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BMC Pulmonary Medicine Jan 2024The predictive value of phase angle for sarcopenia diagnosis has been discussed for years. The present investigation was conducted to determine the association between...
BACKGROUND AND AIMS
The predictive value of phase angle for sarcopenia diagnosis has been discussed for years. The present investigation was conducted to determine the association between phase angle and sarcopenia in patients with COPD.
METHODS
In this case-control study, 222 smoker men were divided into healthy and COPD groups. COPD was diagnosed by a pulmonologist through spirometry. Anthropometric indices, phase angle, muscle function, sarcopenia, and dietary intake were assessed.
RESULTS
A significant inverse association was observed between phase angle and sarcopenia after adjustment for age and energy intake (OR: 0.31, 95% CI 0.18-0.52) and after adjustment for BMI (OR: 0.31, 95% CI 0.18-0.52). A significant decrease was detected in anthropometric indices and indicators of sarcopenia and muscle function in COPD cases compared to the healthy controls.
CONCLUSIONS
Although further studies are suggested, phase angle might be considered an indicator of sarcopenia and muscle function in COPD patients.
Topics: Male; Humans; Case-Control Studies; Sarcopenia; Anthropometry; Muscles; Pulmonary Disease, Chronic Obstructive
PubMed: 38184558
DOI: 10.1186/s12890-023-02814-9 -
European Clinical Respiratory Journal 2024Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) of the pancreas is performed routinely in many endoscopic centers as part of the diagnostic set-up...
Endoscopic ultrasound-guided fine-needle aspiration using the bronchial ultrasound scope (EUS-B-FNA) for diagnosing pancreatic metastasis in a lung cancer patient case report.
Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) of the pancreas is performed routinely in many endoscopic centers as part of the diagnostic set-up for suspected pancreatic cancer. The use of transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) by pulmonologists has expanded significantly, since it enables effective diagnosis of lesions in the mediastinum and upper abdomen. The following case demonstrates the safety and feasibility of EUS-B-FNA in a patient with non-small cell lung cancer (NSCLC) cancer and a pancreatic mass of unknown origin. A patient who was previously diagnosed with NSCLC was referred to the Department of Respiratory Medicine, Odense University Hospital due to suspected recurrence of NSCLC. The patient underwent endobronchial ultrasound guided (EBUS)-FNA from several suspected mediastinal lymph nodes and combined EUS-B-FNA from a pancreatic mass during the same procedure. Pathology results from the pancreatic mass and from the mediastinal lymph nodes showed squamous-cell carcinoma, metastasis from the previous NSCLC. We here by demonstrated that EUS-B-FNA is a feasible and safe technique to obtain tissue samples from pancreatic lesions in patients under investigation for lung cancer.
PubMed: 38178814
DOI: 10.1080/20018525.2023.2294545 -
Cureus Dec 2023This comprehensive review delves into the intricate relationship between asthma and pregnancy, specifically focusing on the challenges encountered in the first trimester... (Review)
Review
This comprehensive review delves into the intricate relationship between asthma and pregnancy, specifically focusing on the challenges encountered in the first trimester and the ensuing impact on maternal and fetal health. Examining physiological changes during pregnancy reveals the dynamic interplay influencing respiratory function and immune responses. Key findings underscore the vulnerability to asthma exacerbations in the critical first trimester, emphasizing the potential risks to both maternal and fetal well-being. Maternal and fetal outcomes are discussed, emphasizing the associations between poorly controlled asthma and adverse perinatal outcomes. Implications for clinical practice highlight the importance of preconception care, continuous monitoring, and collaborative efforts between obstetricians and pulmonologists. Patient education emerges as a fundamental aspect to empower pregnant women in managing their condition. The conclusion emphasizes the imperative for comprehensive care, advocating for individualized treatment plans, multidisciplinary collaboration, and public health initiatives. By adopting this holistic approach, healthcare providers can navigate the complexities of asthma during pregnancy, ultimately ensuring the optimal health of both the expectant mother and her developing fetus.
PubMed: 38169705
DOI: 10.7759/cureus.49849 -
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 -
Pulmonology Dec 2023Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are...
Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society.
INTRODUCTION
Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking.
OBJECTIVE
To establish recommendations for CTD-ILD screening based on the current evidence.
METHOD
Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD.
RESULTS
The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous.
CONCLUSIONS
Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.
PubMed: 38148269
DOI: 10.1016/j.pulmoe.2023.11.007 -
Avicenna Journal of Medicine Oct 2023Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team...
Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinicians and there are few reports on the outcomes of the ILD-MDT approach. We therefore describe the experience of the ILD-MDT meetings at our institution. A single-center retrospective review of the electronic health care records of patients discussed in the ILD-MDT meetings at our institution from February 2016 to January 2021 was performed. At out institution, at each ILD-MDT meeting, the referring pulmonologist presents the clinical history and the results of all relevant investigations including serology, blood gas analyses, lung function tests, bronchoscopy, and bronchoalveolar lavage. A radiologist then describes the imaging including serial computed tomography (CT) scans. When available, the findings on lung biopsy are presented by a pathologist. Subsequent discussions lead to a consensus on the diagnosis and further management. The study included 121 patients, comprising 71 (57%) males and 76 nonsmokers (62.8%), with a mean age of 65 years (range: 25-93 years). The average number of comorbidities was 2.4 (range: 0-7). Imaging-based diagnoses were usual interstitial pneumonia (UIP)/chronic hypersensitivity pneumonitis (CHP) in 32 (26%) patients, UIP in 20 (17%) patients, probable UIP in 27 (22%) patients, nonspecific interstitial pneumonia in 11 (9%) patients, and indeterminate interstitial lung abnormalities (ILA) in 10 (8%) patients. The most common consensus clinical diagnosis after an ILD-MDT discussion was chronic hypersensitivity pneumonitis/idiopathic pulmonary fibrosis in 17 patients (14%), followed by idiopathic pulmonary fibrosis and connective tissue disease associated interstitial lung disease in 16 patients (13%), CHP in 11 patients (9.1%), and ILA in 10 patients (8.4%). Only a 42 patients (35%) required surgical lung biopsy for confirmation of the diagnosis. This study describes the characteristics of the patients discussed in the ILD-MDT meetings with emphasis on their clinical, radiological, and laboratory data to reach a diagnosis and management plan. The decisions on commencement of antifibrotics or immunosuppressive therapy for patients with various ILDs are also made during these ILD-MDT meetings. This descriptive study could help other health care professionals regarding the structure of their ILD-MDT meetings and with discussions about diagnostic and care decisions for diffused parenchymal lung disease patients.
PubMed: 38144909
DOI: 10.1055/s-0043-1776063 -
The European Respiratory Journal Feb 2024Continuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality therapy termination. However,...
BACKGROUND
Continuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality therapy termination. However, there is a lack of data on the rates and impact of resuming CPAP in patients with obstructive sleep apnoea (OSA). This analysis determined the prevalence of CPAP resumption in the year after termination, characterised determinants of CPAP resumption, and examined the impact of CPAP resumption on all-cause mortality.
METHODS
French national health insurance reimbursement system data for adults aged ≥18 years were used. CPAP prescription was identified by specific treatment codes. Patients who resumed CPAP after first therapy termination and continued to use CPAP for 1 year were matched with those who resumed CPAP then terminated therapy for a second time.
RESULTS
Out of 103 091 individuals with a first CPAP termination, 26% resumed CPAP over the next 12 months, and 65% of these were still using CPAP 1 year later. Significant predictors of CPAP continuation after resumption included male sex, hypertension and CPAP prescription by a pulmonologist. In the matched population, the risk of all-cause death was 38% lower in individuals who continued using CPAP after therapy resumption those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48-0.79; p=0.0001).
CONCLUSION
These data suggest that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit.
Topics: Adult; Humans; Male; Adolescent; Continuous Positive Airway Pressure; Patient Compliance; Hypertension; Sleep Apnea, Obstructive; France
PubMed: 38135441
DOI: 10.1183/13993003.01171-2023 -
Tropical Medicine and Infectious Disease Dec 2023During the early stages of the pandemic, computed tomography (CT) of the chest, along with serological and clinical data, was frequently utilized in diagnosing COVID-19,...
