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Objective In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks of gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change. Study Design A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November–March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change. Results There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67–2.27, p <0.001; 1.70, 95% CI: 1.55–1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations. Conclusion We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change. Key Points Immunoprophylaxis rates decreased after the 2014 American Academy of Pediatrics guidelines update. Rate of RSV hospitalization increased among preterm infants after the 2014 AAP guidelines update. Increase in RSV hospitalization persisted for at least 5 years after AAP guidelines update. [ABSTRACT FROM AUTHOR]

Background: The number of head and neck cancer (HNC) survivors has been increasing because of improving survival in the United States. The aim of this study was to evaluate the incidence of respiratory disease diagnoses in HNC survivors in comparison with cancer-free individuals. A second aim was to investigate risk factors for respiratory disease among HNC survivors.Methods: Patients with HNC diagnosed from 1996 to 2012 were identified in the Utah Cancer Registry (n = 1901). Up to 5 cancer-free individuals from the general population (n = 7796) were matched to each HNC survivor by birth year, sex, birth state, and follow-up time. Electronic medical records and statewide health care facility data were used to identify a disease diagnosis after the cancer diagnosis. Cox proportional hazards models were used to estimate the risks of respiratory diseases.Results: The median follow-up times were 4.5 years for HNC survivors and 7.8 years for the general population cohort. The risks of respiratory infection (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.40-1.90), chronic obstructive pulmonary diseases and bronchiectasis (HR, 2.65; 95% CI, 2.13-3.29), and aspiration pneumonitis (HR, 6.21; 95% CI, 3.98-9.68) were higher among HNC survivors than the general population cohort more than 5 years after the cancer diagnosis. Age at diagnosis, baseline body mass index, sex, baseline smoking status, treatment modality, primary site, and stage were associated with the risk of adverse respiratory outcomes among HNC survivors.Conclusions: The risk of adverse respiratory outcomes was much higher among HNC survivors than the general population cohort. Multidisciplinary care is needed to prevent the occurrence of adverse respiratory outcomes among HNC survivors. [ABSTRACT FROM AUTHOR]

For patients with chronic lower respiratory disease, hypobaric hypoxia at a high altitude is considered a risk factor for mortality. However, the effects of residing at moderately high altitudes remain unclear. We investigated the association between moderate altitude and chronic lower respiratory disease mortality. In particular, we examined the lower 48 United States counties for age-adjusted chronic lower respiratory disease mortality rates, altitude, and socioeconomic factors, including tobacco use, per capita income, population density, sex ratio, unemployment, poverty, and education between 1979 and 1998. The socioeconomic factors were incorporated into the correlation analysis as potential covariates. Considerable positive (R = 0.235; P <0.001) and partial (R = 0.260; P <0.001) correlations were observed between altitude and chronic lower respiratory disease mortality rate. In the subgroup with high COPD prevalence subgroup, even stronger positive (R = 0.346; P <0.001) and partial (R = 0.423, P <0.001) correlations were observed. Multivariate regression analysis of all available socioeconomic factors revealed that additional knowledge on altitude improved the adjusted R2 values from 0.128 to 0.186 for all counties and from 0.301 to 0.421 for counties with high COPD prevalence. We concluded that in the lower 48 United States counties, even a moderate altitude may pose considerable risks in patients with chronic lower respiratory disease. [ABSTRACT FROM AUTHOR]

Objective: Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication., Methods: Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges., Results: A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P  < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P  < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P  < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P  < .001)., Conclusion: Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.

