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Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a pathological entity characterized by a series of persistent physical manifestations such as cough, fatigue, dyspnea and sputum production; symptoms that generate discomfort in the patient from the moment of diagnosis and that, being an irreversible disease due to the tissue damage it causes, progressively has a negative impact on quality of life. On the other hand, the presence of psychological symptoms such as depression, insecurity, anxiety and emotional disturbances has been reported in patients diagnosed with COPD. Likewise, patients with this diagnosis tend to develop behaviors that alter their family and work social relationships, as they tend to isolate themselves due to the symptoms, especially physical. This situation generates the need to develop a research work with the objective of recognizing the cluster of physical, psychological and social symptoms of patients diagnosed with COPD, and to identify if a palliative care approach is proposed. The study was developed through a systematic literature review in which 1,776 articles were identified, of which 41 were evaluated for the identification of the symptom cluster. The binomial dyspnea and cough, fatigue and expectoration were identified as the physical symptom cluster; depression and anxiety constitute the psychological symptom cluster, and the impact on quality of life and the perception of isolation or social exclusion. [ABSTRACT FROM AUTHOR]

The Research to Practice column aims to provide advanced practice registered nurses (APRNs) with an analysis of current research topics with implications for practice change within emergency care settings. The article, "Antibiotics for Exacerbations of Acute Chronic Obstructive Pulmonary Disease?" conducted by D. Vollenweider, A. Frei, C. Streurer-Stey, J. Garcia-Aymerich, and M.A. Puhan (2018), examines a Cochrane systematic review and meta-analysis of randomized controlled trials. The investigators evaluate the findings that compare clinical outcomes including adverse events, re-exacerbation, treatment failure, and mortality among intensive care unit patients, inpatient, and outpatient populations treated with antibiotics or placebo medications for acute chronic obstructive pulmonary disease (COPD) exacerbations. The findings are discussed in the context of narrowing the evidence gap to improve clinical recommendations. Their findings have implications for APRN practice, including the signs and symptoms associated with an underlying bacterial triggered COPD exacerbation and the patient populations most likely to benefit from antibiotic therapy. [ABSTRACT FROM AUTHOR]

This study aimed to identify symptom clusters of chronic obstructive pulmonary disease (COPD) and to examine the relationship between symptom clusters and health-related quality of life (HRQoL). It included 154 hospitalized patients with COPD. The majority of the participants (88.6%) were aged 60 years and above, and the numbers of men and women were approximately equal (men: 55.2%). The Charlson Comorbidity Index (CCI), the Memorial Symptom Assessment Scale (MSAS), and the Chinese version of the Clinical COPD Questionnaire (CCQ) were used to evaluate comorbidity, participant's symptoms, and HRQoL, respectively. Five symptom clusters were identified using exploratory factor analysis, and symptom clusters, especially the Psychological, Pain and Fatigue, GI, and Dyspnea-Sweat symptom clusters, had negative effects on HRQoL in patients with COPD. Understanding the patterns and occurrences of symptom clusters could be essential for developing effective interventions to manage COPD symptoms and improve the patients' HRQoL. [ABSTRACT FROM AUTHOR]

Background: Prediction of future lung function will enable the identification of individuals at high risk of developing COPD, but the trajectory of lung function decline varies greatly among individuals. This study involved the development and validation of an individualized prediction model of lung function trajectory and risk of airflow limitation in the general population.Methods: Data were obtained from the Framingham Offspring Cohort, which included 4,167 participants ≥ 20 years of age and who had ≥ 2 valid spirometry assessments. The primary outcome was prebronchodilator FEV1; the secondary outcome was the risk of airflow limitation (defined as FEV1/FVC less than the lower limit of normal). Mixed effects regression models were developed for individualized prediction, and a machine learning algorithm was used to determine essential predictors. The model was validated in two large, independent multicenter cohorts (N = 2,075 and 12,913, respectively).Results: With 20 common predictors, the model explained 79% of the variation in FEV1 decline in the derivation cohort. In two validation datasets, the model had low error in predicting FEV1 decline (root mean square error range, 0.18-0.22 L) and high discriminative power in predicting risk of airflow limitation (C-statistic range, 0.86-0.87). This model was implemented in a freely accessible website-based application, which allows prediction based on flexible sets of predictors (http://resp.core.ubc.ca/ipress/FraminghamFEV1).Conclusions: The individualized predictor is an accurate tool to predict long-term lung function trajectories and risk of airflow limitation in the general population. This model enables identifying individuals at higher risk of COPD, who can then be targeted for preventive therapies. [ABSTRACT FROM AUTHOR]

