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Adv. Respir. Med., Volume 92, Issue 1 (February 2024) – 13 articles

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14 pages, 319 KiB  
Review
The Growing Understanding of the Pituitary Implication in the Pathogenesis of Long COVID-19 Syndrome: A Narrative Review
by Ach Taieb, Ben Haj Slama Nassim, Gorchane Asma, Methnani Jabeur, Saad Ghada and Ben Abdelkrim Asma
Adv. Respir. Med. 2024, 92(1), 96-109; https://doi.org/10.3390/arm92010013 - 14 Feb 2024
Cited by 1 | Viewed by 1433
Abstract
Long COVID-19, also known as post-acute sequelae of SARS-CoV-2 infection, is a condition where individuals who have recovered from the acute phase of COVID-19 continue to experience a range of symptoms for weeks or even months afterward. While it was initially thought to [...] Read more.
Long COVID-19, also known as post-acute sequelae of SARS-CoV-2 infection, is a condition where individuals who have recovered from the acute phase of COVID-19 continue to experience a range of symptoms for weeks or even months afterward. While it was initially thought to primarily affect the respiratory system, it has become clear that Long COVID-19 can involve various organs and systems, including the endocrine system, which includes the pituitary gland. In the context of Long COVID-19, there is a growing understanding of the potential implications for the pituitary gland. The virus can directly affect the pituitary gland, leading to abnormalities in hormone production and regulation. This can result in symptoms such as fatigue, changes in appetite, and mood disturbances. Long COVID-19, the persistent and often debilitating condition following acute COVID-19 infection, may be explained by deficiencies in ACTH and Growth hormone production from the pituitary gland. Corticotropin insufficiency can result in the dysregulation of the body’s stress response and can lead to prolonged feelings of stress, fatigue, and mood disturbances in Long COVID-19 patients. Simultaneously, somatotropin insufficiency can affect growth, muscle function, and energy metabolism, potentially causing symptoms such as muscle weakness, exercise intolerance, and changes in body composition. Recently, some authors have suggested the involvement of the pituitary gland in Post COVID-19 Syndrome. The exact mechanisms of viral action on infected cells remain under discussion, but inflammatory and autoimmune mechanisms are primarily implicated. The aim of our study will be to review the main pituitary complications following COVID-19 infection. Moreover, we will explain the possible involvement of the pituitary gland in the persistence of Post COVID-19 Syndrome. Full article
4 pages, 950 KiB  
Commentary
Administering Nitric Oxide (NO) with High Flow Nasal Cannulas: A Simple Method
by Vladimir L. Cousin, Raphael Joye and Angelo Polito
Adv. Respir. Med. 2024, 92(1), 92-95; https://doi.org/10.3390/arm92010012 - 8 Feb 2024
Cited by 1 | Viewed by 964
Abstract
Inhaled nitric oxide (iNO) is a pulmonary vasodilator that plays an important clinical ICU role. The administration of iNO is usually performed through an endotracheal tube, but spontaneously breathing patients might also benefit from iNO administration. The use of the non-invasive administration of [...] Read more.
Inhaled nitric oxide (iNO) is a pulmonary vasodilator that plays an important clinical ICU role. The administration of iNO is usually performed through an endotracheal tube, but spontaneously breathing patients might also benefit from iNO administration. The use of the non-invasive administration of iNO through high-flow nasal cannula (HFNC) allows for NO delivery in spontaneously breathing patients who still need supplemental oxygen and positive airway pressure. A simple method to administer NO through HFNC is described here using standard commercially available NO administration and HFNC. Full article
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3 pages, 882 KiB  
Correction
Correction: Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324–336
by Irini Patsaki, Vasiliki Avgeri, Theodora Rigoulia, Theodoros Zekis, George A. Koumantakis and Eirini Grammatopoulou
Adv. Respir. Med. 2024, 92(1), 89-91; https://doi.org/10.3390/arm92010011 - 1 Feb 2024
Viewed by 499
Abstract
Error in Figure 3 [...] Full article
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12 pages, 3262 KiB  
Article
Constructing a Nomogram Model to Estimate the Risk of Ventilator-Associated Pneumonia for Elderly Patients in the Intensive Care Unit
by Wensi Gan, Zhihui Chen, Zhen Tao and Wenyuan Li
Adv. Respir. Med. 2024, 92(1), 77-88; https://doi.org/10.3390/arm92010010 - 19 Jan 2024
Viewed by 1088
Abstract
Background: Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and [...] Read more.
