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Background: The shortage of hospital beds for COVID-19 patients has been one critical cause of Emergency Department (ED) overcrowding. Purpose: We aimed at elaborating a strategy of conversion of hospital beds, from non-COVID-19 to COVID-19 care, minimizing both ED overcrowding and the number of beds eventually converted. Research Design: Observational retrospective study. Study Sample: We considered the centralized database of all ED admissions in the Lombardy region of Italy during the second "COVID-19 wave" (October to December 2020). Data collection and Analysis: We analyzed all admissions to 82 EDs. We devised a family of Monte Carlo simulations to evaluate the performance of hospital beds' conversion strategies triggered by ED crowding of COVID-19 patients, determining a critical number of beds to be converted when passing an ED-specific crowding threshold. Results: Our results suggest that the maximum number of patients waiting for hospitalization could have been decreased by 70% with the proposed strategy. Such a reduction would have been achieved by converting 30% more hospital beds than the total number converted in the region. Conclusions: The disproportion between reduction in ED crowding and additionally converted beds suggests that a wide margin to improve the efficiency of the conversions exists. The proposed simulation apparatus can be easily generalized to study management policies synchronizing ED output and in-hospital bed availability. [ABSTRACT FROM AUTHOR]

Background: Respiratory diseases pose a significant challenge in Nepali clinical settings due to elevated smoking rates and environmental risks. This study explores the structural changes in conditions such as asthma, chronic obstructive pulmonary disease, and bronchiectasis, utilizing noninvasive multi-detector computed tomography to assess airway remodeling. Despite conflicting western literature on bronchoarterial ratios, this research emphasizes the importance of evaluating these ratios in the Nepalese context for predicting airway disease severity. Materials and Methods: The cross-sectional study conducted at Nobel Medical College and Teaching Hospital involved 129 participants aged over 20 undergoing chest computed tomography. It aimed to measure the bronchoarterial ratio and investigate its associations with age, gender, smoking history, and altitude of residence. Bronchoarterial ratios was calculated using averaged short-axis diameters of the right apical and right posterior basal segmental bronchi, excluding the left lung due to motion artifacts. Results: Analysis indicated a Mean Bronchoarterial Ratio of 0.823 (SD 0.151), with the apical and basal segment BARs at 0.832 (SD 0.148) and 0.814 (SD 0.153), respectively. Notably, individuals aged over 65 who were smokers exhibited a significant increase in BAR. Additionally, a higher altitude of residence demonstrated a significant correlation with the Bronchoarterial ratio in the apical lung segment. Conclusion: This study provides valuable insights into the bronchoarterial ratio within the Nepalese population, considering age, gender, smoking history, and altitude of residence. The findings underscore the potential relevance of these ratios in conditions involving airway remodeling, contributing to the understanding of respiratory diseases in this specific demographic.

Background/Objectives: SARS-CoV-2 continually mutates, with five identified variants. Many neurological manifestations were observed during the COVID-19 pandemic, with differences between virus variants. The aim of this study is to assess the frequency and characteristics of neurological manifestations during COVID-19 in hospitalized patients over three waves in Poland with comparison and analysis correlation with the course of infection. Methods: This retrospective single-center study included 600 consecutive adults with confirmed COVID-19, hospitalized during 3 waves (pre-Delta, Delta and Omicron) in Poland. Demographic and clinical information and neurological manifestations were collected and compared across three periods. Results: The median age of the study group was 68, lower during the Delta wave. In the Omicron period, the disease severity at admission and inflammatory markers concentration were the lowest. Neurological manifestations were observed in 49%. The most common were altered mentation, headache, myalgia, mood disorder, ischemic stroke and encephalopathy. Smell and taste disturbances (STDs) were less frequent in the Omicron period. Neurological complications were predominant in the pre-Delta and Omicron periods. Ischemic stroke was observed more often in pre-Delta period. Altered mentation was related to higher severity at admission, worse lab test results, higher admission to ICU and mortality, while headache reduced mortality. Pre-existing dementia was related to higher mortality. Conclusions: Neurological manifestations of COVID-19 are frequent, with a lower rate of STDs in the Omicron period and more often cerebrovascular diseases in the pre-Delta period. Headache improves the course of COVID-19, while altered mentation, stroke and neurological comorbidities increase severity and mortality. [ABSTRACT FROM AUTHOR]

Feline Calicivirus (FCV) is a major cause of oral lesions in cats with respiratory tract disease (RTD). FCV is a single-stranded, positive-polarity RNA virus that encodes three open reading frames (ORFs). Active virus excretion occurs through the saliva of cats infected with FCV, which belongs to the Vesivirus genus of the Caliciviridae family. Oral mucosal lesions caused by infectious agents in RTD lead to significant impairment in the quality of life of cats. RTD, which also affects the oral mucosa, is a common problem in cats. Ten cats of different ages, breeds, and genders with ocular lesions were used in this study. At the time of sample collection, the veterinarian performed general and oral examinations on each animal. On oral examination,varying degrees of gingivitis, stomatitis, and ulceration symptoms were noted. Samples were extracted using a commercial viral nucleic acid isolation kit. Three out of ten samples (30%) were found to be positive for FCV using RT-PCR. T In conclusion, the high sensitivity, specificity, and potential for field sample testing make RT-PCR a very important and inevitable method for research and clinical diagnosis related to FCV infection in cats with oral lesions. [ABSTRACT FROM AUTHOR]

