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A major global source of disability as well as mortality is respiratory illness. Though visual evaluation of computed tomography (CT) images and chest radiographs are a primary diagnostic for respiratory illnesses, it is limited in its ability to assess severity and predict patient outcomes due to low specificity and fundamental infectious organisms. In order to address these problems, world cup optimization-based Bi-LSTM classification and lung disease prediction on CT images using REINF-net were employed. To enhance the image quality, the gathered lung CT images are pre-processed using Lucy Richardson and CLAHE algorithms. For the purpose of lung infection segmentation, the pre-processed images are segmented using the REInf-net. The GLRLM method is used to extract features from the segmented images. In order to predict lung disease in CT images, the extracted features are trained using the Bi-LSTM based on world cup optimization. Accuracy, Precision, recall, Error and Specificity for the proposed model are 97.8%, 96.7%, 96.7%, 2.2% and 98.3%. These evaluated values are contrasted with the results of existing methods like WCO-BiLSTM, MLP, CNN and LSTM. Finally, the Lung disease prediction based on CT images using REINF-Net and world cup optimization based BI-LSTM classification performs better than the existing model. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsThis meta-analysis aims to evaluate the potential link between common variations in the Surfactant Protein-B (SFTPB) gene and the risk of bronchopulmonary dysplasia (BPD) in preterm neonates.All pertinent articles published prior to February 1, 2024, in PubMed, Web of Science, EMBASE, CNKI, and Scopus databases were reviewed.Nineteen case-control studies involving 1149 BPD cases and 1845 non-BPD controls, were analyzed. Combined data indicated a significant link between SFTPB −18 A > C and Intron 4 VNTR polymorphisms with increased BPD susceptibility, while the 1580 C > T polymorphism provides a protective impact on BPD initiation.Pooled data indicated a significant association between SFTPB −18 A > C and Intron 4 VNTR polymorphisms with increased BPD risk, whereas the 1580 C > T polymorphism confers protection. These findings suggest a genetic susceptibility to BPD, underscoring the complex interplay of different genetic elements in its development. [ABSTRACT FROM AUTHOR]

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003–04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease. [ABSTRACT FROM AUTHOR]

AbstractIntroduction: Many people who smoke cigarettes report believing that nicotine causes cancer, a misperception that may reduce interest in switching to noncombustible nicotine products. Quantitative survey questions do not capture how this population thinks about nicotine and switching to noncombustible products. Methods: This study used an online convenience sample of 193 US adults who smoke cigarettes and reported that nicotine causes cancer. Respondents were asked if they thought nicotine was harmful (and why or why not) and if they would consider switching to a noncombustible product (and why or why not). Inductive and deductive coding were used, and descriptive statistics are reported. Results: Descriptions of nicotine directly causing disease (61%) were more common than descriptions of nicotine causing addiction to a harmful product (8%). One-third expressly stated that nicotine causes cancer, and 21% that nicotine causes lung disease. Interest in switching was moderate (mean 47.4 out of 100). When asked about switching, 34% described enjoying their current smoking experience, 23% described a perceived health benefit, 16% described a health concern, and 11% worried that switching would not address nicotine addiction. Discussion: Adults who smoke commonly perceived nicotine as a direct cause of cigarette-related disease, and harm and addictiveness perceptions were often mentioned as reasons for interest or disinterest in switching to a noncombustible. Future studies could explore strategies for correcting nicotine misperception, stigma related to addiction, and common concerns related to health as well as user experience. [ABSTRACT FROM AUTHOR]

AbstractPurpose: This article illustrates the replication of asthma and COPD conditions in a laboratory setting and the potential applications of this methodology.Introduction: Biologic drugs have been shown to enhance the treatment of severe asthma and COPD. Monoclonal antibodies against specific targets have dramatically changed the management of these conditions. Although the inflammatory pathways of asthma and COPD have already been clearly outlined, alternative mechanisms of action remain mostly unexplored. They could provide additional insights into these diseases and their clinical management.Aims: In vivo or in vitro models have thus been developed to test alternative hypotheses. This study describes sophisticated ex vivo models that mimic the response of human respiratory mucosa to disease triggers, aiming to narrow the gap between laboratory studies and clinical practice.Results: These models successfully replicate crucial aspects of these diseases, such as inflammatory cell presence, cytokine production, and changes in tissue structure, offering a dynamic platform for investigating disease processes and evaluating potential treatments, such as monoclonal antibodies. The proposed models have the potential to enhance personalized medicine approaches and patient-specific treatments, helping to advance the understanding and management of respiratory diseases. [ABSTRACT FROM AUTHOR]

Background and AimMethods and DesignDiscussionChronic Obstructive Pulmonary Disease (COPD) and Interstitial Lung Disease (ILD) have high symptom burden, serious health-related suffering, and mortality that necessitate palliative care (PC) integration. There is an information gap on PC needs, symptom burden, anxiety and depression in COPD and ILD, and the feasibility of PC integration from low-middle-income countries (LMICs). The PCIntegCOPD-ILD study aims to identify PC needs, symptom burden, and psychological distress in severe COPD/ ILD and assess the feasibility of PC integration within standard care. It will also explore experiences and unmet needs relating to disease and PC services for patients and informal carers.This mixed-methods study will assess PC needs, symptom burden, and psychological distress in patients with severe COPD (stages C, D) and ILD (stages II, III). Assessment will be done at recruitment (T0) and third (T3) month (face-to-face) and first (T1) and second (T2) month (phone call). After initial recruitment, patients will be provided PC interventions as required. At T3, patients’ and informal carers’ experiences and unmet needs of disease and PC services will be explored through semi-structured interviews. Impact and feasibility of integration of PC within standard care will also be assessed.The PCIntegCOPD-ILD study will provide robust data on PC needs, symptom burden, psychological distress and understanding of patient and caregiver perspecitves in severe COPD and ILD. An objective information on feasibility of PC integration will inform development and evaluation of similar models in the management of other progressive chronic diseases in LMICs. [ABSTRACT FROM AUTHOR]

Aim: Knowledge of the cardiovascular and respiratory effects of cannabis use by route of administration is unclear. This evidence is necessary to increase clinical and public health awareness given the recent trend in cannabis legalization, normalization, and surge in the availability and usage of various forms of cannabis products. Methods: Search was conducted in Web of Science, ProQuest, Psych INFO, Scopus, Embase, and Medline databases, and subsequently in the references of retrieved articles. Peer-reviewed articles published between 2009 and 2023, that reported on cardiovascular and respiratory effects of cannabis use by route of administration were included. Studies with no report of the route of administration and combined use of other illicit substances were excluded. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Of the 1873 articles retrieved, 42 met inclusion criteria encompassing six case reports, 21 reviews, and 15 empirical studies. Four administration routes were identified: smoking, vaping, oral ingestion, and dabbing. Smoking was the most common route of administration and was associated with both respiratory effects, such as bronchitis, dyspnea, and chronic obstructive lung disease, and cardiovascular effects including tachycardia, ventricular arrhythmias, and myocardial infarction. Cannabis edibles were associated with minimal respiratory effects. Tachycardia was the most common cardiovascular effect and was associated with all routes of administration. Conclusion: Cannabis use does cause cardiovascular and respiratory effects, but the conclusion remains tentative of the cardiovascular and respiratory effects by route of administration due to methodological limitations of the studies. [ABSTRACT FROM AUTHOR]

Hypoxia is characterised by tissue oxygen concentrations below 2% and occurs in several pathologies including neurodegenerative and chronic lung diseases. Air pollution and its major component, particulate matter, are also a public health concern and are directly implicated in the onset of chronic lung disease. Therefore, an understanding of the effects of hypoxia on the susceptibility of lung tissues to air pollutants is crucial. In this study we investigate the effects of hypoxia on the toxicity of diesel exhaust particles (DEP) in two lung epithelial cells: human and rat type II alveolar cells. The goal is to discern whether hypoxia exacerbates the toxic response to DEP exposure in both 24-hour and 48-hour exposures. We subjected both cell lines to increasing concentrations of DEP for 24 and 48 hours in both normoxic and hypoxic (2% oxygen) incubation conditions and measured the rate of cell death, proliferation, and pro-inflammatory cytokine and chemokine production. The results indicate that hypoxia increases DEP cytotoxicity in RLE6TN but not A549 cells, and that hypoxia decreases the production of pro-inflammatory markers induced by exposure to DEP. These results suggest an increased susceptibility to particulate matter toxicity when prolonged or chronic hypoxia is present. [ABSTRACT FROM AUTHOR]

