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Background: Acute exacerbation is a major cause of morbidity in asthmatic children. It can occur even in well controlled asthma. Aim: To determine the prevalence and pattern of acute exacerbation of asthma in children seen at the emergency room of the University of Nigeria Teaching Hospital (UNTH), Enugu.Materials and methods: This was a descriptive, cross sectional study in which consecutive children with acute exacerbation of asthma presenting to the Children Emergency Room (CHER) of UNTH, Enugu were recruited. Information from the history and examination were documented with a structured questionnaire completed by the attending doctor. Severity of their exacerbation was determined using the Global Initiative for Asthma (GINA) guidelines. The children were treated using the written management protocol used in CHER, UNTH, Enugu which was adapted from GINA guidelines. Results: There were a total of 114 presentations (episodes) of acute exacerbation asthma by 104 children within the study period with eight children having multiple episodes. This represented 6.5% of the overall number of emergency cases seen during the period. Nearly an equal number (ratio; 1: 1.04) of males and females were enrolled with the mean age of 7.9 ± 4.7 years. More children with asthma exacerbations were admitted during the rainy season months of May and June, while the dry season months of December and January recorded lower number of episodes. Most (86.0%) cases were mild to moderate exacerbations and 16 (15.3%) were severe.Three of the 22 (13.6%) children on controller medications were among the 16 that had severe exacerbation. No death was recorded during the period. Conclusion: The prevalence of asthma exacerbation is relatively high in our tropical environment and the pattern is similar to those of the developed countries in terms of age and sex distribution, however, the peak period of presentation differ in our environment.

Abstract Characteristics of chronic obstructive pulmonary disease (COPD) patients with superoptimal peak inspiratory flow rates (PIFR) has not been thoroughly investigated. This study aimed to compare the characteristics between COPD patients with superoptimal PIFR and those with optimal and sub-optimal PIFR. PIFR was measured using In-Check DIAL G16 and categorized into sub-optimal (PIFR lower than that required by the patient’s device), optimal, and superoptimal (peak PIFR ≥ 90 L/min). Considering COPD patients with sub-optimal PIFR as the reference group, analyses were performed to identify PIFR-related factors. Subgroup analysis was performed according to the forced expiratory volume in 1 s (FEV1) % of the predicted value (%pred). Among 444 post-bronchodilator-confirmed COPD patients from seven tertiary hospitals in South Korea, 98, 223, and 123 were classified into the sub-optimal, optimal, and superoptimal PIFR groups, respectively. The superoptimal PIFR group were younger, had an increased proportion of males, a higher body mass index, lowest number of comorbidities and less frequent exacerbation in the previous year, as well as the highest forced vital capacity %pred. The adjusted odds ratio for frequent exacerbation in the previous year was lower in the superoptimal PIFR group than in the sub-optimal PIFR group and was more pronounced in patients with an FEV1%pred of

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system, which is based on inflammatory demyelination and neurodegeneration. Over the course of the COVID-19 pandemic, there has been a perception that the virus has an effect on the course of immune processes. The questions of whether the frequency of autoimmune diseases, including the nervous system, and their course has changed have been discussed. Aim of the study was to assess the clinical and epidemiological characteristics of MS during the COVID-19 pandemic from 01.01.2020 to 01.01.2023 in Novosibirsk. In the course of our work, we studied the incidence of MS and the features of the clinical picture of the debut of MS associated with COVID-19 infection. Material and methods. The study included 628 patients with MS living in Novosibirsk with the onset of the disease in the period before the pandemic from 01.01.2017 to 12/31/2019 (341 patients) and during the pandemic from 01.01.2020 to 01.1.2023 (287 patients). Results. The incidence rates of MS in Novosibirsk were calculated, it was 7.1 7.6 6.4 7.38 6.92 and 3.2 per 100 thousand population in 2017, 2018, 2019, 2020, 2021 and 2020, respectively. The average incidence of MS in the study period before the pandemic was 7.03 per 100 thousand population, during the pandemic – 5.83 per 100 thousand population (critical value of the Student’s t-test = 1.972, with a significance level of a = 0.05). When analyzing the association of clinical manifestations of the onset of MS with COVID-19, it was found that coordination disorders were observed in patients with moderate infection more often than in patients with mild infection (p < 0.05; odds ratio 0.410, 95% confidence interval 0.162–1.035). No statistically significant correlation of clinical manifestations with the severity of infection was shown for patients with primary progressive MS, however, the predominance of the multi-focal nature of disease after a more severe course of COVID-19 was noted (40 %). After the first clinical demyelinating episode in the group of patients with relapsing-remitting MS, the chances of complete recovery in patients with mild infection are 2.8 times higher than in patients with moderate infection (p < 0.05). Conclusions. Thus, as a result of the conducted study, the effect of COVID-19 on the change in the incidence of MS was not revealed. In the process of analyzing the clinical features of MS during the pandemic, it was found that COVID-19 infection can contribute to an unfavorable course of MS with worse recovery of neurological deficits after episodes of exacerbations, which leads to the accumulation of disability of patients.

Abstract The six-minute step test (6MST) has been shown to be effective in assessing exercise capacity in individuals with COPD regardless of severity and, despite its easy execution, accessibility and validity, information on the prognostic power of this test remains uncertain. The aim of this study is to investigate whether the 6MST can predict the occurrence of exacerbations in patients with COPD. This is a prospective cohort study with a 36-month follow-up in patients with COPD. All patients completed a clinical assessment, followed by pulmonary function testing and a 6MST. The 6MST was performed on a 20 cm high step; heart rate, blood pressure, oxygen saturation, BORG dyspnea and fatigue were collected. Sixty-four patients were included in the study, the majority being elderly men. Performance on the 6MST demonstrated lower performance compared to normative values proposed in the literature, indicating a reduced functional capacity. Kaplan Meier analysis revealed that ≤ 59 steps climbed during the 6MST was a strong predictor of COPD exacerbation over a 36-month follow-up. We have identified a minimal threshold number of steps (≤ 59) obtained through the 6MST may be able predict the risk of exacerbations in patients with COPD.

AbstractBackground The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document suggests that patients with chronic obstructive pulmonary disease (COPD) should be divided into a less symptomatic group. Moreover, single-inhaled drugs are recommended as initial inhalation therapy for them. However, many less symptomatic patients are provided double or triple-inhaled drugs as initial therapy in the real world. This study aimed to describe the inhalation prescriptions and compare the effects of different inhalation therapies on less symptomatic COPD patients.Patients and methods This was an observational study. Stable COPD patients were recruited and divided into a less symptomatic group including Groups A and C based on the GOLD 2019 document. We collected the data of inhalation therapies prescriptions. Then, the patients were classified into long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS groups. All the patients were followed up for 1 year to collect exacerbation and mortality data.Results We found that only 45.4% of patients in Group A and 43.6% of patients in Group C received reasonable inhalation therapy in reference to the GOLD document. In addition, the LAMA group had a higher forced expiratory volume in one second (FEV1), FEV1%pred, FEV1/forced vital capacity and peak expiratory flow compared with LABA + ICS, LABA + LAMA and LABA + LAMA + ICS groups. However, we did not find any significant differences of exacerbation, hospitalization and mortality during the follow-up among different inhalation therapies groups on less symptomatic COPD patients.Conclusion Over half of the less symptomatic patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. In fact, the single inhaled drug of LAMA should be recommended and pulmonary function is not a good indicator for the choice of initial inhalation therapy in less symptomatic COPD patients.KEY MESSAGESOver half of the less symptomatic COPD patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world.The clinicians should offer a single inhaled drug of LAMA to less symptomatic COPD patients and pulmonary function is not a good indicator for the choice of initial inhalation therapy.

