Chronic Pulmonary Aspergillosis: Prevalence, favouring pulmonary diseases and prognosis

2021 ◽  
pp. 2003345
Author(s):  
Thomas Maitre ◽  
Jonathan Cottenet ◽  
Cendrine Godet ◽  
Adrien Roussot ◽  
Nafiz Abdoul Carime ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Distribution Profile ◽  
Pulmonary Aspergillosis ◽  
Cancer History ◽  
Obstructive Pulmonary Disease ◽  
Large Cities ◽  
Chronic Pulmonary Diseases ◽  
Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis (CPA) is an emerging disease in patients with common chronic pulmonary diseases (CPD). While its prevalence is linked to tuberculosis (TB) in endemic countries, epidemiologic and prognostic data are lacking in low TB incidence countries. The aim of this study was to describe these features in CPA patients hospitalised in France between 2009 and 2018.We estimated the prevalence and mortality of hospitalised CPA patients using the French nationwide administrative hospital database. We also assessed the association with CPDs, thoracic interventions, and malnutrition.From 2009 to 2018, 17 290 patients were hospitalised in France for CPA, with an increasing prevalence during this period. Most patients were male (63.5%) with a median age of 65 years at CPA diagnosis, living in farming regions and large cities. The proportion of underlying chronic obstructive pulmonary disease (COPD) and emphysema during the previous 5 years was 44% and 22%, respectively, whereas it was only 3% for both TB and non-TB mycobacterial (NTM) infections. The mortality rates during the first hospitalisation, at 1 year, and at 5 years were 17%, 32%, and 45%, respectively. In multivariate analysis, mortality rates were increased in patients aged over 65 years, males and patients with malnutrition, diabetes, or lung cancer history. The risk of mortality in patients with COPD or emphysema was higher compared to those with previous mycobacterial lung infection.In France CPA is an emerging infection commonly associated with non-mycobacterial CPD. This shift in the distribution profile of underlying CPD will likely worsen CPA mortality.

scholarly journals Magnesium serum and urine concentration in patients with acute and chronic pulmonary disease

2004 ◽  
Vol 23 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Ljudmila Nagorni-Obradovic ◽  
Svetlana Ignjatovic ◽  
Vesna Petrovic ◽  
Marija Mitic-Milikic
Keyword(s):  
Pulmonary Disease ◽  
Urine Concentration ◽  
Pulmonary Diseases ◽  
Magnesium Concentration ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
End Of Treatment ◽  
Chronic Pulmonary Diseases ◽  
Serum And Urine

In this study we determined magnesium concentration in serum and in 24-hour urine, at the start (To) and at the end of treatment (T1), in 56 patients with acute pulmonary disease (B1) and in 58 patients with chronic obstructive pulmonary disease - COPD (B2). In group B1 there was disbalance of Mg in serum in 14-25% patients at the start of treatment (To) which decreased significantly at the end of treatment (T1) and persisted in 4-7.1% patients (p < 0.05). In group B2 distribution of normal, decreased and increased values of Mg in serum was similar in patients in period To and T1 (p > 0.05). In group B1, 9 (16.1%) patients had hypomagnesemia at the start of treatment (To), which was accompanied by increased concentration of Mg in 24-hour urine of only 4 (7.2%) patients. There is a possibility that there was extrarenal elimination of Mg in patients with acute pulmonary disease or there was some kind of transcellular distribution. In group B2 in period To, there was proportional ratio between hypomagnesemia (12-20.7% patients) and increased concentration of Mg in 24-hour urine (20 -34.5% patients). This could be because of renal loss. Simultaneous determination and follow up of magnesium in serum and in 24-hour urine can give us reliable information about homeostasis of this electrolyte in acute and chronic pulmonary diseases.

scholarly journals Revolving door respiratory patients: A rehabilitative perspective

2017 ◽  
Vol 87 (3) ◽  
Author(s):  
Massimiliano Polastri ◽  
Lara Pisani ◽  
Andrea Dell'Amore ◽  
Stefano Nava
Keyword(s):  
Sleep Apnea Syndrome ◽  
Neuromuscular Diseases ◽  
Bed Rest ◽  
Revolving Door ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Mobility Limitations ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep ◽  
Chronic Pulmonary Diseases

