210 results on '"Pallav L. Shah"'
Search Results
2. Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic)
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Marcela P. Vizcaychipi, Claire L. Shovlin, Alex McCarthy, Andrew Godfrey, Sheena Patel, Pallav L. Shah, Michelle Hayes, Richard T. Keays, Iain Beveridge, and Gary Davies
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Anticoagulation ,C-reactive protein ,D-dimer ,Discharge ,Ferritin ,Mortality ,Infectious and parasitic diseases ,RC109-216 ,Microbiology ,QR1-502 - Abstract
Introduction: Our goal was to evaluate if traffic-light driven personalized care for COVID-19 was associated with improved survival in acute hospital settings. Methods: Discharge outcomes were evaluated before and after prospective implementation of a real-time dashboard with feedback to ward-based clinicians. Thromboembolism categories were “medium-risk” (D-dimer >1000 ng/mL or CRP >200 mg/L); “high-risk” (D-dimer >3000 ng/mL or CRP >250 mg/L) or “suspected” (D-dimer >5000 ng/mL). Cytokine storm risk was categorized by ferritin. Results: 939/1039 COVID-19 positive patients (median age 67 years, 563/939 (60%) male) completed hospital encounters to death or discharge by 21st May 2020. Thromboembolism flag criteria were reached by 568/939 (60.5%), including 238/275 (86.6%) of the patients who died, and 330/664 (49.7%) of the patients who survived to discharge, p
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- 2020
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3. Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira® lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3)
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Dirk-Jan Slebos, Bruno Degano, Arschang Valipour, Pallav L. Shah, Gaetan Deslée, Frank C. Sciurba, and on behalf of the AIRFLOW-3 Trial Study Group
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COPD ,Nerves ,Targeted lung denervation ,Acetylcholine ,Anticholinergic ,Bronchoscopy ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Targeted lung denervation (TLD) is a bronchoscopically delivered ablation therapy that selectively interrupts pulmonary parasympathetic nerve signaling. The procedure has the potential to alter airway smooth muscle tone and reactivity, decrease mucous secretion, and reduce airway inflammation and reflex airway hyperresponsiveness. Secondary outcome analysis of a previous randomized, sham-controlled trial showed a reduction in moderate-to-severe exacerbations in patients with COPD after TLD treatment. A pivotal trial, AIRFLOW-3 has been designed to evaluate the safety and efficacy of TLD combined with optimal medical therapy to reduce moderate or severe exacerbations throughout 1 year, compared with optimal medical therapy alone. Methods The study design is a multicenter, randomized, full sham bronchoscopy controlled, double-blind trial that will enroll 400 patients (1:1 randomization). Key inclusion criteria are FEV1/FVC
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- 2020
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4. On the role of artificial intelligence in medical imaging of COVID-19
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Jannis Born, David Beymer, Deepta Rajan, Adam Coy, Vandana V. Mukherjee, Matteo Manica, Prasanth Prasanna, Deddeh Ballah, Michal Guindy, Dorith Shaham, Pallav L. Shah, Emmanouil Karteris, Jan L. Robertus, Maria Gabrani, and Michal Rosen-Zvi
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artificial intelligence ,meta-review ,COVID-19 ,Coronavirus ,chest X-ray ,chest CT ,Computer software ,QA76.75-76.765 - Abstract
Summary: Although a plethora of research articles on AI methods on COVID-19 medical imaging are published, their clinical value remains unclear. We conducted the largest systematic review of the literature addressing the utility of AI in imaging for COVID-19 patient care. By keyword searches on PubMed and preprint servers throughout 2020, we identified 463 manuscripts and performed a systematic meta-analysis to assess their technical merit and clinical relevance. Our analysis evidences a significant disparity between clinical and AI communities, in the focus on both imaging modalities (AI experts neglected CT and ultrasound, favoring X-ray) and performed tasks (71.9% of AI papers centered on diagnosis). The vast majority of manuscripts were found to be deficient regarding potential use in clinical practice, but 2.7% (n = 12) publications were assigned a high maturity level and are summarized in greater detail. We provide an itemized discussion of the challenges in developing clinically relevant AI solutions with recommendations and remedies. The bigger picture: During the COVID-19 pandemic, medical imaging (CT, X-ray, ultrasound) has played a key role in addressing the magnified need for speed, low cost, ubiquity, and precision in patient care. The contemporary digitization of medicine and rise of artificial intelligence (AI) induce a quantum leap in medical imaging: AI has proven equipollent to healthcare professionals across a diverse range of tasks, and hopes are high that AI can save time and cost and increase coverage by advancing rapid patient stratification and empowering clinicians.This review bridges medical imaging and AI in the context of COVID-19 and conducts the largest systematic review of the literature in the field. We identify several gaps and evidence significant disparities between clinicians and AI experts and foresee a need for improved, interdisciplinary collaboration to develop robust AI solutions that can be deployed in clinical practice.The key challenges on that roadmap are discussed alongside recommended solutions.
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- 2021
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5. The National Institute for Health and Care Excellence (NICE) Updated Guidance on Endobronchial Valves: What Was Behind the Decision and What Does it Mean for Pulmonologists?
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Pallav L. Shah
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emphysema ,endobronchial valves ,hyperinflation ,lung volume reduction ,Medicine ,Diseases of the respiratory system ,RC705-779 - Abstract
In December 2017, the National Institute for Health and Care Excellence (NICE) updated its interventional procedures guidance, titled ‘Endobronchial valve insertion to reduce lung volume in emphysema’,1 to support the routine use of endobronchial valve therapy for emphysema. The NICE guidance states: ‘Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.’ NICE is the latest organisation to include endobronchial valves in its chronic obstructive pulmonary disease (COPD) treatment pathway, following the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report for the diagnosis, management, and prevention of COPD;2 the German Society for Pneumology and Respiratory Medicine (DGP) guidance;3 and the Australian and New Zealand guidelines for the management of COPD;4 however, what does this mean to us as respiratory physicians?
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- 2018
6. New bronchoscopic treatment modalities for patients with chronic bronchitis
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Jorine E. Hartman, Justin L. Garner, Pallav L. Shah, and Dirk-Jan Slebos
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Diseases of the respiratory system ,RC705-779 - Abstract
Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategies. These therapies are in an early phase of clinical research and larger randomised controlled trials are needed to confirm the pilot data available and to evaluate the treatment durability. The fourth technique, targeted lung denervation (TLD), aims to decrease the release of acetylcholine, which regulates smooth muscle tone and mucus production by ablating the parasympathetic nerves running alongside the main bronchi. Evaluation of this treatment is at a more advanced stage and promising effects on exacerbation frequency have been shown. However, confirmation of the benefit in improvement in chronic bronchitis symptoms is still needed.
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- 2021
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7. Transbronchial cryobiopsy for diagnosis of pleuroparenchymal fibroelastosis
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Abdulrahman Hakami, Evita Zwartkruis, Teodora Radonic, Esther J. Nossent, Felix Chua, Pallav L. Shah, and Johannes M.A. Daniels
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Pleuroparenchymal fibroelastosis ,Transbronchial cryobiopsy ,Diseases of the respiratory system ,RC705-779 - Abstract
Rationale: Pleuroparenchymal fibroelastosis (PPFE) is a rare subtype of idiopathic interstitial pneumonias. PPFE mostly affects the upper lung zones and is characterized radiologically by pleural and subpleural fibrotic thickening with a reticular pattern. There is no established treatment for PPFE but lung transplantation can be considered for advanced stage. The gold standard for the diagnosis of PPFE is surgical lung biopsy (SLB) but the bronchoscopic transbronchial cryobiopsy (TBCB) is a less invasive alternative. Patient concerns: We report here two cases in which the diagnosis of PPFE was established with the help of TBCB. Diagnosis and interventions: Bronchoscopy with TBCB was performed under sedation with spontaneous ventilation and the help of an uncuffed ET tube. Outcomes: Histopathology showed intra-alveolar fibroblastic proliferation with elastosis, which confirmed the diagnosis of PPFE. Lessons: The current report demonstrates that TBCB can be a useful and safe tool to confirm the diagnosis of PPFE. According to our knowledge, this is one of few reports that shows successful diagnosis of PPFE by TBCB.
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- 2020
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8. Evaluation of a re-useable bronchoscopy biosimulator with ventilated lungs
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Justin L. Garner, Stefan D. Garner, Robin J. Hardie, Philip L. Molyneaux, Suveer Singh, Samuel V. Kemp, and Pallav L. Shah
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Medicine - Abstract
Background Restrictions on respiratory trainee time and access to procedures reduce the opportunities to acquire necessary skills in bronchoscopy. Simulation, not subject to such impediments, is a useful supplementary aid to teaching bronchoscopic techniques in a safe environment but there is a limited choice of simulators that are sufficiently realistic and not prohibitively expensive. This study evaluated a low-cost device that simulates an intubated and ventilated patient, employing re-useable, inflatable, BioFlex-preserved, porcine lungs. Methods 26 bronchoscopists, trainee and experienced, after using the bronchoscopy biosimulator, completed a questionnaire using a five-point Likert scale comparing its performance with that of the computerised CAE AccuTouch. Results Participants were largely positive about their experience (mean score of 4.76). The bronchoscopy biosimulator was found to be realistic (mean score 4.64), easy to use (mean score 4.88), and helpful in learning to perform a variety of diagnostic and therapeutic procedures (mean score 4.85). Importantly, the bronchoscopy biosimulator compared favourably to the computer simulator (mean score 4.84). Conclusions These data support the concept of the bronchoscopy biosimulator as an acceptable model with which to supplement the experience of bronchoscopic procedures.
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- 2019
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9. Correction to: Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes
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Christophe Pison, Pallav L. Shah, Dirk‑Jan Slebos, Vincent Ninane, Wim Janssens, Thierry Perez, Romain Kessler, Gaetan Deslee, Justin L. Garner, Jorine E. Hartman, Bruno Degano, Anna Mayr, Martin Mayse, Alexander D. Peterson, and Arschang Valipour
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Diseases of the respiratory system ,RC705-779 - Abstract
An amendment to this paper has been published and can be accessed via the original article.
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- 2021
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10. Patient experience of lung volume reduction procedures for emphysema: a qualitative service improvement project
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Sara Buttery, Adam Lewis, Inger Oey, Joanne Hargrave, David Waller, Michael Steiner, Pallav L. Shah, Samuel V. Kemp, Simon Jordan, and Nicholas S. Hopkinson
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Medicine - Abstract
The aim of this service improvement project was to gain understanding of the patient experience of lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement, from referral through to post-discharge care. Focus group interviews were carried out in two tertiary centres in London and Leicester, UK. Sixteen patients who had undergone lung volume reduction surgery (LVRS), endobronchial valve (EBV) placement, or both, were recruited. Prior to participation in each focus group, participants completed a questionnaire to guide and focus discussion. Thematic analysis identified common themes to the participant experience of receiving lung volume reduction interventions. Themes included patient focus on declining health and the need to “fight” for a referral; consequences of having procedures and potential unexpected complications; and vulnerability post discharge and limited continuity of care. Participants were clear that the benefits of having had either LVRS or EBV procedures outweighed any difficulties experienced. Participants were keen to have further similar interventions if appropriate. These data confirm the need to develop more systematic lung volume reduction pathways, provide appropriate information, and ensure that post-discharge care is optimal.