Chronic obstructive pulmonary disease (COPD), a leading cause of mortality and morbidity, presents significant challenges, particularly with exacerbations, which drastically impact patients' health and healthcare costs. The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend comprehensive assessments beyond spirometry, with the COPD assessment test (CAT) emerging as a pivotal tool. Despite its utility, the relationship between CAT scores and specific biomarkers during exacerbations remains unclear. Hence, this study aims to assess the correlation between the CAT score and specific circulating biomarkers. A cross-sectional study from August 2023 to January 2024 included 59 COPD patients with exacerbations who underwent pulmonary function tests and completed the CAT score assessment. The CAT score cut-off point was set at 20, where a CAT score

Constantinos Kallis,1 Rafael A Calvo,2 Bjorn Schuller,3 Jennifer K Quint1 1National Heart and Lung Institute, and School of Public Health, Imperial College London, London, UK; 2Dyson School of Engineering, Faculty of Engineering, Imperial College London, London, UK; 3Department of Computing, Faculty of Engineering, Imperial College London, London, UKCorrespondence: Jennifer K Quint, National Heart and Lung Institute and School of Public Health, Floor 9, Sir Michael Uren Building, 86 Wood Ln, London, W12 0BZ, United Kingdom, Email j.quint@imperial.ac.ukBackground: Improving accurate risk assessment of asthma exacerbations, and reduction via relevant behaviour change among people with asthma could save lives and reduce health care costs. We developed a simple personalised risk prediction model for asthma exacerbations using factors collected in routine healthcare data for use in a risk modelling feature for automated conversational systems.Methods: We used pseudonymised primary care electronic healthcare records from the Clinical Practice Research Datalink (CPRD) Aurum database in England. We combined variables for prediction of asthma exacerbations using logistic regression including age, gender, ethnicity, Index of Multiple Deprivation, geographical region and clinical variables related to asthma events.Results: We included 1,203,741 patients divided into three cohorts to implement temporal validation: 898,763 (74.7%) in the training sample, 226,754 (18.8%) in the testing sample and 78,224 (6.5%) in the validation sample. The Area under the ROC curve (AUC) for the full model was 0.72 and for the restricted model was 0.71. Using a cut-off point of 0.1, approximately 27 asthma reviews by clinicians per 100 patients would be prevented compared with a strategy that all patients are regarded as high risk. Compared with patients without an exacerbation, patients who exacerbated were older, more likely to be female, prescribed more SABA and ICS in the preceding 12 months, have history of GORD, COPD, anxiety, depression, live in very deprived areas and have more severe disease.Conclusion: Using information available from routinely collected electronic healthcare record data, we developed a model that has moderate ability to separate patients who had an asthma exacerbation within 3 months from their index date from patients who did not. When comparing this model with a simplified model with variables that can easily be self-reported through a WhatsApp chatbot, we have shown that the predictive performance of the model is not substantially different.Keywords: asthma, exacerbation, risk prediction, electronic healthcare records

Cystic fibrosis (CF) is a disease characterized by long-term and troublesome symptoms that affect the patient’s life. This study aimed to assess and compare the health-related quality of life (HRQoL) of Polish CF patients and identify factors influencing it. The study group consisted of 79 patients (6 to 42 years old), who filled in an age-appropriate Cystic Fibrosis Questionnaire-Revised. Medical data were collected from each patient’s medical records. The domains with the highest HRQoL median were eating problems (88.89), digestive symptoms (77.78) and physical functioning (75.00). The lowest-rated domain was social functioning (61.90). Age negatively correlated with eight domains, and most strongly with treatment burden (rho = −0.474). Physical functioning positively correlated with all spirometry parameters, and most strongly with FEV1% (rho = 0.588). Treatment burden, body image and respiratory symptoms were positively correlated with all spirometry parameters except PEF%. Present exacerbations reduced scores in almost all domains, and in the MANCOVA model they were a significant factor differentiating patients’ HRQoL. The univariate analysis of MANCOVA showed the significant effects of both health condition (F = 8.32, p = 0.005) and the COVID-19 pandemic (F = 5.89, p = 0.018) on social functioning domain, and of the place of residence on body image (F = 5.60, p = 0.21). A decreasing HRQoL with increasing age and during exacerbations indicates that it is important to focus on these aspects of patients’ lives and ensure they received the necessary support from their healthcare providers.

AbstractBackground Cough is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Patients with cough may exhibit various clinical characteristics and experience varying outcomes based on inhaled therapies they receive.Objectives This study aimed to explore the clinical characteristics and outcomes of various inhaled therapies in COPD patients with frequent cough.Methods This was a multicenter, prospective cohort study. Of these patients, the median cough score in COPD assessment test (CAT) was two. Patients were classified into frequent cough group if they scored two or over in the first item of CAT and infrequent cough group otherwise. Patients with frequent cough were then divided into long-acting antimuscarinic (LAMA), long-acting beta2-agonist (LABA)/LAMA, inhaled corticosteroids (ICS)/LABA and ICS/LABA/LAMA groups. Minimum clinically important difference (MCID) (CAT scores decreased ≥2 from baseline) and the improvement of cough (cough score decreased ≥1 from baseline) were collected in the six-month follow-up. Frequent exacerbations (experiencing at least two exacerbations) were collected in the one-year follow-up.Results Of 906 patients, 581 (64.1%) patients reported frequent cough at the initial visit. Frequent cough was associated with the current smokers and CAT scores (p

Abstract Background The aim of this study is to assess the impact of the duration of the integrated disease management (IDM) program on COPD-related outcomes in real-world setting. Methods A retrospective cohort study among 3771 patients with COPD who had regularly completed 4 visits of IDM program within 1 year between April 1, 2017 and December 31, 2018. CAT score as the primary outcome used to investigate the association between IDM intervention duration and improvement in CAT score. Change in CAT score from baseline to each follow-up visit determined by using least-squares means (LSMeans) approach. The cut-off value of IDM duration for improving the CAT score was determined by the Youden index. Logistic regression was used to analyze the relationship between IDM intervention duration and MCID (the minimal clinically important difference) improvement in CAT score and the factor associated CAT improvement. Risks of COPD exacerbation events (COPD-related ED visit and COPD-related hospitalization) were estimated by using the cumulative incidence curve and Cox proportional hazards models. Result Among 3771 enrolled COPD patients, the majority of the study cohort were males (91.51%) and 42.7% of patients had CAT score of ≥ 10 at baseline. The mean of age was 71.47 years and the mean CAT at baseline were 10.49. The mean change from baseline in CAT score was − 0.87, − 1.19, − 1.23 and − 1.40 at 3-, 6-, 9- and 12 month follow-up (p 2 episodes/year), wheezing, and GOLD B or D at baseline. In baseline CAT ≥ 10 group, patients were more likely to achieve CAT MCID improvement and had greater decreases from baseline in CAT score observed at 3-, 6-, 9-, and 12 month compared with baseline CAT score

Background: Eosinophilia is often observed in patients with chronic obstructive pulmonary disease (COPD), but the influence of eosinophilia on the clinical outcomes of patients with COPD is unknown. This study aimed to evaluate the clinical characteristics of eosinophilic COPD (E-COPD) and define the effects of treatment with inhaled corticosteroids (ICS) on cardiovascular events in patients with E-COPD. Methods: We included 398 patients with COPD and classified them into two groups: E-COPD (blood eosinophil counts >300 cells/μL or >4%) and non-E-COPD. Patient characteristics and exacerbations between the two groups were compared and the effects of ICS on these variables were studied. Results: E-COPD patients (n = 196) experienced 4.49- and 6.13-time greater numbers of moderate and severe exacerbations, respectively, than non-E-COPD patients (n = 202). In the Cox proportional hazards analysis, higher eosinophil counts and lower pulmonary function values were significantly associated with moderate and severe exacerbations. Patients with E-COPD treated with ICS had fewer cardiovascular events than those treated without ICS (relative risk, 0.39; p = 0.011). Conclusion: These results suggest that eosinophilia may be associated with increased exacerbations of COPD and that treatment with ICS may be considered to reduce cardiovascular events in patients with E-COPD.

