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Introduction: Endoscopic lung volume reduction with endobronchial valves has been widely recognized for treating hyperinflation in advanced chronic obstructive pulmonary disease and emphysema patients. The main challenges include the technical complexity of upper lobe implantation and the number of endobronchial valves required. These issues might be addressed by placing larger diameter valves in the lobar bronchus. This study evaluated the feasibility, efficiency, and safety of the new valve PulmValve (model PV-13) in porcine models. Methods: Six PV-13 valves were bronchoscopically implanted into the caudal lobe bronchus of six healthy pigs. The procedure time, valve deployment, and removability were recorded. Follow-up examinations included blood tests, chest CT scans, and bronchoscopy at 30 min, 14 days, 28 days, and 84 days post-procedure, with necropsy and pathological evaluations after the final follow-up examination. Results: The successful in vivo deployment and removal of PV-13 valves was established, with a median procedure time of 6.5 min. The distal lung volume reduction was evident at 30 min post-operation and was persistently monitored on day 84. No migration or malfunction of any PV-13 valves was detected, but a mild angle deviation was found in 3 cases. Coughing was observed in four pigs within the first 7 days and localized granulation tissue was observed in all pigs. No cases of pneumothorax, diffuse pneumonia, or hemoptysis were detected. Conclusions: In this study, we report the successful implantation and removal of a new valve PulmValve in a short operation time. Complete lobar atelectasis was induced without device migration, malfunction, or severe complications. Further studies are warranted to evaluate the long-term, sustained effects and potential benefits in human patients. Plain Language Summary: Endoscopic lung volume reduction with endobronchial valves has been widely recognized as a treatment for advanced emphysema and chronic obstructive pulmonary disease. The main challenges include the technical complexity of implanting valves in the upper lobes and the number of valves required. These issues may be addressed by using larger diameter endobronchial valves in the lobar bronchi. The newly developed PulmValve System offers five variants of valves designed to accommodate airways with diameters ranging from 7.0 to 15.0 mm. The system is specifically designed for lobar bronchial implantation, with valve diameters within the range of 10.5–16.5 mm. Our study reports the successful implantation and subsequent removal post-placement of the PulmValve (PV-13) within a short operative time in healthy porcine models. During an 84-day follow-up period, significant atelectasis was induced in the distal lung without evidence of device migration, malfunction, or severe complications. [ABSTRACT FROM AUTHOR]

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]

Cough‐ and asthma‐like symptoms are common adverse reactions to angiotensin‐converting enzyme inhibitors (ACEi). However, attributing these symptoms to the use of ACEi might be masked by clinical confounders. We report a 68‐year‐old female residing in a long‐term acute‐care facility for patients requiring prolonged invasive mechanical ventilation treated for years with ACEi. Daily reversible bouts of life‐threatening severe bronchospasm gradually developed over 6 weeks and abruptly resolved following the cessation of ACEi treatment. The late appearance of bronchospasm and the unique clinical setup of chronic invasive ventilation in a patient with smoking‐related chronic obstructive lung disease are among the principal confounders that delay the identification of the causative association between ACEi and respiratory compromise. Chronic positive pressure ventilation may also conceal small airway reactivity and obstruction, similar to auto‐positive end‐expiratory pressure (auto‐PEEP). Conceivably, angiotensin receptor blockers should be preferred over ACEi in such patients. [ABSTRACT FROM AUTHOR]

Exposure to air pollutants such as PM10, PM2.5, PM0.1, O3, CO, NO2, and SO2, and biological pollutants are important factors causing the evolution and furtherance of obstructive lung diseases (OLD), including asthma and chronic obstructive pulmonary disease (COPD). Asthma is the most frequent chronic inflammatory airway disease, characterized by breathlessness, wheezing, chest tightness, and cough, together with the presence of exaggerated expiratory airflow fluctuation that varies over time. COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms such as dyspnea, cough, expectoration, and/or exacerbations due to abnormalities of the airways and/or alveoli that cause persistent, often progressive, airflow obstruction. Understanding the molecular mechanisms and cellular processes based on the development of OLD on exposure to air pollutants will provide insights into the solution of pathogenesis, prevention, and treatment of these conditions. The molecular mechanisms and cellular process involved in signal transduction pathway plays a role in the binding of extracellular signaling molecules and ligands to receptors placed on the cell surface or on the inner side cell that trigger inflammation that occurs, especially when something important enters the cell to bring into a cascade response. This binding then alters the cell metabolism, shape, and gene expression in the airway. This review aimed to reveal the effect of air pollutants on the molecular mechanisms and cellular processes involved in the signal transduction pathways in OLD. [ABSTRACT FROM AUTHOR]