AbstractObjectiveData sourcesStudy selectionsResultsConclusionsThe purpose of this study is to systematically investigate the different phenotypes and functional analyses of macrophages in lung tissue.A search was performed using three databases (Web of Science, Science Direct, and MEDLINE) for all relevant studies published from January 1, 2019, to December 31, 2023.This systematic review complied with the PRlSMA document’s requirements, including studies related to the signaling pathway relationship between pulmonary macrophages and asthma phenotype. The search includedstudies published in English or French lanquage, and was based on title, abstract, and complete textDocuments not meeting inclusion requirements were excludedWe have identified studies published within the past five years that meet the criteria for inclusion in this review. We found that asthma is a heterogeneous chronic inflammatory lung disease, and lung tissue macrophages are important immune cells in the respiratory tract. Pulmonary macrophages are also heterogeneous, as they have different subgroups with varying effector functions depending on the environment. They have different phenotypes and biological functions in different disease environments. The phenotypic changes of pulmonary macrophages occur during asthma, and the study of the different phenotypes and functions of macrophages in lung tissue is of great significance for treatment.This review summarizes current literature and provides a detailed introduction to the role of macrophages as key inflammatory mediators in the pathogenesis of asthma, as well as existing knowledge gaps. In addition, we propose that regulatory macrophages may prevent the development of asthma by producing IL-10, and regulating the polarization of pulmonary macrophages may be a new direction for asthma treatment. [ABSTRACT FROM AUTHOR]

Cigarette smoking can lead to a host of adverse health effects such as lung and heart disease. Increased lung cancer risk is associated with inhalation of carcinogens present in a puff of smoke. These carcinogenic compounds deposit in the lung at different sites and trigger a cascade of events leading to adverse outcomes. Understanding the site-specific deposition of various smoke constituents will inform the study of respiratory diseases from cigarette smoking. We previously developed a deposition model for inhalation of aerosol from electronic nicotine delivery systems. In this study, the model was modified to simulate inhalation of cigarette smoke consisting of soluble and insoluble tar, nicotine, and cigarette-specific constituents that are known or possible human carcinogens. The deposition model was further modified to account for nicotine protonation and other cigarette-specific physics-based mechanisms that affect smoke deposition. Model predictions showed a total respiratory tract uptake in the lung for formaldehyde (99%), nicotine (80%), and benzo[a]pyrene (60%). The site of deposition and uptake depended primarily on the constituent's saturation vapor pressure. High vapor pressure constituents such as formaldehyde were preferentially absorbed in the oral cavity and proximal lung regions, while low vapor pressure constituents such as benzo[a]pyrene were deposited in the deep lung regions. Model predictions of exhaled droplet size, droplet retention, nicotine retention, and uptake of aldehydes compared favorably with experimental data. The deposition model can be integrated into exposure assessments and other studies that evaluate potential adverse health effects from cigarette smoking. [ABSTRACT FROM AUTHOR]

Biomarkers play a role in identifying, managing, and predicting cancer outcomes. In lung cancer, they are used at various time points. Doubts remain regarding their accuracy for differential diagnosis and histological subtyping. A diagnostic test study was conducted. It included malignant lesions and controls with benign lesions. Before lung biopsy, all patients had the following biomarkers measured in serum (Pro-GRP,NSE,CYFRA21-1,SCC-Ag,CEA). The predictive capacity of serum biomarkers was evaluated to discriminate between lung cancer and benign pathology. The accuracy was also assessed for distinguishing between SCLC and NSCLC and explored their ability to perform histological subtyping. 93 patients were included, 60 with lung cancer, 33 with benign pathology. Pro-GRP and NSE were elevated in SCLC compared with NSCLC or nonmalignant disease. The most accurate for differentiating between malignant and benign pathology were CEA and CYFRA21-1. Pro-GRP had a poor predictive capacity for distinguishing NSCLC from SCLC. However, combined with CEA and CYFRA21-1, performance improved. For SCLC, the diagnostic capacity of Pro-GRP increased by combining with biomarkers, such as NSE/CYFRA21–1. Biomarkers lacked the sensitivity and specificity for independent differential diagnosis or histological subtyping. However, the observed patterns in biomarker levels associated with specific histological subtypes suggest potential utility in a multi-biomarker approach or in conjunction with other diagnostic tools. This insight could guide future research to improve diagnostic accuracy and personalized treatment strategies in lung cancer. Biomarkers are crucial for identifying, managing, and predicting outcomes in lung cancer, though they lack accuracy in differentiating histological subtypes. CEA and CYFRA21-1 were the most accurate biomarkers for distinguishing between malignant and benign pathology. Pro-GRP and NSE levels were elevated in SCLC compared to NSCLC. Pro-GRP alone had poor predictive capacity for differentiating NSCLC from SCLC, but combining it with CEA and CYFRA21-1 improved diagnostic performance. Patterns in biomarker levels suggest that a multi-biomarker approach, especially when combined with other diagnostic tools, could improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Respiratory complications are the most frequent cause of morbidity, mortality, and poor quality of life in children with cerebral palsy (CP) and represent the leading cause of hospitalizations. Several factors negatively influence the respiratory status of these children: lung parenchymal alterations and factors modifying the pulmonary pump function of chest and respiratory muscles, as well as concomitant pathologies that indirectly affect the respiratory function, such as sleep disorder, malnutrition, epilepsy, and pharmacological treatments. Early management of respiratory complications can improve the global health of children with CP and enhance quality of life for them and their caregivers. [ABSTRACT FROM AUTHOR]

Carbon monoxide poisoning is associated with severe damage to various organs. In this study, we aimed to determine if previous carbon monoxide poisoning was associated with an increased risk of lung diseases. The study population was derived from the National Health Insurance Service database of Korea between 1 January 2002 and 31 December 2021. Adults with carbon monoxide poisoning, with at least one visit to medical facilities between 2002 and 2021, were included. For comparison, an equal number of matched controls with the same index date were selected from the database. A total of 28,618 patients with carbon monoxide poisoning and 28,618 matched controls were included in this study. Approximately 42.8 per cent of the patient and control groups were female, with a mean age of 51.3 years. In patients with carbon monoxide poisoning, there was a significant increase in the risk of lung cancer (adjusted hazard ratio, 1.84; 95 per cent confidence interval, 1.42–2.39; P < 0.001), chronic obstructive pulmonary disease (adjusted hazard ratio, 1.60; 95 per cent confidence interval, 1.36–1.89; P < 0.001), pulmonary tuberculosis (adjusted hazard ratio, 1.46; 95 per cent confidence interval, 1.13–1.88; P = 0.003), and non-tuberculous mycobacterial infection (adjusted hazard ratio, 1.54; 95 per cent confidence interval, 1.01–2.36; P = 0.047). In this retrospective cohort study, previous carbon monoxide poisoning was associated with an increased risk of lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection. Further studies are needed to confirm such an association in other populations and the risk of lung diseases due to the toxic effect of carbon monoxide from different sources. Previous carbon monoxide poisoning was associated with an increased risk of lung diseases, but the relative importance of the causes and sources of exposure was not known. The long-term management of survivors of acute carbon monoxide poisoning should include monitoring for lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection. [ABSTRACT FROM AUTHOR]