Purpose Our study aimed to compare the predictive value of the COPD Assessment Test (CAT) score at baseline and short-term change in CAT for future exacerbations in chronic obstructive pulmonary disease (COPD) patients.Methods This was a multicentre prospective study. Patients with COPD were recruited into the study and followed up for one year. CAT score and exacerbation in the previous year were collected at baseline. Change in CAT was defined as CAT score changing between baseline and the 6-month follow-up. Exacerbation was recorded during the one-year follow-up from 0th to 12th month.Result A total of 536 patients were enrolled for final analysis. The mean baseline CAT score was 14.5 ± 6.6 and the median (IQR) change in CAT was −2 (8). On Cox regression analysis, baseline CAT score, change in CAT and history of exacerbation were independent risk factors for exacerbation in the one-year follow-up. Compared with the r value of correlation between baseline CAT score and frequency of exacerbations during the one-year follow-up (r = 0.286, p

A 55-year-old female presented with recent exacerbation of the chronic cough, dyspnea, and copious expectoration. The symptoms worsened during the winter months. In the past, she was misdiagnosed with pulmonary tuberculosis. A computed tomography scan revealed bronchiectasis changes, high attenuated mucus, and hypereosinophilia. The diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) with subacute invasion was confirmed through bronchoscopy and fungal culture. Treatment with oral voriconazole significantly improved lung function and quality of life. This case highlights the importance of considering invasive pulmonary aspergillosis in patients with exacerbations of asthma and bronchiectasis. Early diagnosis and appropriate treatment are essential for improved outcomes in such cases.

Introduction: Asthma is the most common chronic respiratory disease during pregnancy. However, reports of new onset asthma during pregnancy are lacking. We report two cases of new onset asthma during pregnancy following respiratory tract infection, subsequently one case with M. pneumoniae infection and the other case with a combined infection with respiratory syncytial virus and rhinovirus. Case presentation: Both patients presented with the clinical features of an acute asthma exacerbation during pregnancy without a medical history of asthma. During follow up the diagnosis of asthma was supported by spirometry showing significant reversibility and elevated fractional exhaled nitric oxide (FeNO). Patients were hospitalized and received supplemental oxygen, treatment for an acute asthma exacerbation with systemic corticosteroids, high dose inhalation therapy. These therapeutic interventions subsequently led to a good outcome for the mother and newborn in both cases. Conclusions: New onset asthma should be part of the differential diagnosis in pregnant patients with respiratory symptoms, particularly in case of mycoplasma infection. Diagnosing asthma during pregnancy can be challenging. In these circumstances, additional diagnostic tests (like inflammatory biomarkers FeNO and blood eosinophils) can be helpful to support the diagnosis.

Introduction: Long-Term Oxygen Therapy (LTOT) has the potential to improve the mortality and morbidity in Chronic Obstructive Pulmonary Disease (COPD) patients. Aim: To assess the effect of LTOT on the Quality of Life (QoL) in stable COPD patients with severe resting hypoxemia. Materials and Methods: This was a prospective observational study conducted in a tertiary care teaching hospital in Kozhikode, Kerala, on stable COPD patients with severe hypoxemia who were newly initiated on home LTOT for ≥15 hours per day. Health Related Quality of Life (HRQoL), modified Medical Research Council (mMRC) grade of dyspnoea, frequency of exacerbations and adherence to treatment on LTOT were studied. Total of 60 patients were followed-up for one year. Significance of mean was tested using paired t-test and association between qualitative variables was tested using Chi-square test. The p-value

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition with fewer treatments available as the severity increases. Previous systematic reviews have demonstrated the benefits of long-term macrolide use. However, the therapeutic differences between different macrolides and the optimal duration of use remain unclear. Methods: A systematic review and meta-analysis were conducted to assess the effectiveness of long-term macrolide use in reducing COPD exacerbations, compare the therapeutic differences among macrolides, and determine the appropriate treatment duration. Four databases (PubMed, Cochrane Library, Web of Science, and ICHU-SHI) were searched until 20 March 2023, and a random-effects model was used to calculate the pooled effect. Results: The meta-analysis included nine randomized controlled trials involving 1965 patients. The analysis revealed an odds ratio (OR) of 0.34 (95% confidence interval [CI] 0.19, 0.59, p < 0.001) for the reduction in exacerbation frequency. Notably, only azithromycin or erythromycin showed suppression of COPD exacerbations. The ORs for reducing exacerbation frequency per year and preventing hospitalizations were −0.50 (95% CI: −0.81, −0.19; p = 0.001) and 0.60 (95% CI: 0.3, 0.97; p = 0.04), respectively. Statistical analyses showed no significant differences between three- and six-month macrolide prescriptions. However, studies involving a twelve-month prescription showed an OR of 0.27 (95% CI: 0.11, 0.68; p = 0.005; I2 = 81%). Although a significant improvement in St George’s Respiratory Questionnaire (SGRQ) total scores was observed with a mean difference of −4.42 (95% CI: −9.0, 0.16; p = 0.06; I2 = 94%), the minimal clinically important difference was not reached. While no adverse effects were observed between the two groups, several studies have reported an increase in bacterial resistance. Conclusions: Long-term use of azithromycin or erythromycin suppresses COPD exacerbations, and previous studies have supported the advantages of a 12-month macrolide prescription over a placebo.

Background: Due to an enormous health care crisis arising out of COVID-19 pandemic, alternate methods of seeking treatment like tele-consultation proved useful to patients. We assessed the role of teleconsultation in managing COPD exacerbations at home in the times of COVID-19 crisis. Materials and Methods: A prospective study of 527 diagnosed cases of COPD seeking treatment for exacerbation of their illness telephonically because of difficulty in visiting the hospitals created by the COVID-19 lockdown. Data were collected telephonically and via social media platforms from April 7,2020 to October 29, 2020. The patients were treated for exacerbation and followed telephonically at day 3,5,7, 14 and day 30. Patients who turned to be COVID-19 positive were referred to COVID health facility centers. Results: 509 patients out of 527 patients were treated for exacerbation of COPD, 18 patients tested positive for COVID-19. Out of 509, 13 patients did not improve and had to be referred to hospital. All of them had acute respiratory failure (Type 2) as documented by their arterial blood gas analysis. 2 out of them did not survive. 496 out of 509 (97.4%) patients of COPD exacerbation were successfully treated via teleconsultations and with a follow-up of 4 weeks period minimum for all the patients. Conclusion: Teleconsultation provided excellent means to manage COPD exacerbation remotely with equally effective outcome as seen in hospital care in the times of health care crises due to COVID-19 pandemic.

Purpose of the study. To study the features of chronic obstructive pyelonephritis in patients with recurrent nephrolithiasis and concomitant diseases of the cardiovascular system.Materials and methods. The study included a total of 618 patients suffering from recurrent nephrolithiasis complicated by ChOP. The 3 groups were formed: the first (I) of them included 42 patients with ChOP and uncomplicated coronary heart disease (CHD); the second (II)- 38 patients with CHD complicated by chronic heart failure (CHF); III (control) group consisted of 24 respondents with recurrent urolithiasis.Results. The sample was dominated by men (78 %). In total, there were 474 (76.7 %) patients with intact cardiovascular system. Cardiovascular disease (CVD) suffered from 144 (23.3 %) patients, 38 (26.4 %) of whom had CHF of varying severity. Exacerbations of ChOP in patients of group I developed 1.5 times more often (once in 2.8-3 years) than in patients from the control group (on average after 18 months versus 28), and in group II almost annually (1 time in 13 months). In the entire cohort (n = 618), pyelonephritis was transformed into purulent-destructive in 19 (3.1 %) cases; with concomitant CVD, this complication developed in 7 (4.9 % of 144) cases, the remaining 12 (2.5 % of 474) respondents did not suffer from CVD. In group II, the purulent-destructive form occurred in 4 (10.5 %) patients; their share in the general group of patients with CVD was 2.8 % (the differences were significant - p < 0.05). Of the 19 patients with purulent-destructive pyelonephritis on the background of nephrolithiasis, more than a third (7 people - 36.8 %) had concomitant CHD, and of the 7 patients with this terrible complication that developed on the background of concomitant CHD, more than half (4 people - 57.1 %) had CHF of varying severity. The chemical composition of the urine samples was determined using a NICOLET iS10 spectral analyzer (Thermo scientific, USA). The stages of CHF were determined in accordance with the Strazhesco-Vasilenko classification [N. D. Strazhesco, V. H. Vasilenko, 1935]. Statistical data processing was carried out using the SPSS program 19. Absolute and relative indicators were calculated, as well as the exact Fisher criterion, taking into account the Bonferroni correction; the differences were considered reliable at p < 0.05.Conclusion. in patients with recurrent nephrolithiasis and concomitant CVD (especially with complicated CHF), exacerbations of obstructive pyelonephritis develop more often, the inflammatory process often turns into a purulent-destructive form.

