The impact of birth weight on the level of lung function and lung function decline in the general adult population. The Inter99 study

Abstract Background Wheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. Methods We recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions. Results Twenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09–1.30), female gender (1.45, 1.2–1.8), self-reported asthma (1.36, 1.00–1.83), and current smoking (1.70, 1.28–2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57–1.99), current smoking, (1.94, 1.40–2.69), mMRC ≥2 (1.79, 1.18–2.65), SpO2 (0.88, 0.81–0.96), and FEV1 Z-score (0.86, 0.77–0.95). Conclusions Nearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.

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Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment

Nutrients ◽

10.3390/nu11061357 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1357 ◽

Cited By ~ 14

Author(s):

Egeria Scoditti ◽

Marika Massaro ◽

Sergio Garbarino ◽

Domenico Maurizio Toraldo

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Lung Function ◽

Pulmonary Disease ◽

Dietary Patterns ◽

Scientific Evidence ◽

Chronic Obstructive ◽

Lung Function Decline ◽

Obstructive Pulmonary Disease ◽

Prevention And Treatment ◽

The Impact

Chronic obstructive pulmonary disease is one of the leading causes of morbidity and mortality worldwide and a growing healthcare problem. Identification of modifiable risk factors for prevention and treatment of COPD is urgent, and the scientific community has begun to pay close attention to diet as an integral part of COPD management, from prevention to treatment. This review summarizes the evidence from observational and clinical studies regarding the impact of nutrients and dietary patterns on lung function and COPD development, progression, and outcomes, with highlights on potential mechanisms of action. Several dietary options can be considered in terms of COPD prevention and/or progression. Although definitive data are lacking, the available scientific evidence indicates that some foods and nutrients, especially those nutraceuticals endowed with antioxidant and anti-inflammatory properties and when consumed in combinations in the form of balanced dietary patterns, are associated with better pulmonary function, less lung function decline, and reduced risk of COPD. Knowledge of dietary influences on COPD may provide health professionals with an evidence-based lifestyle approach to better counsel patients toward improved pulmonary health.

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Asthma progression and mortality: the role of inhaled corticosteroids

European Respiratory Journal ◽

10.1183/13993003.00491-2019 ◽

2019 ◽

Vol 54 (1) ◽

pp. 1900491 ◽

Cited By ~ 16

Author(s):

Paul O'Byrne ◽

Leonardo M. Fabbri ◽

Ian D. Pavord ◽

Alberto Papi ◽

Stefano Petruzzelli ◽

...

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Inhaled Corticosteroids ◽

Administrative Databases ◽

Rapid Decline ◽

Lung Function Decline ◽

The Impact ◽

Asthma Mortality

Overall, asthma mortality rates have declined dramatically in the last 30 years, due to improved diagnosis and to better treatment, particularly in the 1990s following the more widespread use of inhaled corticosteroids (ICSs). The impact of ICS on other long-term outcomes, such as lung function decline, is less certain, in part because the factors associated with these outcomes are incompletely understood. The purpose of this review is to evaluate the effect of pharmacological interventions, particularly ICS, on asthma progression and mortality. Furthermore, we review the potential mechanisms of action of pharmacotherapy on asthma progression and mortality, the effects of ICS on long-term changes in lung function, and the role of ICS in various asthma phenotypes.Overall, there is compelling evidence of the value of ICS in improving asthma control, as measured by improved symptoms, pulmonary function and reduced exacerbations. There is, however, less convincing evidence that ICS prevents the decline in pulmonary function that occurs in some, although not all, patients with asthma. Severe exacerbations are associated with a more rapid decline in pulmonary function, and by reducing the risk of severe exacerbations, it is likely that ICS will, at least partially, prevent this decline. Studies using administrative databases also support an important role for ICS in reducing asthma mortality, but the fact that asthma mortality is, fortunately, an uncommon event makes it highly improbable that this will be demonstrated in prospective trials.

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A cluster-based analysis evaluating the impact of comorbidities in fibrotic interstitial lung disease

Respiratory Research ◽

10.1186/s12931-020-01579-7 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Alyson W. Wong ◽

Tae Yoon Lee ◽

Kerri A. Johannson ◽

Deborah Assayag ◽

Julie Morisset ◽

...

