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Jimei Li,* Yulin Xiong,* Shengyan Li, Qiong Ye, Yan Han, Xiuxin Zhang, Tongxiu Zhao, Yuan Yang, Xiaoshan Cui, Yinglan Li General Medicine Department, Qinghai Provincial People’s Hospital, Xining, Qinghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yinglan Li, General Medicine Department, Qinghai Provincial People’s Hospital, Gonghe Road 2, Xining, Qinghai, People’s Republic of China, Tel +8613997233103, Email qhlyl@126.comPurpose: This study aimed to establish the prevalence of pulmonary embolism (PE) in chronic obstructive pulmonary disease (COPD) patients with secondary polycythemia (SP) and explore the risk factors for PE in COPD patients with SP.Patients and Methods: We analyzed the prevalence of PE among COPD patients with SP who were hospitalized at Qinghai Provincial People’s Hospital between January 2015 and December 2020. From January 2021 to January 2024, we enrolled patients into three groups (COPD+SP+PE, COPD+SP, and control) and performed laboratory measurements, biomarkers, echocardiography, and pulmonary function tests. Patients in the COPD+SP group received clinical treatment, and biomarkers were measured again seven days after treatment.Results: The prevalence of PE in patients with COPD SP was 5.21%. We found that COPD+SP+PE group had significantly higher levels of erythrocyte distribution width (RDW), platelet volume distribution width (PDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte to large platelet ratio (MLPR), 5-hydroxytryptamine (5-HT), activated protein C (APC), urokinase-type plasminogen activator (u-PA), thrombomodulin (TM), interleukin-38 (IL-38), tissue factor (TF), and fractalkine (FKN) in contrast to COPD+SP group. Biomarkers, such as FKN, β-thromboglobulin (β-TG), APC, u-PA, TM, TF, and IL-38, were risk factors for COPD patients with SP who are complicated by PE. Clinical treatment significantly reduced the levels of β-TG, IL-38, APC, endothelin-1 (ET-1), u-PA, FKN, TM, 5-HT, and neutrophil extracellular traps (NETs) in patients with COPD+SP.Conclusion: PE incidence was significantly higher in patients with COPD and SP. In COPD patients with SP, routine joint detection of blood and cardiac markers, blood gas analysis, and pulmonary function tests can help to identify patients with PE. APC, u-PA, TF, FKN, TM, and IL-38 are risk factors for PE in patients with COPD and SP, and clinical treatment can effectively reduce this risk.Keywords: chronic obstructive pulmonary diseases, secondary polycythemia, pulmonary embolism, biomarker, risk factors

Abstract Background Hookah consumption is harmful to human health and can cause various diseases. Developing lung cancer and other lung diseases are one of the health consequences of hookah consumption. Measuring the perceived risk for being diagnosed with these conditions among hookah users is necessary. Therefore, this study was conducted to determine the perceived risk of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) in hookah users in Iran. Methods This cross-sectional study was conducted with a descriptive-analytical approach on 340 hookah users between January-May 2023. These people were recruited through convenience sampling. The information on the perceived risk of participants was collected through a questionnaire on the perceived risk of lung cancer and COPD. Data were analyzed through descriptive tests and multiple linear regression tests. These analyses were performed using Stata statistical software version 17. Results The mean and standard deviation of the perceived risk for lung cancer was 8.41 ± 5.50 and for COPD was 8.51 ± 5.58 out of 20 possible scores. The results of multiple linear regression generally showed that the using other type of tobacco (β = 3.14, p

ABSTRACT Aims Design Methods Results Conclusions Reporting Method Patient or Public Contribution This study aims to describe disease‐specific self‐care behaviours in patients with heart failure (HF), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) in various combinations; to compare these self‐care behaviours within patient groups; and to evaluate differences across these groups.Cross‐sectional study.A total sample of 1079 older patients was recruited from outpatient clinics and home settings. Eligible patients were aged ≥ 65 years and had a diagnosis of HF and/or DM, and/or COPD, along with at least one additional chronic condition. Data were collected using validated tools: the Self‐Care of Heart Failure Index, Self‐Care of Diabetes Inventory and Self‐Care of Chronic Obstructive Pulmonary Disease Inventory. Descriptive statistics were used to analyse disease‐specific self‐care behaviours. Group comparisons were performed using Student's t‐test and univariate, followed by multivariate analyses of variance.The analysis focused on a subset of 223 patients who had a combination of at least two chronic conditions between HF, DM and/or COPD. The mean age of participants was 77.3 (SD 7.5) years, with a majority being female (53.4%). Self‐care maintenance, monitoring and management for HF and COPD were found to be inadequate across all patient groups. Adequate self‐care was only observed in DM management among those with HF and DM and in DM maintenance for those with DM and COPD treated with insulin. Significant differences in all self‐care dimensions were observed across groups, particularly in patients managing all three conditions (HF, DM and COPD).The findings provide valuable insights into the complexities of self‐care in patients with multiple chronic conditions, underscoring the need for tailored, integrated and patient‐centred interventions. Healthcare strategies should focus on enhancing patient education and developing personalised approaches to improve health outcomes and quality of life in this population.All the authors have adhered to the EQUATOR guidelines STROBE Statement.A convenience sample of patients was recruited in outpatient clinics and their homes. Data were collected between March 2017 and August 2022, by face‐to‐face during routine outpatient visits or directly at the patient's home. [ABSTRACT FROM AUTHOR]

Background: Hookah consumption is harmful to human health and can cause various diseases. Developing lung cancer and other lung diseases are one of the health consequences of hookah consumption. Measuring the perceived risk for being diagnosed with these conditions among hookah users is necessary. Therefore, this study was conducted to determine the perceived risk of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) in hookah users in Iran. Methods: This cross-sectional study was conducted with a descriptive-analytical approach on 340 hookah users between January-May 2023. These people were recruited through convenience sampling. The information on the perceived risk of participants was collected through a questionnaire on the perceived risk of lung cancer and COPD. Data were analyzed through descriptive tests and multiple linear regression tests. These analyses were performed using Stata statistical software version 17. Results: The mean and standard deviation of the perceived risk for lung cancer was 8.41 ± 5.50 and for COPD was 8.51 ± 5.58 out of 20 possible scores. The results of multiple linear regression generally showed that the using other type of tobacco (β = 3.14, p < 0.0001), 2 or more use of hookah in past month (β=-3.41, p = 0.025), unskilled workers (β = 1.79, p = 0.017), married smokers (β=-1.31, p = 0.026), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables regarding to lung cancer perceived risk. In line with COPD the using other type of tobacco (β = 3.47, p < 0.0001), once a month use of hookah in past month(β=-3.74, p = 0.041) and twice or more use of hookah in past month (β=-4.82, p = 0.008), smokers in contemplation stage (β = 3.91, p < 0.0001), female smokers (β = 3.08, p < 0.0001), unskilled workers (β = 2.42, p = 0.007), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables to COPD perceived risk. Conclusion: In general, the perceived risk of developing lung cancer and COPD among hookah users was low. Therefore, it is necessary to provide widespread information about the potential harm of hookah in causing lung cancer and COPD, at the community level. [ABSTRACT FROM AUTHOR]

Abstract Background Dry powder inhalers (DPIs) rely on both internal resistance and patients’ inspiratory capacity for effective operation. Optimal inspiratory technique is crucial for DPI users. This study assessed the accuracy and repeatability of two available devices, PF810® and In-Check DIAL®, and analyzed their measurement errors and consistency in detecting inspiratory capacity. Methods The accuracy and repeatability of peak inspiratory flow (PIF) and forced inspiratory vital capacity (FIVC) against various internal resistances of the two devices were assessed using standard waveforms generated by a breathing simulator. The agreement of PIF measurements between the two devices in healthy volunteers and chronic obstructive pulmonary disease (COPD) patients was analyzed with the intraclass correlation coefficient and Bland–Altman graphical analysis. Results PF810® showed great accuracy and repeatability in measuring PIF, except for square waveforms at the lowest flow rate (20 L/min). In-Check DIAL® exhibited poor accuracy against high resistance levels. In scenarios with no resistance, In-Check DIAL® had significantly smaller measurement errors than PF810®, but larger errors against high resistance levels. The two devices showed excellent agreement (ICC > 0.80, P

