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The liver-to-spleen ratio is a risk factor predicting oxygen demand in COVID-19 patients

Infectious Medicine 2023年第2期2卷 105-111页

作者： Hiromasa Nakayasu Shogo Sakurai Shuichi Sugiyama Kotaro Shiratori Kohei Okawa Yoshihiro Kitahara Shingo Takahashi Toshihiro Masuda Yutaro Kishimoto Mika Saigusa Akito Yamamoto taisuke akamatsu Satoru Morita Kazuhiro Asada Toshihiro Shirai Department of Respiratory Medicine Shizuoka General Hospital4-27-1 Kita-AndoAoi420-0805 ShizuokaJapan

Background:We aimed to investigate risk factors predicting oxygen demand in COVID-19 ***:Patients admitted to Shizuoka General Hospital with COVID-19 from August 2020 to August 2021 were ***,we divided patients into groups with and without oxygen ***,we compared patients’clinical characteristics and laboratory and radiological findings to determine factors predicting oxygen ***:One hundred seventy patients with COVID-19(aged 58±15 years,57 females)were *** comorbidities were cardiovascular diseases(47.6%),diabetes mellitus(28.8%),and dyslipidemia(26.5%).Elder age,higher body mass index,cardiovascular diseases,diabetes mellitus,lower lymphocyte count,albumin,hep-atic attenuation value,and the liver-to-spleen ratio(L/S),higher D-dimer,aspartate aminotransferase,lactate dehydrogenase,troponin-T,C-reactive protein,KL-6,chest and abdominal circumference,and visceral fat were found in patients with oxygen *** to the multivariate logistic regression analysis,L/S,lympho-cyte count,D-dimer,and abdominal circumference under the diaphragm were independent risk factors predicting oxygen demand in COVID-19 ***:On admission,L/S,lymphocyte count,D-dimer,and abdominal circumference were predictive factors for oxygen *** factors may help in the appropriate triage of COVID-19 patients in the decision to admit them to the hospital.

关键词： COVID-19 SARS-CoV-2 Oxygen demand The liver-to-spleen ratio Abdominal circumference

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Effects of Direct Switching Dual Bronchodilators between Dry Powder and Soft Mist Inhalers in COPD Patients

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Open Journal of Respiratory Diseases 2020年第1期10卷 11-19页

作者： taisuke akamatsu Toshihiro Shirai Hiromasa Nakayasu Kanami Tamura Toshihiro Masuda Shingo Takahashi Yuko Tanaka Hirofumi Watanabe Yutaro Kishimoto Kyohei Oishi Mika Saigusa Akito Yamamoto Satoru Morita Kazuhiro Asada Department of Respiratory Medicine Shizuoka General Hospital Shizuoka Japan

Objective: Dual bronchodilation with long-acting muscarinic antagonist and long-acting β2-agonist combinations are available worldwide in COPD patients. However, the choice of agents remains under debate. We hypothesized that switching devices between dry powder and soft mist inhalers without a wash-out period to mimic clinical practice would improve clinical symptoms and lung function. The aim of this study was to examine the effects of switching between once-daily glycopyrronium/indacaterol (GLY/IND) or umeclidinium/vilanterol (UMEC/VI), dry powder inhalers, and tiotropium/olodaterol (TIO/OLO), a soft mist inhaler, in COPD patients. Methods: This was a prospective, open-label, 8-week, observational study with follow-up. Subjects included 57 COPD patients, who attended outpatient clinics at Shizuoka General Hospital for routine check-ups between February and December 2015, receiving GLY/IND (50/110 μg) or UMEC/VI (62.5/25 μg). After an 8-week run-in period, medications were switched to TIO/OLO (5/5 μg). Study outcomes included patient’s global rating (PGR), modified MRC (mMRC), COPD assessment test (CAT), and spirometric and forced oscillatory parameters after 8 weeks. PGR used in this study was a 7-point scale ranging from 1 to 7, with 4 in the middle. Patients who consented to switch from TIO/OLO to GLY/IND or UMEC/VI were followed-up thereafter. Results: In total, 53 patients completed the study (mean age, 75 years;48 males and 5 females;GOLD 1/2/3/4 = 19/27/6/1;mMRC 0/1/2/3/4 = 14/22/12/4/1;UMEC/VI 26, GLY/IND 27). PGR, mMRC, and CAT improved in 20 (38%), 9 (17%), and 15 patients (28%), respectively. Respiratory system resistance at 5 Hz (R5), 20 Hz (R20), and the difference between R5 and R20 (R5 - R20) significantly improved. In a follow-up of 16 patients after switching from TIO/OLO to UMEC/VI (9) or GLY/IND (7), PGR, mMRC, and CAT improved in 5 (31%), 3 (12%), and 4 patients (25%), respectively, and R20 significantly improved (p = 0.011). Conclusions: Switc

关键词： Device Dry Powder Inhaler Dual Bronchodilator Soft Mist Inhaler Switching

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Usefulness of Fractional Exhaled Nitric Oxide-Guided Treatment in Patients with Asthma-Chronic Obstructive Pulmonary Disease Overlap

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Open Journal of Respiratory Diseases 2018年第1期8卷 1-12页

作者： taisuke akamatsu Toshihiro Shirai Yuko Tanaka Hirofumi Watanabe Yoshinari Endo Yukiko Shimoda Takahito Suzuki Rie Noguchi Mika Saigusa Akito Yamamoto Yuichiro Shishido Takefumi Akita Satoru Morita Kazuhiro Asada Department of Respiratory Medicine Shizuoka General Hospital Shizuoka Japan

Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p Conclusions: FeNO-guided treatment with BUD/FM improves symptoms in patients with ACO.

关键词： Asthma-COPD Overlap Budesonide/Formoterol Combination COPD Assessment Test Fractional Exhaled Nitric Oxide

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