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Introduction: We examined the relationship between current tobacco use and functionally important respiratory symptoms.Methods: Longitudinal cohort study of 16 295 US adults without COPD in Waves 2-3 (W2-3, 2014-2016) of the Population Assessment of Tobacco and Health Study. Exposure-Ten mutually exclusive categories of tobacco use including single product, multiple product, former, and never use (reference). Outcome-Seven questions assessing wheezing/cough were summed to create a respiratory symptom index; cutoffs of ≥2 and ≥3 were associated with functional limitations and poorer health. Multivariable regressions examined both cutoffs cross-sectionally and change over approximately 12 months, adjusting for confounders.Results: All tobacco use categories featuring cigarettes (>2/3's of users) were associated with higher risk (vs. never users) for functionally important respiratory symptoms at W2, for example, at symptom severity ≥ 3, risk ratio for exclusive cigarette use was 2.34 [95% CI, 1.92, 2.85] and for worsening symptoms at W3 was 2.80 [2.08, 3.76]. There was largely no increased symptom risk for exclusive use of cigars, smokeless tobacco, hookah, or e-cigarettes (adjustment for pack-years and marijuana attenuated the cross-sectional e-cigarette association from 1.53(95% CI 0.98, 2.40) to 1.05 (0.67, 1.63); RRs for these products were also significantly lower compared to exclusive use of cigarettes. The longitudinal e-cigarette-respiratory symptom association was sensitive to the respiratory index cutoff level; exclusive e-cigarette use was associated with worsening symptoms at an index cutoff ≥ 2 (RR = 1.63 [1.02, 2.59]) and with symptom improvement at an index cutoff of ≥ 3 (RR = 1.64 [1.04, 2.58]).Conclusions: Past and current cigarette smoking drove functionally important respiratory symptoms, while exclusive use of other tobacco products was largely not associated. However, the relationship between e-cigarette use and symptoms was sensitive to adjustment for pack-years and symptom severity.Implications: How noncigarette tobacco products affect respiratory symptoms is not clear; some studies implicate e-cigarettes. We examined functionally important respiratory symptoms (wheezing/nighttime cough) among US adults without COPD. The majority of adult tobacco users smoke cigarettes and have higher risk of respiratory symptoms and worsening of symptoms, regardless of other products used with them. Exclusive use of other tobacco products (e-cigarettes, cigars, smokeless, hookah) was largely not associated with functionally important respiratory symptoms and risks associated with their use was significantly lower than for cigarettes. The association for e-cigarettes was greatly attenuated by adjustment for cigarette pack-years and sensitive to how symptoms were defined. [ABSTRACT FROM AUTHOR]

Background The incidence of pertussis in the United States has increased in recent years. While characteristics of severe pertussis infection have been described in infants, fewer data are available in older children and adults. In this analysis, we characterize pertussis infections in hospitalized patients of all ages. Methods Cases of pertussis with cough onset from 1 January 2011 through 31 December 2015 from 7 US Emerging Infections Program Network states were reviewed. Additional information on hospitalized patients was obtained through abstraction of the inpatient medical record. Descriptive and multivariable analyses were conducted to characterize severe pertussis infection and identify potential risk factors. Results Among 15942 cases of pertussis reported, 515 (3.2%) were hospitalized. Three hospitalized patients died. Infants aged <2 months accounted for 1.6% of all pertussis cases but 29.3% of hospitalizations. Infants aged 2–11 months and adults aged ≥65 years also had high rates of hospitalization. Infants aged <2 months whose mothers received acellular pertussis during the third trimester and children aged 2 months to 11 years who were up to date on pertussis-containing vaccines had a 43%–66% reduced risk of hospitalization. Among adolescents aged 12–20 years, 43.5% had a history of asthma, and among adults aged ≥65 years, 26.8% had a history of chronic obstructive pulmonary disease. Conclusions Individuals at the extreme ends of life may be the most vulnerable to severe pertussis infections, though hospitalization was reported across all age groups. Continued monitoring of severe pertussis infections will be important to help guide prevention, control, and treatment options. [ABSTRACT FROM AUTHOR]

The article discusses case study of a 63-year-old female suffering from brain lesion and influenza. Topics include regular acid–Schiff and Grocott methenamine silver staining in the brain-imaging test with narrow angle branching septate suggestive of Aspergillus infection, and magnetic resonance imaging scan being repeated because of increasing size of the abscesses as well as worsening surrounding edema.