Background: Pneumoconiosis among coal miners in the USA has been resurgent over the past two decades, despite modern dust controls and regulatory standards. Previously published studies have suggested that respirable crystalline silica (RCS) is a contributor to this disease resurgence. However, evidence has been primarily indirect, in the form of radiographic features., Methods: We obtained lung tissue specimens and data from the National Coal Workers' Autopsy Study. We evaluated specimens for the presence of progressive massive fibrosis (PMF) and used histopathological classifications to type these specimens into coal-type, mixed-type and silica-type PMF. Rates of each were compared by birth cohort. Logistic regression was used to assess demographic and mining characteristics associated with silica-type PMF., Results: Of 322 cases found to have PMF, study pathologists characterised 138 (43%) as coal-type, 129 (40%) as mixed-type and 55 (17%) as silica-type PMF. Among earlier birth cohorts, coal-type and mixed-type PMF were more common than silica-type PMF, but their rates declined in later birth cohorts. In contrast, the rate of silica-type PMF did not decline in cases from more recent birth cohorts. More recent year of birth was significantly associated with silica-type PMF., Conclusions: Our findings demonstrate a shift in PMF types among US coal miners, from a predominance of coal- and mixed-type PMF to a more commonly encountered silica-type PMF. These results are further evidence of the prominent role of RCS in the pathogenesis of pneumoconiosis among contemporary US coal miners., Competing Interests: Competing interests: LHTG and RAC report preparing independent medical reviews for individuals with occupational lung disease. JLA, CDC and FHYG report pathology consultation for occupational lung disease., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Certain population groups in the United States carry a disproportionate burden of cancer. This work models and analyzes the dynamics of lung and bronchus cancer age-adjusted incidence rates by race (White and Black), gender (male and female), and prevalence of daily smoking in 38 U.S. states, the District of Columbia, and across eight U.S. geographic regions from 1999 to 2012. Methods: Data, obtained from the U.S. Cancer Statistics Section of the Centers for Disease Control and Prevention, reflect approximately 77% of the U.S. population and constitute a representative sample for making inferences about incidence rates in lung and bronchus cancer (henceforth lung cancer). A longitudinal linear mixed-effects model was used to study lung cancer incidence rates and to estimate incidence rate as a function of time, race, gender, and prevalence of daily smoking. Results: Between 1999 and 2012, age-adjusted incidence rates in lung cancer have decreased in all states and regions. However, racial and gender disparities remain. Whites continue to have lower age-adjusted incidence rates for this cancer than Blacks in all states and in five of the eight U.S. geographic regions. Disparities in incidence rates between Black and White men are significantly larger than those between Black and White women, with Black men having the highest incidence rate of all subgroups. Assuming that lung cancer incidence rates remain within reasonable range, the model predicts that the gender gap in the incidence rate for Whites would disappear by mid-2018, and for Blacks by 2026. However, the racial gap in lung cancer incidence rates among Black and White males will remain. Among all geographic regions, the Mid-South has the highest overall lung cancer incidence rate and the highest incidence rate for Whites, while the Midwest has the highest incidence rate for Blacks. Between 1999 and 2012, there was a downward trend in the prevalence of daily smokers in both genders. However, males have significantly higher rates of cigarette smoking than females at all time points. The highest and lowest prevalence of daily smoking are found in the Mid-South and New England, respectively. There was a significant correlation between lung cancer incidence rates and smoking prevalence in all geographic regions, indicating a strong influence of cigarette smoking on regional lung cancer incidence rates. Conclusion: Although age-adjusted incidence rates in lung cancer have decreased throughout the U.S., racial and gender disparities remain. This longitudinal model can help health professionals and policy makers make predictions of age-adjusted incidence rates for lung cancer in the U.S. in the next five to ten years. [ABSTRACT FROM AUTHOR]

Duchenne Muscular Dystrophy (DMD) is a genetic neuromuscular disease affecting the human body's skeletal muscles, resulting in the need for multi-disciplinary care. Complications of the respiratory system are leading causes of morbidity and mortality; therefore, aggressive evidence-based standards of pulmonary care are vital to all patients with DMD. The goal of this presentation is to present evidence-based guidelines from the United States for the pulmonary clinical care of patients with DMD. Collaborative investigation and implementation of evidence-based clinical care for patients with DMD is critical to their quality of life and survival. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the main source of morbidity and mortality in the United States with costs of more than $170 billion. Repetitive respiratory disorders during sleep are assumed to be a major cause of these diseases. Therefore, the understanding of the cardio-respiratory regulation during these events is of high public interest. One of the governing mechanisms is the mutual influence of the cardiac and respiratory oscillations on their respective onsets, the cardio-respiratory coordination (CRC). We analyze this mechanism based on nocturnal measurements of 27 males suffering from obstructive sleep apnea syndrome. Here we find, by using an advanced analysis technique, the coordigram, not only that the occurrence of CRC is significantly more frequent during respiratory sleep disturbances than in normal respiration (p-value<10−51) but also more frequent after these events (p-value<10−15). Especially, the latter finding contradicts the common assumption that spontaneous CRC can only be observed in epochs of relaxed conditions, while our newly discovered epochs of CRC after disturbances are characterized by high autonomic stress. Our findings on the connection between CRC and the appearance of sleep-disordered events require a substantial extension of the current understanding of obstructive sleep apneas and hypopneas. [ABSTRACT FROM AUTHOR]

