Annals of the American Thoracic Society
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Randomized Controlled Trial Comparative Study
Cluster analysis and characterization of response to mepolizumab. A step closer to personalized medicine for patients with severe asthma.
Detailed characterization of asthma phenotypes is essential for identification of responder populations to allow directed personalized medical intervention. ⋯ Using supervised cluster analysis helped identify specific patient characteristics related to disease and therapeutic response. Patients with eosinophilic inflammation received significant therapeutic benefit with mepolizumab, and responses differed within clusters. Clinical trial registered with www.clinicaltrials.gov (NCT01000506).
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The Big Data movement in computer science has brought dramatic changes in what counts as data, how those data are analyzed, and what can be done with those data. Although increasingly pervasive in the business world, it has only recently begun to influence clinical research and practice. As Big Data draws from different intellectual traditions than clinical epidemiology, the ideas may be less familiar to practicing clinicians. ⋯ Second, Big Data asks different kinds of questions of data and emphasizes the usefulness of analyses that are explicitly associational but not causal. Third, Big Data brings new analytic approaches to bear on these questions. And fourth, Big Data embodies a new set of aspirations for a breaking down of distinctions between research data and operational data and their merging into a continuously learning health system.
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Investigation of the human microbiome has become an important field of research facilitated by advances in sequencing technologies. The lung, which is one of the latest body sites being explored for the characterization of human-associated microbial communities, has a microbiome that is suspected to play a substantial role in health and disease. ⋯ We also provide examples of lung microbial communities associated with disease or infection status and discuss the role of fungal species in the lung. Finally, we review studies demonstrating that the environmental microbiome can influence lung health and disease, such as the finding that the diversity of microbial exposure correlates inversely with the development of childhood asthma.
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Comparative Study
Respiratory determinants of diurnal hypercapnia in obesity hypoventilation syndrome. What does weight have to do with it?
Among morbidly obese individuals, obstructive sleep apnea (OSA) is highly prevalent, with up to 20% suffering from hypoventilation syndrome. An increased diurnal PaCO2, the signature of obesity hypoventilation syndrome (OHS), implies diminished global ventilation, hence the term hypoventilation. ⋯ These data emphasize the importance of weight loss, which could potentially reverse hypercapnic OSA to eucapnic OSA, hypothetically even in the absence of improvement in apnea-hypopnea index. In addition, reversal of hypercapnia should also improve oxygenation, both during sleep and while awake, minimizing hypoxia-induced organ dysfunction of OHS.
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The Global Burden of Disease Study suggests almost 3.5 million people die as a consequence of household air pollution every year. Respiratory diseases including chronic obstructive pulmonary disease and pneumonia in children are strongly associated with exposure to household air pollution. Smoke from burning biomass fuels for cooking, heating, and lighting is the main contributor to high household air pollution levels in low-income countries like Malawi. A greater understanding of biomass fuel use in Malawi should enable us to address household air pollution-associated communicable and noncommunicable diseases more effectively. ⋯ This large cross-sectional study has identified extensive use of biomass fuels in a typical sub-Saharan Africa periurban population in which women and people of lower socioeconomic status are disproportionately affected. Biomass fuel use is likely to be a major driver of existing communicable respiratory disease and the emerging noncommunicable disease (especially respiratory and cardiovascular) epidemic in this region. Our data will help inform the rationale for specific intervention studies and the development of appropriately targeted public health strategies to tackle this important and poverty-related global health problem.