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- 2017
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11. Endobronchial ultrasound: morphological predictors of benign disease
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Pratibha Gogia, Tabassum Z. Insaf, William McNulty, Afroditi Boutou, Andrew G. Nicholson, Zaid Zoumot, and Pallav L. Shah
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Medicine - Abstract
The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study. Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied. The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72–0.91) for benign disease was found if lymph node size was
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- 2016
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12. Favipiravir in patients hospitalised with COVID-19 (PIONEER trial): a multicentre, open-label, phase 3, randomised controlled trial of early intervention versus standard care
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Pallav L Shah, Christopher M Orton, Beatriz Grinsztejn, Gavin C Donaldson, Brenda Crabtree Ramírez, James Tonkin, Breno R Santos, Sandra W Cardoso, Andrew I Ritchie, Francesca Conway, Maria P D Riberio, Dexter J Wiseman, Anand Tana, Bavithra Vijayakumar, Cielito Caneja, Craig Leaper, Bobby Mann, Anda Samson, Pankaj K Bhavsar, Marta Boffito, Mark R Johnson, Anton Pozniak, Michael Pelly, Damon Foster, Nadia Shabbir, Simon Connolly, Andrea Cartier, Sajjida Jaffer, Carmen Winpenny, Doris Daby, Samuel Pepper, Christine Adamson, Jamie Carungcong, Kribashnie Nundlall, Serge Fedele, Pardina Samson-Fessale, Alexandra Schoolmeesters, Laura Gomes de Almeida Martins, Rhian Bull, Patricia Correia Da Costa, Carina Bautista, Maria Eleanor Flores, Shameera Maheswaran, Lester Macabodbod, Rosalie Houseman, Marie-Louise Svensson, Amrinder Sayan, Carrie Fung, Justin Garner, Dilys Lai, Mark Nelson, Luke Moore, Shewta Gidwani, Gary Davies, Beatrice Ouma, Clovis Salinos, Jad Salha, Redasaad Yassein, Abdul Abbasi, Metod Oblak, Angelica Steward, Mini Thankachen, Amy Barker, Candida Fernandes, Veronica Beatriz, Leah Flores, Alfredo Soler-Carracedo, Alessandra Rocca, Carmela Martella, Charlotte Lloyd, Ciara Nolan, Latoya Horsford, Laura Martins, Lervina Thomas, Mark Winstanley, Miriam Bourke, Nicholas Branch, Orhan Orhan, Richard Morton, Sangeetha Saunder, Shashank Patil, Stephen Hughes, Wu Zhe, Ashley De Leon, Ayaan Farah, Grace Rya, Katrin Alizadeh, Kirsty Leong, Laure Trepte, Nupur Goel, Patrick McGown, Ursula Kirwan, Tamiris Vilela Baião, Luana Marins, Sandro Nazer, Raquel Malaguthi de Souza, Marcella Feitosa, Flavia Lessa, Elizabeth Silva de Magalhães, Jamile Costenaro, Rita de Cassia Alves Lira, Ana Carolina, Andréa Cauduro de Castro, Andre Machado Da Silva, Dimas Kliemann, Rita De Cassia Alves Lira, Gemma Walker, Donna Norton, Vicki Lowthorpe, Monica Ivan, Patrick Lillie, Nicholas Easom, Juan Sierra Madero, Álvaro López Iñiguez, Guadalupe Patricia Muñuzuri Nájera, Claudia Paola Alarcón Murra, Audelia Alanis Vega, Teresa Muñoz Trejo, and Olivia Pérez Rodríguez
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Pulmonary and Respiratory Medicine - Abstract
COVID-19 has overwhelmed health services globally. Oral antiviral therapies are licensed worldwide, but indications and efficacy rates vary. We aimed to evaluate the safety and efficacy of oral favipiravir in patients hospitalised with COVID-19.We conducted a multicentre, open-label, randomised controlled trial of oral favipiravir in adult patients who were newly admitted to hospital with proven or suspected COVID-19 across five sites in the UK (n=2), Brazil (n=2) and Mexico (n=1). Using a permuted block design, eligible and consenting participants were randomly assigned (1:1) to receive oral favipiravir (1800 mg twice daily for 1 day; 800 mg twice daily for 9 days) plus standard care, or standard care alone. All caregivers and patients were aware of allocation and those analysing data were aware of the treatment groups. The prespecified primary outcome was the time from randomisation to recovery, censored at 28 days, which was assessed using an intention-to-treat approach. Post-hoc analyses were used to assess the efficacy of favipiravir in patients aged younger than 60 years, and in patients aged 60 years and older. The trial was registered with clinicaltrials.gov, NCT04373733.Between May 5, 2020 and May 26, 2021, we assessed 503 patients for eligibility, of whom 499 were randomly assigned to favipiravir and standard care (n=251) or standard care alone (n=248). There was no significant difference between those who received favipiravir and standard care, relative to those who received standard care alone in time to recovery in the overall study population (hazard ratio [HR] 1·06 [95% CI 0·89-1·27]; n=499; p=0·52). Post-hoc analyses showed a faster rate of recovery in patients younger than 60 years who received favipiravir and standard care versus those who had standard care alone (HR 1·35 [1·06-1·72]; n=247; p=0·01). 36 serious adverse events were observed in 27 (11%) of 251 patients administered favipiravir and standard care, and 33 events were observed in 27 (11%) of 248 patients receiving standard care alone, with infectious, respiratory, and cardiovascular events being the most numerous. There was no significant between-group difference in serious adverse events per patient (p=0·87).Favipiravir does not improve clinical outcomes in all patients admitted to hospital with COVID-19, however, patients younger than 60 years might have a beneficial clinical response. The indiscriminate use of favipiravir globally should be cautioned, and further high-quality studies of antiviral agents, and their potential treatment combinations, are warranted in COVID-19.LifeArc and CW+.
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- 2023
13. Long-Term Follow-Up of Intralobar Bullae After Endobronchial Valve Treatment for Emphysema
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Olivier Taton, Vincent Heinen, Benjamin Bondue, Dirk-Jan Slebos, Pallav L Shah, Kris Carron, Olivia Moens, Dimitri Leduc, and Groningen Research Institute for Asthma and COPD (GRIAC)
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chest tube drainage ,endoscopic lung volume reduction ,pneumothorax ,General Medicine ,chest CT scanner ,International Journal of Chronic Obstructive Pulmonary Disease ,THERAPY - Abstract
Olivier Taton,1 Vincent Heinen,2 Benjamin Bondue,1 Dirk-Jan Slebos,3,4 Pallav L Shah,5â 7 Kris Carron,8 Olivia Moens,9 Dimitri Leduc1 1Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; 2Department of Pneumology, Centre Hospitalier Universitaire de Liège, Liège, Belgium; 3Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 4The Netherlands and GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 5Royal Brompton Hospital, London, UK; 6National Heart & Lung Institute, Imperial College, London, UK; 7Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 8Department of Pneumology, AZ Delta, Menen, Belgium; 9Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, BelgiumCorrespondence: Olivier Taton, Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, Brussels, 1070, Belgium, Tel +3225553943, Email Olivier.taton@erasme.ulb.ac.beAbstract: Endoscopic lung volume reduction using unidirectional endobronchial valves is a new technique in the treatment of patients with severe emphysema. However, the movements of the thoracic structures after endobronchial valves insertion are still unpredictable We report the unusual outcome of six patients after valves insertion in the left upper lobe. They all developed a complete atelectasis of the target lobe, a pneumothorax and sequential genuine bullae in the treated left lung of unknown etiology. The chest CT scan prior to the valves insertion was unremarkable. Three patients developed an airâliquid level in the bullae the day before a bacterial infection of their left lower lobe. The three other patients had an uneventful spontaneous resolution of their bullae at long-term follow-up. Therefore, a conservative attitude should be followed in this particular setting.Keywords: endoscopic lung volume reduction, pneumothorax, chest CT scanner, chest tube drainage
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- 2022
14. Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises
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Brian Saccente-Kennedy, Alicja Szczepanska, Joshua Harrison, Justice Archer, Natalie A. Watson, Christopher M. Orton, Declan Costello, James D. Calder, Pallav L. Shah, Jonathan P. Reid, Bryan R. Bzdek, and Ruth Epstein
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Speech and Hearing ,Otorhinolaryngology ,LPN and LVN - Published
- 2023
15. Computed tomographic airway morphology after targeted lung denervation treatment in COPD
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Jorine E. Hartman, Felix J.F. Herth, Pallav Shah, Christophe Pison, Arschang Valipour, Dirk-Jan Slebos, Christine Abele, Irene Firlinger, Kiran Kothakuzhakal, Marina Duller, Bernd Lamprecht, Roland Kropfmueller, Kornelia Holzmann, Sandra Rathmeier, Ralf Hubner, Leonore Erdmann, Bettina Temmesfeld-Wollbrück, Christoph Ruwwe Glösenkamp, Wolfgang Gesierich, Frank Reichenberger, Christa Niehaus, Felix Herth, Ralf Eberhardt, Daniela Gompelmann, Brigitte Rump, Kaid Darwiche, Stephan Eisenmann, Ulrike Kaiser, Birte Schwarz, Ulrike Sampel, Christian Schumann, Robert Kaiser, Kathryn Schumann-Stoiber, Dirk Skowasch, Sabine Ring, Amandine Briault, Francois Arbib, Marie Jondot, Thierry Perez, Clement Fournier, Regis Matran, Michele Catto, Nathalie Bautin, Virginie De Broucker, Marie Willemin, Anne Prevotat, Ludivine Wemeau, Alice Gicquello, Morgane Foulon, Hasna Camara, Gaetan Deslee, Herve Vallerand, Sandra Dury, Delphine Gras, Margaux Bonnaire-Verdier, Romain Kessler, Sandrine Hirschi, Michele Porzio, Tristan Degot, Mathieu Canuet, Armelle Schuller, Julien Stauder, Sahra Ali Azouaou, Armelle Marceau, Hervé Mal, Yolande Costa, Pallav L. Shah, Justin Garner, Karthi Srikanthan, Cielito Caneja, John Thornton, Nick Ten Hacken, Jorine Hartman, Karin Klooster, Sonja Augustijn, Peter Bonta, Jouke Annema, Marianne van de Pol, Annika Goorsenberg, VU University medical center, Groningen Research Institute for Asthma and COPD (GRIAC), Pulmonology, ACS - Pulmonary hypertension & thrombosis, AII - Infectious diseases, AII - Inflammatory diseases, AII - Cancer immunology, CCA - Cancer biology and immunology, and CCA - Imaging and biomarkers
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Pulmonary and Respiratory Medicine - Abstract
This post-hoc analysis of the AIRFLOW-2 trial investigated the changes in airway CT-parameters after targeted lung denervation (TLD) and whether these changes are associated with treatment response. In the treatment group (n = 32), an improvement in air trapping was significantly associated with an improvement in residual volume (RV). Furthermore, improvements in Pi10 and airway lumen were significantly associated with an improvement in both RV and FEV1. Our results could suggest that when improving airway characteristics like decreasing airway wall thickness and increasing the airway lumen, this leads to less air trapping and an improvement in clinical outcomes.
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- 2023
16. Emission rates, size distributions, and generation mechanism of oral respiratory droplets
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Joshua Harrison, Brian Saccente-Kennedy, Christopher M. Orton, Lauren P. McCarthy, Justice Archer, Henry E. Symons, Alicja Szczepanska, Natalie A. Watson, William J. Browne, Benjamin Moseley, Keir E. J. Philip, James H. Hull, James D. Calder, Declan Costello, Pallav L. Shah, Ruth Epstein, Jonathan P. Reid, and Bryan R. Bzdek
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Environmental Chemistry ,General Materials Science ,Pollution - Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought renewed attention to respiratory aerosol and droplet generation. While many studies have robustly quantified aerosol (20 µm diameter) generated by a cohort of 76 adults and children using a water-sensitive paper droplet deposition approach. Unvoiced and voiced activities spanning different levels of loudness, different lengths of sustained phonation, and a specific manner of articulation in isolation were investigated. We find that oral articulation drives >20 µm droplet generation, with breathing generating virtually no droplets and speaking and singing generating on the order of 250 droplets min−1. Lip trilling, which requires extensive oral articulation, generated the most droplets, whereas shouting “Hey,” which requires minimal oral articulation, generated relatively few droplets. Droplet size distributions were all broadly consistent, and no significant differences between the children and adult cohorts were identified. By comparing the aerosol and droplet emissions for the same participants, the full size distribution of respiratory aerosol (0.5–1000 µm) is reported. Although 20 µm droplets dominate the mass concentration. Accurate quantification of aerosol concentrations in the 10–70 μm size range remains very challenging; more robust aerosol analysis approaches are needed to characterize this size range.