Background: No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT). Methods: The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD. Results: CAAT items were internally consistent (Cronbach's alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson's correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4–0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures. Conclusions: CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice. Trial registration: NCT02760329. Plain language summary: Chronic Airways Assessment Test: a questionnaire adapted to assess overall health in asthma and/or COPD What is it about? Asthma and chronic obstructive pulmonary disease (COPD) can have a significant effect on a person's health and wellbeing. For people with these conditions, most of the health questionnaires available for use in patient care are designed for one specific diagnosis – either asthma (e.g. Asthma Control Test) or COPD (e.g. COPD Assessment Test [CAT]). A small number of questionnaires are available for use in both asthma and COPD, but these either take too long to complete, or do not focus on the overall health of patients. Since the symptoms in asthma and COPD overlap, a health questionnaire is needed for use in both asthma and COPD that can be completed during a routine visit to a doctor. This questionnaire could also help with research into the impact of lung diseases in people who have an unclear diagnosis. The CAT was changed so that people with asthma or COPD (or both) could use the same test. We named this new version the Chronic Airways Assessment Test (CAAT). Our goal was to determine whether CAAT scores meant the same level of health in people with asthma, COPD, or both conditions. The CAAT has eight questions, each scored 0 to 5, and takes only a few minutes to complete. The first three questions ask about the person's symptoms, including how often they cough and whether they have chest mucus or chest tightness. The remaining five questions ask how the person's asthma or COPD (or both) affects their daily life. These questions ask about shortness of breath, difficulties doing activities at home, confidence in leaving their home, whether they sleep soundly and how much energy they have. We found that the CAAT performed similarly in people with asthma or COPD (or both). This indicates that the CAAT score means a similar thing for someone with asthma, COPD or both conditions. Why is it important? The CAAT is a quick and simple way for patients to share with their doctor how bad their symptoms are and how much they affect their daily life. The development of the CAAT means that only one questionnaire is needed to measure the effect of a person's symptoms on their current level of health, whether they have asthma, COPD, or both. This will allow doctors to improve the level of care patients receive. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to estimate the safety and efficacy of spray cryotherapy (SCT) in patients with chronic obstructive pulmonary disease (COPD). Methods: We recruited patients aged 40–80 years with a confirmed diagnosis of COPD without serious complications (defined as two consecutive years of chronic cough and cough for at least 3 months with lung function forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] < 70% after inhaled bronchodilators and Global Initiative for Chronic Obstructive Lung Disease [GOLD] grade II–IV). The safety of this study was assessed by incidence of adverse events, and the efficacy was evaluated by St. George's Respiratory Questionnaire (SGRQ), COPD assessment test (CAT), Leicester Cough Questionnaire (LCQ) and changes in exercise capacity, histomorphology and lung function. Results: Eight patients eventually received three complete sessions of SCT, each lasting 41.10 ± 19.72 min. No adverse complications were recorded within 3 months after SCT. Clinically meaningful improvements in SGRQ, CAT, LCQ and exercise capacity were observed at 3 months after SCT: −15.75 ± 6.76 (95% confidence interval [CI] 10.10−21.40; p <.001), −6.88 ± 3.91 (95% CI 3.61−10.14; p =.002), −18.13 ± 13.81 (95% CI 6.58−29.67; p =.008) and 72.75 ± 33.11 (95% CI −100.43 to −45.07; p <.001), respectively. The density of airway epithelial goblet cells per unit area was significantly reduced (p <.05), and lung function parameters such as ∆FVC, ∆FEV1 and ∆ peak expiratory flow (∆PEF) were improved (p =.007,.021 and.012). Conclusions: SCT is a safe and effective strategy to provide a better quality of life for COPD patients. [ABSTRACT FROM AUTHOR]

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]

Introduction: Chronic Obstructive Lung Disease (COPD) is an incurable, gradually worsening respiratory condition characterised by airflow limitation and blockage that cannot be completely reversed. Productive cough caused due to mucus hypersecretion is a common symptom of COPD. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. Therefore, Oscillating Positive Expiratory Pressure (OPEP) devices are designed to aid in sputum clearing in COPD patients. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Need of the Study: Chronic Obstructive Pulmonary Disease (COPD) makes it challenging for air to flow freely into and out of the lungs. Shortness of breath, cough, and mucus in the lungs are all possible symptoms. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. To help clear away excess sputum, numerous airway clearance devices can be used. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Aim: To compare the effect of Aerobika vs. Acaplla device on sputum volume and lung function in COPD patients. Materials and Methods: A comparative study will be performed in respiratory medicine OPD of Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha. Ethical approval was received from the Ethical Review Committee of Datta Meghe Institute of Medical Sciences, Deemed to be University. In this study 30 patients diagnosed with COPD will be categorised into two groups one group will receive aerobika device with conventional physiotherapy and another group will receive acapella device with conventional physiotherapy twice a day. Treatment will be given five days for one week. The assessment will be done on day one of the treatment and at the end of treatment which is first week. Sputum volume and lung function will be assessed by sputum collector and Pulmonary Function Test (PFT), respectively. The statistical analysis will be done using chisquare test. The parameters will be compared between both the groups for sputum volume and lung function over a period of one week. Data will be analysed in a statistical software SPSS 27.0.V. [ABSTRACT FROM AUTHOR]

Background: No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT). Methods: The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD. Results: CAAT items were internally consistent (Cronbach's alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson's correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4–0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures. Conclusions: CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice. Trial registration: NCT02760329. Plain language summary: Chronic Airways Assessment Test: a questionnaire adapted to assess overall health in asthma and/or COPD What is it about? Asthma and chronic obstructive pulmonary disease (COPD) can have a significant effect on a person's health and wellbeing. For people with these conditions, most of the health questionnaires available for use in patient care are designed for one specific diagnosis – either asthma (e.g. Asthma Control Test) or COPD (e.g. COPD Assessment Test [CAT]). A small number of questionnaires are available for use in both asthma and COPD, but these either take too long to complete, or do not focus on the overall health of patients. Since the symptoms in asthma and COPD overlap, a health questionnaire is needed for use in both asthma and COPD that can be completed during a routine visit to a doctor. This questionnaire could also help with research into the impact of lung diseases in people who have an unclear diagnosis. The CAT was changed so that people with asthma or COPD (or both) could use the same test. We named this new version the Chronic Airways Assessment Test (CAAT). Our goal was to determine whether CAAT scores meant the same level of health in people with asthma, COPD, or both conditions. The CAAT has eight questions, each scored 0 to 5, and takes only a few minutes to complete. The first three questions ask about the person's symptoms, including how often they cough and whether they have chest mucus or chest tightness. The remaining five questions ask how the person's asthma or COPD (or both) affects their daily life. These questions ask about shortness of breath, difficulties doing activities at home, confidence in leaving their home, whether they sleep soundly and how much energy they have. We found that the CAAT performed similarly in people with asthma or COPD (or both). This indicates that the CAAT score means a similar thing for someone with asthma, COPD or both conditions. Why is it important? The CAAT is a quick and simple way for patients to share with their doctor how bad their symptoms are and how much they affect their daily life. The development of the CAAT means that only one questionnaire is needed to measure the effect of a person's symptoms on their current level of health, whether they have asthma, COPD, or both. This will allow doctors to improve the level of care patients receive. [ABSTRACT FROM AUTHOR]

