Pieter Goeminne - Academia.edu (original) (raw)

Papers by Pieter Goeminne

Acta Clinica Belgica, Mar 1, 2013

A 52-year-old man, a current smoker (40 pack years) with unremarkable medical history, was referr... more A 52-year-old man, a current smoker (40 pack years) with unremarkable medical history, was referred to the outpatient pneumology clinic because of recent complaints of shortness of breath and wheezing, which were relieved by inhaled bronchodilators. Serial peak expiratory flow (PEF) measurements showed a clear rise in PEF during the weekend and a fall on the evening after the first day of the week. It also showed that evening values were always lower than morning values. During a holiday, a slow but persistent rise in PEF was observed. Such a pattern is highly suggestive for occupational asthma. A detailed description of his job revealed papain exposure. After a positive specific IgE and skin prick test for papain the diagnosis of papain induced asthma was made. When an allergy and serious lung function impairment is proven against products encountered in a work related situation, not improving after maximal preventive measures, the patient is advised to change job.

Memo – Magazine of European Medical Oncology, Apr 23, 2018

SummaryBackgroundThis case shows that a tumor can present in an uncommon way. When dealing with p... more SummaryBackgroundThis case shows that a tumor can present in an uncommon way. When dealing with pulmonary masses, tissue remains the most important issue.Clinical presentationWe present the case of a 71-year-old woman with a mass of more than 10 cm in the left lung. Pulmonary CT scan and PET scan confirmed this with also revealing mediastinal, thoracic and paravertebral invasion, without extrathoracic metastatic lesions. Bronchoscopic evaluation and ultrasound guided transbronchial needle aspiration could not yield a diagnosis. Because of rapid clinical deterioration, new imaging was performed, showing a cavitary lesion with air-fluid level in the tumor. Extensive microbiological work-up remained negative.InterventionTo yield a pathological diagnosis, we performed a thoracotomy, revealing a polymorphic lymphoid infiltrate with scattered large atypical B-cells infected with Epstein-Barr virus, vasculitis and granulomatosis leading to a diagnosis of Lymphomatoid Granulomatosis. The patient received 6 cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Methylprednisolone), 2 doses of Rituximab monotherapy, 4 doses of intrathecal Methotrexate and consolidation radiotherapy with a complete response.ConclusionLymphomatoid granulomatosis (LYG) is a rare pulmonary disease, which should be included in the differential diagnosis of ‘a pulmonary mass’. This case emphasizes the need for tissue acquisition.

ERJ Open Research, 2020

The prevalence of nontuberculous mycobacteria (NTM) pulmonary disease (NTM-PD) is rising worldwid... more The prevalence of nontuberculous mycobacteria (NTM) pulmonary disease (NTM-PD) is rising worldwide, creating a significant health issue and an unmet need. The diagnosis and decision to treat NTM-PD are often a challenge, with complex criteria for diagnosis and multiple factors weighing in the decision to treat [1]. The treatment is lengthy and the drugs used often associated with adverse effects. Adherence to NTM-PD management guidelines were found to be suboptimal, impacting treatment success [2], with substantial differences in physicians' decision to treat and in their adherence to treatment guidelines [2-4]. Both the disease and treatment may have severe impacts on multiple aspects of patients' lives [5-7] with contrasting findings regarding improvement in quality of life (QoL) with treatment [5, 7]. Furthermore, substantial emotional distress may also accompany the process of diagnosis and evaluation, which may take months until a decision to treat is being made [8]. EMBARC, the European Multicenter Bronchiectasis Audit and Research Collaboration, is a European Respiratory Society (ERS) clinical research collaboration dedicated to promoting research and care of bronchiectasis [9]. One of the aspects of this collaboration involves working with patient volunteers, coordinated by the European Lung Foundation (ELF) to involve people with bronchiectasis in research and promotion of care [10]. Some aspects of this collaboration resulted in documents focused on various aspects of care [11, 12]. We aimed to find out patients' experiences and challenges regarding NTM-PD diagnosis and treatment. We conducted a survey among people who self-identified as having bronchiectasis and/or NTM-PD. The survey was developed in collaboration between EMBARC and the ELF and their bronchiectasis patient advisory group, and translated into nine languages (Arabic, French, German, Greek, Italian, Polish, Portuguese, Spanish and Russian). The survey consisted of 25 questions regarding various aspects of NTM-PD clinical features, diagnostic efforts, decision to treat, and treatment modality, duration and outcomes. The full questionnaire and report may be found on the ELF website: www.europeanlunginfo. org/bronchiectasis/news/ntm-report. As this was an anonymous survey, Helsinki approval was not required. The survey was available for responses between May 2019 and January 2020 on the ELF website and was advertised through bronchiectasis clinics and EMBARC websites and newsletters. In total, 361 people responded to the survey from Europe (n=231), North America (n=85), South America (n=7), Asia (n=6), The Middle East (n=8) and Australia/New Zealand (n=12). Of the 361 survey responses, there were 14 exclusions due to respondents not having bronchiectasis or NTM-PD. Of the 347 respondents who were eligible for data analysis, 152 (44%) had isolated NTM in their sputum. Overall, 152 (44%) were identified as having bronchiectasis and NTM-PD, 173 (50%) as having bronchiectasis without NTM-PD, and 19 (5.5%) had NTM-PD without bronchiectasis; 85% were female and 51% were between 51 and 70 years of age, and the most common species (60%) was Mycobacterium avium/intracellulare (MAC). @ERSpublications Patients' experiences of NTM pulmonary disease highlight important and unmet needs for better pharmacological treatment and education of medical staff https://bit.ly/3mjrlwh

