Nguyen Van Tho

Retraction for the article Melatonin and Cortisol Concentration Before and After CPAP Treatment of Obstructive Sleep Apnea

Background/Objectives: Asthma action plans (AAPs) are recommended for patients’ self-management of asthma and should be adapted to a country’s situation. This study aimed to develop expert consensus on the optimal structure, content, and action of asthma action plans for Vietnamese settings to ensure feasibility, acceptance, and implementation. Methods: A Delphi consensus was conducted over two rounds. The proposed items were evaluated by a Vietnamese panel of pulmonologists, allergists, tuberculosis/lung disease specialists, and general practitioners. Structured online questionnaires with five-point Likert scales were used. Consensus was defined as >80% agreement and <10% strong disagreement. Results: A total of 26 and 21 participants completed round 1 and round 2, respectively. The 4-zone format of AAP was preferred (42.3%) over the 3-zone (38.5%) or 2-zone (19.2%) formats. The AAP should include some key statements for asthma, symptoms for self-monitoring, an objective asthma control questionnaire, actions for changes in maintenance medication, and instructions in emergency situations. AAP zones should be classified by symptom frequency and severity. Patient actions should be tailored to their treatment regimen (MART or ICS/LABA + SABA). The APP might not include peak expiratory flow monitoring and oral corticosteroid self-administration for both the MART and ICS/LABA + SABA regimens and might not add SABA together with ICS dose escalation for the ICS/LABA + SABA regimen. Conclusions: This study established an expert consensus on fundamental AAP structural elements and actions for the Vietnamese. The failure to achieve consensus on PEF monitoring tools and OCS for the self-management of asthma exacerbation reflects concerns about medication abuse, especially in Vietnamese healthcare settings.

Background/Objectives: Asthma action plans (AAP) are recommended for patients’ self-management of asthma and should be adapted countries’ situation. This study aimed to develop expert consensus on the optimal structure and content and action of asthma action plans for Vietnamese settings to ensure feasibility, acceptance and implementation. Methods: A Delphi consensus conducted over two rounds. The proposed items were evaluated by a Vietnamese panel of pulmonologists, allergist, tuberculosis/lung disease specialists and general practitioners. Structured online questionnaires with 5-point Likert scales were used. Consensus was defined as >80% agreement and < 10% strong disagreement. Results: 26 and 21 participants completed round 1 and round 2, respectively. 4-zone of AAP was preferred (42.3%) over 3-zone (38.5%) or 2-zone (19.2%). AAP should include some key statements for asthma, symptoms for self-monitoring, objective asthma control questionnaire, actions for changes of maintenance medication and instructions in emergency situations. AAP zones should be classified on symptom frequency and severity. Patient actions should be tailored to their treatment regimen (MART or ICS/LABA + SABA). APP might not include peak expiratory flow monitoring and oral corticosteroid self-administration for both MART and ICS/LABA + SABA regimen, and might not add SABA together with ICS dose escalation for ICS/LABA + SABA regimen. Conclusions: This study established an expert consensus on fundamental AAP structural elements and actions for the Vietnamese. The failure to achieve consensus on PEF monitoring tools and OCS for self-management of asthma exacerbation reflects concerns about medication abuse, especially in Vietnam healthcare settings.

