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AbstractThe study aim was to identify the most problematic self-­reported activities of daily living (ADLs). In a retrospective study, 1935 problematic ADLs were reported by 538 clients with 95% experiencing two or more problematic ADLs. Problematic ADLs were assessed by occupational therapists using the Canadian Occupational Performance Measure with walking (67%), household activities (41%), and climbing the stairs (41%) identified as the most prevalent problematic ADLs. Significant but weak associations were found between clinical determinants (e.g. physical, psychosocial) and problematic ADLs. The wide variety of problematic ADLs and the absence of a strong association with clinical determinants emphasizes the need for using individualized interview-based performance measures in clients with asthma. [ABSTRACT FROM AUTHOR]

Objective To analyze the changes of postoperative pulmonary function in lung transplant recipients. Methods Clinical data of 81 recipients undergoing bilateral lung transplantation and combined heart-lung transplantation were collected, and postoperative status of the recipients was analyzed. Pulmonary ventilation and diffusion function indexes at 1 month, 3 months, every 3 months (3-18 months after lung transplantation) and every 6 months (18-36 months after lung transplantation) were analyzed in the recipients. The characteristics of the optimal pulmonary function in the recipients were assessed. Results Postoperative mechanical ventilation time was 4 (2, 9) d, and the length of postoperative ICU stay was 10 (7, 20) d. Among 81 recipients, 27 recipients developed primary graft dysfunction (PGD) after lung transplantation, with an incidence rate of 33%. Postoperative forced vital capacity (FVC) to predicted value ratio (FVC%pred), forced expiratory volume in one second (FEV1) to predicted value ratio (FEV1%pred), FEV1/FVC to predicted value ratio (FEV1/FVC%pred) and corrected diffusion lung capacity for CO to predicted value ratio (DLCOc%pred) were changed over time (all P<0.001). FVC%pred and FEV1%pred were gradually increased within postoperative 9 months, and DLCOc%pred was gradually elevated within postoperative 3 months (all P<0.05). Thirty-six recipients had FVC%predı80%, FEV1%predı80% in 41 cases, FEV1/FVC%predı92% in 76 cases, FVC%predİ40% in 1 case and FEV1%predİ40% in 1 case, respectively. Sixteen recipients had DLCOc%predı80%, corrected diffusion lung capacity for CO/alveolar volume to predicted value ratio (DLCOc/VA%pred) ı80% in 63 cases, DLCOc%predİ40% in 4 cases and DLCOc/VA%predİ40% in 1 case, respectively. Postoperative FVC%pred, FEV1/FVC%pred and DLCOc%pred in recipients with a primary disease of obstructive pulmonary disease were significantly higher than those in their counterparts with restrictive pulmonary disease (all P<0.05). Postoperative DLCOc%pred in recipients with PGD was significantly lower than that in those without PGD (P<0.05). Conclusions Pulmonary ventilation function in lung transplant recipients reaches the optimal state and maintains a steady state at postoperative 9 months, and pulmonary diffusion function reaches a steady state at postoperative 3 months. Primary diseases and the incidence of PGD may affect postoperative pulmonary function. [ABSTRACT FROM AUTHOR]

Purpose: The Keokuk County Rural Health Study (KCRHS) is a longitudinal population-based study conducted in rural Iowa. A prior analysis of enrollment data identified an association of airflow obstruction with occupational exposures only among cigarette smokers. The current study used spirometry data from all three rounds to investigate whether level of forced expiratory volume in one second (FEV1) and longitudinal change in FEV1 were associated with occupational vapor–gas, dust, and fumes (VGDF) exposures, and whether these associations were modified by smoking. Methods: This study sample comprised 1071 adult KCRHS participants with longitudinal data. A job-exposure matrix (JEM) was applied to participants' lifetime work histories to assign exposures to occupational VGDF. Mixed regression models of pre-bronchodilator FEV1 (millimeters, ml) were fit to test for associations with occupational exposures while adjusting for potential confounders. Results: Mineral dust had the most consistent association with change in FEV1, including ever/never (– 6.3 ml/year) and nearly every level of duration, intensity, and cumulative exposure. Because 92% of participants with mineral dust also had organic dust exposure, the results for mineral dust may be due to a combination of the two. An association of FEV1 level with fumes was observed for high intensity (– 91.4 ml) among all participants, and limited to cigarette smokers with results of – 104.6 ml ever/never exposed, – 170.3 ml high duration, and – 172.4 ml high cumulative. Conclusion: The current findings suggest that mineral dust, possibly in combination with organic dust, and fumes exposure, especially among cigarette smokers, were risk factors for adverse FEV1 results. [ABSTRACT FROM AUTHOR]

Background Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. Methods We used a cross-sectional study design and retrospectively examined risk-adjusted 30- day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers’ Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used.Results Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. Conclusion Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy- makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.

Aim: To examine the relationship between the acute attacks of the patients with chronic obstructive pulmonary disease (COPD) and their general oral hygiene and the general condition of their prostheses. Methods: As a prospective questionnaire and clinical examination study, patients with COPD attacks using total prostheses and healthy individuals were compared using the Rustogi index. After obtaining consent from all patients, age, Modified Medical Research Council Dyspnea Scale (Mmrc) scores, an inhaler used, COPD stage, and the status of total prostheses were recorded. Also the habits of the use of the prostheses were evaluated for each group. Results: 32 COPD patients and 34 healthy participants, 29 female and 37 male, with a mean age of 69.19±3.16 were evaluated. When the correlation between COPD attack and denture cleaning frequency, which was the main hypothesis of the study, was evaluated, a significant correlation was observed. (r:0.549, p<0.001) There was a significant difference between the patient and healthy individuals whether they removed the dentures at night and the frequency of denture cleaning. (p< 0.01) Conclusions: In COPD, whether both mechanical and pharmacological cleaning of the prostheses is done regularly should be evaluated at each control. Regular dental check-ups can control the course of the disease, as well as contribute to reducing morbidity, mortality, and also health outgoings. Further studies in which serum inflammatory markers and microbiological examinations will be evaluated can be recommended. [ABSTRACT FROM AUTHOR]

