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Objectives Fiberglass-reinforced plastics (FRP) manufacturing has been related to cases of severe airway obstruction and elevated risk of respiratory mortality. But the specific job content risk is not clear. This study evaluated the respiratory health effects of the FRP lamination process. Methods A questionnaire was used to evaluate respiratory symptoms of workers in two yacht-building plants. Pre-shift (07:30-08:30 hours) and post-shift (17:00-18:00 hours) lung function was measured, while post-shift induced sputum was collected on the first day of the week. The participants were grouped into FRP laminators and non-laminators. Linear and logistic regression was used to investigate the effects of the lamination process on lung function. Results Laminators had a higher prevalence of chronic cough, lower pre-shift forced expiratory volume in first second (FEV1) and FEV1/force vital capacity (FVC) (-3.3% and -1.5%), lower post-shift FVC and FEV1 (-3.6% and -4.9%), and larger post-shift reduction of FVC (-2.1%) compared to non-laminators. The laminators also had higher risk of early obstructive and overall (obstructive plus restrictive) lung function impairment, and post-shift reduction of FVC >10% [odds ratio (OR) 5.98, 4.98, and 3.87, respectively). They also had higher percentages of neutrophils and lymphocytes in the induced sputum. Conclusion Laminators should undergo regular check-ups of respiratory symptoms and lung function. Further toxicologic studies are warranted to identify the specific causal agent in the FRP lamination process. ispartof: SCANDINAVIAN JOURNAL OF WORK ENVIRONMENT & HEALTH vol:47 issue:1 pages:62-69 ispartof: location:Finland status: published

OBJECTIVE: To determine prevalence of and risk factors for respiratory symptoms in an adult urban Pakistani population.METHODS: We conducted a multi-stage, community-based, cross-sectional survey from May 2014 to August 2015, comprising 1629 adults from 75 random clusters in Karachi using questionnaire-based interviews.RESULTS: Around 60% of participants were females and 43% belonged to the >37 years age group. At least one respiratory symptom was reported by 37.5% of participants. Breathlessness was the most common symptom (25.2%, 95%CI 23.1–27.3), followed by acute wheeze (10.1%, 95%CI 8.7–11.7). Multivariable models revealed that males and those aged >37 years were more likely to report acute and chronic phlegm and bronchitis, and breathlessness. Participants with a higher level of education were less likely to report acute and chronic cough. Participants with >5 years pack-years of smoking were more likely to report acute and chronic cough and breathlessness. Other risk factors included passive smoking, regular use of air conditioning and mosquito coils, wet spots and mould in the house, and exposure to dusty jobs.CONCLUSION: We found breathlessness to be the most prevalent respiratory symptom and identified various risk factors for respiratory symptoms.

Background: Low- and middle-income countries (LMICs) account for >90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings. Methods: We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow. Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61–0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78–0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow. Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings.

Trishul Siddharthan,1,2 Adaeze C Wosu,2,3 Suzanne L Pollard,1,2 Shakir Hossen,1,2 Patricia Alupo,4,5 Timothy Shade,1,2 Robert Kalyesubula,4 Shumonta Quaderi,6 Robert A Wise,1 John R Hurst,6 Bruce Kirenga,4,5 William Checkley1,2 On behalf of LiNK Cohort Study Investigators1Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 2Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; 3Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 4School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 5Makerere Lung Institute, Makerere University, Kampala, Uganda; 6UCL Respiratory, University College London, London, UKCorrespondence: William CheckleyDivision of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD 21287, USATel +1 443-287-4587Email wcheckl1@jhmi.eduBackground: Low- and middle-income countries (LMICs) account for > 90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings.Methods: We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow.Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61– 0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78– 0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow.Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings.Keywords: low- and middle-income countries, COPD, COLA, respiratory symptom