Chung-Sang-Bo-Ha-Hwan (CSBHH) is an herbal prescription widely used to treat various chronic respiratory diseases. To investigate the system-level treatment mechanisms of CSBHH in respiratory tract diseases, we identified 56 active ingredients of CSBHH and evaluated the degree of overlap between their targets and respiratory tract disease-associated proteins. We then investigated the respiratory tract disease-related signaling pathways associated with CSBHH targets. Enrichment analysis showed that the CSBHH targets were significantly associated with various signaling pathways related to inflammation, alveolar structure, and tissue fibrosis. Experimental validation was conducted using phorbol-12-myristate-13-acetate (PMA)-stimulated NCI-H292 cells by analyzing the mRNA expression levels of biomarkers (IL-1β and TNF-α for inflammation; GSTP1, GSTM1, and PTEN for apoptosis) derived from network pharmacological analysis, in addition to the mucin genes MUC5AC and MUC2, to investigate the phlegm-expelling effect of CSBHH. The mRNA expression levels of these genes were consistent with network pharmacological predictions in a concentration-dependent manner. These results suggest that the therapeutic mechanisms of CSBHH in respiratory tract diseases could be attributed to the simultaneous action of multiple active ingredients in the herbal prescription. [ABSTRACT FROM AUTHOR]

Everyone is aware that air and environmental pollutants are harmful to health. Among them, indoor air quality directly affects physical health, such as respiratory rather than outdoor air. However, studies that have examined the correlation between environmental and health information have been conducted with public data targeting large cohorts, and studies with real-time data analysis are insufficient. Therefore, this research explores the research with an indoor air quality monitoring (AQM) system based on developing environmental detection sensors and the internet of things to collect, monitor, and analyze environmental and health data from various data sources in real-time. It explores the usage of wearable devices for health monitoring systems. In addition, the availability of big data and artificial intelligence analysis and prediction has increased, investigating algorithmic studies for accurate prediction of hazardous environments and health impacts. Regarding health effects, techniques to prevent respiratory and related diseases were reviewed.

Introduction: Coronavirus Disease-2019 (COVID-19) infection can cause a wide range of symptoms, from asymptomatic infection and mild upper respiratory tract disease to severe viral pneumonia with respiratory failure and multiorgan malfunction. Through this study, effort was put forward to know the COVID-19 in terms of clinical characteristics, risk factors and laboratory parameters which in turn may serve as predictors of severe sickness and negative outcomes of COVID-19. Aim: To study the clinical characteristics, risk factors and laboratory parameters of COVID-19 patients in a part of North Eastern India, and also to compare these parameters between survivors and non survivors. Materials and Methods: This retrospective study was conducted in Silchar Medical College and Hospital, Silchar, Assam, India. Study included all patients of COVID-19 diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RTPCR) or Rapid Antigen Test (RAT) admitted from 1st July, 2020 to 31st December, 2020. The data included demographic parameters, presenting symptoms, significant medical, surgical or drug history etc., and laboratory parameters including complete blood count, Random Blood Sugar (RBS), chest x-ray, renal and liver function test, C-reactive protein, Lactate Dehydrogenase (LDH), serum ferritin, troponin I etc. Data were statistically analysed by unpaired t-test for continuous variables and chi-square test was used for comparing proportions. Results: Out of a total 2262 study subjects, 2066 (91.34%) were discharged from the hospital after recovery and 196 (8.66%) had expired. The various parameters contributing significantly to mortality were male gender, age >60 years, various co-morbid conditions like diabetes mellitus, hypertension and cardiac illness. The laboratory parameters observed to be significantly associated with mortality were thrombocytopenia, leucocytosis, hyperglycaemia, raised value of lactate dehydrogenase, creatinine, D-dimer, ferritin, C-reactive protein. Radiological findings including ground glass opacities and pleural effusion also were more common in the non survivor group as compared to the survivor group. Conclusion: More than half of the deceased patients were older than 60 years of age. The prevalence of co-morbidities and mean level of laboratory parameters were significantly high among non survivors as compared to those who recovered

Abstract Background Particulate matter (PM) is an important environmental risk factor for the initiation and exacerbation of respiratory disease. Various herbal medicines have exhibited a reduction in symptoms of respiratory diseases induced by PM in animal models. However, the types and characteristics of studies on herbal medicine for respiratory diseases by PM have not been reviewed. This scoping review will focus on the currents status and research gap of herbal medicines for respiratory diseases caused by PM. Methods We will follow the scoping review framework developed by Arksey and O’Malley. MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials will be searched for relevant English-language publications, and only peer-reviewed, controlled comparative in vivo/in-vitro/human studies examining the effects of herbs on respiratory disease induced by PM will be included. The basic characteristics, research methods, detailed regimens, possible mechanisms, outcomes, and results will be extracted using a predefined standardized data extraction form. Outcomes will be presented in the following categories: pulmonary function, inflammatory markers, reactive oxygen species, histology and mechanisms, and adverse events. Two researchers will independently perform the study selection, data extraction, and quality assessment. We will also present the research map and implications for further study. Ethics and dissemination Ethical approval is not required because individual patient data will not be included. The findings will be disseminated through peer-reviewed publications or conference presentations. Systematic review registration This review protocol has been registered with the Open Science Framework on February 12, 2021 ( https://osf.io/s7uvk/ )