During the early stages of the pandemic, computed tomography (CT) of the chest, along with serological and clinical data, was frequently utilized in diagnosing COVID-19, particularly in regions facing challenges such as shortages of PCR kits. In these circumstances, CT scans played a crucial role in diagnosing COVID-19 and guiding patient management. The COVID-19 Reporting and Data System (CO-RADS) was established as a standardized reporting system for cases of COVID-19 pneumonia. Its implementation necessitates a high level of agreement among observers to prevent any potential confusion. This study aimed to assess the inter-observer agreement between physicians from different specialties with variable levels of experience in their CO-RADS scoring of CT chests for confirmed COVID-19 patients, and to assess the feasibility of applying this reporting system to those having little experience with it. All chest CT images of patients with positive RT-PCR tests for COVID-19 were retrospectively reviewed by seven observers. The observers were divided into three groups according to their type of specialty (three radiologists, three house officers, and one pulmonologist). The observers assessed each image and categorized the patients into five CO-RADS groups. A total of 630 participants were included in this study. The inter-observer agreement was almost perfect among the radiologists, substantial among a pulmonologist and the house officers, and moderate-to-substantial among the radiologists, the pulmonologist, and the house officers. There was substantial to almost perfect inter-observer agreement when reporting using the CO-RADS among observers with different experience levels. Although the inter-observer variability among the radiologists was high, it decreased compared to the pulmonologist and house officers. Radiologists, house officers, and pulmonologists applying the CO-RADS can accurately and promptly identify typical CT imaging features of lung involvement in COVID-19.
PubMed: 38133455
DOI: 10.3390/tropicalmed8120523 -
PeerJ 2023To determine the predictability of the MARKO questionnaire and/or its domains, individually or in combination with other markers and characteristics (age, gender,...
AIMS
To determine the predictability of the MARKO questionnaire and/or its domains, individually or in combination with other markers and characteristics (age, gender, smoking history, lung function, 6-min walk test (6 MWT), exhaled breath temperature (EBT), and hsCRP for the incident chronic obstructive pulmonary disease (COPD) in subjects at risk over 2 years follow-up period).
PARTICIPANTS AND METHODS
Patients, smokers/ex-smokers with >20 pack-years, aged 40-65 years of both sexes were recruited and followed for 2 years. After recruitment and signing the informed consent at the GP, a detailed diagnostic workout was done by the pulmonologist; they completed three self-assessment questionnaires-MARKO, SGRQ and CAT, detailed history and physical, laboratory (CBC, hsCRP), lung function tests with bronchodilator and EBT. At the 2 year follow-up visit they performed: the same three self-assessment questionnaires, history and physical, lung function tests and EBT.
RESULTS
A sample of 320 subjects (41.9% male), mean (SD) age 51.9 (7.4) years with 36.4 (17.4) pack-years of smoking was reassessed after 2.1 years. Exploratory factor analysis of MARKO questionnaire isolated three distinct domains (breathlessness and fatigue, "exacerbations", cough and expectorations). We have determined a rate for incident COPD that was 4.911/100 person-years (95% CI [3.436-6.816]). We found out that questions about breathlessness and "exacerbations", and male sex were predictive of incident COPD after two years follow-up (AUC 0.79, 95% CI [0.74-0.84], < 0.001). When only active smokers were analyzed a change in EBT after a cigarette (ΔEBT) was added to a previous model (AUC 0.83, 95% CI [0.78-0.88], < 0.001).
CONCLUSION
Our preliminary data shows that the MARKO questionnaire combined with EBT (change after a cigarette smoke) could potentially serve as early markers of future COPD in smokers.
Topics: Female; Humans; Male; Follow-Up Studies; C-Reactive Protein; Pulmonary Disease, Chronic Obstructive; Respiratory System; Dyspnea
PubMed: 38130928
DOI: 10.7717/peerj.16650 -
Thorax Apr 2024Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK.... (Review)
Review
UNLABELLED
Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK. The absence of robust clinical evidence and expert consensus is a barrier to the implementation of care recommendations in public healthcare systems as is the need to increase awareness of key aspects of care for those living with DMD. Here, we provide evidenced-based and/or consensus-based best practice for the respiratory care of children and adults living with DMD in the UK, both as part of routine care and in an emergency.
METHODOLOGY
Initiated by an expert working group of UK-based respiratory physicians (including British Thoracic Society (BTS) representatives), neuromuscular clinicians, physiotherapist and patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK respiratory teams and neuromuscular services, consensus was achieved on these best practice recommendations for respiratory care in DMD.
RESULT
The resulting recommendations are presented in the form of a flow chart for assessment and monitoring, with additional guidance and a separate chart setting out key considerations for emergency management. The recommendations have been endorsed by the BTS.
CONCLUSIONS
These guidelines provide practical, reasoned recommendations for all those managing day-to-day and acute respiratory care in children and adults with DMD. The hope is that this will support patients and healthcare professionals in accessing high standards of care across the UK.
Topics: Child; Adult; Humans; Muscular Dystrophy, Duchenne; Health Personnel; Pulmonologists; United Kingdom
PubMed: 38123347
DOI: 10.1136/thorax-2023-220811