Objective: The majority of hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD) misuse their inhalers. In a published program, "Nebs no More after 24," the authors found their program to be effective at reducing unnecessary nebulized treatments, increasing patient education, and decreasing costs. The objective of this study was to develop financial models, both internal to our hospital and more generalizable externally, of the cost impact of transitioning adults hospitalized with asthma or COPD to metered dose inhalers (MDIs) after 24 h of scheduled nebulized medications ("nebs"), when appropriate, to help hospitals make cost-efficient decisions for inhaled medications. Methods: "Internal" and "external" cost models were developed using number of patients, medication costs, and labor costs for nebulized medications and education for inhalers. Cost-savings were calculated by subtracting costs of nebulized-only cases from costs of nebulizer-plus-MDI cases. Estimates for staffing costs were obtained from the United States Bureau of Labor Statistics. Results: Cost-savings were estimated at $12,136 or $20,783 in the internal model and $8,927 or $14,283 in the external model when 50% or 80% of patients transitioned from nebs to MDIs, respectively. The marginal cost saving for every additional five new patients (∼1% of n = 552) transitioning to MDIs was estimated at $187.50. Models representing transitions from all-nebulized to nebulizer-plus-MDI respiratory medications resulted in cost savings, largely from the reduction of labor cost of nebulizer administration with nebs-only treatment. Therefore, transitioning from nebs to MDIs can lead to cost savings and could allow greater opportunities for inhaler education. [ABSTRACT FROM AUTHOR]

Objective: Low socioeconomic status based both on educational level and income has been associated with asthma and respiratory symptoms, but changes over time in these associations have rarely been studied. The aim was to study the associations between educational or income inequality and asthma and respiratory symptoms among women and men over a 20-year period in northern Sweden. Methods: The study was performed within the Obstructive Lung disease in Northern Sweden (OLIN) research program. Mailed questionnaire surveys were administered to a random sample of adults (20-69 years of age) living in Sweden, in 1996, 2006 and 2016. Data on educational level and income were collected from the national integrated database for labor market research. Results: The educational inequality associated with asthma and asthmatic wheeze tended to decrease from 1996 to 2016, while it increased for productive cough, the latter among men not among women. The income inequality decreased for productive cough, especially for women, while no clear overall trends were found for asthmatic wheeze and asthma, apart from a decrease in income inequality regarding asthma among men. Conclusion: The patterns for socioeconomic inequality differed for asthma and wheeze compared to productive cough, and the results emphasize that education and income do not mirror the same aspects of socioeconomic inequality in a high-income country. Our findings are important for decision makers, not the least on a political level, as reduced inequality, e.g. through education, could lead to reduced morbidity. [ABSTRACT FROM AUTHOR]

Cough is a common symptom among patients with chronic obstructive pulmonary disease (COPD), but there are currently no patient-reported outcome measures (PROM) for subjective cough symptoms in Norwegian. The objective was to translate and validated the most widely used PROM for chronic cough, the Leicester Cough Questionnaire (LCQ) from English to Norwegian (NLCQ) using established guidelines. Forward and backward translations were performed using external translators. All phases were discussed in an expert workgroup until consensus was achieved. Ten patients were interviewed about the pre-final version to assess understandability and ease to complete. The final NLCQ was externally proofread and tested for content and construct validity, internal consistency, test–retest reliability and measurement error. Mean (SD) age was 67 (7.9) years, and 62% of the sample were female (n = 56/89). According to GOLD stages, 10% had mild, 27% moderate, 35% severe and 22% very severe COPD, respectively. GOLD stages were missing for five patients (6%). The NLCQ showed acceptable accordance with the original, acceptable understandability and ease to complete, satisfactory content reliability, total score construct validity, internal consistency and test–retest reliability. Test–retest bias was low, but measurement error was larger than previously reported. The standard error of measurement and smallest detectable change were 1.56 and 4.32, respectively. Construct validity and factor analysis raised concerns regarding the three subdomains. The present cross-cultural adaptation of the NLCQ showed satisfactory reliability and overall validity. Due to concerns for the validity of the three domains, we suggest use should be restricted to the NLCQ total score until these are reassessed. [ABSTRACT FROM AUTHOR]

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]

Keys to therapeutic success include choosing the right device and drug regimen, providing rigorous patient education, and reducing environmental exposures. [ABSTRACT FROM AUTHOR]

The lower respiratory tract infection, induced by influenza virus, coronaviruses, and respiratory syncytial virus, remains a serious threat to human health that can cause a global pandemic. Thus, finding effective chemicals and therapeutic measures to advance the functional restoration of the respiratory tract after infection has been the emphasis of the studies on the subjects. Mosla scabra is a natural medicinal plant used for treating various lung and gastrointestinal diseases, including viral infection, cough, chronic obstructive pulmonary disease, acute gastroenteritis, and diarrhoea. In this study, the antiviral and anti-inflammatory effects of total lignans (MSTL) extracted from the plant were investigated in influenza A virus (IAV)-infected mice and RAW 264.7 macrophages. MSTL could not only protect the macrophages against IAV-induced pyroptosis but also could lighten the lung inflammation induced by IAV in vivo and in vitro. The network pharmacology analysis revealed that differentially expressed genes, mainly involving in EGFR tyrosine kinase inhibitor resistance, endocrine resistance, HIF-1 signaling pathway, C-type lectin receptor signaling pathway, and FOXO signaling pathway, contributed to the IAV-induced alveolar macrophage dysfunction. It indicated that MSTL enhanced the function of alveolar macrophages and improved IAV-induced lung injury in mice. [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]