Keyword(s):

Interstitial Lung Disease ◽

Lung Function ◽

Pulmonary Fibrosis ◽

Lung Disease ◽

Disease Progression ◽

Rapid Decline ◽

Agglomerative Clustering ◽

Lung Function Decline ◽

Obstructive Sleep ◽

The Impact

Abstract Background Comorbidities are frequent and have been associated with poor quality of life, increased hospitalizations, and mortality in patients with interstitial lung disease (ILD). However, it is unclear how comorbidities lead to these negative outcomes and whether they could influence ILD disease progression. The goal of this study was to identify clusters of patients based on similar comorbidity profiles and to determine whether these clusters were associated with rate of lung function decline and/or mortality. Methods Patients with a major fibrotic ILD (idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis, connective tissue disease-associated ILD, and unclassifiable ILD) from the CAnadian REgistry for Pulmonary Fibrosis (CARE-PF) were included. Hierarchical agglomerative clustering of comorbidities, age, sex, and smoking pack-years was conducted for each ILD subtype to identify combinations of these features that frequently occurred together in patients. The association between clusters and change in lung function over time was determined using linear mixed effects modeling, with adjustment for age, sex, and smoking pack-years. Kaplan Meier curves were used to assess differences in survival between the clusters. Results Discrete clusters were identified within each fibrotic ILD. In IPF, males with obstructive sleep apnea (OSA) had more rapid decline in FVC %-predicted (− 11.9% per year [95% CI − 15.3, − 8.5]) compared to females without any comorbidities (− 8.1% per year [95% CI − 13.6, − 2.7]; p = 0.03). Females without comorbidities also had significantly longer survival compared to all other IPF clusters. There were no significant differences in rate of lung function decline or survival between clusters in the other fibrotic ILD subtypes. Conclusions The combination of male sex and OSA may portend worse outcomes in IPF. Further research is required to elucidate the interplay between sex and comorbidities in ILD, as well as the role of OSA in ILD disease progression.

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A longitudinal study characterising a large adult primary ciliary dyskinesia population

European Respiratory Journal ◽

10.1183/13993003.00209-2016 ◽

2016 ◽

Vol 48 (2) ◽

pp. 441-450 ◽

Cited By ~ 54

Author(s):

Anand Shah ◽

Amelia Shoemark ◽

Stephanie J. MacNeill ◽

Basrull Bhaludin ◽

Andrew Rogers ◽

...

Keyword(s):

Lung Function ◽

Disease Progression ◽

Primary Ciliary Dyskinesia ◽

Adult Population ◽

Age At Diagnosis ◽

Lung Function Decline ◽

High Resolution Computed Tomography ◽

Large Adult ◽

Ciliary Dyskinesia ◽

Ciliary Ultrastructure

Primary ciliary dyskinesia (PCD) in adults has not been well described. In this retrospective observational study we aimed to characterise a large adult population and identify features associated with disease progression.We retrospectively analysed 151 adult patients at a single tertiary centre at baseline and longitudinally for a median of 7 years.We found significant variation in age at diagnosis (median 23.5 years; range <1–72 years). Older age at diagnosis was associated with impaired baseline forced expiratory volume in 1 s (FEV1) (r= −0.30, p=0.01) and increased Pseudomonas aeruginosa colonisation (difference in medians 17 years (95% CI 4.5–20 years); p=0.002). Lung function decline was estimated at FEV1 decline of 0.49% predicted per year. Lung function decline was associated with ciliary ultrastructure, with microtubular defect patients having the greatest decline (p=0.04). High-resolution computed tomography (HRCT) scores of severity of bronchial wall dilatation (p<0.001) and extent of bronchiectasis (p=0.03) additionally showed evidence of modifying FEV1 decline with age.Our study reveals that a large proportion of adult PCD patients are diagnosed late, with impaired FEV1 and increased P. aeruginosa colonisation. Increased disease burden on HRCT and ciliary ultrastructure may predict progressive lung function decline. This study characterises a large adult PCD population, identifies features associated with disease progression and highlights the need for prospective trials to determine whether early diagnosis of high-risk subgroups alongside optimal management can modify disease progression.

