Asthma Attacks Research Articles

Effectiveness of household-level interventions for reducing the impact of air pollution on health outcomes – a systematic review

Background and aimSeveral air pollution mitigation initiatives have been researched worldwide to see how efficient they are at reducing air pollution and the related health benefits. The effectiveness of these interventions for improving health outcomes is key for scaling up and increasing uptake of same by policymakers and people. We aimed to synthesize scientific evidence about the effectiveness of household-level interventions on air quality and health outcomes using a systematic approach.MethodsComprehensive strategy was used to carry out a literature search in PubMed, Cochrane, and Google scholar by two independent investigators using keywords and Medical Subject Heading terms. Research articles published till the year 2021 focusing on interventions for improvement in air quality and health were selected using pre-specified eligibility criteria. All abstracts for inclusion were reviewed independently by two reviewers. In case of doubt, the articles were included for full-text review. Disagreements were resolved by discussion with the third investigator. The quality of the studies and risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool and Cochrane Risk of Bias tool, version 2.0. Effect estimates were reported using odds ratio, relative risks, difference in mean, and percentage changes with 95% confidence intervals. PRISMA guidelines were used to conduct and report the systematic review. The review was registered in PROSPERO (CRD42022295393).ResultsThe search resulted in the identification of 46,809 studies and 18 of them were finally included in the review using eligibility criteria. The household-level interventions were categorized mainly into air purifiers/electric heater use, cookstove use, and behavioural change interventions. These interventions resulted in a decrease in the number of daytime asthma attacks by 33%, an increase in FEV1 by 4.4%, −1.4% and 0.8% overall percent change in microvascular and lung function. PM2.5 was the most commonly reported air pollutant, its concentrations reduced in the range between 31% and 53% across the studies.ConclusionOur review provided consistent evidence for the effectiveness of household-level interventions thus associated with improvements in cardiovascular and respiratory symptoms.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295393, identifier, CRD42022295393

A smartphone app for preschool wheezing and reliability of medical history collection

BackgroundThe use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews.MethodsChildren with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app.ResultsWe enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ‘’simple and intuitive’’ at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21–25) for the control group (42 patients) and 23 (21–24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24–25) and 24 (24–25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable.ConclusionsThe smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit.

The housing environment and its effect on Hispanic children with asthma

IntroductionSubstandard housing in Hispanic minority communities has been associated with detrimental effects on children with asthma that is affected by diverse indoor triggers. Identifying those triggers and offering adequate medical treatment and ways to prevent exposure to triggers will help reduce the number of asthma attacks among children who reside in Hispanic minority communities.ObjectiveOur study aimed to identify the influence of substandard housing quality and its effect on asthma symptoms. Our objectives included assessing the impact of building, flooring types, heating sources, window shading, parental smoking behaviors, moisture and mold in the home, ventilation, and owning a pet on asthma symptom occurrence.Materials and methodsOur study was based on a cross-sectional analytical study involving 353 individuals, their parents, and their homes. Logistic regression modeling was conducted to explain the dependence of each asthma symptom on the investigated independent variables, with child age and sex being investigated as covariables. A post hoc test was employed to ensure goodness of fit, and a pseudo-R square was calculated for each regression model. The Hosmer-Lemenshow test was performed post hoc to ensure goodness of fit, and models were preserved if p > 0.05.ResultsThe overall prevalence of asthma-related symptoms in our study sample was 19.37%, and sleeping quality was affected due to asthma in 23% of participating children. We also found that children living with asthma near agricultural fields were more prone to asthma-related symptoms, as well as those children living in homes with excessive moisture and those who kept stuffed toys or pets inside their rooms.ConclusionsOur study highlights how a variety of environmental factors, such as living near an agricultural area and having curtains, increases shortness of breath. Having leaks and excessive moisture in houses increases shortness of breath, wheezing, coughing, and rates of colds. Another important exposure is having a pet inside the house which increases chest tightness. A comprehensive understanding of these factors and how they impacted targeted participants, especially those who are Hispanic minorities and living in substandard housing, is essential for informing the design of effective interventions and improving respiratory health in the home environment.

