Chronic Obstructive Airways Research Articles

Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation

ObjectiveTo assess the change in relation of the peak quadriceps electromyographic signal to the peak torque produced during a train of 5 isokinetic knee extensions (from 90 degrees below horizontal at a constant speed of 60 degrees/s) at baseline, and at 4 and 8 weeks of pulmonary rehabilitation. DesignIn this prospective observational study, isokinetic contractions were recorded during the extensions from the knee bent at 90 degrees to the horizontal plane against graded resistance. Peak quadriceps torque signal (Tq) and peak electromyographic signal (Eq) were recorded by dynamometry and surface electrodes placed at designated locations over the muscle group, respectively. SettingPhysical therapy department in a tertiary care medical center. ParticipantsEighteen patients (9 restrictive lung disease, 6 chronic airflow limitation, 3 non-ILD restrictive; N=18) were compared with 11 healthy control subjects. InterventionsPatients underwent an 8-week pulmonary rehabilitation program. Main Outcome MeasuresComparisons of Tq, Eq, and Tq/Eq ratio among patients and controls were by analysis of variance. Associations between physiological variables were determined by multivariable Pearson's correlation. ResultsCompared with patients, controls exhibited a 22% higher baseline mean peak Eq (P<.05) and 76% higher mean peak Tq (P=.02) during knee extensions. Patients’ peak Eq/Tq was twice as high as in the controls (P=.02); at 4 weeks, Eq/Tq in patients decreased by 44% (P<.04) with no further decline at 8 weeks; changes in Eq/Tq of 5 of 6 patients paralleled changes in their respective St George's Respiratory Questionnaire scores. There was no change in Tq or Eq/Tq over time among the control cohort. ConclusionsEight weeks of pulmonary rehabilitation result in a decrease in Eq/Tq, indicating improvement in force generation of limb muscles, with the change occurring in the first 4 weeks.

Down syndrome patients with normal hearts: are they really normal?

Even though congenital heart disease is a common finding in down syndrome (DS) patients, some of them have anatomically normal hearts. However, the term "normal" might not be suitable, as these patients usually suffer from functional cardiac dysfunction. Several research highlighted that despite the absence of anatomical heart defects, subtle cardiac function derangements are present in DS patients. We aim to assess cardiac functions by Two-dimensional echocardiography and tissue Doppler imaging (TDI) in pediatric DS patients who have anatomically normal hearts. One hundred seventy-two patients with karyotyping confirmed DS with anatomically normal hearts and 165 healthy normal control children were enrolled in the current study. Their cardiac functions were assessed using both 2-dimensional echocardiography and TDI. Both patients and controls had structurally and anatomically normal hearts. In DS patients, the right side of the heart showed a significant reduction in both systolic and diastolic functions. Systolic dysfunction was evident by significantly decreased levels of Tricuspid annular plane systolic excursion and systolic wave by TDI. Diastolic dysfunction of the right ventricle was evident by prolonged deceleration time by conventional echocardiography and a significant decrease in annular tissue doppler velocity during early diastole/late diastole ratio by TDI. The E/De ratio was significantly increased. Even with anatomically normal hearts, DS patients should undergo cardiac function assessment by echocardiography & TDI. TDI is superior to conventional echocardiography in detecting subtle cardiac dysfunction especially left ventricular diastolic dysfunction in DS patients. TDI showed a significant decrease in the early/atrial ratio of mitral valve annulus and prolongation of left ventricle isometric relaxation time in DS children. Also, the left ventricle E/De ratio was prolonged denoting elevated filling pressures and diastolic dysfunction. This indicates that the TDI has higher sensitivity to detect diastolic dysfunction than conventional Echocardiography. Biventricular TDI-derived myocardial performance index was found to be significantly increased in DS children.