Sepsis and electrolyte disturbances are frequently experienced among acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. It is characterized by organ failure brought on by unbalanced host response to infection. A 63-year-old male presented to the hospital with the complaint of breathlessness with the oxygen saturation of 76%. The leukocyte level increased to 19.000 and the Potassium level decreased to 2.88. The combination of antibiotics, Potassium supplement, oxygen support through NRM of 15 liters per minute and symptomatic treatment were administered to the patient. The NRM was then changed to HFNC due to his worsening condition and successfully decreased oxygen demand. The patient’s condition has made a significant improvement after seven days of hospitalization. Patients with AECOPD are at higher risk of developing sepsis and electrolyte disturbances. Sepsis will change the biological system of the body due to different pathophysiology such as electrolyte imbalance and obviously engaged with the pathogenesis of ensuing regular intensifications. It is important for the clinicians to know the effective management for the patient, so that the critical phase can be passed even at the limited facilities.

The aim of this work is to study the electrical and viscoelastic parameters of erythrocytes for patients with inflammatory bowel diseases (IBD), examined in dynamics, as possible predictors of exacerbation of the disease. Material and methods. In dynamics, 23 patients with IBD (37.9 ± 4.3 years) were examined. The first examination was carried out in the stage of exacerbation, the second – after 6–12 months – in the stage of remission of IBD. Additionally, 36 patients with IBD in remission were examined to assess the predictive capabilities of erythrocyte parameters with subsequent monitoring of their condition for 6–12 months. The electrical and viscoelastic parameters of erythrocytes were investigated by dielectrophoresis. Statistical processing was carried out using a system of machine learning methods – Random Forest, MATLAB (R2019a, MathWorks). Results and discussion. The parameters of erythrocytes, which are predictors of exacerbation of IBD, were revealed: an increase in the proportion of deformed cells (p = 0.0001); altered nature of the erythrocyte surface (p = 0.011); increased electrical conductivity of membranes (p = 0.0019); reduced dipole moment (p = 0.0015), the rate of directional movement of erythrocytes to the electrodes (p = 0.005) (paired and unpaired Volcano plot methods), reduced deformation amplitude at a frequency of 5×105 Hz (p = 0.009), capacity of erythrocyte membranes (p = 0.029 ) (unpaired Volcano plot method). Indicators associated with changes in the charge of cells, the structure of erythrocyte membranes and the level of energy metabolism of the cell turned out to be significant. A high diagnostic accuracy of these indicators was established as predictors: the proportion of deformed cells (AUC 0.939), a summarized viscosity index (AUC 0.932). Cluster analysis of the values of erythrocyte parameters – predictors of exacerbation made it possible to stratify the risk of exacerbation: at the most altered levels of parameters – the development of exacerbation after 2.5–4.5 months, intermediate levels – after 4–6 months, minimally changed – after 8–12 months (predictive accuracy – 92 %). Conclusions. The revealed electrical and viscoelastic parameters of erythrocytes should be considered as promising predictors of exacerbation in patients with IBD.

Chronic obstructive pulmonary disease (COPD) today remains one of the most important problems of modern medicine. The social significance of this disease is determined by the annual health care costs for treating patients with exacerbated COPD, as well as the still high mortality and disability rates worldwide. The main goals of COPD treatment are to slow the rate of disease progression, control the symptoms, reduce the frequency of exacerbations and hospitalizations, and reduce the risk of future exacerbations. Currently, the main groups of drugs for basic therapy of COPD are inhaled prolonged bronchodilators from the groups of β2-adrenergic agonists and M-anticholinergics, as well as their combinations. Patients with COPD and bronchial asthma, as well as patients with COPD with elevated levels of eosinophils and frequent exacerbations, inhaled glucocorticosteroids (ICS) are used. It has been proven that the addition of corticosteroids to LABA in patients with moderate to severe COPD and frequent exacerbations has a more effective influence on pulmonary function and the number of exacerbations. Clinical studies have shown the relationship between the level of blood eosinophilia and the clinical effects of preventing future exacerbations when using iCS in combination with LABA. In our clinical observation, in patient with moderate COPD and blood eosinophilia > 300 cells/μL, when prescribing monotherapy with long-acting agonists, frequent exacerbations of the disease were noted. The addition of corticosteroids to monotherapy with a long-acting agonist made it possible to influence the frequency of exacerbations and reduce the level of eosinophils in the blood.

Abstract Diagnosis of acute low back emergencies during a systemic lupus erythematosus flare necessitates high clinical suspicion and early CT.

The ADBR2 gene has been studied for its possible relationship with the development and clinical course of chronic obstructive pulmonary disease (COPD), including response to beta-2 agonists, with existing data being contentious on the subject. So, the purpose of this study was to look into the potential impact of the arginine-16-glycine (Arg16Gly) polymorphism on the clinical course and drug utilization in COPD patients. Data show that patients with Arg16Arg have a lower number of hospital admissions for exacerbations (p=0.048), but only in the total number of exacerbations, including those treated out-patients (p=0.086). Each glycine (Gly) copy was associated with a higher number of exacerbations (OR: 0.25; 95% CI: 0.00-055; p=0.048). The number of exacerbations after LABA/LAMA treatment was similar across groups, indicating that all ADRB2 variants responded well to the treatment. Furthermore, there were no statistically significant differences in mMRC and CAT values across all study visits. Interestingly, groups differed in their use of antibiotics (AB) at all visits, with Arg16Arg being associated with the least amount of AB use. There was also a link discovered between clycine copies and increased use of glucocorticoids. As a result, Arg16Gly is involved in the clinical course of COPD as well as the utilization of drug groups. Based on the findings, we can speculate that the cross-talk between the ADRB2 gene and the corticosteroid receptor is altered in patients with the Gly16Gly genotype.

Asthma is the most common chronic disease in childhood. Exacerbation is a significant problem for asthmatic patients, and viral infections remain the most frequent triggers of asthma exacerbations. This study explored knowledge, attitudes, and practices (KAP) of parents of asthmatic children towards providing influenza vaccine to their children. This cross-sectional study enrolled parents of asthmatic children who visited the outpatient respiratory clinics of two Jordanian hospitals. The present study enrolled 667 parents of asthmatic children (62.8% female). The median age of the participants’ children was 7 years. The results showed that 60.4% of the children with asthma never received a flu vaccine. Most of those who had received the flu vaccine reported that the side effects were mild (62.7%). Asthma duration was positively and significantly associated with increased vaccine hesitancy/rejection (OR = 1.093, 95% CI = (1.004–1.190), p = 0.04; and OR = 1.092, 95% CI = (1.002–1.189), p = 0.044, respectively). As the attitude towards flu vaccine score increases, odds of vaccination hesitancy/rejection decreased (OR = 0.735, 95% CI = (0.676–0.800), p < 0.001; and OR = 0.571, 95% CI = (0.514–0.634), p < 0.001, respectively). The main reasons for vaccination hesitancy/refusal included “I don’t think my child needs it” (22.3%) followed by “I forget it” (19.5%). The rate of vaccination among children was low and emphasized the necessity of encouraging parents with asthmatic children to vaccinate their children by conducting health awareness campaigns and also emphasized the role of doctors and other healthcare professionals.

Bronchiectasis (BE) is a long-term, chronic lung condition featured by widened and scarred airways. These can alter the physiological mucociliary clearance, making it difficult to clear mucus and microorganisms, leading to frequent exacerbations. High flow nasal therapy (HFNT) is a noninvasive respiratory support that delivers heated and humidified gas eventually enriched with oxygen, through a nasal cannula. Humidification is crucial for adequate airways mucociliary clearance, improving ciliary function and consequently reducing airways inflammation and recurrent infections. HFNT has been mostly used in patients with acute hypoxemic respiratory failure and in selected patients with chronic respiratory failure due to COPD. Still, evidence about its use in acute and long-term home setting in patients with clinically relevant BE are lacking. We report a case of severe widespread BE, already on top medical therapy and pulmonary rehabilitation, still suffering from difficult mucus expectoration and recurrent exacerbations, who has been additionally treated with HFNT, both in hospital and domiciliary, reporting significant improvements on relevant clinical and patient-centered outcomes. Thus, HFNT may confer additional benefits as an add-on treatment of patients with severe BE and respiratory failure.

