156 research outputs found
sj-docx-1-mcr-10.1177_10775587231204105 – Supplemental material for Factors Associated With Intent to Leave the Profession for the Allied Health Workforce: A Rapid Review
No full textSupplemental material, sj-docx-1-mcr-10.1177_10775587231204105 for Factors Associated With Intent to Leave the Profession for the Allied Health Workforce: A Rapid Review by Leonard Roth, Clara Le Saux, Ingrid Gilles and Isabelle Peytremann-Bridevaux in Medical Care Research and Review</p
The adoption of the 2021 definition consensus bronchodilator responsiveness (BDR) on the interpretation of BDR in patients undergoing pulmonary function tests (PFT) in real life
No full textBackground
Bronchodilator responsiveness (BDR) is vital in diagnosing asthma and differentiating it from COPD, but its definition has been debated. The 2005 ATS/ERS guidelines define positive BDR as a 12% and 200 ml increase in FEV1 or FVC, but this has been criticized for favoring patients with lower lung function, older age, and taller height. In 2021, ATS/ERS proposed a new definition to address these biases, yet its clinical impact remains unclear. This study aims to assess the effect of adopting the 2021 BDR definition on patient classification and identify factors influencing reclassification.
Method
Anonymized pulmonary function test (PFT) data from patients of all ages between January 2014 and February 2022 were analyzed.
Three baseline spirometry tests, followed by administration of salbutamol, were conducted. Additional measurements, such as lung volumes, TLCO, and COPD Assessment Test (CAT), were performed if necessary. Patients were divided into four groups based on their bronchodilator responsiveness (BDR). 1) Positive BDR under both 2005 and 2021 definitions. 2) Negative BDR under both definitions 3) Negative under the 2005 definition but positive under the 2021 definition 4) Positive under the 2005 definition but negative under the 2021 definition.
Results
5653 patients were analyzed. Mean age was 57.2 years, and 51.6% were male. Obstructive spirometry was observed in 33% of subjects before bronchodilation, with signs of hyperinflation and reduced diffusion capacity. Overall, 12.4% met the 2005 BDR criterion, and 10.9% met the 2021 criterion. Reclassification occurred in 4.56% of patients, with more subjects transitioning from BDR positive (2005) to negative (2021) than vice versa. Younger patients were more likely to be reclassified as BDR positive under the new definition. Factors such as lower FEV1/FVC ratio, higher FENO, and alveolar volume were predictors of BDR reclassification from BDR negative to positive.
Conclusion
The adoption of the new BDR definition does not change the classification for the vast majority of individuals tested for clinical reasons. However, we found that adopting the new definition has a greater impact on adolescents and children than on adults. Children and adolescents are four times more likely to be reclassified from negative to positive than adults
SERPINA1 PiZ and PiS heterozygotes and lung function decline in the SAPALDIA cohort
No full textBACKGROUND: Severe alpha1-antitrypsin (AAT) deficiency is a strong risk factor for COPD. But the impact of gene variants resulting in mild or intermediate AAT deficiency on the longitudinal course of respiratory health remains controversial. There is indication from experimental studies that pro-inflammatory agents like cigarette smoke can interact with these variants and thus increase the risk of adverse respiratory health effects. Therefore, we tested the effect of the presence of a protease inhibitor (Pi) S or Z allele (PiMS and PiMZ) on the change in lung function in different inflammation-exposed subgroups of a large, population-based cohort study.METHODOLOGY AND PRINCIPAL FINDINGS: The SAPALDIA population includes over 4600 subjects from whom SERPINA1 genotypes for S and Z alleles, spirometry and respiratory symptoms at baseline and after 11 years follow-up, as well as proxies for inflammatory conditions, such as detailed smoking history, obesity and high sensitivity C-reactive protein (hs-CRP), were available. All analyses were performed by applying multivariate regression models. There was no overall unfavourable effect of PiMS or PiMZ genotype on lung function change. We found indication that PiZ heterozygosity interacted with inflammatory stimuli leading to an accelerated decline in measures in use as indices for assessing mild airway obstruction. Obese individuals with genotype PiMM had an average annual decline in the forced mid expiratory flow (?FEF25-75%) of 58.4 ml whereas in obese individuals with PiMZ it amounted to 92.2 ml (p?=?0.03). Corresponding numbers for persistent smokers differed even more strongly (66.8 ml (PiMM) vs. 108.2 ml (PiMZ), p?=?0.005). Equivalent, but less strong associations were observed for the change in the FEV1/FVC ratio. CONCLUSIONS: We suggest that, in addition to the well established impact of the rare PiZZ genotype, one Z allele may be sufficient to accelerate lung function decline in population subgroups characterized by elevated levels of low grade inflammation
Heterogeneity of obesity-asthma association disentangled by latent class analysis, the SAPALDIA cohort