Bronchiolitis obliterans (BO) is a progressive fibrotic process that predominantly affects the small airways and is identified as constrictive bronchiolitis by pathologists. It is commonly associated with allogeneic hematopoietic stem cell transplant (HSCT), lung transplant, exposure to inhaled toxins, post-infectious processes, autoimmune diseases, and sometimes, no known cause. In the latter case, it is referred to as cryptogenic bronchiolitis obliterans.A 52-year-old Hispanic man with a medical history of hypertension, diabetes mellitus, and coronary artery disease was referred to the pulmonary department due to experiencing dyspnea on exertion, intermittent dry cough, and progressive limitation of activities of daily living. Spirometry revealed severe obstructive changes, and chest high-resolution computed tomography showed ground-glass opacities with nodular infiltrates in the upper lobes, leading to a presumptive diagnosis of hypersensitivity pneumonitis. The patient underwent a lung surgical biopsy of the right upper and lower lobes, which revealed extensive constrictive bronchiolitis. Due to the patient's worsening general condition, bilateral lung transplantation succeeded without any further complications. Following the transplantation, the patient showed good recovery and functional improvement. Bronchiolitis obliterans, or constrictive bronchiolitis, has a variable natural history. It is associated with a higher risk of mortality in allogenic HSCT. When BO is secondary to inhalation of toxic gases, it is usually nonprogressive and limited to toxin exposure. Autoimmune diseases or cryptogenic bronchiolitis are rare and have a heterogeneous clinical course. To make a proper diagnosis, clinical history, radiologic and histologic findings must be considered.

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases of the respiratory system in the elderly, and it poses a grave threat to the survival and quality of life. Examining the pathogenesis of COPD is extremely important for COPD prevention and treatment. To date, however, there is no medication for chronic obstructive pulmonary disease that can delay the lung function decline over time. According to studies, vitamin D offers new hope for the treatment of COPD. A deficiency in vitamin D can exacerbate the progression of COPD, whereas adequate vitamin D has a therapeutic effect on COPD. This paper summarizes the relevant domestic and international research, discusses the possible mechanism of vitamin D's effect on COPD, and investigates the role of vitamin D, particularly in COPD patients. [ABSTRACT FROM AUTHOR]

Context: Management of asthma and chronic obstructive pulmonary disease (COPD) includes use of inhalers as an integral component of drug delivery. Awareness about inhaler devices along with demonstration of the usage of inhaler technique aids in the optimization of therapeutic outcome. Aim: This study aimed to assess the correct use of inhaler technique following pre- and posttraining sessions for the management of COPD and asthma among pulmonary outpatients at a tertiary care hospital. Settings: This prospective cross-sectional study was carried out among patients diagnosed with asthma or COPD and prescribed with inhaler medication in the form of pressurized metered-dose inhaler (pMDI), MDI with spacer, or dry powder inhaler (DPI). Subjects and Methods: The inhaler device use by the patients was assessed initially, followed by a demonstration on inhaler device technique, and reassessed post training using a checklist. Statistical Analysis: Comparison of the median total score of pretraining and posttraining inhaler technique was analyzed by Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results: Out of 144 patients, 55.6%, 27.7%, and 16.7% of them were prescribed pMDI, MDI with spacer, and DPI, respectively. Post inhaler technique training, about 79.2% of the patients were able to demonstrate the inhaler technique correctly compared to 52.1% prior to training. A statistically significant difference in the median score of inhaler technique has been observed before and after training. Conclusions: This study reports a significant improvement in the correct use of inhaler technique post training. In addition, the most frequent error among inhaler users was revealed to be in the breath actuation. [ABSTRACT FROM AUTHOR]

Background: Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged =65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. Methods: We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used. Results: Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. Conclusion: Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies. [ABSTRACT FROM AUTHOR]

Williams–Beuren syndrome (WS) results from the deletion of 25–27 coding genes, including elastin (ELN), on human chromosome 7q11.23. Elastin provides recoil to tissues; emphysema and chronic obstructive pulmonary disease have been linked to its destruction. Consequently, we hypothesized that elastin insufficiency would predispose to obstructive features. Twenty-two adults with WS (aged 18–55) and controls underwent pulmonary function testing, 6 min walk, and chest computed tomography (CT). Lung and airspace dimensions were assessed in Eln+/− and control mice via microCT and histology. The forced expiratory volume in 1 s (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) were lower in adults with WS (p < 0.0001 and p < 0.05, respectively). The FEV1/FVC ratio was more frequently below the lower limit of normal in cases (p < 0.01). The ratio of residual volume to total lung capacity (RV/TLC, percent predicted) was higher in cases (p < 0.01), suggesting air trapping. People with WS showed reduced exercise capacity (p < 0.0001). In Eln+/− mice, ex vivo lung volumes were increased (p < 0.0001), with larger airspaces (p < 0.001). Together these data show that elastin insufficiency impacts lung physiology in the form of increased air trapping and obstruction, suggesting a role for lung function monitoring in adults with WS. [ABSTRACT FROM AUTHOR]

Rui Zhang,* Jiechen Zhu,* Yanan Liu,* Yuanqin Li, Wenjing Liu, Maowei Zhang, Bi Chen, Shuyang Zhu Department of Respiratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, People’s Republic of China *These authors contributed equally to this workCorrespondence: Shuyang ZhuDepartment of Respiratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou, West Huaihai Road #99, Xuzhou 221000, People’s Republic of ChinaEmail shuyangzhu@126.comBackground: Clinical studies have suggested nebulized budesonide (NB) as an alternative to systemic corticosteroids for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the optimal budesonide dose for AECOPD remains unclear.Objectives: To compare the efficacy and safety of different doses of NB in the management of AECOPD.Patients and Methods: A total of 321 AECOPD patients with moderate-to-severe exacerbation were randomly divided into three groups and treated with NB. The low dose group (L) was given 4 mg/day (n=95, 1 mg Q6h), while high-dose group 1 (H1, n=111, 2 mg Q6h) and high-dose group 2 (H2, n=115, 4 mg Q12h) were given 8 mg/day. Patients also received routine treatment including oxygen therapy, expectorant, nebulization bronchodilators, antibiotics, and fluid rehydration. The COPD assessment test (CAT), lung function, and artery blood gas were evaluated before and after 3 hrs and 5 days of treatment. In addition, hospital stay, frequency of acute exacerbations within 3 months of discharge, and adverse events during treatment were compared.Results: H1 and H2 showed improved spirograms and CAT score faster than L. In H2, forced expiratory volume in 1 s (FEV1%) at 3 hrs and FEV1%, forced expiratory flow after 50% of the forced vital capacity has been exhaled (FEF50%), mean forced expiratory flow between 25% and 75% of forced vital capacity (FEF25– 75%) and CAT score at 5 days were significantly improved compared to L. FEV1% improved most in H2, moderately in H1, and least in L, with significant differences between groups at 5 days. No differences between groups were observed in adverse effects, hospital stay, and frequency of exacerbations within 3 months of discharge.Conclusion: Compared to the conventional dose (4 mg/day), a high dose (8 mg/day) of NB improved pulmonary function and symptoms more effectively in the early treatment of AECOPD, especially when given as 4 mg twice daily.Keywords: obstructive pulmonary disease, exacerbation, nebulized budesonide, dose, pulmonary function