Background: Appropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiological determinants of test results into functional classifications and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society (ATS) and European Respiratory Society (ERS) jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standards for PFT interpretation., Methods: This technical standards document was developed by an international joint Task Force, appointed by the ERS/ATS with multidisciplinary expertise in conducting and interpreting PFTs and developing international standards. A comprehensive literature review was conducted and published evidence was reviewed., Results: Recommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments., Conclusions: Interpretation of PFTs must be complemented with clinical expertise and consideration of the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements., Competing Interests: Conflict of interest: S. Stanojevic reports grants, support for travel from the European Respiratory Society and was the Co-Chair of the Global Lung Function Initiative for the European Respiratory Society; and additionally acted on the Pulmonary Function Testing Proficiency committee for the American Thoracic Society, all outside the submitted work. Conflict of interest: D.A. Kaminsky reports speaker fees from MGC Diagnostics, Inc. and honoraria from UpToDate, Inc., outside the submitted work. Conflict of interest: M.R. Miller has nothing to disclose. Conflict of interest: B. Thompson reports grants from the NHMRC; consulting fees from 4D Medical and Chiesi; lecture honoraria from 4D Medical, Chiesi and Mundipharma; and reports past academic work with the Global Lung Function Initiative for the European Respiratory Society, outside the submitted work. Conflict of interest: A. Aliverti reports patents on Forced Oscillation Technique from Philips and patents on Opto-Electronic Plethysmography from BTS Bioengineering, outside the submitted work. Conflict of interest: I. Barjaktarevic has nothing to disclose. Conflict of interest: B.G. Cooper acted as Co-Chair of the Global Lung Function Initiative at the European Respiratory Society, outside the submitted work. Conflict of interest: B. Culver has nothing to disclose. Conflict of interest: E. Derom has nothing to disclose. Conflict of interest: G.L. Hall was former Co-Chair of the Global Lung Function Initiative and reports previous academic and leadership work with the Global Lung Function Initiative, both with the European Respiratory Society, outside the submitted work. Conflict of interest: T.S. Hallstrand reports research grants from the NIH (NHLBI, NIAID), outside the submitted work. Conflict of interest: J.D. Leuppi reports grants from the Swiss National Science Foundation (SNF 160072 and 185592) and Swiss Personalised Health Network (SPHN 2018DR108); and has also received unrestricted grants from AstraZeneca AG Switzerland, Boehringer Ingelheim GmbH Switzerland, GSK AG Switzerland and Novartis AG Switzerland, outside the submitted work. Conflict of interest: N. MacIntyre reports consulting fees from Vyaire, outside the submitted work. Conflict of interest: M. McCormack reports royalties for authorship for PFT chapters from UpToDate; consulting fees related to PFT quality and reading from Aridis, outside the submitted work. Conflict of interest: M. Rosenfeld has nothing to disclose. Conflict of interest: E.R. Swenson has nothing to disclose., (The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Our objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65-74. This was a retrospective cohort study. The study setting included 638 hospitals in the USA participating in the Premier database from 2010 to 2015. The study participants were 488,382 adults aged ≥65 years hospitalized with CAP. Patients ≥85 years were more likely to be white (79.8% vs 76.2%), female (58.1% vs 48.3%), and admitted with aspiration pneumonia (17.1% vs 7.0%) as compared with those aged 65-75 years. They had higher rates of dementia (30.4% vs 7.8%), but lower rates of diabetes (11.2% vs 17.6%) and chronic obstructive pulmonary disease (25.5% vs 54.7%). While Staphylococcus aureus (33.4%) was the most common pathogen across all age groups, patients aged ≥85 were more likely to have Escherichia coli pneumonia (16.1% vs 10.7%) compared with those aged 65-74. In adjusted models, patients aged ≥85 had greater in-hospital mortality (OR 1.14, 95% CI 1.11 to 1.18), but were less likely to be admitted to the intensive care unit (OR 0.54, 95% CI 0.53 to 0.55) and receive mechanical ventilation (OR 0.47, 95% CI 0.46 to 0.48). They also had lower rates of acute kidney injury (OR 0.95, 95% CI 0.91 to 1.00) and Clostridium difficile infection (OR 0.91, 95% CI 0.85 to 0.99), shorter lengths of stay (mean multiplier 0.93, 95% CI 0.92 to 0.93) and lower cost (mean multiplier 0.81, 95% CI 0.80 to 0.81), and were more likely to be discharged to a skilled nursing facility (OR 2.19, 95% CI 2.15 to 2.24) or hospice (OR 2.19, 95% CI 2.11 to 2.27). In conclusion, patients aged ≥85 have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years., Competing Interests: Competing interests: P-CY, AD, and MBR were supported by funds from the Agency for Healthcare Research and Quality (R01HS024277)., (© American Federation for Medical Research 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background Influenza virus infection most commonly causes acute respiratory tract illness, however may also lead to non-respiratory complications including acute cardiovascular (CV) events. We describe the frequency of and risk factors for acute CV events in adults hospitalized with influenza in the United States. Methods We included adults aged > 18 years hospitalized during influenza seasons 2010–2011 through 2017–2018 in FluSurv-NET, a multi-state population-based surveillance system that includes detailed medical chart review of patients hospitalized with laboratory-confirmed influenza. We defined acute CV events by International Classification of Diseases (ICD) primary and secondary discharge diagnosis codes for acute heart failure (aHF), acute ischemic heart disease (aIHD), hypertensive crisis, cardiogenic shock, acute myocarditis, acute pericarditis and cardiac tamponade. We calculated the frequency of acute CV events and used multivariable logistic regression among the 87% treated with influenza antivirals to identify independent factors associated with aHF and aIHD, the two most common diagnoses. Results Of 80,374 adults hospitalized with laboratory-confirmed influenza, 12% had > 1 acute CV event. We found that aHF (46%) and aIHD (42%) were the most common, followed by hypertensive crisis (8%), cardiogenic shock (3%), acute myocarditis (0.7%), acute pericarditis (0.4%) and cardiac tamponade (0.2%). Compared with treated patients without an acute cardiovascular event, treated patients with aHF (Figure A) and aIHD (Figure B) were more likely to be older, currently/formerly use tobacco and have underlying conditions including cardiovascular disease, diabetes mellitus, and kidney disease. Conclusion Among adults hospitalized with laboratory-confirmed influenza, acute CV events are common, particularly among those with prior cardiovascular disease. During the influenza season, clinicians should consider influenza virus infection in hospitalized adults who present with acute CV events. Non-respiratory complications, specifically aHF and aIHD, may be an under-recognized contributor to the burden of influenza. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) bronchiolitis is not only the leading cause of hospitalization in U.S. infants, but also a major risk factor for asthma development. While emerging evidence suggests clinical heterogeneity within RSV bronchiolitis, little is known about its biologically-distinct endotypes. Here, we integrated clinical, virus, airway microbiome (species-level), transcriptome, and metabolome data of 221 infants hospitalized with RSV bronchiolitis in a multicentre prospective cohort study. We identified four biologically- and clinically-meaningful endotypes: A) clinical classic microbiome M. nonliquefaciens inflammation IFN-intermediate , B) clinical atopic microbiome S. pneumoniae/M. catarrhalis inflammation IFN-high , C) clinical severe microbiome mixed inflammation IFN-low , and D) clinical non-atopic microbiome M.catarrhalis inflammation IL-6 . Particularly, compared with endotype A infants, endotype B infants-who are characterized by a high proportion of IgE sensitization and rhinovirus coinfection, S. pneumoniae/M. catarrhalis codominance, and high IFN-α and -γ response-had a significantly higher risk for developing asthma (9% vs. 38%; OR, 6.00: 95%CI, 2.08-21.9; P = 0.002). Our findings provide an evidence base for the early identification of high-risk children during a critical period of airway development.