AbstractIntroductionObjectiveMethodsResultsConclusionAllergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by a hypersensitivity reaction to antigens of Aspergillus fumigatus.The aim of this study was to evaluate the long-term clinical outcomes of omalizumab use in patients with ABPA.In this retrospective study, 12 patients diagnosed with ABPA and receiving omalizumab for at least 2 years, and 32 patients diagnosed with severe allergic asthma and receiving omalizumab for at least 2 years (control group) were evaluated.Evaluation was made of a total of 44 participants, comprising 11 (25%) males and 33 (75%) females, who received omalizumab for at least 2 years with the diagnosis of the control group (n = 32) and ABPA (n = 12). The increase in asthma control test (ACT) score after omalizumab was significant at 12 months and at 24 months in patients with ABPA. After omalizumab, the use of oral corticosteroid (OCS), the annual number of asthma attacks and hospitalizations were significantly decreased at 12 months and at 24 months in patients with ABPA. The increase in forced expiratory volume in 1 s (FEV1) (%) and ACT score after omalizumab were significant at 12 months and at 24 months in the control group. After omalizumab, the use of OCS, annual number of asthma attacks and hospitalizations were significantly decreased at 12 months and at 24 months in the control group.Long-term omalizumab use in patients with ABPA seems to be an effective treatment for improving pulmonary function and reducing asthma exacerbations and hospitalizations. [ABSTRACT FROM AUTHOR]

Introduction: Sarcoidosis is a chronic granulomatous of unknown etiology that mostly affects lungs with an heterogenous clinical presentation and prognosis. Therefore, therapeutic management of the disease is challenging. The goals of treatment are to prevent or to minimize organ damage, to relieve symptoms, and to improve the patient's quality of life. Areas covered: The present review covers current pharmacotherapy options for pulmonary sarcoidosis. Corticosteroids are still the first-line treatment option, however, for those patients with prolonged expectation of treatment, undesirable side effects and refractory disease, immunosuppressive drugs are preferred options. Biological drugs are promising third line therapies. Recent evidence shows that antifibrotic agents, such as nintedanib, have a role in fibrotic lung disease, as well as efzofitimob, which has shown promising results in controlling inflammatory lung disease. Expert opinion: Sarcoidosis treatment is evolving as new molecules are available. The number of studies of therapies for pulmonary sarcoidosis has increased in recent years, however, the information available is still limited and there is no consensus on how to monitor the activity of the disease. [ABSTRACT FROM AUTHOR]

Although inspiratory muscle training reduces dyspnea in patients with chronic respiratory diseases, it was not yet evaluated in a sample composed exclusively of patients with interstitial lung diseases. To discuss the perception of patients with interstitial lung diseases about inspiratory muscle training intervention. This is a qualitative study. Data were collected using semi-structured interviews, transcribed, and analyzed by thematic analysis. Fourteen patients (64 ± 7 years) with interstitial lung disease were interviewed. Average participation in the inspiratory muscle training program was 90% (range, 66–100%). Three themes were elaborated: 1) dyspnea and other symptoms in daily life (e.g. "I could not carry out a bag; I was very uncomfortable"); 2) less symptom and greater performance (e.g. "I wash and change my clothes, house cleaning, do everything without feeling anything"); and 3) IMT: a time dedicated to my health (e.g. "For me it was great because I saw my evolution every day"). Patients noticed improvements in symptoms and performance related to daily activities. Despite initial difficulties, patients continued training as planned. [ABSTRACT FROM AUTHOR]

My paper explores the question of when it is wrong for a state's immigration criteria to discriminate against people with disabilities, focusing on the idea that discrimination is wrong when it demeans a group, rather than when it disadvantages them. I argue that selecting against people with disabilities often demeans them but might not always do so even when immigration criteria explicitly exclude people on the basis of having disabilities – that is, in cases of direct discrimination. Moreover, I demonstrate that certain cases of less direct forms of discrimination that select against people with disabilities – in particular, when states apply health-cost limits on admissions – can function as proxies designed to exclude people with disabilities and thereby demean them. Finally, I explain why my analysis of discrimination's wrong does not typically apply to health conditions in general, such as heart, liver, or lung disease or cancer, setting my view apart from a prominent view in the literature. [ABSTRACT FROM AUTHOR]

Pulmonary diseases are the third biggest cause of deaths worldwide. A prominent method to detect these diseases is the observation of lung sound signals. There is an increasing need for an efficient technique that can automatically diagnose such diseases with high accuracy. In this paper, two popular public datasets are considered, and every lung sound signal is decomposed into 8 frequency bands using rectangular zero-phase filters. Features are extracted from every band, including energy, kurtosis, mean absolute deviation and Lp norm. The extracted features are utilized for classification using machine learning schemes. The proposed method achieves 99.9% accuracy for multi-class classification on the combined dataset, and for binary classification, we have evaluated normal signal versus pathogenic signal, which is found to be 100% accurate for most of the diseases. High accuracy is obtained for the individual datasets as well. Top 20 features selected using minimum redundancy maximum relevance algorithm also yield 98.6% accuracy. Therefore, the proposed method can be easily deployed in real-time systems. [ABSTRACT FROM AUTHOR]

From 2018–2020, 19 states enacted Medicaid work requirements as a strategy for reducing program enrollment and overall cost. While these requirements were later rescinded, strategies to reduce Medicaid costs are likely to reemerge as states attempt to recover economically from the COVID-19 pandemic. Here, we evaluated the impact of Medicaid work requirements on adults aged > 50, a group that likely faces significant age-related chronic disease burden. Using 2016 Health and Retirement Study data, we evaluated the chronic disease burden of adult Medicaid beneficiaries aged 51–64 years (n = 1460) who would be at risk of losing their Medicaid coverage due to work requirements. We compared Medicaid beneficiaries working <20 hours per week (i.e. those at risk of coverage loss) to those working at least 20 hours per week on eight chronic health conditions, adjusting for demographic characteristics. Among those with chronic health conditions, we also evaluated differences in disease severity based on hours worked per week. Among those working fewer than 20 hours per week, odds of disease were greater for seven of eight chronic conditions, including history of stroke (OR: 5.66; 95% CI: 2.22–14.43) and lung disease (OR: 3.79; 95% CI: 2.10–6.85). Further, those with greater disease severity were likely to work fewer hours. Thus, the introduction of Medicaid work requirements would likely result in coverage loss and lower access to care among older Medicaid beneficiaries with multiple chronic health conditions. [ABSTRACT FROM AUTHOR]

Malnutrition significantly impacts the post-operative process of gynecological cancer patients. A prominent variable for determining perioperative morbidity is the Prognostic Nutritional Index (PNI). To investigate PNI's predictive value on the risk of post-operative infections, we conducted a prospective cohort study involving women who underwent surgery for gynecological malignancies. Out of the 208 patients enrolled, 28 (13.5%) were malnourished and post-operative infections occurred in 43 patients. Notably, there was a significant difference in PNI between patients who developed infections and those who did not (p = 0.027), as well as between malnourished patients and those with normal nutritional status (p = 0.043). Univariate analysis showed that preoperative PNI predicts the risk of post-operative infections better than post-operative white blood cell count (AUC of 0.562 vs 0.375). However, the most accurate diagnostic results in the multivariate analysis were obtained from random forest and classification tree models (AUC of 0.987 and 0.977, respectively). Essentially, PNI and post-operative white blood cell count provided the best information gain according to rank probabilities. In conclusion, PNI appears to be a critical parameter that merits further investigation during the preoperative evaluation of gynecological malignancies. [ABSTRACT FROM AUTHOR]

Pulmonary rehabilitation (PR) is now recognized as the most effective treatments for individuals with chronic obstructive pulmonary disease (COPD), internet-based PR arises a promising method. The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based PR programs on physical capacity and health-related quality of life in patients with COPD. Randomized controlled trials were identified through systematically searches in PubMed, EMBASE, web of science, CENTRAL, Cochrane Library, and Google Scholar databases. Twelve studies (1433 patients) were included. For physical capacity, there was no significant difference between groups was found according to the 6-min walk test (6MWT) (MD10.42, 95% CI −2.92 to 23.77, p = 0.13, I2 = 0%). For the health-related quality of life, no significant difference between groups was found regarding the St George's Respiratory Questionnaire (SGRQ) (MD −0.64, 95% CI −3.52 to 2.23, p = 0.66), COPD assessment test (CAT)(MD −0.34, 95% CI −1.62 to 0.94, p = 0.60), modified Medical Research Council scale (mMRC)(MD 0.17, 95% CI −0.06 to 0.39, p = 0.15) and Chronic Respiratory Questionnaire (CRQ)(MD 1.32 95% CI −5.88 to 8.53, p = 0.72). This study has established the potential for delivery of PR via the internet in demonstrating non-inferiority of physical capacity and health-related quality of life (HRQoL) compared with conventional PR. Long-term rehabilitation training for patients with chronic obstructive pulmonary disease needs a more convenient and feasible way. In this study, internet-based rehabilitation showed similar effects as conventional rehabilitation on physical activity and health-related quality of life. Internet-based rehabilitation strategies would be helpful for this population. All internet-based rehabilitation strategies should be simple and sustainable. [ABSTRACT FROM AUTHOR]

