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The coexistence of expiratory central airway collapse and diaphragmatic paralysis presents a diagnostic and treatment challenge. Both entities are underrecognized causes of dyspnea, cough, sputum production, and orthopnea. Optimal treatment must be individualized and is best achieved by a multidisciplinary team. We present a case of a patient with profound functional impairment from dyspnea and hypoxemia due to expiratory central airway collapse, complicated by bronchiectasis from recurrent respiratory infections, and diaphragmatic paralysis.

Untreated active tuberculosis (TB) has a very high long-term mortality. Treatment of TB reduces mortality dramatically and should maximize cure, preventing ongoing transmission and TB sequelae. However, predicting the risk of failure and relapse is crucial for the management of individual patients and for the evaluation of effectiveness of programs. Various outcome definitions for drug-sensitive and drug-resistant TB were developed, implemented, and endorsed since introduction of TB chemotherapy by the World Health Organization (WHO), mostly based on culture and smear results. They should be applicable for individual patient care, surveillance, and research. Definitions with focus on program evaluation differ from definitions to evaluate the efficacy and effectiveness of regimens. Lack of sputum production at the later stage of treatment reduces the easy applicability of current definitions. Definitions of failure and cure are sometimes difficult to apply. Alternative approaches suggest culture positivity at 6 months or more of treatment as an indicator for failure. New definitions for cure including a relapse-free period posttreatment and reduced number of culture and smear results are considered. Increasing variation and individualization of treatment and its duration urgently require new approaches using pathogen- or host-specific biomarkers, which indicate risk of failure and define cure. Such biomarkers are under evaluation but still far from translation in clinical routine practice.

In patients with bronchiectasis, a high-resolution CT scan (HRCT) and its score play a significant role in identifying pathological alterations and pulmonary functional impairment. A total of 50 cases were studied. All the cases presenting with the features suggestive of bronchiectasis were screened clinically . 8 out of 50 patients underwent surgical resection of affected lobes. The rest was handled with caution. The primary condition, lung malignancy, claimed the life of one patient. CT can be used to quickly confirm suspected bronchiectasis due to its increased specificity. Confirmation by CT is useful in the management of patients with chronic cough and sputum production who are suspected of having bronchiectasis but for whom surgery is not an option due to age or poor lung function. In some cases, where surgery appears to be a viable option, unmistakable evidence of bilateral bronchiectasis on CT would rule out such treatment without the requirement for bronchography.

Case Presentation A 48-year-old man presented with 6 months of progressive shortness of breath, intermittent exertional left-sided chest pain, and bilateral lower extremity edema. During the 2 days before admission, he experienced new onset confusion, fatigue, and malaise that prompted evaluation. He denied fever, chills, cough, or sputum production. He used anabolic steroids for 20 years as part of his bodybuilding hobby. Recently, he also began injecting mineral oil into his pectoral, bicep, and shoulder muscles for an improved muscular appearance. Additionally, he had a history of provoked DVT after traumatic fracture, schizophrenia, hypertension, and epilepsy. He was a former cigarette smoker with 2.5 pack-year history, having quit 10 years earlier. The patient’s occupation was construction, installing aluminum gutters. He specifically denied exposures to sand-blasting, coal, beryllium, hard metals, silicone, and fine particles. He had no recent travel, sick contacts, or animal exposures.

Cough is the most common symptom leading people to seek medical attention and, therefore, its clinical management is of fundamental importance. Management of chronic cough relies on identification and treatment of the background disorder maintaining the cough. Asthma, upper airway cough syndrome (UACS; previously called postnasal drip syndrome or chronic rhinosinusitis) and gastro-oesophageal reflux disease (GORD) are the most common background disorders in chronic cough [1]., Sputum production may suggest asthma as the most probable background disorder maintaining the cough https://bit.ly/2Qk8aar

Background This study aims to investigate the comparative clinical characteristics of Covid-19 and non-Covid-19 patients. Methods Fifteen Covid-19 and 93 non-Covid-19 patients were included in RNA testing. All epidemiological and clinical data were collected and analyzed, and then comparative results were carried out. Results Covid-19 patients were older (46.40 ± 18.21 years vs 34.43 ± 18.80 years) and had a higher body weight (70.27 ± 10.67 kg vs 60.54 ± 12.33 kg, P P 9/L vs 7.43 × 109/L) and lymphocyte count (0.90 × 109/L vs 1.57 × 109/L, P P P Conclusion Our results suggested that Covid-19patients had a significant history of exposure and familial clustering and a higher rate of severe status; biochemical indicators showed lymphocyte depletion.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is common among non-smokers exposed to solid fuel combustion at home. Different clinical characteristics in these patients may have significant therapeutic and prognostic implications.METHODS: We used medical record review and a questionnaire among COPD patients at 15 centres across India to capture data on demographic details, different types of exposures and clinical characteristics. Chest radiography and pulmonary function testing were performed in all 1984 cases; C-reactive protein and exhaled breath nitric oxide were measured wherever available.RESULTS: There were 1388 current or ex-smokers and 596 (30.0%) non-smokers who included 259 (43.5%) male and 337 (56.5%) female patients. Sputum production was significantly more common in smokers with COPD (P < 0.05). The frequency of acute symptomatic worsening, emergency visits and hospitalisation were significantly higher (P < 0.05) in non-smokers with COPD; however, intensive care unit admissions were similar in the two groups. There was no significant difference with respect to the use of bronchodilators, inhalational steroids or home nebulisation among smoker and non-smoker patients. The mean predicted forced expiratory volume in 1 sec in smokers (43.1%) was significantly lower than in non-smokers (46.5%).CONCLUSION: Non-smoker COPD, more commonly observed in women exposed to biomass fuels, was characterised by higher rate of exacerbations and higher healthcare resource utilisation.

