for RedHill Biopharma, and has received a speaker's honorarium from AstraZeneca. Dr Allison is an employee of Statistical Horizons, LLC. This study was funded by Insmed Inc.
Topics: Humans; Aged; United States; Retrospective Studies; Cough; Hemoptysis; Medicare; Pulmonary Disease, Chronic Obstructive; Mycobacterium Infections, Nontuberculous; Algorithms; Pneumonia; Lung Neoplasms; Emphysema
PubMed: 37243674
DOI: 10.18553/jmcp.2023.22417 -
Diagnostics (Basel, Switzerland) Dec 2023Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the...
Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the interpretation of spirometry results; however, as yet none are validated. We evaluated the interpretation accuracy of the Espiro app using pulmonologist interpretations as the gold standard. This is an observational descriptive study in which 118 spirometry results were interpreted by the Espiro app, two pulmonologists, two primary care physicians, and two residents of a primary care training program. We determined the interpretation accuracy of the Espiro app and the concordance of the pattern and severity interpretation between the Espiro app and each of the observers using Cohen's kappa coefficient (). We obtained a sensitivity and specificity for the Espiro app of 97.5% (95% confidence interval (CI): 86.8-99.9%) and 94.9% (95%CI: 87.4-98.6%) with pulmonologist 1 and 100% (95%CI: 91.6-100%) and 98.7% (95%CI: 92.9-99.9%) with pulmonologist 2. The concordance for the pattern interpretation was greater than 0.907, representing almost perfect agreement. The concordance of the severity interpretation was greater than 0.807, representing substantial to almost perfect agreement. We concluded that the Espiro app is a valid tool for spirometry interpretation.
PubMed: 38201338
DOI: 10.3390/diagnostics14010029 -
Radiology Case Reports Aug 2023Carcinoma lung is a concerning cause of mortality worldwide. Approximately half of the cases are metastatic at diagnosis and uncommon metastatic sites confer a worse...
Carcinoma lung is a concerning cause of mortality worldwide. Approximately half of the cases are metastatic at diagnosis and uncommon metastatic sites confer a worse prognosis. Intracardiac metastasis from lung cancer is rare and limited to a few case reports. The authors describe the case of a 54-year female with left ventricular cavity mass as one of the rarest presentations of lung malignancy. She presented to the cardiology outpatient department with a history of progressive dyspnea for the last two months. Her 2D echocardiogram showed a large heterogeneous mass in the left ventricle cavity along with gross pericardial and pleural effusion. CT guided lung biopsy revealed adenocarcinoma of the lung. The patient was started on tablet geftinib along with other supportive therapy, while awaiting reports of next generation sequencing (NGS) for mutation analysis and immunohistochemistry. However, the patient's condition rapidly worsened and she succumbed to death within one week of hospital admission. Cardiac metastasis is one of the rarest sites for lung cancer spread. Intracavitary metastasis as in our case is an extremely rare presentation. Treatment is not yet well defined for such cases and it carries a poor prognosis despite available therapies. This case required multidisciplinary approach with involvement of cardiologist, oncologist, pulmonologist and intensivists. Further research is required to help define better treatment options.
PubMed: 37250479
DOI: 10.1016/j.radcr.2023.04.014 -
Frontiers in Public Health 2023This study aimed to investigate COVID-19-related disparities in clinical presentation and patient outcomes in hospitalized Native American individuals.
OBJECTIVES
This study aimed to investigate COVID-19-related disparities in clinical presentation and patient outcomes in hospitalized Native American individuals.
METHODS
The study was performed within 30 hospitals of the Banner Health system in the Southwest United States and included 8,083 adult patients who tested positive for SARS-CoV-2 infection and were hospitalized between 1 March 2020 and 4 September 2020. Bivariate and multivariate analyses were used to assess racial and ethnic differences in clinical presentation and patient outcomes.
RESULTS
COVID-19-related hospitalizations in Native American individuals were over-represented compared with non-Hispanic white individuals. Native American individuals had fewer symptoms at admission; greater prevalence of chronic lung disease in the older adult; two times greater risk for ICU admission despite being younger; and 20 times more rapid clinical deterioration warranting ICU admission. Compared with non-Hispanic white individuals, Native American individuals had a greater prevalence of sepsis, were more likely to require invasive mechanical ventilation, had a longer length of stay, and had higher in-hospital mortality.
