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Background: Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown. Methods: Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF25-75) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV1/FVC ≥ LLN). Results: Almost a fifth of the participants had spirometric SAO (19% for FEF25-75; 17% for FEV3/FVC). Using FEF25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77–2.70), chronic cough (OR = 2.56, 95% CI 2.08–3.15), chronic phlegm (OR = 2.29, 95% CI 1.77–4.05), wheeze (OR = 2.87, 95% CI 2.50–3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11–1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV3/FVC. Isolated spirometric SAO (10% for FEF25-75; 6% for FEV3/FVC), was also associated with respiratory symptoms and cardiovascular disease. Conclusion: Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF25-75 and FEV3/FVC, in addition to traditional spirometry parameters. [ABSTRACT FROM AUTHOR]

Background: Low‐dose long‐term azithromycin is recommended in clinical practice guidelines for obstructive airway diseases (OAD); however, an optimal therapeutic regimen is not yet established. Aim: To understand the patterns of azithromycin use in OAD, characterise the patients who received it and evaluate its safety and efficacy using real‐world data. Methods: We audited 91 patients who had received azithromycin for at least 4 weeks for the management of asthma, chronic obstructive pulmonary disease (COPD) or non‐cystic fibrosis bronchiectasis. Results: The mean age was 65 ± 18 years, 60% were female and 48% were ex‐smokers. The majority had asthma (75%), either alone (50%) or in combination with COPD (12%) or bronchiectasis (13%). Most (64%) reported cough or sputum at baseline. The most common treatment regimen was azithromycin 250 mg daily (73%) for more than 1 year (57%), with only seven adverse events. There was a significant reduction in the proportions of patients requiring emergency department visits (48% vs 32%; P < 0.001) and hospital admissions (35% vs 31%; P < 0.001) after starting azithromycin. In 88% of cases, physicians favoured the use of azithromycin. Conclusion: Physicians are currently using low‐dose azithromycin for a long duration of more than 1 year for the management of OAD. The typical case definition is an older non‐smoking adult with persistent asthma, often in combination with another OAD and presenting with bothersome cough or sputum. Azithromycin was well tolerated and led to reduced healthcare utilisation. Further research is required to establish an optimal dosage regimen of azithromycin in OAD. [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]

Objective: To determine if exposure to cold environments, during work or leisure time, was associated with increased reporting of airway symptoms in the general population of northern Sweden. Methods: Through a population-based postal survey responded to by 12627 subjects, ages 18–70, living in northern Sweden, the occurrence of airway symptoms was investigated. Cold exposure during work or leisure time was self-reported on numerical rating scales. Binary logistic regression was used to determine the statistical association between cold exposure and airway symptoms. Results: For currently working subjects (N = 8740), reporting any occupational cold exposure was associated to wheeze (OR 1.3; 95% CI 1.1–1.4); chronic cough (OR 1.2; 95% CI 1.1–1.4); and productive cough (OR 1.3; 95% CI 1.1–1.4), after adjusting for gender, age, body mass index, daily smoking, asthma, and chronic obstructive pulmonary disease. Leisure-time cold exposure was not significantly associated to reporting airway symptoms. Conclusions: Occupational cold exposure was an independent predictor of airway symptoms in northern Sweden. Therefore, a structured risk assessment regarding cold exposure could be considered for inclusion in the Swedish workplace legislation. [ABSTRACT FROM AUTHOR]

To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7–8.2% versus 6.3–6.7%) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7 and 2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex. [ABSTRACT FROM AUTHOR]

Background: To compare peramivir 300 mg single‐dose, peramivir 600 mg repeat‐dose, and oseltamivir effects on health‐related quality of life, including respiratory symptoms and general conditions, time to symptom alleviation, time to fever resolution, incidence of exacerbations, and virus titer, in influenza patients with chronic respiratory disease. Methods: We report additional outcomes from a 2‐week, multicenter, randomized, open‐label study in Japan (UMIN000030118). Influenza patients with chronic respiratory disease received intravenous peramivir (300 mg single‐dose [n = 66], 600 mg repeat‐dose [600 mg/d of 2 consecutive days; n = 70]) or oral oseltamivir (75 mg twice daily, 5 days; n = 72). The principal endpoint of this analysis was change from baseline to Day 14 at each time point in Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scores. Results: Both peramivir regimens reduced total CAT score at Day 3 more than oseltamivir (peramivir 600 mg vs oseltamivir, P =.0032; peramivir 300 mg vs oseltamivir, P =.0203). Cough/phlegm CAT scores were most improved with peramivir 600 mg. Median time to alleviation of three respiratory symptoms was longer with peramivir 600 mg (68.9 hours) than with peramivir 300 mg (50.6 hours, hazard ratio [HR] 1.57; P =.0191) and shorter with peramivir 300 mg than oseltamivir (78.8 hours, HR 0.62; P =.0141). Alleviation of seven influenza symptoms and fever resolution was shortest with peramivir 300 mg. Conclusions: Rapid improvement in CAT score, including cough, and shorter time to alleviation of respiratory symptoms associated with peramivir is of potential benefit to patients with chronic respiratory disease. [ABSTRACT FROM AUTHOR]

