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Mashup Score: 4Epidemiology of idiopathic pulmonary fibrosis: opportunities and hurdles for population-level studies of rare disease - 12 hour(s) ago
Idiopathic pulmonary fibrosis (IPF) is a rare condition for which reliable disease trends over time can be difficult to obtain. Understanding the epidemiology of IPF is crucial given its impact on quality of life and productivity of affected individuals and their families,1 as well as substantial costs to the healthcare system.2 The occurrence of IPF over time has likely changed with growing awareness of the disease, the advent of antifibrotic therapies that slow disease progression and multiple promising clinical trials that may alter the disease’s natural history. Knowledge of the incidence and prevalence of IPF informs healthcare needs, which range from access to specialists and pharmacotherapy to availability of hospice and resources for end-of-life care. Although smaller studies based on primary sources (eg, medical chart review) exist,3 4 many epidemiological studies on IPF have used patient registries.5 Clinical registries allow for increased accuracy in case identification and
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Mashup Score: 1
Estimates of lung cancer among persons who never smoked are 10%–20% in the USA, translating into 20–40 000 cases annually. Globally, and especially in East Asia, the incidence of lung cancer among non-tobacco users is considerably higher than in the USA, especially in women.1 The causes of lung cancer in lifelong never-smokers are not well understood. Possibilities include exposure to other carcinogens such as air pollution, radon, occupational exposures, secondhand tobacco smoke, genetic mutations, infections and hormonal imbalances. A mechanistic explanation may include epigenetic modifications from accumulated DNA damage as part of the ageing process. Some studies have shown that epigenetic age, or DNA methylation markers may be a better indicator of biological age than simple chronological age.2 3 Genes that are silenced, like the tumour suppressor gene p53, can lead to increased cancer risk. DNA methylation, the addition of methyl groups to DNA mainly along sequences, results in s
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Mashup Score: 12
Background Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled asthma. Methods Patients with current asthma (aged ≥12 years) registered with the Clinical Practice Research Datalink (2008‒2019) were included. GHG emissions, measured as carbon dioxide equivalent (CO2e), were estimated for asthma-related medication use, HCRU and exacerbations during follow-up of patients with asthma classified at baseline as well-controlled (<3 short-acting β2-agonist (SABA) canisters/year and no exacerbations) or poorly controlled (≥3 SABA canisters/year or ≥1 exacerbation). Excess GHG emissions due to suboptimal asthma control included ≥3 SABA canister prescriptions/year,
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Mashup Score: 21Randomised controlled trial for the titration of oral corticosteroids using markers of inflammation in severe asthma - 2 day(s) ago
Introduction Biomarkers are used to select biologic therapies for patients with severe asthma, but not to regularly adjust therapy, especially oral corticosteroids (OCS). Objective Our goal was to test the efficacy of an algorithm to guide the titration of OCS using blood eosinophil count and fraction of exhaled nitric oxide (FeNO) levels. Design, participants, interventions and setting This proof-of-concept prospective randomised controlled trial assigned adult participants with severe uncontrolled asthma (n=32) to biomarker-based management (BBM) where OCS dose was adjusted based on a composite biomarker score comprised of blood eosinophil count and FeNO, or a standard best practice (SBP) arm. The study was conducted at the Hunter Medical Research Institute, Newcastle, Australia. Participants were recruited from the local Severe Asthma Clinic and were blinded to their study allocation. Main outcome The coprimary outcomes were number of severe exacerbations and time to first severe ex
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Mashup Score: 29Effect of obesity on airway and systemic inflammation in adults with asthma: a systematic review and meta-analysis - 2 day(s) ago
Background Obesity is associated with more severe asthma, however, the mechanisms responsible are poorly understood. Obesity is also associated with low-grade systemic inflammation; it is possible that this inflammation extends to the airways of adults with asthma, contributing to worse asthma outcomes. Accordingly, the aim of this review was to examine whether obesity is associated with increased airway and systemic inflammation and adipokines, in adults with asthma. Methods Medline, Embase, CINAHL, Scopus and Current Contents were searched till 11 August 2021. Studies reporting measures of airway inflammation, systemic inflammation and/or adipokines in obese versus non-obese adults with asthma were assessed. We conducted random effects meta-analyses. We assessed heterogeneity using the I2 statistic and publication bias using funnel plots. Results We included 40 studies in the meta-analysis. Sputum neutrophils were 5% higher in obese versus non-obese asthmatics (mean difference (MD)=5