Pulmonary diseases impact lung functionality and can cause health complications. X-ray imaging is an initial diagnostic approach for evaluating lung conditions. Manual segmentation of lung infections from X-rays is time-consuming and subjective. Automated segmentation has gained interest to reduce clinician workload. Semantic segmentation involves labelling individual pixels in X-rays to highlight infected regions. This article presents PulmonU-Net, an innovative semantic segmentation model using PulmonNet modules as the base network to highlight infected areas in chest X-rays. PulmonNet modules leverage global and local chest X-ray characteristics to create intricate feature maps. Incorporating leaky ReLU activation enables uninterrupted neuron functioning during learning. By adding PulmonNet modules in the encoder's deeper layers, the model addresses vanishing gradients and improves dice similarity coefficient to 94.25%. Real-time testing and prediction visualization demonstrate PulmonU-Net's effectiveness for automated lung infection segmentation from chest X-rays. [ABSTRACT FROM AUTHOR]

The Coronavirus disease (COVID-19) has emerged as a global epidemic, posing a significant threat to countries worldwide. COVID-19 is closely associated with pneumonia, leading to the unfortunate loss of many lives due to pulmonary conditions. Differentiating between pneumonia and COVID-19 based on chest X-ray images has become a challenging task. This paper proposes a Local Search Enhanced AHO-based Inception-ResNet-v2 Model to develop a robust and accurate classification model for identifying and categorizing chronic lung diseases in patients who have recovered from COVID-19. The proposed model utilizes the Inception-ResNet-v2 architecture to extract features from CT scan images, which are then used to classify the lung diseases present in the patients. A curated dataset of CT scan images from post-COVID-19 patients with known lung disease classes is used to train the model. Experimental results demonstrate that the proposed method achieves an accuracy of 98.97%, precision of 98.95%, sensitivity of 98.91%, F-score of 98.86%, and specificity of 98.89%. These performance metrics are comparable to those achieved by methods based on manually delineated contaminated areas. [ABSTRACT FROM AUTHOR]

To study the possibility of using acoustic parameters, i.e., Acoustic Voice Quality Index (AVQI) and Maximum Phonation Time (MPT) for predicting the degree of lung involvement in COVID-19 patients. This cross-sectional case–control study was conducted on the voice samples collected from 163 healthy individuals and 181 patients with COVID-19. Each participant produced a sustained vowel/a/, and a phonetically balanced Persian text containing 36 syllables. AVQI and MPT were measured using Praat scripts. Each patient underwent a non-enhanced chest computed tomographic scan and the Total Opacity score was rated to assess the degree of lung involvement. The results revealed significant differences between patients with COVID-19 and healthy individuals in terms of AVQI and MPT. A significant difference was also observed between male and female participants in AVQI and MPT. The results from the receiver operating characteristic curve analysis and area under the curve indicated that MPT (0.909) had higher diagnostic accuracy than AVQI (0.771). A significant relationship was observed between AVQI and TO scores. In the case of MPT, however, no such relationship was observed. The findings indicated that MPT was a better classifier in differentiating patients from healthy individuals, in comparison with AVQI. The results also showed that AVQI can be used as a predictor of the degree of patients' and recovered individuals' lung involvement. A formula is suggested for calculating the degree of lung involvement using AVQI. [ABSTRACT FROM AUTHOR]

Assessment of absorbed doses on organs and tissues of miners during radon exposure in the Schneeberg mines in the sixteenth century and calculation of the probability of occurrence of radiation-induced lung cancer and lung fibrosis, considering the life expectancy characteristic and the absence of smoking. The expected radon concentration at the Schneeberg mines has been estimated using published data. Modeling of the accumulation of radon in the working tunnels of mine workings was carried out using the RESRAD-Build 4.0, based on the radium concentration in soil and geometric parameters of the mining tunnel from the engravings in Agricola's book. The dynamics of radionuclides in the human body were performed using the WinAct software in accordance with data from ICRP Publications 130 and 137. The values of absorbed doses on the tissues of the respiratory tract were obtained using the IDAC 2.1 program. Several models based on the epidemiology of uranium miners have been used to calculate radiation risks from radon exposure. The probability of male survival at birth and the age-specific frequency of spontaneous lung cancer not associated with radiation for miners of the sixteenth century (nonsmoking men aged 20–40 years) were estimated to properly calculate the radiation risks. The expected radon concentration in the Schneeberg mines was assessed in the range of 75–100 kBq m−3. The average value of the equilibrium factor was estimated as 0.49 ± 0.03. The annual exposure of miners to radon decay products was assessed as 125–165 WLM year−1. The annual values of absorbed doses to different sections of the respiratory tract were calculated, the maximum absorbed doses of α-radiation are formed on the bronchial and bronchiolar regions of the lungs (2.23 Gy year−1). The deterministic effects as radiation fibrosis of the lungs with 10 years of experience in the mines of Schneeberg have a probability of occurrence from 60 to 100%. All the models used for radiation risk assessments showed that the lifetime risk of developing lung cancer for nonsmoking Schneeberg miners is many times lower than the risk of developing deterministic radiation effects. In contrast, for the smoking cohort of miners in the nineteenth century lung cancer become the dominant cause of death. The deterministic radiation effects of Schneeberg miners in sixteenth century, exposed to extremely high levels of radon, such as radiation pneumosclerosis or pulmonary fibrosis, are more likely than the development of radiation-induced lung cancer. [ABSTRACT FROM AUTHOR]

The diagnosis of lung disease is a challenging process that frequently combines clinical information, such as patient symptoms, medical history and test findings, with medical imaging, like X-rays or CT scans. The classification of lung diseases is very important in healthcare since it helps with diagnosis and treatment of many different lung diseases. A precise classification of lung conditions can aid doctors in choosing the best course of action and enhancing patient outcomes. Additionally, accurate classification can aid in evaluating the effectiveness of therapies, forecasting results and tracking the development of diseases. It is extremely important to accurately classify lung conditions. A comparison of a novel model for lung disease classification from chest CT and CXR images was presented in this paper. A modified VGG-16 model was used as the classification model. To improve the performance, a fine-tuning mechanism was added to the proposed model. The effectiveness of the suggested method is analyzed and compared on two distinct datasets in terms of performance metrics. The experimental outcomes showed that the suggested model performs better on the CXR image dataset. [ABSTRACT FROM AUTHOR]

A fast and precise diagnosis is crucial for the treatment and management of lung diseases, which are a major global cause of morbidity and mortality. Medical diagnosis and treatment planning depend heavily on the classification of lung diseases. The correct diagnosis and classification of many lung disease types is crucial for effective management and treatment. Radiologists with training evaluate medical images subjectively in order to classify lung diseases using traditional approaches. This paper proposed an effective technique for classifying lung diseases from CXR images. For the accurate classification of lung disorders, three distinct fine-tuned models are proposed. The effectiveness of the suggested fine-tuned models was evaluated using a newly developed CXR image dataset. According to the experimental findings, the proposed fine-tuned models outperformed the existing lung disease categorization models the accuracy is 98%. The suggested approach can effectively be used for lung disease classification. [ABSTRACT FROM AUTHOR]