Introduction: Viral lower respiratory tract infections frequently cause morbidity and mortality in children. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic led to isolation and hygiene measures, resulting in decreased respiratory virus transmission and pediatric admissions. This study aimed to assess the impact of these measures and their uplifting on respiratory virus circulation in children before and during the SARS-CoV-2 pandemic (January 2017-December 2022)., Methods: We conducted a weekly time series analysis of multiple virus molecular assays in children. This included those admitted to a university reference hospital's Pediatric Intensive Care Unit (PICU) and those with risk pathologies exhibiting fever and/or respiratory symptoms. We included patients aged 0-18 years residing in Catalonia and adjusted the positive results to account for diagnostic effort., Results: We performed a total of 2991 respiratory virus tests during the period. Confinement significantly decreased the detection of all viruses, especially Rhinovirus (RV). After the deconfinement of children, the viral detection trend remained stable for all viruses, with no short-term impact on virus transmission. The mandatory implementation of facemasks in those aged ≥6 years led to decreased viral circulation, but we observed an influenza virus rebound after facemask removal. At that time, we also noticed an interrupted drop in the detection rates of RV and respiratory syncytial virus (RSV). The reopening of schools led to a progressive increase in viral detections, especially of Rhinovirus., Conclusion: Non-pharmacological interventions significantly impact the circulation of respiratory viruses among children. We observed these effects even when some measures did not specifically target preschool-aged children., (Copyright © 2024 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Chung-Sang-Bo-Ha-Hwan (CSBHH) is an herbal prescription widely used to treat various chronic respiratory diseases. To investigate the system-level treatment mechanisms of CSBHH in respiratory tract diseases, we identified 56 active ingredients of CSBHH and evaluated the degree of overlap between their targets and respiratory tract disease-associated proteins. We then investigated the respiratory tract disease-related signaling pathways associated with CSBHH targets. Enrichment analysis showed that the CSBHH targets were significantly associated with various signaling pathways related to inflammation, alveolar structure, and tissue fibrosis. Experimental validation was conducted using phorbol-12-myristate-13-acetate (PMA)-stimulated NCI-H292 cells by analyzing the mRNA expression levels of biomarkers (IL-1β and TNF-α for inflammation; GSTP1, GSTM1, and PTEN for apoptosis) derived from network pharmacological analysis, in addition to the mucin genes MUC5AC and MUC2, to investigate the phlegm-expelling effect of CSBHH. The mRNA expression levels of these genes were consistent with network pharmacological predictions in a concentration-dependent manner. These results suggest that the therapeutic mechanisms of CSBHH in respiratory tract diseases could be attributed to the simultaneous action of multiple active ingredients in the herbal prescription.

Background: Lung transplantation is a recognised treatment for end‐stage lung disease due to bronchiectasis. Non‐cystic fibrosis (CF) bronchiectasis and CF are often combined into one cohort; however, outcomes for non‐CF bronchiectasis patients vary between centres, and in comparison with those for CF. Aims: To compare lung transplantation mortality and morbidity of bronchiectasis (non‐CF) patients with those with CF and other indications. Methods: Retrospective analysis of patients undergoing lung transplantation between 1 January 2008 and 31 December 2013. Time to and cause of lung allograft loss was censored on 1 April 2018. A case‐note review was conducted on a subgroup of 78 patients, to analyse hospital admissions as a marker of morbidity. Results: A total of 341 patients underwent lung transplantation; 22 (6%) had bronchiectasis compared with 69 (20%) with CF. The 5‐year survival for the bronchiectasis group was 32%, compared with CF (69%), obstructive lung disease (OLD) (64%), pulmonary hypertension (62%) and ILD (55%) (P = 0.008). Lung allograft loss due to chronic lung allograft dysfunction with predominant infection was significantly higher in the bronchiectasis group at 2 years. The rate of acute admissions was 2.24 higher in the bronchiectasis group when compared with OLD (P = 0.01). Patients with bronchiectasis spent 45.81 days in hospital per person year after transplantation compared with 18.21 days for CF. Conclusions: Bronchiectasis patients in the present study had a lower 5‐year survival and poorer outcomes in comparison with other indications including CF. Bronchiectasis should be considered a separate entity to CF in survival analysis. [ABSTRACT FROM AUTHOR]

Respiratory tract diseases (RTDs) are a global cause of mortality and affect patient well-being and quality of life. Specifically, there is a high unmet need concerning respiratory tract infections (RTIs) due to limitations of vaccines and increased antibiotic resistance. Enzyme therapeutics, and in particular plant-based enzymes, represent an underutilised resource in drug development warranting further attention. This literature review aims to summarise the current state of enzyme therapeutics in medical applications, with a focus on their potential to improve outcomes in RTDs, including RTIs. We used a narrative review approach, searching PubMed and clinicaltrials.gov with search terms including: enzyme therapeutics, enzyme therapy, inhaled therapeutics, botanical enzyme therapeutics, plant enzymes, and herbal extracts. Here, we discuss the advantages and challenges of enzyme therapeutics in the setting of RTDs and identify and describe several enzyme therapeutics currently used in the respiratory field. In addition, the review includes recent developments concerning enzyme therapies and plant enzymes in (pre-)clinical stages. The global coronavirus disease 2019 (COVID-19) pandemic has sparked development of several promising new enzyme therapeutics for use in the respiratory setting, and therefore, it is timely to provide a summary of recent developments, particularly as these therapeutics may also prove beneficial in other RTDs. [ABSTRACT FROM AUTHOR]