Background: Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and validate a nomogram to estimate VAP risk to provide early intervention for high-risk patients. Methods: Between January 2016 and March 2021, 293 patients from a tertiary hospital in China were retrospectively reviewed as a training set. Another 84 patients were enrolled for model validation from April 2021 to February 2022. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis were employed to select predictors, and a nomogram model was constructed. The calibration, discrimination, and clinical utility of the nomogram were verified. Finally, a web-based online scoring system was created to make the model more practical. Results: The predictors were hypoproteinemia, long-term combined antibiotic use, intubation time, length of mechanical ventilation, and tracheotomy/intubation. The area under the curve (AUC) was 0.937 and 0.925 in the training and validation dataset, respectively, suggesting the model exhibited effective discrimination. The calibration curve demonstrated high consistency with the observed result and the estimated values. Decision curve analysis (DCA) demonstrated that the nomogram was clinically applicable. Conclusions: We have created a novel nomogram model that can be utilized to anticipate VAP risk in elderly ICU patients, which is helpful for healthcare professionals to detect patients at high risk early and adopt protective interventions. Full article
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11 pages, 262 KiB  
Review
Clinical Effectiveness of Ritonavir-Boosted Nirmatrelvir—A Literature Review
by Sydney Paltra and Tim O. F. Conrad
Adv. Respir. Med. 2024, 92(1), 66-76; https://doi.org/10.3390/arm92010009 - 18 Jan 2024
Viewed by 1124
Abstract
Nirmatrelvir/Ritonavir is an oral treatment for mild to moderate COVID-19 cases with a high risk for a severe course of the disease. For this paper, a comprehensive literature review was performed, leading to a summary of currently available data on Nirmatrelvir/Ritonavir’s ability to [...] Read more.
Nirmatrelvir/Ritonavir is an oral treatment for mild to moderate COVID-19 cases with a high risk for a severe course of the disease. For this paper, a comprehensive literature review was performed, leading to a summary of currently available data on Nirmatrelvir/Ritonavir’s ability to reduce the risk of progressing to a severe disease state. Herein, the focus lies on publications that include comparisons between patients receiving Nirmatrelvir/Ritonavir and a control group. The findings can be summarized as follows: Data from the time when the Delta-variant was dominant show that Nirmatrelvir/Ritonavir reduced the risk of hospitalization or death by 88.9% for unvaccinated, non-hospitalized high-risk individuals. Data from the time when the Omicron variant was dominant found decreased relative risk reductions for various vaccination statuses: between 26% and 65% for hospitalization. The presented papers that differentiate between unvaccinated and vaccinated individuals agree that unvaccinated patients benefit more from treatment with Nirmatrelvir/Ritonavir. However, when it comes to the dependency of potential on age and comorbidities, further studies are necessary. From the available data, one can conclude that Nirmatrelvir/Ritonavir cannot substitute vaccinations; however, its low manufacturing cost and easy administration make it a valuable tool in fighting COVID-19, especially for countries with low vaccination rates. Full article
8 pages, 798 KiB  
Article
Breathing Pattern Response after 6 Weeks of Inspiratory Muscle Training during Exercise
by Eduardo Salazar-Martínez
Adv. Respir. Med. 2024, 92(1), 58-65; https://doi.org/10.3390/arm92010008 - 17 Jan 2024
Viewed by 804
Abstract
(1) Background: The breathing pattern is defined as the relationship between the tidal volume (VT) and breathing frequency (BF) for a given VE. The aim of this study was to evaluate whether inspiratory muscle training influenced the response of the breathing pattern during [...] Read more.