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- 2023
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17. Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data
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Sharyn A. Roodenburg, Jorine E. Hartman, Gaëtan Deslée, Felix J.F. Herth, Karin Klooster, Frank C. Sciurba, Pallav L. Shah, Arschang Valipour, Zaid Zoumot, and Dirk-Jan Slebos
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Emphysema ,Pulmonary and Respiratory Medicine ,Meta-analysis ,Bronchoscopic lung volume reduction ,Chronic obstructive pulmonary disease ,Bronchoscopy - Abstract
Background: Lung volume reduction coil (LVR-coil) treatment provides a minimally invasive treatment option for severe emphysema patients which has been studied in multiple clinical trials. Objectives: The aim of the study was to assess the effect of LVR-coil treatment on pulmonary function, quality of life, and exercise capacity using individual participant data. Method: PubMed, Web of Science, and EMBASE were searched until May 17, 2021. Prospective single-arm and randomized controlled trials that evaluated the effect of LVR-coil treatment on forced expiratory volume in 1 s (FEV1), residual volume (RV), St. George Respiratory Questionnaire (SGRQ) total score, and/or 6-min walk distance (6MWD) and were registered in an official clinical trial database were eligible for inclusion. Individual patient data were requested, and a linear mixed effects model was used to calculate overall treatment effects. Results: Eight trials were included in the final analysis, representing 680 individual patients. LVR-coil treatment resulted in a significant improvement in FEV1 at 3- (0.09 L [95% confidence interval (95% CI): 0.06–0.12]) and 6-month follow-up (0.07 L [95% CI: 0.03–0.10]), a significant reduction in RV at 3- (−0.45L [95% CI: −0.62 to −0.28]), 6- (−0.33L [95% CI: −0.52 to −0.14]), and 12-month follow-up (−0.36L [95% CI: −0.64 to −0.08]), a significant reduction in SGRQ total score at 3- (−12.3 points [95% CI: −15.8 to −8.8]), 6- (−10.1 points [95% CI: −12.8 to −7.3]), and 12-month follow-up (−9.8 points [95% CI: −15.0 to −4.7]) and a significant increase in 6MWD at 3-month follow-up (38 m [95% CI: 18–58]). Conclusions: LVR-coil treatment in emphysema patients results in sustained improvements in pulmonary function and quality of life and shorter lived improvements in exercise capacity. Since the owner of this LVR-coil has decided to stop the production and newer generations LVR-coils are currently being developed, these results can act as a reference for future studies and clinical guidance.
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- 2022
18. Metabolic differences between bronchial epithelium from healthy individuals and patients with asthma and the effect of bronchial thermoplasty
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Peter J. Sterk, Michel van Weeghel, Tamara Dekker, Abilash Ravi, Annika W.M. Goorsenberg, Jouke T. Annema, Nick H. T. ten Hacken, Frédéric M. Vaz, Annemiek Dijkhuis, Yanaika S. Sabogal Piñeros, Pallav L. Shah, Barbara Dierdorp, René Lutter, and Peter I. Bonta
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Male ,0301 basic medicine ,Severity of Illness Index ,Oxidative Phosphorylation ,Transcriptome ,chemistry.chemical_compound ,0302 clinical medicine ,immune system diseases ,OXIDATIVE-PHOSPHORYLATION ,Immunology and Allergy ,health care economics and organizations ,COPD ,Middle Aged ,Healthy Volunteers ,Pathophysiology ,Female ,medicine.symptom ,EXPRESSION ,Adult ,Adolescent ,education ,Immunology ,Bronchial epithelium ,Bronchi ,Inflammation ,Respiratory Mucosa ,Young Adult ,03 medical and health sciences ,INFLAMMATION ,parasitic diseases ,medicine ,Metabolome ,Humans ,Aged ,Asthma ,thermoplasty ,Bronchial Thermoplasty ,Bronchial thermoplasty ,Fatty acid metabolism ,business.industry ,Gene Expression Profiling ,Lipid Metabolism ,medicine.disease ,DYSFUNCTION ,respiratory tract diseases ,SEVERITY ,030104 developmental biology ,030228 respiratory system ,chemistry ,business ,metabolism - Abstract
Background: Asthma is a heterogeneous disease with differences in onset, severity, and inflammation. Bronchial epithelial cells (BECs) contribute to asthma pathophysiology.Objective: We determined whether transcriptomes of BECs reflect heterogeneity in inflammation and severity in asthma, and whether this was affected in BECs from patients with severe asthma after their regeneration by bronchial thermoplasty.Methods: RNA sequencing was performed on BECs obtained by bronchoscopy from healthy controls (n = 16), patients with mild asthma (n = 17), patients with moderate asthma (n = 5), and patients with severe asthma (n = 17), as well as on BECs from treated and untreated airways of the latter (also 6 months after bronchial thermoplasty) (n = 23). Lipidome and metabolome analyses were performed on cultured BECs from healthy controls (n = 7); patients with severe asthma (n = 9); and, for comparison, patients with chronic obstructive pulmonary disease (n = 7).Results: Transcriptome analysis of BECs from patients showed a reduced expression of oxidative phosphorylation (OXPHOS) genes, most profoundly in patients with severe asthma but less profoundly and more heterogeneously in patients with mild asthma. Genes related to fatty acid metabolism were significantly upregulated in asthma. Lipidomics revealed enhanced levels of lipid species (phosphatidylcholines, lysophosphatidylcholines. and bis(monoacylglycerol)phosphate), whereas levels of OXPHOS metabolites were reduced in BECs from patients with severe asthma. BECs from patients with mild asthma characterized by hyperresponsive production of mediators implicated in neutrophilic inflammation had decreased expression of OXPHOS genes compared with that in BECs from patients with mild asthma with normoresponsive production. BECs obtained after thermoplasty had significantly increased expression of OXPHOS genes and decreased expression of fatty acid metabolism genes compared with BECs obtained from untreated airways.Conclusion: BECs in patients with asthma are metabolically different from those in healthy individuals. These differences are linked with inflammation and asthma severity, and they can be reversed by bronchial thermoplasty.
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- 2021
19. Airway Inflammation Before and After Bronchial Thermoplasty in Severe Asthma
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Pieta C Wijsman, Annika WM Goorsenberg, Abilash Ravi, Julia NS d'Hooghe, Barbara S Dierdorp, Tamara Dekker, Charlotte CLM van Schaik, Nick HT ten Hacken, Pallav L Shah, Els JM Weersink, Elisabeth H Bel, Jouke T Annema, René Lutter, Peter I Bonta, Graduate School, Pulmonology, AII - Inflammatory diseases, CCA - Cancer biology and immunology, CCA - Imaging and biomarkers, AII - Infectious diseases, ACS - Pulmonary hypertension & thrombosis, and Pulmonary medicine
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Pulmonary and Respiratory Medicine ,bronchial thermoplasty ,Journal of Asthma and Allergy ,bronchoalveolar lavage fluid cells ,epithelial transcriptome ,Immunology and Allergy ,airway inflammation ,cytokines - Abstract
Pieta C Wijsman,1,* Annika WM Goorsenberg,1,* Abilash Ravi,1,2,* Julia NS dâHooghe,1 Barbara S Dierdorp,2 Tamara Dekker,2 Charlotte CLM van Schaik,1 Nick HT ten Hacken,3 Pallav L Shah,4â 6 Els JM Weersink,1 Elisabeth H Bel,1 Jouke T Annema,1 René Lutter,1,2 Peter I Bonta1 1Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; 2Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; 3Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 4Department of Pulmonology, Royal Brompton Hospital, London, UK; 5National Heart & Lung Institute, Imperial College, London, UK; 6Department of Pulmonology, Chelsea & Westminster Hospital, London, UK*These authors contributed equally to this workCorrespondence: Peter I Bonta, Email p.i.bonta@amsterdamumc.nlBackground: Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma, of which the working mechanism and responder profile are partly unknown. The aim of this study is to analyse whether BT alters airway inflammation by epithelial gene expression, inflammatory cell counts and cytokines, and whether this relates to treatment response.Methods: In this clinical trial, 28 severe asthma patients underwent bronchoscopy before and after treatment to obtain bronchial brushes and bronchoalveolar lavage fluid (BALF) from treated and untreated airways. RNA was extracted from bronchial brushes for transcriptome analysis, and BALF cells and cytokines were analysed. Asthma quality of life questionnaires were used to distinguish responders from non-responders. We compared results before and after treatment, between treated and untreated airways, and between responders and non-responders.Results: Gene expression of airway epithelium related to airway inflammation gene set was significantly downregulated in treated airways compared to untreated airways, although this did not differ for patients before and after treatment. No differences were observed in cell counts and cytokines, neither from the untreated compared to treated airways, nor before and after treatment. At baseline, compared to non-responders, the expression of genes related to glycolysis in bronchial epithelium was downregulated and both BALF and blood eosinophil counts were higher in responders.Conclusion: Local differences in gene sets pertaining to epithelial inflammatory status were identified between treated and untreated airways after treatment, not resulting in changes in differential cell counts and cytokine analyses in BALF. Secondly, baseline epithelial glycolysis genes and eosinophil counts in BALF and blood were different between responders and non-responders. The observations from this study demonstrate the potential impact of BT on epithelial gene expression related to airway inflammation while also identifying a possible responder profile.Keywords: airway inflammation, bronchial thermoplasty, bronchoalveolar lavage fluid cells, cytokines, epithelial transcriptome
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- 2022
20. Endobronchial Coil System versus Standard-of-Care Medical Management in the Treatment of Subjects with Severe Emphysema
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Felix J.F. Herth, Dirk-Jan Slebos, Ralf-Harto Huebner, Armelle Marceau, Dirk Skowasch, Romain Kessler, Karin Klooster, Hervé Dutau, Francesca Conway, Hervé Mal, Arschang Valipour, Kaid Darwiche, Martin Hetzel, Gaëtan Deslée, Arnaud Bourdin, Michaela Bezzi, P Hammerl, Christian Schumann, Christian Grah, Charles-Hugo Marquette, Jacques Boutros, Franz Stanzel, Christophe Pison, Pallav L. Shah, University Medical Center Groningen [Groningen] (UMCG), Klinik Floridsdorf [Wien], FHU OncoAge - Pathologies liées à l’âge [CHU Nice] (OncoAge), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Pharmacologie Moléculaire et Cellulaire [UNIV Côte d'Azur] (UPMC)-Université Côte d'Azur (UCA), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Royal Brompton Hospital, Centre Hospitalier Universitaire de Reims (CHU Reims), Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire [Grenoble] (CHU), Klinik für Anthroposophische Medizin, Krankenhaus vom Roten Kreuz Bad Cannstatt, Klinikverbund Kempten-Oberallgäu gGmbH, Nouvel Hôpital Civil de Strasbourg, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Universitätsklinikum Bonn (UKB), Ruhrlandklinik University Hospital, Lungenfachklinik Immenhausen, Lungenklinik Hemer, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia [Brescia], Service de Pneumologie et Allergie - Hôpital Nord [Marseille], Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), University Medical Center Heidelberg, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Groningen Research Institute for Asthma and COPD (GRIAC)
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bronchoscopic lung volume reduction ,Endobronchial coil treatment ,[SDV]Life Sciences [q-bio] ,Medizin ,Hyperinflation ,Severity of Illness Index ,Quality of life ,Internal medicine ,Bronchoscopy ,MINIMAL IMPORTANT DIFFERENCE ,Interventional Pulmonology ,Humans ,Medicine ,Lung volumes ,Prospective Studies ,Respiratory system ,Pneumonectomy ,Adverse effect ,Aged ,Aged, 80 and over ,Emphysema ,business.industry ,Prostheses and Implants ,Middle Aged ,respiratory system ,3. Good health ,respiratory tract diseases ,Clinical trial ,LUNG-VOLUME REDUCTION ,Electromagnetic coil ,Early Termination of Clinical Trials ,Cohort ,Cardiology ,Female ,business - Abstract
Background: Bronchoscopic lung volume reduction using endobronchial coils is a new treatment for patients with severe emphysema. To date, the benefits have been modest and have been suggested to be much larger in patients with severe hyperinflation and nonmulti-comorbidity. Objective: We aimed to evaluate the efficacy and safety of endobronchial coil treatment in a randomized multicenter clinical trial using optimized patient selection. Method: Patients with severe emphysema on HRCT scan with severe hyperinflation (residual volume [RV] ≥200% predicted and RV/total lung capacity [TLC] >55%) were randomized to coil treatment or control. Primary outcome measures were differences in the forced expiratory volume in 1 s (FEV1) and St George’s Respiratory Questionnaire (SGRQ) total score at 6 months. Results: Due to premature study termination, a total of 120 patients (age 63 ± 7 years, FEV1 29 ± 7% predicted, RV 251 ± 41% predicted, RV/TLC 67 ± 6%, and SGRQ 58 ± 13 points), instead of 210 patients, were randomized. At study termination, 91 patients (57 coil and 34 control) had 6-month results available. Analyses showed significantly greater improvements in favor of the coil group. The increase in FEV1 was greater in the coil group than that in the control group by + 10.3 [+4.7 to +16.0] % and in SGRQ by −10.6 [−15.9 to −5.4] points. At study termination, there were 5 (6.8%) deaths in the coil cohort reported. Conclusion: Despite early study termination, coil treatment compared to control results in a significant improvement in the lung function and quality of life benefits for up to 6 months in patients with emphysema and severe hyperinflation. These improvements were of clinical importance but were associated with a higher likelihood of serious adverse events.