The article investigates the causes and mechanisms of coughing and the treatment choice. Phytotherapy has a special role in the treatment of acute respiratory infections. Biologically active substances of plants integrate into metabolic processes more naturally, treatment with herbal medicines is distinguished by better tolerance, lower frequency of side effects and complications. High biological activity and a wide therapeutic index (the relationship between toxic and therapeutic dosing) can also be designated as advantages of medicinal plants. The article presents research data showing the miscellaneous effects of herbal medicines on the pathogenesis of cough: sputum production, improving the drainage function of the bronchi, as well as antimicrobial effect. The article discusses the pharmacological properties of drugs containing combinations of herbal extracts as active ingredients: thyme, ivy and primrose. Thyme has anti-inflammatory, antiviral and antibacterial effects due to blocking the growth of various strains of bacteria and fungi. Ivy leaf extract is characterized by similar properties. Primrose root extract has expectorant, secretolytic, anti-inflammatory and antiviral properties. It is important to note that the use of a combination of extracts provides a more significant clinical effect compared to the sum of the effects of the individual ingredients. A review of key clinical studies confirming the effectiveness of the use of combinations of thyme, ivy and primrose extracts (approved for medical use in the Russian Federation in the form of drugs Bronchipret and Bronchipret TP) in adults and children for cough and other symptoms of acute respiratory infections treatment. The compatibility of herbal medicines with other drugs for the treatment of respiratory pathology has been noted.

COPD, chronic bronchitis (CB) and active smoking have all been associated with goblet cell hyperplasia (GCH) in small studies. Active smoking is strongly associated with CB, but there is a disconnect between CB clinical symptoms and pathology. Chronic cough and sputum production poorly correlate with the presence of GCH or COPD. We hypothesized that the primary determinant of GCH in ever smokers with or without airflow obstruction is active smoking. Goblet Cell Density (GCD) was measured in 71 current or former smokers [32 subjects without COPD and 39 COPD subjects]. Endobronchial mucosal biopsies were stained with Periodic Acid Schiff-Alcian Blue, and GCD was measured as number of goblet cells/mm basement membrane. GCD was divided into tertiles based on log10 transformed values. Log10GCD was greater in current smokers compared to former smokers. Those with classically defined CB or SGRQ defined CB had a greater log10 GCD compared to those without CB. Current smoking was independently associated with tertile 3 (high log10GCD) whereas CB was not in multivariable regression when adjusting for lung function and demographics. These results suggest that GCH is induced by active smoke exposure and does not necessarily correlate with the clinical symptoms of CB.

Key characteristics of chronic obstructive pulmonary disease (COPD) that significantly affect health-related quality of life (HRQoL) include chest symptoms, dyspnea, cough, sputum production, and exacerbations. Additional areas of impact are sleep, fatigue, emotional well-being, social functioning, and coping. Patient-reported outcomes (PROs) are essential to evaluate symptoms, impact of symptoms on activities of daily living, and treatment response. This review summarizes COPD-specific PRO endpoints from randomized controlled trials of approved and commonly used COPD drugs. A search conducted in "ClinicalTrials.gov" to identify COPD clinical trials (only completed Phase III and IV) incorporating PRO endpoints yielded a total of 104 clinical trials for inclusion in this analysis. Both symptom-based and HRQoL-specific PRO measures were reported. Several COPD-specific PRO measures are available; however, the St. George's Respiratory Questionnaire (SGRQ) and the Baseline and Transition Dyspnea Indexes (BDI/TDI) were reported in the majority of the studies. Results reflected a gap in terms of full coverage of key impacted areas from a patient's perspective. Methodological issues identified in this review related to scoring of instruments require careful consideration, as these challenges may limit the complete assessment of drug benefits. Selection of PRO measures aligned with the expected treatment benefit of a drug in a clinical trial should reflect patients' perspective holistically.

Background Evidence for the diagnosis and management of cough due to acute bronchitis in immunocompetent adult outpatients was reviewed as an update to the 2006 "Chronic Cough Due to Acute Bronchitis: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines." Methods Acute bronchitis was defined as an acute lower respiratory tract infection manifested predominantly by cough with or without sputum production, lasting no more than 3 weeks with no clinical or any recent radiographic evidence to suggest an alternative explanation. Two clinical population, intervention, comparison, outcome questions were addressed by systematic review in July 2017: (1) the role of investigations beyond the clinical assessment of patients presenting with suspected acute bronchitis, and (2) the efficacy and safety of prescribing medication for cough in acute bronchitis. An updated search was undertaken in May 2018. Results No eligible studies relevant to the first question were identified. For the second question, only one relevant study met eligibility criteria. This study found no difference in number of days with cough between patients treated with an antibiotic or an oral nonsteroidal antiinflammatory agent compared with placebo. Clinical suggestions and research recommendations were made based on the consensus opinion of the CHEST Expert Cough Panel. Conclusions The panelists suggested that no routine investigations be ordered and no routine medications be prescribed in immunocompetent adult outpatients first presenting with cough due to suspected acute bronchitis, until such investigations and treatments have been shown to be safe and effective at making cough less severe or resolve sooner. If the cough due to suspected acute bronchitis persists or worsens, a reassessment and consideration of targeted investigations should be considered.

Introduction High-frequency chest wall oscillation (HFCWO) is a commonly prescribed airway clearance technique (ACT) for patients whose ability to expectorate sputum is compromised. This study aimed to assess the effectiveness of a newly developed mobile ACT device (mHFCWO-The Monarch Airway Clearance System) in patients with cystic fibrosis (CF). A standard nonmobile HFCWO device (sHFCWO) was used as a comparator. Methodology This was a randomized, open-label, crossover pilot study. CF patients were treated with each device. Sputum was collected during and after each therapy session, while spirometry tests, Brody score assessment and functional respiratory imaging were performed before and after treatments. Results Wet weight of sputum collected during and after treatment was similar for mHFCWO and sHFCWO (6.53 +/- 8.55 vs 5.80 +/- 5.82; P = .777). Interestingly, the mHFCWO treatment led to a significant decrease in specific airway volume (9.55 +/- 9.96 vs 8.74 +/- 9.70 mL/L; P < .001), while increasing specific airway resistance (0.10 +/- 0.16 vs 0.16 +/- 0.23 KPA*S; P < .001). These changes were heterogeneously-distributed throughout the lung tissue and were greater in the distal areas, suggesting a shift of mucus. Changes were accompanied by an overall improvement in the Brody index (57.71 +/- 16.55 vs 55.20 +/- 16.98; P = .001). Conclusion The newly developed mobile device provides airway clearance for CF patients comparable to a nonmobile sHFCWO device, yielding a change in airway geometry and patency by the shift of mucus from the more peripheral regions to the central airways.