Introduction: Cigarette smoking is the largest known risk factor for chronic obstructive pulmonary disease (COPD), but little is known about the role of time to first cigarette (TTFC), an indicator of nicotine dependence (ND). This study examines whether daily TTFC is associated with pulmonary outcomes, independently of smoking behavior.Methods: A cross-sectional sample of 1461 current adult smokers were drawn from the National Health and Nutrition Examination Survey (NHANES), 2007-2010. The relationships of daily TTFC with outcomes of spirometry-defined pulmonary impairment and self-reported respiratory symptoms (coughing, bringing up phlegm, and wheezing) were examined (1) at the unadjusted level, (2) after adjusting for smoking heaviness and duration, and (3) after also adjusting for environmental exposure and demographics.Results: In fully-adjusted weighted regressions, those reporting TTFC ≤ 5 minutes were three times as likely to have COPD (confidence interval [CI] = 1.30-8.77), had a 3% lower forced vital capacity expired in the first second (FEV1/FVC) (CI = -0.051 to -0.009), were seven times as likely to report coughing (CI = 1.96-26.41), and 16 times as likely to report bringing up phlegm (CI = 3.43-74.82), relative to those reporting TTFC > 60 minutes. Similar associations were often found when comparing TTFC between 5 to 30 minutes and TTFC between 30 to 60 minutes with TTFC > 60 minutes.Conclusions: "Addicted" smoking, as measured by earlier TTFC, is associated with a markedly increased risk of spirometry-measured obstructive pulmonary impairment, and of reporting symptoms of coughing and phlegm, even after controlling for smoking behavior and other risk factors for COPD. TTFC may prove valuable in more precisely assessing smokers' risk of pulmonary impairment.Implications: This study shows that smoking sooner after waking, a reliable indicator of ND, substantially increases the risk of spirometry-defined pulmonary impairment and self-reported symptoms, independently of lifetime and current smoking behavior. This study adds to a small body of literature examining health outcomes associated with higher ND, including outcomes of COPD. The current study overcomes important shortcomings of these existing studies in at least two ways: controlling for other known risk factors for COPD, and using empirical, spirometry-defined outcomes pulmonary function rather than self-reported COPD outcomes. [ABSTRACT FROM AUTHOR]

She presented herself with a chronic obstructive pulmonary disease (COPD) as precondition which was not responsive to standard therapy (e.g. inhalative corticosteroids or beta-agonists) [[1]] and needed 4 L/min of oxygen over a nasal canula to sustain an adequate peripheral oxygen-level (SpO SB 2 sb > 90%). Risk factors for developing laryngoceles are high airway pressures e.g. due to excessive coughing or playing wind instruments, with coughing owing to our patient's COPD being the most feasible explanation in this case [[3]]. Interestingly, we were able to discharge the patient without any additional oxygen-supply, leading to the assumption that the laryngocele was responsible for a great margin of the patient's COPD-symptoms. [Extracted from the article]

Background: Smoking is the primary cause of deterioration in forced expiratory volume (FEV1) and the development of chronic obstructive lung disease. This study assessed the independent association of smoking with respiratory symptoms and lung function in young adults who took part in the European Community Respiratory Health Survey (ECRHS-I). Methods: Cross-sectional multi-centre survey of a general population of young adults aged 20(44 years in the ECRHS(I conducted in five Spanish centres. Several groups were created in an exclusive and descendent manner from the subjects who completed the questionnaire in accordance with how they had answered the questions: asthma-related symptoms; chronic bronchitis symptoms; minor respiratory symptoms; chronic cough; and no respiratory symptoms. Among a subset of the population, forced spirometry tests were performed. Linear and logistical regression models were used to assess the relationship of smoking in the presence of symptoms and its impact on lung function, adjusted by other important variables. Results: The prevalence of respiratory symptoms was higher among smokers. After adjusting for geographical area, total IgE, age, sex, and FEV1, smoking was associated with an increased risk of chronic bronchitis and other respiratory symptoms. These risks increased with increasing number of cigarettes smoked per day. A deterioration of FEV1 and the FEV1/FVC ratio was also directly associated with the number of cigarettes smoked per day. Conclusion: Even among young adults, smoking confers a high risk of developing a number of respiratory symptoms and the deterioration of the ventilatory function. [ABSTRACT FROM AUTHOR]

