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[Display omitted] Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and often fatal lung disease caused by multiple factors. Currently, safe, and effective drugs for the treatment of IPF have been extremely scarce. Baicalin (BA) is used to treat pulmonary fibrosis, IPF, chronic obstructive pulmonary disease, and other lung diseases. Ambroxol hydrochloride (AH), a respiratory tract lubricant and expectorant, is often used to treat chronic respiratory diseases, such as bronchial asthma, emphysema, tuberculosis, and cough. The combination of BA and AH can relieve cough and phlegm, improve lung function, and potentially treat IPF and its symptoms. However, given the extremely low solubility of BA, its bioavailability for oral absorptions is also low. AH, on the other hand, has been associated with certain side effects, such as gastrointestinal tract and acute allergic reactions, which limit its applicability. Therefore, an efficient drug delivery system is urgently needed to address the mentioned problems. This study combined BA and AH as model drugs with L-leucine (L-leu) as the excipient to prepare BA/AH dry powder inhalations (BA/AH DPIs) using the co-spray drying method. We the performed modern pharmaceutical evaluation, which includes particle size, differential scanning calorimetry analysis, X-ray diffraction, scanning electron microscope, hygroscopicity, in vitro aerodynamic analysis, pharmacokinetics, and pharmacodynamics. Notably, BA/AH DPIs were found to be advantageous over BA and AH in treating IPF and had better efficacy in improving lung function than did the positive drug pirfenidone. The BA/AH DPI is a promising preparation for the treatment of IPF given its lung targeting, rapid efficacy, and high lung bioavailability. [ABSTRACT FROM AUTHOR]

In New Zealand, approximately half reported pertussis cases are adult. Studies indicate underestimated pertussis burden in this population and probable reservoir for childhood pertussis. Pertussis is linked to chronic obstructive pulmonary disease (COPD) development and increased risk with pre-existing COPD. While acellular pertussis vaccines are available for adults, data on pertussis disease burden in adults and association with COPD remain limited. To estimate pertussis incidence in New Zealand adult health service user (HSU) population aged ≥ 18 between 2008–2019 and inform adult pertussis vaccination strategies by assessing disease burden and risk factors in different adult populations. Retrospective observational cohort study using an HSU cohort, formed by linking administrative health data using unique National Health Index identifier. For primary analysis, annual incidence rates were calculated using pertussis hospitalisations and notifications. In secondary analysis, Cox proportional hazards survival analyses explored association between pertussis in adults and chronic comorbidities. The cohort had 2,907,258 participants in 2008 and grew to 3,513,327 by 2019, with 11,139 pertussis cases reported. Highest annual incidence rate of 84.77 per 100,000 PYRS in 2012, notably affecting females, those aged 30–49 years, and European or Māori ethnicity. Adjusting for sociodemographic variables found no significant risk of prior pertussis notification leading to comorbidity diagnosis (Adjusted-HR: 0.972). However, individuals with prior comorbidity diagnosis had 16 % greater risk of receiving pertussis notification or diagnosis (Adjusted-HR: 1.162). Study found significant pertussis burden among the HSU adult cohort and highlighted higher risk of pertussis for those with recent comorbidity diagnoses. Vaccination for pertussis should be recommended for individuals with comorbidities to reduce infection risk and disease severity. GPs must have capability to test for pertussis, given it is notifiable disease with implications for individuals, their families, and broader population. High-quality disease surveillance is crucial for informing policy decisions. [ABSTRACT FROM AUTHOR]

Highlights • Cough is a cardinal symptom in COPD and increases during exacerbation. • Cough and sputum production are associated with adverse outcomes in COPD. • Smoking, inflammation, neurogenic factors and comorbidities impact cough in COPD. • Detection of increased cough frequency may prove a useful predictor of exacerbation. Abstract Chronic obstructive pulmonary disease is predicted to become the 4th leading cause of death worldwide by 2030. The natural history of the disease includes progressive symptoms punctuated by acute exacerbations during which symptoms rapidly deteriorate. The resulting disability places significant burden on health and social care systems. Cough is the second most common symptom reported by COPD patients, is a source of significant distress and is associated with adverse outcomes. We discuss the importance of cough in COPD, its mechanism and the relationship between cough and COPD exacerbations. We review the literature and present original data relating to the investigation of cough during COPD exacerbation, its associations and potential benefits of cough monitoring. [ABSTRACT FROM AUTHOR]