Background Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies. Objective To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors. Methods Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression. Results A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P

Omima Mohammed Ali Omima Mohammed,1 Omaima Abdel Majeed Mohamed Salih,2 Islamia Ibrahim Ahmed Omer,3 Yousra Ibrahim Abdallah Mohammed,4 Omer A Mohammed,4 Ammar Elgadi,4 Lina Hemmeda,4 Walaa Elnaiem,4 Malaz Tarig Abdalla Mohamed,4 Areeba Ahsan,5 Khabab Abbasher Hussien Mohamed Ahmed4 1Department of Pediatrics and Child Health, Mohamed Alamin Hamid Tertiary Pediatric Hospital, Omdurman, Sudan; 2Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman, Sudan; 3Pediatrics and Child Health Department, College of Medicine, Sulaiman Al Rajhi University, Al-Bukayriyah, Qassim Province, Saudi Arabia; 4Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 5School of Health Sciences, Foundation University, Islamabad, PakistanCorrespondence: Khabab Abbasher Hussien Mohamed Ahmed, Email khabab9722@gmail.comBackground: Asthma is one of the most common non-communicable diseases. Childhood asthma has been increasing in Sudan, with a 13– 16% prevalence among Khartoum school children. To achieve and maintain good asthma control, proper diagnosis, assessment of severity, and appropriate medication administration are crucial, with phenotyping being a key factor in determining patients’ specific treatment.Objective: To study the frequency of severe asthma and the distribution of its different phenotypes and to investigate associations between age and gender and different phenotypes of asthma.Methodology: This descriptive cross-sectional hospital-based study was conducted in the Asthma Clinic of Mohamed Al-Amin Hamid Pediatrics Hospital. It included 229 patients who were presented to the clinic from September 2021 to April 2022. Data were collected from the patients and/or their caregivers using a modified validated standard questionnaire and were analyzed using SPSS version 26.0. A p-value of 0.05 or less was considered statistically significant.Results: In this study of 229 participants, 14.4% had severe asthma, with 44.5% and 41% exhibiting mild and moderate asthma, respectively. Most were effectively managed in steps 2 or 3. The cohort, primarily aged 5 or younger (40.2%) with a male majority (62%), showed a mean diagnosis age of 2.9 ± 2.8 years. Impressively, 90% maintained well-controlled asthma. Within severe asthma cases (87% atopic), 39.4% represented a severe allergic asthma phenotype. Elevated eosinophil counts were noted in 45.5% (serum) and 78.8% (sputum cytology), while 57.6% had normal serum IgE levels. The predominant symptom pattern in severe asthma was episodic multi-trigger wheezing (48.5%). Age and gender displayed no significant association with severe asthma phenotype.Conclusion: This study reveals a concerning rise in childhood asthma prevalence in Sudan, emphasizing the importance of tailored treatment strategies. Severe asthma, characterized by atopic eosinophilic involvement, necessitates targeted interventions in pediatric asthma care for specific phenotypes.Keywords: asthma, pediatrics, respiratory system, chronic obstructive pulmonary diseases, Sudan

Background: Although cumulative studies have demonstrated a beneficial effect of high-flow nasal cannula oxygen (HFNC) in acute hypercapnic respiratory failure, randomized trials to compare HFNC with non-invasive ventilation (NIV) as initial treatment in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients with acute-moderate hypercapnic respiratory failure are limited. The aim of this randomized, open label, non-inferiority trial was to compare treatment failure rates between HFNC and NIV in such patients. Methods: Patients diagnosed with AECOPD with a baseline arterial blood gas pH between 7.25 and 7.35 and PaCO2 ≥ 50 mmHg admitted to two intensive care units (ICUs) at a large tertiary academic teaching hospital between March 2018 and December 2022 were randomly assigned to HFNC or NIV. The primary endpoint was the rate of treatment failure, defined as endotracheal intubation or a switch to the other study treatment modality. Secondary endpoints were rates of intubation or treatment change, blood gas values, vital signs at one, 12, and 48 h, 28-day mortality, as well as ICU and hospital lengths of stay. Results: 225 total patients (113 in the HFNC group and 112 in the NIV group) were included in the intention-to-treat analysis. The failure rate of the HFNC group was 25.7%, while the NIV group was 14.3%. The failure rate risk difference between the two groups was 11.38% (95% CI 0.25–21.20, P = 0.033), which was higher than the non-inferiority cut-off of 9%. In the per-protocol analysis, treatment failure occurred in 28 of 110 patients (25.5%) in the HFNC group and 15 of 109 patients (13.8%) in the NIV group (risk difference, 11.69%; 95% CI 0.48–22.60). The intubation rate in the HFNC group was higher than in the NIV group (14.2% vs 5.4%, P = 0.026). The treatment switch rate, ICU and hospital length of stay or 28-day mortality in the HFNC group were not statistically different from the NIV group (all P > 0.05). Conclusion: HFNC was not shown to be non-inferior to NIV and resulted in a higher incidence of treatment failure than NIV when used as the initial respiratory support for AECOPD patients with acute-moderate hypercapnic respiratory failure. Trial registration: chictr.org (ChiCTR1800014553). Registered 21 January 2018, http://www.chictr.org.cn [ABSTRACT FROM AUTHOR]

Background: Dry powder inhalers (DPIs) rely on both internal resistance and patients' inspiratory capacity for effective operation. Optimal inspiratory technique is crucial for DPI users. This study assessed the accuracy and repeatability of two available devices, PF810® and In-Check DIAL®, and analyzed their measurement errors and consistency in detecting inspiratory capacity. Methods: The accuracy and repeatability of peak inspiratory flow (PIF) and forced inspiratory vital capacity (FIVC) against various internal resistances of the two devices were assessed using standard waveforms generated by a breathing simulator. The agreement of PIF measurements between the two devices in healthy volunteers and chronic obstructive pulmonary disease (COPD) patients was analyzed with the intraclass correlation coefficient and Bland–Altman graphical analysis. Results: PF810® showed great accuracy and repeatability in measuring PIF, except for square waveforms at the lowest flow rate (20 L/min). In-Check DIAL® exhibited poor accuracy against high resistance levels. In scenarios with no resistance, In-Check DIAL® had significantly smaller measurement errors than PF810®, but larger errors against high resistance levels. The two devices showed excellent agreement (ICC > 0.80, P < 0.05), except for healthy volunteers against medium to high resistance (R3-R5) where the ICC was insignificant. Bland–Altman plots indicated small disagreements between the two devices for both healthy volunteers and COPD patients. Conclusions: In-Check DIAL® exhibited poor accuracy and larger measurement errors than PF810® when detecting PIFs against higher internal resistances. However, its good performance against lower internal resistances, along with its cost-effectiveness and convenience made it appropriate for primary care. PF810® showed good accuracy and repeatability and could detect additional parameters of inspiratory capacity beyond PIF, though required further studies to confirm its clinical benefits. [ABSTRACT FROM AUTHOR]