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- 2021
21. Dual-energy computed tomographic pulmonary angiography accurately estimates lobar perfusion before lung volume reduction for severe emphysema
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Nidhish Jeyin, Sujal R. Desai, Simon P.G. Padley, Kshama Wechalekar, Sima Gregg, Tiago Sousa, Pallav L. Shah, James P. Allinson, Nicholas S. Hopkinson, Sofina Begum, Simon Jordan, Samuel V. Kemp, and Carole A. Ridge
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Pulmonary and Respiratory Medicine ,Radiology, Nuclear Medicine and imaging - Abstract
PURPOSE: To assess if dual-energy computed tomographic pulmonary angiography (DECTPA) derived lobar iodine quantification can provide an accurate estimate of lobar perfusion in patients with severe emphysema, and offer an adjunct to single-photon emission CT perfusion scintigraphy (SPECT-PS) in assessing suitability for lung volume reduction (LVR). MATERIALS AND METHODS: Patients with severe emphysema (forced expiratory volume in 1 s
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- 2022
22. Safety and effectiveness of bronchial thermoplasty after 10 years in patients with persistent asthma (BT10+)
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Salman Siddiqui, Adalberto Sperb Rubin, José Roberto Lapa e Silva, Jennifer L. Olson, Kaharu Sumino, Charlene McEvoy, G. Mark Grubb, Michel Laviolette, Rekha Chaudhuri, Karin Klooster, Edmund McMullen, Sumita Khatri, Robert Niven, Richard G. Barbers, Michael Simoff, and Pallav L. Shah
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Male ,Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Time ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Bronchoscopy ,AIRWAY SMOOTH-MUSCLE ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Lung ,Demography ,Asthma ,DECLINE ,Bronchial Thermoplasty ,Bronchiectasis ,Bronchial thermoplasty ,medicine.diagnostic_test ,business.industry ,ADULTS ,Middle Aged ,Symptom Flare Up ,medicine.disease ,Respiratory Function Tests ,Clinical trial ,LUNG-FUNCTION ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Disease Progression ,Quality of Life ,Female ,business ,Follow-Up Studies - Abstract
Methods BT10+ was an international, multicentre, follow-up study of participants who were previously enrolled in the AIR, RISA, and AIR2 trials and who had 10 or more years of follow-up since bronchial thermoplasty treatment. Data on patient demographics, quality of life, lung function, CT scans (AIR2 participants only), severe exacerbations, and health-care use during the previous year were collected at the BT10+ 10-year outcomes study visit. The primary effectiveness endpoint was durability of the thermoplasty treatment effect, determined by comparing the proportion of participants who had severe exacerbations during the first and fifth years after bronchial thermoplasty treatment with the proportion of participants who had severe exacerbations during the 12-month period before the BT10+ visit. The primary safety endpoint was the absence of clinically significant post-treatment respiratory image changes after bronchial thermoplasty, defined as bronchiectasis or bronchial stenosis as confirmed by pulmonary volumetric highresolution CT scan at the BT10+ visit (AIR2 participants only). All analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT03243292. The last patient was enrolled on Dec 11, 2018. The last patient completed follow-up on Jan 10, 2019.Findings The BT10+ study enrolled 192 (45%) of the 429 participants who were enrolled in the AIR, RISA, and AIR2 trials. The BT10+ participants comprised 136 who received bronchial thermoplasty (52% of the 260 participants who received bronchial thermoplasty in the original trials), and 56 sham or control participants (33% of 169 from the original trials). 18 (32%) sham or control participants received bronchial thermoplasty after the previous trials concluded. The participants included in BT10+ were followed for 10?8?15?6 years (median 12?1 years) post-treatment. Baseline characteristics were similar between participants enrolled in BT10+ and those not enrolled. Participants treated with bronchial thermoplasty had similar proportions of severe exacerbations at the BT10+ visit (34 [25%] of 136 participants) compared with 1 year (33 [24%] of 135 participants; difference 0?6%, 95% CI ?9?7 to 10?8) and 5 years (28 [22%] of 130 participants; difference 3?5%, ?6?7% to 13?6) after treatment. Quality of life measurements and spirometry were similar between year 1, year 5, and the BT10+ visit. At the BT10+ study visit, pulmonary high-resolution CT scans from AIR2 participants treated with bronchial thermoplasty showed that 13 (13%) of 97 participants had bronchiectasis. When compared with baseline high-resolution CT scans, six (7%) of 89 participants treated with bronchial thermoplasty who did not have bronchiectasis at baseline had developed bronchiectasis after treatment (5 classified as mild, 1 classified as moderate). Participants treated with bronchial thermoplasty after the original study and participants in the sham or control group also had reductions in severe exacerbations at the BT10+ visit compared with baseline.Summary Background Bronchial thermoplasty is an endoscopic treatment for uncontrolled asthma. Previous randomised clinical trials have shown that bronchial thermoplasty reduces severe exacerbations in people with asthma. However, the long-term efficacy and safety of bronchial thermoplasty beyond 5 years is unknown. The BT10+ study aimed to investigate the efficacy and safety of bronchial thermoplasty after 10 or more years of follow-up. Methods BT10+ was an international, multicentre, follow-up study of participants who were previously enrolled in the AIR, RISA, and AIR2 trials and who had 10 or more years of follow-up since bronchial thermoplasty treatment. Data on patient demographics, quality of life, lung function, CT scans (AIR2 participants only), severe exacerbations, and health-care use during the previous year were collected at the BT10+ 10-year outcomes study visit. The primary effectiveness endpoint was durability of the thermoplasty treatment effect, determined by comparing the proportion of participants who had severe exacerbations during the first and fifth years after bronchial thermoplasty treatment with the proportion of participants who had severe exacerbations during the 12-month period before the BT10+ visit. The primary safety endpoint was the absence of clinically significant post-treatment respiratory image changes after bronchial thermoplasty, defined as bronchiectasis or bronchial stenosis as confirmed by pulmonary volumetric high resolution CT scan at the BT10+ visit (AIR2 participants only). All analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT03243292. The last patient was enrolled on Dec 11, 2018. The last patient completed follow-up on Jan 10, 2019. Findings The BT10+ study enrolled 192 (45%) of the 429 participants who were enrolled in the AIR, RISA, and AIR2 trials. The BT10+ participants comprised 136 who received bronchial thermoplasty (52% of the 260 participants who received bronchial thermoplasty in the original trials), and 56 sham or control participants (33% of 169 from the original trials). 18 (32%) sham or control participants received bronchial thermoplasty after the previous trials concluded. The participants included in BT10+ were followed for 10middot8-15middot6 years (median 12middot1 years) post-treatment. Baseline characteristics were similar between participants enrolled in BT10+ and those not enrolled. Participants treated with bronchial thermoplasty had similar proportions of severe exacerbations at the BT10+ visit (34 [25%] of 136 participants) compared with 1 year (33 [24%] of 135 participants; difference 0middot6%, 95% CI -9middot7 to 10middot8) and 5 years (28 [22%] of 130 participants; difference 3middot5%, -6middot7% to 13middot6) after treatment. Quality of life measurements and spirometry were similar between year 1, year 5, and the BT10+ visit. At the BT10+ study visit, pulmonary high-resolution CT scans from AIR2 participants treated with bronchial thermoplasty showed that 13 (13%) of 97 participants had bronchiectasis. When compared with baseline high-resolution CT scans, six (7%) of 89 participants treated with bronchial thermoplasty who did not have bronchiectasis at baseline had developed bronchiectasis after treatment (5 classified as mild, 1 classified as moderate). Participants treated with bronchial thermoplasty after the original study and participants in the sham or control group also had reductions in severe exacerbations at the BT10+ visit compared with baseline.Interpretation Our findings suggest that efficacy of bronchial thermoplasty is sustained for 10 years or more, with an acceptable safety profile. Therefore, bronchial thermoplasty is a long-acting therapeutic option for patients with asthma that remains uncontrolled despite optimised medical treatment. Funding Boston Scientific. Copyright (c) 2021 Elsevier Ltd. All rights reserved.
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- 2021
23. Bronchoscopic Lung Volume Reduction: To the Heart of the Matter
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Justin L. Garner and Pallav L. Shah
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Pulmonary and Respiratory Medicine ,Emphysema ,Pulmonary Emphysema ,Humans ,Critical Care and Intensive Care Medicine ,Pneumonectomy ,Lung - Published
- 2022
24. Susceptibility of Patients with Airway Disease to SARS-CoV-2 Infection
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Francesca M. Conway, Chloe I. Bloom, and Pallav L. Shah
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Pulmonary and Respiratory Medicine ,SARS-CoV-2 ,Respiratory System ,airways disease ,COVID-19 ,Humans ,copd ,Critical Care and Intensive Care Medicine ,Respiration Disorders ,11 Medical and Health Sciences ,Asthma - Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic. People with airways disease are at higher risk of respiratory infection, and viruses can trigger respiratory exacerbations. Patients with airways disease may therefore be more susceptible to SARS-CoV-2 infection, development of covid-19, or be at higher risk of adverse outcomes. Here we review susceptibility, based on current epidemiological studies, and explore biological mechanisms. Evidence from multiple large observational studies has shown chronic obstructive pulmonary disease (COPD) is a significant risk factor for covid-19 related mortality. Whether people with asthma are more susceptible to infection or severe outcomes has been much debated but appears to be related to their asthma phenotype and severity. To what extent these differences are biological or influenced by public health non-pharmacological interventions is difficult to quantify. Biological mechanisms that may influence susceptibility and adverse outcomes in airways disease include the increased expression of protein receptors enabling viral cell entry, dysfunctional epithelial airway immunity, type-2 inflammation and the use of inhaled corticosteroids. A better understanding of the susceptibility and mechanisms is essential for developing preventative and therapeutic strategies. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 2022
25. Quantification of Respirable Aerosol Particles from Speech and Language Therapy Exercises
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Brian Saccente-Kennedy, Justice Archer, Henry E. Symons, Natalie A. Watson, Christopher M. Orton, William J. Browne, Joshua Harrison, James D. Calder, Pallav L. Shah, Declan Costello, Jonathan P. Reid, Bryan R. Bzdek, and Ruth Epstein
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voice therapy ,Speech and Hearing ,respirable aerosols ,Otorhinolaryngology ,speech language pathology ,SARS-CoV-2 ,respiratory pathogens ,LPN and LVN - Abstract
Introduction.Voice assessment and treatment involve the manipulation of all the subsystems of voice production, and may lead to production of respirable aerosol particles that pose a greater risk of potential viral transmission via inhalation of respirable pathogens (e.g. SARS-CoV-2) than quiet breathing or conversational speech. Objective: To characterise the production of respirable aerosol particles during a selection of voice assessment therapy tasks.MethodsWe recruited 23 healthy adult participants (12 males, 11 females), 11 of whom were speech-language pathologists specialising in voice disorders. We used an aerodynamic and optical particle sizer to measure the number concentration and particle size distributions of respirable aerosols generated during a variety of voice assessment and therapy tasks. The measurements were carried out in a laminar flow operating theatre, with a near-zero background aerosol concentration, allowing us to quantify the number concentration and size distributions of respirable aerosol particles produced from assessment/therapy tasks studied. ResultsAerosol number concentrations generated while performing assessment/therapy tasks were log-normally distributed among individuals with no significant differences between professionals (speech-language pathologists) and non-professionals or between males and females. Activities produced up to 32 times the aerosol number concentration of breathing and 24 times that of speech at 70-80 dBA. In terms of aerosol mass, activities produced up to 163 times the mass concentration of breathing and up to 36 times the mass concentration of speech. Voicing was a significant factor in aerosol production; aerosol number/mass concentrations generated during voiced activities were 1.1-5 times higher than their unvoiced counterpart activities. Additionally, voiced activities produced bigger respirable aerosol particles than their unvoiced variants except the trills. Humming generated higher aerosol concentrations than sustained /a/, fricatives, speaking (70-80 dBA), and breathing. Oscillatory semi-occluded vocal tract exercises (SOVTEs) generated higher aerosol number/mass concentrations than activities without oscillation. Water resistance therapy (WRT) generated the most aerosol of all activities, ~10 times higher than speaking at 70-80 dBA and >30 times higher than breathing.ConclusionsAll activities generated more aerosol than breathing, although a sizeable minority were no different to speaking. Larger number concentrations and larger particle sizes appear to be generated by activities with higher suspected airflows, with the greatest involving intraoral pressure oscillation and/or an oscillating oral articulation (WRT or trilling).