OBJECTIVES This genetics-based study aimed to evaluate the relationships of long-term lipidlowering agents on lung-related diseases (LRD) outcomes. METHODSWeextracted genetic variations of six drug target genes from a major genome-wide association study of low-density lipoprotein cholesterol (LDL-C) in individuals predominantly of European ancestry to represent the effects of LDL-C-lowering treatment. We conducted drug-targeted Mendelian randomization and utilized a range of outcomes to capture evidence of adverse side effects related to the inhibition of the gene. RESULTS Our study did not find any significant association between genetically proxied APOB, CETP, HMGCR, NPCIL, PCSK9, and LDLR inhibition (equivalent to a one standard deviation reduction in LDL-C) with the risk of Small Cell Lung Cancer, Non-Small Cell Lung Cancer, idiopathic pulmonary fibrosis, and Pneumonia (P > 0.05). However, long-term inhibition of NPC1L that mimics the use of statin drugs may have contradictory effects on pulmonary edema (OR = 0.508, 95%CI = 0.328-0.786,P = 0.002) and chronic obstructive pulmonary disease (OR = 1.524, 95%CI = 1.099-2.115, P = 0.012). A series of sensitivity analyses and positive control analyses have been conducted to confirm the reliability of the results. CONCLUSIONS In conclusion, this study reveals inconsistent associations between genetic proxy inhibition of APOB, CETP, HMGCR, NPCIL, PCSK9 and LDLR with LRD in specific populations. [ABSTRACT FROM AUTHOR]

With the change in global environment, respiratory disorders are becoming more threatening to the health of people all over the world. These diseases are closely linked to performance of immune system. Within the innate arm of immune system, Neutrophils are an important moiety to serve as an immune defense barrier. They are one of the first cells recruited to the site of infection and plays a critical role in pathogenesis of various pulmonary diseases. It is established that the migration and activation of neutrophils can lead to inflammation either directly or indirectly and this inflammation caused is very crucial for the clearance of pathogens and resolution of infection. However, the immunopathological mechanisms involved to carry out the same is very complex and not well understood. Despite there being studies concentrating on the role of neutrophils in multiple respiratory diseases, there is still a long way to go in order to completely understand the complexity of the participation of neutrophils and mechanisms involved in the development of these respiratory diseases. In the present article, we have reviewed the literature to comprehensively provide an insight in the current development and advancements about the role of neutrophils in infectious respiratory disorders including viral respiratory disorders such as Coronavirus disease (COVID-19) and bacterial pulmonary disorders with a focused review on pulmonary tuberculosis as well as in noninfectious disorders like Chronic obstructive pulmonary disease (COPD) and asthma. Also, future directions into research and therapeutic targets have been discussed for further exploration. Respiratory illnesses are becoming more prevalent and a substantial source of sickness and mortality worldwide as a result of the changes in the global environment. Although diagnostic and therapeutic approaches for respiratory disorders have improved over the years, a thorough and in-depth approach is still required to understand the underlying immuno-pathophysiological mechanisms. Neutrophils are a crucial part of innate immune system which functions as a first line defense against various pulmonary infections. They are known to be involved in resistance against invading pulmonary pathogens and also play an important role in repairing of damaged lung tissue by removing debris. However, emerging evidences suggest that neutrophils may also be involved in promoting and aggravating the unabating inflammation in several pulmonary disorders by release of various proteases, forming neutrophil extracellular traps or by attracting and activating other immune cells at the site of inflammation. In this article, we have discussed diverse roles and responses of neutrophils and their use in potential future research and therapeutic approaches in infectious pulmonary disorders like Tuberculosis and COVID-19 and noninfectious pulmonary disorders like Chronic obstructive pulmonary disease (COPD) and asthma. [ABSTRACT FROM AUTHOR]

Paraquat (PQ) is a toxic herbicide to humans. Once absorbed, it accumulates in the lungs. PQ has been well documented that the generation of reactive oxygen species (ROS) is the main mechanism of its toxicity. Oxidative damage of PQ in lungs is represented as generation of cytotoxic and fibrotic mediators, interruption of epithelial and endothelial barriers, and inflammatory cell infiltration. No effective treatment for PQ toxicity is currently available. Several studies have shown that natural compounds (NCs) have the potential to alleviate PQ-induced pulmonary toxicity, due to their antioxidant and anti-inflammatory effects. NCs function as protective agents through stimulation of nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathways. Elevation of Nrf2 levels leads to the expression of its downstream enzymes such as SOD, CAT, and HO-1. The hypothesized role of the Nrf2/ARE signaling pathway as the protective mechanism of NCs against PQ-induced pulmonary toxicity is reviewed. [ABSTRACT FROM AUTHOR]

The study aimed to determine the respiratory effects of solvents among workers in the Mauritius paint industry. A total of 388 participants were selected using simple random sampling, and were subjected to a questionnaire for data collection. Lung function test was performed using a spirometer. Multiple regression was used to analyze the relationship between hours of exposure to solvents, while adjusting for socio-demographic factors. Independent t-test was also used to identify any difference between the means of lung function tests and the two exposed groups. Male participants were found less likely exposed to solvents compared to females (AOR, 3.39, CI 1.97-5.81). Those with secondary and lower secondary education, and worked for ≤12 hours per week, had an increased likelihood of being exposed to solvents (AOR 2.95, CI 1.20-7.28) (AOR 2.48, CI 1.19-5.16). Participants who were aware of occupational hazards (AOR 0.15, CI (0.05-0.46), and have used PPE (AOR 0.14, CI 0.08-0.25) were less likely to be less exposed to solvents. This study highlights the adverse effects of workplace exposures on respiratory health among paint factory workers. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the predictive value of routine pulmonary function testing (PFT) at the 12-month mark post-autologous hematopoietic cell transplant (AHCT) in identifying clinically significant lung disease in lymphoma survivors. In 247 patients, 173 (70%) received BEAM (carmustine, etoposide, cytarabine, melphalan), and 49 (20%) received TBC (thiotepa, busulfan, cyclophosphamide) conditioning regimens. Abnormal baseline PFT was noted in 149 patients (60%). Thirty-four patients had a significant decline (reduction of >/= 20% in DLCO or FEV1 or FVC) in post-AHCT PFT, with the highest incidence in the CNS lymphoma group (39%). The incidence of clinically significant lung disease post-transplant was low at 2% and there was no association between abnormal pre- and 1-year post-transplant PFTs with the development of clinical lung disease. While this study illustrates the impact of treatment regimens on PFT changes, it did not demonstrate a predictive value of scheduled PFTs in identifying clinically significant post-AHCT lung disease. [ABSTRACT FROM AUTHOR]

Lumbar vertebral tuberculosis presenting with a focal solitary osteolytic lesion is rare in spinal tuberculosis (TB) and the English literature describing this entity is scant. The differential diagnosis includes primary and secondary malignancies. In this report, we describe a case of 35-year-old woman who presented with low back pain and was found to have a focal L4 vertebral lytic lesion on MRI and CT. Whole body CT was carried out as a potential malignancy staging procedure and demonstrated lung lesions suggestive of TB. Her neurological and general examination were entirely normal. Her blood test was positive for QuantiFERON Gold. She was managed conservatively with anti-TB medications and serial imaging which showed evidence of resolution of the osteolytic lesion. Although it is unusual for TB to present as an isolated osteolytic vertebral body lesion, the possibility should always be considered in the differential diagnosis, along with neoplastic processes. Conservative medical management, in the absence of neurological deficits and deformity, is the main stay of management with a very good outlook. [ABSTRACT FROM AUTHOR]

Acute lung injury (ALI) is a severe and often fatal pulmonary disease. Current treatments for ALI and acute respiratory distress syndrome (ARDS) are limited. Natural product metabolites have shown promise as therapeutic alternatives. However, the effects of Licochalcone B (LCB) on ALI are largely unknown. We investigated the effects of LCB on lipopolysaccharide-challenged mice and human pulmonary microvascular endothelial cells. Cell viability, apoptosis, and ROS production were assessed. Lung tissue histopathology and oxidative stress and inflammation markers were evaluated. Protein expression levels were measured. LCB had no cytotoxic effects on cells and increased cell viability. It reduced apoptosis and ROS levels in cells. In mice with ALI, LCB decreased lung tissue weight and improved oxidative stress and inflammation markers. It also enhanced expression levels of Nrf2, HO-1, and NQO1 while reducing Keap1. LCB protects against LPS-induced acute lung injury in cells and mice. The Keap1/Nrf2 pathway may be involved in its protective effects. LCB shows potential as a strategy to alleviate ALI caused by LPS. [ABSTRACT FROM AUTHOR]