Abstract Background COPD is a high prevalence chronic disease that involves large reductions of health-related quality of life (HRQL) of patients. This study aims to describe the HRQL of patients with COPD in Extremadura (Spain). Methods This is a cross-sectional observational study carried out using a representative sample of patients diagnosed with COPD in Extremadura. The inclusion criteria were patients of legal age, diagnosed with COPD at least 12 months prior to the visit, residing in Extremadura, with electronic medical records available for the 12 months prior to the visit and providing informed consent. The intervention aimed to elicit HRQL indicators obtained from two validated questionnaires: EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L), and St. George’s Respiratory Questionnaire-COPD (SGRQ-C). The main outcome measures were general HRQL (utility and visual analogue scale) and specific quality of life of COPD patients (total score and three component scores: Symptoms, Activity, and Impacts). Stepwise multiple regression analysis was applied to evaluate the association of EQ-5D-5L and SGRQ-C with respect to clinical and sociodemographic characteristics of the patients. Results We recruited 386 patients (mean age 71.8 ± 10.3 years, 76.2% males). In the EQ-5D-5L, participants reported greater problems with respect to mobility (56.5%) and pain/discomfort (48.2%). The mean utility was 0.72 ± 0.31, and the SGRQ-C total score was 40.9 ± 25.0. The results of both questionnaires were associated with number of exacerbations in the last 12 months, level of COPD severity, gender, and education level of the patient (p

Introduction: Obstructive pulmonary disease may cause some psychiatric disorders such as depression, similar to other chronic diseases. Patients with chronic obstructive pulmonary disease or asthma are especially susceptible to inhaler technique errors. The aim of this study was to evaluate the depression that can affect improper use of inhaler devices and to show the contribution of age, sex, and education to correct usage. Materials and Methods: In this study, trained health care workers in the presence of Chest specialist requested patients to demonstrate their inhaler technique and assessed it according to the checklist. If any of the steps were missing or done incorrectly, it was marked as an incorrect technique. Results: We included 188 participants, mean age of 58.3 ± 12.7 years. Significant variables of individual risk were having comorbidities, age, sex, smoking status, and educational level. There was an inverse relationship between education level and incorrect inhaler technique. Even after controlling for age, gender, and education, depressive symptoms were a significant and independent predictor of improper use of inhaler devices. High levels of depressive symptoms were associated with a 22‐fold increase (95% confidence interval, 8.9 to 53.5) in the odds of improper use of inhaler devices after adjustment for potential confounders. Conclusions: As a result, the presence of depression symptoms may increase the improper use of inhaler devices. Further research is needed to determine if screening for and treating depression improves improper use of inhaler devices and obstructive disease outcomes in this population. [ABSTRACT FROM AUTHOR]

Tobacco smoking is one of the most important risk factors for chronic obstructive pulmonary disease (COPD). However, the most critical genes and proteins remain poorly understood. Therefore, we aimed to investigate these hub genes and proteins in tobacco smoke-induced COPD, together with the potential mechanism(s). Differentially expressed genes (DEGs) were analysed between smokers and patients with COPD. mRNA expression and protein expression of IP3R were confirmed in patients with COPD and extracted smoke solution (ESS)-treated human bronchial epithelial (HBE) cells. Moreover, expression of oxidative stress, inflammatory cytokines and/or autophagy-related protein was tested when IP3R was silenced or overexpressed in ESS-treated and/or 3-MA-treated cells. A total of 30 DEGs were obtained between patients with COPD and smoker samples. IP3R was identified as one of the key targets in tobacco smoke-induced COPD. In addition, IP3R was significantly decreased in patients with COPD and ESS-treated cells. Loss of IP3R statistically increased expression of oxidative stress and inflammatory cytokines in ESS-treated HBE cells, and overexpression of IP3R reversed the above functions. Furthermore, the autophagy-related proteins (Atg5, LC3 and Beclin1) were statistically decreased, and p62 was increased by silencing of IP3R cells, while overexpression of IP3R showed contrary results. Additionally, we detected that administration of 3-MA significantly reversed the protective effects of IP3R overexpression on ESS-induced oxidative stress and inflammatory injury. Our results suggest that IP3R might exert a protective role against ESS-induced oxidative stress and inflammation damage in HBE cells. These protective effects might be associated with promoting autophagy. [ABSTRACT FROM AUTHOR]

Background: The influence of coronary atherosclerosis and related treatment drugs on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) development requires in-depth study. The study investigated the effect of coronary artery calcification (CAC) and drugs for CAC on the development of AECOPD. Methods: This retrospective clinical study recruited subjects with AECOPD from May 2017 to May 2019. All subjects performed spirometry and coronary computed tomography (CT), and were divided into three groups according to whether coronary CT revealed CAC and whether they had received oral aspirin and statins: AECOPD group, AECOPD + CAC nonmedication and AECOPD + CAC medication. The t-test and nonparametric test were used for analyzing the lung function, arterial blood gas, routine blood and lipid between groups. Results: Compared with the AECOPD group, Lym% were significantly higher (P = 0. 0 3 3) in both the AECOPD + CAC nonmedication and the AECOPD + CAC medication. The AECOPD + CAC medication group also had significantly higher PaO2 (P < 0. 0 5). WBC, Neu, and Neu% in the AECOPD + CAC medication group were significantly lower (P < 0. 0 5) compared to the AECOPD group. Conclusions: Aspirin and statins for the treatment of cardiovascular diseases may be linked to improving lung function, normalizing blood gas levels, and reducing inflammation in patients with AECOPD and CAC. Further, randomized controlled trials are needed to explore this topic. [ABSTRACT FROM AUTHOR]