Objectives: Chronic obstructive pulmonary disease (COPD) is underdiagnosed in the general population and possibly also in people living with HIV (PLWH). We evaluated the diagnostic performance of symptoms and risk factors for assessment of airflow limitation in PLWH and in uninfected controls. Methods: Spirometry was performed in the Copenhagen Comorbidity in HIV Infection (COCOMO) study and Copenhagen General Population Study (CGPS), and airflow limitation was defined by forced expiratory volume in 1 s/forced vital capacity < lower limit of normal. We calculated the sensitivity, specificity, predictive values and area under the curve (AUC) of symptoms and risk factors for assessment of airflow limitation in PLWH and uninfected controls. Results: A total of 1083 PLWH and 12 074 uninfected controls were included in the study. The sensitivity for sputum, chronic cough, breathlessness, wheezing, current and cumulative smoking and self‐reported COPD was higher, but the specificity lower, in PLWH than in uninfected controls. The negative and positive predictive values were largely similar between the groups. The AUCs were similar or slightly higher in PLWH and highest for > 20 pack‐years smoked [0.65; 95% confidence interval (CI) 0.58–0.72] and wheezing (0.64; 95% CI 0.57–0.71). A summed score for five variables was associated with slightly higher AUC in PLWH compared with uninfected controls [0.71 (95% CI 0.63–0.79) versus 0.65 (95% CI 0.63–0.68), respectively; P = 0.06]. Conclusions: Clinical variables were relatively poor discriminators of airflow limitation in PLWH and uninfected controls. Active COPD case finding by screening for symptoms and relevant exposures, as recommended in the general population, is likely to yield similar diagnostic power in PLWH. [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.

Aim To investigate the effects of carbocisteine treatment in the reduction of frequency of productive cough episodes, preventing disease progression and improving the quality of life as well as the tolerability of the administered treatment and patient compliance during the study. Methods This observational, non-interventional, multicenter, cohort study included 501 patients with chronic obstructive pulmonary disease (COPD) who were administrated carbocisteine capsules 375 mg and followed up during the next 15 days. The patients were observed at 3 points, baseline and two additional assessments. General clinical condition of patients, along with the spirometry testing at all three points were examined. Thr quality of life was assessed on the 1st and 3rd observation with Leicester Cough Questionnaire. Tolerability and patient compliance were measured throughout the study. Results There was a significant change of forced expiratory volume in 1 second (FEV1) status between the second and third observation (p=0.002). Examination of general symptoms showed a statistically significant reduction in cough by 74.9%, in sputum production by 48.5%, in dyspnea by 29% and in fatigue by 50%. After the administration of carbocisteine the median value of overall quality of life was 3.79 (3.63-3.89). Conclusion 375mg carbocisteine capsules were found to be effective and well-tolerated in the treatment of COPD, with a small percentage of reported mild adverse reactions and with a significant improvement of quality of life. [ABSTRACT FROM AUTHOR]

Background:Respiratory syncytial virus (RSV) is a significant cause of acute respiratory illness with a clinical spectrum ranging from self-limiting upper respiratory infection to severe lower respiratory infection in elderly persons as well as young children. However, there are limited data on risk factors for life-threatening infections that could guide the appropriate use of antiviral agents in adult patients with RSV. Methods:We conducted a retrospective cohort study from October 2013 to September 2015. Adult patients with RSV who visited the emergency department were enrolled. Primary outcome was life-threatening infection (admission to intensive care unit, need for ventilator care or in-hospital death). Results:A total of 227 patients were analysed. Thirty-four (15%) were classified as having life-threatening infections. By logistic regression, lower respiratory infection, chronic lung disease and bacterial co-infection were independent predictors of life-threatening infections. We developed a simple clinical scoring system using these variables (lower respiratory tract infection = score 4, chronic respiratory disease = score 3, bacterial co-infection = score 3 and fever ≥38 °C = score 2) to predict life-threatening infection. A score of >5 differentiated life-threatening RSV from non-life-threatening RSV with 82% sensitivity (95% CI, 66–93) and 72% specificity (95% CI, 65–78). Conclusions:The use of a clinical scoring system based on lower respiratory infection, chronic respiratory disease, bacterial co-infection and fever appears to be useful for outcome prediction and risk stratification in order to select patients who may need early antiviral therapy. [ABSTRACT FROM PUBLISHER]

Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden. [ABSTRACT FROM AUTHOR]

Individuals with human immunodeficiency virus (HIV) represent a population that is at a higher risk of developing chronic obstructive pulmonary disease (COPD). In this study, we sought to determine the effects of smoking on respiratory symptoms and diseases among HIV-positive patients and to determine if symptomatic patients are being appropriately screened for COPD. HIV-positive individuals completed a self-administered questionnaire. The effects of smoking on respiratory symptoms and diseases were reported as odds ratios (ORs). The COPD screening criteria were adapted from the Canadian Thoracic Society (CTS) guidelines. Two hundred and forty-seven participants were recruited. The median age was 49 years; 75% were male and 92% were on highly active antiretroviral therapy. Smokers represented 66% of the population. Smoking had a statistically significant effect on respiratory symptoms including wheeze (OR 4.8 [95% confidence interval (CI) 1.6-14.2]), phlegm production (OR 4.9 [95% CI: 2.2-10.5]), cough (OR 7.0 [95% CI: 3.0-16.2]), and dyspnea (OR 7.2 [95% CI: 1.7-31.2]). Smoking had a higher odds of respiratory diseases including COPD (OR 4.9 [95% CI: 1.1-21.9]) and bronchitis (OR 3.8 [95% CI: 1.9-7.7]). Among HIV-positive smokers, 40% met the CTS screening criteria, while only 12% self-reported a diagnosis of COPD. The burden of smoking in the HIV population is significant. HIV-positive smokers are more likely to report both respiratory symptoms and diseases than HIV-positive non-smokers. A discrepancy exists between patients who met the CTS screening criteria and those who were diagnosed with COPD, raising the concern for under-recognition and under-diagnosis of COPD in this population. [ABSTRACT FROM AUTHOR]

Background and Aims Mounier-Kuhn syndrome is a rare disease with abnormal enlargement of major airways, but epidemiological studies are lacking, and currently the most available data about it come from case reports, making it difficult to collate changes in a particular patient to those in previously published cases. The aim of this work is to systematically review cases published in the last 25 years and to use descriptive statistics to summarize the patient demographic and clinical information therein in order to acquire details about patient clinical characteristics. Methods Cases published in world literature between 1987 and 2013 were sought and reviewed according to PRISMA guidelines. Cases were included only if patient's age was at least 18 years, and a computed tomography scan with tracheal measurements was available. Results An 8:1 male predominance was found in 89 identified reports (128 cases). Mean age was 53.9 years, and average tracheal diameter was 36.1 mm. No correlation between increasing age and increasing tracheal diameter was found. Bronchiectasis, tracheal diverticulosis and tracheobronchial dyskinesia were common (49.2%, 33.6% and 28.9%, respectively). Cough, dyspnea and recurrent respiratory infections (71.1%, 51.6% and 50.8%, respectively) were the most common complaints. Conclusions The data confirm that syndrome mostly manifests with nonspecific respiratory symptoms and is significantly more common in males. Importantly, there was no connection between age and airway diameter, a fact that could mean that the enlargement does not progress over time, and its severity depends on some other yet undetermined factors. [ABSTRACT FROM AUTHOR]