Data used in big data applications are typically kept in decentralized computing resources in the real world, which has an impact on the design of artificial intelligence algorithms. When there are significantly more observations from one class than from another, the dataset is said to be imbalanced. Therefore, in this work, the study elaborates the model as SMOTE-SVM which resolves imbalance issues in sampling the data and improves overall accuracy to 94%. The model deploys K-nearest neighbours to compute the difference between samples and to balance the samples, it computes the kernel space. Further, to optimize the classification, GWO optimizer merges with SMOTE-SVM to achieve enhanced performance. GWO (Grey Wolf Optimizer) induces greedy selection to perform optimization among classification. It is important to remember that grey wolves have a flexible social structure that might change the hierarchy. As the mobilization continues, the grey wolves are reconstructed with the distance between them and their prey, or more specifically, in accordance with the resultant value of the fitness. In addition, to prove the efficiency, the following performance metrics are measured-Overall Accuracy, Classification Accuracy, AUC and ROC. [ABSTRACT FROM AUTHOR]

The exhaustive information about non-communicable diseases associated with COVID-19 and severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) are getting easier to find in the literature. However, there is a lack of knowledge regarding tuberculosis (TB) and chronic obstructed pulmonary disease (COPD), with numerous infections in COVID-19 patients. Priority is placed on determining the patient's prognosis based on the presence or absence of TB and COPD. Additionally, a comparison is made between the risk of death and the likelihood of recovery in terms of time in COVID-19 patients who have either COPD or TB. At the DHQ Hospital in Muzaffargarh, Punjab, Pakistan, 498 COVID-19 patients with TB and COPD were studied retrospectively. The duration of study started in February 2022 and concluded in August 2022. The Kaplan–Meier curves described time-to-death and time-to-recovery stratified by TB and COPD status. The Wilcoxon test compared the survival rates of people with TB and COPD in two matched paired groups and their status differences with their standard of living. The risk of death in COVID-19 patients with TB was 1.476 times higher than in those without (95% CI: 0.949–2.295). The recovery risk in COVID-19 patients with TB was 0.677 times lower than in those without (95% CI: 0.436–1.054). Similarly, patients with TB had a significantly shorter time to death (p=.001) and longer time to recovery (p=.001). According to the findings, the most significant contributor to an increased risk of morbidity and mortality in TB and COPD patients was the COVID-19. SARS-Cov-19 is a new challenge for the universe in terms of prevention and treatment for people with tuberculosis and chronic obstructive pulmonary disease, among other diseases. Propensity score matching to control for potential biases. Compared to hospitalized patients with and without (TB and COPD) had an equivalently higher mortality rate. [ABSTRACT FROM AUTHOR]

A 56-year-old woman was treated for rheumatoid arthritis for 17 years with methotrexate (MTX). Night sweats, fever and weight loss made her visit our hospital. Although levofloxacin failed to resolve her fever, she was suspected of having sepsis because of pancytopenia, elevated procalcitonin and a nodular lesion in the lung. After urgent hospitalization, she was diagnosed finally with the methotrexate-related lymphoproliferative disorder (MTX-LPD) associated with macrophage activation syndrome (MAS). Her general condition was improved with MTX withdrawal and 5-day high-dose glucocorticoid administration. Thus, even when the patient was critically ill with MAS, no cytotoxic agents were required to control MTX-LPD. [ABSTRACT FROM AUTHOR]

Acute lung injury (ALI) is a common lung disease with increasing morbidity and mortality rates due to the lack of specific drugs. Impaired alveolar fluid clearance (AFC) is a primary pathological feature of ALI. Epithelial sodium channel (ENaC) is a primary determinant in regulating the transport of Na+ and the clearance of alveolar edema fluid. Therefore, ENaC is an important target for the development of drugs for ALI therapy. However, the role of ENaC in the progression of ALI remains unclear. Inhibition of early growth response factor (EGR-1) expression has been reported to induce a protective effect on ALI; therefore, we evaluated whether EGR-1 participates in the progression of ALI by regulating ENaC-α in alveolar epithelium. We investigated the potential mechanism of EGR-1-mediated regulation of ENaC in ALI. We investigated whether EGR-1 aggravates the pulmonary edema response in ALI by regulating ENaC. ALI mouse models were established by intrabronchial injection of lipopolysaccharides (LPS). Lentiviruses with EGR-1 knockdown were transfected into LPS-stimulated A549 cells. We found that EGR-1 expression was upregulated in the lung tissues of ALI mice and in LPS-induced A549 cells, and was negatively correlated with ENaC-α expression. Knockdown of EGR-1 increased ENaC-α expression and relieved cellular edema in ALI. Moreover, EGR-1 regulated ENaC-α expression at the transcriptional level, and correspondingly promoted pulmonary edema and aggravated ALI symptoms. In conclusion, our study demonstrated that EGR-1 could promote pulmonary edema by downregulating ENaC-α at the transcriptional level in ALI. Our study provides a new potential therapeutic strategy for treatment of ALI. EGR-1 expression was increased in LPS-induced ALI mice and associated with aggravated pulmonary edema EGR-1 induced pulmonary edema relying on regulating the expression of ENaC-α at the transcriptional level by manipulating the promoter [ABSTRACT FROM AUTHOR]

Asthma is a chronic disease of the lungs. The development of asthma is related to various risk factors. Food insecurity is a critical social determinant of health, although there is little information on the association between adult food insecurity and asthma. The purpose of this study is to explore the potential correlation in US adults. The study population data were extracted from NHANES 2003–2018. Food insecurity was measured using the USDA FSSM and categorized as full, marginal, low, or very low food security. The assessment of self-reported asthma was determined by self-report questionnaires. The self-reported positive outcomes were that participants had asthma and a history of asthma attacks and asthma-related ER visits in the past year. We developed two multivariate logistic regression models. Stratified analyses were performed by gender and age. A total of 38,077 participants were considered in our final analysis. Compared to participants with FFS, the ORs (95% CIs) for asthma were 1.16 (1.00–1.33), 1.42 (1.23–1.64), and 1.56 (1.34–1.80) for participants with MFS, LFS, and VLFS, respectively (Model II). Additionally, after full adjustment, individuals with VLFS had 49% greater risks of asthma attacks (OR = 1.49; 95% CI 1.13–1.97). The ORs (95% CIs) for asthma-related ER visits were 1.59 (1.14–2.23) and 1.98 (1.36–2.87) for participants with LFS and VLFS, respectively (Model II). The positive correlations remained robust when stratified by gender and age. Our research showed that food insecurity among US adults was associated with asthma, asthma attacks, and asthma-related ER visits. [ABSTRACT FROM AUTHOR]