To study the frequency of severe asthma and the distribution of its different phenotypes and to investigate associations between age and gender and different phenotypes of asthma. Methodology: This descriptive cross-sectional hospital-based study was conducted in the Asthma Clinic of Mohamed Al-Amin Hamid Pediatrics Hospital. It included 229 patients who were presented to the clinic from September 2021 to April 2022. Data were collected from the patients and/or their caregivers using a modified validated standard questionnaire and were analyzed using SPSS version 26.0. A p-value of 0.05 or less was considered statistically significant. Results: In this study of 229 participants, 14.4% had severe asthma, with 44.5% and 41% exhibiting mild and moderate asthma, respectively. Most were effectively managed in steps 2 or 3. The cohort, primarily aged 5 or younger (40.2%) with a male majority (62%), showed a mean diagnosis age of 2.9 ± 2.8 years. Impressively, 90% maintained well-controlled asthma. Within severe asthma cases (87% atopic), 39.4% represented a severe allergic asthma phenotype. Elevated eosinophil counts were noted in 45.5% (serum) and 78.8% (sputum cytology), while 57.6% had normal serum IgE levels. The predominant symptom pattern in severe asthma was episodic multi-trigger wheezing (48.5%). Age and gender displayed no significant association with severe asthma phenotype. Conclusion: This study reveals a concerning rise in childhood asthma prevalence in Sudan, emphasizing the importance of tailored treatment strategies. Severe asthma, characterized by atopic eosinophilic involvement, necessitates targeted interventions in pediatric asthma care for specific phenotypes. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between self-perceived burden and fatigue in patients with chronic obstructive pulmonary disease (COPD), and to provide reference for reducing the self-perceived burden in patients with COPD. Methods A total of 204 COPD patients admitted to a tertiary hospital in Hengyang city. Hunan province from November 2021 to April 2022 were selected as investigation objects by convenience sampling method. General data questionnaire, Manchester COPD Fatigue Scale and Self-perceived Burden Scale were used to collect data, and the status of fatigue and self-perceived burden of COPD patients were investigated. The effect of fatigue on self-perceived burden was analyzed. Results A total of 200 valid questionnaires were collected, with an effective recovery rate of 98.0%. The total score of fatigue was(24.25± 7.79) points, the total score of perceived burden was(28.45±6.89) points, and fatigue was positively correlated with perceived burden(r=0.779,P<0.001). The calibration coefficient R² of the self-perceived burden model was 79.5%, and the marginal contribution of the total fatigue score to the goodness of fit R² was 21.5%, which was the most important factor affecting the self-perceived burden score, fatigue had a positive effect on self-perceived burden. Conclusion Fatigue in patients with COPD is closely related to perceived burden. Therefore, attention should be paid attention to fatigue in clinical work, and effective means such as lung rehabilitation can be used to to improve fatigue, reduce patients' perceived burden, and enhance their happiness. [ABSTRACT FROM AUTHOR]

Objective To investigate the therapeutic effect of high flow nasal cannula oxygen therapy (HFNC) on elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and type Ⅱ respiratory failure. Methods A total of 96 elderly AECOPD patients with type 2 respiratory failure who received treatment at Xuanwu Hospital Capital Medical University from January to December 2022 were selected and divided into observation group ( n=49) and control group ( n=47) randomly. On the basis of conventional anti-inflammatory and antiasthmatic treatment, control group was treated with non-invasive positive pressure ventilation (NPPV), observation group was treated with HFNC. The level of pH value, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) before and after treatment were compared between two groups. The treatment comfort was evaluated with questionnaires. After 28 days of follow-up, the incidence of complications such as aspiration, bloating, tracheal intubation rate and mortality rate were compared between two groups. Results After treatment, pH value and PaO2 increased, and PaCO2 decreased in both group (P＜0.05). However, there was no significant difference in pH, PaO2 and PaCO2 between two groups after treatment (P＞0.05). The score of comfort degree of the observation group was higher than that of the control group (3.57±0.71 vs 2.46±0.83, t=7.020，P＜0.01), and the complication rate was lower than that of the control group (10.20% vs 27.65%, χ2=4.798，P＜0.05). There was no significant difference between the two groups in the tracheal intubation rate and mortality rate (P＞0.05). Conclusion NPPV and HFNC have similar therapeutic effect in elderly AECOPD patients with type 2 respiratory failure, but HFNC has fewer complications and higher degree of comfort.

Objective: To investigate the clinical effect of high flow nasal cannula（HFNC） in the treatment of patients with chronic obstructive pulmonary disease and type Ⅱ respiratory failure. Methods: A total of 151 patients with COPD and type Ⅱ respiratory failure treated in our hospital from April 2020 to March 2022 were selectd and randomly divided into the HFNC treatment group and non-invasive ventilator（NIV） treatment group. The changes of heart rate（HR）, respiratory rate（RR）, Oxygenation index（PaO2/FiO2）, arterial partial pressure of CO2（PaCO2） before and after treatment and intolerance and failure of treatment, endotracheal intubation requirements, length of hospital stay, and inpatient mortality at 1 and 24 hours after treatment and before the end of treatment were compared between two groups. Results: 151 COPD patients with type Ⅱ respiratory failure（77 in HFNC group and 74 in NIV group） were enrolled in this study. No significant diffrence was found in the death rate of patients between HFNC group and NIV group（7.8% and 8.2%）（P=0.94）.There was no significant difference in the HR, RR, mean arterial pressure, white blood cell counts, neutrophil percentage, c-reactive protein, procalcitonin, PaO2/FiO2, PaCO2, and blood potential of hydrogen before and after treatment between two groups. The number of airway care interventions in the HFNC group was significantly lower than that in the NIV group. Skin breakage was significantly more common in the NIV group（20.3% vs 5.2%, P＜0.05）. Conclusions: The therapeutic efficacy of HFNC is equal to NIV in treating COPD patients with type Ⅱ respiratory failure. HFNC can be used as the preferred ventilation supportive treatment for such patients because of its high safety. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment has been well described in patients with Chronic Obstructive Pulmonary Disease (COPD) in addition to cardiorespiratory disability. To reduce this impairment, researchers have recommended the use of single or combined exercise training. However, the combined effect of cognitive training (CT) and pulmonary rehabilitation (PR) program on selective cognitive abilities in patients with COPD has not been fully evaluated. Therefore, we aimed to assess the impact of PR combined with CT on 6 minutes walking test (6MWT) and cognitive parameters in Tunisian males' patients with COPD. Methods: Thirty-nine patients with COPD were randomly assigned to an intervention group (n = 21, age = 65.3 ± 2.79) and a control group (n = 18, age = 65.3 ± 3.2). The intervention group underwent PR combined with CT, and the control group underwent only PR, three times per week for 3 months. The primary outcomes were 6MWT (6 minutes walking test -6MWT-parameters) and cognitive performance, as evaluated by Montreal cognitive assessments (MOCA) and P300 test. Secondary outcomes were patient's characteristics and spirometric data. These tests were measured at baseline and after 3 months of training programs. Results: Results showed a significant improvement of the 6MWT distance after the rehabilitation period in both groups (p < .001). Moreover, both groups showed significant improvement (p < .001) in cognitive performance including MOCA score and P300 test latency in three midline electrodes. However, the improvement in cognitive performance was significantly greater in the PR+CT group than the PR group. Conclusion: In conclusion, although PR alone improves 6MWT parameters and cognitive function, the addition of CT to PR is more effective in improving cognitive abilities in patients with COPD. This combined approach may provide clinicians with a complementary therapeutic option for improving cognitive abilities in patients with COPD. [ABSTRACT FROM AUTHOR]

K+ channels are involved in many critical functions in lung physiology. Recently, the family of Ca2+-activated K+ channels (KCa) has received more attention, and a massive amount of effort has been devoted to developing selective medications targeting these channels. Within the family of KCa channels, three small-conductance Ca2+-activated K+ (KCa2) channel subtypes, together with the intermediate-conductance KCa3.1 channel, are voltage-independent K+ channels, and they mediate Ca2+-induced membrane hyperpolarization. Many KCa2 channel members are involved in crucial roles in physiological and pathological systems throughout the body. In this article, different subtypes of KCa2 and KCa3.1 channels and their functions in respiratory diseases are discussed. Additionally, the pharmacology of the KCa2 and KCa3.1 channels and the link between these channels and respiratory ciliary regulations will be explained in more detail. In the future, specific modulators for small or intermediate Ca2+-activated K+ channels may offer a unique therapeutic opportunity to treat muco-obstructive lung diseases. [ABSTRACT FROM AUTHOR]

IntroductionInconclusive results exist around the effectiveness of telemonitoring for patients with COPD, and studies recommended conducting subgroup analyses to identify patient phenotypes that could benefit from these services. This exploratory study investigated what type of COPD patients were receiving which type of telenursing interventions more frequently using the telemonitoring platform.MethodsA sample of 36 older adults with COPD were receiving telenursing services for 12 months and were asked to answer five COPD-symptom related questions and submit their vital signs daily.ResultsFindings revealed two phenotypes of older adults for whom the frequency of telenursing calls and related interventions differed. Although no statistically significant differences were observed in participants' GOLD grades and hospitalizations, cluster one participants used their COPD action plan significantly more frequently, and were in frequent contact with the telenurse.DiscussionIt is paramount that further research is needed on the development of patient phenotypes who may benefit from telemonitoring.