Tracheobronchomalacia (TBM) is dynamic collapse of the trachea and bilateral mainstem bronchi leading to dyspnea, cough, and recurrent pneumonias. TBM is reported in 10-15% of patients with chronic obstructive pulmonary disease (COPD). Patients with TBM and COPD are not candidates for lung transplant, as TBM will still result in dynamic obstruction of the new allografts. A 70 year old male patient was diagnosed with COPD in 2012 and started on oxygen in 2019. He had worsening dyspnea with a chronic cough, presenting for lung transplant evaluation in 2022. His chest CT showed partial collapse of the right upper lobe, prompting a bronchoscopy notable for severe TBM (Figure 1A). His sputum culture was positive for stenotrophomonas and strep. pneumoniae, which were treated with antibiotics. He was listed for bilateral lung transplant with plan for concurrent tracheobronchoplasty (TBP). Once a suitable allograft was accepted, he was placed in left lateral decubitus position and a right posterolateral thoracotomy was used for the TBP with prolene mesh, which extended from proximal trachea to the mid bilateral mainstem bronchi. Next, the right pneumonectomy and lung transplant was performed with the bronchial anastomosis just distal to the end of the mesh. The thoracotomy was closed, and the patient was placed supine. The left lung transplant was performed via a left anterolateral thoracotomy. The initial P/F ratio was 532 mmHg. He was extubated on postoperative day (POD) 1, and on room air on POD 2. He was discharged on POD 13. A follow up bronchoscopy at 1 month showed resolution of his prior TBM (Figure 1B) with patent bilateral anastomoses. This report is the first known case of combined TBM and lung transplant. For patients with end-stage COPD and TBM, a combined TPS and bilateral lung transplant is technically feasible and safe. [ABSTRACT FROM AUTHOR]

Summary: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in developed countries, and its prevalence is projected to increase over the coming decades. According to the World Health Organization, COPD will become the third leading cause of death worldwide by 2020. COPD has a chronic and progressive course, and is often aggravated by exacerbations, which typically arise as a result of bronchial infection. Exacerbations are characterised by periods of increasing acute symptoms, particularly cough, dyspnoea and production of sputum, which worsen airflow obstruction, further impair quality of life and generally require a change in regular medication. Exacerbations are the most common cause of medical visits, hospital admissions and death in patients with COPD, and frequent exacerbations worsen health status and may cause a permanent decline in lung function. Chronic cough and sputum production are common in the general population, but significantly more prevalent in patients with respiratory disorders; these symptoms have been suggested as a risk factor for exacerbations of COPD. This article will review the consequences of chronic cough and sputum production in patients with COPD and analyse whether these risk factors may be useful for identifying a specific phenotype of patient that requires different management to reduce the occurrence of exacerbations. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Distinguishing community acquired pneumonia (CAP) from chronic obstructive pulmonary disease (COPD) exacerbation is a challenging task, since fever, productive cough, dyspnea, and leukocytosis are all common features of both conditions. Moreover, chest X-ray might not be sensitive enough. It is therefore quite common for physicians to prescribe unnecessary antibiotics for COPD exacerbation, leading to resistant bacteria and other related adverse affects. Aim: To study whether CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment, could provide an efficient tool for distinguishing CAP from COPD exacerbation. Methods: The study group included 36 COPD exacerbation and 49 CAP patients, admitted to a single Internal Medicine department during the years 2004–2006. All patients were treated with cephalosporins and macrolides upon admission. Results: CRP levels upon admission were significantly higher among CAP patients than among COPD exacerbation patients (111.5±104.4 vs. 34.9±28.6 mg/l, p <0.0001). CRP levels on the second day of hospitalization, following antibiotic administration to all patients, made a sharp incline in 36.7% of CAP patients compared to only 5.9% of COPD exacerbation patients (p =0.005), and remained unchanged in 61.8% of COPD patients compared to 16.3% of CAP patients (p =0.0006). Conclusions: CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment could provide an efficient tool for distinguishing CAP from COPD exacerbation. [Copyright &y& Elsevier]

Summary: Background: Cough is a frequent symptom of cigarette smokers that often precedes the development of airflow obstruction. We determined whether chronic cigarette smoking is associated with an increase in capsaicin cough response in the absence of cough. Methods: We examined this in asymptomatic smokers with normal lung function (n =68, FEV1 99.3±2.1% predicted) and in patients with established COPD without cough symptoms (n =42; FEV1 57.0±2.6% predicted), using healthy non-smoking volunteers as control (n =92; FEV1 100.6±1.7% predicted). Using an incremental capsaicin concentration challenge protocol, we recorded the concentrations that induced 2 (C2) and 5 or more coughs (C5). Results: Because females have a lower C2 and C5 than males in the control group, we analysed the data in each group according to gender. Log C5 was decreased both in asymptomatic smokers (1.56±0.11μmol/L, p <0.05) and in COPD patients (1.44±0.14μmol/L, p <0.01) when compared to non-smokers (1.90±0.09μmol/L). Log C2 did not differ between groups. Log C2 and log C5 were decreased in women (0.772±0.071μmol/L and 1.481±0.094μmol/L, respectively) when compared to men (1.045±0.088μmol/L and 1.923±0.087μmol/L, respectively) (p <0.05 for log C2; p <0.001 for log C5). Conclusion: We conclude that chronic cigarette smoking increases capsaicin cough reflex and that this remains so with the development of COPD. [Copyright &y& Elsevier]