Background: Particulate matter (PM) is an important environmental risk factor for the initiation and exacerbation of respiratory disease. Various herbal medicines have exhibited a reduction in symptoms of respiratory diseases induced by PM in animal models. However, the types and characteristics of studies on herbal medicine for respiratory diseases by PM have not been reviewed. This scoping review will focus on the currents status and research gap of herbal medicines for respiratory diseases caused by PM. Methods: We will follow the scoping review framework developed by Arksey and O'Malley. MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials will be searched for relevant English-language publications, and only peer-reviewed, controlled comparative in vivo/in-vitro/human studies examining the effects of herbs on respiratory disease induced by PM will be included. The basic characteristics, research methods, detailed regimens, possible mechanisms, outcomes, and results will be extracted using a predefined standardized data extraction form. Outcomes will be presented in the following categories: pulmonary function, inflammatory markers, reactive oxygen species, histology and mechanisms, and adverse events. Two researchers will independently perform the study selection, data extraction, and quality assessment. We will also present the research map and implications for further study. Ethics and dissemination: Ethical approval is not required because individual patient data will not be included. The findings will be disseminated through peer-reviewed publications or conference presentations. Systematic review registration: This review protocol has been registered with the Open Science Framework on February 12, 2021 (https://osf.io/s7uvk/) [ABSTRACT FROM AUTHOR]

Suvina Amin,1 Mena Soliman,2 Andrew McIvor,3 Andrew Cave,4 Claudia Cabrera5 1US Oncology Medical Affairs, AstraZeneca, Gaithersburg, MD, USA; 2BioPharmaceuticals Medical (Europe and Canada), AstraZeneca, Mississauga, ON, Canada; 3Department of Medicine, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare and McMaster University, Hamilton, ON, Canada; 4Department of Family Medicine, University of Alberta, Edmonton, AL, Canada; 5BioPharmaceuticals Medical (Evidence), AstraZeneca, Gothenburg, SwedenCorrespondence: Suvina AminAstraZeneca, One Medimmune Way, Gaithersburg, MD 20878, USATel +1 800 565 5877Email suvina.amin@astrazeneca.comAbstract: Adherence to asthma medications is generally poor and undermines clinical outcomes. Poor adherence is characterized by underuse of inhaled corticosteroids (ICS), often accompanied by over-reliance on short-acting β2-agonists for symptom relief. To identify drivers of poor medication adherence, a targeted literature search was performed in MEDLINE and EMBASE for articles presenting qualitative data evaluating medication adherence in asthma patients (≥ 12 years old), published from January 1, 2012 to February 26, 2018. A thematic analysis of 21 relevant articles revealed several key themes driving poor medication adherence, including asthma-specific drivers and more general drivers common to chronic diseases. Due to the episodic nature of asthma, many patients felt that their daily life was not substantially impacted; consequently, many harbored doubts about the accuracy of their diagnosis or were in denial about the impact of the disease and, in turn, the need for long-term treatment. This was further compounded by poor patient-physician communication, which contributed to suboptimal knowledge about asthma medications, including lack of understanding of the distinction between maintenance and reliever inhalers, suboptimal inhaler technique, and concerns about ICS side effects. Other drivers of poor medication adherence included the high cost of asthma medication, general forgetfulness, and embarrassment over inhaler use in public. Overall, patients’ perceived lack of need for asthma medications and medication concerns, in part due to suboptimal knowledge and poor patient-physician communication, emerged as key drivers of poor medication adherence. Optimal asthma care and management should therefore target these barriers through effective patient- and physician-centered strategies.Keywords: Inhaled corticosteroids, over-reliance, patient-physician communication, respiratory tract disease, short-acting β2-agonist, underuse

ObjectiveHIV-infected individuals are susceptible to development of chronic lung diseases, but little is known regarding the prevalence and risk factors associated with different spirometric abnormalities in this population. We sought to determine the prevalence, risk factors and performance characteristics of risk factors for spirometric abnormalities among HIV-infected individuals.DesignCross-sectional cohort study.MethodsWe analyzed cross-sectional US data from the NHLBI-funded Lung-HIV consortium - a multicenter observational study of heterogeneous groups of HIV-infected participants in diverse geographic sites. Logistic regression analysis was performed to determine factors statistically significantly associated with spirometry patterns.ResultsA total of 908 HIV-infected individuals were included. The median age of the cohort was 50 years, 78% were men and 68% current smokers. An abnormal spirometry pattern was present in 37% of the cohort: 27% had obstructed and 10% had restricted spirometry patterns. Overall, age, smoking status and intensity, history of Pneumocystis infection, asthma diagnosis and presence of respiratory symptoms were independently associated with an abnormal spirometry pattern. Regardless of the presence of respiratory symptoms, five HIV-infected participants would need to be screened with spirometry to diagnose two individuals with any abnormal spirometry pattern.ConclusionsNearly 40% of a diverse US cohort of HIV-infected individuals had an abnormal spirometry pattern. Specific characteristics including age, smoking status, respiratory infection history and respiratory symptoms can identify those at risk for abnormal spirometry. The high prevalence of abnormal spirometry and the poor predictive capability of respiratory symptoms to identify abnormal spirometry should prompt clinicians to consider screening spirometry in HIV-infected populations.