Vitamin D supplementation decrease asthma exacerbations in children: a systematic review and meta-analysis of randomized controlled trials

Background Observational studies have linked low vitamin D (VD) levels to increased asthma attacks in children. Subsequent meta-analyses of adults and children revealed that VD treatment might benefit asthmatic patients by reducing the incidence of exacerbations. Therefore, this review aims to analyze the effects of VD supplementation in reducing asthma exacerbations in children. Methods Published reports from PubMed, Cochrane, and Google Scholar were systematically searched until April 2023. The study protocol was registered in the PROSPERO database CRD42023411796. Randomized controlled trial studies were included in this review. Meta-analysis was performed using Cochrane RevMan 5.1 and presented with 95% confidence intervals (CIs). Results Ten relevant studies enrolled 1243 asthmatic children (631 children receiving vitamin D3 supplementation, 612 children receiving placebo) were included in this review. Our pooled analysis found that VD supplementation had a significant effect on lowering the total number of asthma exacerbations (RR 0.62; 95% CI: 0.44, 0.87; p = 0.01). Subgroup analysis revealed that a daily dose of VD given based on standard daily dose recommendation had a significant improvement on asthma exacerbations [(RR 0.41; 95% CI: 0,18, 0,92; p = 0.03). Conclusions Vitamin D supplementation can lower the occurrence of exacerbations in children with asthma, along with the improvement of FEV1.

Clinical characteristics and factors associated with mucus plugs under bronchoscopy in children hospitalized for acute asthma attack.

To describe clinical characteristics of hospitalized children with acute asthma attacks complicated with mucus plugs and to investigate the factors associated with mucus plugs in asthma children. This retrospective study analyzed hospitalized children and adolescents with acute asthma attacks from January 2016 to December 2021. The demographic information and characteristics were collected. Subjects were categorized into the mucus plug group and the control group based on the bronchoalveolar lavage results. The Logistic regression analyses were utilized to assess the relative factors associated with mucus plugs. All data were analyzed using SPSS 22.0. This study included 242 individuals. Out of the 151 subjects who underwent bronchoscopy, 62.9% were classified in the mucus plug group and 37.1% in the control group. The subjects with dyspnea had a higher proportion in the mucus plug group (52.6% vs. 26.8%). The serum total IgE level of the mucus plug group was lower than the control group. The proportion of subjects who were diagnosed with asthma for the first time during hospitalization (87.4% vs. 76.8%) and combined with respiratory infection (91.6% vs. 82.1%) in the mucus plug group might be higher than that in the control group. More subjects in the mucus plug group were administered systemic glucocorticoid, magnesium sulfate, aminophylline, and mucolytic drugs after hospitalization. In multivariable analysis, diagnosed with asthma for the first time during hospitalization (OR = 4.404; 1.101-17.614), dyspnea (OR = 4.039; 1.306-12.496), and cesarean (OR = 0.274; 0.092-0.812) might be associated with mucus plug in children hospitalized for an acute asthma attack. While our retrospective study suggests that some clinical features of children hospitalized with asthma who have mucus plugs differ from those without, further studies are required.

Effects of oral montelukast on pulmonary function and clinical symptoms in acute asthma exacerbations: a randomized, double-blind, placebo-controlled trial

Introduction: Montelukast is a leukotriene receptor antagonist that helps treat chronic asthma and allergic rhinitis by reducing inflammation and bronchoconstriction. However, oral montelukast’s effectiveness in managing acute asthma attacks has yet to be completely identified. Methods: This randomized, double-blind, placebo-controlled trial investigated the efficacy of oral montelukast in acute exacerbations of asthma. Seventy patients between 18 and 65 years of age with a primary diagnosis of asthma attack were included in the study and were randomly assigned to receive 10 mg of montelukast orally daily or placebo. Symptoms, signs, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEFR) were evaluated. Results: Our findings showed a statistically significant difference between montelukast and placebo regarding FEV1 (78.05 ± 7.84 vs. 72.05 ± 12.00, P = 0.016), PEFR (322.86 ± 28.95 vs. 290.86 ± 44.21, P = 0.003), and wheezing (P = 0.022) on the fifth day of treatment. Additionally, FEV1 and PEFR values were compared in two subgroups of patients, ICS users (ICSU) and non-ICS users (NICSU), in both the montelukast and placebo groups. In the montelukast group, while PEFR improved significantly for day 5 in both the ICSU (P = 0.007) and NICSU (P = 0.027) subgroups, FEV1 only improved in the ICSU (P = 0.009) subgroup compared to placebo. Conclusion: The present study demonstrated that oral montelukast administered in acute asthma exacerbation could lead to better values of PEFR and FEV1 on pulmonary function and improvement of wheezing in terms of symptoms.