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- 2022
26. Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes
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Anna Mayr, Justin L. Garner, Pallav L. Shah, Vincent Ninane, Christophe Pison, Thierry Perez, Bruno Degano, Gaëtan Deslée, Dirk-Jan Slebos, Alexander D. Peterson, Wim Janssens, Jorine E. Hartman, Romain Kessler, Arschang Valipour, Martin Mayse, Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), Royal Brompton and Harefield NHS Foundation Trust, Chelsea and Westminster Hospital, Imperial College London, University Medical Center Groningen [Groningen] (UMCG), Université libre de Bruxelles (ULB), University Hospitals Leuven [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil de Strasbourg, Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims (CHU Reims), Klinik Floridsdorf [Wien], Nuvaira, Inc., Minneapolis, MN, USA, The AIRFLOW-1 clinical trial was funded by Nuvaira, Inc., Minneapolis, MN, USA., Groningen Research Institute for Asthma and COPD (GRIAC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), and dormoy, valerian
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Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Forced Expiratory Volume/physiology ,Anticholinergic ,Sciences du Vivant [q-bio]/Médecine humaine et pathologie ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Lung/diagnostic imaging ,Pulmonary function testing ,Pulmonary Disease ,03 medical and health sciences ,FEV1/FVC ratio ,0302 clinical medicine ,Quality of life ,Double-Blind Method ,Chronic Obstructive/diagnosis ,Internal medicine ,Bronchoscopy ,medicine ,Humans ,COPD ,030212 general & internal medicine ,Prospective Studies ,Adverse effect ,Denervation ,lcsh:RC705-779 ,Lung ,business.industry ,Nerves ,Research ,Généralités ,lcsh:Diseases of the respiratory system ,medicine.disease ,Acetylcholine ,3. Good health ,respiratory tract diseases ,medicine.anatomical_structure ,030228 respiratory system ,Denervation/methods ,Pulmonary Disease, Chronic Obstructive/diagnosis ,Quality of Life ,[SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Female ,business ,Targeted lung denervation ,Follow-Up Studies - Abstract
Following publication of the original article [1], we were notified that the first and last author names have been swapped. The original article has been corrected., SCOPUS: er.j, info:eu-repo/semantics/published
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- 2021
27. Bronchial Thermoplasty Induced Airway Smooth Muscle Reduction and Clinical Response in Severe Asthma. The TASMA Randomized Trial
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Annika W. M. Goorsenberg, Julia N. S. d’Hooghe, Karthikan Srikanthan, Nick H. T. ten Hacken, Els J. M. Weersink, Joris J. T. H. Roelofs, Samuel V. Kemp, Elisabeth H. Bel, Pallav L. Shah, Jouke T. Annema, Peter I. Bonta, C. Caneja, J. Hartman, S. Augustijn, M. van de Pol, S. Lone-Latif, O. de Boer, T. Dirksen, AII - Inflammatory diseases, Pulmonology, ACS - Pulmonary hypertension & thrombosis, Groningen Research Institute for Asthma and COPD (GRIAC), and Lifestyle Medicine (LM)
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Pulmonary and Respiratory Medicine ,Severe asthma ,Mass reduction ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Bronchial thermoplasty ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,030212 general & internal medicine ,Reduction (orthopedic surgery) ,business.industry ,Airway remodeling ,Airway smooth muscle ,respiratory system ,musculoskeletal system ,respiratory tract diseases ,030228 respiratory system ,Anesthesia ,business - Abstract
Rationale: Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma targeting airway smooth muscle (ASM). Observational studies have shown ASM mass reduction after BT, but appropriate control groups are lacking. Furthermore, as treatment response is variable, identifying optimal candidates for BT treatment is important. Objectives: First, to assess the effect of BT on ASM mass, and second, to identify patient characteristics that correlate with BT response. Methods: Patients with severe asthma (n = 40) were randomized to immediate (n = 20) or delayed (n = 20) BT treatment. Before randomization, clinical, functional, blood, and airway biopsy data were collected. In the delayed control group, reassessment, including biopsies, was performed after 6 months of standard clinical care, followed by BT. In both groups, post-BT data including biopsies were obtained after 6 months. ASM mass (% positive desmin or a-smooth muscle actin area in the total biopsy) was calculated with automated digital analysis software. Associations between baseline characteristics and Asthma Control Questionnaire and Asthma Quality of Life Questionnaire (AQLQ) improvement were explored. Measurements and Main Results: Median ASM mass decreased by .50% in the immediate BT group (n = 17) versus no change in the delayed control group (n = 19) (P = 0.0004). In the immediate group, Asthma Control Questionnaire scores improved with 20.79 (interquartile range [IQR], 21.61 to 0.02) compared with 0.09 (IQR, 20.25 to 1.17) in the delayed group (P = 0.006). AQLQ scores improved with 0.83 (IQR, 20.15 to 1.69) versus 20.02 (IQR, 20.77 to 0.75) (P = 0.04). Treatment response in the total group (n = 35) was positively associated with serum IgE and eosinophils but not with baseline ASM mass. Conclusions: ASM mass significantly decreases after BT when compared with a randomized non–BT-treated control group. Treatment response was associated with serum IgE and eosinophil levels but not with ASM mass.
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- 2021
28. Identifying Responders and Exploring Mechanisms of Action of the Endobronchial Coil Treatment for Emphysema
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Sonja W S Augustijn, Justin L. Garner, Jorine E. Hartman, Karin Klooster, Dirk-Jan Slebos, Pallav L. Shah, Wouter H. van Geffen, Nick H. T. ten Hacken, and Groningen Research Institute for Asthma and COPD (GRIAC)
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Male ,Pulmonary and Respiratory Medicine ,Spirometry ,Vital capacity ,medicine.medical_specialty ,Hyperinflation ,Air trapping ,law.invention ,Airway resistance ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Interventional Pulmonology ,Humans ,Prospective Studies ,Pneumonectomy ,Pneumonectomy/adverse effects ,Dynamic hyperinflation ,Lung ,COPD ,medicine.diagnostic_test ,business.industry ,Lung/physiopathology ,Middle Aged ,medicine.disease ,Respiratory Function Tests ,Residual Volume ,Treatment Outcome ,Pulmonary Emphysema ,Pulmonary Emphysema/physiopathology ,Cardiology ,Female ,medicine.symptom ,business - Abstract
Background: So far, 3 randomized controlled trials have shown that the endobronchial treatment using coils is safe and effective. However, the more exact underlying mechanism of the treatment and best predictors of response are unknown. Objectives: The aim of the study was to gain more knowledge about the underlying physiological mechanism of the lung volume reduction coil treatment and to identify potential predictors of response to this treatment. Methods: This was a prospective nonrandomized single-center study which included patients who were bilaterally treated with coils. Patients underwent an extensive number of physical tests at baseline and 3 months after treatment. Results: Twenty-four patients (29% male, mean age 62 years, forced expiratory volume in 1 s [FEV1] 26% pred, residual volume (RV) 231% pred) were included. Three months after treatment, significant improvements were found in spirometry, static hyperinflation, air trapping, airway resistance, treated lobe RV and treated lobes air trapping measured on CT scan, exercise capacity, and quality of life. The change in RV and airway resistance was significantly associated with a change in FEV1, forced vital capacity, air trapping, maximal expiratory pressure, dynamic compliance, and dynamic hyperinflation. Predictors of treatment response at baseline were a higher RV, larger air trapping, higher emphysema score in the treated lobes, and a lower physical activity level. Conclusions: Our results confirm that emphysema patients benefit from endobronchial coil treatment. The primary mechanism of action is decreasing static hyperinflation with improvement of airway resistance which consequently changes dynamic lung mechanics. However, the right patient population needs to be selected for the treatment to be beneficial which should include patients with severe lung hyperinflation, severe air trapping, and significant emphysema in target lobes.
- Published
- 2021
29. Bronchoscopic Targeted Lung Denervation in Patients with Severe Asthma: Preliminary Findings
- Author
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Karthi Srikanthan, Huib A. M. Kerstjens, Jorine E. Hartman, Nick H. T. ten Hacken, Dirk-Jan Slebos, Cielito Caneja, Pallav L. Shah, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Bronchoscopy ,Internal medicine ,medicine ,Lung volumes ,General anaesthesia ,Vagal nerve ,Adverse effect ,Asthma ,Denervation ,Lung ,medicine.diagnostic_test ,business.industry ,LONG-TERM SAFETY ,medicine.disease ,Acetylcholine ,respiratory tract diseases ,BRONCHIAL THERMOPLASTY ,medicine.anatomical_structure ,Novel Insights from Clinical Practice ,business ,TIOTROPIUM ,Targeted lung denervation - Abstract
Treatment options for severe asthma are limited, particularly in those patients who do not meet criteria for biologicals. Targeted lung denervation (TLD) is the bronchoscopic ablation of the peribronchial vagal nerve trunks to reduce cholinergic stimulation of airway smooth muscle and submucosal glands. This report describes the experience of the first 2 asthma patients treated with TLD worldwide. The participants were 54 and 51 years of age, and both had severe asthma (GINA 5) (FEV1: 53% and 113% of predicted; AQLQ scores: 5.3 and 4.4). Both participants were treated with TLD in a single day-case procedure under general anaesthesia. Lung function, health status, and adverse event data were collected at baseline and 12 months after TLD. No treatment-related serious adverse events were reported up to 12 months. Cough symptoms improved in both participants, and 1 participant reported a marked reduction in rescue medication use at 6 months. There were no significant changes in spirometry, lung volumes, or health status. In conclusion, TLD was performed safely in both participants, but more evidence is needed to clarify safety and efficacy of TLD in severe asthma. Therefore, further investigation of the treatment in severe asthma patients would be useful.