Respiratory tract diseases (RTDs) are a global cause of mortality and affect patient well-being and quality of life. Specifically, there is a high unmet need concerning respiratory tract infections (RTIs) due to limitations of vaccines and increased antibiotic resistance. Enzyme therapeutics, and in particular plant-based enzymes, represent an underutilised resource in drug development warranting further attention. This literature review aims to summarise the current state of enzyme therapeutics in medical applications, with a focus on their potential to improve outcomes in RTDs, including RTIs. We used a narrative review approach, searching PubMed and clinicaltrials.gov with search terms including: enzyme therapeutics, enzyme therapy, inhaled therapeutics, botanical enzyme therapeutics, plant enzymes, and herbal extracts. Here, we discuss the advantages and challenges of enzyme therapeutics in the setting of RTDs and identify and describe several enzyme therapeutics currently used in the respiratory field. In addition, the review includes recent developments concerning enzyme therapies and plant enzymes in (pre-)clinical stages. The global coronavirus disease 2019 (COVID-19) pandemic has sparked development of several promising new enzyme therapeutics for use in the respiratory setting, and therefore, it is timely to provide a summary of recent developments, particularly as these therapeutics may also prove beneficial in other RTDs.

Objective: To assess whether an asthma intervention program reduces treatment days outside the home among children with severe asthma receiving comprehensive care (CC) in our center. Methods: Between October 21, 2014 and September 28, 2016, children with severe asthma were randomized to receive CC alone (n = 29) or CC plus the asthma intervention program (n = 34) which involved collaboration with pharmacists and school nurses, motivational interviewing, and tracking the one-second forced expiratory volume at home. All patients were followed through March 31, 2017. Frequentist and Bayesian intent-to-treat analyses were performed. Results: The asthma intervention program doubled the telephone calls between the staff and families (753 vs 356 per 100 child years for the intervention group vs. control group; Rate Ratio [RR], 2.11 [95% confidence interval, 1.29-3.45]). Yet, we found no evidence that it reduced the composite number of days of healthcare outside home which includes: clinic visits, ED visits, and hospital admissions (1179 vs 958 per 100 child-years in the intervention group vs. control group; [RR], 1.23 [95% CI, 0.82-1.84]) or secondary outcomes which are individual components (clinic visits, ED visits, hospitalizations, PICU admissions and school absences; RR 1.15 – 2.30; p > 0.05). Bayesian analysis indicated a 67% probability that the intervention program increases total treatment days outside the home and only a 14% probability of a true decrease of >20% as originally hypothesized. Conclusion: A multi-component intervention program provided to children with severe asthma failed to reduce and may have increased days of healthcare outside home and school absenteeism. [ABSTRACT FROM AUTHOR]

Objective measurements of asthma impairment could aid teens in recognition of changes in asthma status over time. Ready access to a conventional spirometer is not realistic outside of the clinical setting. In this proof-of-concept study, we compared the performance of the VitalFlo mobile spirometer to the nSpire KoKo® sx1000 spirometer for accuracy in measuring Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) in adolescents with asthma. Two hundred forty pulmonary function measurements were collected from 48 adolescents with persistent asthma from the University of North Carolina's pediatric allergy and pulmonology subspecialty clinics. Participants performed spirometry with the nSpireKoKo® sx1000 spirometer and the VitalFlo spirometer during their clinic visits. 119 simulated FVC maneuvers were conducted on both devices to standardize measurements. Pearson correlations, Bland-Altman procedure, and two-sample comparison tests were performed to assess the relationship between the two spirometers. VitalFlo measurements were significantly highly correlated with nSpireKoKo® spirometer values for FEV1, (r2=0.721, [95% CI, 0.749 ± 0.120], P < 0.001) and moderately for FVC (r2= 0.617, [95% CI, 0.640 ± 0.130], P < 0.001) measurements. There were no statistically significant differences of the mean FEV1 (M = 0.00764, SD = 0.364, t(59)=0.16, P = 0.87) and FVC measurements (M = 0.00261, SD = 0.565, t(59)=0.036, P = 0.97.) between the VitalFlo and nSpireKoKo® systems. Both devices demonstrated significantly high correlation when comparing the automated FVC (r2 = 0.997, [95% CI, 1.00 ± 0.00974], P < 0.001) measurements. Bland-Altman plots did not demonstrate significant bias between devices for both FEV1 (0.00764 L) and FVC (0.00261 L) measurements. Lung function measurements from the VitalFlo mobile spirometer were comparable to a commercially-available spirometer commonly used in clinical settings. This validated app-based spirometer for home use has the potential to improve asthma self-management. [ABSTRACT FROM AUTHOR]

Introduction Young children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age. Methods A secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms. Results The analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016). Conclusions Household ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.

Aim: National data report respiratory illness to be the most common chronic illness in Australian Indigenous people aged <35 years but multi-centre data on specific diseases is sparse. Respiratory health is now known to be an independent predictor of future all-cause mortality and cardiovascular disease. We aimed to describe the respiratory health profile (clinical and spirometry data) of randomly recruited Indigenous Australian children and young adults from several sites.Methods: As part of the Indigenous Respiratory Reference Values study, 1278 Australian Indigenous children and young adults (aged 3-25 years) were recruited from nine communities (Queensland, n = 8; Northern Territory, n = 1). Self-reported and medical records were used to ascertain respiratory history. Participants were classified as 'healthy' if there was no current/previous respiratory disease history. Spirometry was performed on all participants and assessed according to forced expiratory volume at 1 s impairment.Results: Medical history data were available for 1245 (97.4%) and spirometry for 1106 participants (86.5%). Asthma and bronchitis were the most commonly reported respiratory conditions (city/regional 19.5% and rural/remote 16.8%, respectively). Participants with a history of any respiratory disease or those living in rural/remote communities had lower lung function compared to the 'healthy' group. Almost 52.0% of the entire cohort had mild-moderate forced expiratory volume at 1 s impairment (47.7% in 'healthy' group, 58.5% in 'respiratory history' group).Conclusion: The high prevalence of poor respiratory health among Indigenous Australian children/young adults places them at increased risk of future all-cause mortality and cardiovascular disease. Respiratory assessments including spirometry should be part of the routine evaluation of Indigenous Australians. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is associated with a high burden of comorbid respiratory disease subsequent to multiple risk factors associated with increasing levels of disability. Correspondingly, respiratory disease is the leading cause of death in CP, including amongst young people who are transitioning or who have just transitioned between paediatric and adult healthcare services. Therefore, consideration of both preventive and therapeutic respiratory management is integral to transition in patients with CP, as summarised in this review. [ABSTRACT FROM AUTHOR]

