Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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The primary aims of this study were (1) to evaluate whole-body mechanical efficiency (ME) in a large group of chronic obstructive pulmonary disease (COPD) patients with a wide range of degrees of illness and (2) to examine how ME in COPD is related to absolute work rate and indices of disease severity during exercise testing. A total of 569 patients (301 male patients; GOLD stage I: 28, GOLD stage II: 166, GOLD stage III: 265, and GOLD stage IV: 110) with chronic obstructive pulmonary disease (COPD) were included in the data analysis. Individual maximal workload (watt), peak minute ventilation ((Equation is included in full-text article.)E, L/min body temperature and pressure, saturated), and peak oxygen uptake ((Equation is included in full-text article.)O2, mL/min standard temperature and pressure, dry) were determined from a maximal incremental cycle ergometer test. Ventilatory and metabolic response parameters were collected during a constant work rate test at 75% of the individual maximal workload. From the exercise responses of the constant work rate test, the gross ME was calculated. The mean whole-body gross ME was 11.0 ± 3.5% at 75% peak power. The ME declined significantly (P < .001) with increasing severity of the disease when measured at the same relative power. Log-transformed absolute work rate (r = .87, P < .001) was the strongest independent predictor of gross ME. Body mass was the single other variable that contributed significantly to the linear regression model. Gross ME in COPD was largely predicted by the absolute work rate (r = .87; P < .001) while indices of the severity of the disease did not predict ME in COPD.
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Inhalation therapy is essential for the management of respiratory conditions such as asthma and chronic obstructive pulmonary disease. However, current inhalation systems face limitations, including polydisperse aerosols that reduce drug delivery efficiency and complex treatment regimens that affect patient adherence. To improve drug targeting and efficacy, Gilbert Innovation B.V. is developing a next-generation soft-mist inhaler based on electrohydrodynamic atomization (EHDA), which produces uniform micrometer sized droplets. Effective drug delivery requires high flow rates and precise aerosol discharge to ensure deep lung deposition while minimizing losses to the device and oropharynx. To achieve this, the device employs a multi-nozzle system for increased flow and corona discharge needles for charge neutralization. However, ensuring uniform neutralization across multiple nozzles and maintaining stable electrospray operation remain key challenges. COSMIC aims to increase system robustness by optimizing neutralization efficiency, refining material selection, and controlling electrospray stability under varying conditions. The electrospray control system will incorporate advanced strategies leveraging computer vision, machine learning and big data analytics. These innovations will increase efficiency, accessibility and patient comfort in inhalation therapy.
Every year in the Netherlands around 10.000 people are diagnosed with non-small cell lung cancer, commonly at advanced stages. In 1 to 2% of patients, a chromosomal translocation of the ROS1 gene drives oncogenesis. Since a few years, ROS1+ cancer can be treated effectively by targeted therapy with the tyrosine kinase inhibitor (TKI) crizotinib, which binds to the ROS1 protein, impairs the kinase activity and thereby inhibits tumor growth. Despite the successful treatment with crizotinib, most patients eventually show disease progression due to development of resistance. The available TKI-drugs for ROS1+ lung cancer make it possible to sequentially change medication as the disease progresses, but this is largely a ‘trial and error’ approach. Patients and their doctors ask for better prediction which TKI will work best after resistance occurs. The ROS1 patient foundation ‘Stichting Merels Wereld’ raises awareness and brings researchers together to close the knowledge gap on ROS1-driven oncogenesis and increase the options for treatment. As ROS1+ lung cancer is rare, research into resistance mechanisms and the availability of cell line models are limited. Medical Life Sciences & Diagnostics can help to improve treatment by developing new models which mimic the situation in resistant tumor cells. In the current proposal we will develop novel TKI-resistant cell lines that allow screening for improved personalized treatment with TKIs. Knowledge of specific mutations occurring after resistance will help to predict more accurately what the next step in patient treatment could be. This project is part of a long-term collaboration between the ROS1 patient foundation ‘Stichting Merels Wereld’, the departments of Pulmonary Oncology and Pathology of the UMCG and the Institute for Life Science & Technology of the Hanzehogeschool. The company Vivomicx will join our consortium, adding expertise on drug screening in complex cell systems.
De chronische longziekte COPD (Chronic Obstructive Pulmonary Disease) kenmerkt zich door een toename van kortademigheid, hoesten en slijmvorming en is een veelvoorkomende ziekte in Nederland. Momenteel zijn er therapieën beschikbaar, waaronder het voorschrijven van een lage onderhoudsdosis Azitromycine, die ervoor zorgt dat het aantal longaanvallen drastisch daalt. De samenstelling van de microbiële populatie (het microbioom) in deze patiëntenpopulatie speelt een belangrijke rol in het ziekteverloop. Microvida analyseert COPD-patiëntmonsters voor het Amphia met behulp van klassieke kweektechnieken en wil nu haar dienstverlening graag uitbreiden. Nieuwe innovatieve ‘next-generation sequencing’ (NGS) maakt het mogelijk om het volledige microbioom van deze patiëntenpopulatie snel en gedetailleerd in kaart te brengen zonder kweek vooraf. Binnen dit project gaan we met een driehoek van MKB-, kennis- en praktijkpartners een high-throughput methode opzetten die het mogelijk maakt het microbioom in sputum snel en gebruiksvriendelijk te analyseren binnen deze patiëntenpopulatie. In het Amphia ziekenhuis loopt momenteel een klinische trial die het veilig afbouwen van het antibioticum Azitromycine onderzoekt en waarbij sputum samples verzameld worden. Met deze samples wordt in dit project een methode opgezet voor het isoleren van zuiver genetisch materiaal alvorens deze samples met behulp van NGS-technieken geanalyseerd worden. Als laatste stap zal een gebruikersinterface ontwikkeld worden die het mogelijk maakt om de verkregen data gebruiksvriendelijk te interpreteren en de resultaten te beoordelen. Alles met uiteindelijke doel meer kennis te vergaren over de samenstelling van het microbioom in relatie tot ziekte en gezondheid van de COPD-patiënt.