This study aimed to evaluate pulmonary function among workers exposed to 1,3-butadiene and was carried out in a petrochemical industry in Iran. The study participants consisted of fifty male workers with current respiratory exposure to 1,3-butadiene and fifty non-exposed workers as the control group. Exposure to 1,3-butadiene was measured according to the NIOSH 1024 method. Respiratory symptom histories were collected through the American Thoracic Society respiratory symptom questionnaire. Lung functions were evaluated using spirometry method. The results showed that exposed participants had significantly higher prevalence rates of all respiratory symptoms compared to the control group. Statistical tests demonstrated a significant difference between pulmonary function tests of exposed and non-exposed personnel. Ultimately, the results of the present study indicate that respiratory exposure to 1,3-butadiene can lead to negative effects on pulmonary functions.

Influenza potentially has a high mortality rate when it affects the elderly. We aimed to examine the differences in clinical manifestations in patients with influenza according to their age. This multicenter prospective study was performed in six medical institutions in Okayama and Kagawa prefectures (Japan). Between December 1, 2019 and March 31, 2020, we collected data on adult patients diagnosed with influenza type A, who were strat-ified into younger (20-49 years), middle-aged (50-64 years), and older groups (≥ 65 years). We compared the presence or absence of fever, respiratory symptoms, and extrapulmonary symptoms according to age group. In total, 203 patients (113, younger; 51, middle-aged; and 39, older) were eligible for the analysis. The maxi-mum body temperature and temperature at first physician visit in the older group were significantly lower than those in the younger group. The incidence of respiratory symptoms was not different among the three groups. Chills, muscle pain, and arthralgia as systemic symptoms were noted significantly more frequently in the younger (80.9%) and middle-aged (75.5%) groups than in the older group (51.3%) (p = 0.002). Fever and sys-temic symptoms were less likely to appear in older patients, possibly resulting in the delaying of hospital visits among older adults.

Conversion of fetal circulation to adult-type occurs immediately after birth but neonates with problems in the development of pulmonary vasculature are prone to revert back to fetal circulation. This phenomenon is known as flip-flop circulation which may be induced perioperatively and as such anesthesiologist are central to its management. We report a case of term neonate planned for repair of duodenal atresia that despite having no respiratory symptom preoperatively developed severe hypoxemia under anesthesia that was even unresponsive to 100% oxygen. The intraoperative hemodynamics of the neonate was managed along with supportive care successfully. A postoperative echocardiogram confirmed the evidence of persistent pulmonary hypertension of the newborn.Keywords: Duodenal atresia; flip flop circulation; neonates; persistent pulmonary hypertension of newborn

Objective: Air pollution is becoming one of the public concerns requiring urgent feasible response per local context. Defining accurately the level of exposure of outdoor air pollution effect on health of venders working along main roads and roundabouts with high traffic is important. This study was conducted to assess respiratory health risks on venders associated with different geographical positions in Cotonou. Methods: A cross-sectional study was conducted along the main road with high traffic including three roundabouts in Cotonou. The 194 study participants from all shops, one respondent per shop, were given a unique GPS data associated to indicate the shop’s geographical position. The study employed validated questionnaire on respiratory symptoms. Results: Study participants had mean age of 36.26 (±11.65) years with sex ratio of (M/F) 1.8. Majority (72.7%) of study participates reported to have at least one respiratory symptom and 69% of them were working in non-ventilated rooms. The proportion of having at least one respiratory symptom was significantly different (p < 0.001) between the subpopulations at roundabouts (96.15%) and apart from the roundabouts (64.08%). The most reported symptoms were cough (47.94%) and itchy nose (42.27%). The risk of cough (OR = 5.15; 95% CI = [2.21 - 12.04]; p < 0.001) and itchy nose symptoms (OR = 3.44; 95% CI = [1.55 - 7.63]; p = 0.002) were higher in individuals working at the roundabouts compared to those working along the main road. Conclusion: Working in roundabout is associated with more respiratory symptoms than working in shops along main road. Air pollution mitigation efforts should focus in such settings, taking into account the sub-population of workers in resource limited countries.