Rehabilitation is an integral component of care for patients affected by either acute or chronic pulmonary diseases. The key elements of rehabilitation treatment for critical respiratory patients are as follows: weaning from mechanical ventilation, respiratory therapy, physical reconditioning, and occupational therapy. It should be noted that patients affected by pulmonary diseases are prone to hospital re-admission due to frequent exacerbations, especially in cases with more severe stages of chronic obstructive pulmonary disease. A periodical worsening of clinical conditions is common in asthma, acute respiratory distress syndrome survivors, obstructive sleep apnea syndrome, and pulmonary fibrosis, as well as in patients with severe neuromuscular diseases. These patients are often identified as “revolving door patients”. Pulmonary patients are typically forced to maintain bed rest, or at least spend most of their waking hours dealing with mobility limitations, due to various pathological conditions including dyspnea, fatigue, and poor tolerance of movements. Alterations in mood are common in pulmonary patients who experience a decreased quality of life and limited social interactions. These negative emotional and cognitive aspects can be a major limitation to the provision of care, because to enhance and facilitate a degree of autonomy, the patient must be cooperative and pro-active.

scholarly journals Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study

2021 ◽  
Vol 7 (7) ◽  
pp. 532
Author(s):  
Ngoc Thi Bich Nguyen ◽  
Huy Le Ngoc ◽  
Nhung Viet Nguyen ◽  
Luong Van Dinh ◽  
Hung Van Nguyen ◽  
...  
Keyword(s):  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
High Resolution Computed Tomography ◽  
Pulmonary Aspergillosis ◽  
Obstructive Pulmonary Disease ◽  
Female Ratio ◽  
High Burden ◽  
Pleural Thickening ◽  
Number Of Patients ◽  
Chronic Pulmonary Aspergillosis

This study provides a brief view of chronic pulmonary aspergillosis (CPA) in the post-tuberculosis treatment community in Vietnam, a high burden tuberculosis (TB) country. In three months in late 2019, 70 post-TB patients managed at Vietnam National Lung Hospital were enrolled. Of these, 38 (54.3%) had CPA. The male/female ratio was 3/1 (28 males and ten females). CPA patients had a mean age of 59 ± 2.3 years (95%CI 54.4–63.6). The mean Body mass index (BMI) was 19.0 ± 0.5 (18.0–20.0) and 16 of 38 (42.1%) patients had concurrent diseases, the most common of which were chronic obstructive pulmonary disease (COPD) and diabetes. Twenty-six patients (68.4%) developed hemoptysis, 21 (55.3%) breathlessness, and weight loss was seen in 30 (78.9%). Anaemia was seen in 15 (39.5%) and 27 of 38 (71.1%) patients had an elevated C-reactive protein (CRP). The most common radiological findings were multiple cavities (52.6%) and pleural thickening (42.7%), followed by aspergilloma (29.0%) and non-specific infiltrates. There were five of 38 patients (13.2%) with a cavity containing a fungal ball on the chest X-ray, but when the high resolution computed tomography (HRCT) was examined, the number of patients with fungal balls rose to 11 (28.9%). Overall, 34 of 38 (89.5%) cases had an elevated Aspergillus IgG with an optical density ≥ 1, and in 2 cases, it was 0.9–1.0 (5%), borderline positive. In nine patients (23.7%) Aspergillus fumigatus was cultured from sputum. CPA is an under-recognised problem in Vietnam and other high burden TB countries, requiring a different diagnostic approach and treatment and careful management. HRCT and Aspergillus IgG serum test are recommended as initial diagnostic tools for CPA diagnosis.

scholarly journals Predictors of mortality in chronic pulmonary aspergillosis

2016 ◽  
Vol 49 (2) ◽  
pp. 1601062 ◽  
Author(s):  
David Lowes ◽  
Khaled Al-Shair ◽  
Pippa J. Newton ◽  
Julie Morris ◽  
Chris Harris ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Mycobacterial Infection ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Pulmonary Aspergillosis ◽  
Obstructive Pulmonary Disease ◽  
Kaplan Meier ◽  
St George's Respiratory Questionnaire ◽  
Chronic Pulmonary Aspergillosis ◽  
The Impact

Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50–85% 5-year mortality, with few prognostic factors identified.A cohort of 387 CPA patients referred to the UK's National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnoea score, quality of life, serum albumin and C-reactive protein and radiological appearances were assessed using Kaplan–Meier curves, log rank tests and Cox proportional hazards modelling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated.Survival was 86%, 62% and 47% at 1, 5 and 10 years, respectively. Increased mortality was associated with nontuberculous mycobacterial infection (hazard ratio 2.07, 95% CI 1.22–3.52; p<0.001) and chronic obstructive pulmonary disease (1.57, 1.05–2.36; p=0.029) as well as higher age (1.053, 1.03–1.07 per year; p<0.001), lower albumin (0.92, 0.87–0.96 per g·L−1), lower activity (1.021, 1.01–1.03 per point increase in St George's Respiratory Questionnaire activity domain; p<0.001) and having one, and especially, bilateral aspergillomas (p<0.001).Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis.