Background: Symptomatic relief is an important treatment goal for patients with COPD. To date, no diary for evaluating respiratory symptoms in clinical trials has been developed and scientifically-validated according to FDA and EMA guidelines. The EXACT - Respiratory Symptoms (E-RS) scale is a patient-reported outcome (PRO) measure designed to address this need. The E-RS utilizes 11 respiratory symptom items from the existing and validated 14-item EXACT, which measures symptoms of exacerbation. The E-RS total score quantifies respiratory symptom severity, and 3 domains assess breathlessness, cough and sputum, and chest symptoms. Methods: This study examined the performance of the E-RS in each of 3 controlled trials with common and unique validation variables: one 6-month (N = 235, US) and two 3-month (N = 749; N = 597; international). Subjects completed the E-RS as part of a daily eDiary. Tests of reliability, validity, and responsiveness were conducted in each dataset. Results: In each study, RS-Total score was internally consistent (Cronbach α) (0.88, 0.92, 0.92) and reproducible (intra-class correlation) in stable patients (2 days apart: 0.91; 7 days apart: 0.71, 0.74). RS-Total scores correlated significantly with the following criterion variables (Spearman's rho; p < 0.01, all comparisons listed here): FEV1% predicted (-0.19, -0.14, -0.15); St. George's Respiratory Questionnaire (SGRQ) (0.65, 0.52, 0.51); Breathlessness, Cough, and Sputum Scale (BCSS) (0.89, 0.89); modified Medical Research Council dyspnoea scale (mMRC) (0.40); rescue medication use (0.43, 0.42); Functional Performance Inventory Short-Form (FPI-SF) (0.43); 6-minute walk distance (6-MWT) (-0.30, -0.14) and incremental shuttle walk (ISWT) (-0.18) tests. Correlations between these variables and RS-Breathlessness, RS-Cough and Sputum, RS-Chest Symptoms scores supported subscale validity. RS-Total, RS-Breathlessness, and RS-Chest Symptoms differentiated mMRC levels of breathlessness severity (p < 0.0001). RS-Total and domain scores differentiated subjects with no rescue medication use and 3 or more puffs (p < 0.0001). Sensitivity to changes in health status (SGRQ), symptoms (BCSS), and exercise capacity (6MWT, ISWT) were also shown and responder definitions using criterion- and distribution-based methods are proposed. Conclusions: Results suggest the E-RS is a reliable, valid, and responsive measure of respiratory symptoms of COPD suitable for use in natural history studies and clinical trials. [ABSTRACT FROM AUTHOR]

This review presents the available evidence for the effects of expiratory muscle strength training (EMST) with the use of a pressure threshold device. The investigators used computerized database searches for studies reporting the outcomes of pressure threshold EMST published after 1994. A total of 24 selected articles presented outcomes related but not limited to respiratory function, such as speech, swallow, voice, and cough function in persons with neurologic conditions such as Parkinson disease, multiple sclerosis, and Lance-Adams syndrome; in persons with respiratory diseases, such as chronic obstructive pulmonary disease; and in healthy young adults and sedentary and active elderly. Several studies demonstrated promising outcomes of EMST as a non-task-specific training for airway protection in persons with dysphagia secondary to neuromuscular impairments; however, further research is needed to confirm and generalize the reported findings. [ABSTRACT FROM AUTHOR]

The article describes the case of a 78-year-old woman with complaints of fatigue, dry cough, and dyspnea lasting for two months. Medical history of the woman showed complications like chronic obstructive pulmonary diseases (COPD), seizure order, and hypothyroidism. A chest x-ray revealed a bandlike opacity in her right lower lobe. The patient's intake of amiodarone was stopped when a diagnosis of amiodarone-induced pulmonary toxicity (APT) was made then a corticosteroid therapy was initiated.

Whether respiratory symptoms are associated with mortality independent of lung function is unclear. The authors explored the association of the exposures i) lung function, ii) respiratory symptoms, and iii) lung function and respiratory symptoms combined, with the outcomes all-cause and cardiovascular mortality. The study included 10,491 adults who participated in the Nord-Trøndelag Health Study (HUNT) Lung Study in 1995-1997 and were followed through 2009. Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals for all-cause and cardiovascular mortality associated with pre-bronchodilator% predicted forced expiratory volume in 1 second (ppFEV1), chronic obstructive pulmonary disease (COPD) grades, and respiratory symptoms (chronic bronchitis, wheeze, and levels of dyspnoea). Lung function was inversely associated with all-cause mortality. Compared to ppFEV1 ≥100, ppFEV1 <50 increased the HR to 6.85 (4.46-10.52) in women and 3.88 (2.60-5.79) in men. Correspondingly, compared to normal airflow, COPD grade 3 or 4 increased the HR to 6.50 (4.33-9.75) in women and 3.57 (2.60-4.91) in men. Of the respiratory symptoms, only dyspnoea when walking remained associated with all-cause mortality after controlling for lung function (HR 1.73 [1.04-2.89] in women and 1.57 [1.04-2.36] in men). Analyses of lung function and dyspnoea when walking as a combined exposure further supported this finding. Overall, associations between lung function and cardiovascular mortality were weaker, and respiratory symptoms were not associated with cardiovascular mortality. In conclusion, lung function was inversely associated with all-cause and cardiovascular mortality, and dyspnoea when walking was associated with all-cause mortality independent of lung function. [ABSTRACT FROM AUTHOR]

The article presents questions that offer an example that potential Certified Medical-Surgical Registered Nurse certificants may use to test their knowledge about chronic obstructive pulmonary disease, with topics mentioned such as respiratory acidosis, hypoxia, and nebulized bronchodilator.