The first part of the article was dedicated to the problem of comorbidities in cardiac surgery patients with coronary artery disease (CAD), considered modern literary sources discussing endocrinopathies, connective tissue diseases, COVID-19-associated autoimmune processes, chronic kidney disease and diseases of the gastrointestinal tract. The aim. To continue the analysis of current literature data on comorbidities in patients hospitalized for surgical myocardial revascularization. Results. When assessing the preoperative status of a cardiac surgery patient with CAD, not only their cardiological status and the percentage of stenotic lesion of the coronary arteries are important, but also the presence of concomitant diseases and the degree of their compensation. According to the modern literary sources, 4-20.5% of patients undergoing coronary artery bypass grafting (CABG) have chronic pulmonary disease (COPD). In order to avoid bronchopulmonary complications in the postoperative period, high-quality preoperative diagnosis based on spirometric research is important. When verifying COPD, even of a moderate degree, a course of preventive therapy is required, and in the case of a severe course of COPD with a forced expiratory volume

Background: Oral breath can be used as a chairside investigation method in the detection of volatile sulfur compounds (VSCs), which can serve as a potential biomarker in the early detection of underlying systemic diseases. Aim: The primary aim was to study the hydrogen sulfide levels in oral breath of patients with chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF), and peptic ulcer disease. Materials and Methods: The study included 100 patients divided into four groups with 25 patients in each group of CRF, COPD, peptic ulcer, and control. The oral breath sample collected from each participant was passed through a sensor in the hydrogen sulfide detector (Tanita, Japan), which registers the level of sulfides. The maximum level attained was determined in parts per billion sulfide equivalents using direct readings from the monitor's digital display. The values obtained were statistically analyzed using statistical tests: Shapiro-Wilk test, analysis of variance, and post hoc analysis. Results: The mean values for the age and hydrogen sulfide scores were as follows: control group (35.16 ± 14.12 and 0.44 ± 1.00), CRF (49.16 ± 13.93 and 2.32 ± 0.98), COPD (48.16 ± 15.58 and 2.40 ± 0.95), and the peptic ulcer (42.36 ± 15.44 and 1.68 ± 1.02). The post hoc analysis for intergroup comparison of mean values reveals that statistically significant (P = 0.001*) differences exist between the control group and the CRF group, the control group and the COPD group, and the control group and the peptic ulcer group. Conclusion: The CRF group had slightly higher hydrogen sulfide measurements among the four groups, indicating the release of more VSCs. [ABSTRACT FROM AUTHOR]

Induced sputum is a minimally invasive methodology useful to evaluate airway inflammation. Sputum induction with the nebulization of a saline hypertonic solution favours accumulation and production of airway sputum. The collected sample is processed with mucolytic agent. Eosinophils are usually scarcely represented in the sputum sample of healthy subjects and when their percentage is ≥ 3%, we can define the inflammatory pattern as eosinophilic. Increase of neutrophils (≥ 61%) can be a characteristic of the disease or be induced by infections, pollution or smoking habit and it defines a neutrophilic pattern. When both eosinophils and neutrophils are high, a mixed granulocytic pattern is defined. Asthmatic patients frequently present an eosinophilic inflammation which can be reduced with inhaled corticosteroid (ICS) therapy. There are asthmatic patients without a significant airway inflammation, either because the inhaled therapy is successful in maintaining low the inflammatory profile or because bronchoconstriction, thickening of the airway wall are the major components of the disease, in this case the inflammatory pattern is defined paucigranulocytic. In severe asthmatic patients, ICS is not sufficient to maintain the control of the disease and if the patient has a T2 endotype (increased blood and or sputum eosinophils or fractional exhaled nitric oxide (FeNO) or high IgE), biologic therapy could be attempted. Blood eosinophils are a modest surrogate evaluation for sputum eosinophils. FeNO levels, which mildly correlate with sputum eosinophils, are high when a T2 pattern is present. Patients with chronic obstructive pulmonary disease (COPD), usually have mucopurulent sputum samples with a high percentage of neutrophils. However, in a subgroup of subjects, an eosinophilic airway inflammation with a lower correlation with blood eosinophils has been detected. In conclusion, induced sputum methodology can be useful when the characterization of airway inflammation is needed in order to phenotype patients or to evaluate an insufficient response to therapy. [ABSTRACT FROM AUTHOR]

Cross-sectional evidence suggests a higher burden of chronic respiratory diseases in people with inflammatory bowel disease, but there is a lack of prospective evidence to clarify the direction of their associations. We aimed to investigate the association of inflammatory bowel disease with the risk of 2 major chronic respiratory diseases, chronic obstructive pulmonary disease, and asthma. We included 430,414 participants from UK Biobank and followed them from recruitment (2006-2010) to 2021. Chronic obstructive pulmonary disease and asthma cases were obtained from inpatient data and death register. Using Cox proportional hazards models, we estimated the multivariable-adjusted hazard ratios (HR) of developing chronic obstructive pulmonary disease and asthma in participants with inflammatory bowel disease compared with inflammatory bowel disease-free groups. We also investigated the association among Crohn's disease and ulcerative colitis with the risk of chronic obstructive pulmonary disease and asthma. Over a median follow-up of 11.9 years, there were 11,196 incidents of chronic obstructive pulmonary disease and 9831 asthma cases. The adjusted HRs of developing chronic obstructive pulmonary disease (HR 1.54; 95% confidence interval [CI], 1.33-1.79) and asthma (HR 1.52; 95% CI, 1.29-1.79) were higher for those with inflammatory bowel disease when compared with inflammatory bowel disease-free participants. Participants with Crohn's disease and ulcerative colitis were also found to have a higher risk of chronic obstructive pulmonary disease (Crohn's disease: HR 1.71; 95% CI, 1.36-2.15; ulcerative colitis: HR 1.45; 95% CI, 1.20-1.75) and asthma (Crohn's disease: HR 1.73; 95% CI, 1.33-2.25; ulcerative colitis: HR 1.41; 95% CI, 1.15-1.73) when compared with those free of inflammatory bowel disease. This study suggested that individuals with inflammatory bowel disease have a higher risk of developing chronic obstructive pulmonary disease and asthma, highlighting the importance of preventing chronic respiratory diseases among inflammatory bowel disease patients. [ABSTRACT FROM AUTHOR]