Structure of comorbidity in ascending aortic aneurysm

Aim. To analyze the comorbidity structure in patients with ascending thoracic aortic aneurysm (TAA) in the Siberian Federal District (SFD).Material and methods. The study included 163 patients (114 men (56,8±12,1 years) and 49 women (59,4±10,4 years)) with ascending TAA, who underwent open surgical treatment at the Cardiology Research Institute of the Tomsk National Research Medical Center. Concomitant pathologies were assessed on the basis of anamnesis and paraclinical investigations. Comparison of the prevalence of concomitant diseases in the group of patients with ascending TAA between men and women, as well as between patients ascending TAA in the SFD, other groups of patients with this pathology, population samples and patients with other cardiovascular diseases was performed using the χ2 test or Fisher’s exact test in the Statistiсa 12 program.Results. In patients with ascending TAA, hypertension (67,5%), bicuspid aortic valve (44,2%), coronary artery disease (38,6%), arrhythmia (31,3%), and heart failure (27,6%). Atherosclerosis of the aorta, coronary and carotid arteries occur with a prevalence of 12,9%, 16,6% and 5,5%, respectively. Among other forms of pathologies, the most common are connective tissue dysplasia (65,6%), obesity (12,3%), and chronic obstructive bronchitis (9,8%). In men with ascending TAA, myocardial infarction and atrial fibrillation are detected more often than women (11,4% and 20,2% vs 2% and 6,1%; p&lt;0,05), and in women — carotid atherosclerosis and impaired cerebral circulation (12,2% and 18,4% vs 2,6% and 5,3%, p&lt;0,05). Compared to other compared groups, aortic, coronary and carotid atherosclerosis, myocardial infarction, stroke, and type 2 diabetes were less frequently recorded in patients with ascending TAA in the SFD.Conclusion. Patients with ascending TAA in the SFD are characterized by a complex structure of comorbidity, including both cardiovascular pathologies and related risk factors, and other pathologies, including diseases of the lungs, kidneys, gastrointestinal tract, infectious and cancer diseases. To confirm the presence of inverse comorbidity between ascending TAA, atherosclerosis of other location, and type 2 diabetes, large-scale epidemiological, morphological, and molecular genetic studies are needed, which will reveal the fundamental mechanisms underlying it.

Structure of comorbidity in ascending aortic aneurysm

Aim. To analyze the comorbidity structure in patients with ascending thoracic aortic aneurysm (TAA) in the Siberian Federal District (SFD).Material and methods. The study included 163 patients (114 men (56,8±12,1 years) and 49 women (59,4±10,4 years)) with ascending TAA, who underwent open surgical treatment at the Cardiology Research Institute of the Tomsk National Research Medical Center. Concomitant pathologies were assessed on the basis of anamnesis and paraclinical investigations. Comparison of the prevalence of concomitant diseases in the group of patients with ascending TAA between men and women, as well as between patients ascending TAA in the SFD, other groups of patients with this pathology, population samples and patients with other cardiovascular diseases was performed using the χ2 test or Fisher’s exact test in the Statistiсa 12 program.Results. In patients with ascending TAA, hypertension (67,5%), bicuspid aortic valve (44,2%), coronary artery disease (38,6%), arrhythmia (31,3%), and heart failure (27,6%). Atherosclerosis of the aorta, coronary and carotid arteries occur with a prevalence of 12,9%, 16,6% and 5,5%, respectively. Among other forms of pathologies, the most common are connective tissue dysplasia (65,6%), obesity (12,3%), and chronic obstructive bronchitis (9,8%). In men with ascending TAA, myocardial infarction and atrial fibrillation are detected more often than women (11,4% and 20,2% vs 2% and 6,1%; p&lt;0,05), and in women — carotid atherosclerosis and impaired cerebral circulation (12,2% and 18,4% vs 2,6% and 5,3%, p&lt;0,05). Compared to other compared groups, aortic, coronary and carotid atherosclerosis, myocardial infarction, stroke, and type 2 diabetes were less frequently recorded in patients with ascending TAA in the SFD.Conclusion. Patients with ascending TAA in the SFD are characterized by a complex structure of comorbidity, including both cardiovascular pathologies and related risk factors, and other pathologies, including diseases of the lungs, kidneys, gastrointestinal tract, infectious and cancer diseases. To confirm the presence of inverse comorbidity between ascending TAA, atherosclerosis of other location, and type 2 diabetes, large-scale epidemiological, morphological, and molecular genetic studies are needed, which will reveal the fundamental mechanisms underlying it.

