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Background: Pulmonary rehabilitation (PR) is widely recommended for short-term benefits in chronic respiratory diseases, yet long-term outcomes remain uncertain. This retrospective cohort study addresses this gap, comparing 20-year mortality rates between PR participants and matched controls, and hypothesizing that the short-term benefits of PR contribute to improved long-term survival. Methods: The 20-year mortality of stable chronic respiratory patients who participated in an outpatient PR program was compared with a matched control group based on the type of lung disease. Demographic and clinical variables, and the dates of deaths, were extracted and compared between two groups with two sample t-test and chi-square tests. Kaplan-Meier plots and Cox regression analyses were employed to evaluate survival differences. Results: Between 2000 and 2002, 238 individuals enrolled in a pulmonary rehabilitation (PR) program (58% male, mean age ± SD: 69 ± 8 years, mean FEV1% predicted ± SD: 46 ± 21%). An equal number of people with comparable lung disease were selected as controls (88% COPD, 5% ILD). Controls had lower FEV1% predicted values (mean ± SD: 39 ± 17%, P < 0.001), smoked more (mean ± SD: 48 ± 35 pack-years, P = 0.032), and no differences in age, BMI, sex, and Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Median (IQR) follow-up time was 68 months (34–123), with 371 (78%) deaths. Univariable (HR = 1.71, p < 0.001) and multivariable (HR = 1.64, p < 0.001) Cox regression found higher mortality risk in controls. Subgroup analysis for COPD replicated these findings (HR = 1.70, P < 0.001). Discussion: Despite some methodological limitations, our study suggests that clinically stable patients with chronic respiratory disease who undertake PR may have lower mortality than matched controls. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Introduction: Azithromycin is an effective treatment for various respiratory conditions but its effect on cough is poorly understood. We synthesised data from randomised controlled trials (RCTs) and noncomparative studies (NCT) examining its effect on objective and subjective cough. Methods: After prospective registration on PROSPERO, we searched MEDLINE, EMBASE, and CENTRAL for both RCTs and NCT trials examining the effect azithromycin on cough in respiratory disease. Results: We identified 1240 studies of which 6 (4 RCTs and 2 NCT studies) were included in the meta-analysis, with a total of 275 patients. Azithromycin was associated with significant improvement in Leicester Cough Questionnaire scores at follow-up when compared to baseline scores (SMD = 0.62 [95% CI 0.12 to 1.12], p = 0.01). However, when only RCTs were synthesised, no significant effect was observed (SMD = 0.12 [95% CI − 0.36 to 0.60], p = 0.62). There was no significant reduction in cough severity VAS score (SMD = − 0.39 [95% CI − 0.92 to 0.14], p = 0.15). There was no significant reduction in objective cough count (SMD = − 0.41 [95% CI − 1.04 to 0.32], p = 0.09). Conclusion: Azithromycin therapy improves cough-related quality of life in various chronic respiratory diseases; however, there was no significant effect on cough outcomes when only data from RCTs were synthesised. We believe that to accurately identify which patients whose cough would benefit from azithromycin a large-scale clinical trial of patients with a broad spectrum of respiratory diseases, with sufficiently severe cough, should be undertaken with subgroup analysis of individual disease areas. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary rehabilitation (PR) is widely recommended for short-term benefits in chronic respiratory diseases, yet long-term outcomes remain uncertain. This retrospective cohort study addresses this gap, comparing 20-year mortality rates between PR participants and matched controls, and hypothesizing that the short-term benefits of PR contribute to improved long-term survival. Methods The 20-year mortality of stable chronic respiratory patients who participated in an outpatient PR program was compared with a matched control group based on the type of lung disease. Demographic and clinical variables, and the dates of deaths, were extracted and compared between two groups with two sample t-test and chi-square tests. Kaplan-Meier plots and Cox regression analyses were employed to evaluate survival differences. Results Between 2000 and 2002, 238 individuals enrolled in a pulmonary rehabilitation (PR) program (58% male, mean age ± SD: 69 ± 8 years, mean FEV1% predicted ± SD: 46 ± 21%). An equal number of people with comparable lung disease were selected as controls (88% COPD, 5% ILD). Controls had lower FEV1% predicted values (mean ± SD: 39 ± 17%, P

Purpose: Diet rich in antioxidant may protect against chronic respiratory disease (CRD), but few studies have evaluated the association between composite dietary antioxidant index (CDAI) and CRD. The study aimed to examine the association of CDAI with the risk of CRD and all-cause mortality in CRD patients from the US. Methods: Data were obtained from the National Health and Nutrition Examination Survey, 2003–2018. Logistic and Cox regression analyses were used to estimate association of CDAI with CRD and all-cause mortality. Dose-response relationship was examined by restricted cubic spline analyses. Results: Total 44,094 participants were eligible for CRD (aged 1–85 years; mean age: 45.71 years old), and 7,685 CRD patients for all-cause mortality (median follow-up: 7.58 years; 1,136 deaths before 12/31/2019). The risk for CRD, asthma, and chronic obstructive pulmonary disease was significantly decreased by 13–32% with the increase intake of CDAI, even after adjusting for confounders (all P < 0.001). The relationship between CDAI and three respiratory endpoints was U-shaped (all P for nonlinearity < 0.001). There was an obvious declining trend in the magnitude of mortality risk with the increase of intake of CDAI, especially in patients with asthma. Fully adjusted hazard ratio was 0.72 (95% confidence interval: 0.54–0.95), 0.55 (0.42–0.72), and 0.48 (0.34–0.66) for the second, third, and fourth quartile of CDAI in patients with asthma relative to the first quartile, respectively. The association with CRD risk was significantly modified by smoking status (P-interaction: 0.006). Conclusion: Our findings indicate that high CDAI is a significant protective factor against CRD and all-cause mortality in the US population. [ABSTRACT FROM AUTHOR]