Background: Though, smoking is the leading cause of chronic obstructive pulmonary disease worldwide, the household air pollution due to use of solid biomass fuel is considered as a major risk factor for the development of obstructive lung disease. The aim of the study was to assess the effect of solid biomass fuel exposure on lung functions in non-smoking female population. Methods: A hospital based, descriptive cross sectional study was carried out among 140 non-smoking female patients aged 40 or more and who had been exposed to solid biomass fuel. These patients underwent spirometry to assess their lung function and were classified as obstructive, restrictive or mixed. Modified medical research council (mMRC) dyspnoea scale for symptom assessment, 6-minute walk test (6 MWT) to determine the exercise capacity and Cumulative exposure index to assess the duration of exposure were also done. Results: All 140 (100%) patients having abnormal lung function, 4 (2.86%) had restrictive pattern, 5 (3.57%) had mixed pattern and 131 (93.57%) had obstructive pattern. Of 131 patients having obstructive pattern, 11 had mild obstruction, 49 had moderate obstruction, 39 had severe obstruction and 32 had very severe obstruction. Most commonly used biomass fuel was wood (43.57%). All the patients had shortness of breath, whereas cough was present in only 35.71% cases. 77 (55%) patients presented with a dyspnoea of mMRC grade 3 and above. Conclusion: Cumulative exposure index for solid biomass fuel is directly proportional to the severity of lung impairment as well as the symptom severity. [ABSTRACT FROM AUTHOR]

Cough sound analysis has attracted interest as a potential low-cost diagnostic tool for lowresource settings, where the burden of pulmonary disease is quite high. However, published results on cough sound analysis aregenerally limited to specific pulmonary diseases (e.g. detection of Whooping cough - Pertussis) and the studysizes are small. In this paper, we present a general framework for cough sound analysis, which includesautomatic cough segmentation, feature extraction and a general classification design that can be applied to a wide range of pulmonary diseases. For our analysis, three evidence-based features were selected (variance, kurtosis, and zero crossing Iirregularity) as well as an additional feature that we developed (rate of decay). Our cough sound analysis framework was tested using voluntary cough data collected from 54 patients presenting a combination of pulmonary conditions (COPD, asthma, and allergic rhinitis) equally sampled from all patients arriving at apulmonary clinic, as well as 33 healthy individuals. All study subjects were examined with a stethoscope auscultation, clinical questionnaire, and peak flow meter, and were given a full pulmonary function test (spirometer, body plethysmograph), which was the gold standard used to determine each patient's diagnosis. When the classifiers were trained using cough sounds alone, the accuracy (as determined by the AUC of the ROC curve) was 74% for Healthyvs Unhealthy, 80% for Obstructive vs non-Obstructive, and 81% for Asthma vs COPD. We also compared the performance of our cough sound analysis against other lowcost diagnostic tools and observed that cough sounds surprisingly had better performance than lungs oundauscultation alone, but had significantly lower performance compared to our clinical questionnaire or peak flow meter test. From these data, we conclude that cough sounds have value as a rapid and simple screening tool, but are of less diagnostic value compared to a clinical questionnaire or peak flow meter. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease, COPD, exacerbations of chronic obstructive pulmonary disease, global initiative for chronic obstructive lung disease, forced spirometry, risk factors Expert Interview COPD Keywords: Keywords: Chronic obstructive pulmonary disease; COPD; exacerbations of chronic obstructive pulmonary disease; forced spirometry; global initiative for chronic obstructive lung disease; risk factors EN Chronic obstructive pulmonary disease COPD exacerbations of chronic obstructive pulmonary disease forced spirometry global initiative for chronic obstructive lung disease risk factors The definition of chronic obstructive pulmonary disease (COPD) hasrecently been reformulated better to encompass the heterogeneousnature of this lung condition.1 The new definition is broader, includesrisk factors other than smoking, and aims to improve the diagnosis,management and clinical trials of a disorder with high morbidity andmortality rates.1 In this expert interview, MeiLan K Han and Alvar Agustí discuss the GlobalInitiative for Chronic Obstructive Lung Disease (GOLD) 2023 executivereport, which proposes a new definition for COPD and covers the latestupdates in its diagnosis, management, and prevention.2 Q. Could you please give us a brief overview ofthe definition of chronic obstructive pulmonarydisease proposed by the Global Initiative forChronic Obstructive Lung Disease (GOLD) 2023report? For instance, a recentepidemiological study on the prevalence of COPD in patients 40 years orolder among the general population of Spain found that almost 80% ofindividuals with COPD were not diagnosed and, therefore, not treated.6There are potential explanations for this situation. Approximately one-third of patients with COPD worldwideare not smokers; therefore, there have to be other causative factorsbesides smoking.4 This is not to say that smoking is not important; it isan extremely important risk factor for COPD. [Extracted from the article]

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]

Intercostal lung hernias are uncommon and usually a consequence of trauma or surgery. True spontaneous lung hernias are extremely rare, with only 51 cases identified over the past four‑and‑half decades. We report a case of nontraumatic chest wall ecchymosis secondary to spontaneous posterior‑lateral lung herniation followed by a review of the literature. Interesting radiographic images are presented. The pathophysiology and therapeutic options of this condition are discussed. The case highlights that advanced chronic obstructive pulmonary disease (COPD) may be an etiological factor for the development of this rare entity, with cough being the precipitating event. Given the increasing prevalence of COPD, the authors believe further awareness of this pathology is needed. [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]