Fatigue in severe pediatric asthma patients: Results of the PANDA study.

Fatigue is a commonly reported clinical symptom, yet research on fatigue in children with severe asthma is missing. We aimed to explore the extent of fatigue in severe pediatric asthma and identify associated factors. This study was conducted within the Pediatric Asthma Non-Invasive Diagnostic Approaches (PANDA), an observational cohort of 6- to 17-year-old Dutch children with severe asthma. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL™-MFS) was used to measure self-reported fatigue. Fatigue levels were compared with a general pediatric Dutch population using linear regression, and quantifying the prevalence of "fatigued" (-2 < Standard deviations [SD] ≤ -1) and "severely fatigued" (SD ≤ -2) children. Secondly, we performed linear regression analyses to explore whether fatigue levels were independently associated with asthma attacks, comorbidities, medication, pulmonary function, symptom control, and asthma-related quality of life (QoL). Severe pediatric asthma patients (n = 78, mean age 11.8 ± 3.1 years) reported significantly more fatigue than Dutch peers (n = 328, mean age 11.8 ± 3.2 years) mean difference in z-score: -0.68; 95%CI -0.96, -0.40. In the severe asthma group, 28.2% scored as "fatigued" and 15.4% as "severely fatigued," compared with 14.0% and 3.4% in the general population. In pediatric asthma patients, asthma-related QoL (β = 0.77, p < .01, ΔR2 = .43), symptom control (β = 0.56, p < .01, ΔR2 = .24) and a dysfunctional breathing pattern (β = -0.36, p < .01, ΔR2 = .12) were most strongly associated with fatigue scores. Fatigue is a common symptom in children with severe asthma and is associated with multiple clinical factors and patient-reported outcomes. It should be considered as an important treatment target.

Antibiotic Therapy in Asthma as One of First Step Treatment, a Phase 3 Randomized Clinical Trial

Background: Focus of this study was on subjects suffering from new onset asthma, but actually, they may involve with an infection. Objectives: The target of this study was to determine the frequency of total control of asthma in new onset asthma. Methods: this is a phase 3 randomized clinical trial. The participants were 50 new onset asthma, who feel suffering from respiratory infection, however the physician diagnosis was asthma according to wheezy chest, spirometry and clear chest roentgenogram. Age less than 18 years and pregnant women were excluded. The subjects were randomly divided into two groups, doxycycline hyclate and the placebo arms. The drugs were repacked in similar in shape container. Primary endpoint was time to first recurrence. Secondary endpoints were frequency of total control of asthma, dyspnea, cough, asthma control test (ACT) score, FEV1, FEV1/FVC, eosinophil and neutrophil in blood and sputum. Results: The difference of clinical findings between two groups before the trial were not significant. Ten percent reported acute attack of asthma during last two months. Treatment with Doxycyline revealed significant improvement of clinical findings, asthma attack and ACT score after two months of treatment, however, complete resolution of clinical findings were significantly higher in Doxycyline group compare to placebo. Clinical findings and FEV1 percent predicted in Doxycyline group T2low asthma group showed significant improvement which were not depicted in T2high group. Eighteen months follow up of the subjects showed complete resolution of asthma symptoms in 12 (48%) on Doxycyline group, which was significantly higher than control group (5 (20%). Time to first exacerbation in doxycycline group was 13.6±5.64 months which was significantly longer than control group (7.49±6.95, P=0.002). Time to first exacerbation in CRP positive was significantly longer (13.64±5.35 months) than CRP negative subjects (9.67±7.76 months, P=0.02). Conclusion: Doxycycline is an effective antibiotic for preventing recurrence of asthma, in selected new subjects who suspicious for respiratory infection.

High ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 increases the risk of asthma attack in American asthma adults: a population study.