BACKGROUND: Pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients reduce quality of life. Lung function, measured by the percent predicted forced expiratory volume in one second (ppFEV1), is widely used to evaluate PEx treatments. We analyzed the correspondence of ppFEV1 with 8 patient-reported symptom-based questions from the Cystic Fibrosis Respiratory Symptom Diary–Chronic Respiratory Infection Symptom Score (CFRSD-CRISS). METHODS: Data were derived from the observational Standardized Treatment of Pulmonary Exacerbations (STOP) study. CF patients who had CFRSD-CRISS and ppFEV1 measurements on ≥2 timepoints were included: 1) day of initial PEx, 2) 7 days later, and/or 3) end of PEx. We calculated age-stratified Spearman correlation coefficients and 95% confidence intervals (95% CIs) between the change in ppFEV1 and change in CFRSD-CRISS items from index to day 7 and from index to the end of PEx treatment. RESULTS: Lung function and symptom scores improved by the end of treatment; however, correlations between ppFEV1 and the specific CFRSD-CRISS measures were mostly weak to moderate. An exception was that among patients

Various exposure estimates have been used to assess health impact of unconventional natural gas development (UNGD). The purpose of this study was to (1) use an air pollution dispersal screening model and wind direction to characterize the air emissions from UNGD facilities at each residence and (2) assess association of this exposure estimate with respiratory symptoms. Respiratory symptoms were abstracted from health records of a convenience sample of 104 adults from one county in southwestern PA who had completed a standard clinical interview with a nurse practitioner. Using publicly available air emission data, we applied a "box" air pollution dispersion screening model to estimate the median ambient air level of CO, NOx, PM 2.5, VOCs, and formaldehyde at the residence during the year health symptoms were reported. Sources and median emissions were categorized as north, south, east, or west of the residence to account for the effect of wind direction on dispersion. Binary logistic regression was performed for each respiratory symptom. Number of sources had varying magnitudes of association with some symptoms (i.e., cough, shortness of breath, and "any respiratory symptom") and no association with others (i.e., sore throat, sinus problems, wheezing). Air emissions were not associated with any symptom.

Respiratory symptoms are common reasons for patients to seek care and contribute significantly to use of health care resources. Identifying the underlying etiology of a respiratory symptom is key to management; yet, pinpointing the cause can be a challenge. Familiarity with the tools available to help discern between the various contributing etiologies is crucial in guiding management. Assessment and quantification of pulmonary function can provide an objective measure to guide diagnosis and therapy. We review key points of pulmonary function evaluation, highlighting indications and contraindications, fundamentals of interpretation, and the limitations of each individual component.

BACKGROUND: Pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients decrease lung function, increase symptoms and reduce health-related quality of life (HRQoL). We evaluated associations between 8 symptom-based questions from the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and the 5-level EuroQOL-5 Dimensions (EQ-5D-5L) summary score and hypothesized the CFRSD-CRISS would be a meaningful way to asses quality-of-life in future cost effectiveness studies among CF patients with PEx. METHODS: CF patients who had CFRSD-CRISS and EQ-5D-5L measurements on the day of the initial PEx, 7 days later, and at the end of intravenous antibiotic treatment were included. We examined age-stratified (

OBJETIVO: demonstrar a efetividade da educação permanente na busca ativa dos sintomáticos respiratórios. MÉTODO: pesquisa-ação de abordagem descritiva quantitativa realizada no ano de 2017. Os dados foram coletados dos registros laboratoriais e do livro de registro dos sintomáticos respiratórios por área da estratégia de saúde da família. Após a identificação da fragilidade foi realizada a capacitação e reflexão crítica por meio de problematizações temáticas. RESULTADOS: mudanças consideráveis ocorreram nos indicadores da UBS, verificados com o aumento expressivo das coletas de escarro e do registro dos interrogados de sintomáticos respiratórios. CONCLUSÃO: com aumento de 241,8% no total de coletas na unidade foi possível verificar a melhoria na identificação dos sintomáticos, tratamento em tempo adequado dos portadores da doença e promoção de saúde.