Pertussis is a highly contagious disease of the respiratory tract caused by Bordetella pertussis. Although the burden of pertussis is highest in children, available data suggests that pertussis in the elderly and those with underlying chronic conditions or illnesses can result in significant morbidity, mortality and costs. We undertook a comprehensive review to assess the association between pertussis and chronic conditions/illnesses. A search was undertaken on 17 June 2019 across EMBASE, Medline and BIOSIS. Citations were limited to those in English, in humans and published since 1 January 1990. There were 1179 papers identified with an additional 70 identified through a review of the reference lists. Of these, 34 met the inclusion criteria. Papers included were categorised in groups, those which reported: associations between prior pertussis and subsequent chronic conditions or illnesses; a link between chronic conditions/illnesses and subsequent risk of pertussis; and those which reported on the effect of the chronic conditions/illnesses on pertussis complications or exacerbations. Pertussis appears to increase the likelihood of developing some chronic conditions/illnesses, but also appears to decrease the likelihood of developing some haematological cancers. There were several chronic conditions/illnesses where the study results were mixed, and several studies that found no association with previous pertussis. There were also studies which showed that having some comorbid health condition(s) might increase the risk of developing pertussis. Three studies showed pertussis can lead to increased exacerbations of chronic conditions/illnesses and associated hospitalisations, although one study showed it reduced the effects of chronic bronchitis. Previous pertussis appears to contribute to the increased likelihood of developing some respiratory conditions like asthma, and conversely those with asthma or COPD are at increased risk of severe pertussis requiring further intervention. Further research is required to confirm or disprove these associations, and to characterise the pathophysiological mechanisms behind the potential associations with pertussis. Plain Language Summary: Pertussis, or whooping cough as it is more commonly known, is a respiratory disease that mainly affects young children, although it can be caught at any age. An increasing number of cases are being identified in older adults. This is concerning since older people typically have other underlying health conditions that can increase the risk of severe outcomes leading to increased mortality. We assessed 34 published studies that examined the link between whooping cough and some health conditions. Several studies found that prior whooping cough was more likely in those with an underlying health condition, and this was particularly true in those with respiratory conditions like asthma and chronic obstructive pulmonary disease, whilst there were also studies which showed that having some health condition(s) might increase the risk of developing severe whooping cough which might require medical attention or hospitalisation. There was also some evidence that previous whooping cough might be protective against some blood cancers. Whooping cough was shown to exacerbate several underlying health conditions, although a single study found that it may reduce the risk of chronic bronchitis exacerbations. More research is required to corroborate these findings. [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]

Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5–2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the behaviors related to and the factors affecting complementary and alternative medicine (CAM) use in patients with chronic lung diseases, such as lung cancer and chronic obstructive pulmonary disease (COPD). Material and Method: A total of 60 patients with lung cancer and COPD were enrolled in the study. The data were collected by a form of demographic and clinical characteristics, the State-Trait Anxiety Inventory (STAI), and the Eysenck Personality Questionnaire Revised-Abbreviated Form (EPQR-A). Results: The most commonly used CAM method was the combination of phytotherapy and apitherapy, accounting for 48.3% (n=29) of the patients. 48.8% (n=22), to whom the CAM method was administered, used the combination at least once a month. The most common cause for the use of CAM method was cough. No statistically significant relationship was observed between the dependent variable - the decision of CAM use - and the independent variables sociodemographic characteristics, disease type, and the scores from STAI and EPQR-A. On the other hand, the EPQR-A psychoticism subscale was found to be a significant and independent predictor of the CAM users' views of benefit (ß=0.354, p=0.029). Conclusion: Our study suggests that the most commonly used CAM method was the combination of phytotherapy and apitherapy. It was understood that psychoticism, one of the personality traits, may be a significant factor affecting the CAM users' views of benefit. [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]

Background: Chronic cough is a common respiratory symptom, and, if persistent, the patient's quality of life can worsen and result in a depressive mood, or vice versa. Although previous reports suggest a relationship between chronic cough and depression, we further investigated this relationship according to smoking status and lung function. Methods: This observational study used cross‐sectional data from the 6th Korean National Health and Nutrition Examination Survey (2014 and 2016). Propensity score matching using age, sex, smoking status, and lung function was performed for participants with and without chronic cough to reduce the confounding effects associated with depressive mood. Questionnaires recorded coughs persisting for >3 months and the Patient Health Questionnaire‐9 (PHQ‐9) assessed the severity of depressive mood. Results: Among 12 494 participants who were >18 years old, 226 with chronic cough were matched with 226 with non‐chronic cough. Overall, chronic cough participants showed higher PHQ‐9 scores than the non‐chronic cough participants (4.29 ± 5.23 vs. 2.63 ± 3.38, P <.001). When stratified by sex, the difference remained significant in women (5.69 ± 5.96 vs. 3.05 ± 3.97, P <.001) but not in men (3.18 ± 4.27 vs. 2.31 ± 3.65, P =.092). When stratified by lung function status, the difference remained significant for those with normal lung function (4.32 ± 5.32 vs. 2.78 ± 3.86, P =.003) and reduced lung function (4.19 ± 4.93 vs. 2.11 ± 3.55, P ≤ 0.001). Multivariate logistic regression analysis revealed that chronic cough was associated with PHQ‐9 score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.014–1.27, P =.014), chronic obstructive pulmonary disease (OR, 4.87; 95% CI, 1.041–22.86, P =.044) and physician‐diagnosed bronchial asthma (OR, 2.93; 95% CI, 1.162–7.435, P =.023). Conclusions: Depressive mood is significantly correlated with chronic cough in females. [ABSTRACT FROM AUTHOR]