The relationship between vitamin D3 and asthma remains controversial. However, previous studies have largely overlooked the impact of epi-25-(OH)-vitamin D3. This study aims to investigate the effects of different forms of vitamin D3 on asthma attack in adults. In this cross-sectional study, a total of 3,873 eligible adult participants were extracted from the national health and nutrition examination survey (NHANES) database from 2007 to 2018. Based on quartiles method, different levels of vitamin D were divided into four groups (Quartile 1-4). Bivariate correlation analysis was performed for vitamin D and covariates to avoid multicollinearity. Multivariate logistic regression was used to investigate the association between serum levels of vitamin D3 (epi-25-(OH)-vitamin D3 and 25-(OH)-vitamin D3) and asthma attack, adjusting for covariates including age, gender, race, length of time in the U.S., house poverty income ratio (PIR), education level, smoking history, hypertension history, and diabetes history. The ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 was used for secondary analysis of its association with asthma attack. The outcomes were assessed by odds ratios (ORs) and 95% confidence intervals (CIs). Among the 3,873 eligible adults American with asthma, 1,508 (38.94%) had experienced at least one acute asthma attack in the past year. There was no significant correlation between vitamin D and covariates. After adjusting for covariates including age, gender, race, length of time in the U.S., house poverty income ratio (PIR), education level, smoking history, hypertension history and diabetes history, we found a positive correlation between the ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 and asthma attack. Additionally, a high ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 was more common among elder, male, of normal weight, non-Hispanic American, have a long time stay in the U.S., a high house PIR, and a history of hypertension individuals. Our findings suggest that attention should be given to asthma attack associated with a high ratio of epi-25-(OH)-vitamin D3 to 25-(OH)-vitamin D3 in American adults who are elderly, male, of normal weight, non-Hispanic Americans, have long-term residence in the U.S., a high house PIR, and a history of hypertension.

Improving Asthma Management through Iot-Based Telemedicine Spirometry in The Post-COVID-19 Era in Sidoarjo Tofu Making Community, Indonesia

Asthma is a chronic inflammatory disease of the airways that causes recurrent episodes of wheezing, shortness of breath, chest tightness and coughing. The partners in this study face the problem that tofu factories in their area use plastic waste as fuel, which can aggravate respiratory conditions. In addition, the partners need more knowledge about the clear signs of asthma attacks, asthma symptom control and risk factors for asthma patients. The solution provided through the Community Service Programme with the PKM (Student Creativity Programme) scheme is to measure lung volumes using an IoT-based telemedicine device, specifically a spirometry tool that can be used with an Android mobile phone. In addition, partners will receive support to improve their knowledge, skills and attitudes in the management of asthma exacerbations. The implementation method includes providing health education on asthma, clear signs of asthma attacks, asthma symptom control and risk factors for asthma patients, as well as self-management skills for asthma patients and efforts to monitor asthma signs and symptoms. Lung capacity is measured using a spirometry device connected to an Android mobile phone for direct measurement by health workers. The results of the community service show an increase in respondents' knowledge about asthma after a lecture intervention. This was tested using the Wilcoxon signed rank test, which showed a statistically significant increase in scores from pre-test to post-test. All changes were positive, indicating the effectiveness of the learning methods used. Spirometry measurements showed that the respondents' lungs were functioning well without significant airway obstruction, indicating that the intervention was successful in increasing knowledge about asthma and asthma control

BIOEQUIVALENCE STUDY OF GENERIC SALBUTAMOL TABLETS WITH LOGO AND BRANDED GENERIC

Salbutamol is a medication that stimulates beta receptors, particularly beta agonists, which are widely used as a remedy for sudden asthma attacks and those triggered by physical exercise due to its potent and rapid bronchodilating properties. These medications are known as short-acting beta-agonists (SABA). The purpose of this study was to examine in detail the significant differences in dissolution and absorption rates associated with the active ingredient in two pharmaceutically equivalent drug products, and to compare them to determine their bioequivalence. The research methodology involved experimental studies using a quantitative approach, including tests of physical quality, content determination, and dissolution testing. The results of the physical quality test for the uniformity of salbutamol tablet sizes showed that generic branded tablets, brand A, brand C, and brand D had a thickness of 0.10 cm ± 0 and a diameter of 0.50 cm ± 0, brand B had a thickness of 0.20 cm ± 0 and a diameter of 0.60 cm ± 0, and brand E had a thickness of 0.10 cm ± 0 and a diameter of 0.40 cm ± 0. The weight uniformity test results indicated that none of the generic branded tablets, brand B, or brand D deviated from columns A (7.5%) and B (15%), whereas none of the tablets from brands A, C, or E deviated from columns A (10%) and B (20%) ...