Inadequate housing is commonplace in First Nations in Canada, often leading to environmental impacts on housing such as dampness and mold. First Nations communities suffer from a higher prevalence of respiratory-related health conditions than the general Canadian population. There is limited Canadian literature evaluating the relationship between housing factors and the respiratory health of adults within First Nations communities. This study was undertaken with two Saskatchewan First Nations communities. The study population consisted of 293 individuals within 131 households. The individuals completed questionnaires on their general and respiratory health, and one member of each household completed a household questionnaire. The collection of environmental samples from within the house was undertaken. The respiratory outcomes of interest focused on the individuals with ever wheeze, reported by 77.8% of the individuals, and shortness of breath, reported by 52.6% of the individuals. Body mass index, the nontraditional use of tobacco (i.e., current and ex-smoking), the nontraditional use of tobacco in the house (i.e., smoking in the house), dampness in the house in the last 12 months, and always having a smell of mold in the house were significantly associated with respiratory symptoms. The results reveal that respiratory symptom rates were high in the population and housing factors were significantly associated with respiratory symptoms. Addressing and redressing housing inadequacies in First Nations communities are important in preventing additional burdens to health.

The symptom of breathlessness is well recognized as part of the presentation of a wide range of medical conditions. It can be a manifestation of a life-threatening emergency. In acute medical settings, the priority is to quickly recognize patients who are critically unwell and require emergency treatment. For these patients, rapid initial assessment and immediate treatment are essential. However, once symptoms have stabilized or in less acute settings, a more thorough assessment is required. Cough is a common respiratory symptom, often part of a symptom complex, which is troublesome for the patient. It is important to recognize worrying associated features to prompt further investigation. In late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection emerged from a zoonotic source, resulting in many cases of infection, hospitalizations and deaths, and has since spread in a pandemic across every continent. A substantial percentage of patients with COVID-19 develop an acute respiratory illness requiring hospital care. Cough and acute breathlessness are two of the most prevalent symptoms in this infection; any patient presenting to an acute setting should currently be assumed to have this infection and immediately tested with a viral swab from the upper airway to guide management.

Early warning of a potential pandemic with res- piratory symptoms is crucial for global health management. It enables timely intervention to reduce the likelihood of uncon- trollable massive virus spread. In this research, we propose to leverage the ubiquitous wearable devices to develop a wearable crowdsource system to monitor respiratory symptoms such as cough and fever. Wearable devices nowadays can directly and non-intrusively measure people’s vital signs in real-time with a variety of sensors embedded. We collect the data from wearable devices and develop machine learning algorithms to analyze the data for respiratory symptom monitoring and early warning. In particular, we focus on cough detection through multi-source data fusion (e.g., accelerometer amplitude and microphone audio). Preliminary results show that our algorithms result in higher detection accuracy and less false positive with the least use of computing resources. This research potentially transforms the way the pandemic early warning is implemented and the way we respond to public health crises in the years to come. Nanyang Technological University National Research Foundation (NRF) Accepted version This research is funded by National Research Foundation (NRF) via the Green Buildings Innovation Cluster (Grant NO.: NRF2015ENC_GBICRD001-012), administered by Building and Construction Authority (BCA) Singapore. In addition, this research is sponsored by National Research Foundation (NRF) via the Behavioural Studies in Energy, Water, Waste and Transportation Sectors (Grant NO.: BSEWWT2017_2_06), administered by National University of Singapore (NUS). Moreover, this research is funded by Nanyang Technological University (NTU) via the Data Science & Artificial Intelligence Research Centre @ NTU (Grant NO.: DSAIR@NTU).