Background: Considering the increasing incidence of carbapenem-resistant Enterobacteriaceae in China, this study aimed to establish the in vitro effectiveness of imipenem/relebactam (IMI/REL) on clinical Enterobacteriaceae isolates derived from intra-abdominal infections (IAIs), respiratory tract infections (RTIs), and urinary tract infections (UTIs) in China between 2015 and 2018., Methods: In total, 8781 Enterobacteriaceae isolates from IAI, RTI, and UTI samples were collected from 22 hospitals across 7 geographic regions of China. Susceptibility to antimicrobial drugs was tested using the Clinical and Laboratory Standards Institute broth microdilution and breakpoints, and IMI/REL activity was assessed using United States Food and Drug Administration guidelines., Results: In 2015-2018, the most frequently identified Enterobacteriaceae species was Escherichia coli (n = 4676 [53.3%]), followed by Klebsiella pneumoniae (n = 2949 [33.6%]) and Enterobacter cloacae (n = 542 [6.2%]). The Enterobacteriaceae isolates showed 95.2% overall susceptibility to IMI/REL, of which the susceptibility rates in isolates from IAI, RTI, and UTI were 95.8%, 91.4%, and 96.6%, respectively. Overall, the susceptibilities of both intensive care unit (ICU) and non-ICU Enterobacteriaceae isolates to colistin were 92.9%, followed by IMI/REL (90.7% [95.9%]) and amikacin (83.3% [92.3%]). In addition, IMI/REL restored 66.3% susceptibility in imipenem-nonsusceptible Enterobacteriaceae., Conclusions: Given their high in vitro susceptibility, Enterobacteriaceae infections in China should be considered for IMI/REL treatment, especially with isolates that are not susceptible to carbapenems., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objectives: To ascertain whether insurance type is associated with postoperative adverse effects and hospital length of stay for inpatient airway foreign body removal., Methods: Retrospective analysis of children <18 years of age that underwent inpatient bronchoscopy with removal of airway foreign body in the national Healthcare Cost and Utilization Project Kid's Inpatient Database (KID). Postoperative outcomes and length of stay were analyzed for racial disparities and insurance type using multivariable logistic regression and negative binomial regression. Models adjusted for race, insurance type, sex, age, and presence of pulmonary risk factors., Results: A total of 5,850 children underwent bronchoscopy for foreign body removal. The median age was 2 (IQR: 4-1) years and 61.6% patients were male. Payer status included Medicaid (38.9%), private insurance (51.5%), self-pay (4.3%) and other (9.6%). The Medicaid cohort had a higher proportion of black (19.1%) and Hispanic patients (34.5%) (P < 0.001). Children covered under Medicaid had higher odds of postoperative complications (odds ratio [OR] 1.216; P = 0.031) and a greater length of stay (OR 1.533; P < 0.001) relative to the private insurance group when adjusting for sex, age, race and presence of pulmonary risk factors. The odds of having a greater length of stay was 33% higher for black (P < 0.001) and 37% higher for Hispanic (P < 0.001) children compared to white children. The average adjusted LOS under Medicaid was 8.37 days compared to 5.46 days for privately insured children., Conclusion: This study demonstrated that a difference in postoperative complications and LOS exist between public and privately insured children for foreign body removal via bronchoscopy. Further studies are warranted to investigate factors that drive these disparities., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Respiratory tract infections are one of the most frequent infections worldwide, with an increasing number being associated with (multiple) antibiotic-resistant pathogens. Improved treatment requires the development of new therapeutic strategies, including the possible development of antibiotic-nanomedicines. Antibiotic-nanomedicines comprise antibiotic molecules coupled to nanocarriers via surface adsorption, surface attachment, entrapment or conjugation and can be administered via aerosolization. The efficacy and tolerability of this approach has been shown in clinical studies, with amikacin liposome inhalation suspension being the first inhalatory antibiotic-nanomedicine approved by the US FDA. In this special report, we summarize and discuss the potential value and the clinical status of antibiotic-nanomedicines for the treatment of (antibiotic-resistant) respiratory tract infections.