Background: The proportion of recurrences after discharge among patients with coronavirus disease 2019 (COVID-19) was reported to be between 9.1% and 31.0%. Little is known about this issue, however, so we performed a meta-analysis to summarize the demographical, clinical, and laboratorial characteristics of non-recurrence and recurrence groups. Methods: Comprehensive searches were conducted using eight electronic databases. Data regarding the demographic, clinical, and laboratorial characteristics of both recurrence and non-recurrence groups were extracted, and quantitative and qualitative analyses were conducted. Results: Ten studies involving 2071 COVID-19 cases were included in this analysis. The proportion of recurrence cases involving patients with COVID-19 was 17.65% (between 12.38% and 25.16%) while older patients were more likely to experience recurrence (weighted mean difference (WMD)=1.67, range between 0.08 and 3.26). The time from discharge to recurrence was 13.38 d (between 12.08 and 14.69 d). Patients were categorized as having moderate severity (odds ratio (OR)=2.69, range between 1.30 and 5.58), while those with clinical symptoms including cough (OR=5.52, range between 3.18 and 9.60), sputum production (OR=5.10, range between 2.60 and 9.97), headache (OR=3.57, range between 1.36 and 9.35), and dizziness (OR=3.17, range between 1.12 and 8.96) were more likely to be associated with recurrence. Patients presenting with bilateral pulmonary infiltration and decreased leucocyte, platelet, and CD4+ T counts were at risk of COVID-19 recurrence (OR=1.71, range between 1.07 and 2.75; WMD=−1.06, range between −1.55 and −0.57, WMD=−40.39, range between −80.20 and −0.48, and WMD=−55.26, range between −105.92 and −4.60, respectively). Conclusions: The main factors associated with the recurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after hospital discharge were older age, moderate severity, bilateral pulmonary infiltration, laboratory findings including decreased leucocytes, platelets, and CD4+ T counts, and clinical symptoms including cough, sputum production, headache, and dizziness. These factors can be considered warning indicators for the recurrence of SARS-CoV-2 and might help the development of specific management strategies.

Background Smoking and occupational airborne exposures are known to increase asthma symptoms, but less is known about their influence by the age of asthma diagnosis. Objective To evaluate the effect of exposures to VGDF (vapors, gases, dusts and fumes), tobacco smoke and their combination for asthma symptoms comparing subjects with asthma diagnosed in childhood and adulthood. Methods A random sample of 16 000 adults aged 20–69 years were invited to a postal survey on obstructive pulmonary diseases in Finland in 2016. Those reporting physician-diagnosed asthma and age at diagnosis were included in the analysis and their reported VGDF-exposure and smoking habits were analyzed. Age 18 years was chosen to delineate child- and adult-diagnosed asthma. Results 8199 (51.5%) responded. Of the responders, 831 reported physician-diagnosed asthma. 41% of asthmatics reported child-diagnosed and 59% adult-diagnosed asthma. Current smoking was reported by 25.2% and 20.2% and VGDF exposure by 31.3% and 44.7% in child -diagnosed and adult-diagnosed asthma, respectively. Combined VGDF-exposure and current smoking was reported by 9.7% and 10.6%, respectively. Compared to the unexposed, those with asthma diagnosed in childhood and with combined current smoking and VGDF exposure, had higher prevalence of wheeze (69.7% vs 39.5%, p=0.009), sputum production (39.4% vs 11.4%, p=0.001) and morning dyspnea (42.4% vs 21.9%, p=0.002). Corresponding pattern was seen in those with asthma diagnosed in adulthood; for wheeze (78.8% vs 53.6%, p=0.007), sputum production (40.4% vs 25.0%, p=0.014) and morning dyspnea (65.4% vs 42.0%, p=0.008). Child-diagnosed asthmatics both without exposure history (46.5% vs 69.6%, p=0.001) and with combined exposure to smoking and VGDF (66.7% vs 94.2%, p=0.003) reported less often ≥3 symptoms compared to adult-diagnosed asthmatics, even though they reported less frequently use of asthma medication (60.7% vs 82.0%, p>0.001). Smoking asthmatics with adult-diagnosis and exposure to VGDF had the highest prevalence estimates of having multiple symptoms (94.2%) in our study. Conclusion Although asthmatics diagnosed in child- and adulthood reported symptoms related to exposure to smoking and VGDF, symptoms were reported more often by those with adult diagnosis. The results indicate the importance of targeted asthma treatment and follow-up by patient’s exposure history and asthma diagnosis age.

The aim of this study was to improve efficacy of treatment of patients with comorbidity of chronic obstructive pulmonary disease and hypertension using laser and ultrasonic therapy (LUST). Methods. The study involved 68 patients with comorbid acute exacerbation of moderate COPD (AECOPD) and hypertension. Main clinical, laboratory and functional parameters, lung function, systemic blood pressure, and biomarkers of systemic inflammation were analyzed. The study group was treated with the standard pharmacological therapy and LUST, the control group was treated with the standard pharmacological therapy only. Results. Clinical symptoms, such as cough, sputum production and sputum volume, and dyspnea, significantly improved over 5 – 6 days of the treatment and maintained through all study period. Lung function and arterial blood pressure significantly improved in the study group compared to controls. Biomarkers of the systemic inflammation, such as IL-4,IL-8 and TNFα, were higher in both groups at baseline compared to healthy subjects and significantly decreased to the end of treatment in the study group compared to the control group. Conclusion. The combined standard pharmacological therapy plus LUST in patients with AECOPD was associated with significantly greater clinical improvement in clinical symptoms, lung function, arterial blood pressure and systemic inflammation.