Abstract The role of IL‐5 in chronic spontaneous urticarial (CSU) is unclear. It may be that benralizumab is an important bidirectional modifier of CSU; that is, blocking IL‐5 may improve CSU in some patients, but it is possible that it may worsen CSU in others.

Background: Inhaler therapy plays a crucial role in controlling respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD). Incorrect or partially correct use of inhaler devices causes many chronic obstructive pulmonary disease (COPD) patients to continue to have respiratory symptoms due to poor drug deposition in the airways as a result of poor inhaler technique, leading to increased healthcare costs due to exacerbations and multiple emergency room presentations. Choosing the right inhaler device for each individual patient is a bigger challenge for doctors and chronic obstructive pulmonary disease (COPD) patients. The type of inhaler device and the correct inhaler technique depends on the control of symptoms in chronic obstructive pulmonary disease (COPD). Physicians treating patients with chronic obstructive pulmonary disease (COPD) play a central role in educating patients about the correct use of inhalation devices. The steps for the correct use of inhalation devices should be taught to patients by doctors in the presence of the family so that if the patient has difficulties handling the device correctly, the family can support them. Methods: Our analysis included 200 subjects divided into two groups—recommended group (RG) and chosen group (CG)—and aimed primarily to identify the behaviour of chronic obstructive pulmonary disease (COPD) patients when faced with deciding which type of inhaler device is most suitable for them. The two groups were monitored three times during the 12-month follow-up period. Monitoring required the physical presence of the patient at the investigating physician’s office. The study included patients who were smokers, ex-smokers, and/or with significant exposure to occupational pollutants, aged over 40 years diagnosed with chronic obstructive pulmonary disease (COPD), risk group B and C according to the GOLD guideline staging, and on inhaled ICS+LABA treatment, although they had an indication for LAMA+LABA dual bronchodilation treatment. Patients presented for consultation on their own initiative for residual respiratory symptoms under background treatment with ICS+LABA. The investigating pulmonologist who offered consultations to all scheduled patients, on the occasion of the consultation, also checked the inclusion and exclusion criteria. If the patient did not meet the study entry criteria, they were assessed and received the appropriate treatment, and if the study entry criteria were met, the patient signed the consent and followed the steps recommended by the investigating pulmonologist. As a result, patient entry into the study was randomised 1:1, meaning that the first patient was recommended the inhaler device by the doctor and the next patient entered into the study was left to decide for themselves which type of device was most suitable for them. In both groups, the percentage of patients who had a different choice of inhaler device from that of their doctor was statistically significant. Results: Compliance to treatment at T12 was found to be low, but compared to results previously published on compliance, in our analysis, compliance was higher and the only reasons identified as responsible for the better results were related to the selection of the target groups and the regular assessments, where, in addition to reviewing the inhaler technique, patients were encouraged to continue treatment, thus creating a strong bond between patient and doctor. Conclusions: Our analysis revealed that empowering patients by involving them in the inhaler selection process increases adherence to inhaler treatment, reduces the number of mistakes in inhaler use of the inhaler device, and implicitly the number of exacerbations.

Aim: The aim of this study is to assess the use of cardiac troponin I as a prognostic marker in the acute exacerbation of COPD. Objectives: Primary Objective: Evaluate the prevalence of elevation of cTnI in patients admitted with acute exacerbation of COPD. Secondary Objective: Evaluate the association of longer duration of COPD, lower SpO2 and higher PaCO2 at admission, increased need for ventilatory support, increased duration of hospital stay and increased inhospital mortality in cTnI positive patients. Material And Methods: Study Site: Apollo Main Hospital, Chennai Study Population: Patients greater than 40 years with spirometry confirmed COPD according to GOLD guidelines admitted with AECOPD in the emergency or ward in the specified period. Study Design: Prospective, Observational Study Sample Size With Justification: 62 cases. Study Duration: From JANUARY 2018 to NOVEMBER 2019. Inclusion Criteria: Study to be conducted in 62 patients with Spirometry confirmed COPD according to GOLD guidelines, age greater than 40 years and admitted with AECOPD in the emergency or ward in the specified period. Exclusion Criteria: Patients with the below mentioned are all excluded from the study - Acute coronary syndrome, post CPR. post cardiac surgery, persistent hemodynamic instability, acute aortic dissection, pulmonary embolism, primary lung diseases other than COPD, patient already on NIV, marked renal failure, severe anaemia, sepsis ,stroke. Study Methodology: The study design is prospective, observational and non-interventional. Study to be conducted in patients with spirometry proven COPD according to GOLD guidelines admitted with AECOPD in the emergency, ward, HDU, MDCCU in the specified period. Detailed medical history along with smoking history, comorbidities and medication history noted, general and respiratory examination to be done for every patient at the time of admission.SpO2 under room air, O2 requirement, ABG values, CXR, Hemogram values, creatinine levels, ECG findings, ECHO findings at the time of admission to be noted. Blood sample to be taken to analyse serum cTnI levels along with routine investigations with informed consent from each patient at initial point of care. Cardiac Troponin I to be estimated by immunochromatographic qualitative assay, DIAQUICK Troponin I cassette. The DIAQUICK Troponin I Cassette is an immunochromatographic assay. The minimum detection level is 1.0 ng/ml with Sensitivity 95%, Specificity 97% and Accuracy 90%. Whether the patient was admitted in ward or ICU, whether the patient required any ventilatory support (NIV or invasive ventilation), duration of the stay in the hospital was all followed up. The end point of the follow up is discharge or death. Results: Out of the 62 patients, 7(11.3%) patients were tested to be Troponin I positive during exacerbation. These patients had longer duration of COPD, increased presence of Pulmonary hypertension, Lower Spo2 on room air and higher PaCo2 at presentation, increased requirement of ventilatory support with ICU care and more duration of hospitalization.

AbstractBackground Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission.Methods A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Salnés County Hospital in Vilagarcía de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/µL, 300 cells/µL, and 400 cells/µL; in addition, the peripheral BEC was analysed on admission.Results 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator.Conclusion The results of our study do not seem to support the usefulness of BEC as a COPD biomarker.KEY MESSAGESThere is evidence that BEC participates in pathophysiological mechanisms of the COPD.BEC may be useful as a biomarker in COPD for aspects such as the optimization of treatments.We did not find any relationship between BEC levels and prognosis following hospital admission for AECOPD.

Introduction: Quality of life is a multifaceted concept which reflect a number of parameters including different symptoms. These factors are affected by many factors including age, gender, marital status, education levels and socioeconomic status. Quality of life in majority of patients with different medical conditions is significantly affected, however, little is known in patients with heart failure coming to tertiary care hospitals of Peshawar. This study was designed to assess quality of life among heart failure patients and to determine association between quality of life and selected demographic variables. Material & Methods: A cross-sectional study was conducted in three tertiary care hospitals; Lady Reading Hospital, Khyber Teaching Hospital and Hayatabad Medical Complex Peshawar. The data was collected through Minnesota Living with Heart Failure questionnaire. This questionnaire consists of twenty-one Likert's scale questions. Frequencies and percentages were calculated for categorical variables. All the Likert's scale questions were computed and mean and standard deviation were calculated. Independent t-test was applied to see mean difference across two categories of independent variables as male and female and ANOVA was applied to see the mean difference of quality of life across different categories including socioeconomic status. Chi square test was applied to see association between quality of life across different socio-demographic variables. Results: The total number of participants included in this survey was 127, whereas 67 (52.8%) were males and 60 (47.2%) were females. Majority of the participants (52.8%) were of above 50 years of age followed by 40-50 years. A big proportion of the participants (66.1%) was married. Majority of the participants (38.6%) had an education level of matric or below followed by 20.5% and 22.5% intermediate and bachelors, respectively. Nearly half of the participants (44.1%) had an income level from 10,000-20,000 rupees per month. An association of gender was observed with exacerbation of symptoms (p = 0.04), difficulty in climbing upstairs (p