The impact of a history of competitive sports on later smoking behaviour and occurrence of chronic pulmonary diseases is poorly known. We investigated how a history of elite level sports predicted later pulmonary disease morbidity and mortality. Chronic pulmonary disease incidence was assessed from national hospital and cause-of-death registers from 1970 to 2015 among Finnish male former elite athletes (n = 2078) and matched controls (n = 1453) alive in 1970 (mean age 45.0 years). Hazard ratios (HRs) were calculated by Cox proportional hazards model. In 1985, cohort members reported on their smoking habits, engagement in physical activity/sports and physician-diagnosed chronic diseases. The risk of any chronic pulmonary disease or death was lower among former athletes than controls (age-adjusted HR 0.61; 95% CI 0.46–0.83). The risk was significantly lower among endurance (HR 0.54), mixed (HR 0.61), and power sports athletes (HR 0.66) compared to controls. The age- and smoking pack-year-adjusted HRs of incident diseases from the time of the 1985 questionnaire until the end of follow-up in former athletes was 0.58 (95% CI 0.37–0.93) compared to controls. In 1985 athletes smoked less and their cumulative smoking quantity was lower than that of controls. Former athletes were more physically active and self-reported less physician-diagnosed emphysema. The risk of any chronic pulmonary disease was lower among former athletes than controls even after considering smoking status and cumulative smoking quantity. Ability to compete at the highest level of sports in young adulthood associated with a reduced risk of pulmonary disease in later life. [ABSTRACT FROM AUTHOR]

Objectives: Hospice use reduces costly aggressive end-of-life (EOL) care (eg, repeated hospitalizations, intensive care unit care, and emergency department visits). Nevertheless, associations between hospice stays and EOL expenditures in prior research have been inconsistent. We examined the differential associations between hospice stay duration and EOL expenditures among newly diagnosed patients with cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and dementia.Methods: In the Surveillance, Epidemiology, and End Results-Medicare data, we identified 240 246 decedents diagnosed with the aforementioned conditions during 2001 to 2013. We used zero-inflated negative binomial regression models to examine the differential associations between hospice length of services and EOL expenditures incurred during the last 90, 180, and 360 days of life.Results: For the last 360 days of expenditures, hospice stays beyond 30 days were positively associated with expenditures for decedents with COPD, CHF, and dementia but were negatively associated for cancer decedents (all P<.001) after adjusting for demographic and medical covariates. In contrast, for the last 90 days of expenditures, hospice stay duration and expenditures were consistently negatively associated for each of the 4 patient disease groups.Conclusions: Longer hospice stays were associated with lower 360-day expenditures for cancer patients but higher expenditures for other patients. We recommend that Medicare hospice payment reforms take distinct disease trajectories into account. The relationship between expenditures and hospice stay length also depended on the measurement duration, such that measuring expenditures for the last 6 months of life or less overstates the cost-saving benefit of lengthy hospice stays. [ABSTRACT FROM AUTHOR]

Introduction: More than 90% of the deaths caused by chronic obstructive pulmonary disease (COPD) occur in the low- and middle -income countries. The main aim of this study was to investigate the lipid profile levels in COPD patients and examine the correlation of total cholesterol, triglycerides, low-density lipoproteins, high density lipoproteins, and LDL/HDL risk ratio with COPD stages that are developed by the global initiative for chronic obstructive lung disease (GOLD) Materials & Methods: A total of 100 COPD patients including 25 COPD non-smokers were enrolled in this study. The diagnosis of COPD was carried out by using the spirometry following the GOLD guidelines (post-bronchodilator forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio < 70% predicted). Accordingly, the patients were divided into four groups based on the severity of their disease in accordance with the GOLD guidelines, including mild COPD (stage I, FEV1 ≥ 80% predicted), moderate COPD (stage II, 50% ≤ FEV1 < 80% predicted), severe COPD (stage III, 30% ≤ FEV1 < 50% predicted), and very severe COPD (stage IV, FEV1 < 30% predicted). The fasting blood samples of lipid profile were collected. The four COPD groups were compared using the ANOVA test. Results: According to the results, the majority 53 patients (53%) were in age group 40 to 60 years with mean age of 60.46 +/-11.56. Most of the patients had moderate to severe airflow obstruction (GOLD stages II and III). The severity of COPD had no significant correlation with the triglycerides, LDL, HDL, and LDL/HDL risk ratio. The mean total cholesterol levels in the stages I and IV were 151.92±32.82 and 128.50 ±21.46 mg/dL, respectively, which was statistically significant (P=0.04). Conclusion: The present study indicates that there was no significant correlation between various lipid profile parameters and severity of COPD.

Background: COPD is a high prevalence chronic disease that involves large reductions of health-related quality of life (HRQL) of patients. This study aims to describe the HRQL of patients with COPD in Extremadura (Spain).Methods: This is a cross-sectional observational study carried out using a representative sample of patients diagnosed with COPD in Extremadura. The inclusion criteria were patients of legal age, diagnosed with COPD at least 12 months prior to the visit, residing in Extremadura, with electronic medical records available for the 12 months prior to the visit and providing informed consent. The intervention aimed to elicit HRQL indicators obtained from two validated questionnaires: EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L), and St. George's Respiratory Questionnaire-COPD (SGRQ-C). The main outcome measures were general HRQL (utility and visual analogue scale) and specific quality of life of COPD patients (total score and three component scores: Symptoms, Activity, and Impacts). Stepwise multiple regression analysis was applied to evaluate the association of EQ-5D-5L and SGRQ-C with respect to clinical and sociodemographic characteristics of the patients.Results: We recruited 386 patients (mean age 71.8 ± 10.3 years, 76.2% males). In the EQ-5D-5L, participants reported greater problems with respect to mobility (56.5%) and pain/discomfort (48.2%). The mean utility was 0.72 ± 0.31, and the SGRQ-C total score was 40.9 ± 25.0. The results of both questionnaires were associated with number of exacerbations in the last 12 months, level of COPD severity, gender, and education level of the patient (p < 0.05).Conclusions: The results for both utility and total SGRQ-C score indicate that having suffered exacerbations in the last year, presenting a higher level of severity, being a woman, and having a low education level are related to worse HRQL in patients with COPD. [ABSTRACT FROM AUTHOR]

The atmosphere close to earth is composed of some major and several minor constituents in the form of gases having different concentrations. Certain substances, i.e., gases and radioactive materials, when disturbed by human activities, may produce undesirable effects on human habitat. The current studies were aimed to assess the concentrations of various constituents from sugar mills and brick kilns and their impact on environment. Seasonal data were recorded during crushing and non-crushing periods of sugar mills; however, brick kilns were operational during both periods. Random sampling was performed for air quality measurement of PM10, NOx, SO2, and data regarding human resource were collected through questionnaires. The results revealed that people exhibited symptoms of cough (26%), COPD (38%), ARI (53%) and hypertension (15.33%) during crushing period. Cough abnormalities expressed low values of 0.75 ± 0.044 and 0.32 ± 0.047 in affected and controlled areas, respectively. The PM10 concentration of 159.8 ± 1.4 and 17.7 ± 0.5 was observed in experimental areas. Systemic examination of children revealed that several children had wax in ear without any hearing abnormality, and normal BMI value was recorded as 18.80 ± 1.38 and 19.37 ± 1.35 for affected and controlled groups, respectively. It is concluded that PM10 concentration was considerable higher in ambient air than other pollutants. Brick kilns and sugar mills are the prime cause of ambient air pollution in urban areas. The environment protection agencies must keep check on new installation of these industries and also ensure proper disposing of their waste material. [ABSTRACT FROM AUTHOR]