Case Presentation A 73-year-old man presented to the ED of an outside hospital with asymptomatic chest wall swelling 10 h after discharge from our hospital. Four days earlier, he had presented to our hospital with increased dyspnea, cough, and sputum production. His history was notable for severe COPD with bullous emphysema. Chest imaging demonstrated bilateral opacities and a collection of gas and liquid in the major fissure of the left lung. A catheter was placed into the collection of gas and liquid under imaging guidance. After 4 days, the catheter was removed without event and the patient was discharged from the hospital with an extended course of antibiotics. Imaging performed in the ED revealed gas in the tissues of the chest wall and no evidence of a pneumothorax. He was transported back to our hospital by helicopter.

Problem of cough treatment at the background of acute respiratory infections in children was discussed in an article. We presented possibility of plant origin drugs usage in case of acute cough symptom presence. We examined efficacy of syrup Ivy in case of acute respiratory diseases in 40 children from 3 up to 10 years of age that passed treatment in infection-diagnostic department of Vinnytsya regional children’s hospital. We analyzed results of the syrup Ivy usage in patients with acute cough in case of acute respiratory infections with evaluation of the clinical dynamic. Duration and quality changes of the cough, its influence on quality of life, night dreaming were detected. Efficacy of syrup Ivy was checked by comparing of main and control groups. In 92% patients of the main group on the 10 day of the disease cough disappeared completely, in control group – results achieved in 62%. It confirms positive influence of the drug on general condition of the child and clinical manifestation of the disease, sputum production, characteristics of the cough its frequency, etc. Usage of Ivy syrup confirmed clinical efficacy as mucolytic, broncholytic and anti-inflammatory drug for children with symptoms of acute cough in a complex treatment of respiratory system.

Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategies. These therapies are in an early phase of clinical research and larger randomised controlled trials are needed to confirm the pilot data available and to evaluate the treatment durability. The fourth technique, targeted lung denervation (TLD), aims to decrease the release of acetylcholine, which regulates smooth muscle tone and mucus production by ablating the parasympathetic nerves running alongside the main bronchi. Evaluation of this treatment is at a more advanced stage and promising effects on exacerbation frequency have been shown. However, confirmation of the benefit in improvement in chronic bronchitis symptoms is still needed.

BackgroundA standardised framework for selecting outcomes for evaluation in trials has been proposed by the Core Outcome Measures in Effectiveness Trials working group. However, this method does not specify how to ensure that the outcomes that are selected are causally related to the disease and the health intervention being studied. Causal network diagrams may help researchers identify outcomes that are both clinically meaningful and likely to be causally dependent on the intervention, and endpoints that are, in turn, causally dependent on those outcomes. We aimed to (1) develop a generalisable method for selecting outcomes and endpoints in trials and (2) apply this method to select outcomes for evaluation in a trial investigating treatment strategies for pulmonary exacerbations of cystic fibrosis (CF).MethodsWe conducted a series of online surveys and workshops among people affected by CF. We used a modified Delphi approach to develop a consensus list of important outcomes. A workshop involving domain experts elicited how these outcomes were causally related to the underlying pathophysiological processes. Meaningful outcomes were prioritised based on the extent to which each outcome captured separate rather than common aspects of the underlying pathophysiological process.ResultsThe 10 prioritised outcomes were: breathing difficulty/pain, sputum production/clearance, fatigue, appetite, pain (not related to breathing), motivation/demoralisation, fevers/night sweats, treatment burden, inability to meet personal goals and avoidance of gastrointestinal symptoms.ConclusionsThis proposed method for selecting meaningful outcomes for evaluation in clinical trials may improve the value of research as a basis for clinical decisions.

There are only a few case reports of Q fever caused by Coxiella burnetii in China, despite the nature as a ubiquitous zoonotic disease worldwide. In the northeast part of China, a 52-year-old male presented with fever, cough, shortness of breath, and sputum production, accompanied by headache, dizziness, chill, myalgia, and arthralgia. Chest computed tomography images showed pneumonia accompanied by bilateral scattered infiltrates and localized upper-lobe emphysema. The abnormal liver function was indicated by the increased levels of alanine aminotransferase and aspartate aminotransferase. Through high-throughput sequencing and molecular detection, Coxiella burnetii was positive in the patient's blood specimens. After treatment with moxifloxacin hydrochloride and vidarabine monophosphate for 12 days, the patient completely recovered. To our knowledge, this was the first reported case of Q fever with pneumonia and hepatitis in this country.

Background New coronavirus disease 2019 (COVID-19) has posed a severe threat to human life and caused a global pandemic. The current research aimed to explore whether the search-engine query patterns could serve as a potential tool for monitoring the outbreak of COVID-19. Methods We collected the number of COVID-19 confirmed cases between January 11, 2020, and April 22, 2020, from the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). The search index values of the most common symptoms of COVID-19 (e.g., fever, cough, fatigue) were retrieved from the Baidu Index. Spearman’s correlation analysis was used to analyze the association between the Baidu index values for each COVID-19-related symptom and the number of confirmed cases. Regional distributions among 34 provinces/ regions in China were also analyzed. Results Daily growth of confirmed cases and Baidu index values for each COVID-19-related symptom presented robust positive correlations during the outbreak (fever: rs=0.705, p=9.623× 10− 6; cough: rs=0.592, p=4.485× 10− 4; fatigue: rs=0.629, p=1.494× 10− 4; sputum production: rs=0.648, p=8.206× 10− 5; shortness of breath: rs=0.656, p=6.182× 10–5). The average search-to-confirmed interval (STCI) was 19.8 days in China. The daily Baidu Index value’s optimal time lags were the 4 days for cough, 2 days for fatigue, 3 days for sputum production, 1 day for shortness of breath, and 0 days for fever. Conclusion The searches of COVID-19-related symptoms on the Baidu search engine were significantly correlated to the number of confirmed cases. Since the Baidu search engine could reflect the public’s attention to the pandemic and the regional epidemics of viruses, relevant departments need to pay more attention to areas with high searches of COVID-19-related symptoms and take precautionary measures to prevent these potentially infected persons from further spreading.