Pulmonary disease is a major cause of excess mortality among patients with rheumatoid arthritis (RA). Interstitial lung disease (ILD) is a feared complication, but the benefit of screening is unknown. The aim of this study was to assess the frequency of pulmonary disease, including ILD, in early RA. Patients with newly diagnosed RA were recruited prospectively at a single centre and underwent systematic pulmonary function tests (PFTs) and computed tomography (CT) scans at inclusion and after two years. The study included 150 patients (mean age 57 years, 63% female; 59% current or former smokers). Of these, 136 underwent baseline PFTs and 137 CT. Mean forced expiratory volume in one second was 99% predicted and forced vital capacity 106%. Mean diffusing capacity of the lungs for carbon monoxide (DLCO) was 84% predicted. Frequently detected CT abnormalities were pulmonary nodules (42%), bronchiectasis (29%), and emphysema (20%). Two patients had clinically significant ILD and six had mild reticulation suggestive of preclinical ILD. No ILD progression was identified at two-year follow-up. Smoking was associated with DLCO<80% (p=0.004), combined hyperinflation and diffusion impairment (residual volume>120% and DLCO<80%) (p=0.004), and visual emphysema on CT (p<0.001). Emphysema and bronchiectasis were common, but most patients had mild disease with preserved lung function. Preclinical or clinical ILD was seen in a minority in this early phase of RA. These findings suggest symptom-based screening and primary intervention focusing on smoking cessation rather than screening for ILD at the time of RA diagnosis. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality globally. In the major revision of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report, the scientific committee concluded that the use of long-acting β2-agonist/inhaled corticosteroids (LABA/ICS) is not encouraged in patients with COPD. However, current prescribing patterns reveal significant use of LABA/ICS. In this paper, the evidence behind the current practice and the latest treatment recommendations is reviewed. We compare the efficacy and safety of combination therapy with long-acting muscarinic antagonist (LAMA) and LABA vs LABA/ICS and note that LAMA/LABA combinations have reduced the annual rate of moderate/severe exacerbations, delayed the time to first exacerbation, and increased post-dose FEV1 vs ICS-based regimens. The GOLD 2023 report recommends treatment with LABA and LAMA combination (preferably as a single inhaler) in patients with persistent dyspnea, with initiation of ICS in patients based on the symptoms (dyspnea and exercise intolerance as indicated by modified Medical Research Council [mMRC] score ≥ 2 and COPD Assessment Test [CAT™] > 20), blood eosinophil count (≥ 300 cells/µL), and exacerbation history (history of hospitalizations for exacerbations of COPD and ≥ 2 moderate exacerbations per year despite appropriate long-acting bronchodilator maintenance therapy). We describe practical recommendations for primary care physicians to optimize therapy for their patients and prevent overuse of ICS-based regimens. We advocate adherence to current recommendations and a greater focus on effective treatments to successfully control symptoms, minimize exacerbation risk, preserve lung function, maximize patient outcomes, and reduce the burden of drug-related adverse events. Chronic obstructive pulmonary disease (COPD) is a common disease of the lungs associated with continued respiratory symptoms and airflow limitation. COPD causes symptoms such as breathlessness, cough, and production of phlegm, and, if not properly managed, these symptoms may get worse and result in flare-ups, also termed exacerbations. COPD management includes controlling symptoms while reducing the risk of exacerbations. COPD treatments include bronchodilators and inhaled corticosteroids (ICS). Bronchodilators help by widening the airways, making it easier to breathe. The two types of bronchodilators are long-acting muscarinic antagonists (LAMAs; these drugs prevent closing of the airways) and long-acting β2-agonists (LABAs; these drugs relax the muscles around the airways to help keep the airways open for a longer time). ICS may reduce swelling in the airways in some patients with COPD. However, the use of ICS-based regimens as the first treatment choice has been linked to health risks and is not in keeping with the recent national and international recommendations. In this narrative review, we examine why the use of ICS-based regimens is still growing and explore, based on available evidence, and why this treatment course may not be optimal for most patients with COPD. We discuss how the treatment for COPD has changed over time, and our findings support the use of LAMA and LABA as the first course of therapy in many patients with COPD. We conclude that greater adherence to the treatment guidelines can help to improve treatment outcomes for many patients with COPD. [ABSTRACT FROM AUTHOR]

Nicotine and pesticide exposure in agricultural settings have been linked to the development of chronic respiratory disease in workers. However, this has not been extensively studied in Africa. The aim of this study was therefore to determine the prevalence of obstructive lung disease and its relationship to concurrent nicotine and pesticide exposure among small-scale tobacco farmers in Malawi. For this purpose, sociodemographic characteristics, occupational and environmental exposures were evaluated in relation to work-related respiratory symptoms and lung function impairment. A cross-sectional study was conducted enrolling 279 workers in flue-cured tobacco farms in Zomba, Malawi. The study instruments used for assessing the health outcomes were a standardised European Community Respiratory Health Survey II (ECRHS) questionnaire and Spirometry testing. The questionnaires were aimed at collecting relevant data on sociodemographic factors and self-reported respiratory health outcomes. Data were also collected on potential pesticide and nicotine exposures. Spirometry was done to evaluate objective respiratory impairment in accordance with American Thoracic Society guidelines. The mean age of participants was 38 years with 68% being male. The prevalence of work-related ocular nasal symptoms, chronic bronchitis, and work-related chest symptoms was 20%, 17%, and 29%, respectively. Airflow limitation (FEV1/FVC <70%) was found in 8% of workers. Self-reported exposure to pesticides varied from 72%- to 83%, whilst the prevalence of recent green tobacco sickness was 26%. Tasks linked to nicotine exposure, such as sowing (OR: 2.5; CI 1.1–5.7) and harvesting (OR: 2.6; CI 1.4–5.1), were significantly associated with work-related chest symptoms. Pesticide application (OR:1.96; CI 1.0–3.7) was associated with an increased risk of work-related oculonasal symptoms. Duration of pesticide exposure was also associated with obstructive impairment FEV1/FVC

The mechanisms of particle-induced pathogenesis in the lung remain poorly understood. Neutrophilic inflammation and oxidative stress in the lung are hallmarks of toxicity. Some investigators have postulated that oxidative stress from particle surface reactive oxygen species (psROS) on the dust produces the toxicopathology in the lungs of dust-exposed animals. This postulate was tested concurrently with the studies to elucidate the toxicity of lunar dust (LD), which is believed to contain psROS due to high-speed micrometeoroid bombardment that fractured and pulverized lunar surface regolith. Results from studies of rats intratracheally instilled (ITI) with three LDs (prepared from an Apollo-14 lunar regolith), which differed 14-fold in levels of psROS, and two toxicity reference dusts (TiO2 and quartz) indicated that psROS had no significant contribution to the dusts' toxicity in the lung. Reported here are results of further investigations by the LD toxicity study team on the toxicological role of oxidants in alveolar neutrophils that were harvested from rats in the 5-dust ITI study and from rats that were exposed to airborne LD for 4 weeks. The oxidants per neutrophils and all neutrophils increased with dose, exposure time and dust's cytotoxicity. The results suggest that alveolar neutrophils play a critical role in particle-induced injury and toxicity in the lung of dust-exposed animals. Based on these results, we propose an adverse outcome pathway (AOP) for particle-associated lung disease that centers on the crucial role of alveolar neutrophil-derived oxidant species. A critical review of the toxicology literature on particle exposure and lung disease further supports a neutrophil-centric mechanism in the pathogenesis of lung disease and may explain previously reported animal species differences in responses to poorly soluble particles. Key findings from the toxicology literature indicate that (1) after exposures to the same dust at the same amount, rats have more alveolar neutrophils than hamsters; hamsters clear more particles from their lungs, consequently contributing to fewer neutrophils and less severe lung lesions; (2) rats exposed to nano-sized TiO2 have more neutrophils and more severe lesions in their lungs than rats exposed to the same mass-concentration of micron-sized TiO2; nano-sized dust has a greater number of particles and a larger total particle--cell contact surface area than the same mass of micron-sized dust, which triggers more alveolar epithelial cells (AECs) to synthesize and release more cytokines that recruit a greater number of neutrophils leading to more severe lesions. Thus, we postulate that, during chronic dust exposure, particle-inflicted AECs persistently release cytokines, which recruit neutrophils and activate them to produce oxidants resulting in a prolonged continuous source of endogenous oxidative stress that leads to lung toxicity. This neutrophildriven lung pathogenesis explains why dust exposure induces more severe lesions in rats than hamsters; why, on a mass-dose basis, nano-sized dusts are more toxic than the micron-sized dusts; why lung lesions progress with time; and why dose--response curves of particle toxicity exhibit a hockey stick like shape with a threshold. The neutrophil centric AOP for particle-induced lung disease has implications for risk assessment of human exposures to dust particles and environmental particulate matter. [ABSTRACT FROM AUTHOR]

