Prevalence of Overweight and Obesity Among Greek Army Recruits

OBJECTIVE Obesity poses a major public health issue whose prevalence is reaching epidemic proportions, especially among younger ages. Our aim was to determine the prevalence of overweight and obesity among Greek men recruited in the army, and to evaluate potential associations with place of residence and educational level. SUBJECTS & METHODS Height and weight were measured in 3,684 men, aged 23.2±2.8 (mean ± standard deviation) years. Body mass index (BMI, kg/m2) was used as measure of adiposity. Associations between BMI categories and level of education (≤9 school years, >9 years) and between BMI categories and place of residence (urban, rural) were evaluated using chi-square test. RESULTS Average BMI was 25.2±4 kg/m2. The prevalence of overweight (25<BMI<30) was 33.7% and associated positively with a higher educational level (p<0.001), whereas the prevalence of obesity (BMI>30) was 10.0% and was not associated with educational level. Obesity was associated with place of residence; individuals from rural areas were more obese than those from urban areas (p=0.04). Our results, when compared to those of similar studies conducted in 1969, 1990, and 2006 showed a significant increase in mean BMI. CONCLUSION Overall, we documented a high and increasing prevalence of overweight and obesity (43.7%) among younger Greek men

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients’ perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.The document facilitates standardisation of conducting, reporting and interpreting cardiopulmonary exercise tests in chronic lung diseases for comparison of reference data, multi-centre studies and assessment of interventional efficacy. http://bit.ly/31SXeB

The Fitter the Better? Cardiopulmonary Exercise Testing Can Predict Pulmonary Exacerbations in Cystic Fibrosis

Background: The role of cardiopulmonary exercise testing (CPET) in the assessment of prognosis in CF (cystic fibrosis) is crucial. However, as the overall survival of the disease becomes better, the need for examinations that can predict pulmonary exacerbations (PEx) and subsequent deterioration becomes evident. Methods: Data from a 10-year follow up with CPET and spirometry of CF patients were used to evaluate whether CPET-derived parameters can be used as prognostic indexes for pulmonary exacerbations in patients with CF. Pulmonary exacerbations were recorded. We used a survival analysis through Cox Regression to assess the prognostic role of CPET parameters for PeX. CPET parameters and other variables such as sputum culture, age, and spirometry measurements were tested via multivariate cox models. Results: During a 10-year period (2009–2019), 78 CF patients underwent CPET. Cox regression analysis revealed that VO2peak% (peak Oxygen Uptake predicted %) predicted (hazard ratio (HR), 0.988 (0.975, 1.000) p = 0.042) and PetCO2 (end-tidal CO2 at peak exercise) (HR 0.948 (0.913, 0.984) p = 0.005), while VE/VO2 and (respiratory equivalent for oxygen at peak exercise) (HR 1.032 (1.003, 1.062) p = 0.033) were significant predictors of pulmonary exacerbations in the short term after the CPET. Additionally, patients with VO2peak% predicted <60% had 4.5-times higher relative risk of having a PEx than those with higher exercise capacity. Conclusions: CPET can provide valuable information regarding upcoming pulmonary exacerbation in CF. Patients with VO2peak <60% are at great risk of subsequent deterioration. Regular follow up of CF patients with exercise testing can highlight their clinical image and direct therapeutic interventions

Cardiopulmonary exercise testing for the evaluation and prognosis of cystic fibrosis patients

