مجال التميز | تميز دراسي و بحثي |
البحوث المنشورة |
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البحث (1): | |
عنوان البحث: |
Physiological tests of small airways function in diagnosing asthma: a systematic review |
رابط إلى البحث: | |
تاريخ النشر: |
21/12/2020 |
موجز عن البحث: |
Background Asthma is a common, heterogeneous disease that is characterised by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use spirometric measures for asthma assessment. This systematic review aimed to assess whether the most commonly reported tests of small airways function could contribute to the diagnosis of asthma. Methods Standard systematic review methodology was used, and a range of electronic databases was searched (Embase, MEDLINE, CINAHL, CENTRAL, Web of Science, DARE). Studies that included physiological tests of small airways function to diagnose asthma in adults were included, with no restrictions on language or date. The risk of bias and quality assessment tools used were Agency for Healthcare Research and Quality tool for cross-sectional studies and Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic test accuracy (DTA) studies. Results 7072 studies were identified and 10 studies met review criteria. 7 included oscillation techniques and 5 included maximal mid-expiratory flow (MMEF). Studies were small and of variable quality. In oscillometry, total resistance (R5) and reactance at 5 Hz (X5) was altered in asthma compared with healthy controls. The percentage predicted of MMEF was lower in patients with asthma compared with controls in all studies and lower than the % predicted forced expiratory volume in 1 s. In DTA of oscillometry, R5 showed a sensitivity between 69% and 72% and specificity between 61% and 86%. Conclusion There were differences in the results of physiological tests of small airway function in patients with asthma compared with controls. However, studies are small and heterogeneous. Further studies are needed to assess the effectiveness of these tests on a larger scale, including studies to determine which test methodology is the most useful in asthma. |
البحث (2): | |
عنوان البحث: |
A Systematic Review of the Use of Physiological Tests Assessing the Acute Response to Treatment During Exacerbations of COPD (with a Focus on Small Airway Function) |
رابط إلى البحث: | https://www.tandfonline.com/doi/abs/10.1080/15412555.2020.1815183?journalCode=icop20 |
تاريخ النشر: |
12/11/2020 |
موجز عن البحث: |
Exacerbations are prevalent in Chronic Obstructive Pulmonary Disease (COPD) patients and associated with poor clinical outcomes. Currently, there is a lack of sensitive and specific tools that can objectively identify exacerbations and assess their progress or treatment response. FEV1 is often reported as a study outcome, but it has significant limitations. Studies have suggested that small airways measures might provide physiological biomarkers during exacerbations. Therefore, this study was done to assess which physiological tests of small airways function have been used in the acute setting during exacerbations of COPD and the evidence to support their use. An electronic databases search was conducted in April 2019. A standard systematic review methodology was used. Eligible studies were those of ≥10 participants that compared at least one small airway test with FEV1 to assess response to treatment with baseline and a follow-up measurement ≤2 months after. Analyses were narrative. Of 1436 screened studies, seven studies were eligible. There was heterogeneity in which tests of small airways were used and three different small airways measures were reported. Studies were small (including 20 to 87 subjects). Six articles reported improvements in small airway measurements during the recovery from exacerbation which correlated with FEV1. Included studies varied in their timing and duration of the assessment. There is some evidence to support the use of small airway tests in acute exacerbations of COPD. However, studies have been small with different tests being utilized. Further studies to determine the usefulness of each test may be of interest. |
المؤتمرات العلمية |
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المؤتمر (1): | |
عنوان المؤتمر: |
ERS International Congress 2020 |
تاريخ الإنعقاد: |
07/09/2020 |
مكان الإنعقاد: |
Virtual |
طبيعة المشاركة: |
Poster presentation |
عنوان المشاركة: |
Usefulness of physiological tests of small airways function in diagnosing asthma: a systematic review |