A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed. [ABSTRACT FROM AUTHOR]

COPD is a disease manifested as persistent airflow obstruction with an enhanced inflammatory response in the airways and lungs to noxious particles and gases which evokes symptoms of dyspnea on exertion, cough and mucus production. Airway smooth muscle plays a central role in the COPD diathesis and is implicated in many aspects of COPD pathogenesis. Vitamin D deficiency has been associated with COPD severity and studies suggest a role for Vitamin D as a treatment for COPD. In this review, we describe the effects of 1,25-dihydroxyvitamin D on airway smooth muscle function, including agonist-induced shortening, secretion of inflammatory mediators, and myocyte hypertrophy and hyperplasia. [Copyright &y& Elsevier]

The article focuses on diagnostic problems for co-morbid cardio-respiratory ailments in Great Britain. It mentions that one of the biggest spending in the National Health Service (NHS) is related to long-term conditions where co-morbidities are common, that is why early diagnosis is vital to reduce hospital confinement and complications. The Department of Health's Quality, Innovation, productivity and Prevention (QIPP) program is supporting the NHS to improve care effectively.

Supportive and palliative care is an interdisciplinary challenge with the aims of symptom relief and improvement of quality of life in end-stage patients. Main complaints of patients with advanced nonmalignant lung disease are depression and anxiety, dyspnea, pain, and coughing. The discomfort of many physicians, caregivers, and family members with discussions about end-of-life care is one obstacle for the timely initiation of palliative care and the uncertainty of the short-term prognosis in most advanced nonmalignant respiratory diseases. Early dialog about supportive care already at the onset of the patient's first symptoms and contemporaneous to life-prolonging therapy may overcome these barriers. Furthermore, continuing education for health professionals in palliative care ensures adequate palliative support. Here, we review insights into symptom control and palliative care in patients with advanced nonmalignant respiratory disease. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses the case of a 19-year-old woman with asthma who was presented to the hospital due to a month-history of cough and progressive dyspnea. It notes that the patient has been sent to the operating room for an open biopsy of the mass detected at the right iliacus muscle that extends into the upper thigh. Tests results have led to the diagnosis of alveolar soft part sarcoma (ASPS). It describes ASPS as a rare soft-tissue tumor that is prevalent among adolescents and young adults.

Bronchiolitis is an acute, infectious, inflammatory disease of the upper and lower respiratory tract that may result in obstruction of the small airways. A case control study was done at the pediatrics department of the Tikrit Teaching Hospital during the period from the 1st of November 2008 to the last of February 2009 on patients diagnosed as acute bronchiolitis to evaluate the effect of single dose long acting methyleprednisolon in the treatment of acute Bronchiolitis. Most of the cases were from rural areas 97 (63%) while the urban cases were 57 (37%). Most of the study cases were under the age of 6 months 102 (66.2%).Most of the cases present from the 3rd to the 6th day of the illness 127 (82.5%).All the patients have dyspnea, cough and rhonchi of examination of chest (100% for each one). Regarding the time needed for weaning from O2 for the patients after methyleprednisolon injection in the both two groups of the study. Most of the cases in the group 1 (received methyleprednisolon therapy) weaned from O2 within 2 days of treatment 61 cases (79.2 %) while in the other group most of the cases weaned from O2 at the 3rd or 4th day 41 cases (53.2 %).Most of the cases in the group 1 respond within 2 days of treatment 57 cases (74%) while in the other group most of the cases responded at the 3rd or 4th day 39 cases (50.6%). Most of the cases in the group 1 discharged within 2 days of treatment 55 cases (71.4%) while in the other group most of the cases discharged at the 3rd or 4th day 37 cases (48.1%).The study concludes that there is significant effect of using methyleprednisolon therapy in the treatment of acute bronchiolitis. [ABSTRACT FROM AUTHOR]