For many years, CardioPulmonary Exercise Testing (CPET) has been widely used for the assessment of Cystic Fibrosis patients. Its prognostic role in CF has been known since 1992, however the exact factors that make this test so important had not been highlighted so far. Aim therefore of the present study was to explore the significance of CPET in assessing and predicting CF pulmonary disease. Firstly, it was investigated to what extent alveolar ventilation in exercise is impaired in mild, medium and severe CF lung disease. No differences were noted in alveolar ventilation between the three groups and CF patients were found to retain exercise ventilation efficiency during exercise by elevating minute and dead space ventilation. Pseudomonas aeruginosa colonization was found to affect exercise capacity even in patients with normal respiratory function tests. Patients colonized were found to be more prominently affected than those intermittently. Additionally, association between CPET parameters and structural lung damages was examined. Our study showed that exercise testing could predict structural damages as seen on HRCT. In fact it was shown that CPET was more sensitive than spirometry in predicting these damages. Apart from total prognosis, we also examined whether CPET could predict pulmonary exacerbations in CF patients. VE/VO2, VO2peak and PETCO2 were found to be predictors of future exacerbations. For the first time in literature survival graphs regarding to time for pulmonary exacerbation were created for CF patients according to their VO2peak values. Results were quite impressive: patients with VO2peak<60% were found to be significantly more probable (about 80%) to have a pulmonary exacerbation in the next months. In conclusion, CardioPulmonary Exercise Testing holds a very important role in assessing and following CF patients. Not only this test can provide very useful data for the prognosis of patients, it can also present a holistic image of the CF patient’s various systems, guiding treatment and interventions.Η καρδιοαναπνευστική δοκιμασία κόπωσης (Cardiopulmonary Exercise Testing- CPET) χρησιμοποιείται εδώ και πάρα πολλά έτη για την παρακολούθηση των ασθενών με Κυστική ίνωση. Ο ρόλος της στην πρόγνωση της επιβίωσης των ασθενών αυτών είχε ήδη αναδειχθεί από το 1992, ωστόσο οι ακριβείς αιτίες που η εξέταση αυτή υπερτερεί έναντι άλλων δοκιμασιών δεν ήταν σαφώς διευκρινισμένοι. Σκοπός της παρούσας μελέτης ήταν η διερεύνηση της σημασίας του CPET στην παρακολούθηση και πρόγνωση των ασθενών με ΚΙ. Πιο συγκεκριμένα, η διερεύνηση τυχόν δυνατότητας της δοκιμασίας κόπωσης να εκτιμά περιορισμούς όπως απεικονίζονται από άλλες λειτουργικές δοκιμασίες του αναπνευστικού καθώς και ο έλεγχος η δοκιμασίας κόπωση να μπορεί να προσφέρει στοιχεία στην πρόγνωση των ασθενών αυτών. Αρχικά, εξετάστηκε κατά πόσο ο κυψελιδικός αερισμός κατά την άσκηση στην ΚΙ ήπιας, μέτριας και μεγάλης βαρύτητας είναι επηρεασμένος. Βρέθηκε ότι δεν παρατηρούνται διαφορές μεταξύ των 3 ομάδων (ήπιας, μέτριας και σοβαρής πνευμονικής νόσου) και ότι οι ασθενείς με ΚΙ διατηρούν κατά την άσκηση την επάρκεια αερισμού αυξάνοντας τον κατά λεπτό αερισμό και τον αερισμό του νεκρού χώρου. Διαπιστώθηκε ότι ο αποικισμός με Pseudomonas aeruginosa επηρεάζει την ικανότητα προς άσκηση ακόμη και σε ασθενείς με φυσιολογική αναπνευστική λειτουργία σημαντικότερα από ότι σε ασθενείς διαλειπόντως ή καθόλου αποικισμένους. Επιπλέον διερευνήθηκε η συσχέτιση των παραμέτρων της δοκιμασίας κόπωσης με δομικές βλάβες των πνευμόνων. Φάνηκε ότι το CPET μπορεί να προβλέψει βλάβες στην αξονική θώρακος με μεγαλύτερη ευαισθησία από τη σπιρομέτρηση. Εξετάσαμε επιπλέον κατά πόσο πέρα από τη συνολική επιβίωση το CPET μπορεί να προβλέψει και τις πνευμονικές εξάρσεις των ασθενών με ΚΙ. Διαπιστώθηκε ότι τόσο η VO2peak, η VE/VO2 όσο και το PETCO2 της καρδιοαναπνευστικής δοκιμασίας κόπωσης μπορούν να αποτελέσουν δείκτες πρόγνωσης για επόμενες πνευμονικές εξάρσεις. Για πρώτη φορά στη διεθνή βιβλιογραφία, δημιουργήθηκαν καμπύλες επιβίωσης για τις ομάδες ασθενών ανάλογα με τις τιμές VO2peak που παρουσιάζουν. Τα αποτελέσματα ήταν θεαματικά: βρέθηκε ότι ασθενείς με VO2peak<60% παρουσιάζουν σημαντικά αυξημένο κίνδυνο κατά 80% για εμφάνιση πνευμονικών εξάρσεων της νόσου σε σχέση με τους υπολοίπους. Συμπερασματικά η συμβολή της καρδιοαναπνευστικής δοκιμασίας πρόγνωσης στην παρακολούθηση και πρόγνωση των ασθενών με ΚΙ είναι καθοριστική. Όχι μόνο η δοκιμασία αυτή προσφέρει σημαντικά στοιχεία για την επιβίωση των ασθενών προβλέποντας επερχόμενη λοίμωξη, αλλά ειδικότερα παρέχει και σημαντικές πληροφορίες για την συνολική κατάσταση του οργανισμού του ασθενούς κατευθύνοντας τη θεραπευτική φαρέτρα