Introduction: In children, coughs lasting longer than 4 weeks are considered to be chronic, with etiological factors varying widely., Objective: This study included children with chronic cough who were followed for 1 year. All cases were evaluated with the guidance of the American College of Chest Physicians (ACCP), and etiological factors were analyzed., Methods: The study included 270 children between the ages of 2 months and 14 years. Their presenting symptoms, physical examination findings and laboratory data were recorded. All patients underwent laboratory tests including direct chest X-ray and spirometric measurements. Several patients required additional advanced examinations such as a sweat test, determination of immunoglobulin levels and bronchoscopy. Patients were reevaluated according to ACCP recommendations, and etiological factors were investigated., Results: The total of 270 patients were included in the study included 43.3% (n=153) females with a mean age of 6.5 ± 2.3 years (7 months to 17 years). After a 1-year follow-up of patients, we determined that the most common etiologic factors were asthma (27%), asthma-like syndrome (15.5%) and gastroesophageal reflux (10%). Other etiological factors included upper airway cough syndrome and protracted bronchitis, respectively., Conclusion: The use of a standardized clinical approach such as the ACCP increases the possibility for fast and accurate diagnosis during the treatment of children with chronic cough, and the use of these guidelines should be required., (© 2013 John Wiley & Sons Ltd.)

Study Objective: We describe magnetic foreign body injuries among children and obtain national estimates of magnetic foreign body injury incidence over time., Methods: We searched the National Electronic Injury Surveillance System for cases of magnetic foreign bodies in children younger than 21 years in the United States, from 2002 to 2011. Cases were analyzed by location: alimentary or respiratory tract, nasal cavity, ear canal, or genital area., Results: We identified 893 cases of magnetic foreign bodies, corresponding to 22,581 magnetic foreign body cases during a 10-year period (95% confidence interval [CI] 17,694 to 27,469). Most magnetic foreign bodies were ingested (74%) or intranasal (21%). Mean age was 5.2 years for ingested magnetic foreign bodies and 10.1 years for nasal magnetic foreign bodies (difference 4.9; 95% CI 4.1 to 5.6), suggesting different circumstances of injury. The incidence of pediatric magnet ingestions increased from 2002 to 2003 from 0.57 cases per 100,000 children per year (95% CI 0.22 to 0.92) to a peak in 2010 to 2011 of 3.06 cases per 100,000 children per year (95% CI 2.16 to 3.96). Most ingested magnetic foreign bodies (73%) and multiple magnet ingestions (91%) occurred in 2007 or later. Patients were admitted in 15.7% of multiple magnet ingestions versus 2.3% of single magnet ingestions (difference 13.4%; 95% CI 2.8% to 24.0%)., Conclusion: Magnet-related injuries are an increasing public health problem for young children, as well for older children who may use magnets for play or to imitate piercings. Education and improved magnet safety standards may decrease the risk small magnets pose to children., (Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)

Purpose: Nonalcoholic fatty liver disease (NAFLD) is considered the liver component of the metabolic syndrome and is strongly associated with cardiometabolic diseases. In adults, cardiorespiratory fitness (CRF) is inversely associated with alanine aminotransferase (ALT), a blood biomarker for NAFLD. However, information regarding these associations is scarce for youth. The objective of this study is to examine associations between CRF, waist circumference, and ALT in youth., Methods: Data were obtained from youth (n = 2844, 12-19 yr) in the National Health and Nutrition Examination Survey 2001-2004. CRF was dichotomized into youth FITNESSGRAM categories of "low" and "adequate" CRF. Logistic and quantile regression were used for a comprehensive analysis of associations, and variables with previously reported associations with ALT were a priori included in the models., Results: Results from logistic regression suggested that youth with low CRF had 1.5 times the odds of having an ALT >30 than youth with adequate CRF, although the association was not statistically significant (P = 0.09). However, quantile regression demonstrated that youth with low CRF had statistically significantly higher ALT (+1.04, +1.05, and +2.57 U·L) at the upper end of the ALT distribution (80th, 85th, and 90th percentiles, respectively) than youth with adequate CRF. For every 1-cm increase in waist circumference, the odds of having an ALT >30 increased by 1.06 (P < 0.001), and the strength of this association increased across the ALT distribution., Conclusions: Future studies should examine whether interventions to improve CRF can decrease hepatic fat and liver enzyme concentrations in youth with ALT ≥80th percentile or in youth diagnosed with NAFLD.