INFLUÊNCIAS DO EXERCÍCIO AERÓBICO ASSOCIADO AO TRATAMENTO FARMACOLÓGICO DA DPOC

ABSTRACT Introduction: Chronic obstructive pulmonary disease (COPD) is a type of inflammatory respiratory system disease characterized by chronic airflow limitation. Aerobic exercise training is believed to influence the drug treatment of this disease positively. Objective: Study the impact of complementary aerobic exercise intervention on pharmacological treatment in patients with COPD. Methods: In a controlled experiment, 40 volunteers under pharmacological treatment for COPD were selected and equally divided into two groups. The experimental group was treated with aerobic exercise training and drug treatment, while the control group was treated with regular drug treatment only. The exercise protocol lasted 60 minutes daily for a total period of eight weeks. Borg scale, oxygen saturation, and six-minute walk test among other markers were checked before and after the intervention. Results: According to the data obtained from the experiment, the peak oxygen consumption of aerobic exercise combined with the drug group was from 1,205.42±293.74ml/min to 1,301.84±293.91ml/min, peak ventilation started at 37.85±11.67L/min to 48.81±13.11L/min. However, the variations in the control group were not significant. Conclusion: Aerobic exercise associated with pharmacological intervention positively influenced the treatment of patients with COPD. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Long-term efficiency of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease, bronchiectasis, and asthma: Does it differ?

The long-term effects of pulmonary rehabilitation (PR) and maintenance programs in obstructive pulmonary diseases have not been sufficiently investigated, particularly in diseases other than COPD. This retrospective study aimed to examine the long-term results of individualized comprehensive outpatient pulmonary rehabilitation in patients with obstructive pulmonary disease. This study is a single-center, retrospective cohort study. Between 2010 and 2019, 269 patients with chronic airway obstruction were treated in our multidisciplinary PR center at a tertiary training and research hospital, and they were divided into three groups based on their diagnosis: COPD, bronchiectasis, and asthma. Patients' perceptions of dyspnea, exercise capacity, inspiratory and peripheral muscle strength, body composition, quality of life, and psychosocial status were compared at the beginning, end, and 12th and 24th months of PR. Improvements in dyspnea perception remained longer in asthmatics than in the other two groups. The increases in exercisecapacity in the bronchiectasis and asthma groups lasted two years. All groups maintained their respiratory muscle strength gains at the end of the second year. Improvements in hand grip strength in the COPD and bronchiectasis groups have been sustained for two years, but in the asthma group, enhancements were lost in the second year. Even after the second year, quality of life was still better than the baseline in all groups, despite a worsening in the first year. However, groups anxiety and depression improvements were not sustained after the first year. The long-term effectiveness of PR in patients with bronchiectasis and asthma was similar to that of COPD patients. Therefore,multidisciplinary, comprehensive PR programs should be integrated into the management of patients with bronchiectasis and asthma. We also recommend structured follow-up programs to maintain gains and to detect the need for rerehabilitation.

Atmospheric Aerosols and their Effect on Human Health: A Review

Atmospheric aerosols are one of the main pollutants which are harmful to human health and environment. Atmospheric aerosols emitted from different sources are of different sizes and depending upon the size of the aerosol particle, it deposits in different parts of the body and cause varying health problems. Fine Particulate (PM2.5) is associated with more severe health consequences than coarse particulate (PM10) which might be short-term acute symptoms like coughing, shortness of breath, wheezing, respiratory diseases, to more serious problems like asthma, Chronic Obstructive Pulmonary Disease (COPD), bronchitis, pneumonia and long-term chronic irritation and inflammation of the respiratory tract, which may eventually result in lung cancer. Inhalation of ultrafine particles (

Activity of the inflammatory process depending on sputum markers in children with different onset of bronchial asthma