C-CBL/LCK/c-JUN/ETS1/CD28 axis restrains childhood asthma by suppressing Th2 differentiation

BackgroundAsthma is a common immune disease with high morbidity in children. Type 2 inflammation is the center of asthma development, and mainly mediated by a subset of CD4 + T cells, T helper 2 (Th2) cells. Excess Th2 differentiation was generally associated with asthmatic attack. Casitas B-lineage lymphoma (c-CBL) was reported to involved in T cell development and databank showed its decreased expression in CD4 + T cells from peripheral blood of asthmatic children. This study aims to investigate the role of c-CBL in childhood asthma and Th2 differentiation, and explore the underlying mechanism.MethodsWe collected peripheral blood samples from clinical childhood asthma cases and healthy controls, and determined c-CBL expression in CD4 + T cells. Asthma was induced in neonatal mice by ovalbumin (OVA) intraperitoneal injection and aerosol inhalation, and c-CBL expression in CD4 + T cells from peripheral blood and spleen was measured. Gain-of-function experiments was performed to confirm the effects of c-CBL on Th2 differentiation in vitro. Finally, c-CBL was delivered into asthmatic mice via lentivirus infection to verify its effects on experimental asthma.Resultsc-CBL was lowly expressed in CD4 + T cells from asthmatic children than those of healthy controls. Similarly, it was downregulated in CD4 + T cells from peripheral blood and spleen of asthma mice. Overexpression of c-CBL restrained lung pathological injury and type 2 inflammation in experimental asthmatic mice. Gain-of-function experiments demonstrated that c-CBL inhibited Th2 differentiation of CD4 + T cells from healthy children, and mediated the ubiquitination of lymphocyte cell-specific protein-tyrosine kinase (LCK). LCK acted as a kinase to phosphorylate and activate c-JUN, which was predicted to bind promoter sequence of CD28 by bioinformatic analysis. Dual-luciferase reporter assay verified that c-JUN and ETS1 synergically enhanced transcription of CD28, and this transcription activation was aggravated by LCK overexpression.Conclusionc-CBL alleviated asthma and suppressed Th2 differentiation by facilitating LCK ubiquitination, interrupting c-JUN activation and CD28 expression in vivo and in vitro. c-CBL/LCK/c-JUN/ETS1/CD28 axis was partially involved in childhood asthma, and may provide novel insights for clinical treatment for asthma.

Efficacy of medical education combined with extended care on adherence to inhaled glucocorticoids and clinical effects in patients with bronchial asthma

Objective To observe the clinical efficacy of medical education combined with extended care in patients with bronchial asthma and its effect on adherence to inhaled glucocorticoids. Methods Ninety-eight patients with bronchial asthma were divided into the control group and the experimental group, n = 49, by utilizing the random number table method. The control group was given routine education and care as well as routine out-of-hospital instructions, and the experimental group was given medical education and extended care based on the control group. Asthma disease knowledge mastery, asthma control, quality of life, medication adherence and lung function were compared between both groups, and the number of asthma attacks and re-hospitalizations were recorded. Results The experimental group performed higher scores of health knowledge, asthma control test and quality of life, rate of complete adherence, forced expiratory volume in one second (FEV1), peak expiratory flow rate, and FEV1/forced vital capacity. The number of asthma attacks and the times of re-hospitalizations were lower in the experimental group (all p < 0.05). Conclusion Medical education combined with extended care can improve bronchial asthma patients’ mastery of asthma disease knowledge, effectively control patients’ conditions, enhance patients’ quality of life and lung function, increase patients’ adherence to inhaled glucocorticoids, and reduce the recurrence of bronchial asthma patients.

Medical Emergencies in Dental Practice

Medical emergencies in Dental Practice:Abstract "In the middle of difficulty lies opportunity."– Albert Einstein.In the realm of dental practice, the presence of medical emergencies poses both challenges and opportunities for dental professionals.We will look into specific emergencies such as syncope,seizures, asthma attacks, allergic reactions, anaphylaxis, airway obstruction,diabetes-related issues, and cardiac emergencies. Each emergency will be discussed in terms of its occurrence in dental practice, underlying causes,symptoms, and effective treatment protocols. Two more important topics:Importance of history taking,Medico legal aspect of medical emergency in dental office will be seen.

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.