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Mashup Score: 15Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma - 3 day(s) ago
Background Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations. Methods Primary care medical records, 2004–2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5–8 years, 9–11 years and adolescents (12–16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations. Results 119 611 children were eligible: 61 940 (51.8%) 5–8 years, 32 316 (27.7%) 9–11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5–8 years had the highest proportion with eczema, food/drug allergy and cough, but
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Mashup Score: 23Cardiac MRI in the assessment of chronic thromboembolic pulmonary hypertension and response to treatment - 4 day(s) ago
Chronic thromboembolic pulmonary disease (CTEPD) arises in patients with prior pulmonary embolism who do not clear the obstructive material from the pulmonary circulation and may experience persistently raised pulmonary pressures (chronic thromboembolic pulmonary hypertension, CTEPH) and right heart failure. CTEPH affects between 1% and 9% of patients following a single episode of pulmonary embolism.1 The diagnosis of CTEPD requires characteristic radiological appearances, at least 3 months of anticoagulation therapy, and the diagnosis of concomitant pulmonary hypertension requires mean pulmonary artery pressure (mPAP)>20 mm Hg and pulmonary vascular resistance (PVR)>2 Wood units with a pulmonary capillary wedge pressure≤15 mm Hg.2 3 The literature included in this review is based on the previous threshold of mPAP>25 mm Hg for the diagnosis of CTEPH4 Surgical pulmonary endarterectomy (PEA) has offered a breakthrough by improving the 3-year survival to 89% vs 70% with medical management
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Mashup Score: 33Unilateral pleural effusion with pulmonary hypertension in sarcoidosis: do not forget the pulmonary veins! - 4 day(s) ago
A 64-year-old woman presented with exertional dyspnoea and ankle oedema. She had lung biopsy-confirmed sarcoidosis 6 years previously, having initially responded to prednisolone, with clinical stability for several years. Pulmonary function tests (PFTs) showed forced expiratory volume in 1 s, 2 litres; forced vital capacity, 2.5 litres; and carbon monoxide transfer factor, 4.03 (49.2% predicted). Chest radiography showed Scadding stage 4 sarcoidosis with prominent hila and coarse reticulation throughout both lungs. CT showed stable fibrotic features and ground-glass opacification, new right lower lobe interlobular septal thickening and right-sided pleural effusion (figure 1A). Echocardiography suggested severe pulmonary hypertension (PH) (estimated right ventricular (RV) systolic pressure 68 mm Hg) with RV dilatation, with confirmed precapillary haemodynamics on right heart catheterisation. Cardiac MRI revealed abnormal remodelling of the RV (without evidence of cardiac sarcoidosis); c
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Mashup Score: 8
Background Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). We aimed to evaluate the impact of a symptom screening programme to detect CTEPH in PE survivors. Methods This was a multicentre cohort study of patients diagnosed with acute symptomatic PE between January 2017 and December 2018 in 16 centres in Spain. Patients were contacted by phone 2 years after the index PE diagnosis. Those with dyspnoea corresponding to a New York Heart Association (NYHA)/WHO scale≥II, visited the outpatient clinic for echocardiography and further diagnostic tests including right heart catheterisation (RHC). The primary outcome was the new diagnosis of CTEPH confirmed by RHC. Results Out of 1077 patients with acute PE, 646 were included in the symptom screening. At 2 years, 21.8% (n=141) reported dyspnoea NYHA/WHO scale≥II. Before symptom screening protocol, five patients were diagnosed with CTEPH following routine care. In p
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Mashup Score: 26Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk - 6 day(s) ago
Rationale Lung function in early adulthood is associated with subsequent adverse health outcomes. Objectives To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function. Methods Using latent profile modelling, we studied three population-based birth cohorts with repeat spirometry data from childhood into early adulthood to identify trajectories of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used multinomial logistic regression models to investigate early-life predictors of the derived trajectories. We then ascertained the extent of the association between the derived FEV1/FVC trajectories and blood pressure and echocardiographic markers of increased cardiovascular risk and stroke in ~3200 participants at age 24 years in one of our cohorts. Results We identified four FEV1/FVC trajectories with strikingly similar
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Editorial: Epidemiology of idiopathic pulmonary fibrosis: opportunities and hurdles for population-level studies of rare disease https://t.co/6H0Qtck5a2