Background & Aims: Chronic obstructive pulmonary disease is an important common respiratory disorder. Determination of the prognostic factors is important to improve the outcomes and decrease the burden of problem. We aimed to determine the relationship between peripheral blood eosinophil count and neutrophil/lymphocyte ratio (NLR) with number of attacks leading to hospital admission in patients with chronic obstructive pulmonary disease. Materials & Methods: In this cohort study, 200 consecutive patients with chronic obstructive pulmonary disease from 2016 to 2018 were enrolled including those with and without attacks leading to hospital admission and eosinophil and NLR were compared in them. Results: The results in this study demonstrated that mean eosinophil was 1.5 and 1.4 in those without and with attack without significant difference (p=0.641). The mean NLR was 4.6 and 5.9 in those without and with attack with significant difference (p=0.022). Conclusion: Totally, according to the obtained results, it is concluded that higher NLR is related to further attacks leading to hospital admissions but the eosinophil count has no significant effect in this area.

Introduction. Ulcerative colitis (UC) is a more severe pathology in children than adults, with an increasing incidence in young ages. The most common exacerbations are due to Clostridium difficile (CD) infection and can lead to severe complications. Case presentation. We present the case of a 6-year-old patient diagnosed with ulcerative colitis at the age of 5, admitted in our Clinic for watery diarrheic stools with blood, abdominal pain, anorexia, and weight loss. Laboratory tests at the time of admission revealed anemia, leukocytosis with neutrophilia, hydro-electrolytic disorders, and severe hypoalbuminemia. The A and B toxin detection test for CD in feces was positive, stool culture was negative. Anamnestic, clinical and paraclinical data established the diagnosis of CD infection associated with exacerbation of UC. Initially, the evolution under pulse therapy with Solu-Medrol and Metronidazole by vein was slightly favorable, but with a period of decline 5 days after the per oral administration of corticosteroids. Therefore, it was necessary to reinitiate intravenous corticosteroids associating also Vancomycin orally. Under the established treatment the symptomatology improved, with the normalization of the laboratory parameters and after 21 days of admission the patient was discharged. Conclusions. The coexistence of CD infection in pediatric patients with UC remains a real challenge, due to the high rate of recurrence and higher mortality compared to the general population. The undulating evolution under treatment, as well as the psychological profile of the patient, have customized the case.

Background: The role of fractional exhaled nitric oxide in guiding asthma treatment in children is uncertain. Objective: To compare treatment guided by both fractional exhaled nitric oxide and symptoms (intervention) with treatment guided by symptoms alone (standard care) in children with asthma who are at risk of an asthma exacerbation, in terms of the number of asthma exacerbations over 12 months. Design: This was a pragmatic, multicentre, randomised controlled trial with embedded cost-effectiveness and qualitative process evaluations. Randomisation (1 : 1) was carried out using a remote web-based system and was minimised on recruitment centre, age, sex and British Thoracic Society treatment step. Clinical teams and participants were not blind to treatment allocation. Setting: The trial took place in 35 hospitals and seven primary care practices in the UK. Participants: Children aged 6–15 years with a diagnosis of asthma who were currently prescribed inhaled corticosteroids and who had one or more parent-/patient-reported asthma exacerbation treated with oral corticosteroids in the 12 months prior to recruitment. Interventions: Asthma treatment guided by symptoms alone (standard care) and asthma treatment guided by symptoms plus fractional exhaled nitric oxide (intervention). Treatment recommendations in both groups were protocolised within a web-based algorithm, incorporating inhaled corticosteroid adherence (objectively measured using an electronic logging device) and current treatment. Main outcome measures: The primary outcome measure was asthma exacerbations treated with oral corticosteroids in the year post randomisation. Secondary outcomes included time to first exacerbation, number of exacerbations, lung function, fractional exhaled nitric oxide, daily dose of inhaled corticosteroid, asthma control and quality of life. Results: In total, 509 eligible participants were recruited and the primary outcome was available for 506 participants. The primary outcome occurred in 123 out of 255 (48.2%) participants in the intervention group and 129 out of 251 (51.4%) participants in the standard-care group (adjusted odds ratio 0.88, 95% confidence interval 0.61 to 1.27). There was algorithm non-compliance on 21% of assessments. Per-protocol and complier-average causal effect analysis did not change the interpretation. This non-statistically significant estimate was consistent across predefined subgroups. There were no differences between the groups in secondary outcomes. There were no serious adverse events or deaths. No meaningful differences in health service costs, direct patient costs or indirect costs to society were identified between the groups. The economic evaluation does not provide evidence to support the cost-effectiveness of the intervention. In the qualitative process evaluation, 15 trial staff and six families were interviewed. Overall, their experiences were positive. The intervention was broadly acceptable, with caveats around clinicians using the algorithm recommendation as a guide and wariness around extreme step ups/downs in treatment in the light of contextual factors not being taken into account by the algorithm. Limitations: Potential limitations included the choice of cut-off point to define uncontrolled asthma and the change in fractional exhaled nitric oxide to trigger a change in treatment. Furthermore, the treatment decisions in the two groups may not have been sufficiently different to create a difference in outcomes. Conclusions: The RAACENO (Reducing Asthma Attacks in Children using Exhaled Nitric Oxide) trial findings do not support the routine use of fractional exhaled nitric oxide measurements as part of asthma management in a secondary care setting. The potential for other objective markers to guide asthma management in children needs to be evaluated. Trial registration: This trial was registered as ISRCTN67875351. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health and Care Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

The purpose of the article is to determine the place of the combined bronchodilator fenoterol + ipratropium bromide in the treatment of exacerbations of bronchial asthma, COPD and recommendations on various delivery methods. The treatment of exacerbations of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) is of interest to a general practitioner. Although this concept has lost most of its gloomy colors in the last decade thanks to the new concept of diagnosing and treating patients, the problem of providing qualified timely assistance at the time of an exacerbation remains acute and not always solvable. Often the basis for the treatment of exacerbation of asthma and COPD is repeated administration of a fast-acting inhaled short-acting b2-agonist or an anticholinergic drug, or their combination, early administration of systemic corticosteroids and oxygen inhalation. Exacerbation therapy should be as safe as possible for patients. Following the recommendations for the treatment of asthma and COPD exacerbations both on an outpatient basis and in a hospital can significantly reduce the frequency of asthma and COPD exacerbations. Medical care that a patient can receive at home depends on the experience of the physician and the patient, as well as on the possibilities of medicine and instrumental provision. Ideally, the level of peak expiratory flow (PEF) should be a measure of control over one’s well-being, both in remission and in an exacerbation.

The literature review is devoted to the discussion of the role of respiratory viral infections in the development of exacerbations of bronchial asthma. Despite significant advances in the development of new approaches and means of treating bronchial asthma, an insufficient level of control of the disease remains, one of the consequences of which is an exacerbation of asthma, which causes significant damage both to the health of patients and leads to high costs of the healthcare system for treatment. The article provides data on the leading causal role in the development of exacerbations of bronchial asthma in children, as well as adult respiratory viruses, among which rhinoviruses are most often detected during exacerbations, especially rhinovirus C. Based on the research results, the mechanisms of predisposition of patients with bronchial asthma to virus-induced exacerbations are considered in detail., including at the gene level, associated both with the suppression of the production of cytokines suppressing the replication and spread of viruses, in particular alpha-interferon, and the stimulation of the production of T2 cytokines, such as IL5. An important role in the development of asthma exacerbations in viral infections of allergic sensitization is indicated, the role of allergen-specific IgE antibodies in the pathogenesis of asthma exacerbations caused by viruses is discussed. The data on the role of plasmacytoid dendritic cells in the formation of the pathological process in virusinduced exacerbations in patients with atopic bronchial asthma are presented. The results of studies obtained both in real clinical practice and in experimental rhinovirus infection in patients with asthma, testifying to the high therapeutic efficacy of the preparation of monoclonal antibodies against IgE – omalizumab – in the prevention and treatment of exacerbations of bronchial asthma caused by respiratory viruses are presented.