INTRODUCTION Young children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age. METHODS A secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013-2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children's sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households' respiratory symptoms were made to ascertain the association between ETS and children's respiratory symptoms. RESULTS The analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00-- 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06--4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04--2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05--5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12--3.52; p=0.016). CONCLUSIONS Household ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent. [ABSTRACT FROM AUTHOR]

Background: Periodontitis, an inflammatory disease of multibacterial etiology that affects the protective and supporting tissues surrounding teeth, can influence the course of respiratory diseases, such as asthma, due to epithelial alterations arising from inflammatory and immunological processes, bronchial remodeling, or by the aspiration of pathogenic colonizers found in periodontal pockets. This study evaluated the levels of periodontal pathogens Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans in the subgingival biofilm of individuals with and without severe asthma.Methods: A case-control study enrolling 457 individuals (220 with asthma and 237 without asthma) was conducted at the Program for Control of Asthma in Bahia (ProAR) Clinic located in Salvador, Bahia, Brazil. A structured questionnaire was used to obtain data on sociodemographic, health status, and lifestyle habits. A clinical periodontal assessment was performed, including bleeding on probing, probing depth, and clinical attachment level. Subgingival biofilm was collected at the deepest site of each sextant, and bacterial DNA was extracted. Quantitative real-time PCR analysis was performed to detect and relatively quantify periodontopathogens in the biofilm.Results: Statistically significant positive associations were found between periodontitis and severe asthma, (odds ratio [OR]adjusted] : 4.00; 95% confidence interval [CI]: 2.26 to 7.10). High levels of P. intermedia were found in association with the presence of severe asthma (ORadjusted : 2.64; 95% CI: 1.62 to 4.39; P < 0.01).Conclusions: The present results suggest that periodontitis and P. intermedia are associated with severe asthma. However, the functional consequences of this dysbiosis upon asthma susceptibility and its phenotypes remain unclear. [ABSTRACT FROM AUTHOR]

Introduction: Upper respiratory tract infection ( URTI ) is an acute respiratory infection that attacks human with the most number of infection are infants. Family has a function as a family health care that can be seen by five tasks of family health, the role of family is very needed for the prevention to reduce morbidity and mortality rates in toddlers, especially in cases of URTI. This study were aimed to analyze the relationship between implementation of family health tasks with URTI incidence in toddlers patients. Method: This study used correlation descriptive design. The samples were 147 families who have toddlers had experienced URTI and have been visit Puskesmas Martapura during November 2013. The variables are family health tasks and incindents of URTI in toddlers.Samples were taken by consecutive sampling that appropiate with inclusion and exclusion criterias. The data were analyzed by Spearman's rho with significance level (p) ≤ 0.05. Result: The result showed that family health task and incindents of URTI in toddlers did have negative significance correlation (r) = -0,387 and (p) = 0,01. Discussion: Implementation of family health tasks had a weak correlation with URTI incidence in toddlers patients. It is recommended to the stake holder of URTI disease in Puskesmas Martapura to continue give a socialization about URTI definition, sign and symptom, and right treatment especially for toddler with URTI disease. It is necessary futher research to analyze the correlation between toddler characteristics with insindece of URTI.

Background: Although chronic bronchitis is associated with impaired quality of life, hospitalisations and increased mortality, it has been less in focus after the introduction of the term chronic obstructive pulmonary disease (COPD). There are no recent published data on the prevalence of chronic bronchitis from the Scandinavian countries. Aim: The main aim of the present study was to estimate the prevalence of chronic bronchitis in West Sweden by using data from a large-scale epidemiological study of the general population. A further aim was to identify current risk factors for chronic bronchitis in a population with a major decrease in the proportion of smokers. Methods: From the 18,087 questionnaire responders out of 30,000 invited to participate at the West Sweden Asthma Study, 2,000 subjects were randomly selected and invited to detailed clinical examinations performed during 2009–2013. A total of 1,172 subjects aged 17–79 participated in the examinations which included, among others, spirometry and structured interviews. Chronic bronchitis was defined according to reported symptoms. Results: The overall prevalence of chronic bronchitis was 7.2% (men 7.6%; women 6.8% ns), and it was 8.7% in subjects older than age 60. Chronic bronchitis was strongly associated with smoking, defined both as current smoking status and pack-years. Other risk factors were increasing age, low socio-economic class and urban living. Of those with chronic bronchitis, 22% fulfilled the GOLD criteria of COPD. Conclusion: The prevalence of chronic bronchitis was somewhat lower than found by studies in Sweden in the 1980s and the prevalence was now similar in men and women. Although smoking was still the dominating risk factor for chronic bronchitis, the relative importance of smoking had decreased parallel with a decreasing smoking prevalence, while the relative importance of other factors than smoking had increased compared to previous studies.