Aim of the study: To analyse the activity of the inflammatory process in the airways in children with bronchial asthma depending on the onset of the disease. Materials and methods: In compliance with the principles of bioethics, a comprehensive retrospective examination of 319 children suffering from bronchial asthma was performed. In 257 children (clinical group I), bronchial asthma developed on the background of chronic obstructive bronchitis. The second (II) clinical group included 43 children, in whom asthma occurred after community-acquired pneumonia. The third (III) clinical group consisted of 19 children in whom asthma was first verified after inpatient treatment for asthmatic status. Results: Based on the severity of bronchial asthma, it was found that the representatives of the clinical group III, compared with other patients, significantly more often had a severe course of the disease. For patients of the clinical group I, the onset was characterised by increased eosinophils and decreased neutrophil counts in sputum, for group II patients – increased eosinophils and epitheliocytes, but a decrease in lymphocytes, and in children of the clinical group III – low eosinophils in the sputum with a simultaneous increase in neutrophils. In particular, a statistically significant increase in the level of vascular endothelial growth factor, and a decrease in the content of cationic proteins, matrix metalloproteinase-9, and interleukins 6 and 13, in sputum indicates the predominance of neoangiogenesis in children of the clinical group III. Instead, in the clinical group II the remodelling processes were mainly caused by the inflammatory process with the release of intracellular eosinophilic cationic proteins. Conclusion: These data indicate the discrete nature of the type and severity of the inflammatory process of the respiratory tract over the dynamic follow-up period in children classified in different clinical comparison groups, which suggests the presence of certain phenotypic differences due to alternative onsets of the disease, which were determined by different triggers. Such deviations in the inflammatory process indicate that patients with asthma require a personalised approach to ensure differentiated diagnostic monitoring and targeted anti-inflammatory treatment, taking into account the peculiarities of the onset of the disease.

Outdoor air pollution impacts chronic obstructive pulmonary disease deaths in South Asia and China: a systematic review and meta-analysis

Background: Chronic obstructive lung disease is among leading causes of death globally. Exposure to outdoor pollution is an important cause for increased mortality and morbidity. Objective: To present a systemic synthesis evidence regarding impact of outdoor pollution on COPD mortality in south asia and china. Methods: A systematic search on studies with statistical power has been conducted from 1990 - June 30th 2021, in English electronic databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from MEDLINE and PUBMED databases with terms: Chronic Obstructive Pulmonary disease OR COPD OR Chronic Bronchitis OR Emphysema OR COPD Deaths OR Chronic Obstructive Lung Disease OR Airflow Obstruction OR Chronic Airflow Obstruction OR Airflow Obstruction, Chronic OR Bronchitis, Chronic AND Mortality OR Death OR Deceased AND Outdoor pollution, ambient pollution was conducted. Results: Out of 1899 papers screened only 16 found eligible to be included in the study. Subjects with COPD exposed to higher levels of outdoor air pollution had a 49 % higher risk of death as compared to COPD subjects exposed to lower levels of outdoor air pollution. When taken individual pollutants into consideration, common air pollutants like PM10 had an OR of 1.06 at CI 95%, where as SO2 had OR of 0.66 at 95% CI , and NO2 with 1.01 OR at 95% CI. These values suggest that there is an effect of outdoor pollution on COPD but not to a significant level. Conclusion: Despite heterogeneity across selected studies, exposure to outdoor pollutants found to have risk of COPD mortality. Though it appears to have risk, COPD mortality was not significantly associated with outdoor pollutants. Controlling air pollution can substantially decrease the risk of COPD in South Asia and China. Further research including more prospective and longitudinal studies are urgently needed in COPD sub-groups.

Understanding user concerns and choice of app architectures in designing Audio-based mHealth Apps