Purpose: The patient's preference plays an important role in clinical practice. There currently is no available evidence regarding the perception and attitudes of patients with chronic obstructive pulmonary disease (COPD) towards the use of Chinese medicine (CM) approaches. This study was designed to explore preferences and factors associated with CM among COPD patients. Patients and Methods: A pilot survey was conducted among COPD patients using a structured, pre-tested questionnaire. The perceptions of CM therapies (including herbal medicine, non-pharmacotherapies), and expected clinical outcomes were investigated based on patient preference. Factors associated with preference of treatment scenarios were estimated in order of importance. Results: Thirty patients were enrolled in the survey, including 27 males and 3 females. Two-thirds of the patients preferred integrative Chinese and Western medicine for the treatment of COPD. Chinese patent medicines and CM decoction therapy were more popular than CM injections. The preferred non-drug therapy was point application, followed by acupuncture, Tai chi, or Qigong. More than 70% of patients reported that important clinical outcomes were improvements in lung function (77%) and dyspnea, cough, and sputum symptoms (73%), followed by exercise endurance (50%). Besides clinical efficacy, costs and side effects were also important factors for treatment selection. Conclusion: This pilot study showed that Chinese patent medicine and CM decoctions were preferred options for complementary medicines to combine with routine pharmacotherapy for COPD treatment according to the patients' preferences. The improvement of dyspnea, cough symptoms, and lung function was the most desired clinical outcomes for patients. Quicker symptom relief, lower costs, and fewer side effects were key attributes for the treatment selection. Further research with a larger sample size is needed to definitively address the comprehensive conclusion. [ABSTRACT FROM AUTHOR]

Solid organ transplant (SOT) recipients are a complex, immunocompromised population in whom greater coronavirus disease 2019 (COVID-19) mortality has been reported compared with the general population. We examined a retrospective cohort of 58 SOT recipients with first-wave COVID-19, comparing patients with severe and nonsevere illness. Additionally, SOT recipients are compared with general patients with first-wave COVID-19. Organs transplanted included 38 kidneys, 8 livers, 5 hearts, and 3 pancreases. Average SOT recipient age was 57.4 years; 62% were male; 46.6% were African American 36.2% were white. Comorbidities included hypertension (86%), chronic kidney disease (86%), diabetes mellitus (50%), coronary artery disease (26%), and chronic obstructive pulmonary disease (14%). Twenty patients had severe COVID-19 (34.5%) and 38 had nonsevere disease (65.5%). Severe disease was more common in older SOT recipients with comorbidities and was associated with cough, dyspnea, pneumonia, C-reactive protein >10 mg/L, and platelet count <150/μL. Sex, race, body mass index, time from transplant, baseline immunosuppression, and diagnosis month did not differ among those with severe and nonsevere COVID-19. Seventy percent of SOT recipients were hospitalized vs 27.2% of general patients with COVID-19 and inpatient SOT recipients had a higher mechanical ventilation rate. Though a trend toward longer length of stay, higher intensive care unit admission, and greater inpatient mortality was observed (19.5% vs 14.8%), these differences were not significant. The severe acute respiratory syndrome coronavirus 2 has greatly impacted SOT recipients. One-third of our SOT recipients seen during the first wave had severe illness with associated standard risk factors for poor outcome. Compared with general first-wave patients, more SOT recipients were hospitalized, although inpatient COVID-19 mortality did not significantly differ. [ABSTRACT FROM AUTHOR]

Introduction: Acute exacerbations of COPD (AE-COPD) are a leading cause of health service utilisation and are associated with morbidity and mortality. Identifying the prodrome of AE-COPD by monitoring symptoms and physiological parameters (telemonitoring) has proven disappointing and false alerts limit clinical utility. We report objective monitoring of cough counts around AE-COPD and the performance of a novel alert system identifying meaningful change in cough frequency. Methods: This prospective longitudinal study of cough monitoring included chronic obstructive pulmonary disease (COPD) patients experienced in telemonitoring that had two or more AE-COPD in the past year. Participants underwent cough monitoring and completed a daily questionnaire for 90 days. The automated system identified deteriorating trends in cough and this was compared with alerts generated by an established telemonitoring questionnaire. Results: 28 patients [median age 66 (range 46–86), mean FEV-1% predicted 36% (SD 18%)] completed the study and had a total of 58 exacerbations (43 moderate and 15 severe). Alerts based on cough monitoring were generated mean 3.4 days before 45% of AE-COPD with one false alert every 100 days. In contrast, questionnaire-based alerts occurred in the prodrome of 88% of AE-COPD with one false alert every 10 days. Conclusion: An alert system based on cough frequency alone predicted 45% AE-COPD; the low false alert rate with cough monitoring suggests it is a practical and clinically relevant tool. In contrast, the utility of questionnaire-based symptom monitoring is limited by frequent false alerts. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) may increase the risk and severity of pertussis infection. Health care resource utilization (HCRU) and direct medical costs (DMC) of treating pertussis among patients with COPD are unknown. Reported incidence of pertussis among individuals aged ≥ 50 years with COPD was assessed in Clinical Practice Research Datalink and Hospital Episode Statistics databases during 2009–2018 using a retrospective cohort design. HCRU and DMC from the National Health Service perspective were compared between patients with COPD and pertussis and propensity score-matched patients with COPD without pertussis. Seventy-eight new pertussis events were identified among 387 086 patients with COPD aged ≥ 50 years (incidence rate: 4.73; 95% confidence interval 3.74–5.91 per 100 000 person-years). HCRU and DMC were assessed among 67 patients with COPD and pertussis and 267 matched controls. During the month before the pertussis diagnosis, the rates of general practitioner (GP)/nurse visits (4289 vs. 1774 per 100 patient-years) and accident and emergency visits (182 vs. 18 per 100 patient-years) were higher in the pertussis cohort; GP/nurse visits (2935 vs. 1705 per 100 patient-years) were also higher during the following 2 months (all p < 0.001). During the month before the pertussis diagnosis, annualized per-patient total DMC were £2012 higher in the pertussis cohort (£3729 vs. £1717; p < 0.001); during the following 2 months, they were £2407 higher (£5498 vs. £3091; p < 0.001). In conclusion, a pertussis episode among individuals with COPD resulted in significant increases in HCRU and DMC around the pertussis event. [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]