The oxidant-antioxidant imbalance is an important factor in the pathogenesis of COPD and yet there is a lack of evidence about total antioxidant levels of COPD patients, which may provide valuable information about the prognosis of the disease. In this study, we aimed to evaluate and compare the oxidant-antioxidant systems in healthy controls and in COPD patients with a stable disease and during an acute exacerbation. The study was conducted with 42 COPD patients diagnosed by a pulmonologist and 21 healthy volunteers. Pulmonary function tests were performed, arterial blood gas; white blood cell, hemoglobin, hematocrit, platelet, neutrophil%, MCV, CRP, and sedimentation rate results were compared with total antioxidant status, total oxidant status levels, and oxidative stress index. There was a statistically significant difference between the three groups in FEV1/FVC, FEV1, FVC, pCO2, pO2, % SpO2, white blood cell count, neutrophil %, CRP, and ESR values. In regard to oxidant-antioxidant system measurements there was no statistically significant difference in TAS levels, but there was a significant difference in TOS and oxidative stress index levels. Positive correlation between WBC and TOS was detected in the analysis performed and no correlation was found in other parameters. Our study showed that the measurement of TAS, TOS and OSI were meaningful parameters in the evaluation of oxidative imbalance. Oxidant stress was found to be significantly increased in all COPD patients, especially in patients with COPD exacerbations. Despite the increase in oxidative stress, no increase in antioxidant levels was observed in COPD patients. [Med-Science 2020; 9(3.000): 609-13]

The article presents data on the use of nebulizer therapy for major respiratory diseases: chronic obstructive pulmonary disease (COPD), bronchial asthma. The conditions for using aerosol-producing devices for new COVID-19 coronavirus infection, in the hospital and at home are also given. Historical aspects of the creation and use of devices for nebulizer therapy are considered. A differentiated approach is given when choosing an inhaler depending on the clinical situation, taking into account the need to use devices with a high level of precipitated fine particle fraction of the pharmaceutical aerosol, external minimal losses, with a reduced inhalation time and an economical treatment regime with optimal medication consumption. These advantages are inherent to nebulizers of the company PARI: PARI BOY SX and VELOX®. In patients with COPD, options for using nebulizer therapy in a stable state and in exacerbation are considered. It is emphasized that the inhaled route of administration of drugs provides direct penetration of the drug into the respiratory tract and, thus, contributes to a more effective drug effect. In addition, the inhalation route of administration reduces the potential risk of side effects. In patients with bronchial asthma, priority is given to the appointment of inhaled corticosteroids and β2-agonists in exacerbation. Data on the main types of devices, their advantages and disadvantages are provided. In conclusion, it is concluded that nebulizer therapy is a modern way to deliver the drug to the respiratory tract. In a number of clinical situations, the use of nebulizers is the only way to deliver the drug to a pathological focus. The use of nebulizers significantly expands the treatment options for patients with COPD and BA, reduces the need for hospitalization, and prevents the development of severe exacerbations.

Idiopathic pulmonary fibrosis (IPF) is usually characterized by a chronic and slowly progressive course. According to several studies, a small number of patients with IPF (about 515%) develops an acute deterioration of deasese exacerbation of IPF. Exacerbations of IPF can occur at any time of the disease and sometimes becomes the first manifestation of IPF. Pulmonary hypertension in IPF is a fairly frequent complication, which leads to severe violations of gas exchange and reduced tolerance to physical stress. Currently, proven effective treatments for exacerbations of IPF do not exist, the management of this condition is based on supportive therapy (oxygen, respiratory support) and interventions with inadequate evidences (corticosteroids, immunosuppressant). During exacerbation of IPF a careful search of all the possible triggers is justified. In the presented clinical case of exacerbation of IPF there was demonstrated the efficacy of complex therapy including antifibrotic therapy, PAH-specific medicines and enhanced oxygen therapy.

Objective: to study and analyze the clinical and laboratory manifestations, course, and outcome of systemic lupus erythematosus (SLE) in patients living in Kyrgyzstan.Patients and methods. The prospective study included 150 young patients aged 34 [26, 44] years in a Kyrgyz cohort (KC) with SLE, the disease of which was 3.0 [0.7; 10] years. All clinical, laboratory, and instrumental data of patients, health-related quality of life (HRQOL) indicators, and treatment regimens were recorded in the international research base, such as British Lupus Integrated Prospective System (BLIPS). SLE activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). At the end of the observation, the investigators assessed the following indicators: the number of exacerbations of SLE by the SELENA Flare Index (SFI); the onset of complete or drug-induced remission; the number of deaths; and the development of irreversible organ damages (IOD) according to the damage index (DI).Results and discussion. When seeing the physician for the first time, the KC included more patients with high (n=61 (40.66%)) and very high (n=40 (26.67%)) disease activity. Most (n=60 (40%)) patients were observed to have a subacute type of the course of the disease. At the first visit, the most common manifestations of SLE were damages to the skin (n=99 (72.67%)), serous membranes (n=91 (60.67%)), and lupus nephritis (n=79 (52.67%)). IODs were identified in 15.33% of the patients and were absent in 84.67%. IODs were more often due to the administration of glucocorticoids (GCs) in 43.48% of cases. However, GC therapy was not a predictor of organ damages (relative risk, 0.91; p>0.05). In the KC, the significant predictors of adverse outcomes were old-age onset SLE and its high activity, acute course, and frequent exacerbations.Conclusion. The KC patients had high and very high clinical and laboratory activities (40.6 and 26.6%, respectively), mainly those of acute and subacute SLE (32 and 40%, respectively), obvious immunological disorders. There was a preponderance of damages to the skin (73%), serous membranes (61%), and kidney (53%) among the clinical manifestations of SLE. IODs were found in 15.33% of patients at their study inclusion. These were more frequently represented by GC-induced changes. However, the ongoing GC therapy in the KC patients was not a predictor of organ damages. The significant predictors of an adverse outcome in our patients were old-age onset SLE and its high activity, acute course, and frequent exacerbations.

Early recognition of COPD exacerbations and prompt treatment could reduce recovery time, hospitalization risk and improve quality of life. We aimed to assess whether education of patients and healthcare providers could reduce the time between onset of COPD exacerbation symptoms and patient presentation in primary care. All the patients who were included in this REDUX pilot study received specific education about exacerbation management and a personalized action plan. Additional training about exacerbation management and training in how to educate patients was offered to the general practitioners and primary care nurses who were not experienced in giving this education. They received the REducing Delay through edUcation on eXacerbations (REDUX) training session, focusing on early recognition and treatment of COPD exacerbation symptoms. Outcomes were assessed of each patients exacerbation course before and after they received REDUX education. This included: (1) delay between exacerbation onset and recognition, (2) delay between recognition and action, (3) delay between recognition and consultation of GP. Wilcoxon Signed Rank tests were performed for the outcomes on delay. A total of 36 patients (female: 58%; mean age 70 [SD: 10.0]; mean FEV1%predicted: 51.3 [SD: 19.0]) were included. REDUX shortened days between onset of an exacerbation and recognition (from 7.7 to 2.9 days; mean gain: 4.8 days) [SD: 5.6], days between recognition and action (from 12.1 to 2.8 days; mean gain: 9.3 days) [SD: 10.5] and days between recognition and GP visit (from 11.5 to 3.2 days; mean gain: 8.3 days [SD: 11.2] (i.e. 72% decrease). The main reasons patients gave for the delay were “confusion with common cold” (68%), “don’t want to bother GP” (56%) and “trying to avoid oral steroids” (44%). We estimated that if REDUX could reduce hospital-treated COPD exacerbation recovery time by 2 days, Dutch national scale-up of REDUX could potentially save up to 33 million euros. Parallel, but apart from the REDUX study, the questions about the delay outcomes were included in a digital app for measurement of disease burden. This app was freely accessible during our REDUX study in the regular app stores as a support tool for self-management. Unfortunately, the fact that it was freely available meant that there was no check on the app's entered data. The data provided by the developer of the application showed that there were extreme differences in the days that were entered, and that it was not clear if the app was used by patients or healthcare providers who wanted to test the app. Therefore the results of the app were not usable for additional analysis to support our research. In conclusion the REDUX pilot program could successfully reduce the time between COPD exacerbation onset and patient presentation in primary care. Larger studies are required to confirm clinical effectiveness and cost-effectiveness both for the paper version of the program as for the digital application.

