Does Changing Inhaler Device Impact Real-Life Asthma Outcomes? : Clinical and Economic Evaluation

This study was funded by Mundipharma Korea Limited (Seoul, Korea).Peer reviewedPostprin

Genetic Association and Risk Scores in a Chronic Obstructive Pulmonary Disease Meta-analysis of 16,707 Subjects

The heritability of chronic obstructive pulmonary disease (COPD) cannot be fully explained by recognized genetic risk factors identified as achieving genome-wide significance. In addition, the combined contribution of genetic variation to COPD risk has not been fully explored. We sought to determine: (1) whether studies of variants from previous studies of COPD or lung function in a larger sample could identify additional associated variants, particularly for severe COPD; and (2) the impact of genetic risk scores on COPD. We genotyped 3,346 single-nucleotide polymorphisms (SNPs) in 2,588 cases (1,803 severe COPD) and 1,782 control subjects from four cohorts, and performed association testing with COPD, combining these results with existing genotyping data from 6,633 cases (3,497 severe COPD) and 5,704 control subjects. In addition, we developed genetic risk scores from SNPs associated with lung function and COPD and tested their discriminatory power for COPD-related measures. We identified significant associations between SNPs near PPIC (P = 1.28 X 10-8) and PPP4R4/SERPINA1 (P = 1.0131028) and severe COPD; the latter association may be driven by recognized variants in SERPINA1. Genetic risk scores based on SNPs previously associated with COPD and lung function had a modest ability to discriminate COPD (area under the curve, ~0.6), and accounted for a mean 0.9–1.9% lower forced expiratory volume in 1 second percent predicted for each additional risk allele. In a large genetic association analysis, we identified associations with severe COPD near PPIC and SERPINA1. A risk score based on combining genetic variants had modest, but significant, effects on risk of COPD and lung function

The cutoff point of clinical chronic obstructive pulmonary disease questionnaire for more symptomatic patients

Abstract Background An adequate threshold for the Clinical Chronic Obstructive Pulmonary Disease (COPD) Questionnaire (CCQ) defining more symptomatic COPD patients has not been determined. We aimed to determine the efficacy of the CCQ and the appropriate CCQ threshold for more symptomatic COPD patients. Methods COPD patients aged > 40 years who smoked/had smoked ≥10 packs/year were prospectively enrolled over 1 year from three South Korean hospitals (n = 126). Correlations between the CCQ and St. George’s Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), the modified Medical Round Council (mMRC) scale, lung function, and exercise capacity were evaluated. “More symptomatic patients” were those with an SGRQ score ≥ 25. Area under the receiver operating curve and classification and regression tree analyses were performed to determine the CCQ threshold equivalent to an SGRQ score ≥ 25. Results The CCQ significantly correlated with the SGRQ, CAT, and mMRC scale (r = 0.76, 0.69, and 0.53, respectively). A CCQ cutoff of 1.4 predicted an SGRQ score of 25 better than others. A CCQ score of 1.4 was a significant determinant of an SGRQ score ≥ 25 even after adjusting for potential confounders. Conclusions The CCQ was correlated with other symptom indicators, lung function, and exercise capacity. A CCQ cutoff of 1.4 agreed better than CCQ cutoff of 1.0, suggested by guideline, and this cutoff value may identify more symptomatic COPD patients well. Trial registration ClinicalTrials.gov Identifier: NCT02527486. Date of registration: December 19, 2014, retrospectively registered

Mild form of 2009 H1N1 influenza infection detected by active surveillance: Implications for infection control