- Published
- 2022
30. Immuno-proteomic profiling reveals aberrant immune cell regulation in the airways of individuals with ongoing post-COVD-19 respiratory disease
- Author
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Bavithra Vijayakumar, Karim Boustani, Patricia P. Ogger, Artemis Papadaki, James Tonkin, Christopher M. Orton, Poonam Ghai, Kornelija Suveizdyte, Richard J. Hewitt, Sujal R. Desai, Anand Devaraj, Robert J. Snelgrove, Philip L. Molyneaux, Justin L. Garner, James E. Peters, Pallav L. Shah, Clare M. Lloyd, James A. Harker, Asthma UK, Rosetrees Trust, Action for Pulmonary Fibrosis, Medical Research Council (MRC), and Wellcome Trust
- Subjects
Adult ,Male ,Immunoproteins ,Proteome ,COVID19 ,Respiratory System ,Immunology ,T cells ,tissue-resident memory ,Article ,Monocytes ,tissue resident memory ,proteomics ,Immunology and Allergy ,Humans ,long COVID ,respiratory viral infection ,Aged ,B-Lymphocytes ,Immunity, Cellular ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,respiratory tract ,Respiration Disorders ,Infectious Diseases ,1107 Immunology ,Female ,airways ,Follow-Up Studies ,T-Lymphocytes, Cytotoxic - Abstract
Some patients hospitalized with acute COVID-19 suffer respiratory symptoms that persist for many months. We delineated the immune-proteomic landscape in the airway and peripheral blood of healthy controls and post-COVID-19 patients 3 to 6 months after hospital discharge. Post-COVID-19 patients showed abnormal airway (but not plasma) proteomes, with elevated concentration of proteins associated with apoptosis, tissue repair and epithelial injury versus healthy individuals. Increased numbers of cytotoxic lymphocytes were observed in individuals with greater airway dysfunction, while increased B cell numbers and altered monocyte subsets were associated with more widespread lung abnormalities. 1 year follow-up of some post-COVID-19 patients indicated that these abnormalities resolved over time. In summary, COVID-19 causes a prolonged change to the airway immune landscape in those with persistent lung disease, with evidence of cell death and tissue repair linked to ongoing activation of cytotoxic T cells., Graphical Abstract, Many individuals recovering from acute SARS-CoV-2 infection suffer prolonged respiratory dysfunction for months to years after viral clearance. Vijayakumar, Boustani, Ogger, Papadaki et al. show that individuals with persistent symptoms 3-6 months after infection have an altered airway immune cell landscape and evidence of ongoing lung damage. Importantly, different immune cell types correlate with the severity of distinct aspects of ongoing respiratory disease.
- Published
- 2022
31. Is Fibrosis Really Fibrosis?
- Author
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Pallav L. Shah and Bavithra Vijayakumar
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Fibrosis ,business.industry ,Internal medicine ,medicine ,Critical Care and Intensive Care Medicine ,medicine.disease ,business ,Gastroenterology - Published
- 2021
32. Increase in COVID-19 inpatient survival following detection of Thromboembolic and Cytokine storm risk from the point of admission to hospital by a near real time Traffic-light System (TraCe-Tic)
- Author
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Gary Davies, Richard T Keays, Claire L. Shovlin, Sheena Patel, Andrew Godfrey, Iain Beveridge, Marcela P. Vizcaychipi, Alex J. McCarthy, Pallav L. Shah, and Michelle Hayes
- Subjects
Male ,Microbiology (medical) ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,lcsh:QR1-502 ,Improved survival ,Age and sex ,Microbiology ,lcsh:Microbiology ,Article ,lcsh:Infectious and parasitic diseases ,C-reactive protein ,Gary Davies on behalf of the ChelWest COVID19 Consortium ,1117 Public Health and Health Services ,Anticoagulation ,Betacoronavirus ,03 medical and health sciences ,Traffic signal ,Thromboembolism ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,lcsh:RC109-216 ,Prospective Studies ,Mortality ,Pandemics ,Aged ,Ferritin ,Inpatients ,0303 health sciences ,SARS-CoV-2 ,030306 microbiology ,business.industry ,COVID-19 ,1103 Clinical Sciences ,medicine.disease ,Confidence interval ,Infectious Diseases ,D-dimer ,SARS-CoV2 ,Cytokines ,FLAG (chemotherapy) ,Discharge ,Coronavirus Infections ,business ,Cytokine storm - Abstract
Introduction Our goal was to evaluate if traffic-light driven personalized care for COVID-19 was associated with improved survival in acute hospital settings. Methods Discharge outcomes were evaluated before and after prospective implementation of a real-time dashboard with feedback to ward-based clinicians. Thromboembolism categories were “medium-risk” (D-dimer >1000 ng/mL or CRP >200 mg/L); “high-risk” (D-dimer >3000 ng/mL or CRP >250 mg/L) or “suspected” (D-dimer >5000 ng/mL). Cytokine storm risk was categorized by ferritin. Results 939/1039 COVID-19 positive patients (median age 67 years, 563/939 (60%) male) completed hospital encounters to death or discharge by 21st May 2020. Thromboembolism flag criteria were reached by 568/939 (60.5%), including 238/275 (86.6%) of the patients who died, and 330/664 (49.7%) of the patients who survived to discharge, p < 0.0001. Cytokine storm flag criteria were reached by 212 (22.6%) of admissions, including 80/275 (29.1%) of the patients who died, and 132/664 (19.9%) of the patients who survived, p < 0.0001. The maximum thromboembolism flag discriminated completed encounter mortality (no flag: 37/371 [9.97%] died; medium-risk: 68/239 [28.5%]; high-risk: 105/205 [51.2%]; and suspected thromboembolism: 65/124 [52.4%], p < 0.0001). Flag criteria were reached by 535 consecutive COVID-19 positive patients whose hospital encounter completed before traffic-light introduction: 173/535 (32.3% [95% confidence intervals 28.0, 36.0]) died. For the 200 consecutive admissions after implementation of real-time traffic light flags, 46/200 (23.0% [95% confidence intervals 17.1, 28.9]) died, p = 0.013. Adjusted for age and sex, the probability of death was 0.33 (95% confidence intervals 0.30, 0.37) before traffic light implementation, 0.22 (0.17, 0.27) after implementation, p < 0.001. In subgroup analyses, older patients, males, and patients with hypertension (p ≤ 0.01), and/or diabetes (p = 0.05) derived the greatest benefit from admission under the traffic light system. Conclusion Personalized early interventions were associated with a 33% reduction in early mortality. We suggest benefit predominantly resulted from early triggers to review/enhance anticoagulation management, without exposing lower-risk patients to potential risks of full anticoagulation therapy.
- Published
- 2020
33. Bronchoscopic interventions for severe emphysema
- Author
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Dirk-Jan Slebos and Pallav L. Shah
- Subjects
Pulmonary and Respiratory Medicine ,Lung volume reduction ,Ablation Techniques ,Male ,medicine.medical_specialty ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,Medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Pneumonectomy ,medicine.diagnostic_test ,Medical treatment ,business.industry ,Patient Selection ,Treatment options ,Prostheses and Implants ,respiratory system ,respiratory tract diseases ,Clinical trial ,Clinical Practice ,030228 respiratory system ,Pulmonary Emphysema ,Polyvinyl Alcohol ,business ,Airway - Abstract
Patients with severe emphysema have limited treatment options and only derive a small benefit from optimal medical treatment. The only other therapy to have significant clinical beneficial effect in emphysema is LVRS but the perceived risk and invasiveness of surgery has fuelled bronchoscopic approaches to induce lung volume reduction. There are multiple bronchoscopic methods for achieving volume reduction in severe emphysema: EBV, airway bypass procedure, endobronchial coils, thermal (vapour) sclerosis and chemical sclerosis (sealants). Optimal patient selection is key to successful patient outcomes. This review discusses bronchoscopic approaches for emphysema treatment which has progressed through clinical trials to clinical practice.
- Published
- 2020
34. Clinical characteristics and 28-day mortality of medical patients admitted with COVID-19 to a central London teaching hospital
- Author
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O. Orhan, Justin L. Garner, Pallav L. Shah, Hugo Farne, E. Starren, D. McNally, K. Agbontaen, K. Khalil, R. Dhunnookchand, G. Davies, D. Lai, R. Morton, S. Mandalia, A. Love, Mark T. Nelson, and Winston Banya
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Survival ,Coronavirus disease 2019 (COVID-19) ,medicine.disease_cause ,Article ,Internal medicine ,Pandemic ,medicine ,Mortality ,Coronavirus ,biology ,SARS-CoV-2 ,Viral Epidemiology ,business.industry ,COVID-19 ,Pneumonia ,biology.organism_classification ,medicine.disease ,Infectious Diseases ,28 day mortality ,business ,Betacoronavirus ,Cohort study - Published
- 2020
35. Interventional Bronchoscopy
- Author
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Neal Patel, Pallav L. Shah, Fabien Maldonado, Momen M. Wahidi, Sebastian Fernandez-Bussy, Arschang Valipour, Mark H. Weir, Felix F.J. Herth, Dirk-Jan Slebos, Daniela Gompelmann, Gerard J. Criner, and Ralf Eberhardt
- Subjects
Lung Diseases ,musculoskeletal diseases ,Pulmonary and Respiratory Medicine ,Chronic bronchitis ,medicine.medical_specialty ,education ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,Flexible fiberoptic bronchoscopy ,medicine ,Humans ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,State of the art review ,respiratory system ,respiratory tract diseases ,stomatognathic diseases ,030228 respiratory system ,Therapeutic Aspiration ,Radiology ,business ,Airway ,Interventional bronchoscopy ,Electromagnetic navigation bronchoscopy - Abstract
For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.
- Published
- 2020
36. Lung Volume Reduction Surgery: Reinterpreted With Longitudinal Data Analyses Methodology
- Author
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Peter J. Diggle, Eric Lim, Peter Goldstraw, Inês Sousa, and Pallav L. Shah
- Subjects
Pulmonary and Respiratory Medicine ,Vital capacity ,medicine.medical_specialty ,Time Factors ,Longitudinal data ,MEDLINE ,030204 cardiovascular system & hematology ,Lung volume reduction surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Forced Expiratory Volume ,medicine ,Humans ,In patient ,Pneumonectomy ,Lung ,Retrospective Studies ,business.industry ,Retrospective cohort study ,respiratory tract diseases ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary Emphysema ,030228 respiratory system ,Emergency medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
The largest randomised controlled trial evaluating results of lung volume reduction surgery (LVRS) was conducted by the National Emphysema Treatment Trial (NETT) that published a series of reports for outcomes up to 24 months. However, patient outcomes were difficult to interpret due to limitations in and the presentation of conventional statistical analyses applied to longitudinal data. We reevaluated the NETT results using longitudinal data methodology to report longer-term outcomes to facilitate interpretation by clinicians and patients who are considering LVRS for emphysema management.Trial data were released by the United States National Institutes of Health and the National Heart, Lung, and Blood Institute and analyzed using a mixed-effects model. Data on the difference in lung function variables between patients receiving LVRS vs medical care out to 5 years were estimated and are presented.The 5-year differences in patients randomised to LVRS were a small but sustained improvement in lung function indicators of forced expiratory volume in 1 second, forced vital capacity, and residual volume of +1.4% (P.001), +3.44% (P.001) and -19.49% (P.001) of the predicted values, respectively. With regards to physiological function, the 5-year difference in patients randomised to LVRS was an overall 0.89 W improvement in maximum workload (P = .069), -4.12 improvement in shortness of breath score (P.001), and 0.088 improvement in quality of well-being score (P = .102).Our results suggest that LVRS continues to have an important role in the treatment of patients with severe emphysema, with long-term benefits to lung function variables and a sustained improvement to the relief of dyspnea.
- Published
- 2020
37. T5 Respiratory particle and droplet emission during speech and exercise
- Author
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B Moseley, Dae Costello, William J Browne, Bryan R. Bzdek, Christopher M. Orton, NA Watson, J Archer, B Saccente-Kennedy, James D. F. Calder, Pallav L. Shah, HE Symons, K. E. J. Philip, JH Hull, and Jonathan P. Reid
- Subjects
business.industry ,Medicine ,Particle ,Mechanics ,Respiratory system ,business - Published
- 2021
38. Comparing aerosol number and mass exhalation rates from children and adults during breathing, speaking and singing
- Author
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Justice Archer, Lauren P. McCarthy, Henry E. Symons, Natalie A. Watson, Christopher M. Orton, William J. Browne, Joshua Harrison, Benjamin Moseley, Keir E. J. Philip, James D. Calder, Pallav L. Shah, Bryan R. Bzdek, Declan Costello, Jonathan P. Reid, and Imperial College London
- Subjects
Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,Biochemistry ,Biotechnology - Abstract
Aerosol particles of respirable size are exhaled when individuals breathe, speak and sing and can transmit respiratory pathogens between infected and susceptible individuals. The COVID-19 pandemic has brought into focus the need to improve the quantification of the particle number and mass exhalation rates as one route to provide estimates of viral shedding and the potential risk of transmission of viruses. Most previous studies have reported the number and mass concentrations of aerosol particles in an exhaled plume. We provide a robust assessment of the absolute particle number and mass exhalation rates from measurements of minute ventilation using a non-invasive Vyntus Hans Rudolf mask kit with straps housing a rotating vane spirometer along with measurements of the exhaled particle number concentrations and size distributions. Specifically, we report comparisons of the number and mass exhalation rates for children (12–14 years old) and adults (19–72 years old) when breathing, speaking and singing, which indicate that child and adult cohorts generate similar amounts of aerosol when performing the same activity. Mass exhalation rates are typically 0.002–0.02 ng s−1from breathing, 0.07–0.2 ng s−1from speaking (at 70–80 dBA) and 0.1–0.7 ng s−1from singing (at 70–80 dBA). The aerosol exhalation rate increases with increasing sound volume for both children and adults when both speaking and singing.