Purpose: Respiratory diseases affect the lungs and other parts of the respiratory system. The respiratory disease affects hundreds of millions of humans, and premature death is observed in nearly four million people yearly. The major cause of the increase in this disease is the increased level of air pollution and higher tobacco usage in public places. Design/methodology/approach: We have used the search engines PubMed and Google Scholar for the keywords Respiratory diseases, Nanomaterials, diagnosis, Nanomedicine, and Target drug delivery; recent and relevant articles are selected for reviewing this paper. Findings: Nanomedicine is a recent field of research that deals with monitoring, repairing, theragnosis, and development of human biological systems at the sub-atomic level, where we utilize engineered nanodevices and nanostructures. The conventional therapeutic strategies designed for respiratory diseases have limited solubility and bioavailability. Moreover, the robust effect of the drugs led to adverse side effects due to their high dose requirement. The local delivery of therapeutic Nanoparticles (NPs) or drug-loaded nano vehicles to the lung is a safe technique for managing various respiratory tract-related diseases like chronic obstructive pulmonary diseases, cystic fibrosis, lung cancer, tuberculosis, asthma, and infection. To overcome the difficulties of conventional treatment with antibiotics and anti-inflammatory drugs, nano-enabled drug delivery, nanoformulations of drugs as well as drug nanoencapsulation have been used recently. In this mini-review, we will discuss the importance and application of nanomedicine for diagnosis, treatment and clinical research involved in the different types of respiratory diseases. Practical implications: Nanomedicine provides an alternative delivery of drugs with the help of various nanocarriers, which enhances controlled drug delivery at the pulmonary region and can be used for treating and diagnosing respiratory diseases in vivo and in vitro studies. Further experiments followed by clinical examination are warranted to prove the potential application of nanomedicine in treating respiratory disease. Originality/value: This mini-review will help the readers and budding scientists apply new methods for developing highly efficient drugs with low side effects and improved targeted sites of action. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment has been well described in patients with Chronic Obstructive Pulmonary Disease (COPD) in addition to cardiorespiratory disability. To reduce this impairment, researchers have recommended the use of single or combined exercise training. However, the combined effect of cognitive training (CT) and pulmonary rehabilitation (PR) program on selective cognitive abilities in patients with COPD has not been fully evaluated. Therefore, we aimed to assess the impact of PR combined with CT on 6 minutes walking test (6MWT) and cognitive parameters in Tunisian males' patients with COPD. Methods: Thirty-nine patients with COPD were randomly assigned to an intervention group (n = 21, age = 65.3 ± 2.79) and a control group (n = 18, age = 65.3 ± 3.2). The intervention group underwent PR combined with CT, and the control group underwent only PR, three times per week for 3 months. The primary outcomes were 6MWT (6 minutes walking test-6MWT-parameters) and cognitive performance, as evaluated by Montreal cognitive assessments (MOCA) and P300 test. Secondary outcomes were patient's characteristics and spirometric data. These tests were measured at baseline and after 3 months of training programs. Results: Results showed a significant improvement of the 6MWT distance after the rehabilitation period in both groups (p < .001). Moreover, both groups showed significant improvement (p < .001) in cognitive performance including MOCA score and P300 test latency in three midline electrodes. However, the improvement in cognitive performance was significantly greater in the PR+CT group than the PR group. Conclusion: In conclusion, although PR alone improves 6MWT parameters and cognitive function, the addition of CT to PR is more effective in improving cognitive abilities in patients with COPD. This combined approach may provide clinicians with a complementary therapeutic option for improving cognitive abilities in patients with COPD. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is traditionally perceived as Th1-inflammation, but some patients have Th2-inflammation. A high fraction of exhaled nitric oxide (FE NO ) is seen in asthma with Th2-inflammation, justifying FE NO as a point-of-care biomarker. The use of FE NO in COPD is much less frequent. We aimed to review the evidence in favor of FE NO measurement in COPD and discuss its potential usefulness in clinical settings., Areas Covered: This review covers nitric oxide production in the airways and FE NO measurements in COPD patients during stable conditions and acute exacerbation. It discusses why COPD patients may have both low and high FE NO levels and the potential clinical utility of FE NO ., Expert Opinion: There is good evidence that FE NO increases with an exacerbation irrespective of the initial low or high baseline value. However, there is insufficient evidence to establish a fixed cutoff value for elevated FE NO in COPD today. Instead, a personal baseline FE NO level should be established when the patient is in a stable phase of the disease, which will subsequently set high and low FE NO levels in a personalized manner. In the future, home monitoring of FE NO could help identify exacerbations early, allowing proper action to be taken.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow obstruction and is one of the leading causes of death globally. The changes in pulmonary functions in COPD are irreversible with devastating consequences. Cognitive functioning in COPD patients is often found impaired and postulated to happen due to hypoxemia, i.e., oxygen deprivation to the brain. An impaired cognitive functioning can have direct impact on functional abilities as well as quality of life of patients and could be a vital treatment goal. The study aimed to explore the attention, memory, and executive functioning in hypoxemic COPD patients in backdrop of dearth of studies from India. Materials and Methods: Using purposive sampling, 30 patients with COPD, having mild-to-moderate level of illness severity, and having minimum illness for duration of 5 years were compared with 30 healthy controls. Participants were assessed for cognitive functioning in the domains of sustained attention, processing and psychomotor speed, working memory, verbal learning, and memory and executive functions using neuropsychological tests, namely, Digit Symbol Substitution Test, Trial Making Test, Verbal N Back Test, Rey's Audio Visual Learning Test, Controlled Oral Word Association Test, Animal Naming Test, Stroop Neuropsychological Test, and Modified Wisconsin Card Sorting Test. Results: Findings suggest significant differences between COPD patients and healthy controls over processing and psychomotor speed, working memory, memory, learning, and executive functioning. Conclusion: In addition to pulmonary distress, COPD patients also have compromised cognitive functions affecting overall daily functioning and quality of life. Understanding the nature of decline in cognitive functions could be vital in improving daily psychosocial functioning of the patients with COPD, and the exploration could help professionals in intervention of specific cognitive functioning.

Background: Studies have demonstrated that red blood cell distribution width (RDW) is closely associated with the prognosis of patients with chronic obstructive pulmonary disease (COPD). In addition, the dynamic changes in RDW appear to play an important role. Thus, we aimed to investigate the relationship between dynamic changes in RDW and 30-day all-cause readmission of patients with acute exacerbation of COPD (AECOPD). Methods: This is a prospective and observational study was conducted in the Department of Pulmonary Medicine, J J M Medical college, Davangere Patients hospitalized for AECOPD between April 2020 to March 2021 were revised. Clinical and laboratory parameters were noted. Participants were followed to determine the incidence of readmission due to AECOPD, readmission from any cause and composite end point of readmission or death during 60 days after discharge. Result: Maximum patients in both groups were found in>60 years age group. The mean age in AECOPD group was 66.75±10.35 years and in Stable COPD was 65.31±11.25 years. Both groups were comparable. Maximum patients in both groups were presented with cough and breathlessness. Maximum patients in AECOPD group was from GOLD stage 4 and in stable COPD was also from GOLD stage 4. The difference in both group was foundstatically significant. Mean FEV1% significantly lower in AECOPD patients (43.87±14.26) as compare to stable COPD patients (50.15±22.22). The difference in both groups was found statistically significant. Mean RDW was significantly higher in AECOPD (19.65±7.75%) as compare to stable patients (15.85±5.55%). The difference in both groups was found statistically significant. Conclusion: Prolonged hospital stay was closely associated with increased RDW on admission in AECOPD patients. Elevated RDW may be an independent predictor for prolonged hospital stay in AECOPD patients. [ABSTRACT FROM AUTHOR]

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Cigarette smoke (CS) is the major factor in the development of chronic obstructive pulmonary disease (COPD), the third leading cause of death worldwide. Furthermore, although Camellia sinensis (CN) has been known as an anti-inflammatory material, the effect of CN has not yet been known on pulmonary inflammation in COPD. Thus, we investigated the protective effects of Camellia sinensis L. extract (CLE) against pulmonary inflammation in porcine pancreas elastase (PPE) and a cigarette smoke extract (CSE)-induced COPD mouse model. Oral administration of CLE suppressed the symptoms such as infiltration of immune cells, cytokines/chemokines secretion, mucus hypersecretion, and injuries of the lung parenchyma. Increased inflammatory responses in COPD are mediated by various immune cells such as airway epithelial cells, neutrophils, and alveolar macrophages. Thus, we investigated the effect and mechanisms of CLE in H292, HL-60, and MH-S cells. The CLE inhibited the expression of IL-6, IL-8, MUC5AC and MUC5B on CSE/LPS-stimulated H292 cells and also suppressed the formation of neutrophil extracellular traps and secretion of neutrophil elastase by inhibiting reactive oxygen species in PMA-induced HL-60 cells. In particular, the CLE suppressed the release of cytokines and chemokines caused by activating the nuclear factor kappa-light-chain-enhancer of activated B via the activation of nuclear factor erythroid-2-related factor 2 and the heme oxygenase-1 pathway in CSE/LPS-stimulated MH-S cells. Therefore, we suggest that the CLE administration be the effective approach for treating or preventing chronic pulmonary diseases such as COPD induced by CS. [ABSTRACT FROM AUTHOR]

K+ channels are involved in many critical functions in lung physiology. Recently, the family of Ca2+-activated K+ channels (KCa) has received more attention, and a massive amount of effort has been devoted to developing selective medications targeting these channels. Within the family of KCa channels, three small-conductance Ca2+-activated K+ (KCa2) channel subtypes, together with the intermediate-conductance KCa3.1 channel, are voltage-independent K+ channels, and they mediate Ca2+-induced membrane hyperpolarization. Many KCa2 channel members are involved in crucial roles in physiological and pathological systems throughout the body. In this article, different subtypes of KCa2 and KCa3.1 channels and their functions in respiratory diseases are discussed. Additionally, the pharmacology of the KCa2 and KCa3.1 channels and the link between these channels and respiratory ciliary regulations will be explained in more detail. In the future, specific modulators for small or intermediate Ca2+-activated K+ channels may offer a unique therapeutic opportunity to treat muco-obstructive lung diseases.