Background Chronic sputum production in the general population is historically associated with clinical indices including male sex and smoking history. However, its relationship with gastroesophageal reflux disease (GERD), which may prove an underlying factor in sputum production, is unclear. We aimed to clarify factors associated with sputum production in the general population in cross-sectional and longitudinal manners. Methods In the Nagahama study, a community-based cohort study, 9804 subjects were recruited between 2008 and 2010 (baseline assessment), 8293 of whom were followed from 2013 to 2015 (follow-up assessment). This study contained a self-completed questionnaire which included medical history, assessment of sputum production, and a frequency scale for symptoms of GERD. A Frequency Scale for Symptoms of Gastroesophageal Reflux Disease score of ≥ 8 was defined as GERD. In addition to the frequency of sputum production at each assessment, frequency of persistent sputum production defined as sputum production at both assessments was examined. Results Frequency of sputum production was 32.0% at baseline and 34.5% at follow-up. Multivariable analysis demonstrated that sputum production at baseline was significantly associated with GERD [odds ratio (OR), 1.92; 95% confidence interval (CI) 1.73–2.13] and post-nasal drip (PND) (OR, 2.40; 95% CI 2.15–2.68), independent of other known factors such as older age, male sex and smoking history. These associations between sputum production and GERD or PND were also observed at follow-up. In longitudinal analysis, 19.4% had persistent sputum production and 12.3% had transient sputum production, i.e., at baseline only. Multivariable analysis for risk of persistence of sputum production revealed that persistent sputum production was associated with GERD and PND, in addition to the known risk factors listed above. The proportion of subjects with GERD at both assessments was highest among subjects with persistent sputum production. Conclusions Cross-sectional and longitudinal analysis demonstrated an association in the general population between sputum production and GERD, as well as PND, independent of known risk factors. The presence of GERD should be assessed in patients complaining of sputum production.

Background There currently is a lack of easy-to-use instruments with which to assess cough. The aim of the present study was to develop a scale for measuring the characteristics of cough and sputum. Methods The authors developed a scale for assessing cough, including aspects such as intensity, frequency, physical impact, psychosocial impacts and sputum characteristics. The first four components were scored using a Cough Index, with a range of 0 to 20. Sputum information included volume, appearance, and hemoptysis. The scale was administered to 105 patients and re-administered to 51 about two weeks later. The patients also reported cough frequency and intensity using a 100-mm visual analogue scale (VAS) and answered the Leicester Cough Questionnaire (LCQ). Additionally, 12 patients with acute exacerbation (AE) of chronic airways disease were interviewed upon admission to and discharge from the hospital. Results Analysis identified only one factor for the Cough Index, and Cronbach's alpha value was 0.819. Cough Index was significantly correlated with VASfrequency (r = 0.651, p Conclusion The Multidimensional Cough Index condenses complex aspects related to cough and sputum production into a single instrument, with satisfactory validation.

The coronavirus (COVID-19) is considered a global pandemic with several respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The main symptoms of COVID-19 are fever, cough, and fatigue, while other symptoms include sputum production, diarrhea and alterations on the gastrointestinal system. The COVID-19 was recently identified in the saliva of infected patients and the transmission through of droplets and aerosols generated during clinical dental care is possible among dentists, oral health assistants and/or oral health technicians and others around the social cycle of the friendship of these health professionals, such as families and colleagues. Thus, there is very necessary to improve the several types of prevention to healthcare professionals that realize the liberation of aerosol during oral assistance. It’s important to mention that these precautions are important to prevent human-to-human transmission and protect the global system of health. In addition, this care is essential to decrease the spread of COVID-19 in this moment. Descriptors: Coronavirus Infections; Dentistry; Occupational Diseases.ReferencesLi LY, Wu W, Chen S, Gu JW, Li XL, Song HJ et al. Digestive system involvement of novel coronavirus infection: Prevention and control infection from a gastroenterology perspective. J Dig Dis. 2020;21(4):199-204. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-73.Gabutti G, d'Anchera E, Sandri F, Savio M, Stefanati A. Coronavirus: update related to the current outbreak of COVID-19. Infect Dis Ther. 2020;9(2):1-13.Liu L, Wei Q, Alvarez X, Wang H, Du Y, Zhu H et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. J Virol. 2011;85(8):4025-30.To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JMC et al. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect Dis. 2020;71(15):841-43.Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020;24(4):1619-21.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-69.Brazilian Ministry of Health. https://saude.gov.br/Brazilian Institute of Geography and Statistic. https://www.ibge.gov.br/Lauc G, Sinclair D. Biomarkers of biological age as predictors of COVID-19 disease severity. Aging (Albany NY). 2020;12(8):6490-91.Federal Council of Dentistry from Brazil. http://website.cfo.org.br/dados-estatisticos-de-profissionais-e-entidades-ativas-por-ano/Regional Dentistry Council of the State of São Paulo. http://www.crosp.org.br/intranet/estatisticas/estMunicipios.phpThompson RN. Novel Coronavirus Outbreak in Wuhan, China, 2020: Intense Surveillance Is Vital for Preventing Sustained Transmission in New Locations. J Clin Med. 2020;9(2):498.