Background: This investigation was triggered by three cases of asthma-about 10% of the workforce-occurring in a salmon processing plant over a short period of time. The aim of the investigation was to characterize the work exposure of inhalable organic particles with personal measurements. Respiratory symptoms at work among workers were also assessed., Methods: Exposures to airborne salmon allergen, airborne mold spores, and endotoxin in water and air were measured during work. To assess the Atlantic salmon (Salmo salar) Sal s 1 allergen exposure a polyclonal sandwich enzyme-linked immunosorbent assay (ELISA) was developed. Current workers (n = 26) answered questionnaires and underwent allergy and lung function tests., Results: Using the sensitive ELISA method (0.05 ng/ml), we found that workers were exposed to high levels of salmon major allergen at the filleting machine and at the filleting table. Airborne endotoxin levels were low, and mold levels were elevated. Only the three initial asthma cases had IgE to salmon. Of the other workers, 65% reported respiratory symptoms at work. These had lower pulmonary function than workers without such symptoms., Conclusions: We developed a sensitive method to measure salmon antigen in air and found that filleting workers were most exposed. It is important to reduce aerosols by improving the ventilation system, machines and organization of work since respiratory symptoms at work among workers were common., (Copyright © 2012 Wiley Periodicals, Inc.)

We are extending the expiration dates of the following body systems in the Listing of Impairments (listings) in our regulations: Cardiovascular System, Endocrine System, Growth Impairment, Hematological Disorders, Musculoskeletal System, Mental Disorders, Neurological, and Respiratory System. We are making no other revisions to these body system listings. This extension will ensure that we continue to have in the listings the criteria we need to evaluate impairments in the affected body systems at the appropriate steps of the sequential evaluation processes for initial claims and continuing disability reviews.

Objectives: The objective of this study was twofold: 1) to confirm the hypothetical eight scales and two-component summaries of the questionnaire Short Form 36 Health Survey (SF-36), and 2) to evaluate the performance of two alternative measures to the original physical component summary (PCS) and mental component summary (MCS)., Methods: We performed principal component analysis (PCA) based on 35 items, after optimal scaling via multiple correspondence analysis (MCA), and subsequently on eight scales, after standard summative scoring. Item-based summary measures were planned. Data from the European Community Respiratory Health Survey II follow-up of 8854 subjects from 25 centers were analyzed to cross-validate the original and the novel PCS and MCS., Results: Overall, the scale- and item-based comparison indicated that the SF-36 scales and summaries meet the supposed dimensionality. However, vitality, social functioning, and general health items did not fit data optimally. The novel measures, derived a posteriori by unit-rule from an oblique (correlated) MCA/PCA solution, are simple item sums or weighted scale sums where the weights are the raw scale ranges. These item-based scores yielded consistent scale-summary results for outliers profiles, with an expected known-group differences validity., Conclusions: We were able to confirm the hypothesized dimensionality of eight scales and two summaries of the SF-36. The alternative scoring reaches at least the same required standards of the original scoring. In addition, it can reduce the item-scale inconsistencies without loss of predictive validity.

Background: The diagnosis of and criteria for the evaluation of asbestos-related disease impairment remains controversial after decades of research. Assessing agreement among experts who study pneumoconiosis, and diagnose and treat patients with asbestos-related respiratory conditions may be the first step in clarifying clinical and forensic/administrative issues associated with asbestos-related pulmonary conditions., Methods: We conducted a Delphi study, an iterative method of obtaining consensus among a group of experts. An expert panel was identified using an objective, nonbiased algorithm, based on the number of asbestos-related disease publications authored during the preceding 10-year period. Identified experts were invited to participate by accessing an Internet site. Each expert was presented statements developed by the authors regarding the diagnosis or treatment of asbestos-related disease; experts then ranked their degree of agreement or disagreement utilizing an 11-level modified Likert scale for each statement. Each expert was asked to justify their selection and to suggest references in support of their opinion. The Wilcoxon signed rank test and the interquartile range were used to define "consensus." The results of the collective Likert rankings, deidentified comments, and suggested references as well as the initial consensus results were then provided to the participating experts. Each panel member then ranked their extent of agreement with a modified statement for which consensus was not achieved. The process was repeated three times., Results: Consensus was achieved on all but 9 of 32 statements., Conclusions: Consensus was not achieved for nine statements. These statements may be topics for future research.