Background: COPD is characterized by non-remitting airflow limitation and persistent respiratory symptoms which is an enhanced inflammatory response to prolonged exposure to smoking or noxious gases or particles and manifested through chronic cough, effort dyspnea, expectoration and wheezing, symptoms that appears in context of airways hyper-responsiveness and may be partially reversible. Objective: Assessment of COPD patients in Gamal Abd El Nasser Hospital during period from January 2017 to June 2017. Subjects and Methods: This study was a cross sectional study that included 290 COPD patients recommended for spirometric assessment. The patients were classified into 2 groups: Outpatients and inpatients in the period from January 2017 to June 2017, they were subjected to full medical history, general and local examination, Pre and post bronchodilator spirometric study according to (GOLD, 2017) and each patient will be subjected to the following questionnaire [Serial number, Name, Age, Sex, Occupation, Residence, Level of education, Smoking, Smoking index, Family history of COPD, Symptoms, Number and severity of exacerbation attacks in the last year, Number of Hospitalization during the last year, Vaccination status, Spirometry, Treatment prescribed by, Treatment, Inhalation therapy, Regulation of treatment, Non pharmacological therapy, Satisfaction of treatment, co morbidities, Complications, Outcome for inpatient]. Results: The study included 290 patients, 259 males and 31 females with age range of 29 - 83 years, the majority of the studied cases were Current smoking but only 22.5% was exsmoker. Mean FEV1% pred. Post-bronchodilator was 75.9 ± 16.9 in outpatients and mean FEV1% pred. Post - bronchodilator was 52.9 ± 13.4 in inpatient. The most common co morbidities in COPD patients were hypertension in 25% of cases. More than half of all studied cases had complications and the most frequent complication was Cor-pulmonale and respiratory Failure. In this study, Severity of COPD according to GOLD 2017 was 27.8% in mild stage, 34.2% in moderate stage, 35.8% in severe stage and 2.5% in very severe stage. Conclusion: Spirometry had a great role in diagnosis of COPD and its differential diagnosis from asthma. Smoking is the major risk factors in developing COPD and this reflects on the disease occurrence and severity. Some of COPD patients refuse to use inhalers due to fear of addiction and incorrect method in using it. Inhaler steroids were preferred due to fear of systemic complications of steroids. There is great defect in vaccination and trials of quitting smoking as a non-pharmacological treatment for COPD patients. [ABSTRACT FROM AUTHOR]

Background Individuals experiencing homelessness are at an increased risk of respiratory illness due to high prevalence of underlying chronic conditions, inadequate ventilation and crowding in shelters, and difficulty accessing health services. Few studies have investigated the prevalence and transmission of viral respiratory infections within shelters. We sought to determine the prevalence and risk factors for influenza-like illness (ILI) at two homeless shelters in Seattle, WA. Methods Between January and April 2019, we conducted a cross-sectional study of adults experiencing homelessness who identified their primary residence as one of the two shelters in Seattle. Participants voluntarily enrolled if they self-reported at least two symptoms of acute respiratory illness in the past week. Demographic, clinical, and behavioral data were ascertained via questionnaire, and a mid-nasal swab was collected. ILI was defined as fever with cough or sore throat. Chronic lung disease was defined as chronic obstructive pulmonary disease, asthma, and/or chronic bronchitis. Results Among the 480 participants enrolled in the study, 204 (42.5%) reported ILI symptoms. Of those enrolled, 144 (30.0%) had chronic lung disease. The prevalence of ILI was higher among individuals with chronic lung disease (53.5% vs. 42.5%, P = 0.001). A total of 422 (87.9%) had health insurance; the prevalence of ILI was lower among those with health insurance (42.4% vs. 57.8%, P = 0.66). 216 (45.0%) of participants received flu vaccine; the prevalence of ILI was similar among those who received the vaccine than those that did not (42.6% vs. 42.4%, P = 1.00). 129 (30.6%) of those with health insurance sought care for their reported symptoms; ILI was more prevalent in those that sought care than those that did not throughout the observation period (33.8% vs. 21.7%, P = 0.002). Of those with ILI that sought care, 46 (54.8%, P = 0.42) received antivirals or antibiotics. Laboratory results for the corresponding mid-nasal swabs are pending. Conclusion A large proportion of our study population self-reported ILI and chronic lung disease. Despite high insurance coverage, a low proportion of homeless enrolled sought care for their symptoms or received treatment. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The fumes and gases released during welding can lead to respiratory ill-health. Aims To assess prevalence of respiratory symptoms (RS) and respiratory function (RF) of welders in comparison to a control group (CG). Methods A cross-sectional study was conducted among welders and controls selected from office support staff of a medical faculty. RS were determined by administering a questionnaire and RF with the use of an electronic spirometer. Results Forty-one welders and 41 controls participated. Chronic bronchitis was significantly higher among welders (27%; n = 11) than in controls (7%; n = 3) with an odds ratio of 4.6 [95% confidence interval (CI): 1.1–23.3]. Forced vital capacity (FVC), forced expiratory volume in the first second of forced vital capacity (FEV1.0), forced mid-expiratory flow rate (FEF25–75%) and peak expiratory flow rate (PEFR) were slightly higher among welders (2.97 l, 2.6 l, 3.4 l/s and 339 l/min, respectively) than in the CG (2.79 l, 2.4 l, 3.38 l/s and 323 l/min, respectively), the differences of which were not statistically significant. On comparison of the observed values of welders with the predicted normal values, the observed FVC (2.97 versus 3.35 l, respectively) and PEFR (339 versus 538 l/min) had significantly lower values. Conclusions Welders are at a higher risk of developing chronic bronchitis with non-impairment of lung function in comparison to the CG. [ABSTRACT FROM AUTHOR]