Due to recent advancements in smartphone sensing and computing capabilities, artificially intelligent mobile health (mHealth) applications are getting popular to monitor a range of diseases, including coronavirus-caused COVID-19 disease, chronic obstructive pulmonary disease (COPD), asthma, bronchitis, emphysema, and sleep apnea, among many others utilizing the audio recordings obtained from the smartphone microphones. Compared to other mHealth apps, audio-based apps suffer from various user concerns, including the privacy of data and battery drain rate , among many other concerns, which can adversely affect the user compliance, and app utility and life cycle. To address user concerns, mHealth apps should provide users options to configure the app, i.e., choose an architecture from a set of options based on user concerns and preferences. However, there is a dearth of knowledge about audio-based health monitoring app design. In this work, we present a focused user-centric app design study to better understand various concerns and choices that users want to see in an audio-based mHealth app. From a detailed analysis of 60 subjects with varying backgrounds, we find that around 85% subjects are concerned about the privacy of data and 93% subjects prefer to pick an app architecture that will not send raw audio recordings to a server. Findings from this work can guide the design of future mHealth apps that utilizes privacy-sensitive audio data. • Determine the major user concerns about the audio-based health monitoring smartphone apps and user choice when provided with a set of app configurations, i.e., architectures, that a user can choose when using a health monitoring app that relies on continuous microphone sensing to obtain audio recordings. • People with diferent backgrounds have a similar level of concerns while reporting their concerns about audio-based health monitoring apps. • Most of the study paracipants (around 66%) choose either the complete on-phone architecture, i.e., architecture that performs all computations on the phone, or the non- speech data-driven architecture, i.e., architecture that removes all speech components from audio recordings in the phone before sending them to the server for additional computation. • Only 7% participants choose the raw data-driven architecture, i.e., architecture that sends raw audio recordings to the server for all computation. • These fndings could be used as guidelines for the future user-centric app design to address user concerns and provide app customization options with the goal to improve the utility and compliance of the mHealth apps that rely on audio data obtained from the continous microphone sensing.

A machine learning-based prediction model for in-hospital mortality among critically ill patients with hip fracture: An internal and external validated study

IntroductionFew studies have investigated the in-hospital mortality among critically ill patients with hip fracture. This study aimed to develop and validate a model to estimate the risk of in-hospital mortality among critically ill patients with hip fracture. MethodsFor this study, data from the Medical Information Mart for Intensive Care III (MIMIC-III) Database and electronic Intensive Care Unit (eICU) Collaborative Research Database were evaluated. Enrolled patients (n=391) in the MIMIC-III database were divided into a training (2/3, n=260) and a validation (1/3, n=131) group at random. Using machine learning algorithms such as random forest, gradient boosting machine, decision tree, and eXGBoosting machine approach, the training group was utilized to train and optimize models. The validation group was used to internally validate models and the optimal model could be obtained in terms of discrimination (area under the receiver operating characteristic curve, AUROC) and calibration (calibration curve). External validation was done in the eICU Collaborative Research Database (n=165). To encourage practical use of the model, a web-based calculator was developed according to the eXGBoosting machine approach. ResultsThe in-hospital death rate was 13.81% (54/391) in the MIMIC-III database and 10.91% (18/165) in the eICU Collaborative Research Database. Age, gender, anemia, mechanical ventilation, cardiac arrest, and chronic airway obstruction were the six model parameters which were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) method combined with 10-fold cross-validation. The model established using the eXGBoosting machine approach showed the highest area under curve (AUC) value (0.797, 95% CI: 0.696-0.898) and the best calibrating ability, with a calibration slope of 0.999 and intercept of -0.019. External validation also revealed favorable discrimination (AUC: 0.715, 95% CI: 0.566-0.864; accuracy: 0.788) and calibration (calibration slope: 0.805) in the eICU Collaborative Research Database. The web-based calculator could be available at https://doctorwangsj-webcalculator-main-yw69yd.streamlitapp.com/. ConclusionThe model has the potential to be a pragmatic risk prediction tool that is able to identify hip fracture patients who are at a high risk of in-hospital mortality in ICU settings, guide patient risk counseling, and simplify prognosis bench-marking by controlling for baseline risk.

From COPD to Lung Cancer: Mechanisms Linking, Diagnosis, Treatment, and Prognosis.

