scholarly journals Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

2020 ◽  
Vol 14 ◽  
pp. 175346662096303
Author(s):  
Hayoung Choi ◽  
Hyun Lee ◽  
Jiin Ryu ◽  
Sung Jun Chung ◽  
Dong Won Park ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Respiratory Diseases ◽  
Chronic Obstructive ◽  
Study Cohort ◽  
Limited Information ◽  
Term Survival ◽  
Obstructive Pulmonary Disease ◽  
All Cause Mortality ◽  
The Impact

Background: Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma. Methods: A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis. Results: The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 versus 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18–1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42–1.92). Conclusions: Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival. The reviews of this paper are available via the supplemental material section.

scholarly journals The impact of the long-term exposure of industrial aerosols on clinical and functional indices of the broncho-pulmonary system in aluminum smelter workers

2019 ◽  
Vol 95 (12) ◽  
pp. 1160-1163 ◽  
Author(s):  
Elena A. Beygel ◽  
E. V. Katamanova ◽  
S. F. Shayakhmetov ◽  
O. V. Ushakova ◽  
N. A. Pavlenko ◽  
...  
Keyword(s):  
Respiratory Diseases ◽  
Chronic Obstructive ◽  
Bronchial Obstruction ◽  
Moderate Degree ◽  
Aluminum Smelter ◽  
Obstructive Pulmonary Disease ◽  
Complex Chemical Composition ◽  
The Impact ◽  
Functional Indices

It was found that the appearance of respiratory diseases among workers was established to be associated with the impact of aerosols with the complex chemical composition, exceeding corresponding MAC. Among respiratory diseases in workers there were detected predominantly chronic non-obstructive bronchitis - 59.15%, and chronic obstructive pulmonary disease (COPD) - in 35.2% of cases. In the analysis of spirometric indices of examined patients the vast majority (76.3%) of them showed disturbances of the bronchial patency of mild to moderate degree of the pronouncement. As a result of the implementation offlexible bronchoscopy there was established the presence of a diffuse lesion of bronchi with a predominance of subatrophic and atrophic processes in the mucosa. It was found that under the increase of the concentration of HF in the air of industrial premises the probability of bronchial obstruction and deterioration of the tracheobronchial patency in aluminum smelter workers was established to elevate.

scholarly journals The Impact of Chronic Obstructive Pulmonary Disease on Long-Term Survival Following Coronary Artery Bypass Grafting

CHEST Journal ◽  
2004 ◽  
Vol 126 (4) ◽  
pp. 733S
Author(s):  
Ioannis K. Toumpoulis ◽  
Constantine E. Anagnostopoulos ◽  
Robert C. Ashton ◽  
Cliff P. Connery ◽  
Joseph J. DeRose ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Chronic Obstructive ◽  
Bypass Grafting ◽  
Term Survival ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Hazards for Construction Workers

2017 ◽  
Author(s):  
Gavin H. West ◽  
Laura S. Welch
Keyword(s):  
Heavy Metals ◽  
Prevention And Control ◽  
Respiratory Diseases ◽  
Noise Exposure ◽  
Engineered Nanomaterials ◽  
Construction Workers ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
And Control ◽  
The Impact

This chapter describes the hazards for construction workers, with a particular focus on injuries as well as exposures to hazardous chemicals and dusts. A section describes hazardous exposures to lead and other heavy metals. Another section describes noise exposure. The impact of musculoskeletal disorders among construction workers is then discussed. A section on respiratory diseases focuses on asbestosis, silicosis, chronic obstructive pulmonary disease, and asthma. Exposures known to cause dermatitis and cancer are reviewed. There is a discussion of engineered nanomaterials as a potential emerging hazard. Various approaches to prevention and control, including regulations and health services, are described.