Introduction: pneumonia, named by Sir William Osler "the captain of the hosts of men's death", represents one of the main health problems in the world. Both the incidence and the mortality rate increase with age because in the geriatric patient there are diseases that increase the risk of pneumonia. In addition, due to their own health conditions and immune senescence, the probability of dying from this cause is very high. Objective: to study the main characteristics of pneumonia in the elderly and mainly the increased risk factors for developing it. Methods: a prospective quantitative-qualitative research was carried out in 950 patients aged 60 years or older with a diagnosis of community-acquired pneumonia admitted to the "Arnaldo Milián Castro" Hospital, in Villa Clara Province, from January 2016 to December 2018 with the aim of determining the risk factors of community-acquired pneumonia in the elderly. Results: the most frequent clinical manifestations were: fever, cough, decay, tachypnea and tachycardia, in various combinations. Smoking, chronic obstructive pulmonary disease, bronchial asthma, heart failure, diabetes mellitus and alcoholism were risk factors. Age was an independent prognostic factor associated with higher mortality, longer hospital stay and longer recovery time. Conclusions: the most frequently found risk factors were smoking, alcoholism, chronic obstructive pulmonary disease, cancer, diabetes mellitus and heart failure. [ABSTRACT FROM AUTHOR]

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents. Methods: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD). Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma. Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease is a progressive lung disease characterized by chronic obstruction of the lung airflow that interferes with normal bleeding and is not fully reversible. Chronic smoking is the most common risk factor for COPD causing severe cough, wheezing, labored breathing and reduced functionality. COPD not only exerts pulmonary symptoms but also has a spill over the extra pulmonary effects. Owing to the impact of the disease, it may lead to conditions like osteoporosis, cardiovascular complications as well as to psychological effects such as depression and anxiety. Such comorbidities are hidden and are not effectively treated. Depression, one of the most common hidden comorbidities is known to be present but never diagnosed. Various scales like HAM-D and Bode Index can be used to diagnose the extent of depression. Our review mainly focuses on the various studies conducted worldwide and comparing the results of the same. Based on the worldwide analysis, depression is known to affect a COPD patient at later stages and requires immediate diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a common disease and a significant burden worldwide. The clinical symptoms of this disease include progressive dyspnea, cough, expectoration, and wheezing, among others. At present, the primary focus has been on reducing the frequency of acute exacerbations and improving lung function and dyspnea symptoms, and limited attention has been paid to cough and expectoration symptoms, which may be associated with a decrease in lung function, more acute exacerbations, and hospitalizations. Therefore, this outcomes in patients with COPD. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to utilize an artificial neural network in an exploratory fashion to predict self‐management behaviors based on reported symptoms in a sample of stable patients with chronic obstructive pulmonary disease (COPD). Design and Methods: Patient symptom data were collected over 21 consecutive days. Symptoms included distress due to cough, chest tightness, distress due to mucus, dyspnea with activity, dyspnea at rest, and fatigue. Self‐management abilities were measured and recorded periodically throughout the study period and were the dependent variable for these analyses. Self‐management ability scores were broken into three equal tertiles to signify low, medium, and high self‐management abilities. Data were entered into a simple artificial neural network using a three‐layer model. Accuracy of the neural network model was calculated in a series of three models that respectively used 7, 14, and 21 days of symptom data as input (independent variables). Symptom data were used to determine if the model could accurately classify participants into their respective self‐management ability tertiles (low, medium, or high scores). Through analysis of synaptic weights, or the strength or amplitude of a connection between variables and parts of the neural network, the most important variables in classifying self‐management abilities could be illuminated and served as another outcome in this study. Findings: The artificial neural network was able to predict self‐management ability with 93.8% accuracy if 21 days of symptom data were included. The neural network performed best when predicting the low and high self‐management abilities but struggled in predicting those with medium scores. By analyzing the synaptic weights, the most important variables determining self‐management abilities were gender, followed by chest tightness, age, cough, breathlessness during activity, fatigue, breathlessness at rest, and phlegm. Conclusions: The results of this study suggest that self‐management abilities could potentially be predicted through understanding and reporting of patient's symptoms and use of an artificial neural network. Future research is clearly needed to expand on these findings. Clinical Relevance: Symptom presentation in chronically ill patients directly impacts self‐management behaviors. Patients with COPD experience a number of symptoms that have the potential to impact their ability to manage their chronic disease, and artificial neural networks may help clinicians identify patients at risk for poor self‐management abilities. [ABSTRACT FROM AUTHOR]