ملخص المشاركة: |
Introduction: Asthma is a common, heterogeneous disease that is characterized by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use spirometric measures for asthma assessment. This systematic review aimed to assess the use of tests of small airways function to diagnose asthma. Methods: Standard systematic review methodology was used and a range of electronic databases was searched (Embase, MEDLINE, CINAHL, CENTRAL, Web of Science, DARE). Studies that used physiological small airways function tests to diagnose asthma in adults with no restrictions on language or date were included. The risk of bias and quality assessment tools used were AHRQ tool for cross-sectional studies and QUADAS-2 for diagnostic test accuracy (DTA) studies. Results: 7072 studies were identified and 10 studies met the review criteria. 7 included oscillation techniques and 5 included maximal mid-expiratory flow (MMEF). Studies were small and of variable quality. In oscillation, total resistance (R5) was higher in asthmatic compared to control and reactance was lower. Predicted percentage of MMEF in asthmatic was lower than controls in all studies and lower than predicted FEV1. R5 showed 69-72% sensitivity and 61-86% specificity. Conclusion: Small airways tests were found to be different in patients with asthma, showing more limitation in resistance, reactance and lower predicted values in MMEF. Further studies are needed to assess the effectiveness of these tests on a larger scale using different indices reported from the tests such as the difference between inhalation and exhalation in oscillation techniques and how demographics and comorbidities alter results. |
الرابط: | |
المؤتمر (2): | |
عنوان المؤتمر: |
ERS International Congress 2020 |
تاريخ الإنعقاد: |
07/09/2020 |
مكان الإنعقاد: |
Virtual |
طبيعة المشاركة: |
Poster presentation |
عنوان المشاركة: |
A systematic review of the use of physiological tests assessing the acute response to treatment during exacerbations of COPD |
ملخص المشاركة: |
Introduction: Currently there is a lack of sensitive and specific tools which can objectively identify exacerbations and assess their progress or treatment response. FEV1 is often reported as a study outcome, but this forced manoeuvre has significant limitations. Studies have suggested that small airways measures might provide physiological biomarkers during exacerbations. Aims and Objectives: to assess which physiological tests of small airways function have been used in the acute setting during exacerbations of COPD and the evidence to support their use. Methods: Following PRISMA guidelines, a systematic review was conducted using several databases for relevant published studies of >10 participants which compared at least one small airway test with FEV1 at both exacerbation and a follow-up measurement up to and including two months after exacerbation onset to assess response to treatment. Results: From 1436 screened articles, seven studies were found to be eligible for inclusion. There was heterogeneity in which tests of small airways were used. Four different measures were reported (Impulse oscillometry (IOS), Maximal mid-expiratory flow (MMEF), Forced oscillation technique (FOT) and airway resistance (Raw) by body plethysmography). Studies were small (including 20 to 87 subjects). Six articles reported improvements in small airway measurements during the recovery from exacerbation which correlated with FEV1. Conclusion: There is some evidence to support the use of small airway tests in exacerbations of COPD; however, studies have been small with different tests being utilized. Further pilot studies to determine the usefulness of each test may be of interest |
الرابط: | |
المؤتمر (3): | |
عنوان المؤتمر: |
British Thoracic Society Winter Meeting |
تاريخ الإنعقاد: |
17/02/2021 |
مكان الإنعقاد: |
Virtual |
طبيعة المشاركة: |
Poster presentation |
عنوان المشاركة: |
Small airways response to bronchodilator in asthma and COPD: a systematic review |
ملخص المشاركة: |