scholarly journals Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara C. Auld ◽  
Hardy Kornfeld ◽  
Pholo Maenetje ◽  
Mandla Mlotshwa ◽  
William Chase ◽  
...  
Keyword(s):  
Lung Function ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Pulmonary Impairment ◽  
Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

scholarly journals Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction—A Nationwide Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sheng-Fu Liu ◽  
Chih-Kuo Lee ◽  
Kuan-Chih Huang ◽  
Lian-Yu Lin ◽  
Mu-Yang Hsieh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Protective Effect ◽  
Lower Risk ◽  
Beta Blockers ◽  
Term Survival ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
The Impact

Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

P3584Optimal medical therapy improves survival in patients with ischaemic cardiomyopathy: an analysis of the STICH trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Wolfe ◽  
J D Mitchell ◽  
D L Brown
Keyword(s):  
Clinical Trial ◽  
Coronary Artery ◽  
Medical Therapy ◽  
Relative Reduction ◽  
Term Survival ◽  
Ischaemic Cardiomyopathy ◽  
All Cause Mortality ◽  
Stich Trial ◽  
The Impact

Abstract Background Prior studies have demonstrated underuse of optimal medical therapy (OMT) in patients with coronary artery disease (CAD) after revascularization. However, there are limited studies assessing compliance with OMT on long-term survival in patients with CAD and no studies evaluating the impact of OMT in patients with severe CAD and reduced left ventricular (LV) function. The Surgical Treatment for Ischaemic Heart Failure (STICH) Trial was a randomized clinical trial that compared coronary-artery bypass grafting (CABG) with medical therapy versus medical therapy alone in the treatment of ischemic cardiomyopathy. Purpose This study sought to determine compliance with OMT over time and the impact of OMT compliance on survival in patients with or without revascularization. Methods STICH was a multicenter, randomized clinical trial of patients with an LV ejection fraction of 35% or less and CAD amenable to CABG who were randomized to CABG plus medical therapy (N=610) or medical therapy alone (N=602). A medication history was obtained at hospital discharge or 30 days after enrollment, 1 year, 5 years, and 10 years. OMT was defined as the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcome was all-cause mortality. Comparison of mortality between the OMT and non-OMT groups was performed using multivariate Cox regression modeling with OMT as a time-dependent covariate. Results Of the 1212 patients randomized, at a median follow-up of 9.8 years, all-cause mortality was 58.9% in the CABG group and 66.1% in the medical therapy group. In the CABG arm, 63.6% of patients were on OMT throughout the study period compared to 66.5% of patients in the medical therapy arm (p=0.3). Those on OMT were younger (59.6 vs. 61.4 years, p<0.001); were more often in NYHA class I-II (67.4% vs. 56%, p<0.001); and lower rates of atrial fibrillation (9.4% vs. 18.1%, p<0.001), current smoking (18.6% vs. 24.5%, p=0.015), and depression (4.8% vs. 8.8%, p=0.005). Those on OMT had higher rates of hyperlipidemia (63.8% vs. 54.4%, p=0.001) and prior myocardial infarction (79.4% vs. 73.1%, p=0.01). There was no difference in sex, diabetes, and hypertension between those on OMT and non-OMT. In multivariate survival analysis, OMT was associated with a significant reduction in mortality (adjusted hazard ratio, 0.69; 95% confidence interval, 0.58–0.81; p<0.001). The treatment effect with OMT (31% relative reduction in mortality over 10 years) was numerically greater than the treatment effect of CABG (24% relative reduction in mortality with CABG versus medical therapy alone). Conclusions OMT improves long-term survival in patients with ischaemic cardiomyopathy regardless of revascularization status. Strategies to improve OMT use and adherence in this population is needed to maximize survival.

scholarly journals Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial

2019 ◽  
Vol 6 (4) ◽  
pp. 222-230
Author(s):  
Mariusz Tomaniak ◽  
Ply Chichareon ◽  
Kuniaki Takahashi ◽  
Norihiro Kogame ◽  
Rodrigo Modolo ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Aims To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence. Methods and results This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm. Conclusion In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected. Clinical trial registration unique identifier NCT01813435.

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