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis

Several studies have shown that patients with cystic fibrosis (CF), even at a young age, have pulmonary and cardiac abnormalities. The main complications are cardiac right ventricular (RV) systolic and/or diastolic dysfunction and pulmonary hypertension, which affects their prognosis. Exercise training (ET) is recommended in patients with CF as a therapeutic modality to improve physical fitness and health-related quality of life. However, questions remain regarding its optimal effective and safe dose and its effects on the patients&rsquo; cardiac function. The study aimed to provide a wearable activity tracker (WAT)-based ET to promote physical activity in CF patients and assess its effects on cardiac morphology and function. Forty-two stable CF individuals (aged 16.8 &plusmn; 3.6 years) were randomly assigned to either the intervention (Group A) or the control group (Group B). Group A participated in a 1-year WAT-based ET program three times per week. All patients underwent a 6-min walking test (6-MWT) and an echocardiographic assessment focused mainly on RV anatomy and function at the baseline and the end of the study. RV systolic function was evaluated by measuring the tricuspid annular plane systolic excursion (TAPSE), the systolic tricuspid annular velocity (TVS&rsquo;), the RV free-wall longitudinal strain (RVFWSL), and the right ventricular four-chamber longitudinal strain (RV4CSL). RV diastolic function was assessed using early (TVE) and late (TVA) diastolic transtricuspid flow velocity and their ratio TVE/A. Pulmonary artery systolic pressure (PASP) was also estimated. In Group A after ET, the 6MWT distance improved by 20.6% (p &lt; 0.05), TVA decreased by 17% (p &lt; 0.05), and TVE/A increased by 13.2% (p &lt; 0.05). Moreover, TAPSE, TVS&rsquo;, RVFWSL, and RV4CSL increased by 8.3% (p &lt; 0.05), 9.0% (p &lt; 0.05), 13.7% (p &lt; 0.05), and 26.7% (p &lt; 0.05), respectively, while PASP decreased by 7.6% (p &lt; 0.05). At the end of the study, there was a significant linear correlation between the number of steps and the PASP (r = &minus;0.727, p &lt; 0.01) as well as the indices of RV systolic function in Group A. In conclusion, WAT is a valuable tool for implementing an effective ET program in CF. Furthermore, ET has a positive effect on RV systolic and diastolic function

Pancreatic Cystosis in Two Adolescents with Cystic Fibrosis

We present pancreatic cystosis in two adolescents with cystic fibrosis, a 13-year-old girl and an 18-year-old boy. In pancreatic cystosis, which is a rare manifestation of CF, the pancreatic parenchyma is replaced with multiple cysts of different sizes. Pancreatic cystosis is mainly an imaging based diagnosis and frequent follow-up should be recommended

Child Morbidity and Disease Burden in Refugee Camps in Mainland Greece

The crisis conflicts in Syria have forced a lot of people to relocate and live in mainland Greece, where they are hosted in refugee camps. In the present study, our aim was to assess child morbidity and overall disease burden in two camps in northern Greece during a six-month winter period. A primary health care office was founded in each camp. Refugees of all ages with health problems were examined daily by specialty doctors. Cases were classified into two categories: Infectious or non-infectious. In total, 2631 patients were examined during this period (out of the 3760 refugees hosted). Of these patients, 9.8% were infants, 12.7% were toddlers, and 13.4% were children. Most of the visits for children aged less than 12 years old were due to infectious diseases (80.8%). The most common sites of communicable diseases among children were the respiratory tract (66.8%), the skin (23.2%), and the urinary (3.2%) and gastrointestinal tracts (6.2%). Non-communicable diseases were mostly due to gastrointestinal (20.2%), respiratory (18.2%), surgical (13.1%), and allergic (10.3%) disorders. Infants, toddlers, and children suffered more frequently from respiratory infections, while in adolescents and adults, non-infectious diseases were more common. Toddlers and children were more likely to fall ill in comparison to infants. Conclusions: During the winter period, infectious diseases, especially of the respiratory tract, are the main reason for care seeking among refugees in Greek camps, with toddlers suffering more than other age groups. The overall mortality and referral percentage were low, indicating that adequate primary care is provided in this newly established refugee hosting model

ERS International Congress 2020: highlights from the Paediatric Assembly

In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies

ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data

ERS International Congress 2020: highlights from the Paediatric Assembly

In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies