Asthma Attacks Research Articles

Volatile organic compounds in regular and organic vaping liquids: a public health concern

AbstractElectronic cigarettes (e-cigarettes) are a growing public health concern. Vaping liquids used in e-cigarettes emit a range of chemicals, including potentially hazardous volatile organic compounds (VOCs). Exposure to VOCs is associated with adverse effects including asthma attacks, neurological disorders, and increased risk of cancer. This study investigated the VOCs emitted into the headspace of a gas chromatograph/mass spectrometer from e-cigarette vaping liquids, identified potentially hazardous compounds, and compared emissions between regular and organic versions. Vaping liquids (n = 25) were randomly selected from the market and analysed for their volatile emissions using headspace gas chromatography/mass spectrometry. The products were available for sale in the US, Australia, and New Zealand, and included regular (flavoured and flavourless) and organic (flavoured) versions. Results revealed that the vaping liquids collectively emitted 162 VOCs with 47 classified as potentially hazardous. Notably, all of the flavoured vaping liquids (regular and organic) emitted one or more VOCs classified as potentially hazardous. Further, among the 47 VOC occurrences classified as potentially hazardous, none were listed on any vaping liquid label or related product website. We found no significant difference in VOCs emitted between the regular (flavoured) and organic (flavoured) vaping liquids, and 40% of the hazardous VOCs detected were the same among these regular and organic versions. This study adds to the growing body of evidence that vaping liquids are a source of exposure to numerous volatile compounds, including potentially hazardous VOCs such as benzene, toluene and xylene. Moreover, the long-term health effects of vaping liquids are not well understood, highlighting the need for improved information on ingredients and health risks.

A study on physicians' knowledge and practices of asthma managementin Angola.

Asthma is the most common chronic non-communicable disease in children and one of the most common in adults, and the majority of asthma-related deaths are attributed to middle- and low-income countries. Physicians' knowledge and practice have been recognized as fundamental elements in the approach to the asthmatic patient with an impact on the treatment and control of the disease. This study aimed to assess the knowledge and practice of Angolan physicians in the management of asthma, as well as to identify the main gaps. It was a cross-sectional study carried out in Angola. The data were collected through an online questionnaire to assess the knowledge about asthma among the physicians and the Physicians Practice Assessment Questionnaire. Categorical variables were described with frequencies and percentages. All associations between good practice and possible predictors were established with logistic regression analysis. P<0.05 was considered statistically significant. A total of 204 physicians throughout Angola participated; the majority of whom were female, aged -between 31 and 40, and from the Luanda province. The average percentage of correct answers for all domains was 65.8% (±SD11.1%). The lowest percentages were in the answers about the diagnosis, drugs, and the signs of an asthma attack. Out of the 204 participants, 81.9% of physicians confirmed seeing patients with asthma. The average percentage of them who reported practicing asthma management based on recommended guidelines was 59.8% (±SD27.8%). More than half of the physicians did not achieve that percentage. The lowest percentages of correct answers concerned assessment of the inhaler technique, provision of a written referral for asthma education, and use of the GINA guidelines to assess the patient's asthma control. Concerning the predictors of best practices, our results showed that being a physician of older age and with more work experience, as well as having the category of specialist were significant predictors of adherence to recommended practices for asthma management. The physicians' level of knowledge about asthma was moderate, but there are important practical gaps in asthma management regarding standard guidelines.

Изменения климата и лесные пожары как факторы риска здоровью (аналитический обзор)

Climate change in Russia contributes to an increase in the number of forest fires, especially in Siberia and the Far East, leading to the rise in the forest fire danger index. Increased air pollution, which is typical for a number of cities in these regions, is the reason for changes in population health due to the influx of significant volumes of smoke gases from forest fires into populated areas. Smoke from forest fires, consists of aerosols and gases and contains more than 40 pollutants. During fires, frequency of calls for emergency medical care for children tends to increase due to exacerbation of upper respiratory tract diseases, including laryngitis, pharyngitis and acute respiratory infections, as well as attacks of bronchial asthma, and longer exacerbation periods of this disease. Such respiratory dysfunctions appear a few days after fires, which should be taken into account when organizing health monitoring in such situations. Among adult population, an increase in the number of deaths from cardiovascular and respiratory diseases has been proven during forest fires, and there tends to be an increase in the number of requests for medical care for COPD, bronchial asthma, myocardial infarction, coronary heart disease and other diseases. Fires in forest highlands in the Khabarovsk Krai result in deteriorating health of patients with neurological diseases. The generalization of the results obtained by domestic and foreign studies on this issue confirms the need to improve the air pollution monitoring system during forest fires with the determination of PM for timely preventive measures by health systems, Rospotrebnadzor, FMBA and other agencies. It also seems necessary to develop modeling of pollutant spread in ambient air in settlements exposed to them, with assessments of population health risks and development of preventive measures. Given the relevance of these studies, it is advisable to hold seminars with BRICS countries within the framework of international cooperation.

Climate change and forest fires as health risk factors (Analytical review)

Climate change in Russia contributes to an increase in the number of forest fires, especially in Siberia and the Far East, leading to the rise in the forest fire danger index. Increased air pollution, which is typical for a number of cities in these regions, is the reason for changes in population health due to the influx of significant volumes of smoke gases from forest fires into populated areas. Smoke from forest fires, consists of aerosols and gases and contains more than 40 pollutants. During fires, frequency of calls for emergency medical care for children tends to increase due to exacerbation of upper respiratory tract diseases, including laryngitis, pharyngitis and acute respiratory infections, as well as attacks of bronchial asthma, and longer exacerbation periods of this disease. Such respiratory dysfunctions appear a few days after fires, which should be taken into account when organizing health monitoring in such situations. Among adult population, an increase in the number of deaths from cardiovascular and respiratory diseases has been proven during forest fires, and there tends to be an increase in the number of requests for medical care for COPD, bronchial asthma, myocardial infarction, coronary heart disease and other diseases. Fires in forest highlands in the Khabarovsk Krai result in deteriorating health of patients with neurological diseases. The generalization of the results obtained by domestic and foreign studies on this issue confirms the need to improve the air pollution monitoring system during forest fires with the determination of PM for timely preventive measures by health systems, Rospotrebnadzor, FMBA and other agencies. It also seems necessary to develop modeling of pollutant spread in ambient air in settlements exposed to them, with assessments of population health risks and development of preventive measures. Given the relevance of these studies, it is advisable to hold seminars with BRICS countries within the framework of international cooperation.

The Effect of Mask Use on Seasonal Virus Diversity in SARS CoV-2 Negative Patients Treated as Inpatients During the 2021-2022 and 2022-2023 Seasonal Flu Period.

The study aimed to explore the protective effect of mask use against respiratory tract viral agents during the pandemic. The study included patients with a COVID-19 negative test who were hospitalized in the pulmonary disease clinic with the diagnoses of asthma attack, chronic obstructive pulmonary disease (COPD) exacerbation, and pneumonia in two periods: during mandatory mask use (October 2021 - May 2022) and after the mask mandate was lifted (October 2022 - May 2023). Combined nose and throat swab samples taken from the patients were evaluated for viral agents by using the PCR test method. Viral agents isolated from the patients in the two periods were compared based on hospitalization diagnoses and periods. The study enrolled 1,335 patients, 483 female and 852 male. It was found that viral agents significantly increased during the period without a mask mandate compared to the period when the mask mandate was in effect (41.6% vs. 23.4%) (p < 0.001). During the period without mask mandate, influenza A, H1N1, and RSV/AB viruses significantly increased (p = 0.019, p = 0.003, p < 0.001, respectively). Our results indicated that mask use during the pandemic is protective against the transmission of respiratory tract viruses. Thus, it can be concluded that mask use is important not only in the coronavirus pandemic but also especially in influenza and RSV epidemics.

Impact of short-term exposure to ambient air pollutants and meteorological factors on COVID-19 incidence and mortality: A retrospective study from Dammam, Saudi Arabia

The symptoms of COVID-19 included fever with or without respiratory syndrome, but patients subsequently developed pulmonary abnormalities. Exposure to air pollution, meanwhile, is associated with complications such as acute respiratory inflammations, asthma attack, and deaths from cardiorespiratory disease. To analyze the association of the air quality index (AQI), ambient air pollutants (PM10, SO2 and O3) and meteorological parameters (temperature and relative humidity [RH]) with COVID-19 incidence and mortality, a retrospective study was conducted to examine COVID-19 infection, meteorological parameters, ambient air quality and ambient air pollutants in Dammam from 1 January to 30 April 2021. Data of COVID-19 incidence and mortality for Dammam were retrieved from Saudi Arabia Ministry of Health's publicly accessible database. Meteorological data, AQI and average PM10, SO2 and O3 values were extracted from the publicly available website of Ministry of Environment, Water and Agriculture. The correlation of COVID-19 incidence and mortality with the independent variables was analysed by Pearson's correlation test or Spearman's rho test as applicable, and a p-value less than 0.05 was considered significant. COVID-19 incidence exhibited a positive correlation with temperature (r = 0.537, p = .0001) and a negative correlation with RH (r=−0.487, p=.0001). No correlation was observed between the meteorological variables and COVID-19 mortality. COVID-19 incidence showed a positive correlation with AQI (r=0.269, p=.015) and with the ambient air pollutants SO2 and O3 (r=0.258, p=.018), and COVID-19 mortality showed a positive correlation with PM10 (rs = 0.344, p=.002). Short-term exposure to O3, SO2 and higher temperature had direct relationship with COVID-19 incidence, while RH had inverse relationship. PM10 is positively associated with COVID-19 mortality.

Catalase: A Potential Pharmacologic Target for Hydrogen Peroxide in the Treatment of COVID-19.

This manuscript is a meta-analysis performed according to PRISMA guidelines. It shows that acute respiratory distress syndrome in COVID-19 complicated by airway obstruction with sputum and mucus, as well as cases of asphyxia with blood, serous fluid, pus, or meconium, can sometimes cause hypoxemia because the medical standard does not include intrapulmonary solutions that release oxygen. One promising avenue for finding and developing the necessary drugs may be the physical-chemical repurposing of hydrogen peroxide solution from antiseptics into inhaled and intrapulmonary mucolytics, pyolytics, and oxygen-releasing antihypoxants by replacing the acidic properties of hydrogen peroxide with alkaline properties. The fact is that an alkaline hydrogen peroxide solution liquefies said biological masses through alkaline saponification of lipid and protein-lipid complexes and simultaneously "blasts" the masses through catalase cleavage of hydrogen peroxide into water and oxygen gas, since these masses are rich in catalase. The results of the first experiments show that inhalation and intrapulmonary injections of alkaline hydrogen peroxide solutions can significantly optimize the treatment of suffocation and hypoxemia. Value of the data: 1. Why are these data useful? These data provide a new perspective way for intrapulmonary drugs and new technologies for the emergency increase of blood oxygenation through the lungs in asphyxia with thick sputum, mucus, pus, meconium and blood. 2. Who can benefit from these data? New drug developers, drug manufacturers, medical professionals providing emergency medical care, as well as pulmonologists, physiatrists, obstetricians and gynecologists can benefit from the data presented in this article. 3. How can these data be used/reused for further insights or development of experiments? These data can be used to develop new drugs and new technologies for the treatment of suffocation and hypoxia in the final stage of COVID-19, severe asthma attacks, purulent obstructive bronchitis, blood asphyxia in cancer and wounded lung in intensive care and anesthesiology departments. In addition, these data can be used to modernize expectorant, mucolytic, pyolytic, hemolytic and meconiolytic and expand the arsenal of intrapulmonary drugs.

Enhancing Asthma Self-Management with Environmental Passive-Monitoring Data and Machine Learning-Based Predictions.

Monitoring enables timely action which is critical in avoiding asthma attacks. With the abundance of local weather and pollution data, when augmented with machine learning, it is becoming possible to replace traditional tedious active monitoring in certain instances for some groups of patients. This analysis on the AAMOS-00 dataset, with 22 severe asthma patients, compared the performance of XGBoost to predict worsening asthma conditions using either passive or active monitoring on two groups of patients: individuals who were and were not triggered by outdoor environmental factors. On patients triggered by environmental factors, the performances of the passive- and the active-monitoring models were close to matching (passive: AUC = 0.83, 2.9-fold increase in precision; active: AUC = 0.89, 3.1-fold increase in precision). On the other hand, the active-monitoring model was significantly superior for patients not triggered by environmental factors (passive: AUC = 0.52, 1.2-fold increase in precision; active: AUC = 0.83, 3.7-fold increase in precision). Robustness evaluation showed it was possible to have good predictions of asthma attacks in the coming 5 to 7 days using 5 to 28 days of data.

Treating severe paediatric asthma with mepolizumab or omalizumab: a protocol for the TREAT randomised non-inferiority trial

IntroductionA minority of school-aged children with asthma have persistent poor control and experience frequent asthma attacks despite maximal prescribed maintenance therapy. These children have higher morbidity and risk of death....

Effects of benralizumab in patients with severe eosinophilic asthma (SEA): A plain language summary of the ANANKE study.

This summary outlines the findings from the ANANKE study on the treatment of patients with severe eosinophilic asthma (SEA) with benralizumab. SEA is an inflammatory disease of the lungs caused by eosinophils. Patients with SEA may experience asthma attacks (exacerbations) and decreased ability to breathe (lung function) despite taking medications. Benralizumab (Fasenra®) is a biologic therapy (a medicine produced using living cells) approved for the treatment of SEA.The ANANKE study was conducted in Italy and evaluated the characteristics of patients with SEA who received benralizumab as prescribed by their doctors. It also described the effects of benralizumab on participants in terms of frequency of exacerbations, lung function and overall control of asthma, and their need to take oral corticosteroids (OCS) to control symptoms. The effects of benralizumab have been observed in participants treated for: 1) an average of 10.3months, and 2) up to 96weeks (approximately 2years). The effects were also compared between different groups: 1) participants with chronic rhinosinusitis with nasal polyps (CRSwNP) and those without, and 2) participants who received other biologics before benralizumab (bio-experienced) and those who started with benralizumab as their first biologic (naïve). CRSwNP is an inflammatory condition that makes breathing even more difficult. Before receiving benralizumab, participants showed a high blood eosinophil count (the number of eosinophils in the bloodstream), frequent exacerbations, insufficient lung function, and poor disease control (symptom management). After 96weeks, benralizumab almost eliminated exacerbations, improved lung function, reduced the use of OCS, and increased the control of SEA symptoms while lowering blood eosinophil count. Comparable effects were observed between participants with and without CRSwNP and between naïve and bio-experienced participants. The ANANKE study showed that participants had frequent exacerbations and were characterized by eosinophilic inflammation before starting benralizumab. Overall, benralizumab improved the control of the disease for up to 2years and induced similar beneficial effects regardless of the presence of CRSwNP and the use of previous biologics. These findings highlight the long-lasting and broad action of benralizumab.Clinical Trial Registration: NCT04272463 (ANANKE) (ClinicalTrials.gov).

The temporal-spatial association of respiratory manifestations and air pollution in children referred to the Emergency Department of Akbar Children’s Hospital, Mashhad, Iran

BackgroundAir pollution causes many respiratory disorders, especially in children and the elderly. These disorders include asthma exacerbations, bronchiolitis, and pneumonia. Research on the association between air pollution and respiratory disorders helps to reevaluate environmental policies in developing countries.MethodsThis descriptive cross-sectional study was conducted on 932 children with respiratory manifestations admitted from December 2017 to December 2019 at the Emergency Department of Akbar Children’s Hospital of Mashhad University of Medical Sciences, Mashhad, Iran. Air pollution indices such as concentration of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matter (PM) smaller than 2.5 and 10 μm and other parameters, including the air quality index (AQI), air temperature, and humidity level from 2017 to 2019, were retrieved from Mashhad Environmental Pollution Monitoring Center. Demographic and clinical data of patients were collected from patients’ hospital documents. We used descriptive analytical methods such as central tendency, variability, and frequency distribution to report and analyze demographic and clinical data through tables and diagrams. The association between air pollution indices and respiratory manifestations was examined by the Spearman correlation test. The correlation between the AQI and total hospital admissions and asthma-related hospital admissions was also evaluated by the Spearman correlation test.ResultsHospital admissions due to respiratory manifestations were not associated with the AQI of each month (p-value = 0.794). The concentration of SO2 was correlated with respiratory-related hospital admissions (correlation coefficient = 0.487, p-value = 0.016) but not asthma attacks.ConclusionGenerally, our cross-sectional study showed no statistically considerable association between air pollution and hospital admissions due to respiratory manifestations and asthma attacks in children. Of the air pollution indices, only SO2 concentration was associated with respiratory-related hospital admissions but not asthma attacks.

Air Quality Analysis through IoT Device and Risk Prediction of Asthma Attack using ML Techniques

Background: The air quality of any area depends upon the various PMs (particulate matter) and hazardous gases present in the air. Low-cost PM sensors and gas sensors are present in different target places to monitor the air quality, read the environmental data, and transmit it to local servers through the IoT device. The low-cost sensor is not reliable due to its low sensing capacity; therefore, the read data is calibrated with the meteorological data presented by the nearby meteorological Centre of that particular area. The calibrated reading data sent to the server could be analyzed through some Machine Learning [ML] models. The ML models help to predict the risk of asthma in a particular area. The risk of asthma is directly related to the air quality of the surroundings. It is observed that the air quality of the industrial area is much worse than the non-industrial belt. Air quality monitoring of industrial areas is always a challenging task due to the ununiformed pollution in some segregated places around the industry, emitting pollutants mostly from chimneys. The air quality of any area depends upon the PM (PM), i.e., PM2.5 and PM10.0, as well as the gasses like NO2(Nitrogen Dioxide), NH3 (Ammonia), SO2(Sulfur dioxide), CO(Carbon monoxide), O3(Ozone) and Benzene. These are the most hazardous gases generally emitted by common heavy industries like iron and steel. In this article, the researchers considered the industrial belt of the Asansol- Durgapur region of West Bengal, India, and predicted the risk of asthma attacks for the test dataset. The experiment was carried out on 10 different supervised machine learning [SML] models as well as semi-supervised machine learning (SSML) models. The SML models have been further refined through hyper-parameter tuning, and better results have been obtained in the case of some ML models. The result has been compared with the existing literature considering the same external environment from where the meteorological data was collected, and similar ML models have been used. The research outperformed the existing literature, which is depicted in the result and analysis section of the article. Methods: The study evaluated ML models, both supervised and semi-supervised, to assess pollution levels. Relevant features were selected while less relevant ones were discarded. Accuracy levels of different ML algorithms werecompared in the results. The most effective model for an IoT system was chosen to maximize accuracy. In semi-supervised learning, feature selection followed supervised learning, but testing was akin to unsupervised learning. Results were compared with supervised learning data, enhancing reliability. Results: The result employing various classifiers werepresented across tables after the independent parameter Ozone was removed. Following the output of several classifiers, the results were verified using the k-fold validation method, with k being set to 5 or 10, accordingly. Tables display the best outcome, which is indicated in bold characters. method: In this research work the researcher considered 9 different ML models and used them as supervised as well as semi supervised model to determine the pollution level of the certain area. In this research work the researcher also selected the most relevant features and discarded the less relevant features. In case of SML algorithm, the accuracy level of the different ML algorithm has been determined and depicted in the result analysis section. The most effective ML model has been chosen for the proposed embedded system so that accuracy could be achieved at most. In case of semi supervised algorithm the feature selection is done as per the supervised algorithm. In this case the training is done same as the SML algorithm, but the testing phase is done like unsupervised machine learning algorithm where the decision parameter is predicted and ultimately matched with the previously achieved data of SML algorithm. The reliability of this approach is much more effective than simple SML algorithm. Conclusion: This study focused on predicting asthma risk in the Asansol-Durgapur industrial belt, India, using low-cost PM and gas sensors. Data calibration with meteorological inputs enhanced accuracy. ML models predicted risk and were refined through hyper-parameter tuning. Comparative analysis showed superior performance, emphasizing the importance of precise air quality monitoring. While offering a robust framework for future research, the study’s limitation lies in its area-specific dataset.

Direct and indirect costs of paediatric asthma in the UK: a cost analysis

ObjectiveTo estimate the cost of paediatric asthma from a UK National Health Service (NHS) and societal perspective and explore determinants of these costs.DesignCost analysis based on data from a large...

Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK)

BackgroundAsthma is a leading cause of children’s hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention — now termed “Better Asthma Control for Kids (BACK)" — with tailoring to regional priorities, needs and resources.MethodsIn this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates (“attacks”) and improved asthma control as compared to usual care.DiscussionWe expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state – the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities.Trial registrationClinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06003569.

Small airway dysfunction links asthma exacerbations with asthma control and health-related quality of life

BackgroundSmall airway dysfunction not only affects asthma control, but also has adverse effects on the psychological and/or social activities of asthma patients. However, few long-term observational studies have explored the complex relationship between small airway dysfunction and asthma control and health-related quality of life in patients with asthma exacerbations.MethodsThe study recruited 223 patients with exacerbations of asthma (i.e. those with at least one asthma attack over the past year) and 228 patients without exacerbations of asthma (i.e. those without asthma attacks over the past year). We evaluated SAD in patients with asthma exacerbations using impulse oscillometry method. At each evaluation time point within one year of follow-up, the attending physician conducts a case investigation of the patients. We analyzed the correlation between SAD and general characteristics (age, obesity, smoking history), type 2 inflammation (blood eosinophils, exhaled nitric oxide), FEV1, as well as asthma control (ACT) and health-related quality of life (mini-AQLQ) in patients with asthma exacerbations, and constructed a structural equation model to evaluate the causality of these clinical variables.ResultsThe SAD prevalence in patients with asthma exacerbation is as high as 75%. SAD is connected with poor asthma control and poor health-related quality of life. The structural equation model indicates that age, obesity, FeNO, and FEV1 are independent predictive factors of SAD. SAD is the main determinant factor of asthma control, which in turn affected health-related quality of life. FEV1 and age directly affect asthma control and affect health-related quality of life through asthma control. In addition, there is a bidirectional relationship between FEV1 and small airway dysfunction and between asthma control and health-related quality of life.ConclusionsSmall airways are involved from an early stage in asthma. Abnormal function of the small airways can significantly increase airway resistance in asthma patients, while worsening their clinical symptoms. In addition, aging is also a key risk factor for asthma control. Especially, small airway dysfunction links asthma control with health-related quality of life.

Longitudinal association of exclusive and dual use of cigarettes and cigars with asthma exacerbation among US adults: a cohort study

BackgroundCigar use among adults in the United States has remained relatively stable in the past decade and occupies a growing part of the tobacco marketplace as cigarette use has declined. While studies have established the detrimental respiratory health effects of cigarette use, the effects of cigar use need further characterization. In this study, we evaluate the prospective association between cigar use, with or without cigarettes, and asthma exacerbation.MethodsWe used data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study to run generalized estimating equation models examining the association between time-varying, one-wave-lagged cigarette and cigar use and self-reported asthma exacerbation among US adults (18+). We defined our exposure as non-established (reference), former, exclusive cigarette, exclusive cigar, and dual use. We defined an asthma exacerbation event as a reported asthma attack in the past 12 months necessitating oral or injected steroid medication or asthma symptoms disrupting sleep at least once a week in the past 30 days. We adjusted for age, sex, race and ethnicity, household income, health insurance, established electronic nicotine delivery systems use, cigarette pack-years, secondhand smoke exposure, obesity, and baseline asthma exacerbation.ResultsExclusive cigarette use (incidence rate ratio (IRR): 1.26, 95% confidence interval (CI): 1.03–1.54) and dual use (IRR: 1.41, 95% CI: 1.08–1.85) were associated with a higher rate of asthma exacerbation compared to non-established use, while former use (IRR: 1.01, 95% CI: 0.80–1.28) and exclusive cigar use (IRR: 0.70, 95% CI: 0.42–1.17) were not.ConclusionWe found no association between exclusive cigar use and self-reported asthma exacerbation. However, exclusive cigarette use and dual cigarette and cigar use were associated with higher incidence rates of self-reported asthma exacerbation compared to non-established use. Studies should evaluate strategies to improve cigarette and cigar smoking cessation among adults with asthma who continue to smoke.

High-altitude speleotherapy in the treatment of bronchial asthma

The present study concerns clinical effects of speleotherapy in bronchial asthma. The aim of our work was to study the efficiency of speleotherapy in a group of patients with bronchial asthma. We observed a group of 51 patients with bronchial asthma (BA) aged 18 to 50 years, who received a course of treatment at the private center “Solevik” (Yakutsk City), carried out at the Department of Allergology and Immunology. All the examined patients were diagnosed with atopic bronchial asthma, of moderate severity. Basic therapy in all cases included Symbicort and Seretide treatment. The patients were managed and monitored before and after the course of treatment by a therapist, pulmonologist and allergologist-immunologist at the outpatient center. Laboratory parameters included general blood tests and the levels of total serum IgE. Examination of patients after a course of speleotherapy revealed disappearance and reduction of asthma attacks (up to 1 attack per month) in 80% of the examined. General blood testing before and after speleotherapy showed decreased levels of blood eosinophils after the course of treatment. I.e., the average initial level of blood eosinophils before treatment was 12±0.4%, being decreased after the course of speleotherapy to 5.5±0.2%. Measurements of total IgE before and after speleotherapy revealed the following results: in patients before therapy, the average level of this index was 500±0.8 units/mL. After a course of speleotherapy, this parameter decreased to 80±0.3 units/ mL. Speleotherapy shows a positive effect on the clinical course of the patients with bronchial asthma and significantly increases the efficiency of treatment.

A Review of the Latest Guidelines for Diagnosing and Managing Asthma in Children in the United States and Canada.

Globally, asthma remains the most widespread chronic respiratory condition in children, with a larger proportion of children being affected by the condition. Regardless of the higher prevalence rates, the outcomes of pediatric asthma have remained inadequate, even as there are numerous preventable deaths (approximately 300 children in the United States and 250 children in Canada, annually). The characteristic symptoms of pediatric asthma include wheezing, cough, and shortness of breath that are characteristically triggered by several potential stimuli. However, several diagnostic challenges exist and have resulted in either overdiagnosis or underdiagnosis, making pediatric asthma diagnosis and management problematic. Effective management of asthma in children entails a holistic approach that encompasses non-pharmacological and pharmacological management, alongside self-management and educational aspects. Working with pediatric asthma patients and their families/caregivers is vital to promoting and realizing better asthma diagnosis and management outcomes. Educational guidelines regarding the best ways for effective treatment, avoidance of triggers, modifiable risk factors, and the actions that should be taken during chronic asthma attacks through individualized action plans are vital. Thus, the objective of this systematic review is to provide an overview of the latest guidelines on pediatric asthma diagnosis and management. In this regard, this review presents several similarities in existing pediatric asthma diagnosis and management guidelines in the United States and Canada. For instance, most guidelines and studies reviewed have proposed the use of objective tests for confirmation of asthma diagnosis, particularly in symptomatic individuals. The peak flow variability measurement, bronchodilator reversibility testing, and spirometry have also been proposed by the guidelines and studies, even as the recommendations regarding the timing and hierarchy of the objective test substantially vary between the guidelines and studies. We hope that the present review will be helpful to physicians and healthcare service providers working within pediatric health contexts.

Organophosphate insecticide exposure and respiratory symptoms among school children in Northern Thailand: Interaction by biomass burning, dampness and season

The aim was to study associations between dialkylphosphates (DAPs), organophosphate (OP) metabolites in urine, biomarkers of OP insecticide exposure, and respiratory symptoms among children in upper northern Thailand. We recruited junior high school children in randomly selected schools in four cities (N = 337), with repeated data collection in wet and dry seasons. Urine was collected and analyzed for six OP metabolites, with creatinine adjustment. Total DAP was expressed as sum of DAPs. Data on respiratory symptoms was collected by a standardized questionnaire. Associations were analyzed by multiple logistic regression. Totally 11.3 % lived in farm families. Total DAPs concentration was higher in dry season (p = 0.002) but did not differ between farm and non-farm children. Total DAPs in wet season was associated with current wheeze (p = 0.019), current asthma attacks (p = 0.012) and attacks of breathlessness in last 12 months (p = 0.021). Total DAPs in dry season was associated with current wheeze (p = 0.042), and associations between DAPs and respiratory symptoms were stronger for dimethylphosphate metabolites (DMPs) than for diethylphosphate metabolites (DEPs). DMPs are produced by certain OP pesticides. Biomass burning inside or outside the home, and dampness or mold at home, enhanced the association between total DAPs and attacks of breathlessness.In conclusion, OP pesticide exposure, measured as urinary DAPs, was higher in dry season and similar in farm and non-farm children. OPs exposure, especially to DMP related pesticides, can increase asthmatic symptoms, especially in wet season. Combined exposure to OP and smoke from biomass burning, or dampness and mold, can further increase the prevalence of attacks of breathlessness. There is a need to reduce OP insecticide and biomass smoke exposure among Thai children. Since different pesticides can be used in different seasons, studies on respiratory health effects of OPs pesticide exposure should be done in different seasons.

The Status of Asthma in the United States.

Asthma imposes a substantial health and economic burden on patients and their families and on the health care system. An assessment of the status of asthma in the US may lead to effective strategies to improve health and quality of life among people with asthma. The objective of our study was to assess the historical trends and current state of asthma illness and death among children and adults in the US. We assessed asthma-related emergency department visits and hospitalizations among children and adults by using data from the 2010-2021 National Health Interview Survey (NHIS), the 2010-2020 Nationwide Emergency Department Sample (NEDS), the National (Nationwide) Inpatient Sample (NIS), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ). Asthma death rates were calculated by using 2010-2021 National Vital Statistics System data. Asthma prevalence increased significantly among adults from 2013 through 2021 (P = .04 for the annual percentage change [APC] slope) and decreased among children from 2010 through 2021 (P values for slopes: 2010-2017, P = .03; 2017-2021, P = .03). Prevalence of current asthma was higher among non-Hispanic Black people (children, 12.5%; adjusted prevalence ratio [APR] = 2.19; 95% CI, 1.68-2.84 and adults, 10.6%; APR = 1.25; 95% CI, 1.09-1.43) compared with non-Hispanic White people (children, 5.7%; adults, 8.2%). Prevalence of asthma attacks and use of asthma-related health care declined among adults and children. Asthma prevalence and asthma-related emergency department visits, hospitalization, and death rates differed by select characteristics. Although asthma attacks, ED visits, hospitalizations, and deaths have declined since 2010 among all ages, current asthma prevalence declined only among children, and significant disparities in health and health care use still exist.