Background: Respiratory symptoms in infancy are more common in premature infants. Nitric oxide (NO) is involved in prenatal and neonatal lung development. Measurement of exhaled NO is easy and well-tolerated by neonates. We investigated whether neonatal exhaled NO can be used to predict subsequent respiratory symptoms. Furthermore, we sought to determine prenatal and postnatal factors associated with increased respiratory symptom risk during the first year of life in premature and mature infants. Methods: Tidal fractional exhaled NO (FeNO) was measured in a birth cohort (n = 135) of premature and mature infants, up to six times during the first month of life. Primary outcomes were troublesome respiratory symptoms (TRS) and doctor-diagnosed asthmatic bronchitis (AB) at 1 year of age. Findings: The correlation between FeNO and TRS changed significantly in an age-dependent pattern in moderately premature infants (p =.02). Moderately premature infants with a low FeNO of 2 ppb on postnatal Day 3 had a 48% (95% confidence interval [CI]: 17%–80%) probability of TRS, compared with a probability of 12% (95% CI: 1%–64%) for otherwise similar infants with a FeNO of 11 ppb. Respiratory syncytial virus infection and parental smoking significantly increased the TRS risk in premature infants. Parental asthma and maternal antibiotic use during pregnancy significantly increased the TRS risk in mature infants. Interpretation: An age-specific association between neonatal FeNO and respiratory symptoms was seen in moderately premature infants. TRS risk was associated with postnatal factors in premature and prenatal factors in mature infants.

Diesel-powered equipment is used frequently in the mining industry. They are energetically more efficient and emit lower quantities of carbon monoxide and carbon dioxide than the gasoline equipment. However, diesel engines release more diesel particulate matter (DPM) during the combustion process which has been linked to harmful health effects. This study assessed the trends in DPM exposure and the prevalence of respiratory symptoms among Western Australian miners, using the available secondary data collected from 2006 to 2012. The data consisted of elemental carbon (EC) concentrations and information on miner&rsquo, s respiratory symptoms. The measured EC concentrations from n = 2598 miners ranged between 0.01 mg/m3 and 1.00 mg/m3 and tended to significantly decrease over the study period (p &lt, 0.001). Underground mine workers were exposed to significantly higher (p &lt, 0.01) median EC concentrations of 0.069 mg/m3 (IQR 0.076) when compared to surface workers&rsquo, 0.038 mg/m3 (IQR 0.04). Overall, 29% of the miners reported at least one respiratory symptom, with the highest frequency recorded for cough (16%). Although the exposure levels of DPM in the mining industry of Western Australia have declined over the study period, they are still high and adhering to stringent occupational standard for DPM is recommended.

The spread of the SARS-CoV-2 infection among population has imposed a re-organization of healthcare services, aiming at stratifying patients and dedicating specific areas where patients with suspected COVID-related respiratory disease could receive the necessary health care assistance while waiting for the confirmation of the diagnosis of COVID-19 disease. In this scenario, the pathway defined as a “grey zone” is strongly advocated. We describe the application of rules and pathways in a regional context with low diffusion of the infection among the general population in the attempt to provide the best care to respiratory patients with suspected COVID-19. To date, this process has avoided the worst-case scenario of intra-hospital epidemic outbreak.

