Chronic Phlegm Research Articles

The effect of exposure to biomass smoke on respiratory symptoms in adult rural and urban Nepalese populations.

BackgroundHalf of the world’s population is exposed to household air pollution from biomass burning. This study aimed to assess the relationship between respiratory symptoms and biomass smoke exposure in rural and urban Nepal.MethodsA cross-sectional study of adults (16+ years) in a rural population (n = 846) exposed to biomass smoke and a non-exposed urban population (n = 802) in Nepal. A validated questionnaire was used along with measures of indoor air quality (PM2.5 and CO) and outdoor PM2.5.ResultsBoth men and women exposed to biomass smoke reported more respiratory symptoms compared to those exposed to clean fuel. Women exposed to biomass were more likely to complain of ever wheeze (32.0 % vs. 23.5%; p = 0.004) and breathlessness (17.8% vs. 12.0%, p = 0.017) compared to males with tobacco smoking being a major risk factor. Chronic cough was similar in both the biomass and non-biomass smoke exposed groups whereas chronic phlegm was reported less frequently by participants exposed to biomass smoke. Higher PM2.5 levels (≥2 SDs of the 24-hour mean) were associated with breathlessness (OR = 2.10, 95% CI 1.47, 2.99) and wheeze (1.76, 1.37, 2.26).ConclusionsThe study suggests that while those exposed to biomass smoke had higher prevalence of respiratory symptoms, urban dwellers (who were exposed to higher ambient air pollution) were more at risk of having productive cough.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-92) contains supplementary material, which is available to authorized users.

Association between occupational exposure and lung function, respiratory symptoms, and high-resolution computed tomography imaging in COPDGene.

Although occupational exposure to dust and fumes is considered a risk factor for chronic obstructive pulmonary disease, this determination has been limited by reliance on spirometry alone to assess disease severity in predominantly male populations. To determine the effect of occupational exposure on lung function, respiratory symptoms, and findings of emphysema and airway wall thickness measured using quantitative computed tomography in men and women. COPDGene is a multicenter study of current and former smokers that underwent standardized volumetric chest computed tomography scans to assess airways, % emphysema, and % gas trapping. Spirometry and a respiratory questionnaire including occupational history were also analyzed in 9,614 subjects (4,496 women). Logistic regression and analysis of covariance was used to assess associations with exposure. Occupational exposure to both dust and fumes was reported by 47.9% of men and 20.1% of women. Adjusting for age, race, body mass index, education, and current and lifetime smoking, the odds ratios for persons with dust and fume exposures for chronic cough, chronic phlegm, persistent wheeze, and Global Initiative for Chronic Obstructive Lung Disease stages 2 and higher chronic obstructive pulmonary disease were significantly elevated and similar for men (1.83, 1.84, 2.0, 1.61, respectively) and women (1.65, 1.82, 1.98, 1.90, respectively). The % predicted FEV1 was similarly lower in those with exposure in men (70.7 ± 0.8 vs. 76.0 ± 0.9; P < 0.001) and women (70.5 ± 0.8 vs. 77.2 ± 0.8; P < 0.001). Percent emphysema and gas trapping was greater in those exposed to dust and fumes in men and women. In men, but not in women, persons with exposure had a greater mean square root wall area of 10-mm internal perimeter airways. Occupational exposure to dust and fumes in men and women is similarly associated with airflow obstruction, respiratory symptoms, more emphysema, and gas trapping in men and women.

Impact of obesity on the clinical profile of a population-based sample with chronic obstructive pulmonary disease.

AimsTo characterize the distribution of BMI in a population-based sample of COPD patients and to evaluate the impact of obesity on their health status, exercise tolerance, systemic inflammation and comorbidity.MethodsA population-based sample of 3,797 subjects aged 40–80 years from the EPI-SCAN study was selected. Subjects were categorized according their body mass index (BMI) as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2) or obese (BMI≥30.0 kg/m2). Subjects were evaluated with post-bronchodilator spirometry and 6-minute walk tests. Smoking habits, respiratory symptoms, generic and specific quality of life, daily physical activities, comorbidities and systemic inflammatory biomarkers were recorded.ResultsThe prevalence of obesity or being overweight was higher in the 382 COPD patients than in the subjects without airflow limitation (29.4%, 95%CI 24.8–33.9% vs. 24.3, 95%CI 22.9–25.8; and 44.7%, 95%CI 39.7–49.6% vs. 43.0%, 95%CI 41.3–44.6, respectively; p = 0.020). In the COPD subgroup, obese subjects presented more dyspnea and less chronic cough, chronic bronchitis or chronic phlegm than normal-weight patients, as well as a worse health status. Moreover, reduced exercise tolerance and higher plasmatic C-reactive protein levels were found in the obese patients, who also presented a greater prevalence of cardiovascular disease (adjusted odds ratio 4.796, 95%CI 1.806–12.736, p = 0.002).ConclusionsIn a population-based sample, obesity is more prevalent in COPD patients than in subjects without airflow limitation. Furthermore, obesity affects the clinical manifestations, quality of life and exercise tolerance of COPD patients, and it may contribute to a phenotype characterized by increased systemic inflammation and greater frequency of cardiovascular comorbidity.