Studies conducted in recent years ranked chronic obstructive pulmonary disease in third place as the leading cause of death worldwide. COPD exacerbations are important events in the management of this pathology, as these have a negative impact on the quality of life, the rate of hospitalization and remission, but also on the progression of the disease. One of the factors that have been targeted as being involved in the occurrence of COPD exacerbations is vitamin D. This is a liposoluble secosteroid vitamin with a number of biological effects that cause various pathologies to occur. Vitamin D deficiency has been associated with increased rates of exacerbations and hospitalization in COPD patients. Recent meta-analyzes have concluded that vitamin D deficiency is directly associated with the severity of COPD and vitamin D supplementation may prevent exacerbations. It is assumed that this association is mediated by the immunomodulatory effects of vitamin D. Obtaining optimal vitamin D status may not only help prevent comorbidities, but also prevent exacerbations, which have been shown to be at higher risk of mortality

Acute exacerbations of chronic obstructive pulmonary disease are caused by a variety of different etiologies. The aim of the current study was to determine the diagnostic biomarkers for verifying the diagnosis of acute exacerbations of chronic obstructive pulmonary disease and predicting the length of hospital stay at elderly patients. The files of 120 patients who had been hospitalized with the diagnose of acute exacerbation of chronic obstructive pulmonary disease between January 2017 to December 2018 in the Chest Disease Department of Gulhane Education and Training Hospital were examined retrospectively. The numbers and the percentage of male and female patients were 83 (% 69) and 37 (% 31) respectively. Increases in the prohormone brain natriuretic peptide values of elderly patients were found as statistically significant (p [Med-Science 2019; 8(4.000): 847-51]

Low levels of physical activity (PA) lead to a worsening of physical condition and contributes to multimorbidity in Chronic Obstructive Respiratory Disease (COPD). Unsupervised PA related to dog ownership may contribute to reducing sedentary behavior. We aimed to investigate the relationship between dog walking, patient-reported outcomes (PROs) and exacerbations in COPD. A pre-defined sample of 200 COPD patients (dog owners and non-dog owners) with symptomatic COPD was sourced from a database representative of the Italian population. A computer-assisted personal interview was used to assess health status impairment (CAT), fatigue (FACIT), health-related quality of life (HRQoL) (EQ-5D), and PA frequency. In the whole sample, PA was associated with better CAT, EQ-5D, VAS, FACIT scores and reduced number of exacerbation (p < 0.001). Under the same CAT scores, dog-walking duration was associated with a better HRQoL (EQ5D, p = 0.015) and less fatigue (FACIT, p = 0.017). In an adjusted regression model, walking dogs >30 min was associated with lower fatigue (FACIT) than having no dogs and walking dogs p = 0.026 and p = 0.009, respectively). Motivation related to dog walking could modify patients’ tendency to focus on symptoms during PA and, therefore, to perceive the fatigue. Dog walking may be effective for increasing and maintaining regular PA, reducing the subjective impact of COPD.

Chronic obstructive pulmonary disease (COPD) and its exacerbations remain an important problem of clinical medicine. Aim. To assess the quality of medical care provided in large Russian hospitals to patients with COPD exacerbation. Materials and methods. The study included patients with acute exacerbations of COPD hospitalized into three large clinical hospitals in Moscow. The diagnosis of "COPD exacerbation" was established in accordance with current clinical recommendations. We collected the data about patients’ demography, clinical signs and symptoms, blood gas analysis, chest radiography, drug therapy, oxygen therapy and respiratory support. The follow-up period was 90 days. The obtained data were compared with the data of patients from the multicenter study "European COPD Audit". Results and discussion. The leading clinical symptoms in COPD exacerbation were dyspnea (95.4%) and sputum production (60.7%). The majority of patients with COPD received short-acting β2-agonists (77.4%), systemic steroids (85.1%), antibiotics (79.0%) and theophyllines (48.1%). Noninvasive ventilation was performed in 8.6% of patients, oxygen therapy - in 23,8% of patients, pulmonary rehabilitation - in only 6,2% of patients. Chest radiography was performed in 97.9% of patients, pulmonary function tests - in 79.8%, blood gases analysis - in 19.3% of patients. The mean duration of hospitalization was 18.2±3.9 days, repeated hospitalization within 90 days occurs in 36.2% of patients. In-hospital mortality was 3.3%. Conclusion. Based on the results of the study practical recommendations for improving the quality of medical care in acute exacerbations of COPD are proposed.

INTRODUCTION: L´association dilatations des bronches (DDB) et broncho-pneumopathie chronique obstructive (BPCO) a été proposée ces dernières années comme un nouveau phénotype potentiel de la BPCO en raison d´une présentation clinique et d´un pronostic différent. L´objectif de notre travail était d´étudier le profil clinique et les caractéristiques para cliniques des patients BPCO porteurs des DDB et de déterminer l´impact des DDB sur l´évolution de la maladie. METHODES: étude rétrospective incluant 100 patients ayant une BPCO confirmée pris en charge entre 2014 et 2018 au service de Pneumologie 4 à l´hôpital Abderrahmane Mami. Les patients ont été répartis en deux groupes: groupe 1: patients BPCO ayant des DDB (n=50) et groupe 2: patients BPCO sans DDB (n=50). Les deux groupes ont été appariés sur leurs caractéristiques épidémiologiques. RESULTATS: tous les patients étaient de sexe masculin, âgés en moyenne de 65,9 ans. Les patients BPCO et DDB avaient une fréquence plus élevée de cardiopathie ischémique (p=0,037), une dyspnée évaluée par le modified Medical Resaerch Council plus élevée (mMRC2) (p=0,02), une obstruction bronchique plus sévère (p=0,005) et une fréquence plus élevées d´exacerbation aiguë (p=0,001) et d´hospitalisation (p=0,004). En étude multivariée, les facteurs indépendants associés à la présence de DDB étaient l´obstruction bronchique sévère (OR=9,16), le phénotype exacerbateur fréquent (2 exacerbations par an) (OR=1,91) et l´isolement de germes à l´examen cytobactériologique des crachats (OR=4,99). CONCLUSION: les patients BPCO et DDB pourraient ainsi représenter un phénotype distinct de la BPCO avec un pronostic plus réservé.

Background: Individuals with severe atopic asthma are poorly controlled with standard treatments, including corticosteroids. A humanized monoclonal antibody binding immunoglobulin E (IgE), omalizumab, is approved to treat patients that are managed poorly despite optimal therapy and that have elevated serum levels of IgE. Objective: The purpose of this study was to determine omalizumab’s effectiveness in a real-world setting. The primary outcome was the number of exacerbations of asthma requiring oral corticosteroid treatment in the 2 year pre-treatment period compared to 2 years post-treatment. The secondary outcome was cumulative dose of prednisone used before and after treatment. Other outcomes that were measured included: reduction in maintenance therapy, change in spirometry (FEV1) data, the stratification of patient population based on smoking status, and average exacerbation number and prednisone use as a function of IgE level and blood eosinophilia count. Methods: Patient data were retrieved (n=41) through the hospital records of patients treated at the Montreal Chest Institute of the McGill University Health Center. Data were gathered and analyzed for the 2 years before the treatment start date and compared to data 2 years after. Results: There was a significant reduction in average exacerbation number from 6.4 pre-treatment to 3.2 post-treatment (p=0.003). There was also a reduction in cumulative prednisone use from 2504mg to 1423mg (p=0.04) following the institution of omalizumab treatment. There was no correlation between either the initial IgE levels and blood eosinophilia and the reduction in exacerbations Conclusion: Omalizumab was effective in reducing exacerbation number and prednisone use for patients with severe refractory asthma.