Fei Gao,1,&ast; Siqi He,1,&ast; Jing Li,1 Xiaoyue Wang,2 Xiaoting Chen,2 Xiaoning Bu1 1Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaoning Bu, Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring Road West, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +8613641000837, Email 13641000837@163.comPurpose: Systemic Immune-Inflammation Index (SII), calculated by (neutrophils count × platelet count)/lymphocytes count, is a novel index of the local immune response and systemic inflammation response. The SII has been shown to play an important role in the prognosis of many diseases, including cardiovascular diseases, cancer and COPD. However, its role in the prognosis of bronchiectasis remains unclear and requires further investigation. This study aimed to investigate the association between SII and readmissions in patients with acute exacerbations of bronchiectasis.Patients and Methods: We conducted a retrospective cohort study of all bronchiectasis patients admitted to the respiratory ward in Beijing Chaoyang Hospital from January 2020 to January 2022. Patients were classified into four groups according to the quartiles of log2(SII) at admission. The primary endpoint was readmission at 1-year follow up. Univariate and multivariate cox regression models were applied to investigate the relationship between SII and readmissions at 1-year follow up in patients with bronchiectasis.Results: A total of 521 patients were included in our study. The median (IQR) SII at admission were 506.10 (564.84). Patients with higher SII tended to be older, male, past and current smokers, have lower BMI, and more dyspnea symptoms. They also had higher inflammatory markers and received a greater spectrum of antibiotics and more intravenous glucocorticoids. Higher SII at admission were independently associated with readmission in patients with acute exacerbations for bronchiectasis following confounder adjustment (OR =1.007; 95% CI, 1.003– 1.011; p < 0.001).Conclusion: Patients with elevated SII levels were typically older males, often smokers, with lower BMI and increased dyspnea. They received more antibiotics and intravenous glucocorticoids. Higher SII at admission are associated with readmission in patients with acute exacerbations of bronchiectasis. SII has potential clinical value as a predictive biomarker for clinical outcomes in bronchiectasis, offering a valuable tool for management strategies.Keywords: chronic respiratory disease, inflammation, prognosis

Background: This study aimed to evaluate the impact of a structured, tailor-made 12-week deep squat intervention on lower extremity muscle strength, cardiorespiratory functional capacity, and health-related quality of life in patients with chronic respiratory dysfunction. Materials and Methods: Thirty patients aged 18–65 years were randomly assigned to a deep squat intervention group (n = 15) or a walking program group (n = 15). Assessments conducted before and after the 12-week intervention included lower extremity muscle strength, pulmonary function, cardiorespiratory endurance, and health-related quality of life (HRQoL). These were measured using trunk-leg dynamometry, the chair-stand test, the deep squat test, lung volume measurements, maximum inspiratory and expiratory pressures, the 6-min walk test, and the 12-item Short Form Survey questionnaire. Results: The results revealed that the deep squat intervention group showed greater muscle strength and cardiorespiratory endurance improvements than the walking group. Significant improvements were observed in lower extremity muscle strength (42.9%), chair-stand repetitions (26%), deep squat repetitions (30.2%), maximum inspiratory pressure (67%), maximum expiratory pressure (29%), peak expiratory flow rate (32%), 6-min walk test distance (16%), forced expiratory volume in 1 s (53%), forced vital capacity (36%), and HRQoL (physical component 42% and mental component 25%) with a large effect size ranging from 1.6 to 10.7 (P < 0.001). Conclusion: This study concludes that the deep squat intervention proved to be a safe and effective exercise program for mitigating physical deconditioning in individuals with mild to moderate chronic respiratory dysfunction compared with a walking program. These findings support the inclusion of deep squat training in routine pulmonary rehabilitation programs.

The management of patients with life-threatening respiratory disease in the ICU and at home has become increasingly of interest over the past decades. Growing knowledge supports the use of NRS, aimed at improving patient comfort and improving quality of life. However, its role during palliative care is not well defined, and evidence of support remains limited. The aim of this narrative review is to examine the recent evidence relating to the use of non-invasive respiratory support at the end of life, in order to clarify who benefits and when. The literature research was conducted on PubMed, using MeSH words. A review of the relevant literature showed that non-invasive respiratory support techniques for patients with life-limiting respiratory disease vary (from high-flow oxygen therapy to conventional oxygen therapy, from CPAP to NPPV) and each has precise indications. To date, from the hospital to the home setting, the monitoring and application of these respiratory support techniques have varied widely. In conclusion, the choice of respiratory support in this category of patients should be based on the technique that will optimize the comfort of the patient and improve the quality of their life. On the other hand, regarding monitoring, both telemedicine and ultrasound diagnostics help to satisfy the patient's wish to spend the last period of his life in the home environment, to avoid inappropriately aggressive diagnostic interventions, and to reduce the high costs of hospitalized procedures in this category of patients. [ABSTRACT FROM AUTHOR]

Objective To explore the main risk factors for cancer, cardiovascular and cerebrovascular diseases, diabetes and chronic respiratory disease (referred to as the four major chronic diseases), and to evaluate the disease burden associated with the exposure to risk factors. Methods The data of this study were collected from the 2019 Global Burden of Disease Study (GBD) database. By analyzing the number of deaths and disability-adjusted life years (DALYs) of four major chronic diseases among Chinese residents in 2019, the proportion of these four major chronic diseases attributable to the exposure to related risk factors was determined. Results The primary risk factor for disease burden was the tobacco exposure, which accounted for 31.4% of DALYs. High systolic blood pressure was the main risk factor for cardiovascular and cerebrovascular diseases, which accounted for 55.6% of DALYs. The common risk factors of four major chronic diseases were tobacco exposure, air pollution and high body mass index (BMI); among them, tobacco exposure had the highest proportion of attributable risk in the disease burden of cancer and chronic respiratory disease. Diet related risk factors, alcohol consumption, and physical inactivity were associated with cancer, cardiovascular and cerebrovascular diseases, and diabetes. The results of the attribution analysis of major cancers showed that lung cancer had the highest proportion of attributable risk due to tobacco exposure, followed by esophageal cancer, gastric cancer, liver cancer, and colorectal cancer. Conclusions Tobacco exposure, air pollution and high BMI are common risk factors for the four major chronic diseases in Chinese residents. This result provides important evidence for high⁃risk population screening. [ABSTRACT FROM AUTHOR]

Asthma is a common chronic respiratory diseases, and the relationship between pulmonary ventilation function and the prognosis of patients with suspected asthma is not well understood. This study aims to explore the impact of pulmonary ventilation functions on the prognosis of patients with suspected asthma. This retrospective observational study included patients with suspected asthma who were diagnosed and treated at the Guangdong Provincial Hospital of Traditional Chinese Medicine between August 2015 and January 2020. The primary outcome of interest was improvement in asthma symptoms, as measured by bronchial provocation test (BPT) results within one year after diagnosis. The impact of pulmonary ventilation functions on prognosis was explored by multivariable logistic regression analysis. Seventy-two patients were included in the study. Patients with normal (OR = 0.123, p =.004) or generally normal (OR = 0.075, p =.039) pulmonary ventilation function were more likely to achieve improvement in asthma symptoms compared with patients with mild obstruction. There were no significant differences between the improvement and non-improvement groups in baseline characteristics. These results suggest that suspected asthma patients with normal or generally normal pulmonary ventilation function are more likely to achieve improvement in asthma symptoms within one year compared to patients with mild obstruction. [ABSTRACT FROM AUTHOR]