Sample of extraction grid. Grids for capturing the data extracted (PDF 50 kb)

Respiratory infections, 2020

Pediatric Pulmonology, 2014

Respiratory infections and bronchiectasis, 2021

European Respiratory Journal, 2020

IntroductionInhaled antibiotics may improve symptom scores, but it is not known which specific sy... more IntroductionInhaled antibiotics may improve symptom scores, but it is not known which specific symptoms improve with therapy. Item-level analysis of questionnaire data may allow us to identify which specific symptoms respond best to treatment.MethodsPost hoc analysis of the AIR-BX1 studies and two trials of inhaled aztreonam versus placebo in bronchiectasis. Individual items from the quality of life bronchiectasis (QOL-B) respiratory symptom scale, were extracted as representing severity of nine distinct symptoms. Generalised linear models were used to evaluate changes in symptoms with treatment versus placebo from baseline to end of first on-treatment cycle and mixed models were used to evaluate changes across the full 16-week trial.ResultsAztreonam improved cough (difference 0.22, 95% CI 0.08–0.37; p=0.002), sputum production (0.30, 95% CI 0.15–0.44; p<0.0001) and sputum colour (0.29, 95% CI 0.15–0.43; p<0.0001) versus placebo equating to a 20% improvement in cough and 25% i...

Respiratory infections, 2019

memo - Magazine of European Medical Oncology, 2018

Background This case shows that a tumor can present in an uncommon way. When dealing with pulmona... more Background This case shows that a tumor can present in an uncommon way. When dealing with pulmonary masses, tissue remains the most important issue. Clinical presentation We present the case of a 71year-old woman with a mass of more than 10 cm in the left lung. Pulmonary CT scan and PET scan confirmed this with also revealing mediastinal, thoracic and paravertebral invasion, without extrathoracic metastatic lesions. Bronchoscopic evaluation and ultrasound guided transbronchial needle aspiration could not yield a diagnosis. Because of rapid clinical deterioration, new imaging was performed, showing a cavitary lesion with air-fluid level in the tumor. Extensive microbiological work-up remained negative. Intervention To yield a pathological diagnosis, we performed a thoracotomy, revealing a polymorphic lym-Notation of prior abstract publication/presentation This abstract has not been previously published.

Respiratory infections, 2018

Respiratory research, Jan 10, 2017

Cystic fibrosis (CF) lung disease is characterised by vigorous airway inflammation eventually res... more Cystic fibrosis (CF) lung disease is characterised by vigorous airway inflammation eventually resulting in severe lung damage. This study aimed to describe the diversity of the inflammatory pattern in end-stage CF lungs by evaluating and quantifying which components of the innate and adaptive immunity are involved, and by assessing whether this is gender-specific. CF explant lung tissue (n = 20) collected at time of transplantation and control tissue (n = 22) was sectioned (9 μm) and stained for neutrophils, eosinophils, mast cells, dendritic cells, macrophages, CD4 T cells, cytotoxic T cells and B cells. Quantification with special attention for immune cell location was performed. Neutrophils, mast cells, dendritic cells, macrophages, CD4 T and cytotoxic T cells were significantly increased in CF compared to controls and there was a disproportionate increase of neutrophils around the airways in CF. Large amounts of lymphoid follicles were found in the CF lung and they had a skewed ...

European Respiratory Journal, Sep 1, 2013

Body: Introduction: Both acute and chronic air pollution exposure have been shown to influence cy... more Body: Introduction: Both acute and chronic air pollution exposure have been shown to influence cystic fibrosis bronchiectatic disease. (1,2) Air pollution in non-cystic fibrosis bronchiectasis (NCFB) has not been studied before. We studied the association between residential distance to major road and death in a cohort of patients with NCFB. Methods: We included 189 patients between 18 and 65 years who had visited the outpatient clinic at the University Hospital of Leuven, Belgium, between June 2006 and October 2012. All patients had chronic productive cough and a chest CT scan confirming NCFB. We calculated the hazard ratios (HR) for mortality in relation to proximity of the home to major roads, adjusting for relevant covariables. Results: Of the 189 patients (45% male, 49 years ± 13), 20 died during the study period. Patients with a history of Pseudomonas aeruginosa in their sputum had a 3.6 fold increased risk of dying during follow-up (p=0.01). Never smokers showed a reduced risk (HR=0.30; p=0.03) and chronic macrolide therapy appeared protective (HR=0.34; p=0.07). Independently from gender, age, Pseudomonas aeruginosa in sputum and macrolide therapy, residential proximity to a major road was associated with the risk of mortality (HR=0.40; p=0.01; for a tenfold increase in distance to a major road). Conclusion: Living close to a major road is associated with a higher risk of dying in patients with NCFB. A history of Pseudomonas aeruginosa in sputum has a negative effect on mortality while patients who never smoked and patients receiving chronic macrolide therapy have a lower mortality risk. 1.