Cross-sectional associations between air pollution and chronic bronchitis: an ESCAPE meta-analysis across five cohorts

BackgroundThis study aimed to assess associations of outdoor air pollution on prevalence of chronic bronchitis symptoms in adults in five cohort studies (Asthma-E3N, ECRHS, NSHD, SALIA, SAPALDIA) participating in the...

Active smoking, environmental tobacco smoke and bronchitic symptoms among adolescents in Taiwan: A prospective cohort study

ObjectiveThe study investigates the association between active smoking, exposure to environmental tobacco smoke (ETS) and the development of bronchitis and bronchitic symptoms among adolescents. MethodsA prospective cohort study was conducted with 4134 adolescents aged 12–14 from the Taiwan Children Health Study in 14 communities in Taiwan since 2007. Parents or guardians completed written questionnaires regarding demographic information, household ETS and respiratory symptoms at baseline. The adolescents themselves completed identical questionnaires on respiratory outcomes in the 2009 survey. Associations between active smoking, exposure to ETS and the 2-year incidence of respiratory outcomes were analyzed by multiple Poisson regression models, taking overdispersion into account. ResultsActive smoking was associated with an increased risk of developing chronic cough and chronic phlegm. We found significant dose–response associations between the duration of smoking, the numbers of cigarettes and the onset of bronchitic symptoms. Exposure to ETS was a significant risk factor for the development of chronic cough. Among asthmatic adolescents, exposure to ETS was associated with an additional risk for the onset of chronic phlegm. ConclusionThis study demonstrates that active smoking and exposure to ETS are associated with higher risks for developing bronchitic symptoms among adolescents.

Trawler fuel exhaust and respiratory impairments: a cross-sectional pilot study among Indian fishermen working in informal sectors.

An estimated half a billion people are engaged in fishing related occupations in India. Exposure to adulterated fuel exhaust is common among deep-sea fishermen, yet little is known about the potential impacts on the exposure to health. The aim of this study was to investigate whether fuel emission exposure was associated with increased respiratory impairments among fishermen who were occupationally exposed to fuel exhaust compared to fisherman occupationally unexposed to fuel exhaust. This cross-sectional study compared the prevalence of respiratory symptoms and lung function variables between 152 marine-water and 107 fresh water fishermen considering the use of fuel-driven trawlers. Data were obtained from questionnaires and computerized spirometer. Fishermen exposed to trawler fuel exhaust reported more than double the number of respiratory symptoms compared to the unexposed fisherman (86·2 vs. 40·2%). They also had a significantly higher chance experiencing chronic cough (adjusted OR = 3·51, 95% confidence interval (CI) = 2·09-6·35), chronic phlegm (8·61, 4·76-15·97), and wheezing (4·29, 2·55-7·61) symptoms. Finally, there was a significant reduction of the ratio of mid portion of forced expiratory flow rate and forced vital capacity (FEF25-75/FVC) in the exposed fishermen compared to the unexposed (0·84 vs. 0·73 second(-1), P = 0·015). Fuel exhaust may negatively impact on the respiratory health of Indian fishermen. More attention and surveillance of occupational health for fishermen in India is needed.