Antibiotics alter the gut microbiome and cause dysbiosis leading to antibiotic-resistant organisms. Different patterns of antibiotic administration cause a difference in bacterial composition and resistome in the human gut. We comprehensively investigated the association between the distribution of antibiotic resistance genes (ARGs), bacterial composition, and antibiotic treatments in patients with chronic obstructive pulmonary diseases (COPD) and Clostridioides difficile infections (CDI) who had chronic or acute intermittent use of antibiotics and compared them with healthy individuals. We analyzed the gut microbiomes of 61 healthy individuals, 16 patients with COPD, and 26 patients with CDI. The COPD patients were antibiotic-free before stool collection for a median of 40 days (Q1: 9.5; Q3: 60 days), while the CDI patients were antibiotic-free for 0 days (Q1: 0; Q3: 0.3). The intra-group beta diversity measured by the median Bray-Curtis index was the lowest for the healthy individuals (0.55), followed by the COPD (0.69) and CDI groups (0.72). The inter-group beta diversity was the highest among the healthy and CDI groups (median index = 0.89). The abundance of ARGs measured by the number of reads per kilobase per million reads (RPKM) was 684.2; 1,215.2; and 2,025.1 for the healthy, COPD, and CDI groups. It was negatively correlated with the alpha diversity of bacterial composition. For the prevalent ARG classes, healthy individuals had the lowest diversity and abundance of aminoglycoside, ß-lactam, and macrolidelincosamide-streptogramin (MLS) resistance genes, followed by the COPD and CDI groups. The abundances of Enterococcus and Escherichia species were positively correlated with ARG abundance and the days of antibiotic treatment, while Bifidobacterium and Ruminococcus showed negative correlations for the same. In addition, we analyzed the mobilome patterns of aminoglycoside and ß-lactam resistance gene carriers using metagenomic sequencing data. In conclusion, the ARGs were significantly enhanced in the CDI and COPD groups than in healthy individuals. In particular, aminoglycoside and ß-lactam resistance genes were more abundant in the CDI and COPD groups, but the dominant mobile genetic elements that enable the transfer of such genes showed similar prevalence patterns among the groups. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow obstruction and is one of the leading causes of death globally. The changes in pulmonary functions in COPD are irreversible with devastating consequences. Cognitive functioning in COPD patients is often found impaired and postulated to happen due to hypoxemia, i.e., oxygen deprivation to the brain. An impaired cognitive functioning can have direct impact on functional abilities as well as quality of life of patients and could be a vital treatment goal. The study aimed to explore the attention, memory, and executive functioning in hypoxemic COPD patients in backdrop of dearth of studies from India. Materials and Methods: Using purposive sampling, 30 patients with COPD, having mild-to-moderate level of illness severity, and having minimum illness for duration of 5 years were compared with 30 healthy controls. Participants were assessed for cognitive functioning in the domains of sustained attention, processing and psychomotor speed, working memory, verbal learning, and memory and executive functions using neuropsychological tests, namely, Digit Symbol Substitution Test, Trial Making Test, Verbal N Back Test, Rey’s Audio Visual Learning Test, Controlled Oral Word Association Test, Animal Naming Test, Stroop Neuropsychological Test, and Modified Wisconsin Card Sorting Test. Results: Findings suggest significant differences between COPD patients and healthy controls over processing and psychomotor speed, working memory, memory, learning, and executive functioning. Conclusion: In addition to pulmonary distress, COPD patients also have compromised cognitive functions affecting overall daily functioning and quality of life. Understanding the nature of decline in cognitive functions could be vital in improving daily psychosocial functioning of the patients with COPD, and the exploration could help professionals in intervention of specific cognitive functioning [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a persistent inflammatory lung disease which is characterized by progressive and partially reversible symptoms. The incidence rate of COPD is accelerating and becoming remarkable among worldwide population. Increasing recognition of psychological comorbidities among patients with COPD is more likely to be seen than non-COPD patients. Impairment in physiological functioning and restricted lifestyle leads to higher rate of mental health deterioration. Understanding the spectrum of negative consequences related to the psychological and social functioning of the patients with COPD has been underrecognized, and deficits are mostly untreated. Due to deleterious effects of COPD on physical functioning, decline in quality of life (QOL) has been acknowledged. Aim: The aim of the study is to compare the health-related QOL (HRQL) and psychological well-being between COPD patients and normal controls. Methods: In the present study, sixty individuals, thirty individuals diagnosed with COPD and 30 normal controls were taken of both genders, with the age range of 50–70 years. Measures were taken on the basis of psychological well-being and HRQOL. Results: Results suggest that individuals with COPD differed significantly in subjective psychological well-being and HRQOL in comparison with normal controls. Conclusion: In conclusion, COPD affects patients overall psychological well-being and QOL adversely, and requirement of comprehensive psychosocial management is recommended.

Abstract Background High-flow nasal cannula (HFNC) oxygen therapy is being increasingly used to prevent post-extubation hypoxemic respiratory failure and reintubation. However, evidence to support the use of HFNC in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure after extubation is limited. This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. Methods COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. The primary endpoint was treatment failure, defined as either resumption of invasive ventilation or switching to the other study treatment modality (NIV for patients in the NFNC group or vice versa). Results Ninety-six patients were randomly assigned to the HFNC group or NIV group. After secondary exclusion, 44 patients in the HFNC group and 42 patients in the NIV group were included in the analysis. The treatment failure rate in the HFNC group was 22.7% and 28.6% in the NIV group—risk difference of − 5.8% (95% CI, − 23.8–12.4%, p = 0.535), which was significantly lower than the non-inferior margin of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of − 50.0% (95% CI, − 74.6 to − 12.9%, p = 0.015). One hour after extubation, the mean respiratory rates of both groups were faster than their baseline levels before extubation (p

Objective: The objective of this review is to examine the relationship between oral diseases and respiratory health, investigating how oral microbiome disruptions contribute to respiratory tract infections. Additionally, it aims to explore the impact of respiratory disease symptoms and treatments on the oral microbiome., Data Sources: The literature utilized in this review was sourced from studies focusing on the correlation between oral health and respiratory infections, spanning a period of 40 years. Various databases and scholarly sources were likely consulted to gather relevant research articles, reviews, and clinical studies., Study Selection: This review summarizes four decades-long research, providing insights into the intricate relationship between oral and respiratory health. It delves into how oral diseases influence respiratory tract conditions and vice versa. The selection process likely involved identifying studies that addressed the interaction between oral microbiome disruptions and respiratory complications., Conclusion: Oral diseases or poor oral habits have been known to increase the risk of getting respiratory infections. Modern techniques have demonstrated the relationship between oral disease and respiratory tract infections like influenza, chronic obstructive pulmonary diseases, asthma, and Pneumonia. Apart from that, the medications used to treat respiratory diseases affect oral physiological factors like the pH of saliva, and saliva flow rate, which can cause significant changes in the oral microbiome. This review provides regular oral hygiene and care that can prevent respiratory health and respiratory infections., Clinical Significance: Understanding the intricate relationship between oral health and respiratory infections is crucial for healthcare providers. Implementing preventive measures and promoting good oral hygiene habits can reduce respiratory tract infections and improve overall respiratory health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Giant right ventricular thrombus is a rare characteristic of pulmonary thrombosis-embolism that is typically associated with chronic obstructive pulmonary disease (COPD) exacerbation. We found such a giant right ventricular thrombus in a patient who was a heavy smoker who had extreme type of COPD with cor pulmonale. He also had hypotension, hypoxia, low tolerance for exercise, congestive heart failure, and poor quality of life, which are the prognostic qualities in the patient's clinical scenario we mentioned.