Many studies have proved that the pathogenesis of the chronic obstructive pulmonary disease (COPD) and lung cancer is related, and may cause and affect each other to a certain extent. In fact, the change of chronic airway obstruction will continue to have an impact on the screening, treatment, and prognosis of lung cancer.In this comprehensive review, we outlined the links and heterogeneity between COPD and lung cancer and finds that factors such as gene expression and genetic susceptibility, epigenetics, smoking, epithelial mesenchymal transformation (EMT), chronic inflammation, and oxidative stress injury may all play a role in the process. Although the relationship between these two diseases have been largely determined, the methods to prevent lung cancer in COPD patients are still limited. Early diagnosis is still the key to a better prognosis. Thus, it is necessary to establish more intuitive screening evaluation criteria and find suitable biomarkers for lung cancer screening in high-risk populations with COPD. Some studies have indicated that COPD may change the efficacy of anti-tumor therapy by affecting the response of lung cancer patients to immune checkpoint inhibitors (ICIs). And for lung cancer patients with COPD, the standardized management of COPD can improve the prognosis. The treatment of lung cancer patients with COPD is an individualized, comprehensive, and precise process. The development of new targets and new strategies of molecular targeted therapy may be the breakthrough for disease treatment in the future.

COPD-X Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update.

Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease characterised by persistent respiratory symptoms and chronic airflow limitation on spirometry. COPD is highly prevalent and is associated with exacerbations and comorbid conditions. "COPD-X" provides quarterly updates in COPD care and is published by the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand. The COPD-X guidelines (version 2.65) encompass 26 recommendations addressing: case finding and confirming diagnosis; optimising function; preventing deterioration; developing a plan of care; and managing an exacerbation. Both non-pharmacological and pharmacological strategies are included within these recommendations, reflecting the importance of a holistic approach to clinical care for people living with COPD to delay disease progression, optimise quality of life and ensure best practice care in the community and hospital settings when managing exacerbations. Several of the new recommendations, if put into practice in the appropriate circumstances, and notwithstanding known variations in the social determinants of health, could improve quality of life and reduce exacerbations, hospitalisations and mortality for people living with COPD.

Identification of Modifiable Risk Factors of Exacerbations Chronic Respiratory Diseases with Airways Obstruction, in Vietnam.

Objectives: to determine modifiable risk factors of exacerbations in chronic respiratory diseases with airways obstruction (i.e., asthma and COPD) in southern Vietnam. Methods: an environmental and health-related behavioural questionnaire was submitted to patients with both chronic respiratory symptoms and airways obstruction. An exacerbation was defined as any acute worsening in clinical symptoms requiring a change in treatment, in a patient receiving prophylactic therapy. Results: 235 patients were evaluated, including 131 (56%) chronic obstructive pulmonary disease (COPD) and 104 (44%) asthmatics. There were 75% males and 69% smokers. Occupational exposure accounted for 66%, mainly among construction and industry workers. Smoking was associated with more severe airways obstruction. Respiratory exacerbations were reported in 56/235 patients (24%). The risk of exacerbation was increased in patients with a lower education level, exposure to occupational pollutants, cumulative smoking ≥ 20 pack year, housing space < 10 m2, and poorly ventilated housing. Based on multivariate analysis, the risk of exacerbation remained significantly higher among patients with occupational exposure and low housing space per person. Conclusions: besides smoking cessation, more supportive policies, including improvement of occupational environment and housing design for better ventilation, are needed to prevent the severity of chronic respiratory diseases in Vietnam.

Glycyl-L-histidyl-L-lysine-Cu2+ attenuates cigarette smoke-induced pulmonary emphysema and inflammation by reducing oxidative stress pathway.