No full textAlthough evidence for the heterogeneity of asthma accumulated, consensus for definitions of asthma phenotypes is still lacking. Obesity may have heterogeneous effects on various asthma phenotypes. We aimed to distinguish asthma phenotypes by latent class analysis and to investigate their associations with different obesity parameters in adults using a population-based Swiss cohort (SAPALDIA). We applied latent class analysis to 959 self-reported asthmatics using information on disease activity, atopy, and age of onset. Associations with obesity were examined by multinomial logistic regression, after adjustments for age, sex, smoking status, educational level, and study centre. Body mass index, percent body fat, waist hip ratio, waist height ratio, and waist circumference were used as obesity measure. Four asthma classes were identified, including persistent multiple symptom-presenting asthma (n = 122), symptom-presenting asthma (n = 290), symptom-free atopic asthma (n = 294), and symptom-free non-atopic asthma (n = 253). Obesity was positively associated with symptom-presenting asthma classes but not with symptom-free ones. Percent body fat showed the strongest association with the persistent multiple symptom-presenting asthma. We observed heterogeneity of associations with obesity across asthma classes, indicating different asthma aetiologies
Swiss Recommendations for the Follow-Up and Treatment of Pulmonary Long COVID
No full textIntroduction: Emerging evidence suggests that long-term pulmonary symptoms and functional impairment occurs in a proportion of individuals following SARS-CoV-2 infection. Although the proportion of affected patients remains to be determined, physicians are increasingly being confronted with patients reporting respiratory symptoms and impairment beyond the acute phase of COVID-19. In face of limited evidence, the Swiss Society for Pulmonology established a working group to address this area of unmet need and formulated diagnostic and treatment recommendations for the care of patients with pulmonary long COVID (LC). Method: The Swiss COVID Lung Study group and Swiss Society for Pulmonology (SSP) formulated 13 questions addressing the diagnosis and treatment of pulmonary LC. A survey within the SSP special interest groups involved in care of LC patients was conducted in Switzerland. A CORE process/Delphi-like process was used to formulate recommendations. Forty experienced pulmonologists replied to the first survey and 22 completed the second follow-up survey. Agreement of ≥70% consensus led to formulation of a recommendation. Results: The participants in the survey reached consensus and formulated a strong recommendation for regarding the following points. Patients hospitalized for COVID-19 should have a pulmonary assessment including pulmonary function tests. Symptomatic subjects affected by COVID-19, including those with mild disease, should benefit from a pulmonary follow-up. Persistent respiratory symptoms after COVID-19 should be investigated by a pulmonary follow-up including plethysmography, diffusion capacity measurement, and blood gases analysis. Individuals having suffered from COVID-19 and who present with persistent respiratory symptoms should be offered a rehabilitation. Additional questions were given moderateor weak recommendations for. The panel did not reach sufficient consensus for pharmacological therapy (e.g., therapy specifically targeting lung fibrosis) to formulate recommendations for LC drug treatment. Conclusion: The formulated recommendations should serve as an interim guidance to facilitate diagnosis and treatment of patients with pulmonary LC. As new evidence emerges, these recommendations may need to be adapted
Soins intégrés et BPCO bénéfiques pour les patients !
No full textLa BPCO est responsabled'une diminution de la qualité de vie et de la tolérance à l'exercice, et cause des exacerbations pouvant nécessiter des hospitalisations. Idéalement, sa prise en charge devrait comprendre des éléments pharmacologiques (par exemple bronchodilatateurs, corticostéroïdes inhalés) et non pharmacologiques (éducation, autogestion, plan d'action,
réentraînement). L'objectif de cette revue systématique est d'évaluer l'efficacité des programmes de soins intégrés de la BPCO en termes de qualité de vie, de tolérance à l'exercice, de risque et de durée d'hospitalisation. Elle actualise les revues systématiques non Cochrane publiées auparavant
Diagnosis and Management of Asthma - The Swiss Guidelines
No full textThe Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA (“Global Strategy for Asthma Management and Prevention”) report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a “new” definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.</jats:p
Évaluation de l’acceptabilité et utilisabilité d’infographies exposant les co-bénéfice en santé planétaire: Étude qualitative par observation non participante
No full textContexte: Alors que les systèmes de santé arrivent au bout de leurs limites et que les écosystèmes se dégradent, plusieurs nouveaux concepts émergent, mettant en lumière les bénéfices concomitants d’une préservation de l’environnement pour améliorer la santé individuelle. C’est dans ce contexte que la campagne 12 mois 12 actions s’est inscrite, en publiant mensuellement des infographies présentant des co-bénéfices santé individuelle et santé environnementale. Nous avons voulu évaluer l’acceptabilité et l’utilisabilité de ces infographies en salle d’attente de cabinets de médecine de premier recours dans les cantons suisse romands.