OBJECTIVE: Readmission after hospitalization for a chronic disease is a major concern of interest for health care quality. Our aim was to investigate the predictors and rates of early readmission after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary care hospital. MATERIAL AND METHODS: Over a 3-year period, patients hospitalized in our pulmonary disease clinic with a diagnosis of chronic obstructive pulmonary disease (COPD) and who had an index hospitalization for AECOPD were included. Readmission was defined as rehospitalization within 30 days of AECOPD discharge. Demographics, comorbidities, exacerbations, prior intensive care unit (ICU) stay, and long-term oxygen therapy (LTOT), blood eosinophil count, and antibiotic and/or steroid treatment at the index AECOPD admission were recorded. RESULTS: Fifty-two (17.3%) readmissions occurred in 300 patients. Readmissions were due to AECOPD in 46.2%, pneumonia in 19.2%, and cardiovascular disease in 15.4% patients. Twenty-one (40%) of the readmitted patients were frequent exacerbators. After adjusting for individual and clinical predictors, the odds ratio for readmission was 2.11 (95% CI, 1.07-4.15, P = .03) for those with congestive heart failure, 3.30 (95% CI, 1.05-9.75, P = .04) for those with arrhythmia, and 1.99 (95% CI, 1.04-3.81, P = .04) for LTOT users prior to AECOPD. CONCLUSION: A significant majority of patients readmitted after an AECOPD mainly suffered from recurrent AECOPD. Associated congestive heart failure, arrhythmia, and prior LTOT were risk factors identified for early AECOPD readmissions in our study. Better recognition of readmission risk factors might help to reduce readmission rates of AECOPD. [ABSTRACT FROM AUTHOR]

Background Asthma–chronic obstructive pulmonary diseases overlap syndrome (ACOS) carries a higher risk than either condition alone, with more symptoms, more exacerbations, higher cost, and increased mortality, so the diagnosis and accurate treatment of patients with ACOS is very important in the clinical setting. Aim To study the prevalence of ACOS among patients with asthma and those with COPD and to detect the predictive factors of ACOS. Patients and methods We conducted an observational cross-sectional study involving 100 patients with bronchial asthma and 100 patients with COPD. We recorded demographic data, spirometric data, chest radiograph finding, peripheral blood eosinophil and neutrophils, and response to inhaled corticosteroids. Results Among the 200 studied patients, 16% of patients with asthma and 20% of patients with COPD fulfilled the ACOS criteria. Male sex and prebronchodilator forced expiratory volume in first second/forced vital capacity% are predictors of ACOS development in asthmatic patients and that blood eosinophil are predictors of ACOS development in patients with COPD using odds ratio. Conclusion ACOS should be considered as an independent subgroup distinguished by demographic data, symptoms, spirometric indices, and granulocytic pattern.

Jiayan Sun,1 Yujie Li,1 Bingyu Ling,1 Qingcheng Zhu,1 Yingying Hu,2 Dingyu Tan,1 Ping Geng,1 Jun Xu31Department of Emergency, Clinical Medical College, Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou, People’s Republic of China; 2Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 3Department of Emergency, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, People’s Republic of ChinaBackground: High-flow nasal cannula (HFNC) oxygen therapy in acute hypoxic respiratory failure is becoming increasingly popular. However, evidence to support the use of HFNC in acute respiratory failure (ARF) with hypercapnia is limited.Methods: Chronic obstructive pulmonary disease (COPD) patients with moderate hypercapnic ARF (arterial blood gas pH 7.25–7.35, PaCO2>50 mmHg) who received HFNC or non-invasive ventilation (NIV) in the intensive care uint from April 2016 to March 2018 were analyzed retrospectively. The endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa), and 28-day mortality.Results: Eighty-two COPD patients (39 in the HFNC group and 43 in the NIV group) were enrolled in this study. The mean age was 71.8±8.2 and 54 patients (65.9%) were male. The treatment failed in 11 out of 39 patients with HFNC (28.2%) and in 17 of 43 patients with NIV (39.5%) (P=0.268). No significant differences were found for 28-day mortality (15.4% in the HFNC group and 14% in the NIV group, P=0.824). During the first 24 hrs of treatment, the number of nursing airway care interventions in the HFNC group was significantly less than in the NIV group, while the duration of device application was significantly longer in the HFNC group (all P

Chronic obstructive pulmonary disease is a chronic inflammation affecting the peripheral airways and pulmonary parenchyma, leading to irreversible and progressive airflow limitation. In recent years attention has been paid to more frequent coexistence with psoriasis. Both diseases are provoked by similar factors, such as smoking, abdominal obesity, lack of physical activity, and concomitance with the metabolic syndrome. In addition, similarities in pathogenesis, regarding the roles of Th1 and Th17 can be found, resulting in an increase in the proinflammatory cytokines levels. Both in psoriasis and chronic obstructive pulmonary disease, an increased activity of proteases produced by neutrophils and adhesion molecules is observed. In addition, neutrophils are an abundant source of inflammation mediators, including reactive oxidants and lipid mediators with chemotactic activity. Awareness of the increased risk of developing chronic obstructive pulmonary disease in psoriatic patients, allows to implement preventive and therapeutic actions such as smoking cessation or treatment of the inflammatory processes.

Cigarette smoke (CS) is the major factor in the development of chronic obstructive pulmonary disease (COPD), the third leading cause of death worldwide. Furthermore, although Camellia sinensis (CN) has been known as an anti-inflammatory material, the effect of CN has not yet been known on pulmonary inflammation in COPD. Thus, we investigated the protective effects of Camellia sinensis L. extract (CLE) against pulmonary inflammation in porcine pancreas elastase (PPE) and a cigarette smoke extract (CSE)-induced COPD mouse model. Oral administration of CLE suppressed the symptoms such as infiltration of immune cells, cytokines/chemokines secretion, mucus hypersecretion, and injuries of the lung parenchyma. Increased inflammatory responses in COPD are mediated by various immune cells such as airway epithelial cells, neutrophils, and alveolar macrophages. Thus, we investigated the effect and mechanisms of CLE in H292, HL-60, and MH-S cells. The CLE inhibited the expression of IL-6, IL-8, MUC5AC and MUC5B on CSE/LPS-stimulated H292 cells and also suppressed the formation of neutrophil extracellular traps and secretion of neutrophil elastase by inhibiting reactive oxygen species in PMA-induced HL-60 cells. In particular, the CLE suppressed the release of cytokines and chemokines caused by activating the nuclear factor kappa-light-chain-enhancer of activated B via the activation of nuclear factor erythroid-2-related factor 2 and the heme oxygenase-1 pathway in CSE/LPS-stimulated MH-S cells. Therefore, we suggest that the CLE administration be the effective approach for treating or preventing chronic pulmonary diseases such as COPD induced by CS.

Muscle dysfunction often occurs in patients with chronic obstructive pulmonary diseases (COPD) and affects ventilatory and non-ventilatory skeletal muscles. We have previously reported that hypercapnia (elevated CO2 levels) causes muscle atrophy through the activation of the AMPKα2-FoxO3a-MuRF1 pathway. In the present study, we investigated the effect of normoxic hypercapnia on skeletal muscle regeneration. We found that mouse C2C12 myoblasts exposed to elevated CO2 levels had decreased fusion index compared to myoblasts exposed to normal CO2. Metabolic analyses of C2C12 myoblasts exposed to high CO2 showed increased oxidative phosphorylation due to increased fatty acid oxidation. We utilized the cardiotoxin-induced muscle injury model in mice exposed to normoxia and 10% CO2 for 21 days and observed that muscle regeneration was delayed. High CO2-delayed differentiation in both mouse C2C12 myoblasts and skeletal muscle after injury and was restored to control levels when cells or mice were treated with a carnitine palmitoyltransfearse-1 (CPT1) inhibitor. Taken together, our data suggest that hypercapnia leads to changes in the metabolic activity of skeletal muscle cells, which results in impaired muscle regeneration and recovery after injury.