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder manifested as chronic airway inflammation and persistent airflow limitation with the essential mechanism as inflammatory response and oxidative stress induced by toxic exposures such as cigarette smoke (CS). Glycyl-L-histidyl-L-lysine (GHK) is a nontoxic tripeptide involved in the process of healing and regeneration as a natural product. With the combination of Cu(II), glycyl-L-histidyl-L-lysine-Cu2+ (GHK-Cu) improves antioxidative and anti-inflammatory bioavailability, and they might offer potential therapeutic properties for COPD. Thus, the present study aimed to identify the potential effects of GHK-Cu on emphysema induced by cigarette smoke. Methods: In the in vivo experiment, C57BL/6J mice were exposed to CS for 12 weeks to induce pulmonary emphysema. GHK-Cu was injected intraperitoneally at doses of 0.2, 2 and 20 μg/g/day in 100 µl of saline on alternative days from the 1st day after CS exposure. The effects of GHK-Cu on the morphology of CS-induced emphysema, the inflammatory response and oxidative stress were evaluated. The antioxidative effect of GHK-Cu on human alveolar epithelial A549 cells was assessed in vitro. Results: GHK-Cu treatment attenuated the CS-induced emphysematous changes and partially reversed the matrix metalloprotein -9 (MMP-9)/tissue inhibitor of metalloproteinases-1 (TIMP-1) imbalance in the lung tissue. GHK-Cu reduced the inflammation and oxidation by decreasing the expression of inflammatory cytokines (IL-1β and TNF-α) in the bronchoalveolar lavage and the enzymatic activity of MPO and MDA in the lung homogenate while restoring the T-AOC and GSH content. Furthermore, administration of GHK-Cu reversed the increase in NF-κB expression induced by CS and increased the Nrf2 level, as an antioxidant defense component, in mice with chronic CS exposure. In CSE-exposed human alveolar epithelial A549 cells, GHK-Cu also inhibited oxidative stress by suppressing MDA levels and restoring T-AOC and GSH levels, which were modulated by upregulating Nrf2 expression. Conclusion: GHK-Cu treatment attenuated CS-induced emphysema by anti-inflammation by downregulating NF-κB and antioxidation via upregulation of the Nrf2/Keap1 in lung tissues.

Some Risk Factors of Asthma in Bronchial Asthma Patient in Sulaimani City- Iraq

Background: Asthma is a chronic heterogeneous disease usually characterized by chronic airflow limitation. The risk factors of asthma include genetic, environmental, host factors and family history. neither sufficient nor necessary for the development of asthma.So the aim of this study to find some risk factors of asthma in asthmatic patients and some worse and trigger factors. Methodology: A prospective case control study, One hundred patients were participated in the study with diagnosed asthma before 6 month as patient group conducted at asthma and allergy center and another one hundred person were participated with no history of asthma as control group in shar hospital in Suliamani city from June 2021 to September 2021 Result: Both groups were comparable in age and gender .No significant difference between case and control groups regarding marital status, employment (p -value > 0.05).while level of education had a significant relation to asthma patient just 8% of patient had high educational (P-value =0.01).in addition to residency, 86% of patients live in rural area with p=0.00. A significant difference were found between family history and participants, (31%) of cases had family history of asthma with (P-value =0.04.) Conclusion: This study concludes that level of education, residency, and family history had direct effect on asthma initiation.

Long-term oxygen therapy in COPD: what is the evidence?

Thomas L Petty was the founder of modern long-term oxygen therapy (LTOT).1 In 1967, Petty's group published the seminal study of six patients with severe chronic airway obstruction, in whom LTOT improved clinical status, exercise capacity, secondary erythrocythemia, and pulmonary hypertension.2 Notably, all patients had severe hypoxaemia (partial pressure of oxygen [PaO2] 41·5–46·5 mm Hg) and four patients were severely hypercapnic (partial pressure of carbon dioxide [PaCO2] 55·0–61·5 mm Hg). Thereafter, two randomised controlled trials that were initiated in the 1970s established a clear survival benefit related to LTOT in patients with chronic obstructive pulmonary disease (COPD) with severe resting hypoxaemia: the Nocturnal Oxygen Therapy Trial (NOTT)3 and the British Medical Research Council (BMRC) trial.