Purpose: Physical activity may protect against breast cancer. Few prospective studies have evaluated breast cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of physiologic response to physical activity habits., Methods: We examined the association between CRF and risk of death from breast cancer in the Aerobics Center Longitudinal Study. Women (N = 14,811), aged 20 to 83 yr with no prior breast cancer history, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1970 and 2001. Mortality surveillance was completed through December 31, 2003. CRF was quantified as maximal treadmill exercise test duration and was categorized for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%). At baseline, all participants were able to complete the exercise test to at least 85% of their age-predicted maximal heart rate., Results: A total of 68 breast cancer deaths occurred during follow-up (mean = 16 yr). Age-adjusted breast cancer mortality rates per 10,000 woman-years were 4.4, 3.2, and 1.8 for low, moderate, and high CRF groups, respectively (trend P = 0.008). After further controlling for body mass index, smoking, drinking, chronic conditions, abnormal exercise ECG responses, family history of breast cancer, oral contraceptive use, and estrogen use, hazard ratios (95% CI) for breast cancer mortality across incremental CRF categories were 1.00 (referent), 0.67 (0.35-1.26), and 0.45 (0.22-0.95) (trend P = 0.04)., Conclusions: These results indicate that CRF is associated with a reduced risk of dying from breast cancer in women.

Context: Multiple race data collection/reporting are relatively new among United States federal statistical systems. Not surprisingly, very little is known about the multiple race population in the USA. It is well known that some race and ethnic groups experience some respiratory diseases (e.g., asthma) disproportionately. However, not much is known about the experience of multiple race adults. If differences exist in how single/multiple race adults experience respiratory conditions, this information could be useful in public health education., Objective: To explore differences in respiratory conditions between single race white adults, single race American Indian/Alaska Native (AIAN) adults, and adults who are both white and AIAN (largest multiple race group of adults in the USA)., Methods: Data from the National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were analyzed. Hispanic and black populations are oversampled. Multiple logistic regressions were performed to predict if the occurrence of each respiratory condition analyzed differed by single/multiple race reporting., Sample: A nationally representative sample of 127,596 civilian non-institutionalized adults (> or = 18 years of age) from the 2000--2003 NHIS., Outcome Measure: Adults told by a doctor or other health professional that they had asthma, hay fever, sinusitis, and/or chronic obstructive pulmonary disease., Results: Adults who are both AIAN and white generally had higher rates of respiratory conditions than did their single race counterparts. These differences persisted even after controlling for socio-demographic and health care access measures., Conclusions: This paper presents some of the first research of how the health of some multiple race adults differs from their single race counterparts. Contrary to some previous expectations for these estimates, respiratory condition estimates for adults who are both AIAN and white do not appear to be located between those of the component single race groups.

Objective: The purpose of this study was to compare the prevalence, severity, and impact of respiratory symptoms in asthmatics and nonasthmatics during Operation Enduring Freedom and Operation Iraqi Freedom., Methods: A survey was given to 1,250 active duty soldiers and Department of Defense contractors returning from Operation Enduring Freedom/Operation Iraqi Freedom. Subjects were asked about demographics, smoking habits, respiratory symptoms, and impact on job performance before and during deployment. Patients with a history of asthma were asked method of diagnosis, current symptoms, and asthma therapy., Results: A total of 1,193 subjects returned the completed questionnaire (95% response rate). Mean age of respondents was 38 +/- 11 years, 83% (n = 977) were male, and 31% (n = 375) were past or present smokers. Sixty-one subjects (5%) reported a previous diagnosis of asthma. Both asthmatics and nonasthmatics had increased respiratory symptoms of wheezing, cough, sputum production, chest pain/tightness, and allergy symptoms during deployment compared to predeployment (p < 0.05 for all). When compared to nonasthmatics, asthmatic subjects reported more wheezing, sputum production, and chest pain/tightness during deployment (p < 0.0001, 0.05, 0.05 respectively), had more difficulty with military duties (p < 0.05), and were more likely to seek medical attention and receive duty restrictions (p < 0.0001). Twenty-six percent (n = 16) of asthmatics reported poor baseline symptom control, and this group had significantly increased symptoms, functional limitations, and health care utilization when compared to asthmatics who were symptom-controlled at baseline., Conclusions: Respiratory symptoms were common among both asthmatics and nonasthmatics during deployment. Differences in symptoms and health care utilization in this group of asthmatics were primarily due to subjects with poor baseline control.

Objective: To examine the cross-sectional association between hostility and pulmonary function (PF) and its consistency across race/ethnicity-gender groups., Design: Data were from the Coronary Artery Risk Development in (Young) Adults (CARDIA) cohort study (N=4,629). Participants were recruited from 4 metropolitan areas in the United States, ages 18-30 years at baseline in 1985-1986, approximately balanced across race/ethnicity (Black, White) and gender., Main Outcome Measures: Main outcome measures were percent predicted values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)., Results: In full-sample multiple linear regression analyses, each 1 standard deviation (SD) increase in hostility was associated with a 0.66% decrease in FEV-sub-1 (p=.0002) and a 0.60% decrease in FVC (p=.0006). This inverse association of hostility with PF remained after controlling for age, height, current socioeconomic status (SES), participant smoking status, and asthma and is more consistent than that of smoking and PF. In stratified analyses, each 1 SD increase in hostility predicted statistically significant reductions in PF for Black women, White women, and Black men. For White men, hostility showed no statistically significant relation with PF, although the pattern relating hostility to PF was similar to the pattern in the other three groups. Further, both of the post hoc three-way interaction terms for hostility, race/ethnicity, and gender predicting FEV-sub-1 and FVC were nonsignificant., Conclusion: PF was inversely associated with hostility across race/ethnicity and gender, independent of age, height, current SES, smoking, and asthma. On the basis of these cross-sectional findings, the authors hypothesize that higher hostility will predict a more rapid decline in PF., (Copyright (c) 2007 APA, all rights reserved.)