Background: Cough is one of the most common complaints, for which patients seek medical attention. Health-care expenditure for managing cough is substantial with which quality of life can be severely affected. This study was conducted to analyze the clinical and radiological characteristics of common causes of chronic cough. Materials and Methods: This is a cross-sectional study conducted in the Department of Tuberculosis and Respiratory Medicine in GSL General Hospital during the period of October 1, 2016-June 30, 2018. Socio-demographic variables and clinical and laboratory parameters were collected and analyzed. Results: Among the 241 study participants, 68.9% were males. About 90% belong to low socioeconomic class, 56% were daily labourers, and 76.3% of them used biomass fuel for cooking. Other symptoms such as fever, chest pain, and shortness of breath were found along with cough. About 43.1% had other comorbidities. Normal chest X-ray is seen in 28%, non-cavitating lesions 22%, consolidation in 10%, emphysematous changes in 10%, bronchiectasis changes in 6%, mass lesion in 3%, interstitial pattern in 2%, pleural effusion in 0.6%, and cavity with air-fluid level in 0.4%. Sputum is negative for acid-fast bacilli in 51.5% of the study population. Pulmonary function tests were normal in 32%, which showed mild, moderate, severe obstruction in 24%, 17%, and 11%, respectively, while restriction in only 2% of the cases. Among 241, 49% diagnosed as pulmonary tuberculosis, 22% as chronic obstructive pulmonary disease, 11% were bronchiectasis, 7% were bronchial asthma, 7% were carcinoma, 3% were interstitial lung diseases, 3% were bronchitis, 1% gastroesophageal reflux disease, and 0.4% lung abscess. Conclusion: The treatment of chronic cough should include a systematic step-wise approach to diagnose the cause of cough. Timely management of the disease should be done effectively to decrease the disease burden. [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 and objective: Symptoms negatively impact the quality of life and long‐term prognosis of patients with chronic obstructive pulmonary disease (COPD). Little is known about the relationship linking airway inflammation and symptoms in stable COPD. In this study, we evaluated whether respiratory symptoms in COPD are related to sputum inflammatory cellular profile and whether symptom changes are associated with changes in airway inflammation. Methods: A total of 40 patients with stable COPD with moderate‐to‐severe airflow obstruction were enrolled. Patients were visited weekly over 4 weeks. At each visit, patients underwent clinical assessments, lung function tests and sputum induction. Patients recorded daily dyspnoea, sputum and cough scores. Results: The changes between two consecutive visits in the percent of sputum neutrophils and eosinophils were related to the changes in the cough (P < 0.001; r = 0.63) and dyspnoea scores (P < 0.001; r = 0.58) of the prior week. Furthermore, using regression analyses, we were able to demonstrate that changes in the cough score were specifically associated to the change in neutrophils, while changes in the dyspnoea score and use of rescue medications were associated with changes in eosinophils numbers. Conclusion: Our study showed an association between symptoms and the sputum inflammatory profile. In particular, changes in symptoms (cough and dyspnoea) were correlated with changes in the specific sputum inflammatory cell components of airway inflammation (neutrophils and eosinophils, respectively), providing novel information on the mechanisms of disease manifestation. The symptom severity and variability negatively impact the short‐ and long‐term prognosis of chronic obstructive pulmonary disease (COPD). Our study showed an association between symptoms and the sputum inflammatory profile. In particular, changes in cough and dyspnoea were correlated with changes in neutrophils and eosinophils, respectively, providing novel information on the mechanisms of disease manifestation. See relatedEditorial [ABSTRACT FROM AUTHOR]