CONCLUSION
Native American individuals manifested greater case-fatality rates following hospitalization than other races/ethnicities. Atypical symptom presentation of COVID-19 included a greater prevalence of chronic lung disease and a more rapid clinical deterioration, which may be responsible for the observed higher hospital mortality, thereby underscoring the role of pulmonologists in addressing such disparities.
Topics: Aged; Humans; American Indian or Alaska Native; Clinical Deterioration; COVID-19; Hospitalization; SARS-CoV-2; Health Status Disparities
PubMed: 37649785
DOI: 10.3389/fpubh.2023.1220582 -
Journal of Asthma and Allergy 2023It has been estimated that, in 2019, 54,000 patients in Germany had uncontrolled GINA step 4/5 asthma. In the current study we analyzed which health care providers were...
PURPOSE
It has been estimated that, in 2019, 54,000 patients in Germany had uncontrolled GINA step 4/5 asthma. In the current study we analyzed which health care providers were involved in the management of these patients and their role in disease phenotyping.
PATIENTS AND METHODS
The year 2019 was retrospectively analyzed using the IQVIA LRx, a longitudinal anonymized prescription database, and the electronic, anonymized medical records database, the IQVIA Disease Analyzer.
RESULTS
Of 54,000 uncontrolled GINA step 4/5 asthma patients in Germany, 52% had consulted both general practitioners (GPs) and pulmonologists, and 48% were seen exclusively by a GP. Of these 54,000 patients, 45% were being prescribed and were thus overusing short-acting β2-agonists (SABAs) and oral corticosteroids (OCS) for ≥2 years, 26% for ≥3 years, and 16% for ≥4 years. In most regions, pulmonologists saw one of their uncontrolled GINA step 4/5 asthma patients per week. Laboratory tests from consultations with a GP were available for only 10% of patients referred to a pulmonologist. In 50% of uncontrolled asthma patients treated according to GINA step 4/5, these were initiated by the pulmonologist, and 34% received laboratory testing within the first year (in GINA step 4/5 asthma, the numbers are 20% and 18%, respectively).
CONCLUSION
Fifty percent of uncontrolled asthma patients treated according to GINA step 4/5 were regularly seen by pulmonologists, who performed most of the phenotyping confirming their importance in the management of severe, uncontrolled asthma in Germany. To understand treatment pathways for these patients, further studies are needed.
PubMed: 37559894
DOI: 10.2147/JAA.S418658 -
Annals of the American Thoracic Society Mar 2024Indoor sources of air pollution worsen indoor and outdoor air quality. Thus, identifying and reducing indoor pollutant sources would decrease both indoor and outdoor air...
Indoor sources of air pollution worsen indoor and outdoor air quality. Thus, identifying and reducing indoor pollutant sources would decrease both indoor and outdoor air pollution, benefit public health, and help address the climate crisis. As outdoor sources come under regulatory control, unregulated indoor sources become a rising percentage of the problem. This American Thoracic Society workshop was convened in 2022 to evaluate this increasing proportion of indoor contributions to outdoor air quality. The workshop was conducted by physicians and scientists, including atmospheric and aerosol scientists, environmental engineers, toxicologists, epidemiologists, regulatory policy experts, and pediatric and adult pulmonologists. Presentations and discussion sessions were centered on ) the generation and migration of pollutants from indoors to outdoors, ) the sources and circumstances representing the greatest threat, and ) effective remedies to reduce the health burden of indoor sources of air pollution. The scope of the workshop was residential and commercial sources of indoor air pollution in the United States. Topics included wood burning, natural gas, cooking, evaporative volatile organic compounds, source apportionment, and regulatory policy. The workshop concluded that indoor sources of air pollution are significant contributors to outdoor air quality and that source control and filtration are the most effective measures to reduce indoor contributions to outdoor air. Interventions should prioritize environmental justice: Households of lower socioeconomic status have higher concentrations of indoor air pollutants from both indoor and outdoor sources. We identify research priorities, potential health benefits, and mitigation actions to consider (e.g., switching from natural gas to electric stoves and transitioning to scent-free consumer products). The workshop committee emphasizes the benefits of combustion-free homes and businesses and recommends economic, legislative, and education strategies aimed at achieving this goal.