(1) Background: The breathing pattern is defined as the relationship between the tidal volume (VT) and breathing frequency (BF) for a given VE. The aim of this study was to evaluate whether inspiratory muscle training influenced the response of the breathing pattern during an incremental effort in amateur cyclists. (2) Methods: Eighteen amateur cyclists completed an incremental test to exhaustion, and a gas analysis on a cycle ergometer and spirometry were conducted. Cyclists were randomly assigned to two groups (IMTG = 9; CON = 9). The IMTG completed 6 weeks of inspiratory muscle training (IMT) using a PowerBreathe K3® device at 50% of the maximum inspiratory pressure (Pimax). The workload was adjusted weekly. The CON did not carry out any inspiratory training during the experimental period. After the 6-week intervention, the cyclists repeated the incremental exercise test, and the gas analysis and spirometry were conducted. The response of the breathing pattern was evaluated during the incremental exercise test. (3) Results: The Pimax increased in the IMTG (p < 0.05; d = 3.1; +19.62%). Variables related to the breathing pattern response showed no differences between groups after the intervention (EXPvsCON; p > 0.05). Likewise, no differences in breathing pattern were found in the IMTG after training (PREvsPOST; p > 0.05). (4) Conclusions: IMT improved the strength of inspiratory muscles and sport performance in amateur cyclists. These changes were not attributed to alterations in the response of the breathing pattern. Full article
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13 pages, 1784 KiB  
Article
Pulmonary Embolism (PE) to Chronic Thromboembolic Pulmonary Disease (CTEPD): Findings from a Survey of UK Physicians
by Joanna Pepke-Zaba, Luke Howard, David G. Kiely, Shruti Sweeney and Martin Johnson
Adv. Respir. Med. 2024, 92(1), 45-57; https://doi.org/10.3390/arm92010007 - 9 Jan 2024
Viewed by 840
Abstract
Chronic thromboembolic pulmonary disease (CTEPD) is a complication of pulmonary embolism (PE). We conducted an online survey of UK PE-treating physicians to understand practices in the follow-up of PE and awareness of CTEPD. The physicians surveyed (N = 175) included 50 each [...] Read more.
Chronic thromboembolic pulmonary disease (CTEPD) is a complication of pulmonary embolism (PE). We conducted an online survey of UK PE-treating physicians to understand practices in the follow-up of PE and awareness of CTEPD. The physicians surveyed (N = 175) included 50 each from cardiology, respiratory and internal medicine, plus 25 haematologists. Most (89%) participants had local guidelines for PE management, and 65% reported a PE follow-up clinic, of which 69% were joint clinics. Almost half (47%) had a protocol for the investigation of CTEPD. According to participants, 129 (74%) routinely consider a diagnosis of CTEPD and 97 (55%) routinely investigate for CTEPD, with 76% of those 97 participants investigating in patients who are symptomatic at 3 months and 22% investigating in all patients. This survey demonstrated variability in the follow-up of PE and the awareness of CTEPD and its investigation. The findings support the conduct of a national audit to understand the barriers to the timely detection of CTEPD. Full article
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9 pages, 253 KiB  
Article
Predictive Value of Fractional Exhaled Nitric Oxide (FeNO) in the Diagnosis of Asthma for Epidemiological Purposes—An 8-Year Follow-Up Study
by Kamil Barański
Adv. Respir. Med. 2024, 92(1), 36-44; https://doi.org/10.3390/arm92010006 - 4 Jan 2024
Viewed by 884
Abstract
At the population level, respiratory symptoms in children can be estimated cross-sectionally. However, such methods require additional objective support parameters, such as the measurement of fractional exhaled nitric oxide (FeNO). The aim of the present study was to analyze if the FeNO value [...] Read more.