This meta-analysis study was performed to examine the relationship between occupational exposure to pesticides and the risk of obstructive pulmonary diseases such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis. This is a systematic review and meta-analysis study. PubMed and Scopus databases were searched for English-language publications. Eight cohort studies and one case–control study were included in the pooled analysis. These studies had a total of 101,353 participants from eleven different countries and were published between 2006 and 2018. The heterogeneity among the studies was high (P < 0.001, I2 = 68.7%). In a random-effects model meta-analysis, a pooled odds ratio (OR) analysis showed that there was a direct relationship between occupational exposure to the pesticides and obstructive pulmonary diseases (OR = 1.33, 95% confidence interval [CI]: 1.21–1.47). A positive significant relationship was also observed between exposure to the pesticides and risk of chronic bronchitis (OR = 1.27, 95% CI: 1.23–1.31). Also, there was a significant relationship between occupational exposure to the pesticides and an increased risk of COPD (OR = 1.44, 95% CI: 1.14–1.81). No evidence of publication bias was found among the studies according to the results of the Egger's test (P of bias = 0.157). Findings of this study show that occupational exposure to pesticides can be associated with an increased risk of obstructive lung diseases including chronic bronchitis and COPD. • An association between the type of pesticide and risk of obstructive lung diseases was shown. • A significant positive risk of chronic bronchitis and occupational exposure to pesticides was observed. • A significant positive risk of chronic obstructive pulmonary disease (COPD) and occupational exposure to pesticides was shown. • COPD diagnosis by GOLD and LLN criteria showed a significant association with occupational exposure to pesticides. [ABSTRACT FROM AUTHOR]

Bronchiolitis obliterans (BO) is a progressive fibrotic process that predominantly affects the small airways and is identified as constrictive bronchiolitis by pathologists. It is commonly associated with allogeneic hematopoietic stem cell transplant (HSCT), lung transplant, exposure to inhaled toxins, post-infectious processes, autoimmune diseases, and sometimes, no known cause. In the latter case, it is referred to as cryptogenic bronchiolitis obliterans. A 52-year-old Hispanic man with a medical history of hypertension, diabetes mellitus, and coronary artery disease was referred to the pulmonary department due to experiencing dyspnea on exertion, intermittent dry cough, and progressive limitation of activities of daily living. Spirometry revealed severe obstructive changes, and chest high-resolution computed tomography showed ground-glass opacities with nodular infiltrates in the upper lobes, leading to a presumptive diagnosis of hypersensitivity pneumonitis. The patient underwent a lung surgical biopsy of the right upper and lower lobes, which revealed extensive constrictive bronchiolitis. Due to the patient's worsening general condition, bilateral lung transplantation succeeded without any further complications. Following the transplantation, the patient showed good recovery and functional improvement. Bronchiolitis obliterans, or constrictive bronchiolitis, has a variable natural history. It is associated with a higher risk of mortality in allogenic HSCT. When BO is secondary to inhalation of toxic gases, it is usually nonprogressive and limited to toxin exposure. Autoimmune diseases or cryptogenic bronchiolitis are rare and have a heterogeneous clinical course. To make a proper diagnosis, clinical history, radiologic and histologic findings must be considered. [ABSTRACT FROM AUTHOR]

Aim. To study the influence of chronic obstructive pulmonary disease (COPD) on post-operation period course in coronary heart disease (CHD) patients after coronary bypass surgery (CBG).Material and methods. Totally, 92 patients included, with CHD. Two groups were formed: 1st — 50 patients with CHD, 2nd — 42 patients with CHD and COPD. We studied the condition of ventilation via bodypletismography method, and registered oxygen consumption at rest and assessed the effectiveness of pulmonary ventilation — oxygen utilization coefficient (OUC2 , mL/L). Via the method of monofactor logistic regression analysis we calculated independent predictors of cardiovascular and respiratory complications during the nearest period of CBG.Results. After CBG the number of in-hospital complications in the 2nd group was higher than in the 1st. In 2nd group there were more prevalent respiratory failure, atrial fibrillation, cerebral function alteration. As predictor for complications after CBG was COPD (OR 2,1; CI 1,7-2,9; p=0,002). Combination of low values of the forced expiration by 1 s (FEV1) — less than 60% from normal with increase of residual volume (RV) more than 130% is significant predictor for the increase of ventilatory support (VS) (OR 2,5; CI 1,9-3,2; p=0,01). At baseline, decrease of OUC2 less than 20 mL/L is also the predictor for RS prolongation (OR 1,9; CI 1,4-2,8; p=0,003).Conclusion. COPD in CHD increases the chances of complicated clinical course of in-hospital period 2,1 times. Such specifics of baseline disorder in ventilation system as decrease FEV1 less than 60% with increase of RV more 130%, and significant decrease of effectiveness of pulmonary ventilation — OUC2 less than 20 mL/L increase chances for RS duration after CBG 2,5 and 1,9 times, respectively.