Purpose: This study investigated changes in salivary melatonin and cortisol concentrations before and after Continuous Positive Airway Pressure (CPAP) therapy in patients with OSA. Underlying these hormonal changes is a key mechanism involving dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis and circadian rhythm. Patients and Methods: A prospective before-and-after study was conducted on 59 adults with OSA, of whom 27 completed an 8-week follow-up after CPAP therapy. Salivary melatonin and cortisol were measured via ELISA in morning and afternoon samples. Other habits that affect sleep were also assessed. Hormonal changes were analyzed using Wilcoxon signed-rank tests, and correlations with clinical variables were evaluated using Spearman correlation. Results: At baseline, mean melatonin concentration was 80.80 ± 52.48 pg/mL, higher in the afternoon, and mean cortisol concentrations was 7.58 ± 5.45 ng/mL, higher in the morning. After CPAP treatment, melatonin concentration decreased to 63.78 ± 39.85 pg/mL, with a reduced difference between morning and afternoon concentrations. Cortisol concentration increased slightly to 8.06 ± 8.08 ng/mL. These hormonal changes were not statistically significant (p> 0.05). Notably, melatonin concentrations correlated negatively with tea consumption (rho = – 0.43, p< 0.05) after adjustment. Conclusion: This research investigated salivary melatonin and cortisol as biomarkers for CPAP efficacy in OSA patients. Although no significant changes were detected, trends indicated reduced sleep pressure, including lower afternoon melatonin and higher cortisol levels. The substantial dropout rate limits how these results can be interpreted. More studies with larger sample sizes, longer treatment durations, and more comprehensive hormonal evaluations at various times of the day are needed to elucidate the potential significance of salivary biomarkers in understanding circadian control in OSA.

COPD patients with asthma features usually benefit from inhaled corticosteroids (ICS)-containing regimens, but their burden and diagnostic criteria remain to be established. The aims of this study were to estimate the proportion of patients with asthma features among patients with physician-diagnosed COPD and to investigate differences in clinical characteristics and current medications between COPD patients with asthma features and patients with COPD alone. A cross-sectional study was conducted at two respiratory out-patient clinics at the University Medical Center in Ho Chi Minh City and Bach Mai Hospital in Ha Noi, Vietnam. COPD patients with asthma features were identified by attending physicians following the approach recommended by the GINA/GOLD joint committee. Of the 332 patients screened, 300 were enrolled in the study. The proportion of COPD patients with asthma features was 27.3% (95% confidence interval (95% CI) 22.6–32.6%). COPD patients with asthma features were younger, with higher FEV₁ values, a greater proportion of positive bronchodilator reversibility tests, higher blood eosinophil count, and were more often treated with ICS/LABA (ICS/long-acting bronchodilator beta-2 agonist) than patients with COPD alone. The prevalence of COPD patients with asthma features is particularly high in Vietnam thus requiring appropriate action plans in clinical practice.

Symptoms control remains challenging for most patients with asthma. This study was conducted to evaluate the level of asthma symptoms control and lung function over 5 years of GINA (Global INitiative for Asthma) implementation. We included all patients with asthma who had been managed following GINA recommendations at the Asthma and COPD Outpatient Care Unit (ACOCU) of the University Medical Center in Ho Chi Minh City, Vietnam from October 2006 to October 2016. Of 1388 patients with asthma managed following GINA recommendations, the proportion of patients with well-controlled asthma significantly improved from 2.6% at baseline to 66.8% at month 3, 64.8% at year 1, 59.6% at year 2, 58.6% at year 3, 57.7% at year 4, and 59.5% at year 5 (p < 0.0001 for all comparisons). The proportion of patients with persistent airflow limitation significantly decreased from 26.7% at baseline to 12.6% at year 1 (p < 0.0001), 14.4% at year 2 (p < 0.0001), 15.9% at year 3 (p = 0.0006), 12.7% at year 4 (p = 0.0047), and 12.2% at year 5 (p = 0.0011). In patients with asthma managed according to GINA recommendations, asthma symptoms control and lung function improved after 3 months and the improvement was sustained over 5 years.