At the population level, respiratory symptoms in children can be estimated cross-sectionally. However, such methods require additional objective support parameters, such as the measurement of fractional exhaled nitric oxide (FeNO). The aim of the present study was to analyze if the FeNO value measured at baseline can have a predictive value for asthma-like symptoms after 8 years of measurement. Methods: The follow-up included 128 (out of 447) children, 70 girls and 58 boys. The FeNO was measured at baseline only. The prevalence of asthma-like symptoms was measured with the adopted version of the ISAAC questionnaire. Results: After 8 years of FeNO measurement, 5 new cases of asthma, 2 cases of attacks of dyspnoea, 1 case of wheezy in the chest, and 18 cases of allergic rhinitis occurred. The FeNO values, measured at the baseline of the study, for new cases of the above diseases were 53.4 ± 75.9 ppb, 11 ± 1.5 ppb, 12.0 ppb, and 16.3 ± 12.4 ppb, respectively. The best diagnostic accuracy parameters were found in the new cases of asthma, where the sensitivity was 40.0%, the specificity was 98.6%, and the AUC was 66.6%. The diagnostic odds ratio was 46.9 when considering the FeNO cut-off >35 ppb. Conclusions: The FeNO measurement is a fair method for asthma prognosis in early school-aged children with asthma-like symptoms measured on the population level but requires further confirmation at the clinical level with more accurate diagnostic tools. Full article
9 pages, 1187 KiB  
Brief Report
Expression of Inflammatory Genes in Murine Lungs in a Model of Experimental Pulmonary Hypertension: Effects of an Antibody-Based Targeted Delivery of Interleukin-9
by Judith Heiss, Katja Grün, Isabell Singerer, Laura Tempel, Mattia Matasci, Christian Jung, Alexander Pfeil, P. Christian Schulze, Dario Neri and Marcus Franz
Adv. Respir. Med. 2024, 92(1), 27-35; https://doi.org/10.3390/arm92010005 - 3 Jan 2024
Viewed by 959
Abstract
Background: Pathogenesis of pulmonary hypertension (PH) is a multifactorial process driven by inflammation and pulmonary vascular remodeling. To target these two aspects of PH, we recently tested a novel treatment: Interleukin-9 (IL9) fused to F8, an antibody that binds to the extra-domain A [...] Read more.
Background: Pathogenesis of pulmonary hypertension (PH) is a multifactorial process driven by inflammation and pulmonary vascular remodeling. To target these two aspects of PH, we recently tested a novel treatment: Interleukin-9 (IL9) fused to F8, an antibody that binds to the extra-domain A of fibronectin (EDA+ Fn). As EDA+ Fn is not found in healthy adult tissue but is expressed during PH, IL9 is delivered specifically to the tissue affected by PH. We found that F8IL9 reduced pulmonary vascular remodeling and attenuated PH compared with sham-treated mice. Purpose: To evaluate possible F8IL9 effects on PH-associated inflammatory processes, we analysed the expression of genes involved in pulmonary immune responses. Methods: We applied the monocrotaline (MCT) model of PH in mice (n = 44). Animals were divided into five experimental groups: sham-induced animals without PH (control, n = 4), MCT-induced PH without treatment (PH, n = 8), dual endothelin receptor antagonist treatment (dual ERA, n = 8), F8IL9 treatment (n = 12, 2 formats with n = 6 each), or with KSFIL9 treatment (KSFIL9, n = 12, 2 formats with n = 6 each, KSF: control antibody with irrelevant antigen specificity). After 28 days, a RT-PCR gene expression analysis of inflammatory response (84 genes) was performed in the lung. Results: Compared with the controls, 19 genes exhibited relevant (+2.5-fold) upregulation in the PH group without treatment. Gene expression levels in F8IL9-treated lung tissue were reduced compared to the PH group without treatment. This was the case especially for CCL20, CXCL5, C-reactive protein, pentraxin related (CRPPR), and Kininogen-1 (KNG1). Conclusion: In accordance with the hypothesis stated above, F8IL9 treatment diminished the upregulation of some genes associated with inflammation in a PH animal model. Therefore, we hypothesize that IL9-based immunocytokine treatment will likely modulate various inflammatory pathways. Full article
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2 pages, 175 KiB  
Reply
Reply to Salimi, M. Comment on “Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324–336”
by Irini Patsaki, Vasiliki Avgeri, Theodora Rigoulia, Theodoros Zekis, George A. Koumantakis and Eirini Grammatopoulou
Adv. Respir. Med. 2024, 92(1), 25-26; https://doi.org/10.3390/arm92010004 - 22 Dec 2023
Viewed by 558
Abstract
We are writing in response to the comment [...] Full article
10 pages, 559 KiB  
Article
The Added Value of Bronchoalveolar Lavage for Pulmonary Tuberculosis Diagnosis in High-Risk Hospitalized Patients with Negative Sputum Samples
by Ophir Freund, Yitzhac Hadad, Tomer Lagziel, Inbal Friedman Regev, Eyal Kleinhendler, Avraham Unterman, Amir Bar-Shai and Tal Moshe Perluk
Adv. Respir. Med. 2024, 92(1), 15-24; https://doi.org/10.3390/arm92010003 - 21 Dec 2023
Viewed by 1075
Abstract
Hospitalized patients with a high suspicion of pulmonary tuberculosis (HS-PTB) are isolated until a definite diagnosis can be determined. If doubt remains after negative sputum samples, bronchoscopy with bronchoalveolar lavage (BAL) is often sought. Still, evidence of the added value of BAL in [...] Read more.