- Published
- 2021
39. Expert Statement: Pneumothorax Associated with One-Way Valve Therapy for Emphysema: 2020 Update
- Author
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Rick Sue, Janwillem W. H. Kocks, Gerard J. Criner, Marlies van Dijk, Daniela Gompelmann, D. Kyle Hogarth, Arschang Valipour, Dirk-Jan Slebos, Felix J.F. Herth, Pallav L. Shah, Hugo Goulart de Oliveira, Karin Klooster, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bronchoscopic lung volume reduction ,Statement (logic) ,IMPACT ,Airflow obstruction ,PANEL ,Bronchoscopy ,Quality of life ,medicine ,Interventional Pulmonology ,LUNG-VOLUME-REDUCTION ,Intensive care medicine ,PREDICTORS ,Emphysema ,One-way valves ,medicine.diagnostic_test ,business.industry ,Pneumothorax ,respiratory system ,ENDOBRONCHIAL VALVES ,medicine.disease ,respiratory tract diseases ,surgical procedures, operative ,SAFETY ,TRIAL ,business ,Risk assessment ,Complication - Abstract
For selected patients with advanced emphysema, bronchoscopic lung volume reduction with one-way valves can lead to clinically relevant improvements of airflow obstruction, hyperinflation, exercise capacity, and quality of life. The most common complication of this procedure is pneumothorax with a prevalence of up to ±34% of the treated patients. Patients who develop a pneumothorax also experience meaningful clinical benefits once the pneumothorax is resolved. Timely resolution of a post-valve treatment pneumothorax requires skilled and adequate pneumothorax management. This expert panel statement is an updated recommendation of the 2014 statement developed to help guide pneumothorax management after valve placement. Additionally, mechanisms for pneumothorax development, risk assessment, prevention of pneumothorax, and outcomes after pneumothorax are addressed. This recommendation is based on a combination of the current scientific literature and expert opinion, which was obtained through a modified Delphi method.
- Published
- 2021
40. CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge
- Author
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Anand Devaraj, Christopher M. Orton, Sujal R. Desai, Bavithra Vijayakumar, James Tonkin, Keir E J Philip, and Pallav L. Shah
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,chemistry.chemical_compound ,Internal medicine ,medicine ,Hospital discharge ,Humans ,Radiology, Nuclear Medicine and imaging ,Traction bronchiectasis ,Lung ,Original Research ,Creatinine ,Adult patients ,business.industry ,COVID-19 ,Fibrosis ,Hospitals ,Patient Discharge ,medicine.anatomical_structure ,Dyspnea ,chemistry ,business ,Volume loss ,Tomography, X-Ray Computed ,Cohort study - Abstract
Background Data on the long-term pulmonary sequelae in COVID-19 are lacking. Purpose To assess symptoms, functional impairment, and residual pulmonary abnormalities on serial chest CT scans in COVID-19 survivors discharged from hospital at up to 1-year follow-up. Materials and Methods Adult patients with COVID-19 discharged between March 2020 and June 2020 were prospectively evaluated at 3 months and 1 year through systematic assessment of symptoms, functional impairment, and thoracic CT scans as part of the PHENOTYPE study, an observational cohort study in COVID-19 survivors. Lung function testing was limited to participants with CT abnormalities and/or persistent breathlessness. Bonferroni correction was used. Results Eighty participants (mean age, 59 years ± 13 [SD]; 53 men) were assessed. At outpatient review, persistent breathlessness was reported in 37 of the 80 participants (46%) and cough was reported in 17 (21%). CT scans in 73 participants after discharge (median, 105 days; IQR, 95-141 days) revealed persistent abnormalities in 41 participants (56%), with ground-glass opacification (35 of 73 participants [48%]) and bands (27 of 73 participants [37%]) predominating. Unequivocal signs indicative of established fibrosis (ie, volume loss and/or traction bronchiectasis) were present in nine of 73 participants (12%). Higher admission serum C-reactive protein (in milligrams per liter), fibrinogen (in grams per deciliter), urea (millimoles per liter), and creatinine (micromoles per liter) levels; longer hospital stay (in days); older age (in years); and requirement for invasive ventilation were associated with CT abnormalities at 3-month follow-up. Thirty-two of 41 participants (78%) with abnormal findings at 3-month follow-up CT underwent repeat imaging at a median of 364 days (range, 360-366 days), with 26 (81%) showing further radiologic improvement (median, 18%; IQR, 10%-40%). Conclusion CT abnormalities were common at 3 months after COVID-19 but with signs of fibrosis in a minority. More severe acute disease was linked with CT abnormalities at 3 months. However, radiologic improvement was seen in the majority at 1-year follow-up. ClinicalTrials.gov identifier: NCT04459351. © RSNA, 2022
- Published
- 2021
41. Bronchoscopic Diagnosis of Peripheral Lung Lesions
- Author
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Pallav L. Shah and Stephen Lam
- Subjects
Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Lung ,business.industry ,MEDLINE ,Peripheral ,Text mining ,medicine.anatomical_structure ,Bronchoscopy ,Humans ,Medicine ,business - Published
- 2021
42. Durability of Zephyr Valve treatment: 24-month follow-up in the TRANSFORM Study
- Author
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Alan Kirk, Ralf-Harto Hübner, Jagan Rao, Kris Carron, Valery Trosini-Desert, Nicola J. Downer, Hervé Mal, Dirk-Jan Slebos, Malgorzata Kornaszweska, Ralf Eberhardt, Eric Derom, Narinder S. Shargill, Felix J.F. Herth, Christophe Pison, Kaid Darwiche, Samuel V. Kemp, Pallav L. Shah, and Charles H. Marquette
- Subjects
medicine.medical_specialty ,business.industry ,Medizin ,medicine ,business ,Durability ,Month follow up ,Surgery - Published
- 2021
43. Immuno-proteomic profiling reveals abundant airway CD8 T cells and ongoing epithelial injury in prolonged post-COVID19 respiratory disease
- Author
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Karim Boustani, Philip L. Molyneaux, Patricia P. Ogger, Poonam Ghai, James A. Harker, Robert J. Snelgrove, Pallav L. Shah, Christopher M. Orton, Kornelija Suveizdyte, Artermis Papadaki, James Tonkin, Justin L. Garner, Bavithra Vijayakumar, Clare M. Lloyd, Richard J. Hewitt, and James E. Peters
- Subjects
medicine.diagnostic_test ,business.industry ,Respiratory disease ,medicine.disease ,Epithelial Damage ,Bronchoalveolar lavage ,Immune system ,Immunology ,medicine ,Cytotoxic T cell ,Respiratory system ,Airway ,business ,CD8 - Abstract
SummarySome patients hospitalized with acute COVID19 suffer respiratory symptoms that persist for many months. To characterize the local and systemic immune responses associated with this form of ‘Long COVID’, we delineated the immune and proteomic landscape in the airway and peripheral blood of normal volunteers and patients from 3 to 6 months after hospital discharge. The bronchoalveolar lavage (but not peripheral blood) proteome was abnormal in patients with post-COVID19 lung disease with significantly elevated concentration of proteins associated with apoptosis, tissue repair and epithelial injury. This correlated with an increase in cytotoxic lymphocytes (especially tissue resident CD8+T cells), lactate dehydrogenase and albumin (biomarkers of cell death and barrier integrity). Follow-up of a subset of these patients greater than 1-year post-COVID19 indicated these abnormalities resolved over time. Collectively, these data indicate that COVID-19 results in a prolonged change to the airway immune landscape in those with persistent lung disease, with evidence of cell death and tissue repair linked to ongoing activation of cytotoxic T cells.HighlightsThe post-COVID19 airway is characterized by increased cytotoxic lymphocytes.Distinct airway proteomes are associated with the airway immune cell landscape.The peripheral blood does not predict immune-proteome alterations in the airway post-COVID19.Persistent abnormalities in the airway immune-proteome post-COVID19 airways correlate with ongoing epithelial damage.
- Published
- 2021
44. Risk of bleeding in patients undergoing pulmonary procedures on antiplatelet or anticoagulants: A systematic review
- Author
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V. Trosini-Desert, Moishe Liberman, Semra Bilaceroglu, Carey C. Thomson, David Ost, Gaetane Michaud, S. Brosnhan, Rohini S. Chatterjee, Jason T. Poston, R. I. Patel, Derrick D. Herman, and Pallav L. Shah
- Subjects
Adult ,Lung Diseases ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.drug_class ,Thoracentesis ,medicine.medical_treatment ,Clinical Decision-Making ,Hemorrhage ,Postoperative Hemorrhage ,03 medical and health sciences ,Tracheostomy ,0302 clinical medicine ,Bronchoscopy ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Pulmonary procedures ,Intensive care medicine ,Diagnostic Techniques and Procedures ,medicine.diagnostic_test ,business.industry ,Anticoagulant ,Anticoagulants ,Awareness ,Pleural Diseases ,030228 respiratory system ,Percutaneous tracheostomy ,Anticoagulant Agent ,business ,Platelet Aggregation Inhibitors - Abstract
As many as 25% of all patients undergoing invasive pulmonary procedures are receiving at least one antiplatelet or anticoagulant agent. For those undergoing elective procedures, the decision-making process is uncomplicated and the procedure may be postponed until the antiplatelet or anticoagulant agent may be safely held. However, many invasive pulmonary procedures are semi-elective or emergent in nature in which case a risk-benefit calculation and discussion occur between the provider and patient or surrogate decision-maker. Therefore, it is critical for providers to have an awareness of the risk of bleeding complications with different pulmonary procedures on various antiplatelet and anticoagulant agents. This systematic review summarizes the bleeding complications associated with different pulmonary procedures in patients on various antiplatelet or anticoagulant agents in the literature and reveals a paucity of high-quality evidence across a wide spectrum of pulmonary procedures and antiplatelet or anticoagulant agents. The results of this review can help inform providers of the bleeding risk in these patients to aid in the shared decision-making process and risk vs benefit discussion.
- Published
- 2019
45. Endoscopic Lung Volume Reduction
- Author
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Dirk-Jan Slebos, Pallav L Shah, Felix J.F. Herth, Arschang Valipour, Frank C. Sciurba, Gerard J. Criner, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
Pulmonary and Respiratory Medicine ,Lung volume reduction ,medicine.medical_specialty ,Nice ,Air trapping ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,medicine ,Humans ,030212 general & internal medicine ,Pneumonectomy ,Intensive care medicine ,computer.programming_language ,Emphysema ,COPD ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Fda approval ,Treatment options ,Endoscopy ,Guideline ,medicine.disease ,Respiratory Function Tests ,030228 respiratory system ,Practice Guidelines as Topic ,medicine.symptom ,business ,computer - Abstract
Endoscopic lung volume reduction (ELVR) therapies are gaining prominence as a treatment option with guideline recommendations by COPD GOLD and NICE and the recent FDA approval for endobronchial valves. The transition from an experiment-based therapy only to clinical care comes with new challenges. A significant volume of evidence-based data has been published; all data demonstrate consistent improvements in several aspects of patient outcomes. Patients suffering from severe air trapping and thoracic hyperinflation seem to benefit the most from ELVR. In addition to lung function, baseline assessment should ideally include cardiopulmonary exercise testing, high-resolution computer tomography scan, perfusion scintigraphy, and echocardiography. This expert ELVR statement updates best practice recommendations from 2017 regarding patient selection and utilization of these various techniques for treating patients with advanced emphysema.