Background: Fractal dimension (D) characterises the size distribution of low attenuation clusters on CT and assesses the spatial heterogeneity of emphysema that per cent low attenuation volume (%LAV) cannot detect. This study tested the hypothesis that %LAV and D have different roles in predicting decline in FEV₁, exacerbation and mortality in patients with COPD.Methods: Chest inspiratory CT scans in the baseline and longitudinal follow-up records for FEV₁, exacerbation and mortality prospectively collected over 10 years in the Hokkaido COPD Cohort Study were examined (n=96). The associations between CT measures and long-term outcomes were replicated in the Kyoto University cohort (n=130).Results: In the Hokkaido COPD cohort, higher %LAV, but not D, was associated with a greater decline in FEV₁ and 10-year mortality, whereas lower D, but not %LAV, was associated with shorter time to first exacerbation. Multivariable analysis for the Kyoto University cohort confirmed that lower D at baseline was independently associated with shorter time to first exacerbation and that higher LAV% was independently associated with increased mortality after adjusting for age, height, weight, FEV₁ and smoking status.Conclusion: These well-established cohorts clarify the different prognostic roles of %LAV and D, whereby lower D is associated with a higher risk of exacerbation and higher %LAV is associated with a rapid decline in lung function and long-term mortality. Combination of %LAV and fractal D may identify COPD subgroups at high risk of a poor clinical outcome more sensitively.

Background and Aim of Study: In patients with asthma, worse pulmonary function is associated with worse clinical outcomes. Appropriate treatment of asthma may improve pulmonary function. In this study, we evaluated the improvement of FEV1 (forced expiratory volume in one second) and the proportion of patients with FEV1 < 60% over 5 years of GINA (Global INitiative for Asthma) implementation. Methods: We included all patients with asthma who had been managed following GINA guidelines at the Asthma and COPD Outpatient Care Unit (ACOCU) of the University Medical Center in Ho Chi Minh City, Vietnam from July 2008 to July 2016. The comparisons of pre-bronchodilator FEV1 or the proportion of patients with FEV1 < 60% between each follow-up visit and the baseline visit were performed by using paired Student t test or McNemar’s test, respectively. Results: Among patients with asthma screened from the hospital’s medical records, 1388 patients were included. The mean age was 40.0 ± 16.7 years old; 64.6% were female; 88.5% were non-smokers. Over 5 years of asthma management, FEV1 (% predicted) significantly improved from 77.5 ± 20.8 at baseline to 86.3 ± 17.4 at year 1, 86.2 ± 17.4 at year 2, 85.6 ± 18.2 at year 3, 85.9 ± 16.9 at year 4, and 85.7 ± 16.7 at year 5 (P < 0.0001 for all comparisons). The proportion of patients with FEV1 < 60% significantly decreased from 18.5% at baseline to 7.4% at year 1 (P < 0.0001), 7.3% at year 2 (P < 0.0001), 9.2% at year 3 (P = 0.0006), 7.3% at year 4 (P = 0.0073), and 6.5% at year 5 (P = 0.0455). Conclusion: Pulmonary function of patients with asthma consistently improved over 5 years of GINA implementation.

Epicardial adipose tissue (EAT) has been shown to be a non-invasive marker that predicts the progression of cardiovascular disease (CVD). It has been reported that the EAT volume is increased in patients with chronic obstructive pulmonary disease (COPD). However, little is known about which phenotypes of COPD are associated with increased EAT. One hundred and eighty smokers who were referred to the clinic were consecutively enrolled. A chest CT was used for the quantification of the emphysematous lesions, airway lesions, and EAT. These lesions were assessed as the percentage of low attenuation volume (LAV%), the square root of airway wall area of a hypothetical airway with an internal perimeter of 10 mm (√Aaw at Pi10) and the EAT area, respectively. The same measurements were made on 225 Vietnamese COPD patients to replicate the results. Twenty-six of the referred patients did not have COPD, while 105 were diagnosed as having COPD based on a FEV₁/FVC1 (%predicted), FEV₁/FVC, self-reported hypertension, self-reported CVD, statin use, LAV%, and √Aaw at Pi10 in COPD patients. The multiple regression analyses showed that only BMI, self-reported CVD and √Aaw at Pi10 were independently associated with the EAT area (R² = 0.51, p<0.0001). These results were replicated in the Vietnamese population. The EAT area is independently associated with airway wall thickness. Because EAT is also an independent predictor of CVD risk, these data suggest a mechanistic link between the airway predominant form of COPD and CVD.