Méthodes: Plusieurs infographies ont été conçues et distribuées dans la Revue Médicale Suisse à disposition des médecins généralistes pour être exposées dans les salles d’attente. Des observations non-participante de l’agencement des salles d’attentes ainsi que du comportement des patients durant leurs attentes ont été réalisées. Les résultats ont ensuite été analysés sur Atlas.ti.
Résultats: Un facteur facilitant considérablement la lecture des infographies par les patients est la disposition sur une table basse au centre de la salle d’attente des infographies disponibles à être emportée. La présentation antérieure du projet 12M12A semble également renforcer l’intérêt et la lecture des infographies par les patients. Le facteur limitant le plus important semble être l’utilisation personnelle d’un appareil électronique, même si un tiers de ces patients ont tout de même porté une attention passive ou active aux infographies en salle d’attente.
Conclusion: Nos résultats permettent de proposer qu’encourager la visibilité des infographies par format électronique ainsi que la présentation du projet par les assistantes/secrétaires médicales pourraient améliorer l’impact d’un sujet de prévention en médecine de premiers recours. De futures études évaluant l’implémentation et l’utilisabilité de ces facteurs sont donc nécessaires.</p
Mortality of patients with COPD participating in chronic disease management programmes: A happy end?
No full textBACKGROUND: Concerns about increased mortality could question the role of COPD chronic disease management (CDM) programmes. We aimed at extending a recent Cochrane review to assess the effects of CDM on mortality in patients with COPD.
METHODS: Mortality data were available for 25 out of 29 trials identified in a COPD integrated care systematic review. Meta-analysis using random-effects models was performed, followed by subgroup analyses according to study length (3-12 months vs >12 months), main intervention component (exercise, self-management, structured follow-up) and use of an action plan.
RESULTS: The meta-analysis showed no impact of CDM on mortality (pooled OR: 1.00, 95% CI 0.79 to 1.28).
CONCLUSIONS: These results do not suggest that CDM programmes expose patients with COPD to excessive mortality risk
Improved air quality and attenuated lung function decline: Modification by obesity in the SAPALDIA cohort
No full textBackground: Air pollution and obesity are hypothesized to contribute to accelerated decline in lung function with age through their inflammatory properties.Objective: We investigated whether the previously reported association between improved air quality and lung health in the population-based SAPALDIA cohort is modified by obesity.Methods: We used adjusted mixed-model analyses to estimate the association of average body mass index (BMI) and changes in particulate matter with aerodynamic diameter ≤ 10 µm (PM10; ΔPM10) with lung function decline over a 10-year follow-up period.Results: Lung function data and complete information were available for 4,664 participants. Age-related declines in lung function among participants with high average BMI were more rapid for FVC (forced vital capacity), but slower for FEV1/FVC (forced expiratory volume in 1 sec/FVC) and FEF25-75 (forced expiratory flow at 25-75%) than declines among those with low or normal average BMI. Improved air quality was associated with attenuated reductions in FEV1/FVC, FEF25-75, and FEF25-75/FVC over time among low- and normal-BMI participants, but not overweight or obese participants. The attenuation was most pronounced for ΔFEF25-75/FVC (30% and 22% attenuation in association with a 10-μg/m3 decrease in PM10 among low- and normal-weight participants, respectively.)Conclusion: Our results point to the importance of considering health effects of air pollution exposure and obesity in parallel. Further research must address the mechanisms underlying the observed interaction.Citation: Schikowski T, Schaffner E, Meier F, Phuleria HC, Vierkötter A, Schindler C, Kriemler S, Zemp E, Krämer U, Bridevaux P-O, Rochat T, Schwartz J, Künzli N, Probst-Hensch N. 2013. Improved air quality and attenuated lung function decline: modification by obesity in the SAPALDIA cohort. Environ Health Perspect 121:1034-1039; http://dx.doi.org/10.1289/ehp.1206145
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