The Course of Asthma in Young Adults: A Population-Based Nine-Year Follow-Up on Asthma Remission and Control

BackgroundOnly few longitudinal studies on the course of asthma among adults have been carried out.ObjectiveThe aim of the present prospective study, carried out between 2000 and 2009 in Italy, is to assess asthma remission and control in adults with asthma, as well as their determinants.MethodsAll the subjects with current asthma (21–47 years) identified in 2000 in the Italian Study on Asthma in Young Adults in 6 Italian centres were followed up. Asthma remission was assessed at follow-up in 2008–2009 (n = 214), asthma control at baseline and follow-up. Asthma remission and control were related to potential determinants by a binomial logistic and a multinomial logistic model. Separate models for remission were used for men and women.ResultsThe estimate of the proportion of subjects who were in remission was 29.7% (95%CI: 14.4%;44.9%). Men who were not under control at baseline had a very low probability of being in remission at follow-up (OR = 0.06; 95%CI:0.01;0.33) when compared to women (OR = 0.40; 95%CI:0.17;0.94). The estimates of the proportion of subjects who were under control, partial control or who were not under control in our sample were 26.3% (95%CI: 21.2;31.3%), 51.6% (95%CI: 44.6;58.7%) and 22.1% (95%CI: 16.6;27.6%), respectively. Female gender, increasing age, the presence of chronic cough and phlegm and partial or absent asthma control at baseline increased the risk of uncontrolled asthma at follow-up.ConclusionAsthma remission was achieved in nearly 1/3 of the subjects with active asthma in the Italian adult population, whereas the proportion of the subjects with controlled asthma among the remaining subjects was still low.

Effect of air pollution on prevalence of chronic bronchitis symptoms-a cross-sectional analysis of 5 cohort studies

Background and Aims: Chronic bronchitis symptoms are associated with increased risk of COPD and, in some studies, overall as well as COPD mortality. This study aims to assess effects of outdoor air pollution exposures on chronic bronchitis prevalence in five cohort studies participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE) project. Methods: Annual average air pollution exposures of particulate matter (PM) metrics PM2.5, PM10, PMcoarse, PM2.5absorbance, NO2, NOx derived from Land Use Regression models for 2008-2011 and road traffic measures, were assigned to home address of five European cohorts (E3N, ECRHS,NSHD,SALIA,SAPALDIA) at follow-up periods in 2000-2011. Chronic bronchitis was defined as questionnaire-reported chronic cough and phlegm production for ³3 months for 2 or more years. Cross-sectional multivariable logistic regression analyses were conducted in each cohort, adjusting for a confounder set common to all studies (age, sex, smoking status, interview season, education) followed by random-effect meta-analysis. Results: 13,758 and 8,784 participants respectively were included in NO2 and PM analyses at follow-up. Prevalence of chronic bronchitis ranged from 1.5% in E3N (non-asthmatic females) to 6.8% in SALIA (elderly females). No consistent associations were observed between any air pollution measure and prevalence of chronic bronchitis. Meta-analysis combined ORs were: for NO2 OR: 0.96 (95%CI: 0.89-1.04) per 10ug/m3; for PM10 OR 0.85 (95%CI: 0.53-1.39) per 10ug/m3. Results were suggestive of possible effects in asthmatics and never-smokers in some cohorts but this was not consistent across all studies. Conclusions:In contrast to some previously published European studies, this study did not find consistent effects of current air pollution exposures level on chronic bronchitis symptoms. Further investigations including use of back-extrapolated air pollution values to actual year of questionnaire are needed.

Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) guidelines make no recommendations for allergy diagnosis or treatment. To determine whether an allergic phenotype contributes to respiratory symptoms and exacerbations in patients with COPD. Two separate cohorts were analyzed: National Health and Nutrition Survey III (NHANES III) and the COPD and domestic endotoxin (CODE) cohort. Subjects from NHANES III with COPD (n = 1,381) defined as age > 40 years, history of smoking, FEV1/FVC < 0.70, and no diagnosis of asthma were identified. The presence of an allergic phenotype (n = 296) was defined as self-reported doctor diagnosed hay fever or allergic upper respiratory symptoms. In CODE, former smokers with COPD (n = 77) were evaluated for allergic sensitization defined as a detectable specific IgE to perennial allergens. Bivariate and multivariate models were used to determine whether an allergic phenotype was associated with respiratory symptoms and exacerbations. In NHANES III, multivariate analysis revealed that individuals with allergic phenotype were more likely to wheeze (odds ratio [OR], 2.1; P < 0.01), to have chronic cough (OR, 1.9; P = 0.01) and chronic phlegm (OR, 1.5; P < 0.05), and to have increased risk of COPD exacerbation requiring an acute doctor visit (OR, 1.7; P = 0.04). In the CODE cohort, multivariate analysis revealed that sensitized subjects reported more wheeze (OR, 5.91; P < 0.01), more nighttime awakening due to cough (OR, 4.20; P = 0.03), increased risk of COPD exacerbations requiring treatment with antibiotics (OR, 3.79; P = 0.02), and acute health visits (OR, 11.05; P < 0.01). An increasing number of sensitizations was associated with a higher risk for adverse health outcomes. Among individuals with COPD, evidence of an allergic phenotype is associated with increased respiratory symptoms and risk of COPD exacerbations.