Context: India has 18% of the global population and an increasing burden of chronic respiratory diseases. The prevalence of Metabolic syndrome (MS) was found to be as high as 39.7% among Indian population. Metabolic syndrome is found to be more common in Chronic Obstructive Pulmonary Disease (COPD) when compared to the general population. This study was done to assess the prevalence of metabolic syndrome in COPD and the association of systemic inflammation in COPD patients with metabolic syndrome. Methodology: This study enrolled 150 consecutive consenting patients of stable COPD attending the outpatient pulmonology department. Detailed history, clinical examination, spirometry, and relevant routine laboratory investigations including complete blood count, fasting blood sugar, and lipid profile were done. In addition, hsCRP, Serum lactate and Vitamin D level was assessed in all patients. Diagnosis of COPD and Metabolic syndrome was done according to GOLD guidelines, 2018 and the International Diabetes Federation criteria respectively. Result: The prevalence of metabolic syndrome was found to be 27.3% in our COPD patients. The frequency of metabolic syndrome in GOLD stage I, II, III, and IV was 75%, 32%, 17%, and 13.5%, respectively. Logistic regression analysis showed a significant relationship of blood leucocyte count (OR = 0.342, CI = 0.171-0.686), hs-CRP (OR = 0.020, CI = 0.003-0.122), pack years (OR = 1.083, CI = 1.026-1.14) and vitamin D levels (OR = 1.219, CI = 1.093-1.359) with metabolic syndrome in COPD patients. Conclusion: Metabolic syndrome is a co-morbidity that is very often overlooked in patients of COPD. Systemic inflammation which is a common characteristic of both COPD and Metabolic syndrome has been found to be an important contributor towards cardiovascular morbidity and mortality.

Background: Abnormal sleep architecture with decreased rapid eye movement sleep and arousals during the periods of nocturnal oxygen desaturation (NOD) are seen in patients with chronic obstructive pulmonary disease (COPD) with significant consequences. This study was done to evaluate the prevalence of NOD and other sleep-related disorders in COPD patients. Patients and Methods: This prospective cross-sectional study was conducted in the sleep laboratory of our tertiary center over 1 year. Fifty COPD patients were enrolled in this study. They were classified into mild COPD and moderate COPD, according to the Global Initiative for Obstructive Lung Disease (GOLD) classification. Complete history, physical examination, and relevant laboratory investigations were taken. All patients were subjected to overnight polysomnography. Results: Eight patients had mild COPD, whereas 42 patients had moderate COPD. Mean sleep efficiency was decreased with an average of 71.08% with a significant difference between mild and moderate COPD cases. Minimal SpO2, average SpO2, SpO2

Pulmonary diseases have known to exert significant human sufferings with high death toll globally. The association between periodontitis and pulmonary diseases is still in its infancy and needs attention. Poor oral health has shown to influence pulmonary health as well as the course of the diseases associated with this system. Numerous studies have emphasized that resident microorganisms of lungs are primarily the habitants of oral cavity. It could be due to the aspiration of oral periodontopathic bacteria into the lungs, thereby initiating the inflammatory process. Added to this, the inflammatory mediators elaborated from the inflamed periodontium in case of periodontal diseases may spread via blood to other organs such as lungs causing infections. Numerous studies have highlighted the beneficial role of periodontal therapy in improving lung function with a decreased frequency of exacerbations, reduced risk of adverse respiratory events, and morbidity, especially in chronic obstructive pulmonary disease patients. Medically compromised dentate patients admitted in intensive care units owing to their inability to maintain oral hygiene properly have increased propensity of acquiring respiratory infections. The present review focuses on emphasizing the relationship between periodontitis and pulmonary diseases with the available published literature utilizing PubMed and Google Scholar databases in the last four decades.

Cigarette smoke (CS) is the main cause of chronic obstructive pulmonary disease (COPD), and continuous CS exposure causes lung inflammation and deterioration. To investigate the protective effects of Artemisia gmelinii against lung inflammation in this study, cigarette smoke extract (CSE)/lipopolysaccharide (LPS)-treated alveolar macrophages (AMs) and mice stimulated with CSE/porcine pancreas elastase (PPE) were used. Artemisia gmelinii ethanol extract (AGE) was effective in decreasing the levels of cytokines, chemokine, inducible nitric oxide synthase, and cyclooxygenase-2 by inhibiting mitogen-activated protein (MAP) kinases/nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway in AMs. Additionally, oral administration of AGE suppressed inflammatory cells’ infiltration and secretion of inflammatory cytokines, chemokines, matrix metallopeptidase 9, and neutrophil extracellular traps in bronchoalveolar lavage fluid from the COPD model. Moreover, the obstruction of small airways, the destruction of the lung parenchyma, and expression of IL-6, TNF-α, IL-1β, and MIP-2 were suppressed by inhibiting NF-κB activation in the lung tissues of the AGE group. These effects are associated with scopolin, chlorogenic acid, hyperoside, 3,4-di-O-caffeoylquinic acid, 3,5-di-O-caffeoylquinic acid, and 4,5-di-O-caffeoylquinic acid, which are the main components of AGE. These data demonstrate the mitigation effect of AGE on lung inflammation via inhibition of MAPK and NF-κB pathways, suggesting that AGE may be instrumental in improving respiratory and lung health.

Introduction. Chronic obstructive pulmonary disease (COPD) was associated with polycythemia as a result of respiratory failure and regarded as a compensatory response of erythropoiesis to chronic hypoxia for a long time. Recent epidemiological studies have shown that anemia is observed in 17.0-24.0 % of patients with COPD and only 6.0-10.0 % of such patients have polycythemia Aim. To find out the clinical and functional features of COPD course, depending on the red branch of blood and content of soluble transferrin receptors (sTFR). Materials and methods. The study enrolled 202 patients aged >40 years with COPD who have signed the consent to participate in the study. The exclusion criteria were: severe concomitant diseases (pulmonary tuberculosis, oncopathology, alcohol and/or drug addiction, AIDS, heart failure – class ІІВ stage III, and decompensated liver failure, kidney failure, or other failures); defined source of bleeding (complications of peptic ulcer, nonspecific ulcerative colitis, chronic hemorrhoids, etc.); diagnosed true anemias (megaloblastic, aplastic, hemolytic); use of angiotensin-converting enzyme inhibitors; pregnancy or lactation; chronic administration of systemic corticosteroids. All examined patients underwent the general clinical, laboratory and instrumental examination. The degree of obstruction and severity of the disease were determined in accordance with GOLD (2014) recommendations: the degree of obstruction was determined by computer spirography (FEVp detected 15 minutes after inhalation of 400.0 mcg of salbutamol), the severity of dyspnea was determined by the modified Medical Research Council (mMRC), and quality of life was determined by COPD Assessment Test (CAT). Patients with COPD were divided into 4 study groups depending on the hemogram parameters and sTFR: 1 group included 144 patients without anemia, 2 group – 33 with anemia of chronic disease (ACD), 3 group – 12 with erythrocytosis, and 4 group – 13 with iron deficiency anemia (IDA). Statistical analysis of the results was performed using SPSS-21 program. Results. As a result of the detailed analysis of the anamnesis, objective examination and laboratory results in patients from group 4, the cause of IDA was established, namely, 5 patients were diagnosed with chronic non-atrophic gastritis, 4 had chronic gastroduodenitis, 2 had peptic ulcer of stomach, 1 had peptic ulcer of duodenum, and in 1 – chronic gastroduodenitis and chronic pancreatitis with exocrine insufficiency. It has been found that ACD is present in patients with COPD II – IV stage of obstruction and is not observe among COPD patients with degree I obstruction. It is established that the frequency of ACD increases according to the degree of obstruction and the severity of the disease. Patients with COPD with ACD and IDA had significantly lower levels of FEVj compared to patients without anemia and erythrocytosis. It was revealed that patients with COPD with ACD and COPD with IDA had a higher rate according to CAT and, lower quality of life compared with patients without anemia and erythrocytosis accordingly. As a result of the correlation analysis, it was found that there is negative correlation between the degree of obstruction and the results of mMRC (r = – 0.591; p = 0.001) and CAT (r = – 0.608; p = 0.001). Consequently, dyspnea significantly increases and the quality of life decreases in the patients with COPD and ACD with the increase of the degree of obstruction. The frequency of exacerbations was higher in patients with COPD and ACD compared with other groups. Conclusions. Anemia is detected in 22.7 % of patients with COPD, specifically, IDA – in 6.4 % of patients, and ACD – in 16.3 %. The frequency of ACH increases with the degree of obstruction and the severity of COPD. Patients with COPD with anemia (ACD or IDA) have significantly lower levels of FEVP dyspnea and quality of life are significantly worsened with the increase of the obstruction degree in patients with COPD and ACD. The frequency of exacerbations was higher in patients with COPD and ACD.