Introduction: The expansions of labor-intensive investments in a developing countries, especially in textile production create a dusty work environment for workers, and those workers are from the low socio-economic group and need special safety concern. Objective: This study was aimed at assessing the prevalence of respiratory symptoms and associated factors among textile factories workers in Bahir Dar, Amhara region, Ethiopia, 2015. Methods: Institutional based cross-sectional study design was employed among randomly selected 384 textile workers using pre-tested interviewer-administered questionnaire. We stratified workers by their working section in the textile industries. Then the proportional numbers of workers were selected from each working section of the factory by using a random number generator. The identification number of workers from each factory was used for selection. The data were checked, coded, and entered to Epi-info Version 7 and exported to the Statistical Package for Social Science Version 20 for further analysis. Both bivariate and multivariate logistic regressions were used to identify associated factors. Variables having a P ⩽ .2 were fitted to multivariate logistic regression so as to assess the presence and strength of association with the respiratory symptom. Variables having a P Results: Three hundred eighty-three (99.74%) of the study participants responded completely filling the questionnaire. In this study, the prevalence of cough, phlegm, bronchitis, chronic bronchitis, and chest pain among the respondents were 31 (8.1%), 45 (11.7%), 26 (6.8%), 2 (0.5%), and 21 (5.5%), respectively. Generally, 141 (36.81%) of the respondents have either of the above respiratory symptoms in the textile industry. Working in the spinning section (AOR = 3.26, 95% CI: 1.80, 5.89), being in the grade 11 and 12 level and below (AOR = 2.36, 95% CI: 1.50, 3.70) and personal protective equipment (PPE) utilization (AOR = 4.88 95% CI: 1.54-15.45) were significantly associated with respiratory symptoms in the multivariate analysis. Conclusion: The prevalence of respiratory symptoms in Bahir Dar Textile workers was relatively high. Working department, educational status, and PPE use were variables significantly associated with respiratory symptoms in this study. Experience sharing across departments, employing educated workers and provision of personal protective equipment are important tasks to be followed to reduce respiratory symptoms in the industry.

Background: Primary Ciliary Dyskinesia (PCD) is characterized by chronic respiratory morbidity but there are limited data on patients’ health-related quality of life (HRQoL) and Health Utilities (HU) that PCD patients attach to their overall health status. We aimed to assess HU in adults with PCD using direct and indirect valuation methods and identify factors determining HU in PCD. Methods: Participants completed three direct tools (Visual Analog Scale-VAS, Time Trade Off-TTO, Standard Gamble-SG), one indirect HU questionnaire (EuroQol 5 dimensions-EQ-5D) as well as the PCD specific HRQoL questionnaire (QOL–PCD). Clinical and lung function data were extracted from medical records. We examined associations of gender, age (median cut-off: 33.6), FEV1 (median cut-off: -2.00 z-score) and FVC (median cut-off: -1.47 z-score) with HU using the Mann-Whitney test. The QOL–PCD scales that determined the HU were identified using regression modeling. Results: For 31 adult PCD patients in total, median HU values were for VAS:0.75, for EQ-5D:0.86, for TTO:0.91 and for SG:0.99. Low FEV1 (0.67 Vs 0.80, p=0.002) and low FVC (0.67 Vs 0.81, p=0.002) were associated with worse VAS. The same applied for EQ-5D and low FEV1 (0.76 Vs 0.91, p=0.001) and FVC (0.80 Vs 0.88, p=0.019). Among 10 QOL-PCD scales, physical functioning and lower respiratory symptoms, explained much of the variability in HU as measured by VAS (R2:0.42) and EQ-5D (R2:0.54). Conclusions: HU in PCD is high but depends on the valuation method. VAS and EQ-5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores. TTO and SG were not sensitive to the examined factors and their applicability in PCD may be limited.

Introduction: asthma is frequently reported in patients with bronchiectasis but its clinical significance is unclear. Methods: The European Bronchiectasis Registry (EMBARC) was studied from Jan 2015 to June 2019. Severity of disease was evaluated using the Bronchiectasis severity index (BSI) and FACED. Quality of life using the QOL-B questionnaire. Asthma was reported by the investigator. Results: Of 13512 patients included in the analysis, asthma was reported in 4119 (30.5%) making it the most common co-morbidity in bronchiectasis. Despite similar age (mean 63 vs 65 years,p=0.3) and similar P. aeruginosa infection rates (21% vs 20%,p=0.005), patients with comorbid asthma had milder severity (BSI 7.6 vs 7.8,p Conclusions: Co-existing asthma in bronchiectasis is associated with increased exacerbations, respiratory symptom and, surprisingly, lower risk of NTM but reasons are unclear.