Post-infectious bronchiolitis obliterans is a rare disease that may occur following a microbiological insult towards the lower respiratory tract causing a severe form of chronic obstructive airway disease. Subpleural lung cyst may occur in 20-36% of Down syndrome. We report a case of a 30-month-old Down syndrome child who had interesting radiological concurrent findings of bronchiolitis obliterans with subpleural cysts on High Resolution Computed Tomography (HRCT) thorax. This patient was born premature and had early onset pneumonia during the neonatal period. Subsequently, he had three episodes of pneumonias at 18, 19 and 26 months. He presented with recurrent symptoms of cough, wheeze, rapid breathing and had features of persistent airway obstruction characterized by chest hyperinflation, persistent tachypnoea with crepitations and rhonchi despite on regular bronchodilators. The only positive culture was Influenza B from his nasopharyneal aspirate culture. To our knowledge, this is the first reported case with both radiological entities in a child with Down syndrome. [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]

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]

OBJECTIVES: The purpose of our study was to compare community-acquired pneumonia (CAP) patients who were and were not administered treatment in accordance with the Turkish Thoracic Society (TTS) 2009 pneumonia guideline in terms of hospital stay length, treatment cost, and treatment efficacy. MATERIAL AND METHODS: Patients who were admitted to our hospital and who were diagnosed with CAP were included in the study. Demographic characteristics of the patients, symptoms at the time of diagnosis, physical examination, laboratory and radiological findings, treatments, response to treatment at follow-up, length of hospital stay, and direct cost of treatment were recorded in the TTS pneumonia database (TURCAP: TURKEY Community Acquired Pneumonia). Taking into consideration the "Turkish Thoracic Society Consensus Report on the Diagnosis and Treatment of Community-acquired pneumonia in Adults (2009)," the patients recorded in the database were evaluated in terms of conformity to the guideline. RESULTS: This present study included 156 patients diagnosed with CAP. Sixty-six patients (42.3%) were females, and 96 (57.7%) were males, and the mean age of the patients was 70.4 years. The most common symptoms on admission were cough (94.9%), expectoration of purulent sputum (77.6%), and fever (58%). Comorbid diseases were chronic obstructive pulmonary disease (COPD; 29.5%), asthma (3.2%), lung cancer (8.3%), cardiovascular diseases (32.7%), and diabetes mellitus (12.8%). It was observed that 67.3% of the patients received treatment in accordance with the guideline. No significant difference was found in terms of gender and symptoms between the groups that received and did not receive treatment in accordance with the guideline. The mean age of the patients who received treatment according to the guideline was higher than that of the patients who did not receive treatment according to the guideline; COPD was more frequent in the group of patients who received treatment according to the guideline. Pneumonia Severity Index and Confusion, Urea, Respiratory rate, Blood pressure-Age>65 scores of the patients who were treated according to the guideline was higher and treatment resulted in death in 8% of these patients. CONCLUSION: Hospital stay length, treatment cost, and treatment efficacy were similar in patients who were and were not administered treatment in accordance with the guideline. [ABSTRACT FROM AUTHOR]

Abstract: Chronic cough remains a challenge to many clinicians because there is often no diagnostic link to causation, and because indirect antitussives are largely ineffective. Chronic cough can also be a predominant symptom associated with many chronic respiratory diseases such as COPD, asthma and pulmonary fibrosis. Chronic cough itself does impair the quality of life and is associated with psychological impairment. The symptoms associated with chronic cough include persistent tickling or irritating sensation in the chest or throat, hoarse voice, dysphonia or vocal cord dysfunction. Currently, the clinical diagnosis of cough is associated with chronic cough caused by airway eosinophilic conditions such as asthma, gastrooesophageal reflux disease or post-nasal drip (or upper airway syndrome), which implies cause and effect, or with chronic cough associated with other diseases such as COPD, cancer or heart failure, that does not necessarily imply cause and effect. A recently-recognised category is idiopathic cough, with no associated or causative diagnosis. We suggest that there is a better label needed for chronic cough, that includes the common association with a hypersensitive cough response to tussive stimuli such as capsaicin or citric acid. This would invoke a hypersensitive syndrome, and there are good reasons to use a new label that would encompass the problem of chronic cough: the chronic ‘cough hypersensitivity syndrome’. This would focus the problem on the cough symptomatology and lead to greater focus on understanding the mechanisms of cough sensitisation, with the ultimate aim of obtaining more effective antitussives. [Copyright &y& Elsevier]

The article offers clinical information on bronchiectasis, an abnormal and permanent dilatation and distortion of the bronchi. Bronchiectasis is causes by the recurrent inflammation or infection of the airways. Its symptoms include chronic cough, fatigue, shortness of breath, weight loss and pleuritic chest pain, among others. The diagnosis, differential diagnosis and therapeutic management of bronchiectasis are also discussed.