Diaphragmatic Thickness in Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease, characterized by chronic airway inflammation and progressive airflow limitation, and is considered as common, preventable and treatable disease. The defining standard values for diaphragm thickness and thickening ratio using B-mode ultrasound may provide a simpler, safer means of evaluating diaphragmatic function in chronic obstructive pulmonary disease patients. Objective: to assess the diaphragmatic structure and function using B-mode ultrasonography studying the diaphragm muscle inspiratory and expiratory thickness and thickening fraction in patients with COPD compared to healthy controls, and to study their sensitivity and specificity as well as their correlation with certain pathophysiologic parameters namely (peripheral capillary oxygen saturation, body mass index and C-reactive protein) to establish possible relation with the pathophysiology of the disease. Materials and Methods: The present study is a case control study was conducted in Al-Imamein Al-Kadhimein Medical City, Baghdad, Iraq in the period extended from November 2019 to October 2021. Forty patients with the diagnosis of COPD underwent B-mode ultrasound analysis. Three images were captured both at end expiration (Tmin) and at maximal inspiration (Tmax). The thickening fraction was calculated as (Tmax-Tmin/Tmin), and each set of values was averaged. Findings were compared with a database of 40 healthy control subjects. Results: Diaphragm thickness and thickening fraction were significantly higher in COPD patients compared to control subjects with the mean of the Rt. inspiratory diaphragmatic thickness equals (3.23 ± 0.68mm versus 2.8 ± 0.55mm; respectively, p=0.006) compared to control, and (2.44 ± 0.71 versus 1.96 ± 0.6; respectively, p=0.004) for the mean Rt. diaphragmatic thickening fraction, while the mean of the Lt. inspiratory diaphragmatic thickness was (3.22 ± 0.63mm versus 2.79 ± 0.51mm; respectively, p=0.003) compared to control, and (2.45 ± 0.63 versus 1.95 ± 0.54; respectively, p=0.003) for the mean Lt. diaphragmatic thickening fraction, ROC analysis shows that the right and left diaphragmatic fractions had the highest sensitivity and specificity parameter for COPD. No correlations were found between body mass index, SpO2 with diaphragmatic parameters. Conclusion: the current study found diaphragmatic ultrasonographic characteristics in patients with COPD show significant increase in inspiratory thickness and thickening fraction compared to control group, yet they were of low diagnostic accuracy.

Pathological Mechanism and Targeted Drugs of COPD.

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis, emphysema, and small airway obstruction. Incompletely reversible airflow limitation, inflammation, excessive mucus secretion and bronchial mucosal epithelial lesions are the main pathological basis of the disease. The prevalence of COPD is increasingly worldwide, which has caused the burden on individuals and society. This paper summarizes the pathogenesis of COPD and clarifies the effect and mechanism of the latest targeted drugs for COPD. Besides, we focus on NOD-like receptor thermal protein domain associated protein 3 inflammasome (NLRP3 inflammasome). NLRP3 can promote production of interleukin-1β (IL-1β) and interleukin-18 (IL-18). NLRP3 is an important factor in the migratory aggregation of macrophages and neutrophils and the generation of oxidative stress. Inhibition of NLRP3 inflammasome indirectly blocks the inflammatory effects of IL-1β and IL-18, which may be regarded as an ideal target for COPD treatment.

Air pollution abatement by selective nanoparticle deposition on filtration systems

Air pollution kills an estimated seven million people worldwide every year. The data from the World Health Organization (WHO) shows that almost all the global population (99%) breathe air that exceeds WHO guideline limits. The growing population and urbanization such as in Africa, which has the fastest growing population, may lead to substantial worsening of the air quality. Urbanization is also a powerful driver of the epidemiologic transition from traditional threats like infectious diseases and malnutrition to chronic, non-communicable diseases. Particulate matter less than 2.5 microns in size, PM2.5, is the leading contributor to air pollution which results in such diseases like chronic obstructive pulmonary disease (COPD), bronchitis, and lung cancer. Recent studies have shown a strong correlation between ambient air pollution and COVID-19 cases, which has affected the lives of billions of people around the world. Abatement technologies such as ionic and other high efficiency filtration systems are quite expensive and hence unaffordable to communities with limited resources. The goal of this study was to develop an air pollution filtration method utilizing selective nanoparticle deposition in optimized concentrations, to maximize the entrapment of PM2.5 particles. The experimental set-up consisted of a wind tunnel with incense sticks as the PM2.5 source, measured by laser particle detectors upstream and downstream of the filters. Different nanoparticle coated filters were tested using the ‘Design of Experiments’ methodology and it was concluded that an optimized mixture of zinc oxide, titanium dioxide &amp; graphene improved filtration efficiency of a baseline filter by 206% and was 70% cheaper than high efficiency filters. The versatility and cost-effectiveness of this design makes it applicable for personal masks &amp; filters, air-conditioning and car-cabin filters, and fire-fighting equipment. The significant correlation between air pollution and fatalities from viral infections like COVID-19, makes such abatement technologies with innovative filtration systems critical to save human lives.