Background: Bronchiectasis is known to be associated with COPD. We studied which degree of radiological alterations was associated with clinical signs of bronchiectasis in COPD. Methods: Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was analysed. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0-2), resulting in a total score of 0-12. We also included data from disease-specific questionnaires, medication, and lung function. Results: 1176 patients were included (mean age 67.3y, 61.1% males), among them 38 (3.2%) with patient-reported physicians’ diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). 429 patients had CT scans, with any signs of bronchiectasis in 46.6%, less than 50% bronchiectasis in ≤2 lobes in 18.6%, in 3-4 lobes in 10.0%, in 5-6 lobes in 15.9%, and more than 50% bronchiectasis in at least 1 lobe in 2.1%. Scores ≥4 were linked to elevated FRC/RV. Links to sputum production, composition (n=105) or inflammatory indices were borderline or absent. Triple therapy was associated with symptoms, but not radiological signs of bronchiectasis. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. AA1D was associated with radiological signs of bronchiectasis and only borderline with the clinical diagnosis. Conclusion: Clinical diagnosis and radiological signs of bronchiectasis showed only weak correlations in COPD patients. For a significant correspondence to symptoms and diagnosis, a threshold CT score implying radiological alterations in several lobes was needed, which was about one third of the maximum score.

Chronic bronchitis is a chronic, progressive disease that is difficult to treat. Despite much effort, patients remain highly symptomatic. Currently, a number of innovative bronchoscopic treatments for this disease are under investigation. Liquid nitrogen metered cryospray, bronchial rheoplasty and balloon desobstruction all aim to destroy the hyperplastic goblet cells and excess submucous glands using different strategies. These therapies are in an early phase of clinical research and larger randomised controlled trials are needed to confirm the pilot data available and to evaluate the treatment durability. The fourth technique, targeted lung denervation (TLD), aims to decrease the release of acetylcholine, which regulates smooth muscle tone and mucus production by ablating the parasympathetic nerves running alongside the main bronchi. Evaluation of this treatment is at a more advanced stage and promising effects on exacerbation frequency have been shown. However, confirmation of the benefit in improvement in chronic bronchitis symptoms is still needed.

Pseudomonas aeruginosachronic lung infections in individuals with cystic fibrosis (CF) significantly reduce quality of life and increase morbidity and mortality. Tracking these infections is critical for monitoring patient health and informing treatments. We are working toward the development of novel breath-based biomarkers to track chronicP. aeruginosalung infectionsin situ. Using comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry (GC×GC-TOFMS), we characterized thein vitrovolatile metabolomes (or volatilomes) of 81P. aeruginosaisolates collected from 17 CF patients over at least a five-year period of their chronic lung infections. We detected 539 volatiles produced by theP. aeruginosaisolates, 69 of which were core volatiles that were highly conserved. We found that each early infection isolate has a unique volatilome, and as infection progresses, the volatilomes of isolates from the same patient become increasingly dissimilar, to the point that these intra-patient isolates are no more similar to one another than to isolates from other patients. We observed that the size and chemical diversity ofP. aeruginosavolatilomes do not change over the course of chronic infections; however, the relative abundances of core hydrocarbons, alcohols, and aldehydes do change, and are correlated to changes in phenotypes associated with chronic infections. This study indicates that it may be feasible to trackP. aeruginosachronic lung infections by measuring changes to the infection volatilome, and lays the groundwork for exploring the translatability of this approach to direct measurement using patient breath.IMPORTANCEPseudomonas aeruginosais a leading cause of chronic lung infections in cystic fibrosis (CF), and are correlated with lung function declines. Significant clinical efforts are, therefore, aimed at detecting infections and tracking them for phenotypic changes, such as mucoidy and antibiotic resistance. Both the detection and tracking of lung infections relies on sputum cultures, but due to improvements in CF therapies, sputum production is declining though risks for lung infections persist. Therefore, we are working toward the development of breath-based diagnostics for CF lung infections. In this study we characterized of the volatile metabolomes of 81P. aeruginosaclinical isolates collected from 17 CF patients over a duration of at least five years of a chronic lung infection. We found that the volatilome ofP. aeruginosaadapts over time, and correlates to infection phenotype changes, suggesting it may be possible to track chronic CF lung infections with a breath test.

Bronchiectasis is a chronic respiratory disease with neutrophilic airway inflammation playing a prominent role in its pathophysiology [1]. The inflammatory process depends on the release of neutrophil elastase (NE) and subsequent formation of neutrophil extracellular traps to facilitate the neutralisation of pathogens. An excessive release of NE can lead to several damaging lung effects, including mucus gland stimulation, increase in sputum production, impairment in ciliary beat frequency, and extracellular matrix and airway epithelia destruction. The activity of NE (aNE) has been previously evaluated in sputum samples of a Scottish cohort of bronchiectasis patients [2]. The authors demonstrated that increased levels of aNE in sputum are associated with disease severity and poor clinical outcomes. This experience identified NE as one of the most promising biomarkers in bronchiectasis and, subsquently, a point-of-care assay for aNE was validated [3]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Gramegna has nothing to disclose. Conflict of interest: Prof. Aliberti reports grants and personal fees from Bayer Healthcare, grants and personal fees from Aradigm Corporation, grants and personal fees from Grifols, personal fees from Astra Zeneca, personal fees from Basilea, personal fees from Zambon, personal fees from Novartis, personal fees from Raptor, grants and personal fees from Chiesi, personal fees from Actavis UK Ltd, personal fees from Horizon, grants and personal fees from INSMED, outside the submitted work. Dr. Aliberti reports grants and personal fees from Bayer Healthcare, grants and personal fees from Aradigm Corporation, grants and personal fees from Grifols, personal fees from Astra Zeneca, personal fees from Basilea, personal fees from Zambon, personal fees from Novartis, personal fees from Raptor, grants and personal fees from Chiesi, personal fees from Actavis UK Ltd, personal fees from Horizon, grants and personal fees from INSMED, outside the submitted work. Dr. Aliberti reports grants and personal fees from Bayer Healthcare, grants and personal fees from Aradigm Corporation, grants and personal fees from Grifols, personal fees from Astra Zeneca, personal fees from Basilea, personal fees from Zambon, personal fees from Novartis, personal fees from Raptor, grants and personal fees from Chiesi, personal fees from Actavis UK Ltd, personal fees from Horizon, grants and personal fees from INSMED, outside the submitted work. Conflict of interest: Dr. Sibila has nothing to disclose. Conflict of interest: Dr. Di Francesco has nothing to disclose. Conflict of interest: Dr. Sotgiu has nothing to disclose. Conflict of interest: Dr. Perea has nothing to disclose. Conflict of interest: Dr. Terranova has nothing to disclose. Conflict of interest: Dr. Oriano has nothing to disclose. Conflict of interest: Dr. Pilocane has nothing to disclose. Conflict of interest: Dr. Saderi has nothing to disclose. Conflict of interest: Dr. Chalmers reports grants and personal fees from Astrazeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Glaxosmithkline, grants and personal fees from Insmed, personal fees from Zambon, grants from Gilead Sciences, outside the submitted work. Conflict of interest: Dr. Marchisio has nothing to disclose. Conflict of interest: Dr. Blasi reports grants and personal fees from astrazeneca, grants from bayer, grants and personal fees from chiesi, grants and personal fees from gsk, personal fees from guidotti, personal fees from grifols, grants and personal fees from insmed, personal fees from menarini, personal fees from mundipharma, personal fees from novartis, grants and personal fees from pfizer, personal fees from zambon, outside the submitted work.