AIM: The objective of the study was to determine chronic respiratory symptoms and lung function of farmers. METHODS: The study was conducted in Utu Village, Tabanan, Bali with 84 subjects. This research was observational analytic cross sectional study. RESULTS: Three dominant chronic respiratory symptoms in farmers were coughing (15.1%), dyspnea (13.1%), and phlegm (13.1%). Average values of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were 83.75 ± 34.42, respectively, 81.62 ± 34.30 and 104.90 ± 13.90, respectively. Cough was dominant experiencing by smokers (p = 0.008). Mean of FEV1% prediction and FVC% prediction value was lower in passive smoker group than no smoker group (p = 0.005 and p = 0.03). CONCLUSION: Occupational exposure while farming and raising livestock can cause chronic respiratory symptom and lung function decline in farmers and can be influenced by smoking history and secondhand smoke exposure.

Background：Wheezing is an important respiratory symptom in the diagnosis of asthma. However, wheezing is common in children and often related to viral infection. This and the lack of reliable biological indicators for asthma create difficulty in diagnosing asthma early in children. Objective: In this study, the levels of CD4+CCR6+CRTh2+ memory Th2 cells in wheezing children with different diagnostic outcomes were investigated to determine correlation with a diagnosis of asthma and to assess their potential clinical value as a biological indicator for this disease. Methods: A prospective study was performed with a cohort of wheezing children aged 3 months to 6 years hospitalized in the Division of Pulmonary Pediatrics at Shanghai Xinhua hospital and Shanghai children’s medical center affiliated to Shanghai Jiao Tong University School of Medicine from July 2017 to March 2018. After inclusion, the level of serum IgE, presence of allergen-specific serum IgE (sIgE) and proportion of circulating CD4+CCR6+CRTh2+ memory Th2 cells were counted. In addition, the patients’ personal and family histories of allergic disease were acquired by questionnaire. The children were followed up annually over 2 years by telephone call with a guardian to record whether the child had been diagnosed with asthma. The accuracy of an increased proportion of CD4+CCR6+CRTh2+ memory Th2 cells as an indicator of asthma was assessed. Results: A total of 43 children completed follow-up. The median of circulating CD4+CCR6+CRTh2+ memory Th2 cells in wheezing children diagnosed with or without asthma was 1.2%(0.8%~2.9%) and 0.6%(0.1%~0.9%), respectively, and was significantly higher in children diagnosed with asthma (P 0.05). Conclusion: Our exploratory study found that an increase in the level of circulating CD4+CCR6+CRTh2+ memory Th2 cells could be used as a biological indicator for early diagnosis of asthma, especially in predicting the risk of asthma in atopic children.

This study attempted to identify the level of ethical awareness and decision-making among healthcare providers (HCPs) in response to pandemic influenza. The data from 227 HCPs working at five hospitals in Seoul and suburbs were analyzed. During the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2015, 31.3% of them had experiences in “active surveillance” or “home-isolation”; 18.9% provided direct care for MERS-CoV patients; and 31.1% of whose parents experienced “refusal” from their children’s kindergarten or school. They were aware of their rights to receive accurate information and to be protected by their hospitals, while there was a significant difference in the level of ethical decision-making across hospitals. In conclusion, HCPs were sensitive to ethical issues related to pandemic influenza, and were faithful to four principles of ethical decision-making. As a further study, developing a tool for measuring ethical aspects of HCPs and ethical guidelines in response to pandemic influenza are recommended