N-acetyl-L-cysteine (NAC) was initially introduced as a treatment for mucus reduction and widely used for chronic respiratory conditions associated with mucus overproduction. However, the mechanism of action for NAC extends beyond its mucolytic activity and is complex and multifaceted. Contrary to other mucoactive drugs, NAC has been found to exhibit antioxidant, anti-infective, and anti-inflammatory activity in pre-clinical and clinical reports. These properties have sparked interest in its potential for treating chronic lung diseases, including chronic obstructive pulmonary disease (COPD), bronchiectasis (BE), cystic fibrosis (CF), and idiopathic pulmonary fibrosis (IPF), which are associated with oxidative stress, increased levels of glutathione and inflammation. NAC's anti-inflammatory activity is noteworthy, and it is not solely secondary to its antioxidant capabilities. In ex vivo models of COPD exacerbation, the anti-inflammatory effects have been observed even at very low doses, especially with prolonged treatment. The mechanism involves the inhibition of the activation of NF-kB and neurokinin A production, resulting in a reduction in interleukin-6 production, a cytokine abundantly present in the sputum and breath condensate of patients with COPD and correlates with the number of exacerbations. The unique combination of mucolytic, antioxidant, anti-infective, and anti-inflammatory properties positions NAC as a safe, cost-effective, and efficacious therapy for a plethora of respiratory conditions. [ABSTRACT FROM AUTHOR]

The production of vaccines in plant cells, termed plant-made pharmaceuticals or molecular farming, is a promising technology for scalable production. Compared to mammalian cell lines, like Chinese Hamster Ovary (CHO) or bacterial cells, plants can be grown with less cost on a large scale to make vaccines antigens and therapeutics affordable and accessible worldwide. An innovative application of this alternative system is the production of vaccines in edible tissues that can be consumed orally to deliver protein antigen without any further processing. In this project, we report stable expression of amino acid sequences corresponding to the TM-1 gene of Mycoplasma gallisepticum as a candidate vaccine antigen against Chronic Respiratory Disease (CRD) in chickens using wheat seed's tissues as a production host. Molecular and immunoblotting analysis confirmed the ubiquitous expression of a recombinant 41.8-kDa protein with an expression level of 1.03 mg/g dry weight in the endosperm tissues. When orally delivered, the plant-made vaccine was effective in terms of developing antibody response in animal model i.e., chicken without any detectable weight loss. Two doses of orally delivered plant-made TM-1 vaccine candidate elicited the immune response and protective effect against MG virus challenge at the level comparable to commercially available inactivated vaccine against CRD. Our study demonstrates that plant-made vaccines are not only safe but also scalable and cost-effective with prolonged stability at room temperature.

Introduction Pulmonary function and functional capacity decline in chronic respiratory diseases, especially in chronic obstructive pulmonary disease. Physiotherapy is an integral part of treating respiratory patients since it helps combat muscle depletion and respiratory symptoms. Nevertheless, the knowledge about applying electromagnetic field (EMF) therapy as a therapeutic option in chronic respiratory patients is minimal. So, the aim of this review is to determine the effect of Electromagnetic Field Therapy on Pulmonary Function and 6-minute walk distance in chronic respiratory disease patients. Methods The PubMed, PeDRO, Scopus, COCHRANE, and Web of Science databases were searched and randomised control trials investigating EMF on pulmonary function and 6MWT distance in a chronic respiratory disease population, published before January 2022, were selected. Three reviewers assessed each study’s quality after data were extracted into a trial description form. Results Three studies met the inclusion criteria on pulmonary function and 6MWT distance. The sample size ranges from 10 to 37 for EMF. The improvement in pulmonary function was not significant in FEV1, FEV1/FVC and significant in PEF versus control. The change in 6MWT distance was 21.68 m, which is a clinically significant change. Conclusions EMF therapy has been shown to improve pulmonary function and 6MWT distance. The study was the first to examine and synthesise existing EMF data.

XiaoLang Miao,1 Yanxia Han,1 Zhenyun Wu,1 Xiaoliang Jin,1 Mei’e Niu,1 Qian Zhao,1 Xiangmin Lu2 1Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 2School of Nursing, Soochow University, Suzhou, People’s Republic of ChinaCorrespondence: Mei’e Niu, Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, 899th, Pinghai Road, Suzhou, 215006, People’s Republic of China, Tel +86 13812671786, Email meniu_123@163.comPurpose: To translate a disease-specific anxiety questionnaire on chronic obstructive pulmonary disease (COPD) and test its reliability and validity in China.Patients and Methods: The German version of the revised COPD Anxiety Questionnaire (CAF-R) was initially validated using step-by-step translation, back-translation, and cross-cultural adaptation. The reliability and validity of the Chinese version of the CAF-R (CAF-R-CN) were tested among 448 patients with COPD (mean age =71.42± 9.33 years, 17.2% female) from four medical institutions in Suzhou, Jiangsu Province, using convenience sampling, from April 2022 to June 2023.Results: The CAF-R-CN included six dimensions with a total of 25 items. The item-level content validity index was 0.860– 1.000; the scale-level content validity index was 0.920. The structural validity χ2/df was 2.326, the root mean square error of approximation was 0.077, the comparative fit index was 0.924, and the Tucker–Lewis index was 0.912. The six-dimensional internal consistency index Cronbach’s α coefficient was 0.696– 0.910, and the test–retest reliability was 0.949. An optimal cut-off score of 50.5 was selected with a sensitivity of 0.786 and specificity of 0.870.Conclusion: The CAF-R-CN had satisfactory reliability and validity and can be used to identify and assess anxiety in COPD patients with a Chinese cultural background.Keywords: fear, scale, specificity, chronic respiratory disease, Chinese translation, assessment

Background: Although frailty is one of the aging syndromes, it can occur at a younger age and in individuals with organ diseases. Identifying frailty and pre-frailty in patients with chronic respiratory diseases (CRDs) is an emerging assessment in the field of pulmonary medicine and rehabilitation. The aim of this study was to find out the prevalence of frailty among chronic respiratory disease patients. Methods: A single centre cross-sectional survey study with a total population of 381 patients, adults aged 18–90 years presenting to the pulmonology OPD was included based on the inclusion and exclusion criteria. Primary data collected were demographics, medical history, including comorbidities, use of long-term oxygen therapy (LTOT), BiPAP (Bilevel Positive Airway Pressure), previous hospital admissions, medication history and frailty assessment were done using the Fried frailty index. Results: Univariate analysis showed that sex, ECHO abnormality, patients using LTOT, BiPAP, home nebulizers and patients who did not attend the pulmonary rehabilitation programme had a significant association with frailty. Multivariate analysis showed that female sex, LTOT use and older age were significantly associated with frailty. Conclusion: Frailty is frequent in CRD patients regardless of age. The prevalence of frailty has an association with female sex, patients using LTOT, and home BiPAP.

