Effect of a Soy Isoflavone Supplement on Lung Function and Clinical Outcomes in Patients With Poorly Controlled Asthma

Rationale: Approval of aztreonam lysine for inhalation solution (AZLI) raised concerns that additional antibiotic exposure would potentially affect susceptibility profiles of Pseudomonas aeruginosa (PA) isolates from cystic fibrosis (CF) patients.Objective: This 5-year, prospective, observational study tracked susceptibility changes and clinical outcomes in CF patients in the United States with chronic PA infection.Methods: Sputum cultures were collected annually (2011-2016). The primary study endpoint was the proportion of subjects whose least susceptible PA isolate had an aztreonam minimum inhibitory concentration (MIC) that was >8 μg/mL (parenteral breakpoint) and increased ≥4-fold compared with the least susceptible isolate from the previous year. Annualized data for pulmonary exacerbations, hospitalizations, and FEV1% predicted were obtained from the CF Foundation Patient Registry and compared between subjects meeting/not meeting the primary endpoint.Results: 510 subjects were enrolled; 334 (65%) completed the study. A consistent proportion of evaluable subjects (13-22%) met the primary endpoint each year; and AZLI use during the previous 12 months was not associated with meeting the primary endpoint. While the annual decline in lung function was comparable for subjects meeting/not meeting the primary endpoint, more pulmonary exacerbations and hospitalizations were experienced by those who met it.Conclusions: Aztreonam susceptibility of PA remained consistent during the 5-year study. The relationship between PA isolate susceptibilities and clinical outcomes is complex; reduced susceptibility was not associated with accelerated decline in lung function, but was associated with more exacerbations and hospitalizations, likely reflecting increased overall antibiotic exposure.

Download Full-text

Strengths, Pitfalls, and Lessons from Longitudinal Childhood Asthma Cohorts of Children Followed Up into Adult Life

BioMed Research International ◽

10.1155/2016/2694060 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Andrew Tai

Keyword(s):

Lung Function ◽

Cohort Studies ◽

Longitudinal Studies ◽

Clinical Outcomes ◽

Childhood Asthma ◽

Adult Life ◽

Future Directions ◽

Insight Into

Asthma is a common problem worldwide and longitudinal studies of children followed up into adult life enable the assessment of clinical outcomes, examine the pattern of lung function outcomes, and importantly provide insight into aetiology and prognosis for patients with asthma. The aim of this review is to examine the major childhood asthma cohort studies which have continued into adult life, describing the strengths and weaknesses and the lessons that can be learnt regarding pathophysiology and potential future directions for research.

Download Full-text

Characterising a Weight Loss Intervention in Obese Asthmatic Children

Nutrients ◽

10.3390/nu12020507 ◽

2020 ◽

Vol 12 (2) ◽

pp. 507

Author(s):

Shaun Eslick ◽

Megan E. Jensen ◽

Clare E. Collins ◽

Peter G. Gibson ◽

Jodi Hilton ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Lung Function ◽

Clinical Outcomes ◽

Asthma Control ◽

Diet Quality ◽

Activity Level ◽

Weight Loss Intervention ◽

Z Score ◽

Asthmatic Children

The prevalence of obesity in asthmatic children is high and is associated with worse clinical outcomes. We have previously reported that weight loss leads to improvements in lung function and asthma control in obese asthmatic children. The objectives of this secondary analysis were to examine: (1) changes in diet quality and (2) associations between the baseline subject characteristics and the degree of weight loss following the intervention. Twenty-eight obese asthmatic children, aged 8–17 years, completed a 10-week diet-induced weight loss intervention. Dietary intake, nutritional biomarkers, anthropometry, lung function, asthma control, and clinical outcomes were analysed before and after the intervention. Following the intervention, the body mass index (BMI) z-score decreased (Δ = 0.18 ± 0.04; p < 0.001), %energy from protein increased (Δ = 4.3 ± 0.9%; p = 0.002), and sugar intake decreased (Δ = 23.2 ± 9.3 g; p= 0.025). Baseline lung function and physical activity level were inversely associated with Δ% fat mass. The ΔBMI z-score was negatively associated with physical activity duration at baseline. Dietary intervention is effective in achieving acute weight loss in obese asthmatic children, with significant improvements in diet quality and body composition. Lower lung function and physical engagement at baseline were associated with lesser weight loss, highlighting that subjects with these attributes may require greater support to achieve weight loss goals.