scholarly journals Distinct Roles of Wnt/β-Catenin Signaling in the Pathogenesis of Chronic Obstructive Pulmonary Disease and Idiopathic Pulmonary Fibrosis

2017 ◽  
Vol 2017 ◽  
pp. 1-16 ◽  
Author(s):  
Juan Shi ◽  
Feng Li ◽  
Meihui Luo ◽  
Jun Wei ◽  
Xiaoming Liu
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Wnt Signaling ◽  
Signaling Pathways ◽  
Pulmonary Disease ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Pulmonary Diseases

Wnt signaling pathways are tightly controlled under a physiological condition, under which they play key roles in many biological functions, including cell fate specification and tissue regeneration. Increasing lines of evidence recently demonstrated that a dysregulated activation of Wnt signaling, particularly the Wnt/β-catenin signaling, was involved in the pathogenesis of chronic pulmonary diseases, such as chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). In this respect, Wnt signaling interacts with other cellular signaling pathways to regulate the initiation and pathogenic procedures of airway inflammation and remodeling, pulmonary myofibroblast proliferation, epithelial-to-mesenchymal transition (EMT), and development of emphysema. Intriguingly, Wnt/β-catenin signaling is activated in IPF; an inhibition of this signaling leads to an alleviation of pulmonary inflammation and fibrosis in experimental models. Conversely, Wnt/β-catenin signaling is inactivated in COPD tissues, and its reactivation results in an amelioration of airspace enlargement with a restored alveolar epithelial structure and function in emphysema models. These studies thus imply distinct mechanisms of Wnt/β-catenin signaling in the pathogenesis of these two chronic pulmonary diseases, indicating potential targets for COPD and IPF treatments. This review article aims to summarize the involvement and pathogenic roles of Wnt signaling pathways in the COPD and IPF, with a focus on the implication of Wnt/β-catenin signaling as underlying mechanisms and therapeutic targets in these two incurable diseases.

Abstract WP340: Prevalence and Influence of Chronic Obstructive Pulmonary Disease on Stroke Outcomes in Hospitalized Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Oladimeji Akinboro ◽  
Odunayo Olorunfemi ◽  
Stanley Holstein ◽  
Daniel Pomerantz ◽  
Stephen Jesmajian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Chronic Obstructive ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Index Stroke ◽  
Nationally Representative ◽  
Shared Risk

Background: COPD recently overtook stroke as the third leading cause of death in the United States. Intriguingly, smoking is an important shared risk factor for both stroke and COPD; COPD patients have baseline cerebral hypoxia and hypercapnia that could potentially exacerbate vascular brain injury; and stroke patients with COPD are at higher risk of aspiration than those without COPD. Yet, relatively little is known about the prevalence of COPD among stroke patients or its impact on outcomes after an index stroke. Objective: To assess prevalence of COPD among hospitalized stroke patients in a nationally representative sample and examine the effect of COPD with risk of dying in the hospital after a stroke. Methods: Data were obtained for patients, 18 years and older, from the National Inpatient Sample from 2004-2009 (n=48,087,002). Primary discharge diagnoses of stroke were identified using ICD-9 diagnosis codes 430-432 and 433-436, of which a subset with comorbid COPD were defined with secondary ICD-9 diagnoses codes 490-492, 494, and 496. In-hospital mortality rates were calculated, and independent associations of COPD with in-hospital mortality following stroke were evaluated with logistic regression. All analysis were survey-weighted. Results: 11.71% (95% CI 11.48-11.94) of all adult patients hospitalized for stroke had COPD. The crude and age-adjusted in-hospital mortality rates for these patients were 6.33% (95% CI 6.14-6.53) and 5.99% (95% CI 4.05-7.94), respectively. COPD was independently and modestly associated with overall stroke mortality (OR 1.03, 95% CI 1.01-1.06; p=0.02). However, when analyzed by subtype, greater risks of mortality were seen in those with intracerebral hemorrhage (OR 1.12, 95% CI 1.03-1.20; p<0.01), and ischemic stroke (OR 1.08; 95% CI 1.03-1.13, p<0.01), but not subarachnoid hemorrhage (OR 0.98, 95% CI 0.85-1.13; p=0.78). There were no statistically significant interactions between COPD and age, gender, or race. Conclusion: 12% of hospitalized stroke patients have COPD. Presence of COPD is independently associated with higher odds of dying during ischemic stroke hospitalization. Prospective studies are needed to identify any modifiable risk factors contributing to this deleterious relationship.

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