Background The disease burden of non-communicable diseases (NCDs) among residents in China is relatively severe, which had become an important influencing factor in limiting the increase of healthy life expectancy of the population. Objective To identify the premature mortality of four major NCDs (cancer, cardiovascular and cerebrovascular diseases, diabetes and chronic respiratory diseases) and the achievement of "Health China 2030" goal in Baise from 2015 to 2021, so as to provide reference for the development of prevention and control strategies for NCDs in western poverty-stricken regions. Methods The mortality data registered in the cause of death surveillance system of the Baise Center for Disease Prevention and Control from 2015-2021 was collected, indicators such as mortality and the probability of premature mortality were calculated, Joinpoint 24.0 software was used to describe the trend of change in terms of average annual percentage change (AAPC) and rate. Results The crude mortality of the four major NCDs was 549.06/100 000 (AAPC=0.13%) and the age-standardized mortality was 302.92/100 000 (AAPC=-5.66%) from 2015-2021, with no significant change in any of them (P>0.05). The age-standardized mortality in women showed a significant decrease (AAPC=-1.66%, P=0.046). There was an increasing trend in the crude mortality for cardiovascular disease in the total population, males, and females (AAPC=2.74%, P=0.004; AAPC=2.43%, P=0.013; AAPC=3.17%, P=0.011), and a decreasing trend in the standardized mortality rate for chronic respiratory diseases in men and women (AAPC=-8.66%, P=0.023; AAPC=-8.17%, P=0.027). The probability of premature mortality of the four major NCDs was 15.77%, 26.03% and 10.42% for the total population, men and women, with a decreasing trend from chronic respiratory diseases (AAPC=-6.89%, P=0.012; AAPC=-7.18%, P=0.007; AAPC=-6.94%, P=0.020). The probability of premature mortality from four NCDs in men was about 2.5 times higher than that in women. According to the average growth rate of the probability of premature mortality of the 4 NCDs in Baise City from 2015-2021, the probability of premature mortality of the four major NCDs was projected to be 14.62% in 2030, while the goal of the probability of premature mortality was 13.69%, only the goal of the women, cancer and chronic respiratory diseases is higher than the projected. To achieve the 2030 target, the average rate of decline in the probability of premature death for the four chronic diseases from 2021 to 2030 will need to be increased to 2.63%, with the average rate of decline for men increasing to 2.70%. The probability of early death of diabetes should be paid attention to, its predicted value is lower than the target value and the gap is large, and the decline rate should be increased to 6.76%. Conclusion Crude mortality of cardiovascular and cerebrovascular diseases showed an increasing trend, whereas the mortality and the probability of premature mortality from chronic respiratory diseases showed an obvious decrease. Based on the current average growth rate, it is predicted that Baise City is still far from realizing the target value of "Healthy China 2030", men should be the primary focus group, and the main intervention diseases should be diabetes, cardiovascular and cerebrovascular diseases, so that the average growth rate from 2021 to 2030 can reach -2.63%, to achieve the goal of "Healthy China 2030".

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases. [ABSTRACT FROM AUTHOR]

Background: Although frailty is one of the aging syndromes, it can occur at a younger age and in individuals with organ diseases. Identifying frailty and pre-frailty in patients with chronic respiratory diseases (CRDs) is an emerging assessment in the field of pulmonary medicine and rehabilitation. The aim of this study was to find out the prevalence of frailty among chronic respiratory disease patients. Methods: A single centre cross-sectional survey study with a total population of 381 patients, adults aged 18-90 years presenting to the pulmonology OPD was included based on the inclusion and exclusion criteria. Primary data collected were demographics, medical history, including comorbidities, use of long-term oxygen therapy (LTOT), BiPAP (Bilevel Positive Airway Pressure), previous hospital admissions, medication history and frailty assessment were done using the Fried frailty index. Results: Univariate analysis showed that sex, ECHO abnormality, patients using LTOT, BiPAP, home nebulizers and patients who did not attend the pulmonary rehabilitation programme had a significant association with frailty. Multivariate analysis showed that female sex, LTOT use and older age were significantly associated with frailty. Conclusion: Frailty is frequent in CRD patients regardless of age. The prevalence of frailty has an association with female sex, patients using LTOT, and home BiPAP. [ABSTRACT FROM AUTHOR]

Background and objective: Chronic respiratory diseases in children deteriorate their daily life due to dyspnea and reduced lung function. We aimed to evaluate the feasibility of home-based pulmonary rehabilitation in pediatric chronic respiratory diseases. Methods: This prospective, single-arm, cohort study included children with chronic lung disease. They were instructed to perform home-based pulmonary rehabilitation 30 min/session, three sessions/week for three months. Pulmonary function test (PFT) using spirometry, respiratory muscle strength (RMT), cardiopulmonary exercise test (CPET), 6 min walk test (6MWT), dyspnea questionnaires, speech evaluation, and pediatric quality of life inventory (PedsQL) were assessed pre- and post-pulmonary rehabilitation. Compliance and satisfaction of the program were also evaluated. Results: Twenty children (mean age: 11.2 ± 3.1 years) with chronic respiratory diseases without cardiopulmonary instability participated. The overall compliance was 71.1% with no related adverse events. After pulmonary rehabilitation, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), RMT, 6MWT, dyspnea questionnaire, speech rate, and PedsQL (child) significantly improved (p < 0.05), particularly better in the FEV1 < 60% group than in the FEV1 ≥ 60% group and in the high-compliance group (compliance ≥ 50%) than in the low-compliance group (compliance < 50%). Conclusions: Home-based pulmonary rehabilitation for children with chronic lung disease was feasible with high compliance and effective in terms of objective functions, subjective dyspnea symptom, and quality of life. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the efficacy and safety of digital therapeutics (DTx), EASYBREATH, for pulmonary rehabilitation (PR) in patients with chronic respiratory diseases (CRDs). Materials and Methods: This prospective randomized controlled trial was conducted at multiple centers. Participants were randomly allocated 1:1 to the DTx group (DTxG), provided with DTx using EASYBREATH. The DTxG underwent an 8-week PR program with evaluations conducted at baseline, four weeks, and eight weeks. The control group (CG) underwent one PR session and was advised to exercise and undergo the same evaluation. The primary outcome was the change in six-minute walking distance (6MWD) over eight weeks, and secondary outcomes included changes in scores of Modified Medical Research Council (mMRC), chronic obstructive pulmonary disease assessment test (CAT), and St. George's respiratory questionnaire (SGRQ). Results: The change in 6MWD after eight weeks demonstrated a significant difference between the DTxG and CG (57.68 m vs. 21.71 m, p = 0.0008). The change in mMRC scores (p = 0.0008), CAT scores (p < 0.0001), and total SGRQ scores (p = 0.0003) also showed a significant difference between the groups after eight weeks. Conclusions: EASYBREATH significantly improved exercise capacity, alleviated dyspnea, and enhanced the overall quality of life at eight weeks. EASYBREATH is a highly accessible, time-efficient, and effective treatment option for CRD with high compliance. [ABSTRACT FROM AUTHOR]

Introduction. Pulmonary function and functional capacity decline in chronic respiratory diseases, especially in chronic obstructive pulmonary disease. Physiotherapy is an integral part of treating respiratory patients since it helps combat muscle depletion and respiratory symptoms. Nevertheless, the knowledge about applying electromagnetic field (EMF) therapy as a therapeutic option in chronic respiratory patients is minimal. So, the aim of this review is to determine the effect of Electromagnetic Field Therapy on Pulmonary Function and 6-minute walk distance in chronic respiratory disease patients. Methods. The PubMed, PedRo, Scopus, CoCHRANE, and Web of Science databases were searched and randomised control trials investigating EMF on pulmonary function and 6MWT distance in a chronic respiratory disease population, published before January 2022, were selected. Three reviewers assessed each study's quality after data were extracted into a trial description form. Results. Three studies met the inclusion criteria on pulmonary function and 6MWT distance. The sample size ranges from 10 to 37 for EMF. The improvement in pulmonary function was not significant in FEV1, FEV1/FVC and significant in PEF versus control. The change in 6MWT distance was 21.68 m, which is a clinically significant change. Conclusions. EMF therapy has been shown to improve pulmonary function and 6MWT distance. The study was the first to examine and synthesise existing EMF data. [ABSTRACT FROM AUTHOR]

Chronic respiratory diseases (CRDs) pose a serious public health issue, affecting social functioning and psychological well-being and leading to a deterioration in the quality of life. The aim of this study was to assess the quality of life of patients with CRDs and determine the factors associated with their impairment in Morocco. A cross-sectional study was conducted in the Pulmonology Department of the Hassan II University Hospital in Fez in 2021. Data collection was carried out using an anonymous questionnaire containing sociodemographic, clinical, and therapeutic information. We employed the Moroccan version of the 12-item short-form (SF-12) scale to assess the mental and physical quality of life of patients. Bivariate analysis was performed to investigate the association between various factors and quality of life, using tests appropriate to the types of variables studied. Subsequently, multivariate analysis through multiple linear regression was employed to determine factors associated with quality of life, taking into account confounding factors. The threshold for inclusion in the model was set at 20%. Significant associations are presented as β values along with their 95% confidence intervals (CI). Our study included 209 patients, with 50.7% being female and 74.2% aged over 50 years. The most frequent clinical symptom was coughing. The average physical quality of life was estimated at 34.45±13.78, and the mental quality of life was 33.72±19.79. Multivariate analysis revealed that the deterioration of physical quality of life was associated with marital status (single) [β=-6.84; 95% CI (-11.43; -2.25); p=0.004], stage II dyspnea on the Modified Medical Research Council scale [β=-4.94; 95% CI (-9.41; -0.52); p=0.029], and the presence of cyanosis [β=-9.65; 95% CI (-15.64; -3.67); p=0.002]. The factors negatively associated with mental health in our patients were age ≥50 [β=-7.84; 95% CI (-15.05; -0.62); p=0.033], marital status (single) [β=-7.81; 95% CI (-15.14; -0.48); p=0.037], and presence of cyanosis [β=-10.70; 95% CI (-20.08; -1.32); p=0.026]. The SF-12 calculation reflected an impairment in the quality of life of patients with CRDs. It is imperative to integrate the assessment of quality of life into the management strategy for this pathology.

Background: Chronic respiratory diseases (CRDs) are among the top three causes of human mortality. The relationship between modifiable environmental risk factor of noise and risk of mortality in CRDs is unclear. We investigated the longitudinal association between environmental noise exposure and cause-specific mortality in individuals with CRDs, considering the modifying effect of air pollution. Methods: Residential noise exposure was modelled using Common Noise Assessment Methods in Europe. Information on death causes were acquired from death registry data. Cox proportional-hazards models were used to estimate effect sizes. Results: Among 41,222 participants selected from UK Biobank with CRDs in baseline, a total of 3618 death cases occurred during an average follow-up of 12 years with mortality density of 7.16 per 1000 person years. Exposure with highest noise level (> percentile 90) were associated with 22 % (Hazard ratio [HR] = 1.22, 95 % confidence interval [CI]: 1.05, 1.42), 71 % (HR = 1.71, 95 % CI: 1.14, 2.56), and 84 % (HR = 1.84, 95 % CI: 1.10, 3.07) increased risks for all-cause, respiratory disease (RD)-cause, and COPD-cause mortalities, separately. Both multiplicative and additive interactions was found between air pollution and noise with the risk of RD-cause mortality. Participants with high air pollution and noise exposure were associated with a 101 % (HR = 2.01, 95 % CI: 1.10, 3.66) increased risk of RD-cause mortality. Conclusion: It is imperative to mitigate noise exposure as a preventive measure against incident mortality in individuals with CRDs.

Few studies have investigated the acceptability of wearable technology in patients with long-term respiratory disease. We conducted a 24-item cross-sectional survey (September 2022–February 2023), developed using four common themes universal to previously described models of technology acceptance and social behavioural therapy, to explore the acceptability of wearable technology spanning the breadth of chronic respiratory disease. A total of 74 valid survey responses were analysed with 50 % aged 51–70years; 72 % female; 63 % white British ethnicity; 79 % having an income less than £50,000, and 93 % having at least obstructive airways disease. A third of participants current used wearables with 85 % using smart watches. Most of these participants used wearables to monitor their symptoms (69 %) and as a general health measurement device (85 %). Likert scale questions (ranked 1–7) showed that participants valued accuracy and approval of wearables by regulatory bodies (median (IQR) rank score 7 (Huberty et al., 2015; Preusse et al., 2016) 6–76–7 and felt that wearables would increase their confidence in managing their long-term health condition (median (IQR) rank score 6 (Huberty et al., 2015; Preusse et al., 2016) 6–76–7. Favourable product characteristics for wearables were accuracy (73 %), easy to learn (63 %) and easy to use (50 %). They were less concerned about aesthetics (23 %) and battery life (27 %). This survey will guide future developers to produce a wearable for a population with chronic respiratory disease which will improve acceptability, usability and longevity.