Topics: Humans; Child; United States; Air Pollution, Indoor; Natural Gas; Environmental Monitoring; Air Pollution; Air Pollutants; Particulate Matter
PubMed: 38426826
DOI: 10.1513/AnnalsATS.202312-1067ST -
Patient Preference and Adherence 2023Idiopathic Pulmonary Fibrosis (IPF) is a rare disease that causes shortness of breath, dry cough, and tiredness. While there is no cure for IPF, current therapeutic...
INTRODUCTION
Idiopathic Pulmonary Fibrosis (IPF) is a rare disease that causes shortness of breath, dry cough, and tiredness. While there is no cure for IPF, current therapeutic treatments aim to slow lung degeneration while managing side effects. There is little known about patient experience and attitude with regards to their disease and medication.
PURPOSE
To understand the perceptions, behaviors and drivers of treatment decision-making among patients, caregivers and pulmonologists in IPF.
PATIENTS AND METHODS
Online surveys to patients with IPF, caregivers and pulmonologists were developed and administered in Belgium, Finland, France, Greece (pulmonologists only), the Netherlands, Ireland and the United Kingdom between November 2021 and January 2022.
RESULTS
A total of 111 patients, 22 caregivers and 140 pulmonologists participated. Half (47%) of patients rated their disease as "severe", while pulmonologists reported that a quarter of their patients had a low Forced Vital Capacity (FVC) (below 50% of the predicted value). Between 21% and 42% of the patients do not take an IPF medication (patients' perception) or antifibrotic (physicians' perception). Pulmonologists reported that a total of 58% of their patients were receiving antifibrotic medication, any IPF medication, while around 53%, 55%, 35% and 73% of the patients limited their exposure (sometimes or often) to the sun due to IPF, considered taking medication against diarrhea, nausea/vomiting and heartburn, respectively. Treatment adherence was relatively high (81%), in line with the caregivers' view and the pulmonologists' expectations. Overall, cultural, clinical or socio-demographic factors impacted patients' perceptions or behaviors.
CONCLUSION
This study shows there is a significant proportion of IPF patients who remain untreated, a misalignment of disease severity between patients and their physicians and patient background impacts behavior. Overall, more in-depth patient-physician communication is needed to improve treatment experience.
PubMed: 37560148
DOI: 10.2147/PPA.S408857 -
Medicina 2024Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory... (Review)
Review
Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory infections due to viruses, pneumococcus and other bacteria, affect both healthy and sick adults. There are vaccines that the pulmonologist must know and prescribe. The target strains of the influenza vaccine are defined by the WHO for the Southern hemisphere considering those involved in the previous influenza season in the Northern hemisphere. Its effectiveness depends on virulence, concordance between circulating and vaccine strains, and population coverage. The anti-pneumococcal polysaccharide vaccine available since 1983 is being replaced by more effective conjugate vaccines to prevent infections related to serotypes present in them. Immunization against SARS-CoV-2 reduced the contagion, severity, and lethality of COVID-19. The acellular vaccine against Bordetella pertussis for adults is present for specific situations in the adult calendar; vaccinating them strengthens the control of childhood contagion. The double (diphtheria + tetanus), and triple (double + pertussis) bacterial vaccines, and the vaccines against measles, chickenpox, rubella, human papillomavirus, Haemophilus influenzae, meningococcus, herpes zoster, Argentine hemorrhagic fever and yellow fever, are of a more limited use. Soon we will have new vaccines such as the one recently approved by the FDA against respiratory syncytial virus. Through a consensus of experts in respiratory infections, we review the new evidence regarding the immunization of adults who consult a pulmonologist, and thus update the recommendations on vaccination made eight years ago.
Topics: Adult; Humans; Infant; Aged; Pulmonary Medicine; Vaccination; Pneumococcal Vaccines; Influenza Vaccines; COVID-19
PubMed: 38271938
DOI: No ID Found