Introduction Exclusive e-cigarette use has been shown to be associated with reduced levels of respiratory symptoms relative to smoking combustible cigarettes; this association has been less frequently studied in smokers using advanced-generation e-cigarette devices. Advanced-generation devices generate denser vapor than either early generation or pod-style devices, and engender longer inhalations; these vaping topography patterns may contribute to respiratory symptoms. Methods In a single-session, cross-sectional study of exclusive e-cigarette users (N = 59) and dual users of e-cigarettes and cigarettes (N = 54), participants completed questionnaires, including the American Thoracic Society Questionnaire (ATSQ) and were videotaped vaping their own device in the lab for 1 hour. Using a hierarchical regression method, we examined whether topography variables, level of nicotine concentration used in their e-cigarette device in the past month, e-cigarette dependence, amount of e-cigarette use in the past month, and smoking status (any smoking in the last month vs. none) predicted ATSQ score severity. Results There was a significant mean difference in ATSQ score across smoking status, with greater ATSQ scores for vapers who also smoked cigarettes (19.0, SD = 6.7) than for exclusive vapers (13.4, SD = 5.3). In the final model, of the predictors of interest, only cigarette smoking status predicted significantly greater ATSQ scores (overall F = 2.51, p = .006; R2 = .26; smoking status β = 0.39, p < .0001). Conclusions Findings suggest that differences in respiratory symptoms between dual and exclusive e-cigarette users appear to be attributable to combustible cigarette smoking, rather than more intense or frequent e-cigarette use across groups. Implications In this comparison of exclusive advanced-generation vape device users (N = 59) versus dual users of these devices and combustible cigarettes (N = 54), we set out to determine the extent to which smoking status and e-cigarette use variables predicted self-reported respiratory symptom severity. We found that dual users showed greater respiratory symptom severity (ATSQ scores) than exclusive vapers. Despite examining vaping topography and other variables, smoking status and race were the only significant predictor of respiratory symptoms. We conclude that combustible cigarette use, not individual vaping topography, likely accounts for differences in respiratory symptoms between dual users and exclusive vapers.

ObjectThe COVID-19 outbreak emerged in late 2019 in China, expanding rapidly thereafter. Even in Japan, epidemiological linkage of transmission was probably lost already by February 18, 2020. From that time, it has been necessary to detect clusters using syndromic surveillance.MethodWe identified common symptoms of COVID-19 as fever and respiratory symptoms. Therefore, we constructed a model to predict the number of patients with antipyretic analgesics (AP) and multi-ingredient cold medications (MIC) controlling well-known pediatric infectious diseases including influenza or RS virus infection. To do so, we used the National Official Sentinel Surveillance for Infectious Diseases (NOSSID), even though NOSSID data are weekly data with 10 day delays, on average. The probability of a cluster with unknown febrile disease with respiratory symptoms is a product of the probabilities of aberrations in AP and MIC, which is defined as one minus the probability of the number of patients prescribed a certain type of drug in PS compared to the number predicted using a model. This analysis was conducted prospectively in 2020 using data from October 1, 2010 through 2019 by prefecture and by age-class.ResultsThe probability of unknown febrile disease with respiratory symptom cluster was estimated as less than 60% in 2020.DiscussionThe most severe limitation of the present study is that the proposed model cannot be validated. A large outbreak of an unknown febrile disease with respiratory symptoms must be experienced, at which time, practitioners will have to “wing it”. We expect that no actual cluster of unknown febrile disease with respiratory symptoms will occur, but if it should occur, we hope to detect it.

Chronic bronchitis is defined epidemiologically as cough and sputum production for ≥3 months in each of at least two consecutive years.1 It affects about a third of patients with chronic obstructive pulmonary disease but also occurs in individuals with normal lung function, with prevalence estimates varying widely.2–7 While it is not, by itself, associated with a substantially higher risk of death,8 it is associated with exacerbations of disease, incapacity and poor quality of life. The identification of chronic bronchitis was standardised in the first instance by the British Medical Research Council questionnaire,9 and subsequently, the questions were introduced into other respiratory symptom questionnaires. Ambient air pollution is increasingly being linked to a range of human conditions, and in the case of chronic bronchitis, which affects over two million individuals in the UK,10 there is some evidence of an association between the incidence or prevalence of chronic bronchitis and long-term exposure to air pollution.11–13 Early reports, however, relate to a time when the bulk of outdoor air pollution came from coal burning …