Abstract Background Promoting integrated care is a key goal of the NHS Long Term Plan to improve population respiratory health, yet there is limited data-driven evidence of its effectiveness. The Morecambe Bay Respiratory Network is an integrated care initiative operating in the North-West of England since 2017. A key target area has been reducing referrals to outpatient respiratory clinics by upskilling primary care teams. This study aims to explore space-time patterns in referrals from general practice in the Morecambe Bay area to evaluate the impact of the initiative. Methods Data on referrals to outpatient clinics and chronic respiratory disease patient counts between 2012-2020 were obtained from the Morecambe Bay Community Data Warehouse, a large store of routinely collected healthcare data. For analysis, the data is aggregated by year and small area geography. The methodology comprises of two parts. The first explores the issues that can arise when using routinely collected primary care data for space-time analysis and applies spatio-temporal conditional autoregressive modelling to adjust for data complexities. The second part models the rate of outpatient referral via a Poisson generalised linear mixed model that adjusts for changes in demographic factors and number of respiratory disease patients. Results The first year of the Morecambe Bay Respiratory Network was not associated with a significant difference in referral rate. However, the second and third years saw significant reductions in areas that had received intervention, with full intervention associated with a 31.8% (95% CI 17.0-43.9) and 40.5% (95% CI 27.5-50.9) decrease in referral rate in 2018 and 2019, respectively. Conclusions Routinely collected data can be used to robustly evaluate key outcome measures of integrated care. The results demonstrate that effective integrated care has real potential to ease the burden on respiratory outpatient services by reducing the need for an onward referral. This is of great relevance given the current pressure on outpatient services globally, particularly long waiting lists following the COVID-19 pandemic and the need for more innovative models of care.

Background Long-term oxygen therapy (LTOT) improves the survival of patients with hypoxemia due to chronic respiratory diseases. The clinical outcomes of LTOT are strongly associated with patient adherence. To improve the adherence of patients, physicians have focused on the efficacy of LTOT. However, poor adherence may stem from patients’ perceptions of LTOT. Herein we evaluated patients’ perceptions of LTOT affecting adherence. Methods We conducted a cross-sectional survey study using descriptive, open, and closed-ended questionnaire. Patients using oxygen therapy (OT) or requiring it but avoiding OT responded to the questionnaires at three university hospitals. Results Seventy-nine patients responded to the questionnaires. The number of patients using home and portable OT was 69 (93%) and 37 (46.3%), respectively. Patients with good adherence were 22 (30.1%). Among patients with good adherence, 90.9% used oxygen according to physicians’ prescriptions whereas only 37.3% of those with poor adherence followed physicians’ prescriptions (p

A study published in the Archives of Dermatological Research explores the potential causal relationship between psoriasis and chronic respiratory diseases, such as asthma and COPD. The researchers used Mendelian randomization to assess this relationship and found that patients with psoriasis have a higher susceptibility to asthma compared to the general population. However, there was no significant association between psoriasis and COPD, idiopathic pulmonary fibrosis, or lung cancer. The study suggests that early assessment and prevention of asthma and airway hyperresponsiveness are important in psoriasis patients. Further research is needed to confirm causality and investigate underlying mechanisms. [Extracted from the article]

Respiratory infections, a global health priority according to the World Health Organization, cause around 7.5 million deaths annually, constituting 14% of global mortality. Beyond severe health implications, these diseases exacerbate social disparities and impose a substantial economic burden. Chronic obstructive pulmonary disease (COPD) combines chronic bronchitis (airway inflammation) and emphysema (air sac destruction) caused by prolonged exposure to irritants, and poor lifestyle choices lead to airway blockage and breathing difficulties. Lifestyle choices significantly influence health trajectories, evidenced by a consistent increase in “positive comfort” over time. A Chinese study highlights the correlation between adopting a healthy lifestyle and increased life expectancy. European health initiatives address these challenges, emphasizing early detection through large-scale health camps to identify new cases and assess severity. Exacerbation and infections are primary triggers, with bacteria and viruses requiring antibiotic interventions. Awareness campaigns targeting causes, symptoms, and prevention, including childhood infection initiatives with influenza and pneumococcal vaccinations, are crucial. Motivating smoking cessation and encouraging whole grain, fruit, and vegetable consumption mitigate lung oxidative damage. Promoting physical activity and addressing environmental pollution contribute to overall lung health. Timely nutritional evaluations for newly diagnosed cases manage obesity and malnutrition and prevent further lung function deterioration. There is growing attention toward the influence of poor lifestyle choices like sedentary lifestyle, environmental exposure, and unhealthy dietary patterns on the increased risk of COPD development besides smoking. This essay explores these factors, recognizing the intricate interplay between lifestyle and COPD prevention and management.

Mycoplasma gallisepticum (MG) is a bacterial pathogen that causes chronic respiratory disease (CRD) in poultry. CRD not only reduces productivity in poultry farms but also leads to significant economic losses in the poultry industry. Molecular methods have emerged as a reliable tool for the diagnosis of this bacterial infection. The aim of this study was to identify virulence factors of Mycoplasma gallisepticum isolated from chickens with respiratory diseases using Real-time PCR High-Resolution Melting curve (HRM) technique. In general, 50 broiler farms were included in this study. 20 samples were collected from each farm. DNA extraction was performed using CTB i-genomic DNA extraction kit. From 50 farms where samples were collected, four farms were identified as Mycoplasma positive using Real-time PCR method. The melting curve was performed with high-resolution real-time PCR and the obtained data were analyzed using the PCR max system. PCR results showed that pvpA, crmA and gapA genes were present in these samples, the results of phylogenetic tree drawing were compared with similar samples in previous studies. HRM analysis reveals molecular diversity between isolates. The results of this study showed that the use of HRM Real-time PCR is a reliable method to identify and investigate the presence of virulence factors related to the Mycoplasma pathogen. [ABSTRACT FROM AUTHOR]

Introduction: Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation. Methods: A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi‐structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team. Results: Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18–72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life. Conclusion: Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal. Patient or Public Contribution: This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network—a collaborative network of research in respiratory health. Public Summary: In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal. [ABSTRACT FROM AUTHOR]

Copyright of Pediatrie pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Treatable traits is a personalized approach to the management of respiratory disease. The approach involves a multidimensional assessment to understand the traits present in individual patients. Traits are phenotypic and endotypic characteristics that can be identified, are clinically relevant and can be successfully treated by therapy to improve clinical outcomes. Identification of traits is followed by individualized and targeted treatment to those traits. First proposed for the management of asthma and chronic obstructive pulmonary disease (COPD) the approach is recommended in many other areas of respiratory and now immunology medicine. Models of care for treatable traits have been proposed in different diseases and health care setting. In asthma and COPD traits are identified in three domains including pulmonary, extrapulmonary and behavioural/lifestyle/risk‐factors. In bronchiectasis and interstitial lung disease, a fourth domain of aetiological traits has been proposed. As the core of treatable traits is personalized and individualized medicine; there are several key aspects to treatable traits models of care that should be considered in the delivery of care. These include person centredness, consideration of patients' values, needs and preferences, health literacy and engagement. We review the models of care that have been proposed and provide guidance on the engagement of patients in this approach to care. [ABSTRACT FROM AUTHOR]