We present the case of a comorbid patient with Chronic Obstructive Pulmonary disease who developed a pulmonary herniation secondary to a coughing episode. He complained of severe and invalidating somatic pain in the herniation area, pain score was 4 out of 10 in the Verbal Numeric Scale (VNS) at rest, that worsened with cough to 9 out of 10. Buprenorphine and acetaminophen were initiated with only slight improvement in pain. Surgical reparation was discarded. An erector spinae plane nerve block (ESP block) was performed with improvement in the VNS to 0 out of 10 at rest and 6 out of 10 with cough. After the procedure, the patient only needed acetaminophen as analgesic for pain relief, and the improvement was maintained in time. The ESP block was described in 2016, and since then there has been growing evidence of its safety and efficacy in post-operative analgesia for breast, thoracic and abdominal surgery. The main ESP block benefits compared to similar blocks are the relative less incidence of pneumothorax, less systemic absorption of local anaesthetics and the simplicity of its performance. Although there is less evidence in chronic pain, it has been described in the treatment of post thoracotomy chronic pain with good results. This case is described because of the great clinical improvement in an uncommon and very symptomatic disease. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of rivaroxaban and low molecular weight heparin on the symptom relief, blood gas analysis indexes and coagulation function in elderly patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods: A total of 72 elderly patients with AECOPD admitted to our hospital from August 2016 to November 2019 were selected, and were randomly divided into control group（n=36, low molecular weight heparin treatment） and study group（n=36,rivaroxaban treatment） by lottery. The efficacy, symptom relief, blood gas analysis index and coagulation function of the two groups were compared, and adverse reactions during the treatment were recorded. Results: The total effective rate of the study group 10 days after treatment was higher than the control group（P<0.05）. There were no significant differences in the relief time of cough, sputum, fever and dyspnea between the two groups（P>0.05）. 10 days after treatment, the oxygen partial pressure（PaO2）, oxygen saturation（SaO2） of the two groups increased, while the partial pressure of carbon dioxide（PaCO2） of the two groups decreased（P<0.05）. 10 days after treatment,PaO2 and SaO2 of the study group were higher than the control group, while PaCO2 was lower than those of the control group（P<0.05）.10 days after treatment, fibrinogen（Fib） of the two groups increased, D-Dimer（D-D）, activated partial thromboplastin time（APTT）,plasma prothrombin time（PT） and thrombin time（TT） decreased（P<0.05）. 10 days after treatment, D-D of the study group was lower than the control group（P<0.05）. There were no significant differences between Fib, APTT, TT and PT of the two groups（P>0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）. Conclusion: Elderly patients with AECOPD treated with rivaroxaban and low molecular weight heparin can improved their clinical symptoms and showed better safety, but those treated with rivaroxaban had better efficacy, and better improvement in blood gas analysis indicators and coagulation function. [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]

Background: Electronic auscultation technology has advanced dramatically in the last few years. Therefore, long-term pulmonary auscultation could provide additional information about respiratory system by monitoring acute chronic obstructive pulmonary disease (AECOPD) exacerbations or by identifying wheezing phenotypes amongst stable COPD patients. Objectives: Comparison of respiratory sounds in stable versus AECOPD patients recorded with a portable respiratory sound monitor over a period of 24 h. Methods: This prospective trial evaluated cough and wheezing events using an auscultation monitor specially developed for this purpose with 4 integrated highly sensitive microphones, in stable and severely AECOPD patients for a period of 24 h in an inpatient setting. Results: Twenty stable COPD patients (12 male, 60%) and 20 severely exacerbated COPD patients (14 male, 70%) were analyzed. In AECOPD patients, long-term auscultation revealed a significantly higher number of wheezing epochs than stable COPD patients (591 [IQR: 145–1,645] vs. 152 [IQR: 90–400]; p = 0.021). Conversely, cough epochs did not differ between AECOPD and stable COPD patients (213 [IQR: 140–327] vs. 162 [IQR: 123–243]; p = 0.256). The Borg-dyspnea scale, CAT score, and total CCQ score each showed no correlation with wheezing frequency, while CAT and CCQ scores did correlate with coughing frequency. Conclusion: Wheezing, but not coughing, occurs more frequently in AECOPD patients than in stable COPD patients, indicating that severe wheezing is an important clinical sign of exacerbation, while coughing is not. Therefore, the patterns of wheezing and coughing, as assessed by long-term auscultation, differ in stable versus exacerbated COPD patients. [ABSTRACT FROM AUTHOR]

This study provides a quantitative analysis to investigate the effects of cough intensity and initial mucus thickness on the mucus transport and clearance in a mouth-to-trachea airway geometry using an experimentally validated Volume of Fluid (VOF) based multiphase model. In addition, the accuracy of simplifying mucus as Newtonian fluid is also quantified by the comparisons of mucus transport and clearance efficiencies with the simulations using realistic shear-thinning non-Newtonian fluid viscosities as a function of shear rate. It proves that the VOF model developed in this study can capture air–mucus interface evolution and predict the mucus transport behaviors driven by the expiratory cough waveforms. Numerical results show that noticeable differences can be identified between the simulations using simplified Newtonian fluid and the realistic non-Newtonian fluid viscosity models, which indicates that an appropriate non-Newtonian fluid model should be applied when modeling mucus transport to avoid the possible inaccuracy induced by the Newtonian fluid simplification. Furthermore, the results also indicate that an intense cough can enhance the mucus clearance efficiency in chronic obstructive pulmonary disease (COPD) upper airways. Additionally, although higher mucus clearance efficiency is observed for severe COPD conditions with a thicker mucus layer, there is a possibility of mucus accumulation and obstruction in the upper airway for such a COPD condition if the cough is not strong enough, which will possibly cause further breathing difficulty. The VOF model developed in this study can be further refined and integrated with discrete phase models to predict the mucus clearance effect on inhaled particles explicitly. [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]