Objective: To investigate cardiorespiratory health effects associated with chronic exposure to volcanogenic sulphur dioxide (SO2) and fine sulphate particle (≤0.3 pm) air pollution emitted from Kilauea Volcano, Hawaii. Study design: Environmental-epidemiological cross-sectional study. Methods: An air study was conducted to measure exposure levels in the downwind area, and to confirm non-exposure in a reference area. Cross-sectional health data were collected from 335 adults, ≥20 years of age, who had resided for ≥7 years in the study areas. Prevalence was estimated for cardiorespiratory signs, and self-reported symptoms and diseases. Logistic regression analysis estimated effect measures between exposed and unexposed groups considering potential confounding including age, gender, race, smoking, dust and body mass index (BMI). Student's tests compared mean differences in blood pressure (BP), pulse and respiratory rates. Results: There were statistically significant positive associations between chronic exposure and increased prevalence of cough, phlegm, rhinorrhoea, sore/dry throat, sinus congestion, wheezing, eye irritation and bronchitis. The magnitude of the associations differed according to SO2 and fine sulphate particulate exposure. Group analyses found no differences in pulse rate or BP; however, significantly faster mean pulse rates were detected in exposed non-medicated, non-smoking participants with BMI <25, and in participants aged ≤65 years. Higher mean systolic BP was found in exposed participants with BMI <25. Conclusions: Long-term residency in active degassing volcanic areas may have an adverse effect on cardiorespiratory health in adults. Further study at Kilauea is recommended, and the authors encourage investigations in communities near active volcanoes worldwide. Public health interventions of community education, and smoking prevention and cessation are suggested. [ABSTRACT FROM AUTHOR]

Background: Codeine is the standard antitussive treatment to which novel agents are compared. Little is known about the objective effect of any treatments on cough in chronic obstructive pulmonary disease (COPD). Objective: To quantify the effect of codeine on objective cough frequency (quantified as time spent coughing: cough seconds, cs/h), citric acid cough threshold, and subjective measures in a double-blind, placebo-controlled crossover study in COPD. Methods: We studied 21 patients with physician-diagnosed, stable disease who complained of cough (76.9% male; mean age, 67.7 years; mean predicted FEV1, 53.4%; median smoking history, 43.5 pack-years). Each subject performed a cough challenge (single breath, citric acid), 10-hour daytime ambulatory and overnight cough recordings, subjective cough scores, and visual analog scales at baseline and on 2 study days, 1 week apart. Codeine phosphate 60 mg or matched placebo were given, in random order, at the start of each cough recording (0 and 12 hours). Results: Median time spent coughing at baseline was 8.27 cs/h (interquartile range [IQR], 5.94-11.67); after placebo treatment, 7.22 cs/h (IQR 4.42-10.40); and after codeine treatment, 6.41 cs/h (IQR 3.86-9.10). Codeine treatment had a significant effect on time spent coughing compared with baseline (P = .02) but not compared with placebo (P = .52). There were no significant differences in cough challenge thresholds (log concentration of tussive agent causing 2 coughs or log concentration of tussive agent causing 5 coughs) or subjective cough measures for codeine compared with placebo. Conclusion: In this study, codeine was no more effective than placebo in patients with COPD complaining of cough. Clinical implications: Codeine is the antitussive agent to which we compare new treatments; however, in a group of stable patients with COPD, it had no effect on cough frequency over placebo. [Copyright &y& Elsevier]

Summary: Cough syncope is a well-known entity which results in loss of consciousness during episodes of cough. It commonly occurs in patients with severe chronic obstructive lung disease (COPD) and asthma. We report a 50-year-old African American male who presented with a syncopal episode during vigorous bout of coughing. He was noted to have clonic movements with brief loss of consciousness during this episode. Initially, he was evaluated for seizures but careful history revealed that he had similar episodes in the past with coughing. Physical examination was remarkable for diffuse bilateral wheezing and tachycardia. Chest X-ray showed hyperinflation of the lungs. Transthoracic echocardiogram showed evidence of moderate pulmonary hypertension. EEG and CT scan of the head were unremarkable. His bronchodilator regimen was optimized. He was treated with antitussives for the cough and was advised to exhale before coughing. His syncopal episodes resolved on his follow up visits after the discharge. This case demonstrates that cough syncope is a known presentation of severe COPD. It can often be confused with a seizure episode but a careful history is helpful to differentiate it from seizures. Treatment of underlying COPD and cough is associated with resolution of syncopal episodes. [Copyright &y& Elsevier]

Summary: An 87-year-old man was admitted to hospital because of fever, productive cough, dyspnea and altered consciousness. His medical history was significant for chronic obstructive pulmonary disease. He owned several pets. Physical examination and a chest radiograph revealed right upper lobe pneumonia. Blood cultures taken on admission yielded Pasteurella multocida and antimicrobial susceptibility testing showed susceptibility to β-lactams. The fever subsided four days after treatment with intravenous ceftriaxone and the patient was discharged in a very good clinical condition after two weeks of treatment. Although no history of bites or scratches was documented, it is likely that our patient was exposed to the secretions of his many pets through inhalation of contaminated aerosols. This resulted in tracheobronchial tree colonization by P. multocida, which later developed into pneumonia. Close animal contact should be avoided by frail, elderly patients with chronic pulmonary diseases, as it is a risk factor for pneumonia due to Pasteurella spp. [Copyright &y& Elsevier]