The term 'lung disease' covers a wide range of conditions that affect the lungs, including asthma, COPD, infections like the flu, pneumonia, tuberculosis, lung cancer, COVID, and numerous other breathing issues. Respiratory failure may result from several respiratory disorders. Recently, various methods have been proposed for lung disease detection, but they are not much more efficient. The proposed model has been tested on the COVID dataset. In this work, Littlewood-Paley Empirical Wavelet Transform (LPEWT) based technique is used to decompose images into their sub-bands. Using locally linear embedding (LLE), linear discriminative analysis (LDA), and principal component analysis (PCA), robust features are identified for lung disease detection after texture-based relevant Gabor features are extracted from images. LLE's outcomes inspire the development of new techniques. The Entropy, ROC, and Student's t-value methods provide ranks for robust features. Finally, LS-SVM is fed with t-value-based ranked features for classification using Morlet wavelet, Mexican-hat wavelet, and radial basis function. This model, which incorporated tenfold cross-validation, exhibited improved classification accuracy of 95.48%, specificity of 95.37%, sensitivity of 95.43%, and an F1 score of.95. The proposed diagnosis method can be a fast disease detection tool for imaging specialists using medical images. [ABSTRACT FROM AUTHOR]

Pyrethroids are popular insecticides. Shortness of breath and dyspnea are key signs of exposure; however, their respiratory effects are rarely studied. This study investigated the combination and ratios of specific blood tests and lung lesions as respiratory effects of cypermethrin (CY) in rabbits. The effects of CY at various doses and times are the novelty of this study. Doses (50, 100, and 150 mg.kg-1 body weight) of CY were injected intraperitoneally every week for up to 9 weeks in rabbits assigned into four equal groups. Data analysis revealed various respiratory signs, significantly (p ≤ 0.05) lower fibrinogen, higher neutrophils-lymphocytes (NL), LDH-lymphocytes (LL), and De-Ritis ratios (DR), and lesions in the lungs. The frequency and incidence of these effects were dose and dosage dependent. The CY leads to pulmonary signs and allergic effects. Lung injury increases cell-free heme in plasma, causing pulmonary edema with hemolysis. Emphysema and fibrosis followed the migration of basophils and mononuclear cells to the lungs. This study inferred that CY exposure caused lower fibrinogen, higher NL, LL, and DR ratios, and pulmonary lesions, which forecast poor immunity, especially increased risk for cardiac and lung diseases. [ABSTRACT FROM AUTHOR]

Mycobacterium abscessus is a nontuberculous mycobacterium, associated with broncho-pulmonary infections in individuals suffering from cystic fibrosis, bronchiectasis, and pulmonary diseases. The risk factors for transmission include biofilms, contaminated water resources, fomites, and infected individuals. M. abscessus is extensively resistant to antibiotics. To date, there is no vaccine and combination antibiotic therapy is followed. However, drug toxicities, low cure rates, and high cost of treatment make it imperfect. Over the last 20 years, bioinformatic studies on M. abscessus have advanced our understanding of the pathogen. This review integrates knowledge from the analysis of genomes, microbiomes, genomic variations, phylogeny, proteome, transcriptome, secretome, antibiotic resistance, and vaccine design to further our understanding. The utility of genome-based studies in comprehending disease progression, surveillance, tracing transmission routes, and epidemiological outbreaks on a global scale has been highlighted. Furthermore, this review underlined the importance of using computational methodologies for pinpointing factors responsible for pathogen survival and resistance. We reiterate the significance of interdisciplinary research to fight M. abscessus. In a nutshell, the outcome of computational studies can go a long way in creating novel therapeutic avenues to control M. abscessus mediated pulmonary infections. [ABSTRACT FROM AUTHOR]

With more women being diagnosed with obstructive pulmonary disease, it is important to know how women experience non-pharmacological rehabilitation including different types of physical activity and exercise. This study aimed to explore how women with obstructive pulmonary disease experienced participating in pulmonary rehabilitation including yoga or strength- and endurance training to promote physical activity. A second aim included exploring experiences of physical activity and exercise through life. Fifteen women with asthma or chronic obstructive pulmonary disease were interviewed about their experiences of participating in an exercise intervention and about their experiences of physical activity and exercise in their lives. The transcribed interviews were analyzed using qualitative content analysis. An overall theme, "Wishing to succeed in attending physical activity and exercise," emerged. Three categories were identified: 1) strategies to overcome insecurity; 2) a life situation which enables and hinders; and 3) an inner drive and focus on myself. The women's wishes to be physically activity and exercise involved hindering and enabling factors. Specifically, their gender roles as women were described as a hinder. This suggests a need to include a gender perspective when promoting physical activity and exercise to women with obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

The 2010 Lung Allocation Score (LAS) version considers the estimated survival benefit offered by lung transplantation (LTx) and uses 6-minute Walk Test (6MWT) distance as a dichotomous covariate of whether an individual can walk more than 150 ft or 45.7 m in 6 min. This study aimed to provide evidence that 6MWT gives no clinically meaningful information to be used in the current LAS for candidates to LTx with cystic fibrosis (CF). We collected data from 6MWTs performed since 2003 at our CF centre. A joint model was fitted to describe the effect of changes in walked distance on the hazard of LTx or death. Up to 2019, 552 6MWTs were performed on 163 individuals with CF. None of the individuals included walked for less than 45.7 m during the 6MWT. Based on the joint modelling, the association of walked distance with the hazard ratio (HR) of LTx or death was significant (HR 0.99, 95% Credible Interval [CI]: 0.99 to 1.00). When adopted dichotomously for LAS calculation, walked distance does not add any useful information about exercise capacity. Longitudinal trajectories of walked distance may provide complementary information about prognosis in individuals with CF. Dichotomized walked distance does not contribute to lung allocation score in candidates to lung transplantation with cystic fibrosis Changes in the longitudinal trajectory of walked distance can be clinically meaningful for prognostication. Sensitive outcomes to be incorporated in the lung allocation scoring system for individuals with CF are yet needed to catch rapid falls in functional capacity. [ABSTRACT FROM AUTHOR]

To investigate if a reduction in the frequency of long term physiotherapy leads to an increase of exacerbations, prescriptions of medication and hospital admissions in patients with chronic obstructive pulmonary disease (COPD). 296 adults with severe COPD (GOLD III & IV) followed a weekly physiotherapy program with a focus on endurance capacity, muscle function and education. In this study, participants were divided into two groups: a High-Frequency Group (HFG) and a Low Frequency Group (LFG). The HFG had consistent lower rates of exacerbations (LFG x̄ 4.14; HFG x̄ 2.71), prescriptions antibiotics LFG x̄ 28.63; HFG x̄ 12.64), number of hospital admissions (LFG x̄ 1.22; HFG x̄ 0.36) and days in hospital (LFG x̄ 8.85; HFG x̄ 1.36) compared to LFG. Differences between both groups (Independent samples T-test, p < 0.05) were significant for exacerbations (p = 0.001), antibiotic prescriptions (p = 0.009), hospital admissions (p = 0.000) and days in hospital (p = 0.000). Reducing the frequency of long-term physiotherapy leads to significantly higher rates of exacerbations, medication use, hospital admissions and days in hospital in patients with severe COPD. [ABSTRACT FROM AUTHOR]

Persistent respiratory tract inflammation contributes to the pathogenesis of various chronic respiratory diseases, such as asthma, chronic obstructive pulmonary disease, and pulmonary fibrosis. These inflammatory respiratory diseases have been a major public health concern as they are the leading causes of worldwide mortality and morbidity, resulting in heavy burden on socioeconomic growth throughout these years. Although various therapeutic agents are currently available, the clinical applications of these agents are found to be futile due to their adverse effects, and most patients remained poorly controlled with a low quality of life. These drawbacks have necessitated the development of novel, alternative therapeutic agents that can effectively improve therapeutic outcomes. Recently, nutraceuticals such as probiotics, vitamins, and phytochemicals have gained increasing attention due to their nutritional properties and therapeutic potential in modulating the pathological mechanisms underlying inflammatory respiratory diseases, which could ultimately result in improved disease control and overall health outcomes. As such, nutraceuticals have been held in high regard as the possible alternatives to address the limitations of conventional therapeutics, where intensive research are being performed to identify novel nutraceuticals that can positively impact various inflammatory respiratory diseases. This review provides an insight into the utilization of nutraceuticals with respect to their molecular mechanisms targeting multiple signaling pathways involved in the pathogenesis of inflammatory respiratory diseases. [ABSTRACT FROM AUTHOR]