Constrictive bronchiolitis (CB) is a rare disease with unclear etiology. We report a 37-year-old female with CB who developed progressive dyspnea and cough after completing a course of 5-fluorouracil (5-FU) for colon cancer. The patient had evidence of irreversible obstructive lung disease and lung biopsy showed typical findings of chronic inflammation, submucosal thickening and obliteration of bronchioles. To the best of our knowledge this is the first reported case of CB after treatment with 5-FU. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstracts: Patients with chronic obstructive pulmonary disease (COPD) most commonly complain of cough, production of phlegm and breathlessness. The cough reflex sensitivity is heightened compared with that in healthy volunteers and is similar to that in subjects with asthma. The degree of airflow obstruction does not predict cough reflex sensitivity or objective cough counts, implying an independent process. Objective cough rates seem to be relatively low in COPD, despite frequent reporting of the symptom by patients. The relative contribution of cough to disability in COPD seems to be small, if assessed by subjective reporting. Effective treatments for cough in COPD have not yet been identified. Improved outcome measures of cough, a better understanding of the mechanisms underlying cough, and the importance of cough to patients is required to progress in this field. [Copyright &y& Elsevier]

Background: A patient report of respiratory symptoms in COPD is essential to successfully monitoring disease, adjusting treatment, and evaluating outcomes. Objective: To develop empirically based guidelines for interpreting mean changes in symptom scores using the Breathlessness, Cough, and Sputum Scale (BCSS). Methods: Analyses were performed on data from three multinational trials (n = 2,971). Mean changes in BCSS score with treatment were examined by physician and patient ratings of treatment efficacy, juxtaposed with percentage change in symptoms, statistical effect size (ES), ΔFEV[sub 1], and change in St. George Respiratory Questionnaire (SGRQ) score. BCSS scores during an exacerbation were examined relative to changes in peak expiratory flow and rescue medication use. Results: Mean baseline BCSS total score was 5.2 ± 2 (± SD); 90% of scores were between 2 and 9. Highly efficacious treatment (n = 257; physician rating) was associated with a ΔBCSS total score of -1.3 ± 1.8, representing a 24% improvement (ES = 0.7), and corresponding to a 10% improvement in FEV[sub 1] and ΔSGRQ score total of -10.3 ± 13.8. Similar changes in BCSS score were observed during recovery from an exacerbation (n = 713; -1.3 ± 1.8). Mean change with moderately efficacious treatment (n = 965) was -0.7 ± 1.8, a 13% improvement (ES = 0.3) corresponding to ΔSGRQ total score of -6.8 ± 12.6. Mildly efficacious treatment (n = 891) was associated with a change of -0.35, a 7% improvement (ES = 0.18), with a ΔFEV[sub 1] <1% and ΔSGRQ total score of -2.6 ± 11.7. Conclusions: Patient-reported daily symptom data are sensitive to change and useful for both observational studies and controlled clinical trials of patients with COPD. A mean ΔBCSS total score >1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small. [ABSTRACT FROM AUTHOR]

The article presents a case study of 55-year-old man with chronic obstructive pulmonary disease (COPD) brought to the emergency department (ED) because of progressive shortness of breath, cough, and sputum production. The importance of using oral glucocorticoids in the management of acute COPD exacerbations is outlined. The article also highlights the prescription of a 5-day regimen of glucocorticoid therapy for acute COPD exacerbations.

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]

A 69-year-old man with chronic obstructive pulmonary disease (COPD) presented with an exacerbation of cough and breathlessness, as well as a 5 day history of sudden-onset bilateral calf tenderness. He had been commenced on inhaled steroids 4 1 /2 years earlier and then received maintenance oral prednisone. Upon examination, there was a haematoma inferior to the medial malleolus with no Achilles tenderness on the left side. On the right side, there was focal tenderness over the mid-portion of the Achilles tendon with pain accentuated upon dorsi flexion. A venous duplex study confirmed superficial venous thrombosis involving the left gastrocnemius vein extending proximally to the popliteal vein junction. The major axial deep veins of the left lower leg were patent. Findings on the right side were normal. A subsequent diagnostic ultrasound demonstrated unequivocal bilateral Achilles tendon ruptures. The patient subsequently underwent corrective surgery. There have been several reports of bilateral Achilles tendon rupture associated with long-term corticosteroid use. It is likely that this entity is underdiagnosed because of a lack of awareness of this association by physicians. Recognition and surgical intervention are likely to reduce morbidity and improve outcome. [ABSTRACT FROM AUTHOR]