- Published
- 2019
46. Surgical and endoscopic interventions that reduce lung volume for emphysema: a systemic review and meta-analysis
- Author
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Walter Weder, Wouter H. van Geffen, Pallav L. Shah, Samuel V. Kemp, Dirk-Jan Slebos, and Felix J.F. Herth
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,SURGERY ,MULTICENTER ,MEDLINE ,Psychological intervention ,MEDICAL THERAPY ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Bronchoscopy ,medicine ,Humans ,Lung volumes ,030212 general & internal medicine ,Pneumonectomy ,Adverse effect ,Lung ,HETEROGENEOUS EMPHYSEMA ,business.industry ,Endobronchial valve ,Odds ratio ,ENDOBRONCHIAL VALVES ,OPEN-LABEL ,RANDOMIZED-TRIAL ,Pulmonary Emphysema ,030228 respiratory system ,Meta-analysis ,COILS ,business - Abstract
Background Severe emphysema is a debilitating condition with few treatment options. Lung volume reduction procedures in the treatment of severe emphysema have shown excellent results in selected patients but their exact role remains unclear with studies reporting a wide variation in outcomes. We therefore aimed to evaluate the effects of volume reduction. Methods We did a systematic review and meta-analysis. We searched MEDLINE on Sept 29, 2016, for trials of lung volume reduction in patients with emphysema, and we did an updated search on Embase and PubMed on June 18, 2018. We only included randomised controlled studies published in English evaluating the intervention with either sham or standard of care. Inclusion was limited to trials of techniques in which there was sustainable volume reduction. Primary outcomes were residual volume, FEV 1, St George's Respiratory Questionnaire (SGRQ), and 6-min walk distance (6MWT). Secondary outcomes were severe adverse events (including mortality), short-term mortality, and overall mortality. We extracted summary level data from the trial publications and where necessary we obtained unpublished data. A random-effects model with the I (2) statistic was used to determine heterogeneity and trial weight in each analysis. The study is registered with the PROSPERO database, number CRD42016045705. Findings We identified 4747 references in the search, and included 20 randomised controlled trials of lung volume reduction involving 2794 participants with emphysema. Following lung volume reduction from any of the interventions in pooled analyses (ie, surgery, endobronchial valve, endobronchial coil, or sclerosing agents), the mean differences compared with the control were reduction in residual volume of 0.58 L (95% CI -0.80 to -0.37), increase in FEV1 of 15.87% (95% CI 12.27 to 19.47), improvement in 6MWT of 43.28 m (31.36 to 55.21), and reduction in the SGRQ of 9.39 points (-10.92 to -7.86). The odds ratio for a severe adverse event, which included mortality, was 6.21 (95% CI 4.02 to 9.58) following intervention. Regression analysis showed improvements relative to the degree of volume reduction: FEV 1 (r(2) = 0.86; p Interpretation Despite limitations of high risk of bias and heterogeneity for some analyses, our results provide support that lung volume reduction in patients with severe emphysema on maximal medical treatment has clinically meaningful benefits. These benefits should be considered alongside potential adverse events. Copyright (C) 2019 Elsevier Ltd. All rights reserved.
- Published
- 2019
47. Airway smooth muscle reduction after bronchial thermoplasty in severe asthma correlates with <scp>FEV</scp> 1
- Author
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Els J.M. Weersink, Jouke T. Annema, Annika W.M. Goorsenberg, Pallav L. Shah, Julia N S d'Hooghe, Nick H. T. ten Hacken, Peter I. Bonta, Joris J. T. H. Roelofs, Thais Mauad, Lifestyle Medicine (LM), Groningen Research Institute for Asthma and COPD (GRIAC), ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, AII - Inflammatory diseases, Pathology, and Pulmonology
- Subjects
medicine.medical_specialty ,Asthma therapy ,Bronchial thermoplasty ,business.industry ,Severe asthma ,medicine.medical_treatment ,Immunology ,Treatment outcome ,Airway smooth muscle ,DEFINITION ,Text mining ,Internal medicine ,Severity of illness ,medicine ,Cardiology ,Immunology and Allergy ,business ,Reduction (orthopedic surgery) - Published
- 2019
48. Contemporary Concise Review 2018: Lung cancer and pleural disease
- Author
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Justin L. Garner, Christopher M. Orton, Karthi Srikanthan, Francesca Conway, Pallav L. Shah, and Samuel V. Kemp
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pleural disease ,Pneumothorax ,Pleural effusion ,business.industry ,medicine ,Pleural infection ,Radiology ,medicine.disease ,business ,Lung cancer ,Interventional pulmonology - Published
- 2019
49. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE)
- Author
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Gerard J. Criner, Richard Sue, Shawn Wright, Mark Dransfield, Hiram Rivas-Perez, Tanya Wiese, Frank C. Sciurba, Pallav L. Shah, Momen M. Wahidi, Hugo Goulart de Oliveira, Brian Morrissey, Paulo F. G. Cardoso, Steven Hays, Adnan Majid, Nicholas Pastis, Lisa Kopas, Mark Vollenweider, P. Michael McFadden, Michael Machuzak, David W. Hsia, Arthur Sung, Nabil Jarad, Malgorzata Kornaszewska, Stephen Hazelrigg, Ganesh Krishna, Brian Armstrong, Narinder S. Shargill, Dirk-Jan Slebos, Francis Cordova, Parag Desai, Nathaniel Marchetti, Victor Kim, Kartik Shenoy, John Travaline, Jiji Thomas, Lii-Yoong H. Criner, Aaron Thornburg, Terry Thomas, Surya Bhatt, James Michael Wells, Necole Seabron-Harris, Umair Gauhar, Crissie Despirito, Frank Sciurba, Jessica Bon Field, Divay Chandra, Joseph Leader, Roy Semaan, Christina Ledezma, Pallav Shah, Samuel Kemp, Justin Garner, Arafa Aboelhassan, Karthi Srikanthan, Eric Tenda, Anita Abraham, Cai Sim, Momen Wahidi, Kamran Mahmood, Scott Shofer, Kathleen Coles, Guilherme Augusto Oliveira, Betina Machado, Igor Benedetto, Fabio Svartman, Amarilio de Macedo Neto, Leonardo Schreiner, Taiane Vieira, Ken Yoneda, Tina Tham, Daniel Tompkins, Paulo F. Guerreiro Cardoso, Rodrigo Athanazio, Felipe Nominando, Samia Rached, Luciana Cassimiro, Eric Seeley, Pavan Shrestha, Gabriela R. Dincheva, Daniel Alape-Moya, Mihir Parikh, Alichia Paton, Alexis Agnew, Charlie Strange, Tatsiana Beiko, Danielle Woodford, Mary Blanton, Timothy Connolly, Jose Fernando Santacruz, Bhavin Shah, Luis Herrera, Rumi Khan, Kristine Sernulka, Richard Barbers, Michelle Hernandez, Francisco Almeida, Joseph Cicenia, Thomas Gildea, Atul Mehta, Sonali Sethi, Yvonne Meli, David Hsia, Richard Casaburi, William Stringer, Leticia Diaz, Meghan Ramsey, Ryan Van Wert, Karen Morris, Tim Batchelor, Iara Sequeiros, Katy Tucker, Malgorzata Kornaszweska, Hazem Fallouh, Ramsey Sabit, Hatam Naase, Joseph George, Azin Salimian, Helen Dyer, Kristal Adams, Karen Bade, Bryan S. Benn, Michelle Canfield, Sharmila Vetri Villalan, Travis Stewart, Nick H. T. ten Hacken, Karin Klooster, Jorine Hartman, Sonja Augustijn, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
Male ,Pulmonary and Respiratory Medicine ,CLINICAL-OUTCOMES ,medicine.medical_specialty ,Randomization ,SURGERY ,lung reduction ,Bronchi ,Critical Care and Intensive Care Medicine ,OBSTRUCTIVE PULMONARY-DISEASE ,chronic obstructive pulmonary disease ,MEDICAL THERAPY ,Collateral ventilation ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Randomized controlled trial ,law ,Forced Expiratory Volume ,Surveys and Questionnaires ,Internal medicine ,Bronchoscopy ,Correspondence ,Humans ,COPD ,Medicine ,030212 general & internal medicine ,LUNG-VOLUME-REDUCTION ,Respiratory system ,Exercise Tolerance ,IMPORTANT DIFFERENCE ,business.industry ,Walk distance ,OPERATIVE MORTALITY ,Endobronchial valve ,Equipment Design ,Prostheses and Implants ,Middle Aged ,NATIONAL EMPHYSEMA ,medicine.disease ,Treatment Outcome ,emphysema ,Pulmonary Emphysema ,030228 respiratory system ,TESTS ,Female ,business - Abstract
Rationale: This is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV) in patients with little to no collateral ventilation out to 12 months.Objectives: To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation in the treated lobe.Methods: Subjects were enrolled with a 2:1 randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at 12 months was the Delta EBV-SoC of subjects with a post-bronchodilator FEV1 improvement from baseline of greater than or equal to 15%. Secondary endpoints included absolute changes in post-bronchodilator FEV1, 6-minute-walk distance, and St. George's Respiratory Questionnaire scores.Measurements and Main Results: A total of 190 subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and 16.8% SoC subjects had a Delta FEV1 greater than or equal to 15% (P Conclusions: Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea, and quality of life out to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe.
- Published
- 2018
50. Comparing aerosol concentrations and particle size distributions generated by singing, speaking and breathing
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Lauren P. McCarthy, Christopher M. Orton, James D. F. Calder, Allen E. Haddrell, Declan Costello, Nick Gent, Jonathan P. Reid, Florence K. A. Gregson, Bryan R. Bzdek, Thomas Finnie, Gavin C. Donaldson, Pallav L. Shah, and Natalie A. Watson
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Technology ,Engineering, Chemical ,010504 meteorology & atmospheric sciences ,Coronavirus disease 2019 (COVID-19) ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,04 Earth Sciences ,Environmental Sciences & Ecology ,macromolecular substances ,010501 environmental sciences ,01 natural sciences ,09 Engineering ,Engineering ,Pandemic ,medicine ,Environmental Chemistry ,Meteorology & Atmospheric Sciences ,General Materials Science ,Tiina Reponen ,0105 earth and related environmental sciences ,Cultural sector ,Science & Technology ,musculoskeletal, neural, and ocular physiology ,virus diseases ,Pollution ,humanities ,Aerosol ,Engineering, Mechanical ,nervous system ,Emergency medicine ,Physical Sciences ,Breathing ,03 Chemical Sciences ,Life Sciences & Biomedicine ,Environmental Sciences ,psychological phenomena and processes - Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in an unprecedented shutdown in social and economic activity, with the cultural sector particularly severely affected. Restrictions on musical performances have arisen from a perception that there is a significantly higher risk of aerosol production from singing than speaking, based upon high-profile examples of clusters of COVID-19 following choral rehearsals. However, comparing aerosol generation from different types of vocalization, including singing, across a range of volumes is a rapidly evolving area of research. Here, we measured aerosols from singing, speaking and breathing from a large cohort of 25 professional singers in a range of musical genres in a zero-background environment, allowing unequivocal attribution of aerosol production to specific vocalizations. We do not assess the relative volumes at which people speak and sing. However, both showed steep increases in mass concentration with increase in loudness (spanning a factor of 20–30 across the dynamic range measured, p < 0.001). At the quietest volume (50 to 60 dBA), neither singing (p = 0.19) nor speaking (p = 0.20) were significantly different to breathing. At the loudest volume (90 to 100 dBA), a statistically significant difference (p < 0.001) was observed between singing and speaking, but with singing only generating a factor of between 1.5 and 3.4 more aerosol mass. Guidelines for musical performances should be based on the loudness and duration of the vocalization, the number of participants and the environment in which the activity occurs, rather than the type of vocalization. Mitigations such as the use of amplification and increased attention to ventilation should be employed where practicable. Copyright © 2021 American Association for Aerosol Research
- Published
- 2021
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