Introduction: Chronic obstructive pulmonary disease has a guide in charge of prevention and treatment, called the Global Initiative for Chronic Lung Disease, which is annually updated and catalogs pulmonary rehabilitation, within the treatment options., Objective: To describe the effects on clinical variables, functional capacity, anxiety/depression and health-related quality of life in patients with chronic obstructive pulmonary disease, after a pulmonary rehabilitation program, according to the GOLD 2020 classification in a Cali clinic., Materials and Methods: Descriptive, longitudinal study where 79 patients divided into 3 groups were included (B, C and D)., Results: The mean age was 70 years, 69% men. The number of hospitalized days was greater for groups C and D with an average of 8 and 13 days, respectively (p≤0.000). The functional capacity showed a greater distance in group C (421m) and the shortest distance for group D (328m), p≤0.006. In anxiety and depression, group D managed to obtain improvements as well as in the quality of life questionnaire., Conclusion: Group C presented greater functional capacity and better quality of life, group B had better results in clinical variables, and group D had worse clinical condition, functional capacity and quality of life. At the end of pulmonary rehabilitation, group D presented greater changes in functional capacity and quality of life., (Copyright © 2023 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Aim: The aim of this article is to present and discuss the conclusions of a fi nalized pilot project implementing telemedical solutions for COPD management within the senior population in Wrocław and the Lower Silesian Voivodeship during 2022-2023. It also aimed to contribute to the development of innovative strategies to improve care for individuals with COPD through the use of telemedical technologies., Patients and Methods: Materials and methods: An interdisciplinary and comprehensive pilot project in pulmonology was applied, dividing it into health, organizational, and tech-nological areas. The steps and data collection strategy were presented, enabling the implementation of telemedical solutions among COPD patients in Poland., Results: Results: The implementation of telemedical solutions in COPD represented an innovative approach to improving care. Among the main goals of the project were to reduce patient waiting times, enhance disease progress monitoring, and provide access to specialized healthcare through the use of modern telemedical technologies. Various telemedical solutions were implemented, including remote monitoring of health parameters, online consultations with pulmonology specialists, and patient education on self-monitoring of symptoms. The fi nal summary of the materials collected within the described methodology allowed for a holistic view of the implementation of telemedicine in pulmonary healthcare in Poland, using the discussed pilot project as an example., Conclusion: Conclusions: The analysis of the pilot project implementing telemedical solutions in the fi eld of pulmonology in the Polish healthcare sector has shown that telemedicine can improve care for COPD patients. The project's outcomes indicate the potential for reducing patient waiting times and better monitoring of disease progression. However, these aspects require improvement and ref i nement, particularly in terms of systemic solutions.

Drug therapy in patients with obstructive lung diseases - bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) - is aimed at preventing and controlling symptoms, reducing the frequency and severity of exacerbations, improve health status and exercise tolerance. One of the main groups of drugs that can reduce and control symptoms in patients with asthma and COPD are glucocorticosteroids (GCS).

The use of heated and humidified high-flow nasal cannula oxygen (HFNC) is increasingly popular in place of conventional oxygen therapy for patients with acute hypoxemic respiratory failure. HFNC oxygen rapidly alleviates symptoms of respiratory distress and the effort to breathe through several mechanisms, including dead space washout, reduction in inspiratory nasopharyngeal resistance, and a positive airway pressure effect that may generate alveolar recruitment. HFNC oxygen increases the comfort and tolerance of patients and reduces the requirement for respiratory support in patients with respiratory failure. Several studies have shown that HFNC oxygen may also reduce breathing effort and respiratory rate, and increase alveolar ventilation, tidal volume, and exercise tolerance in patients with hypercapnic respiratory failure. Presently described are 2 cases in which a HFNC system was used to successfully manage hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease in 2 patients unable to tolerate conventional noninvasive mechanical ventilation. This report is presented in order to draw attention to the use of HFNC oxygen in patients with hypercapnic respiratory failure. [ABSTRACT FROM AUTHOR]

Purpose: Ophthalmic beta‐blockers, used in the treatment of increased intraocular pressure, are known to cause pulmonary adverse effects. Few, if any, studies have quantified the extent of the problem in a real‐life population. In this nationwide study, we assess the pulmonary safety of patients initiating treatment with ophthalmic beta‐blockers. Methods: Using the Danish Nationwide Registries from 1995 to 2012, we identified all individuals aged 20–90 years who initiated monotherapy with an intraocular pressure‐lowering drug, with or without concomitant obstructive pulmonary disease. Risks of (i) switching to another drug and (ii) new onset of obstructive pulmonary disease during a 90‐day follow‐up were examined by cumulative risk and logistic regression models adjusted for available covariates. Results: The cohort consisted of 97 463 individuals. Odds ratios for drug switch in individuals without concomitant obstructive pulmonary disease (n = 86 568) were as follows: 1.47 for beta‐blockers (95% confidence interval (CI): 1.35–1.61; p < 0.001), 2.68 for parasympathomimetics (95% CI: 2.32–3.10; p < 0.001) and 4.80 for alfa‐2‐agonists (95% CI: 4.17–5.53; p < 0.001). Odds ratios in individuals with concomitant obstructive pulmonary disease (n = 10 895) were as follows: 2.61 for parasympathomimetics (95% CI: 1.83–3.72; p < 0.001), 2.96 for beta‐blockers (95% CI: 2.31–3.78; p < 0.001) and 3.54 for alfa‐2‐agonists (95% CI: 2.56–4.88; p < 0.001). There was no significant association between treatment class and new onset of obstructive pulmonary disease (p = 0.30). Conclusion: Ophthalmic beta‐blockers were associated with an increased risk of drug switch. However, the absolute risk was very small. No increased risk of new onset of obstructive pulmonary disease was found. Our data suggest that more patients might be eligible for ophthalmic beta‐blockers. [ABSTRACT FROM AUTHOR]

Aim. The article presents a review of the literature on comorbidity of chronic obstructive pulmonary disease and coronary heart disease on the occurrence, pathogenetic connection with clinical manifestations. Methods and results. This article analyzed the prevalence of the combination of these diseases, suggesting an important role of the clinician in a timely diagnosis to improve their pharmacotherapeutic approach, management of patients. Also provides an overview of the pathogenetic link between chronic obstructive pulmonary disease and coronary heart disease.

During the course of chronic obstructive pulmonary disease (COPD) and it's progression occurs oxidative stress (OS) is characterized as a shift of pro-/anti-oxidants in the direction of the first link. For a comprehensive evaluation of the operating system used was an integral indicator of prooksidant-/antioxidant systems - a combo of blood. A significant increase in this index during exacerbation of COPD show a sharp imbalance in the pro-/anti-oxidants. Installed opposite changes of indicators of activity of enzymes of the antioxidant protection (AOP) of red blood cells, with a sharp oppression of non-enzymatic link of AOP, which is an additional adverse factor in the functioning of the antioxidant system. Identified significant oxidative changes in patients with COPD give ground to the additional purpose of drug therapy, with strong directional antihypoxic and antioxidant effects.