Introduction and Objectives The airways response to bronchodilators (BDR) has been used as a test to diagnose asthma and to differentiate it from other obstructive pulmonary diseases. The main outcome in assessing BDR is FEV1, mainly a large airway measure. Measures of small airways are not included in everyday practice for BDR testing, although evidence suggests small airways dysfunction is found in asthma and COPD patients. This systematic review assessed the current evidence on small airways response to short-acting inhaled bronchodilators in asthma and COPD. Methods The protocol was registered in PROSPERO (CRD42020164140). Electronic medical databases (EMBASE and Medline) were searched using related keywords. Abstracts and full texts were screened independently by two reviewers. Studies that reported the change of physiological small airways function (spirometric, oscillometry, multiple breath washout) and FEV1 were included. The revised Cochrane risk of bias tool for RCT and the NIH quality assessment tool for cohort and cross-sectional studies were used to evaluate the studies. Results Of 934 articles identified from the databases search, 13 met the inclusion criteria, with asthma (n=10) and COPD (n=3) patient studies. A total of 1110 participants were included; 911 were asthmatic, 90 COPD and, 109 were controls. Heterogeneity between studies was noted in the (1) diagnostic criteria for asthma or COPD, (2) agreed criteria for demonstrating BDR using standard spirometry, (3) methods used to deliver aerosolised medications and, (4) included measures of small airways function. Using spirometry, MMEF showed higher percentage of change (5.3–47%) in asthma and (3.6–25%) COPD, than FEV1 which was (3.9–32%) in asthma and (2.8–16.3%) COPD [Abstract P78 figure 1]. The contrary was noted in severe asthma patients. Using oscillometry, BDR was observed with total resistance change of (R5) in asthma patients (-0.16 kPa/L/s) and between (-9.0— -22.4 kPa/L/s) in COPD patients. Conclusions Small airways function appears to change following BDR, but currently studies are too heterogeneous to recommend their inclusion in clinical practice. More research is needed to form a consensus on how to assess BDR in general and in small airways in specific, and whether this adds utility to the diagnosis and management of airway disease patients. |
الرابط: | |
المؤتمر (4): | |
عنوان المؤتمر: |
British Thoracic Society Winter Meeting |
تاريخ الإنعقاد: |
17/02/2021 |
مكان الإنعقاد: |
Virtual |
طبيعة المشاركة: |
Poster presentation |
عنوان المشاركة: |
Mechanical ventilation utilization in COVID-19: a systematic review and meta-analysis |
ملخص المشاركة: |
Introduction and Objectives In December 2019, SARS-CoV-2 caused a global pandemic with a viral infection called COVID-19. The disease usually causes respiratory symptoms but in a small proportion of patients can lead to pneumonitis, Adult Respiratory Distress Syndrome and death. Invasive Mechanical Ventilation (IMV) is considered a life-saving treatment for COVID-19 patients and a huge demand for IMV devices was reported globally. This review aimed to provide insight on the initial IMV practices for COVID-19 patients in the initial phase of the pandemic. Methods Electronic databases (Embase and MEDLINE) were searched for applicable articles using relevant keywords. The references of included articles were hand searched. Articles that reported the use of IMV in adult COVID-19 patients between December 2019 and 23rd of April were included in the review. The NIH quality assessment tool for cohort and cross-sectional studies was used to appraise studies. Results 106 abstracts were identified from the databases search, of which 16 were included. 4 studies were included in the meta-analysis. In total, 9988 patients were included across all studies. The overall cases of COVID-19 requiring IMV ranged from 2–75%. Increased age and pre-existing comorbidities increased the likelihood of IMV requirement. The reported mortality rate in patients receiving IMV ranged between 50–100%. On average, IMV was required and initiated between 10–10.5 days from symptoms onset. When invasively ventilated, COVID-19 patients required IMV for a median of 10–17 days across studies. Little information was provided on ventilatory protocols or management strategies and was inconclusive. Conclusions In these initial reporting studies for the first month of the pandemic, patients receiving IMV were older and had more pre-existing co-morbidities than those who did not require IMV. The mortality rate was high in COVID-19 patients who received IMV. Studies are needed to evaluate protocols and modalities of IMV to improve outcomes and identify the populations most likely to benefit from IMV. |
الرابط: |
محمد أحمد محمد المشاري
دكتوراه
الطب والخدمات الصحية
University of Birmingham