Purpose The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is widely used to assess the impact of COPD symptoms on health status. Whilst the CAT consists of eight different items, details on the distribution of each item are limited. This study aimed to investigate the distribution and clinical implication of each CAT item, stratified by CAT severity group, in stable COPD patients. Patients and Methods This was a cross-sectional study at a single referral hospital in South Korea. Spirometry confirmed COPD patients with CAT measured at the first clinical visit were retrospectively identified. Patients were categorized into three groups: low (0 ≤ CAT < 10), medium (10 ≤ CAT < 20), and high (20 ≤ CAT ≤ 40) impact group. For the purpose of this analysis, the first four items (cough, sputum, chest tightness, and dyspnea) and the remaining four items (activities, confidence, sleep and energy) were also grouped as “pulmonary” and “extra-pulmonary”, respectively. Results A total of 815 patients were included, and mean (SD) forced expiratory volume in 1 s (FEV 1 ) was 62.8 (17.4) % pred. Among them, 300 patients (36.8%) were in the high impact group and had a greater exacerbation history and lower lung function. The proportion of “extra-pulmonary” items score was greater in patients with higher total CAT scores, with the activity and confidence items showing higher scores. Conclusion In our study, in addition to dyspnea, activity limitation is a particular problem in individual patients with higher CAT total scores, for which physicians need to pay more attention. Our study suggests that whilst CAT total score captures the overall impact of COPD, each item of the CAT contains potentially useful information in understanding the patient’s symptom burden.
BackgroundEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) may be necessary for patients with incidental lung cancer during or after coronary intervention. Although EBUS‐TBNA is quite safe, the safety in patients who recently received percutaneous coronary intervention (PCI) has not been demonstrated. The aim of this study was to assess the safety of EBUS‐TBNA in patients with lung cancer who underwent PCI within one year.MethodsWe retrospectively reviewed the medical records of 24 patients who underwent EBUS‐TBNA within one year after PCI between May 2009 and June 2017. Cardiovascular complications (death, myocardial infarction, arrhythmia, and acute heart failure) were assessed as primary outcomes. Procedural‐related complications were assessed as secondary outcomes.ResultsThe coronary artery diseases requiring PCI were: myocardial infarction (n = 10), unstable angina (n = 10), stable angina (n = 2), and silent ischemia (n = 2). The median interval between PCI and EBUS‐TBNA was 125 days (interquartile range: 66–180). Atrial fibrillation with a rapid ventricular response temporarily occurred in one patient after EBUS‐TBNA. No other significant cardiovascular complications were encountered. Fifteen patients were administered an anti‐thrombotic agent the day of EBUS‐TBNA, while four had ceased taking the agent < 4 days before EBUS‐TBNA, however, there was no significant bleeding among those patients.ConclusionEBUS‐TBNA was safe and did not cause serious adverse events in patients with lung cancer who required tissue confirmation or mediastinal staging within one year after PCI. Incidental lung cancer found during or after a coronary intervention should be actively evaluated by EBUS‐TBNA.
Background/Aims: Most studies on hospital-acquired pneumonia (HAP) have been conducted in intensive care unit (ICU) settings. This study aimed to investigate the microbiological and clinical characteristics of non-ICU-acquired pneumonia (NIAP) and to identify the factors affecting clinical outcomes in Korea.Methods: This multicenter retrospective cohort study was conducted in patients admitted to 13 tertiary hospitals between July 1, 2019 and December 31, 2019. Patients diagnosed with NIAP were included in this study. To assess the prognostic factors of NIAP, the study population was classified into treatment success and failure groups.Results: Of 526 patients with HAP, 379 were diagnosed with NIAP. Overall, the identified causative pathogen rate was 34.6% in the study population. Among the isolated organisms (n = 113), gram-negative bacilli were common pathogens (n = 91), such as <i>Pseudomonas aeruginosa</i> (n = 25), <i>Acinetobacter baumannii</i> (n = 23), and <i>Klebsiella pneumoniae</i> (n = 21). The multidrug resistance rates of <i>A. baumannii</i>, <i>P. aeruginosa</i>, and <i>K. pneumoniae</i> were 91.3%, 76.0%, and 57.1%, respectively. Treatment failure was significantly associated with <i>K. pneumoniae</i> (odds ratio [OR], 3.50; 95% confidence interval [CI], 1.35 to 9.05; <i>p</i> = 0.010), respiratory viruses (OR, 3.81; 95% CI, 1.34 to 10.82; <i>p</i> = 0.012), hematological malignancies (OR, 3.54; 95% CI, 1.57 to 8.00; <i>p</i> = 0.002), and adjunctive corticosteroid treatment (OR, 2.40; 95% CI, 1.27 to 4.52; <i>p</i> = 0.007).Conclusions: The causative pathogens of NIAP in Korea are predominantly gram-negative bacilli with a high rate of multidrug resistance. These were not different from the common pathogens of ICU-acquired pneumonia.
Background/Objective Metabolic syndrome (MS) is related to lung dysfunction. However, its impact according to insulin resistance (IR) remains unknown. Therefore, we evaluated whether the relation of MS with lung dysfunction differs by IR. Subject/Methods This cross-sectional study included 114,143 Korean adults (mean age, 39.6 years) with health examinations who were divided into three groups: metabolically healthy (MH), MS without IR, and MS with IR. MS was defined as presence of any MS component, including IR estimated by HOMA-IR ≥ 2.5. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for lung dysfunction were obtained in MS, MS without IR, and MS with IR groups compared with the MH (reference) group. Results The prevalence of MS was 50.7%. The percent predicted forced expiratory volume in 1 s (FEV1%) and forced vital capacity (FVC%) showed statistically significant differences between MS with IR and MH and between MS with IR and MS without IR (all P < 0.001). However, those measures did not vary between MH and MS without IR (P = 1.000 and P = 0.711, respectively). Compared to MH, MS was not at risk for FEV1% < 80% (1.103 (0.993–1.224), P = 0.067) or FVC% < 80% (1.011 (0.901–1.136), P = 0.849). However, MS with IR was clearly associated with FEV1% < 80% (1.374 (1.205–1.566) and FVC% < 80% (1.428 (1.237–1.647) (all p < 0.001), though there was no evident association for MS without IR (FEV1%: 1.078 (0.975–1.192, P = 0.142) and FVC%: 1.000 (0.896–1.116, p = 0.998)). Conclusion The association of MS with lung function can be affected by IR. However, longitudinal follow-up studies are required to validate our findings.
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