BACKGROUND: People with interstitial lung disease (ILD) want to actively manage their condition; however, the effects of self-management interventions (SMIs) in this population have not been synthesized. This review summarizes the effects of SMIs on health-related quality of life (HRQOL), functional status, psychological and social factors, symptoms, exacerbations, health care utilization, and survival in people with ILD. METHODS: The protocol of this systematic review was registered (PROSPERO ID: CRD42022329199). Six digital databases were searched in May 2022 with monthly updates until August 2023. Studies implementing SMIs in people with any type of ILD were included. Risk of bias (RoB) and quality of evidence were assessed with the Cochrane tool for RoB assessment and the grading of recommendations, assessment, development, and evaluations. Meta-analysis was used to summarize the results. RESULTS: Four studies that examined 217 participants (81% male, 71 y old, 91% idiopathic pulmonary fibrosis) were included. SMIs were highly heterogeneous. Meta-analysis showed no difference in HRQOL (standardized mean difference: 0.08 [95% CI 20.21 to 0.37], P .58) nor in the secondary outcomes. No evidence for the effects of SMIs on functional capacity, exacerbations, and survival was found. The quality of evidence ranged from low to very low. CONCLUSIONS: There is low to very low-quality evidence that SMIs have no effect in people with ILD. However, this conclusion is limited by high methodological heterogeneity. A consensus definition of SMIs is needed to implement more comparable interventions and strengthen results. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Investigación en Salud VIVE is the property of Revista de Investigacion en Salud VIVE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Allergic rhinitis and rhinosinusitis are global problems that are frequently encountered in daily clinical practice. This disease has an impact on the quality of life of sufferers who can resulting in decreased productivity, interpersonal relationships, and social activities. Socialization is needed regarding allergic rhinitis and rhinosinusitis so that medical personnel can participate in early diagnosis and management of allergic rhinitis and rhinosinusitis. Educational activities are carried out through outreach activities using lecture methods, discussions, training, as well as pretest and posttest. Based on the results of the pretest and posttest, the pretest average was 56,55 (± 27.51) and the posttest average was 89.27 (±12.95). Based on the comparison of pretest and posttest results, we found a statistically significant difference (p < 0.05). Medical personnel's knowledge of allergic rhinitis and rhinosinusitis needs to be increased so that they can participate in early diagnosis and management of allergic rhinitis and rhinosinusitis.

Abstract Background A heavy financial burden is imposed on patients suffering from chronic diseases due to medicine out-of-pocket payments. Objectives This study focuses on assessing the affordability of medications used for chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) in Iran, specifically on the category R medicines listed in the 2017 Iran drug list (IDL) that are used for the treatment of these diseases, based on the anatomical therapeutic chemical (ATC) drug code. Methods The affordability of medicines in mono and combination therapy approaches was assessed in CRDs using the World Health Organization/Health Action International (WHO/HAI) methodology. Accordingly, if out-of-pocket payment for 30-days of pharmacotherapy exceeds one day for the lowest-paid unskilled government worker (LPGW), it’s considered non-affordable. Results Based on the monotherapy approach, our finding demonstrates that all generic medicines of category R were affordable. However, branded drugs such as Symbicort®, Pulmicort Respules®, Flusalmex®, Seretide®, Fluticort Plus®, Seroflo®, and Salmeflo® cost between 1.2 and 2.5 days’ wage of LPGW and considered unaffordable despite 70% insurance coverage. Moreover, based on the affordability ratio in the combination therapy approach, all medicines used in asthma, COPD, and CF patients with mild respiratory problems are affordable except omalizumab (inj), which is non-affordable due to its high price and no insurance coverage. Conclusion Results showed that the existing insurance coverage does not protect households from hardship, so more considerations are needed such as different insurance schedules and patient support programs.

Abstract Background Physical activity (PA) counseling holds promise for increasing PA levels in people with chronic respiratory disease, though little long-term change has been shown to date. Here, we describe the development of a Health Action Process Approach-based PA counseling intervention that aims to promote PA and exercise in people with chronic respiratory disease who are enrolled in pulmonary rehabilitation. Methods To collaborate in defining and refining the intervention, we convened a varied team of authors that included a panel of five stakeholder partners: three patients, one clinician, and one health behavior change researcher. We completed three steps in the intervention development process: (1) initial intervention creation, (2) iterative intervention refinement, and (3) assessment of intervention acceptability. In step 1, we created an initial draft of the PA counseling intervention based on the HAPA theoretical framework, previous evidence in people with chronic respiratory disease, and clinical experience. In step 2, we used qualitative methods of focus groups and interviews to further develop and refine the intervention. Fifteen meetings occurred with the five-member stakeholder partner panel (six focus groups with the three patient partners, four interviews with the clinician partner, and five interviews with the researcher partner) over 5 months to systematically elicit input and incorporate it into the intervention. In step 3, we measured the intervention acceptability using five-point Likert scale ratings. Results Intervention materials included the eligibility screen, participant workbook, and leader guide. We identified key themes in the input from the stakeholder partners and incorporated this input into the intervention content and methods. Ratings of the intervention by the stakeholder partners (n=5) were high with mean ratings ranging 4.0–5.0 on a five-point scale. Conclusions This development process successfully engaged an intervention development team with diverse perspectives and resulted in a PA counseling intervention for people with chronic respiratory disease. The intervention’s strong theoretical underpinning, person-centeredness, and the contributions from varied perspectives during intervention development position it well for future evaluations of feasibility, efficacy, and effectiveness.

Nowadays, around 50% of the world's population lives in cities and urban areas and is exposed to increasingly higher levels of air pollutants including gaseous pollutants and particulate matter (PM). The latter is a key indicator of air pollution transported into the air by a variety of natural processes and human activities. The particles’ size has been directly related to their potential impact on health problems. Particles of concern include small particles with diameters of 2.5 to 10 μm (coarse particles) and smaller than 2.5 μm (fine particles). Exposure to air pollutants over a long period of time not only decompensates pre-existing diseases but also leads to pulmonary and respiratory health problems such as asthma, chronic obstructive pulmonary disease (COPD), and lung cancer even in rural areas. A thorough analysis has to be provided to address the implications for policymakers. Hence, more stringent strategies can be implemented to control air pollution and prevent its health effects.

Introduction: Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease that has a significant global impact. Unfortunately, current treatments and prevention remain insufficient. Nigella sativa (NS) has been traditionally used as an anti-inflammatory, antioxidant, and immunomodulatory agent, which can be helpful in the treatment of COPD, through its essential component thymoquinone. This review examined the potential benefits of NS for COPD patients as a possible treatment option. Methods: The literature investigation was conducted by searching relevant articles on Google Scholar and NCBI using the keywords "black seed", “black cumin”, "Nigella sativa", "thymoquinone", "carvacrol", and "COPD". The results from five identified studies were then summarized. Results: This review reveals that NS offers benefits to individuals with COPD by reducing inflammation and oxidative stress, thereby leading to improved pulmonary function tests (PFTs). However, it is important to note that the majority of experiments have been conducted on animals, with only one involving humans, and these experiments have mostly been short-term. Additionally, since different studies have used various preparations of NS, determining the recommended dose is challenging. Unfortunately, the research does not provide any insights into the potential long-term effects of these treatments or the possible adverse effects of the medications used. Conclusion: Studies on the benefits of NS as an anti-inflammatory and antioxidant for COPD adjuvant therapy show promising results, but more research is needed to confirm the findings with larger and more well-designed studies to determine the appropriate doses and long-term effects.