European Respiratory Journal, Sep 1, 2012

Body: Introduction: Cluster analysis revealed 5 clinically different clusters of asthma: mild ato... more Body: Introduction: Cluster analysis revealed 5 clinically different clusters of asthma: mild atopic (1), mild to moderate atopic(2), late-onset non-atopic (3), severe atopic (4) and severe with fixed airflow obstruction (5) (Moore et al, 2009). Aim: To link differential cell count and associated comorbidities (BMI, smoking, atopy, reflux, sinusitis and bronchiectasis) to 5 clusters of asthma based on clinical features (baseline FEV1, maximal FEV1 and age of onset). Methods: We retrospectively evaluated clinical records from 140 asthma patients (44% male; 43y ± 14) with induced sputa, recruited from outpatient clinic of the University Hospital Leuven between January 1st 2008 and November 1st 2011 and were free of exacerbation for three months prior to sputum induction. Results: Cluster 1 accounted for 37%, cluster 2 for 26%, cluster 3 for 14% and cluster 4 for 12%. Cluster 5 was too small for further analysis. Cluster 4 as defined by Moore and coworkers is significantly associated with more neutrophils (median: 72%, interquartile: 60-82%); p<0.02) in induced sputum as compared to the other clusters. Relative number of patients with reflux was highest in cluster 3 (55%) compared to cluster 1, 2 and 4 (29%, 34% and 38%). Presence of sinusitis was equally distributed between all clusters (p=0.95). Conclusion: Severe atopic asthmatics have a predominant neutrophilic airway inflammation. Patients with late-onset non-atopic asthma have the highest rate of reflux. Previously unrecognized bronchiectasis were detected in 9% of patients.

ERJ Open Research, 2016

Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approv... more Bronchiectasis is one of the most neglected diseases in respiratory medicine. There are no approved therapies and few large-scale, representative epidemiological studies.The EMBARC (European Multicentre Bronchiectasis Audit and Research Collaboration) registry is a prospective, pan-European observational study of patients with bronchiectasis. The inclusion criterion is a primary clinical diagnosis of bronchiectasis consisting of: 1) a clinical history consistent with bronchiectasis; and 2) computed tomography demonstrating bronchiectasis. Core exclusion criteria are: 1) bronchiectasis due to known cystic fibrosis; 2) age <18 years; and 3) patients who are unable or unwilling to provide informed consent.The study aims to enrol 1000 patients by April 2016 across at least 20 European countries, and 10 000 patients by March 2020. Patients will undergo a comprehensive baseline assessment and will be followed up annually for up to 5 years with the goal of providing high-quality longitu...

European Respiratory Journal, 2015

Introduction: Previous research has shown that traffic-related chronic air pollution exposure inc... more Introduction: Previous research has shown that traffic-related chronic air pollution exposure increases risk of death in patients with non-cystic fibrosis bronchiectasis (NCFB). However the effect of acute air pollution exposure in patients with NCFB remains to be established. Aims: We aimed to establish the effect of acute air pollution fluctuations on NCFB pulmonary exacerbations. Methods: NCFB patients from the Royal Infirmary of Edinburgh, UK, suffering an exacerbation between July 2012 and October 2014 were included in the case-crossover analysis. An exacerbation was defined as the use for antibiotic treatment due to respiratory deterioration. We linked these data with concentrations of particulate matter with a diameter smaller than 2.5 mm (PM 2.5 ) and ozone on the day of the event and on the 2 days prior to the event near each patient9s home address. Results: Forty patients (median 68 year, IQR 57-74; 17 male) each had one exacerbation during the study period. Thirty patients had no identifiable cause of their NCFB, 5 had post-infectious NCFB with the remaining five suffering from an auto-immune disease. The mean FEV 1 was 81% (±SD 24%) and four patients had chronic Pseudomonas aeruginosa colonization. An increase of 1 µg/m 3 of daily mean PM 2.5 concentrations was associated with a 10.2% increase in the risk of suffering an exacerbation in the next 24 hours (p=0.02; 95% CI 1.6%-19.7%). We found no evidence of an association between ozone levels and NCFB exacerbations. Conclusion: Ambient concentrations of PM 2.5 were associated with a higher risk of exacerbations, suggesting that ambient air pollution affects the health of patients with NCFB.

Clinical and Translational Allergy, 2015

Background Airway inflammation in asthma can be subdivided in Th2-high and Th2-low. Objective To ... more Background Airway inflammation in asthma can be subdivided in Th2-high and Th2-low. Objective To identify unique patient clusters with a specific airway cytokine expression profile in an unselected population with asthma.