Objective: To assess pressurised metered dose inhaler technique of the nursing staff in different government hospitals of Karachi. Methods: A cross-sectional study was carried out in four randomly chosen government hospitals of Karachi. After checking for study criteria and obtaining written informed consent, a total of 120 nurses were interviewed and then given a placebo inhaler to demonstrate their inhaler technique. The reference for assessment was the 12-step inhalation technique suggested by the American College of Chest Physicians. Results: The study results revealed that out of the 12 steps of the inhaler technique, only 3 steps were followed by a majority of the study participants i.e. taking the cap off (64.2%), putting the metered dose inhaler in mouth with lips sealed (59.2%) and breathing in slowly by pressing down the metered dose inhaler (62.5%). The mean inhaler technique score of the study participants was 3.18 ± 2.34 out of 12 and only 1 (0.8%) of them had correct inhaler technique. Furthermore, the mean inhaler technique score was significantly higher for higher education level (p=0.001) and greater experience (p<0.001). Conclusion: The study results demonstrated the acute deficiency of knowledge about the correct inhaler technique among the study nurses. Appropriate resources should be directed towards educating nurses to make sure that their needed knowledge and skills stay updated. [ABSTRACT FROM AUTHOR]

Aspergillosis is a common and life-threatening respiratory disease in raptors with acute and chronic courses. Among raptors, gyrfalcons (Falco rusticolus) and their hybrids are often declared to be highly susceptible with juvenile individuals being the most susceptible. However, species- and age-specific experimental studies are lacking and minimal infective doses (IDs) forAspergillusspp. conidia are unknown.Therefore, 8-week-old, healthy gyr-hybrid falcons (F. rusticolus X F. cherrug) (N = 18) were experimentally infected withAspergillus fumigatususing a single intratracheal inoculation with varying dosages of conidia (102to 107conidia). Over 28 days, clinical signs were monitored as well as haematological and serological parameters. Following euthanasia, necropsy, histopathology, bacteriology, and mycology were performed. Re-isolated fungi were compared to the inoculum using microsatellite length polymorphisms. During the trial, clinical signs and dyspnoea correlated significantly with the ID. Necropsy revealed fungal lesions in the upper and lower airways of 10/18 inoculated falcons, but not in the control birds. In 9/18 inoculated falcons, fungal granulomas were confirmed in histopathology andA. fumigatuswas re-isolated from these granulomas. Except one nasal isolate all re-isolated fungal strains were identical to the inoculum strain. Based on mycology and histopathology a minimal ID of 50% was calculated to be MID50% (±S.E.) = 104.52±0.67for a single tracheal inoculation ofA. fumigatusconidia. This study demonstrates for the first time that a single exposure is able to cause acute aspergillosis in juvenile falcons. [ABSTRACT FROM PUBLISHER]

Introduction: Use of homeopathy is frequent for respiratory conditions. Homeopaths explain that effectiveness (real life) studies offer more external validity and allow the individualised approach characteristic of homeopathy. Thus, these results could be relevant to the clinical practice. Methods: Analysis of systematic reviews, assessment reports (HTA), and clinical studies of indexed journals. Selection of the observational studies, description of their main characteristics and conclusions and estimation of effectiveness and drug-use ratios (OR-E<1 = clinically effective; OR-D<1 = drug-use reduced). Results: Ten most relevant studies were found (6 multicentre, 2 multinational), published between 1996 and 2016 in four conventional, three CAM, and four homeopathic journals (Beghi 2016; Grimaldi-Bensouda 2014; Rossi 2009; Haidvogl 2007; Trichard 2004; Weber 2002; Frei 2001; Riley 2001; Friese 1997; Eizayaga 1996). Four thousand one hundred patients were included, with respiratory allergies and infections, acute and serous otitis media, sinusitis, and asthma. Follow-up was up to 14 days in acute problems and 1 to 10 years in chronic and prevention treatments. Clinical results were similar or better in the groups treated by homeopathy compared with the controls treated exclusively with conventional drugs, regarding response rate, speed of improvement, frequency of recurrence, and indirect measures such as absence from work. For the main variable or the more relevant to this analysis, the global OR of effectiveness was 0.656 (0.47-0.84). Conventional drug use, especially antibiotics, was less than half in the homeopathy groups, with a global OR of drug-use of 0.420 (0.27-0.56). This indicates more resolution and prevention capacity with a less consumption of conventional drugs, when homeopathy is used. Also fewer adverse reactions were reported. Conclusion: The observational studies of better quality point out that homeopathy could be useful in the approach to respiratory and ENT ailments. Additionally, this strategy seems to reduce the use of conventional drugs and antibiotics in particular, as recommended by the clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Background: The aim of this study was to describe the epidemiological profile of childhood respiratory tract diseases (RTD) in the region of Sfax, Tunisia, and to evaluate their trends over a 13 year period. Methods: We conducted a retrospective study of all children hospitalized with RTD aged under 14 years. We collected data from the regional morbidity register of the university hospital of Sfax from 2003 to 2015. Results: A total of 10 797 RTD patients were enrolled from 49 880 pediatric hospitalizations (21.7%). A male predominance was noted (60%). The median age was 8 months (IQR, 2–36 months). Acute bronchitis (AB) accounted for 53.8%, followed by asthma (15%), pneumonia (14%) and acute upper respiratory infection (AURI; 7.2%). The hospital incidence rate (HIR) of RTD was 34/10 000 inhabitants/year. It was 18.2; 5.07; 4.7 and 2.4/10 000 inhabitants for AB, asthma, pneumonia and AURI, respectively. We noted a significant increase in the HIR of RTD with an annual percentage change (APC) of 10.94% (P < 0.001); in the HIR of AB (APC, 5.27%; P < 0.001); and in asthma HIR (APC, 11.2%; P < 0.001). Otherwise, a significant decrease in AURI HIR was observed (APC, –8.8%; P < 0.001). AB lethality rate increased significantly, with an APC of 7.4% (P < 0.001). Projected trends analysis up to 2024 showed a significant rise in AB and in asthma, while AURI would significantly decrease. Conclusions: RTD continues to be a serious health problem over time in terms of morbidity and mortality. Preventive and curative strategies are needed urgently. [ABSTRACT FROM AUTHOR]