Background: Screening patients with suspected influenza is a key step for infection control within communities and institutions. By analyzing the clinical characteristics of mild 2009 H1N1 influenza cases detected by active surveillance, we assessed the utility of the commonly used influenza case definition. Methods: We retrospectively reviewed medical records of 44 patients who were hospitalized and quarantined and who tested positive for the 2009 H1N1 virus using real-time reverse-transcriptase polymerase chain reaction between May 29 and July 28, 2009. Results: Patient median age was 17 years (range, 8-79 years), and 37 patients were male (84%). Common symptoms included cough (34/44; 77.3%), subjective fever (23/44; 52.3%), rhinorrhea or nasal congestion (22/44; 50%), sore throat (19/44; 43.2%), and diarrhea (7/44; 15.9%). All patients were treated with oseltamivir after the onset of initial symptoms (mean, 2.6 days). Common laboratory test results included leucopenia (23/44; 52.3%) and mildly elevated C-reactive protein (26/44; 59.1%). Conclusion: There were many mild afebrile cases of the 2009 pandemic H1N1 influenza. Cough, mild leukopenia, and mildly elevated C-reactive protein were relatively common clinical manifestations. Thus, case-based surveillance for the index cluster of 2009 pandemic influenza is not an effective method for infection control in communities or hospital settings.POALILLO FE, 2010, CRIT CARE MED, V38, pS1Jain S, 2009, NEW ENGL J MED, V361, P1935, DOI 10.1056/NEJMoa0906695Michaelis M, 2009, INFECTION, V37, P381, DOI 10.1007/s15010-009-9181-5Petrosillo N, 2009, ANN THORAC MED, V4, P163, DOI 10.4103/1817-1737.56008van Hal SJ, 2009, PLOS ONE, V4, DOI 10.1371/journal.pone.0006620Lister P, 2009, LANCET, V374, P605Hackett S, 2009, LANCET, V374, P605, DOI 10.1016/S0140-6736(09)61511-7Perez-Padilla R, 2009, NEW ENGL J MED, V361, P680, DOI 10.1056/NEJMoa0904252Jamieson DJ, 2009, LANCET, V374, P451, DOI 10.1016/S0140-6736(09)61304-0Dawood FS, 2009, NEW ENGL J MED, V360, P2605, DOI 10.1056/NEJMoa0903810GINSBERG M, 2009, MMWR-MORBID MORTAL W, V58, P400CORDOVA JA, 2009, MMWR-MORBID MORTAL W, V58, P585*CDCP, 2009, OV INFL SURV USShen CF, 2008, J MICROBIOL IMMUNOL, V41, P294Carrat F, 2008, AM J EPIDEMIOL, V167, P775, DOI 10.1093/aje/kwm375BEIGEL JH, 2005, NEW ENGL J MED, V353, P1374

The factors associated with mortality and progressive disease of nontuberculous mycobacterial lung disease: a systematic review and meta-analysis

Abstract This systematic review and meta-analysis aimed to comprehensively evaluate the factors associated with mortality and progressive disease in NTM-LD patients. We conducted a literature search to identify the eligible studies, dated between January 1, 2007, and April 12, 2021. Forty-one studies with total 10,452 patients were included. The overall all-cause mortality rate was 20% (95% CI 17–24%). The overall rates of clinical and radiographic progressive disease were 46% (95% CI 39–53%) and 43% (95% CI 31–55%), respectively. Older age, male sex, history of TB, diabetes, chronic heart disease, malignancy, systemic immunosuppression, chronic liver disease, presence of cavity, consolidative radiologic features, acid-fast bacillus (AFB) smear positivity, hypoalbuminemia, anemia, increasing platelet count, high CRP, and high ESR were significantly associated with increased all-cause mortality, whereas increasing body mass index (BMI), hemoptysis, and treatment with rifamycin regimen (in M. xenopi) were significantly associated with decreased all-cause mortality in multivariable analysis. History of TB, Aspergillus co-infection, cough, increased sputum, weight loss, presence of cavity, and AFB smear positivity were significantly associated with increased clinical progression with treatment, while older age and low BMI were significantly associated with decreased clinical progression in multivariable analysis. Older age, interstitial lung disease, presence of cavity, consolidative radiologic feature, anemia, high CRP, and leukocytosis were significantly associated with increased radiographic progression after adjusting for covariates. Older age, history of tuberculosis, presence of cavity, consolidative radiologic features, AFB smear positivity, anemia, and high C-reactive protein were common significant factors associated with the all-cause mortality and clinical or radiographic progressive disease of NTM-LD. These factors are thought to directly affect NTM-LD related mortality. The future prediction models for the prognosis of NTM-LD should be established considering these factors