Chronic obstructive pulmonary disease (COPD) and asthma are chronic respiratory diseases with high prevalence and mortality that significantly alter the quality of life in affected patients. While the cellular and molecular mechanisms engaged in the development and evolution of these two conditions are different, COPD and asthma share a wide array of symptoms and clinical signs that may impede differential diagnosis. However, the distinct signaling pathways regulating cough and airway hyperresponsiveness employ the interaction of different cells, molecules, and receptors. Transient receptor potential cation channel subfamily V member 1 (TRPV1) plays a major role in cough and airway inflammation. Consequently, its agonist, capsaicin, is of substantial interest in exploring the cellular effects and regulatory pathways that mediate these respiratory conditions. Increasingly more studies emphasize the use of capsaicin for the inhalation cough challenge, yet the involvement of TRPV1 in cough, bronchoconstriction, and the initiation of inflammation has not been entirely revealed. This review outlines a comparative perspective on the effects of capsaicin and its receptor in the pathophysiology of COPD and asthma, underlying the complex entanglement of molecular signals that bridge the alteration of cellular function with the multitude of clinical effects. [ABSTRACT FROM AUTHOR]

The article offers insights on chronic obstructive pulmonary disease (COPD) exacerbations. The British National Institute for Clinical Excellence defines an exacerbation as a sustained worsening of the patient's symptoms, which include increasing cough. More than 10% of acute medical admissions are accounted for by COPD exacerbations. It cites the importance of patient education on determining an exacerbation and how to deal with it.

Chronic obstructive pulmonary disease (COPD) is a pathological condition that involves excessive production of mucus, chronic cough and inflammatory changes leading to airway limitation. The most common cause of COPD is cigarette smoking. COPD can be categorized into either chronic bronchitis or emphysema; both conditions can be differentiated by age and the production of copious, tenacious sputum. Patients with COPD are susceptible to pulmonary infections of bacterial or viral origin. Nurses should be aware of the subtle differences in conditions and the usefulness of antibiotics in the treatment of acute bacterial exacerbations of chronic bronchitis. [ABSTRACT FROM AUTHOR]

Introduction: This is a case report of a rare presentation of case of pulmonary-renal syndrome, in which an elderly patient who presented with fever, cough and hemopysis, was wrongly diagnosed to have a Lower Respiratory tract infection/ Chronic obstructive pulmonary disease and treated with multiple courses of antibiotics and a 6 month course of anti tuberculous treatment, with no improvement in symptoms. During his second admission at our hospital, in view of persistent renal failure with subnephrotic range proteinuria and few RBCs on urine microscopy, a renal biopsy was performed. The renal biopsy showed pauci immune glomerulonephritis with a few crescents and linear IgG deposits. c-ANCA was also tested positive and hence a dual positive glomerulonephritis / vasculitis was considered and patient was started on steroids and immunosuppressive therapy. The patient showed significant improvement in symptoms and renal function after four doses of cyclophosphamide Materials and methods: A study of case report through hospital records/ patient interviews Results: c- ANCA (PR 3) positive vasculitis presenting as pulmonary renal syndrome is a rare presentation with predominant respiratory symptoms followed by late onset progressive renal dysfunction. This caused a diagnostic dilemma and delay in initiation of treatment Conclusion: Not all fevers with cough and hemoptysis is tuberculosis Atypical presentation of pulmonary renal syndrome should be kept in mind to avoid diagnostic/ treatment delays. [ABSTRACT FROM AUTHOR]

The article focuses on the use of spirometry in chronic obstructive pulmonary disease (COPD) management. The primary cause of COPD is cigarette smoking. The role of nurses is significant to the management of respiratory conditions. Chronic cough is one of the symptoms of COPD. Volumes of air breathed in and out is being measured in spirometry.