The International Agency for Research on Cancer and the World Health Organization have designated airborne particulates, including particulates of median aerodynamic diameter = 2.5 µm (PM2.5), as Group 1 carcinogens. It has not been determined, however, whether exposure to ambient PM2.5 is associated with an increase in respiratory related diseases. This meta-analysis assessed the association between exposure to ambient fine particulate matter (PM2.5) and the risk of respiratory tract diseases, using relevant articles extracted from PubMed, Web of Science, and Embase. In results, of the 1,126 articles originally identified, 35 (3.1%) were included in this meta-analysis. PM2.5 was found to be associated with respiratory tract diseases. After subdivision by age group, respiratory tract disease, and continent, PM2.5 was strongly associated with respiratory tract diseases in children, in persons with cough, lower respiratory illness, and wheezing, and in individuals from North America, Europe, and Asia. The risk of respiratory tract diseases was greater for exposure to traffic-related than non-traffic-related air pollution. In children, the pooled relative risk (RR) represented significant increases in wheezing (8.2%), cough (7.5%), and lower respiratory illness (15.3%). The pooled RRs in children were 1.091 (95%CI: 1.049, 1.135) for exposure to < 25 µg/m3 PM2.5, and 1.126 (95%CI: 1.067, 1.190) for exposure to = 25 µg/m3 PM2.5. In conclusion, exposure to ambient PM2.5 was significantly associated with the development of respiratory tract diseases, especially in children exposed to high concentrations of PM2.5. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Noninfectious pulmonary complications are common among HIV-infected individuals and may be detected early by quantitative computed tomography (CT) scanning. The association of HIV disease markers with CT lung density measurement remains poorly understood.Materials and Methods: One hundred twenty-five participants free of spirometry-defined lung disease were recruited from a longitudinal cohort study of HIV-infected and HIV-uninfected individuals to undergo standardized CT scan of the chest. Parenchymal density for the entire lung volume was calculated using computerized software. Qualitative assessment of CT scans was conducted by two radiologists masked to HIV status. Linear regression models were developed to determine the independent association of markers of HIV infection on inspiratory scan mean lung density (MLD).Results: HIV-infected participants had a significantly higher MLD (denser lung) compared to HIV-uninfected participants (-815 Hounsfield unit [HU] vs -837 HU; P = 0.002). After adjusting for relevant covariates, HIV infection was independently associated with 19.9 HU higher MLD (95% CI 6.04 to 33.7 HU; P = 0.005). In qualitative assessment, only ground glass attenuation and cysts were noted more commonly among HIV-infected individuals compared to HIV-uninfected individuals (34% vs 17% [P = 0.045] and 27% vs 10% [P = 0.03], respectively). No qualitative radiographic abnormalities attenuated the association between HIV infection and increased MLD.Conclusions: HIV infection is independently associated with increased lung density. Although qualitative CT abnormalities were common in this cohort, only ground glass attenuation and cysts were noted more frequently in HIV-infected participants, suggesting that the increased lung density observed among HIV-infected individuals may be associated with subclinical inflammatory lung changes. [ABSTRACT FROM AUTHOR]

Background: Health-care professionals have a responsibility to be attentive to patients' adherence behavior but it could be difficult to identify poor adherence in the context of clinical practice. Assessment of personality could be used to identify individuals who are in need for support with their adherence behavior. To our knowledge, existing adherence questionnaires are not based on individuals reflecting asthmatics in the general population and there is limited research describing adherence with asthma medication in relation to personal goals with the treatment. The aim was to develop and validate an adherence questionnaire in adult individuals with asthma from the general population and to assess adherence in relation to personality traits and goals with the asthma medication using the developed questionnaire. Methods: The study was conducted in three phases: 1. A preliminary postal 46-item questionnaire was refined after psychometric testing (n = 157). 2. The questionnaire was validated (n = 104). 3. The developed adherence questionnaire was analyzed in relation to personality traits and achieved goals with the asthma medication. Adult respondents with physician diagnosed asthma using asthma medications were selected from the population-based West Sweden Asthma Study. The respondents completed the Neuroticism, Extraversion and Openness to Experience Five-Factor Inventory and the Medication Adherence Report Scale and stated their goals with the asthma medication. Data were analyzed using t-tests, correlations, multiple regression and principal component analysis. Results: A final questionnaire was developed consisting of ten items organized in three subscales - "medication routines", "self-adjusting the medication" and "concerns about side-effects". Two of the subscales - "medication routines" and "self-adjusting the medication" - were associated with the Medication Adherence Report Scale. The subscale "medication routines" was associated with the personality traits - Conscientiousness and Neuroticism and unachieved goals with the asthma medication. Conclusions: The developed questionnaire appears to be useful for measuring adherence to asthma medication in adult individuals with asthma. The study suggests that both individual differences and personal treatment goals need to be addressed in efforts to promote adherence to asthma medication treatment. [ABSTRACT FROM AUTHOR]