Background: The COPD Assessment Test (CAT) contains eight items (cough, phlegm, chest tightness, breathlessness, limited activities, confidence leaving home, sleeplessness and energy). The current study aimed 1) to better understand the impact of the respiratory and non-respiratory CAT item scores on the CAT total score; and 2) to determine the impact of pulmonary rehabilitation (PR) on CAT items and CAT total score.Methods: CAT total score of ≥10 or ≥ 18 points was used to classify patients as highly symptomatic, a decrease of 2 points was considered as clinically relevant improvement. 'Cough', 'phlegm', 'chest tightness', 'breathlessness' were defined as respiratory items; ≥3 points on each item was defined as highly symptomatic.Results: In total, 497 clinically stable patients (55% male, age 64.0 (57.5-71.0) years, FEV1 46.0 (32.0-63.0)% predicted, CAT total score 22.0 (17.5-26.0) points) were included. 95% had CAT score ≥ 10 points and 75% ≥18 points. Respectively, 45% and 54% of subjects scored high on 3 or 4 of the respiratory CAT items. Following PR, 220 patients (57.7%) reported an improved health status as assessed by CAT total score (- 3.0 (- 7.0-1.0) points). Change in CAT item scores ranged from 0.0 (- 1.0-0.0) to - 1.0 (- 2.0-0.0) points) with best improvements in 'energy' (- 1.0 (- 2.0-0.0)points).Conclusions: A substantial number of patients classified as highly symptomatic did not report a high level of respiratory symptoms, indicating that non-respiratory symptoms impact on disease classification and treatment algorithm. The impact of PR on CAT item scores varied by individual item.Trial Registration: Netherlands National Trial Register ( NTR3416 ). Registered 2 May 2012. [ABSTRACT FROM AUTHOR]

The article presents case report of a 56-year-old man presented with a 5-day history of a shortness of breath, fever, cough and chest pain. He had a 14 pack-year smoking history and moderate chronic obstructive pulmonary disease. Physical examination revealed decreased respiratory sounds in the right lung field. Computed tomography revealed a mass 25 by 35 mm in size, obstructing the superior bronchus of the lower lobe of the right lung and the distal portion of bronchus intermedius. Postobstructive pneumonitis and atelectasis were seen in the middle and right lower lobe parenchyma. Readers are invited to supply one possible diagnosis.

Background: The impact of COPD on patient's quality of life is well established, but gender differences have received little attention.Methods: To describe factors associated with the health-related quality of life by gender: A cross-sectional observational study (NCT01007734) was conducted in COPD patients followed by pulmonologists. The first patient included had to be a woman. Data concerning the patient, COPD and their management were collected by the physician. The patient had to fill in several questionnaires: Saint-George Hospital respiratory Questionnaire (SGRQ-C), and motivation to quit smoking.Results: Four hundred and thirty patients were included: mean age 63.9 ± 11.3 years; 57.4% were women. Women were significantly younger than men (61.9 vs. 66.6) and their tobacco use was lower (37.1 vs. 40.4 PY). Cardiovascular comorbidities were more frequent in men while osteoporosis, anxiety and depression were frequent in women. The frequency of cough, sputum and the severity of dyspnea did not differ significantly between genders. Lung function impairment was less severe in women than in men (mean FEV1 52% predicted normal vs. 47. 8%). Anxiety score was higher (score 9.8 vs. 7.1) and quality of life (SGRQ-C) more impaired in women (scores 50.6 vs. 45.4; p < 0.02) than in men. Moreover, in multivariate analysis, chronic sputum was associated with higher SGRQ-C scores in women but not in men.Conclusions: This study underlines that despite less airflow limitation, quality of life is more impacted by chronic sputum in women than in men. [ABSTRACT FROM AUTHOR]

Presents a case of obstructive lung disease with chronic cough and exertional dyspnea. Findings of the fiberoptic bronchoscopy; Findings of the thoracic computed tomography; Prevalence of tracheobronchomalacia; Inspection of the flow-volume loop.