Este artículo resume las diferentes formas de presentación clínica de la enfermedad COVID-19 causada por el virus SARS-Co-2 documentadas fundamentalmente en las tres principales revisiones sistemáticas disponibles. Entre las manifestaciones clínicas de frecuente aparición se destacan la fiebre (83 %), la tos (60 %) y la fatiga (38 %), seguidas por las mialgias (29 %), el aumento de la producción del esputo (27 %) y la disnea (25 %). Entre los hallazgos de laboratorio, predominan el aumento de los valores de proteína C reactiva (69 %), la linfopenia (57 %) y el aumento de los niveles de lactato-deshidrogenasa (52 %). Respecto de las manifestaciones radiológicas, tienen especial importancia las opacificaciones en vidrio esmerilado (80 %), la neumonía bilateral (73 %) y la afectación de tres lóbulos pulmonares o más (57 %). Si bien la evidencia sintetizada tiene limitaciones, permite una aproximación actualizada a los conocimientos disponibles sobre la clínica de esta nueva enfermedad en la población adulta.

BackgroundWith the emergence of 4rd generation transmission, the prevention and treatment of the novel coronavirus disease 2019 (COVID-19) has entered a new period. We aimed to report several changes in the clinical characteristics at admission of patients with COVID-19.MethodsClinical records and laboratory results of patients suffering from COVID-19 were retrospectively reviewed and matched with the admission dates to analyze the changes in characteristics at the onset of illness.ResultsOf the 89 affected patients, 31 [34.8%] patients were admitted from January 16 to 22, and 58 [65.2%] were admitted from January 23 to 29. Patients were admitted with more systemic symptoms, such as fever (21 [67.7%] of 31), fatigue (13 [41.9%] of 31), and myalgia (7 [22.6%] of 31), before January 23. More patients (10 [32.3%] of 31) admitted before January 23 had a small amount of sputum production compared with a smaller proportion (4 [6.9%] of 58) of the patients admitted after January 23. Other symptoms, such as cough, nausea, diarrhea, and chest tightness, were not significantly different between the two groups. In addition, the group admitted before January 23 had a larger proportion of patients with reduced lymphocyte (13 [54.2%] of 24), CD3 (11 [54.4%] of 21), and CD8 (9 [42.9%] of 21) counts and elevated serum amyloid A (SAA, 18 [75%] of 24).ConclusionsThe initial symptoms of recently infected patients seem more insidious, indicating that the new coronavirus may gradually evolve into a virus similar to influenza and latent in asymptomatic carriers for a long time.SummaryCompared with the cases admitted earlier, more hidden initial symptoms and improved immune system disorders appeared in COVID-19 patients infected recently.

Alpha-1-antitrypsin deficiency (AATd) is a hereditary disease, mainly characterized by early onset and the lower lobes’ predominant emphysema. Bronchiectasis is characterized by dilatation of the bronchial wall and a clinical syndrome whose features are a cough, sputum production and frequent respiratory exacerbations. In the literature, there are many papers concerning these two clinical entities, but there is still a lot of debate about a possible association between them, in particular about the frequency of their association and causal links. The aim of this short communication is to show the literature reports about the association between AATd and bronchiectasis to establish the state of the art and possible future developments in this research field.

Chronic obstructive pulmonary disease (COPD) is currently a leading cause of death worldwide, and its burden is expected to rise in the coming years. Common COPD symptoms include dyspnea, cough and/or sputum production. Some patients may experience acute worsening of symptoms (known as an exacerbation), and therefore require additional therapy. Exacerbations are mainly triggered by respiratory infections and environmental factors. Healthcare professionals face many challenges in COPD management, including the heterogeneity of the disease and under-reporting of symptoms. The authors review these challenges and provide recommendations for the best methods to assess COPD. The goals of COPD treatment include recognising the impact that both symptoms and exacerbations have on patients' lives when considering optimal patient-focused management. The review discusses the need for COPD management strategies to include both pharmacologic and non-pharmacologic approaches and provides recommendations for monitoring treatment outcomes and adjusting management strategies accordingly. Novel treatment strategies including precision medicine and point-of-care testing are also discussed.