Hospitalized patients with a high suspicion of pulmonary tuberculosis (HS-PTB) are isolated until a definite diagnosis can be determined. If doubt remains after negative sputum samples, bronchoscopy with bronchoalveolar lavage (BAL) is often sought. Still, evidence of the added value of BAL in this patient population is scarce. To address this issue, we included consecutive HS-PTB patients with negative sputum samples who underwent BAL between 2017 and 2018. Chest X-rays (CXR) and CT scans were evaluated by a chest radiologist blind to the final diagnosis. Independent predictors for PTB were assessed by multivariate regression, using all positive PTB patients between 2017 and 2019 (by sputum or BAL) as a control group (n = 41). Overall, 42 HS-PTB patients were included (mean age 51 ± 9, 36% female). BAL was a viable diagnostic for PTB in three (7%) cases and for other clinically relevant pathogens in six (14%). Independent predictors for PTB were ≥2 sub-acute symptoms (adjusted OR 3.18, 95% CI 1.04–9.8), CXR upper-lobe consolidation (AOR 8.70, 95% CI 2.5–29), and centrilobular nodules in chest CT (AOR 3.96, 95% CI 1.20–13.0, p = 0.02). In conclusion, bronchoscopy with BAL in hospitalized patients with HS-PTB had a 7% added diagnostic value after negative sputum samples. Our findings highlight specific predictors for PTB diagnosis that could be used in future controlled studies to personalize the diagnostic evaluation. Full article
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2 pages, 176 KiB  
Comment
Comment on Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324–336
by Mostafa Salimi
Adv. Respir. Med. 2024, 92(1), 13-14; https://doi.org/10.3390/arm92010002 - 20 Dec 2023
Cited by 1 | Viewed by 566
Abstract
I am writing this comment regarding the review article by Patsaki et al. titled “Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis” [...] Full article
12 pages, 636 KiB  
Review
Testing Alpha-1 Antitrypsin Deficiency in Black Populations
by Pascale Lafortune, Kanza Zahid, Magdalena Ploszaj, Emilio Awadalla, Tomás P. Carroll and Patrick Geraghty
Adv. Respir. Med. 2024, 92(1), 1-12; https://doi.org/10.3390/arm92010001 - 19 Dec 2023
Viewed by 940
Abstract
Alpha-1 antitrypsin (AAT) deficiency (AATD) is an under-recognized hereditary disorder and a significant cause of chronic obstructive pulmonary disease (COPD), a disease that contributes to global mortality. AAT is encoded by the SERPINA1 gene, and severe mutation variants of this gene increase the [...] Read more.
Alpha-1 antitrypsin (AAT) deficiency (AATD) is an under-recognized hereditary disorder and a significant cause of chronic obstructive pulmonary disease (COPD), a disease that contributes to global mortality. AAT is encoded by the SERPINA1 gene, and severe mutation variants of this gene increase the risk of developing COPD. AATD is more frequently screened for in non-Hispanic White populations. However, AATD is also observed in other ethnic groups and very few studies have documented the mutation frequency in these other ethnic populations. Here, we review the current literature on AATD and allele frequency primarily in Black populations and discuss the possible clinical outcomes of low screening rates in a population that experiences poor health outcomes and whether the low frequency of AATD is related to a lack of screening in this population or a truly low frequency of mutations causing AATD. This review also outlines the harmful SERPINA1 variants, the current epidemiology knowledge of AATD, health inequity in Black populations, AATD prevalence in Black populations, the clinical implications of low screening of AATD in this population, and the possible dangers of not diagnosing or treating AATD. Full article
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