Risk assessment associated with the inhalation of radioactive aerosols requires as an initial step the determination of particle deposition within the various anatomic regions of the respiratory tract. The model outlined in ICRP Publication 66 represents to date one of the most complete overall descriptions of not only particle deposition, but of particle clearance and local radiation dosimetry of lung tissues. In this study, a systematic review of the deposition component within the ICRP 66 respiratory tract model was conducted in which probability density functions were assigned to all input parameters. These distributions were subsequently incorporated within a computer code LUDUC (LUng Dose Uncertainty Code) in which Latin hypercube sampling techniques are used to generate multiple (e.g., 1,000) sets of input vectors (i.e., trials) for all of the model parameters needed to assess particle deposition within the extrathoracic (anterior and posterior), bronchial, bronchiolar, and alveolar-interstitial regions of the ICRP 66 respiratory tract model. Particle deposition values for the various trial simulations were shown to be well described by lognormal probability distributions. Geometric mean deposition fractions from LUDUC were found to be within approximately +/- 10% of the single-value estimates from the LUDEP computer code for each anatomic region and for particle diameters ranging from 0.001 to 50 microm. In all regions of the respiratory tract, LUDUC simulations for an adult male at light exertion show that uncertainties in particle deposition fractions are distributed only over a range of about a factor of approximately 2-4 for particle sizes between 0.005 to 0.2 microm. Below 0.005 microm, uncertainties increase only for deposition within the alveolar region. At particle sizes exceeding 1 microm, uncertainties in the deposition fraction within the extrathoracic regions are relatively small, but approach a factor of 20 for deposition in the bronchial region. Deposition fractions for particles above 1 microm become very uncertain within the deeper regions of the lungs (bronchiolar and alveolar-interstitial).

On March 30, CDC was notified by the Pennsylvania Department of Health of an acute febrile respiratory illness characterized by fever, chills, dry cough, chest pain, and headache among college students who traveled to Acapulco during March 2001. Initial laboratory testing indicated that most students had histoplasmosis, an infection caused by the soil-inhabiting fungus, Histoplasma capsulatum. While in Acapulco, most ill students had stayed at the Calinda Beach Hotel. This report updates the investigation of the outbreak and presents possible evidence of ongoing transmissions.

We adjudicate claims at the third step of our sequential evaluation process for evaluating disability using the Listing of Impairments (the Listings) under the Social Security and Supplemental Security Income (SSI) programs. This final rule extends until July 2, 2002, the date on which the respiratory body system listings will no longer be effective. We have made no revisions to the medical criteria in these listings; they remain the same as they now appear in the Code of Federal Regulations. This extension will ensure that we continue to have medical evaluation criteria in the listings to adjudicate claims for disability based on impairments in the respiratory body system at step three of our sequential evaluation process.

Objective: To study factors associated with sudden infant deaths occurring with the external airways (ie, nose and mouth) covered by bedding., Design: Case-comparison study of infants dying with vs those dying without the external airways covered., Setting: Death-scene investigation and reconstruction at the site of death using an infant mannequin; 18 metropolitan areas., Participants: Caregivers for a consecutive sample of infants who died of sudden infant death syndrome (SIDS). Complete data from 206 of 382 eligible cases., Main Outcome Measures: Among infants dying suddenly and unexpectedly, an analysis of whether sociodemographic risk factors for SIDS, sleep practices, or bedding increased the risk of dying with the external airways covered., Results: Data were analyzed by using univariate and 2 types of multivariate risk analysis, logistic regression and latent class. Of the victims, 59 (29%) were found with the external airways covered. Conventional risk factors for SIDS did not affect the risk of death with the external airways covered. Factors increasing the risk of death with the external airways covered included prone sleep position (odds ratio [OR], 2.86) and using soft bedding (OR, 5.28), such as comforters (OR, 2.46) and pillows (OR, 3.31). Infants at low risk for death with the external airways covered slept in the prone position, but rarely on a pillow, comforter, or other bedding that allowed a pocket to form beneath the face. All 9 infants who were positioned supine or on one side for sleep and found with the external airways covered had turned and were found dead in the prone position., Conclusions: Sudden infant deaths with the external airways covered were common in the United States when most infants slept prone. Soft bedding, including pillows and comforters, increased the risk that an infant who died would be found with the external airways covered. Therefore, these items should not be placed near infants, regardless of the sleep position.