Purpose To introduce a reproducible, nonenhanced 1H MRI method for rapid in vivo functional assessment of the whole lung at 1.5 Tesla (T). Methods At different respiratory volumes, the pulmonary signal of ultra-fast steady-state free precession (ufSSFP) follows an adapted sponge model, characterized by a respiratory index α. From the model, α reflects local ventilation-related information, is virtually independent from the lung density and thus from the inspiratory phase and breathing amplitude. Respiratory α-mapping is evaluated for healthy volunteers and patients with obstructive lung disease from a set of five consecutive 3D ultra-fast steady-state free precession (ufSSFP) scans performed in breath-hold and at different inspiratory volumes. For the patients, α-maps were compared with CT, dynamic contrast-enhanced MRI (DCE-MRI), and Fourier decomposition (FD). Results In healthy volunteers, respiratory α-maps showed good reproducibility and were homogeneous on iso-gravitational planes, but showed a gravity-dependent respiratory gradient. In patients with obstructive pulmonary disease, the functional impairment observed in respiratory α-maps was associated with emphysematous regions present on CT images, perfusion defects observable on DCE-MRI, and impairments visualized on FD ventilation and perfusion maps. Conclusion Respiratory α-mapping derived from multivolumetric ufSSFP provides insights into functional lung impairment and may serve as a reproducible and normative measure for clinical studies. Magn Reson Med 78:1059-1069, 2017. © 2016 International Society for Magnetic Resonance in Medicine. [ABSTRACT FROM AUTHOR]

Introduction: More than 90% of the deaths caused by chronic obstructive pulmonary disease (COPD) occur in the low- and middle -income countries. The main aim of this study was to investigate the lipid profile levels in COPD patients and examine the correlation of total cholesterol, triglycerides, low-density lipoproteins, high density lipoproteins, and LDL/HDL risk ratio with COPD stages that are developed by the global initiative for chronic obstructive lung disease (GOLD). Materials & Methods: A total of 100 COPD patients including 25 COPD non-smokers were enrolled in this study. The diagnosis of COPD was carried out by using the spirometry following the GOLD guidelines (postbronchodilator forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio < 70% predicted). Accordingly, the patients were divided into four groups based on the severity of their disease in accordance with the GOLD guidelines, including mild COPD (stage I, FEV1 ≥ 80% predicted), moderate COPD (stage II, 50% ≤ FEV1 < 80% predicted), severe COPD (stage III, 30% ≤ FEV1 < 50% predicted), and very severe COPD (stage IV, FEV1 < 30% predicted). The fasting blood samples of lipid profile were collected. The four COPD groups were compared using the ANOVA test. Results: According to the results, the majority 53 patients (53%) were in age group 40 to 60 years with mean age of 60.46 +/-11.56. Most of the patients had moderate to severe airflow obstruction (GOLD stages II and III). The severity of COPD had no significant correlation with the triglycerides, LDL, HDL, and LDL/HDL risk ratio. The mean total cholesterol levels in the stages I and IV were 151.92±32.82 and 128.50 ±21.46 mg/dL, respectively, which was statistically significant (P=0.04). Conclusion: The present study indicates that there was no significant correlation between various lipid profile parameters and severity of COPD. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is a progressive multifactorial systemic skeletal disease resulting from a loss of bone mass and damage of bone structure (microarchitectonics). Chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) are major contributors to the development of osteoporosis.

Objective: To study the effect of obesity on Flow Volume curves of middle aged individuals with obstructive pulmonary disease. Background: Obesity and obstructive pulmonary disease quite often co-exist in the same individual seeking treatment for respiratory illness. Not many studies have been done about the impact of obesity on dynamic respiratory mechanics in patients with obstructive lung disease in South India. Materials & Methods: This is a retrospective cross sectional study where data was collected from the Department of Pulmonary Medicine, JSS hospital, Mysore. 120 normotensive non diabetic subjects in the age group of 40-60 years, were divided into four groups based on their BMI and the presence of obstructive findings. Flow Volume loop, FEV1, FVC and FEV1/ FVC were recorded using computerised spirometer. Results: The measured FEV1/FVC % in obese patients with obstructive findings was significantly lower than in normal BMI patients with obstructive findings. Obese individuals without obstructive findings also showed significantly lower measured FEV1/FVC % than normal BMI individuals without obstructive findings. Conclusion: Obese individuals have more obstruction when compared to even normal BMI individuals with symptoms. As the changes in respiratory mechanics due to obesity are almost completely reversible, early intervention in obese patients with COPD will ensure lower dependence on medicines to manage the respiratory condition.

Garbage collectors areoccupationally exposed to a variety of airborne contaminants. The mainobjective of this study was to evaluate the respiratory health of garbagecollectors. This study was carried out in Fars Province, south of Iran. A groupof 105 garbage collectors and 93 referent subjects were investigated. Astandard questionnaire was administered to both groups. Furthermore, subjectsunderwent Pulmonary Function Tests. The data revealed that a few symptoms ofrespiratory disease were significantly more prevalent among garbage collectors.Likewise, significant decrements were observed in some parameters of pulmonaryfunction such as FEV1and FEV1/FVC ratio among garbage collectors. Theventilatory disorder found in spirometry of garbage collectors was consistentwith that of obstructive pulmonary disease. Our findings indicate that theprevalence of respiratory symptoms as well as impaired lung functionalcapacities were more common among garbage collectors than in their controlcounterparts. This is likely to be attributed to the occupational exposure ofthis group to workplace contaminants, particularly, bioaerosols.

Abstract Since the discovery of alpha‐1 antitrypsin in the early 1960s, several new genes have been suggested to play a role in chronic obstructive pulmonary disease (COPD) pathogenesis. Yet, in spite of those advances, much about the genetic basis of COPD still remains to be discovered. Unbiased approaches, such as genome‐wide association (GWA) studies, are critical to identify genes and pathways and to verify suggested genetic variants. Indeed, most of our current understanding about COPD candidate genes originates from GWA studies. Experiments in form of cross‐study replications and advanced meta‐analyses have propelled the field towards unravelling details about COPD's pathogenesis. Here, we review the discovery of genetic variants in association with COPD phenotypes by discussing the available approaches and current findings. Limitations of current studies are considered and future directions provided.

Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is a complication of pregnancy where the fetus does not achieve its genetic growth potential. FGR is characterized by a pathological retardation of intrauterine growth velocity in the curve of intrauterine growth. However, the FGR definition is still debated, and there is a lack of a uniform definition in the literature. True IUGR, compared to constitutional smallness, is a pathological condition in which the placenta fails to deliver an adequate supply of oxygen and nutrients to the developing fetus. Infants with IUGR, compared to appropriately grown gestational age infants, have a significantly higher risk of mortality and neonatal complications with long-term consequences. Several studies have demonstrated how suboptimal fetal growth leads to long-lasting physiological alterations for the developing fetus as well as for the newborn and adult in the future. The long-term effects of fetal growth retardation may be adaptations to poor oxygen and nutrient supply that are effective in the fetal period but deleterious in the long term through structural or functional alterations. Epidemiologic studies showed that FGR could be a contributing factor for adult chronic diseases including cardiovascular disease, metabolic syndrome, diabetes, respiratory diseases and impaired lung function, and chronic kidney disease. In this review we discussed pathophysiologic mechanisms of FGR-related complications and potential preventive measures for FGR., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Garbage collectors are occupationally exposed to a variety of airborne contaminants. The main objective of this study was to evaluate the respiratory health of garbage collectors. This study was carried out in Fars Province, south of Iran. A group of 105 garbage collectors and 93 referent subjects were investigated. A standard questionnaire was administered to both groups. Furthermore, subjects underwent Pulmonary Function Tests. The data revealed that a few symptoms of respiratory disease were significantly more prevalent among garbage collectors. Likewise, significant decrements were observed in some parameters of pulmonary function such as FEV1and FEV1/FVC ratio among garbage collectors. The ventilatory disorder found in spirometry of garbage collectors was consistent with that of obstructive pulmonary disease. Our findings indicate that the prevalence of respiratory symptoms as well as impaired lung functional capacities were more common among garbage collectors than in their control counterparts. This is likely to be attributed to the occupational exposure of this group to workplace contaminants, particularly, bioaerosols.

Several co-existing diseases and/or conditions (co-morbidities) are present in patients with heart failure (HF), with diverse clinical relevance. Multiple mechanisms may underlie the co-existence of HF and co-morbidities, including direct causation, associated risk factors, heterogeneity, and independence. The complex inter-relationship of co-morbidities and their impact on the cardiovascular system contribute to the features of HF, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). The purpose of this work is to provide an overview of the contribution of major cardiac and non-cardiac co-morbidities to HF development and outcomes, in the context of both HFpEF and HFrEF. Accordingly, epidemiological evidence linking co-morbidities to HF and the effect of prevalent and incident co-morbidities on HF outcome will be reviewed. [ABSTRACT FROM AUTHOR]

Background and objective Quadriceps weakness is seen across all GOLD stages of COPD and is associated with increased morbidity and mortality. As quadriceps weakness is only weakly associated with FEV1, mechanisms other than airflow obstruction are implicated. We tested the hypothesis that insulin resistance contributes to skeletal muscle weakness in people with stable COPD. Methods Fifty-one COPD patients (no exacerbations preceding 6 weeks, no rehabilitation preceding 3 months) without known diabetes mellitus underwent assessment of skeletal muscle, including measurement of quadriceps maximal voluntary contraction ( QMVC). Physical activity was measured for 7 days using a multisensory biaxial accelerometer armband. Insulin resistance ( HOMA2 IR) was calculated from fasting blood glucose and insulin concentrations. Results QMVC was 30 ± 13 kg (74 ± 25% predicted) and 16 (31%) participants had quadriceps weakness. There was a negative univariate correlation between HOMA2 IR and QMVC (r = −0.446, P = 0.002). HOMA2 IR was greater in people with quadriceps weakness (1.59 ± 0.99) than in those without (1.11 ± 0.55, P = 0.032). On multivariate analysis, with age, sex, weight, BODE index and step count per day included in the model, a one-unit increase in insulin resistance was associated with a 5.9 (2.0-9.8)-kg decrease in QMVC ( P = 0.004) and a 4.2 (1.3-14.3)-fold increased risk of quadriceps weakness ( P = 0.02). Conclusion Insulin resistance is associated with skeletal muscle weakness in COPD, independent of potential confounders. Further studies are required to explore underlying mechanisms and determine whether insulin-sensitizing drugs could augment pulmonary rehabilitation in building skeletal muscle strength in COPD. [ABSTRACT FROM AUTHOR]

Background: The burden of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa, but data available for intervention planning are inadequate. We determined the prevalence of selected NCDs and HIV infection, and NCD risk factors in northwestern Tanzania and southern Uganda. Methods: A population-based cross-sectional survey was conducted, enrolling households using multistage sampling with five strata per country (one municipality, two towns, two rural areas). Consenting adults (≥18 years) were interviewed using the WHO STEPS survey instrument, examined, and tested for HIV and diabetes mellitus (DM). Adjusting for survey design, we estimated population prevalences of hypertension, DM, obstructive pulmonary disease, cardiac failure, epilepsy and HIV, and investigated factors associated with hypertension using logistic regression. Results: Across strata, hypertension prevalence ranged from 16 % (95 % confidence interval (CI): 12 % to 22 %) to 17 % (CI: 14 % to 22 %) in Tanzania, and from 19 % (CI: 14 % to 26 %) to 26 % (CI: 23 % to 30 %) in Uganda. It was high in both urban and rural areas, affecting many young participants. The prevalence of DM (1 % to 4 %) and other NCDs was generally low. HIV prevalence ranged from 6 % to 10 % in Tanzania, and 6 % to 12 % in Uganda. Current smoking was reported by 12 % to 23 % of men in different strata, and 1 % to 3 % of women. Problem drinking (defined by Alcohol Use Disorder Identification Test criteria) affected 6 % to 15 % men and 1 % to 6 % women. Up to 46 % of participants were overweight, affecting women more than men and urban more than rural areas. Most patients with hypertension and other NCDs were unaware of their condition, and hypertension in treated patients was mostly uncontrolled. Hypertension was associated with older age, male sex, being divorced/widowed, lower education, higher BMI and, inversely, with smoking. Conclusions: The high prevalence of NCD risk factors and unrecognized and untreated hypertension represent major problems. The low prevalence of DM and other preventable NCDs provides an opportunity for prevention. HIV prevalence was in line with national data. In Tanzania, Uganda and probably elsewhere in Africa, major efforts are needed to strengthen health services for the PREVENTION, early detection and treatment of chronic diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND:: Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. METHODS:: This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. RESULTS:: The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (PEmax 21.49 cm H2O, 95% CI 13.39-29.59) and maximum inspiratory pressure (PImax 7.68 cm H2O, 95% CI 0.90-14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI -39.62 to 97.65) and dyspnea (0.15, 95% CI -0.77 to 1.08). In relation to EMT plus IMT, we observed that PEmax (31.98 cm H2O, 95% CI 26.93-37.03) and PImax (27.98 cm H2O, 95% CI 20.10-35.85) presented higher values compared to control groups. CONCLUSIONS:: EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD. [ABSTRACT FROM AUTHOR]