Download Full-text

The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients

10.21203/rs.3.rs-21076/v1 ◽

2020 ◽

Author(s):

Meng-Fang Wu ◽

Tsai-Yu Wang ◽

Da-Shen Chen ◽

Shou-Fong Shiao ◽

Han-Chuang Hu ◽

...

Keyword(s):

Cardiac Surgery ◽

Chest Pain ◽

Lung Function ◽

Clinical Outcomes ◽

Tertiary Hospital ◽

Forced Expiratory Volume ◽

Pulmonary Complications ◽

Positive Pressure ◽

Lung Expansion ◽

Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy.Methods: This retrospective study included 48 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two type of positive pressure devices, MI-E (n=20) or IPPB (n=28). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups.Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.9±4.96 % vs. 45.21±3.60 %, p=0.026), forced expiratory volume in one second (63.35±5.4 % vs. 45.48±3.63 %, p=0.007), and peak flow rate (68.5±5.53 % vs. 54.75±4.11 %, p=0.047). However, the incidence of chest pain was higher in the MI-E group (n=13, 65%) than in the IPPB group (n=4, 14.3%; odds ratio, 11.14, 95% confidence interval, 2.74-45.26; p=0.001). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups.Conclusion: Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with improved pulmonary function and higher incidence of chest pain.

Download Full-text

Variation in lung function is associated with worse clinical outcomes in cystic fibrosis

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000006 ◽

2015 ◽

Vol 41 (6) ◽

pp. 509-515 ◽

Cited By ~ 4

Author(s):

João Paulo Heinzmann-Filho ◽

Leonardo Araujo Pinto ◽

Paulo José Cauduro Marostica ◽

Márcio Vinícius Fagundes Donadio

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Clinical Outcomes ◽

Hospital Admissions ◽

Antibiotic Use ◽

Coefficient Of Determination ◽

First Year ◽

The Third ◽

One Year ◽

Fev1 Decline

ABSTRACT OBJECTIVE: To determine whether the variation in lung function over one year is associated with worse clinical outcomes, as well as with a decline in lung function in the following years, in patients with cystic fibrosis (CF). METHODS: This was a retrospective study involving CF patients (4-19 years of age), evaluated over a three-year period. We evaluated demographic characteristics, chronic Pseudomonas aeruginosa infection, antibiotic use, hospitalization, six-minute walk distance (6MWD), and lung function. The inclusion criterion was having undergone pulmonary function testing at least three times in the first year and at least once in each of the next two years. RESULTS: We evaluated 35 CF patients. The variation in FEV1 in the first year (FEV1) was greater among those who, in the third year, showed reduced FEV1, had a below-average 6MWD, or were hospitalized than among those with normal FEV1, normal 6MWD, or no hospital admissions, in that same year (p < 0.05), although no such difference was found for antibiotic use in the third year. Subjects showing a FEV1 ≥ 10% also showed a greater decline in FEV1 over the two subsequent years (p = 0.04). The FEV1 also showed an inverse correlation with absolute FEV1 in the third year (r = −0.340, p = 0.04) and with the rate of FEV1 decline (r = −0.52, p = 0.001). Linear regression identified FEV1 as a predictor of FEV1 decline (coefficient of determination, 0.27). CONCLUSIONS: Significant variation in lung function over one year seems to be associated with a higher subsequent rate of FEV1 decline and worse clinical outcomes in CF patients. Short-term FEV1 might prove useful as a predictor of CF progression in clinical practice.

Download Full-text

The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients: A Pilot Study

10.21203/rs.3.rs-21076/v2 ◽

2020 ◽

Author(s):

Meng-Fang Wu ◽

Tsai-Yu Wang ◽

Da-Shen Chen ◽

Hsiu-Fong Hsiao ◽

Han-Chuang Hu ◽

...

Keyword(s):

Cardiac Surgery ◽

Chest Pain ◽

Lung Function ◽

Clinical Outcomes ◽

Tertiary Hospital ◽

Forced Expiratory Volume ◽

Pulmonary Complications ◽

Positive Pressure ◽

Lung Expansion ◽

Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods: This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n=21) or IPPB (n=30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4±4.74 % vs. 46.0±3.70 %, p=0.042), forced expiratory volume in one second (62.4±5.23 % vs. 46.8±3.83 %, p=0.017), and peak flow rate (67.1±5.53 L vs. 55.7±4.44 L p=0.111). However, the incidence of chest pain was higher in the MI-E group (n=13, 61.9%) than in the IPPB group (n=4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03-0.45; p=0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion : Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

Download Full-text