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Background: Pneumonia is a primary cause of morbidity and mortality in infectious disease, and increasing antimicrobial resistance has raised concerns of treatment failure. Therefore, we evaluated the value of a blood culture bottle for bronchoalveolar lavage (BAL) samples on pathogen identification and on treatment modification in patients with pneumonia. Methods: We conducted a prospective study and enrolled 39 patients who were hospitalized for pneumonia. Enrolled patients underwent BAL; a 10-ml aliquot was transferred to a sterile container for standard quantitative culture, and a 5 ml aliquot was transferred to both an aerobic and an anaerobic blood culture bottle. Results: Microbes were detected in all 39 (100 %) specimens and possible pathogens were identified in 34 patients (84.6 %) from BAL blood culture bottles. In contrast, microbes were detected in 10 patients (25.6 %) and possible pathogens were isolated in 8 patients (20.5 %) in BAL fluid using conventional culture methods. Finally, 8 of 39 (20.5 %) patients changed antibiotics according to the BAL blood culture results and pneumonia improved in 6 of these patients. Conclusions: Using blood culture bottles for BAL sampling in patients with pneumonia is a sensitive method to detect pathogens in order to identify an adequate antibiotic treatment regimen.OAIID:RECH_ACHV_DSTSH_NO:T201621516RECH_ACHV_FG:RR00200001ADJUST_YN:EMP_ID:A004455CITE_RATE:2.69FILENAME:BloodCultureBottle.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:YFILEURL:https://srnd.snu.ac.kr/eXrepEIR/fws/file/44d33a98-f998-4967-990f-18c28e5c9694/linkCONFIRM:YCONFIRM:

Veno-arterial extracorporeal membrane oxygenation may be useful in critically ill COVID-19 patients with suspected cardiac injury

Y

Validation of the Rome proposal for severity of acute exacerbation of chronic obstructive pulmonary disease

Background: The Rome proposal provides an objective assessment tool for severity of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) but requires validation. Objectives: We aimed to evaluate the predictive performance of the Rome proposal in patients with AE-COPD. Design: This observational study assessed the patients who visited the emergency room (ER) or were hospitalized due to AE-COPD between January 2010 and December 2020. Methods: We compared the performance of the Rome Proposal with that of the DECAF score or GesEPOC 2021 criteria in predicting intensive care unit (ICU) admission, need for non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), and in-hospital mortality. Results: A total of 740 events of ER visit or hospitalization due to AE-COPD were reviewed and classified into mild (30.9%), moderate (58.6%), or severe (10.4%) group according to the Rome proposal. The severe group had a higher rate of ICU admission, required more NIV or IMV, and had a higher in-hospital mortality than the mild and moderate groups. The predictive performance of the Rome proposal was significantly better for ICU admission [area under the receiver operating characteristic curve (AU-ROC) = 0.850 versus 0.736, p  = 0.004] and need for NIV or IMV (AU-ROC = 0.870 versus 0.770, p  = 0.004) than that of the GesEPOC 2021 criteria but better than that of the DECAF score only in female patients. There was no significant difference in predicting the in-hospital mortality between the Rome proposal and DECAF score or GesEPOC 2021 criteria. Conclusion: External validation of the Rome Proposal in Korean patients demonstrated excellent performance for ICU admission and need for NIV or IMV and an acceptable performance for in-hospital mortality

Microarray analysis of gene expression associated with extrapulmonary dissemination of tuberculosis

OBJECTIVE: Although extrapulmonary organs are involved in 20% of patients with tuberculosis, the host genetic factors associated with the extrapulmonary dissemination of tuberculosis are not yet known. The aim of this study was to identify the host genetic factors associated with the extrapulmonary dissemination of tuberculosis by comparing gene expression profiles of patients who had recovered from extrapulmonary tuberculosis and those who had recovered from pulmonary tuberculosis. METHODS: Five patients from each group were enrolled. Total RNA was extracted from peripheral blood mononuclear cells that had been incubated for 48 h with whole lysate of Mycobacterium tuberculosis (H37Rv, 0.5 microg/mL). Gene expression profiles were acquired using the GeneChip array and its applied systems. Gene expression profiles from five patients with previous extrapulmonary tuberculosis and one pooled control sample from five patients with previous pulmonary tuberculosis were analysed and compared. Genes that were expressed concordantly in more than 80% of arrays and that showed more than twofold changes in at least one array among samples from patients who had recovered from extrapulmonary tuberculosis were identified. RESULTS: Compared with the control sample, the expression of 16 genes, including those for tumour necrosis factor (TNF)-alpha and cathepsin W, was increased, and the expression of 45 genes including that for TNF-receptor superfamily member 7 (TNFRSF7), was decreased in the extrapulmonary tuberculosis patients. The altered expression of the TNF-alpha, cathepsin W and TNFRSF7 genes was confirmed by quantitative RT-PCR. CONCLUSIONS: Altered expression of the genes for TNF-alpha, cathepsin W and TNFRSF7 may be risk factors for the extrapulmonary dissemination of tuberculosis in humans