Discusses the mucolytic therapy for chronic obstructive pulmonary disease (COPD). Description and symptoms of COPD; Causes of COPD; Information on the therapeutic mechanism of mucolytics.

Background: There is conflicting information about the relationship between asthma and socioeconomic status, with different studies reporting no, positive, or inverse associations. Most of these studies have been cross sectional in design and have relied on subjective markers of asthma such as symptoms of wheeze. Many have been unable to control adequately for potential confounding factors.Methods: We report a prospective cohort study of approximately 1000 individuals born in Dunedin, New Zealand in 1972-3. This sample has been assessed regularly throughout childhood and into adulthood, with detailed information collected on asthma symptoms, lung function, airway responsiveness, and atopy. The prevalence of these in relation to measures of socioeconomic status were analysed with and without controls for potential confounding influences including parental history of asthma, smoking, breast feeding, and birth order using cross sectional time series models.Results: No consistent association was found between childhood or adult socioeconomic status and asthma prevalence, lung function, or airway responsiveness at any age. Having asthma made no difference to educational attainment or socioeconomic status by age 26. There were trends to increased atopy in children from higher socioeconomic status families consistent with previous reports.Conclusions: Socioeconomic status in childhood had no significant impact on the prevalence of asthma in this New Zealand born cohort. Generalisation of these results to other societies should be done with caution, but our results suggest that the previously reported associations may be due to confounding. [ABSTRACT FROM AUTHOR]

Cough and phlegm frequently occur in respiratory diseases like upper respiratory tract infections, acute bronchitis, and chronic obstructive pulmonary diseases. To relieve these symptoms and diseases, various ingredients are being used despite the debates on their clinical efficacy. We aimed to investigate the effects of the extract CKD-497, composed of Atractylodis Rhizoma Alba and Fructus Schisandrae, in relieving cough and facilitating expectoration of phlegm. CKD-497 was found to inhibit inflammatory mediators such as interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) in lipopolysaccharide (LPS)-treated mouse macrophages and transient receptor potential cation channel 1 (TRPV-1)-overexpressed human bronchial epithelial cells stimulated by capsaicin. CKD-497 decreased the viscosity of the mucin solution. During in vivo experiments, CKD-497 reduced coughing numbers and increased expectoration of phlegm via mucociliary clearance enhancement. Collectively, these data suggest that CKD-497 possesses potential for cough and phlegm expectoration treatment. [ABSTRACT FROM AUTHOR]

Eosinophilic bronchitis is an important cause of chronic cough. It is characterised by eosinophilic airway inflammation in the absence of airway hyperresponsiveness or other markers of variable airflow obstruction. Treatment with inhaled corticosteroids is associated with a short term improvement in cough and reduced sputum eosinophil count but the longer term outcome is uncertain. Reflux cough is a diagnosis based on the demonstration of gastroesophageal reflux on 24 hour oesophageal pH monitoring (OpHM) and a positive response to anti-reflux therapy. The aim of the study was to determine both the early and long term response to anti-reflux therapy in those with a "positive" pH study, and identily any features on OpHM which could accurately predict response therapy.

This article presents various studies related to cough. Chronic cough is an inflammatory condition of the airways and inhaled steroids are often used empirically as a therapeutic trial. The aim of this study was to determine if non-invasive tests of airway inflammation, such as induced sputum cell counts, exhaled nitric oxide (NO) and exhaled carbon monoxide as well as nasal NO can predict a successful response to inhaled steroid treatment. Cough is commonly associated with symptoms of asthma. However, there is conflicting evidence as to whether cough and bronchoconstriction are directly related.

The article presents a study which investigates the association between men and women with chronic obstructive pulmonary disease (COPD) and urinary incontinence (UI) with poorer quality of life. A descriptive survey design was used to determine the impact of cough and UI on the quality of life among 391 women and 337 men with COPD. Results indicate that women who had UI had a significant higher burden of symptoms than compared to men who had higher prevalence of cough and phlegm production.

This article presents a study, which seeks to examine whether inhaled beta-agonists control cough in upper respiratory infections or acute bronchitis. It notes that even without a history of lung disease, patients presenting with cough due to acute respiratory illness and with evidence of airflow obstruction appear to receive symptom relief from inhaled beta-agonists. Smokers may be another subgroup who benefit from treatment. However, important patient-oriented outcomes do not improve. If using inhaled albuterol to treat acute cough in practice, one must also consider the financial costs and adverse effects associated with treatment.