The COVID -19 began in the city of Wuhan, China, in December 2019, and it’s caused by a newly discovered coronavirus, the SARS-COV-2. Soon after, the COVID-19 epidemic in China became a pandemic with significant burdens on healthcare and the world economy. COVID-19 presents mainly as a respiratory disease, which is sometimes accompanied by gastrointestinal and musculoskeletal events. According to clinical studies in Asia, the most prevalent symptoms consist of fever, cough, dyspnea, sputum production, myalgia, arthralgia, headache, diarrhea, runny nose, and sore throat. A retrospective study in China with more than 200 participants found that a subset of patients with COVID-19 had neurological symptoms. These include impaired consciousness, acute cerebrovascular disease and musculoskeletal symptoms, suggesting the impairment of the central (CNS) and peripheral (PNS) nervous systems. A COVID-19 teve seu inicio na cidade Wuhan, na China, em dezembro de 2019, sendo causada pelo novo coronavirus, o SARS-COV-2. Rapidamente, a epidemia de COVID-19 na China se tornou uma pandemia, com encargos significativos para os cuidados de saude e para a economia mundial. A COVID-19 se manifesta principalmente como doenca respiratoria e e ocasionalmente acompanhada de manifestacoes gastrointestinais e musculoesqueleticas. De acordo com estudos clinicos da Asia, os sintomas mais prevalentes consistem em febre, tosse, dispneia, producao de escarro, mialgia, artralgia, dor de cabeca, diarreia, rinorreia e dor de garganta. Um estudo retrospectivo na China envolvendo mais de 200 participantes revelou que um subconjunto de pacientes com COVID-19 apresentou sintomas neurologicos; estes incluiram consciencia prejudicada, doenca cerebrovascular aguda e sintomas musculoesqueleticos, sugerindo o envolvimento dos sistemas nervosos central (SNC) e periferico (SNP).

Background In Korea, to investigate the casual relationship between humidifier disinfectant and lung disease, four rounds of investigation and judgment were conducted. During this investigation, two adults who performed lung biopsy were recognized for their relevance between humidifier disinfectants and lung disease. At first, we did not think of the relationship to humidifier disinfectant because chest computed tomography (CT) finding of 2 cases were improved. However, they performed lung biopsy and it showed typical humidifier disinfectant lung injury (HDLI) pathologic findings, they could be recognized as HDLI. We report these cases here. Case presentation We selected 2 cases from the fourth-round investigation at Kangbuk Samsung Hospital. Patient of case 1 used humidifier disinfectants since September 2010. The patient was admitted 6 months later to the intensive care unit (ICU) due to severe dyspnea. Pathology following a lung biopsy revealed typical HDLI finding which was determined to be due to humidifier disinfectant exposure. Patient of case 2 used humidifier disinfectant from 2001 to 2008 for about 3 months each winter. The patient's cough and sputum production symptoms began in December of 2007. The patient was admitted to the respiratory medicine department due to worsening dyspnea. Pathology following a lung biopsy revealed typical HDLI finding. This was determined to have been caused by humidifier disinfectant exposure. Conclusions Because the typical radiologic findings associated with HDLI can improve over time, it is necessary to consider the revision of current diagnostic criteria that the presence of radiologic findings is important.

Background: With the emergence of the 4th generation transmission, the prevention and treatment of the novel coronavirus disease 2019 (COVID-19) has entered a new period. During the admission, we found several changes in the clinical characteristics of patients with COVID-19. Methods: Patients suffered from COVID-19 were diagnosed and admitted to Renmin Hospital of Wuhan University. Clinical records, laboratory results were retrospectively reviewed and matched with the admission date to analyze characteristic changes of patients at the onset of illness. Findings: From Jan. 16 to Jan. 29, 2020, 89 patients had been identified as confirmed COVID-19. Patients were assigned into two groups according to the admission date. 31 [34·8%] of the infected patients were admitted from Jan. 16 to 22, and 58 [65·2%] were admitted from Jan. 23 to 29. Most of the infected patients were women (45 [77·6%] of 58) during Jan. 23 to 29, but less female (14 [45·2%] of 31) before Jan. 23. Patients admitted with more systemic symptoms such as fever (21 [67·7%] of 31), fatigue (13 [41·9%] of 31), and myalgia (7 [22·6%] of 31) before Jan. 23. Greater proportion of patients (10 [32·3%] of 31) admitted before Jan. 23 had a small amount of sputum production compared with a small proportion (4 [6·9%] of 58) admitted after Jan. 23. Other symptoms such as cough, nausea, diarrhea, and chest tightness were not significantly different between two groups. In addition, the group admitted before Jan. 23 had a larger proportion of patients with reduced lymphocyte (13 [54·2%] of 24), CD3 (11[52·4%] of 21), CD8 (9 [42·9%] of 21) cells and elevated SAA (18 [75·0%] of 24). Interpretation: The clinical characteristics of COVID-19 patients at the onset became partially different as the novel coronavirus spreads over time and generations, positive infection even appeared in patients after discharge. Findings from this study suggest that initial symptoms of recently infected patients seem more insidious. All provide clues that the new coronavirus may gradually evolve into an influenza-like virus, or it may be latent in some asymptomatic carrier for a long time. Funding Statement: No funding supported this study. Declaration of Interests: All the authors declare no competing interests. Ethics Approval Statement: The research protocol was reviewed and approved by the Ethics Committee in Renmin Hospital of Wuhan University (Wuhan, China). All research procedures adhered to the tenets of the Declaration of Helsinki.

Acute exacerbations of COPD involve increased symptoms such as cough, dyspnea and sputum production. These exacerbations are associated with increased mortality as well as decline in lung function. Non-invasive positive-pressure ventilation (NIPPV) is the preferred method of ventilatory support in respiratory failure secondary to AECOPD. NIPPV reduces work of breathing, improves oxygenation and ventilation and decreases both mortality and the risk of invasive ventilation.

In elderly, pneumonia may be more severe because of impaired immunity and frailty as well as a reduced ability to cough and clear secretions from the lungs. Hence, they have an increased rate of respiratory failure and death. Furthermore, the impact of COVID-19 pneumonia in the elderly may have the characteristics of a multisystem disease with direct consequences on the treatment. Pneumonia in elderly patients with multimorbidity is significantly more complicated. For these reasons, the rate of hospitalisation and the mortality rate is very high in older patients. The presence of comorbidities, as well as a frailty condition, is a risk factor. The most common symptoms on admission were fever and cough, followed by sputum production and fatigue [1]. Elderly may present an atypical presentation of the symptoms. But they are more susceptible to severe complications that may lead to death. In this chapter, the authors analysed the type and the impact of complications in elderly patients.