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COVID-19 and loneliness: A rapid systematic review

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211031489 ◽

2021 ◽

pp. 000486742110314

Author(s):

Nagesh Pai ◽

Shae-Leigh Vella

Keyword(s):

Mental Health ◽

Systematic Review ◽

Adult Population ◽

Future Research ◽

Inclusion Criteria ◽

Physical And Mental Health ◽

Health And Wellbeing ◽

General Adult Population ◽

Key Terms ◽

The Impact

Background: Loneliness is known to be associated with both poorer physical and mental health, being associated with increased mortality. Responses throughout the world to the current COVID-19 pandemic all incorporate varying degrees of social distancing and isolation. There is an imperative to provide a timely review and synthesis of the impact of COVID-19 on loneliness in the general population. Methods: PubMed was searched using the key terms ‘COVID-19’, ‘coronavirus’, ‘SARS-COV2’ and ‘loneliness’. Fifty-four articles were identified and screened against the inclusion criteria. The inclusion criteria stipulated that the study needed to incorporate a measure of loneliness with participants being drawn from the general adult population. Twenty-four studies met the inclusion criteria. Results: The key data extracted from the 24 reviewed studies are presented and summarised with a focus on key demographics of participants, the research designs utilised, the measures of loneliness employed and the other variables assessed in the studies. Overall, the findings indicate that loneliness has been a significant issue during the current COVID-19 pandemic and loneliness is positively associated with mental health symptoms. However, there were inconsistencies in the results evident across studies. Conclusion: To our knowledge, this is the first systematic review of research investigating loneliness during the current COVID-19 pandemic in the general adult population. Despite the inconsistencies evident in some of the results across the studies, it is clearly apparent that loneliness is having an impact on the mental health and wellbeing of the general adult population. Furthermore, it is apparent that the current COVID-19 pandemic has had an impact on loneliness in the general adult population and that loneliness is significantly positively associated with mental illness symptomatology. Thus, there is an imperative to address loneliness through public policy and interventions. The limitations of this review are noted and directions given for future research.

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The Impact of Diagnosed and Undiagnosed Current Asthma in the General Adult Population

International Archives of Allergy and Immunology ◽

10.1159/000320780 ◽

2011 ◽

Vol 155 (4) ◽

pp. 403-411 ◽

Cited By ~ 7

Author(s):

Simone Accordini ◽

Veronica Cappa ◽

Marco Braggion ◽

Angelo G. Corsico ◽

Massimiliano Bugiani ◽

...

Keyword(s):

Adult Population ◽

Current Asthma ◽

General Adult Population ◽

The Impact

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Aspergillus and progression of lung disease in children with cystic fibrosis

Thorax ◽

10.1136/thoraxjnl-2018-211550 ◽

2018 ◽

Vol 74 (2) ◽

pp. 125-131 ◽

Cited By ~ 15

Author(s):

Sabariah Noor Harun ◽

Claire E Wainwright ◽

Keith Grimwood ◽

Stefanie Hennig

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Bronchoalveolar Lavage ◽

Lung Disease ◽

Lung Function Decline ◽

Air Trapping ◽

Cross Sectional ◽

Progression Model ◽

Non Linear ◽

The Impact

BackgroundThe impact of Aspergillus on lung disease in young children with cystic fibrosis is uncertain.AimsTo determine if positive respiratory cultures of Aspergillus species are associated with: (1) increased structural lung injury at age 5 years; (2) accelerated lung function decline between ages 5 years and 14 years and (3) to identify explanatory variables.MethodsA cross-sectional analysis of association between Aspergillus positive bronchoalveolar lavage (BAL) cultures and chest high-resolution CT (HRCT) scan findings at age 5 years in subjects from the Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) study was performed. A non-linear mixed-effects disease progression model was developed using FEV1% predicted measurements at age 5 years from the ACFBAL study and at ages 6–14 years for these subjects from the Australian Cystic Fibrosis Data Registry.ResultsPositive Aspergillus BAL cultures at age 5 years were significantly associated with increased HRCT scores for air trapping (OR 5.53, 95% CI 2.35 to 10.82). However, positive Aspergillus cultures were not associated with either FEV1% predicted at age 5 years or FEV1% predicted by age following adjustment for body mass index z-score and hospitalisation secondary to pulmonary exacerbations. Lung function demonstrated a non-linear decline in this population.ConclusionIn children with cystic fibrosis, positive Aspergillus BAL cultures at age 5 years were associated contemporaneously with air trapping but not bronchiectasis. However, no association was observed between positive Aspergillus BAL cultures on FEV1% predicted at age 5 years or with lung function decline between ages 5 years and 14 years.

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