Abstract Background Chronic respiratory diseases are common in Cape Town, South Africa. Yet the experiences of how adults with these conditions, such as asthma or COPD (chronic obstructive pulmonary disease), negotiate the health system are poorly understood. Qualitative methodology lends itself to investigate this question. Aim of study To explore the “emic” experiences of adults with CRDs in Cape Town when they were negotiating the health system using semi-structured interviews. Methods Interviews were conducted following informed consent with purposively sampled adults who had attended public hospitals in Cape Town with chronic respiratory disease flare-ups. This work was nested in the quantitative “Diagnosing Airways Disease” study. The topic guide explored patients’ experiences of accessing healthcare including receiving and interpretations of the diagnosis and management, and impacts on daily life. Interviews were conducted in Afrikaans, isiXhosa, or English; transcribed, and translated into English and thematically analysed until saturation. Results Thirty-two interviews (16 in Afrikaans, 8 in isiXhosa, 8 in English) were completed in 2022. 17 women and 15 men participated. Most participants were older than 50 years (25/32), and most were unemployed (13/32) or retired (11/32). The identified themes were: Perceived causes of illness; experiences of healthcare; perceived risks and barriers when accessing healthcare; and impact on earnings. The perceived causes of their illness and risks were structural, and included air pollution, poor quality housing, occupational exposures, limited healthcare services, and fear of violence. These factors led to self-treatment, sharing of medicines, and delay in receiving a diagnosis. Many paid privately for treatments or services to overcome identified shortcomings of the public healthcare system, and many reported additional significant indirect costs. Being ill had a profound impact on income. The identified themes were explored through the lens of “structural violence”, where “social structures stop individuals … from reaching their full potential” (Galtung, 1969). Conclusion In Cape Town structural elements such as stretched healthcare professionals, insufficiently enforced policies on e.g., housing or work-place exposures, poverty and crime made it difficult for participants to successfully navigate their illness experience. It forced some to pay out of pocket to receive perceived better healthcare privately.

Abstract Introduction Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation. Methods A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi‐structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team. Results Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18–72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life. Conclusion Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal. Patient or Public Contribution This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network—a collaborative network of research in respiratory health. Public Summary In Portugal, chronic respiratory patients do not have an active role as ‘coinvestigators’. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal.

Background: Dyspnea is an unpleasant subjective symptom and is associated with decreased physical activity level (PAL). Effect of blowing air toward the face has received a great deal of attention as a symptomatic therapy for dyspnea. However, little is known about the duration of its effect and its impact on PAL. Therefore, this study aimed to measure dyspnea severity and changes in dyspnea and PALs with air blasts to the face. Methods: The trial conducted was open-label, randomized, and controlled. This study included out-patients with dyspnea caused by chronic respiratory deficiency. Subjects were provided a small fan and instructed to blow air toward their faces either twice a day or when having trouble breathing. Subsequently, severity of dyspnea and PALs was measured using visual analog scale and physical activity scale for the elderly (PASE), respectively, before and after 3-week treatment. Amounts of changes in dyspnea and PALs before and after treatment were compared using analysis of covariance. Results: Overall, 36 subjects were randomized, and 34 were analyzed. Mean age was 75.4 y (26 males [76.5%] and 8 females [23.5%]). Visual analog scale score for dyspnea (SD) before treatment was 33 (13.9) mm and 42 (17.5) mm in the control and intervention groups, respectively. PASE score before treatment was 78.0 (45.1) and 57.7 (38.0) in the control and intervention groups, respectively. No significant difference in changes in dyspnea severity and PAL was observed between the 2 groups. Conclusions: No significant difference was observed for dyspnea and PALs in subjects after blowing air toward their own faces with a small fan for 3 weeks at home. Disease variability and impact of protocol violations were high due to small number of cases. Further studies with a design focused on subject protocol adherence and measurement methods are required to understand impact of air flow on dyspnea and PAL. [ABSTRACT FROM AUTHOR]

Purpose of review This brief critical review evaluates recent research on the impact of anxiety disorders and post-traumatic stress disorders (PTSD) on patients with chronic obstructive pulmonary disease (COPD) and asthma. In these patients, untreated anxiety and PTSD exacerbate acute symptoms, increase disability and impair quality of life. Therefore, effective interventions are also reviewed. Recent findings Anxiety disorders and PTSD are prevalent in COPD and asthma, worsen symptoms in acute exacerbations, and increase morbidity and healthcare utilization. Pulmonary rehabilitation (PR), cognitive behavioural therapy and pharmacological therapy are each effective in COPD patients with anxiety or PTSD. However, very little work examined therapy for combined anxiety and PTSD in patients with either COPD or asthma. Summary Despite the high prevalence of anxiety disorder or PTSD in patients with chronic respiratory diseases, a paucity of literature remains demonstrating the efficacy of pharmacological therapies for these conditions. This review highlights the promising benefits of PR on anxiety, but prospective trials are needed to demonstrate the efficacy of interventions with PTSD alone, or with concomitant anxiety. [ABSTRACT FROM AUTHOR]

Background: A heavy financial burden is imposed on patients suffering from chronic diseases due to medicine out-of-pocket payments. Objectives: This study focuses on assessing the affordability of medications used for chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) in Iran, specifically on the category R medicines listed in the 2017 Iran drug list (IDL) that are used for the treatment of these diseases, based on the anatomical therapeutic chemical (ATC) drug code. Methods: The affordability of medicines in mono and combination therapy approaches was assessed in CRDs using the World Health Organization/Health Action International (WHO/HAI) methodology. Accordingly, if out-of-pocket payment for 30-days of pharmacotherapy exceeds one day for the lowest-paid unskilled government worker (LPGW), it's considered non-affordable. Results: Based on the monotherapy approach, our finding demonstrates that all generic medicines of category R were affordable. However, branded drugs such as Symbicort®, Pulmicort Respules®, Flusalmex®, Seretide®, Fluticort Plus®, Seroflo®, and Salmeflo® cost between 1.2 and 2.5 days' wage of LPGW and considered unaffordable despite 70% insurance coverage. Moreover, based on the affordability ratio in the combination therapy approach, all medicines used in asthma, COPD, and CF patients with mild respiratory problems are affordable except omalizumab (inj), which is non-affordable due to its high price and no insurance coverage. Conclusion: Results showed that the existing insurance coverage does not protect households from hardship, so more considerations are needed such as different insurance schedules and patient support programs. [ABSTRACT FROM AUTHOR]