Background: Percutaneous Endoscopic Gastrostomy (PEG) can involve some complications, despite the good safety of its track record. The Buried Bumper Syndrome (BBS) is a rare, late and dangerous complication that consists in the erosion of the internal bumper through the gastric wall. Case presentation We report the development of BBS in a man with chronic obstructive pulmonary disease (COPD) who had a persistent chronic cough which was prevalently but not solely in the morning and required placement of a PEG tube for continuous infusion of Levodopa/carbidopa intestinal gel for advanced Parkinson's disease.Conclusion: We believe that COPD with chronic cough while not representing an absolute contraindication to PEG placement, may potentially cause BBS and therefore an appropriate regimen of tube care by expert personnel is mandatory in this setting. [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]

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. One of the most important events in the course of COPD is acute exacerbation. Acute exacerbation of COPD (AECOPD) is characterized by the aggravation of dyspnea, cough, and sputum. Chronic obstructive pulmonary disease exacerbation leads to respiratory failure, hospitalization, morbidity, and mortality. During and after the COPD attack, lung function dramatically decreased. Bacterial pneumonia is an important and serious risk factor for AECOPD. However, there are other inflammatory and non-inflammatory causes of AECOPD. Antibiotic treatment is usually challenging in AECOPD. Procalcitonin is a non-hormone active protein and precursor to calcitonin that consists of 116 amino acids, and 13 kDa weight is produced by the neuroendocrine cells of the thyroid gland. However, procalcitonin is secreted in septic shock, metastatic cancers, bacterial and fungal infections; therefore, serum procalcitonin is increased in bacterial pneumonia of AECOPD. Some studies recommended procalcitonin serum measurement as a guide for antibiotic initiation in AECOPD. [ABSTRACT FROM AUTHOR]

This review provides an assessment of post-inhalation cough with therapeutic aerosols. Factors that increase cough may be mitigated through design of the drug, formulation, and device. The incidence of cough is typically less than 5% for drugs with a nominal dose less than 1 mg, including asthma and COPD therapeutics. Cough increases markedly as the dose approaches 100 mg. This is due to changes in the composition of epithelial lining fluid (e.g., increases in osmolality, proton concentration). Whether an individual exhibits cough depends on their degree of sensitization to mechanical and chemical stimuli. Hypersensitivity is increased when the drug, formulation or disease result in increases in lung inflammation. Cough related to changes in epithelial lining fluid composition can be limited by using insoluble neutral forms of drugs and excipients. Unlabelled Image [ABSTRACT FROM AUTHOR]

Background: Cough is predictive of exacerbations of chronic obstructive pulmonary disease (COPD). Little is known about cough reflex sensitivity during exacerbation of COPD and whether it is associated with exacerbation frequency. This pilot study aimed to investigate cough reflex sensitivity during and following recovery from exacerbation of COPD, and its association with the frequency of future exacerbations. In addition, the repeatability of cough reflex sensitivity in stable COPD was investigated. Methods: Twenty participants hospitalised with exacerbation of COPD underwent inhaled capsaicin challenge during exacerbation and after 6 weeks of recovery. The frequency of future exacerbations was monitored for 12 months. The repeatability of cough reflex sensitivity was assessed in separate participants with stable COPD, who underwent 2 capsaicin challenge tests, 6 weeks apart. Results: Cough reflex sensitivity was heightened during exacerbation of COPD. Geometric mean (SD) capsaicin concentration thresholds to elicit 5 coughs (C5) during exacerbation and after 6 weeks of recovery were 1.76 (3.73) vs. 8.09 (6.25) μmol L−1, respectively (p < 0.001). The change in C5 from exacerbation to 6-week recovery was associated with the frequency of future exacerbations (ρ = − 0.687, p = 0.003). C5 was highly repeatable over 6 weeks in stable COPD, and intraclass correlation coefficient was 0.85. Conclusion: Cough reflex sensitivity is heightened during exacerbation of COPD and reduces after recovery. The persistence of cough reflex hypersensitivity at recovery was associated with the frequency of future exacerbations. [ABSTRACT FROM AUTHOR]

• Cough is a defense mechanism for clearing the airways but may become troublesome. • Chronic cough of known and unknown cause(s) frequently requires medical attention. • Chronic cough of known cause(s) must be treated according to guidelines. • Chronic refractory cough may benefit from neuromodulatory/speech pathology therapy. • Novel promising neuromodulatory agents are in clinical development. Cough, a defense mechanism for clearing the airways of secretions, exudate, or foreign bodies, may become a troublesome symptom. Chronic cough, one of the most frequent symptoms requiring medical attention, is often not due to identifiable causes in adults. Chronic productive cough defines chronic bronchitis, and thus is present in 100% of these patients, and frequently in patients with bronchiectasis, cystic fibrosis, and chronic infectious respiratory diseases. However, chronic cough is most frequently dry. Thus, chronic cough in adults is a difficult syndrome requiring multidisciplinary approaches, particularly to diagnose and treat the most frequent identifiable causes, but also to decide which patients may benefit by treating the central cough hypersensitivity by neuromodulatory therapy and/or non-pharmacologic treatment (speech pathology therapy). Recent guidelines provide algorithms for diagnosis and assessment of cough severity; particularly chronic cough in adults. After excluding life-threatening diseases, chronic cough due to identifiable causes (triggers and/or diseases), particularly smoking and/or the most frequent diseases (asthma, chronic bronchitis, chronic obstructive pulmonary disease, eosinophilic bronchitis, and adverse reactions to drugs [angiotensin-converting enzyme inhibitors and sitagliptin]) should be treated by avoiding triggers and/or according to guidelines for each underlying disease. In patients with troublesome chronic cough due to unknown causes or persisting even after adequate avoidance of triggers, and/or treatment of the underlying disease(s), a symptomatic approach with neuromodulators and/or speech pathology therapy should be considered. Additional novel promising neuromodulatory agents in clinical development (e.g., P2X3 inhibitors) will hopefully become available in the near future. [ABSTRACT FROM AUTHOR]