The impact of COPD on health status: findings from the BOLD study

The aim of this study was to describe the impact of chronic obstructive pulmonary disease (COPD) on health status in the Burden of Obstructive Lung Disease (BOLD) populations.We conducted a cross-sectional, general population-based survey in 11 985 subjects from 17 countries. We measured spirometric lung function and assessed health status using the Short Form 12 questionnaire. The physical and mental health component scores were calculated.Subjects with COPD (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70, n = 2269) had lower physical component scores (44±10 versus 48±10 units, p<0.0001) and mental health component scores (51±10 versus 52±10 units, p = 0.005) than subjects without COPD. The effect of reported heart disease, hypertension and diabetes on physical health component scores (-3 to -4 units) was considerably less than the effect of COPD Global Initiative for Chronic Obstructive Lung Disease grade 3 (-8 units) or 4 (-11 units). Dyspnoea was the most important determinant of a low physical and mental health component scores. In addition, lower forced expiratory volume in 1 s, chronic cough, chronic phlegm and the presence of comorbidities were all associated with a lower physical health component score.COPD is associated with poorer health status but the effect is stronger on the physical than the mental aspects of health status. Severe COPD has a greater negative impact on health status than self-reported cardiovascular disease and diabetes.

A cross-sectional study of secondhand smoke exposure and respiratory symptoms in non-current smokers in the U.S. trucking industry: SHS exposure and respiratory symptoms

BackgroundPrevious studies have suggested associations of adult exposures to secondhand smoke (SHS) with respiratory symptoms, but no study has focused on blue-collar industrial environments. We assessed the association between SHS and respiratory symptoms in 1,562 non-current smoking U.S. trucking industry workers.MethodsInformation on SHS exposure and respiratory health was obtained by questionnaire. Multiple logistic regression analyses were used to assess the associations of recent and lifetime exposures to SHS with chronic phlegm, chronic cough, and any wheeze, defined by American Thoracic Society criteria.ResultsIn analyses adjusted for age, gender, race, childhood SHS exposure, former smoking, pack-years of smoking and years since quitting, body mass index, job title, region of the country, and urban residence, recent exposures to SHS were associated with all three respiratory symptoms (odds ratio (OR) = 1.46; 95% confidence interval (CI) = 1.00-2.13) for chronic cough, 1.55 (95% CI = 1.08-2.21) for chronic phlegm, and 1.76 (95% CI = 1.41-2.21) for any wheeze). Workplace exposure was the most important recent exposure. Childhood exposure to SHS was also associated with all three symptoms, but only statistically significantly for chronic phlegm (OR = 1.84; 95% CI = 1.24-2.75). Additional years of living with a smoker were associated with an increased risk, but there was no evidence of a dose–response, except for chronic phlegm.ConclusionsIn this group of trucking industry workers, childhood and recent exposures to SHS were related to respiratory symptoms.

Respiratory symptoms and illnesses among brick kiln workers: a cross sectional study from rural districts of Pakistan.

BackgroundOccupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work.MethodsThis was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu districts, Sindh, Pakistan. A total of 340 adult men were assessed using translated version of the American Thoracic Society Division of Lung Disease (ATS-DLD) questionnaire. Logistic regression analysis was done to determine the relationship between various socio-demographic and occupational factors (age, education, type of work, number of years at work, smoking status), and the respiratory symptoms and illnesses (chronic cough, chronic phlegm, wheeze, Chronic Bronchitis and asthma).ResultsResults of the study show that 22.4% workers had chronic cough while 21.2% reported chronic phlegm. 13.8% had two or more attacks of shortness of breath with wheezing. 17.1% workers were suffering from Chronic Bronchitis while 8.2% reported physician diagnosed asthma. Amongst the non-smoking workers 8.9% had Chronic Bronchitis. Multivariate analysis found that workers involved in brick baking were more likely to have Chronic Bronchitis (OR= 3.7, 95% CI 1.1-11.6, p=<0.05) and asthma (OR= 3.9, 95% CI 1.01-15.5, p=<0.05) compared to those involved in carriage and placement work.ConclusionA high frequency of respiratory symptoms and illnesses was observed among brick kiln workers. Age, nature of work and smoking were strong predictors of developing these symptoms and illnesses.

Pattern and predictors for respiratory illnesses and symptoms and lung function among textile workers in Karachi, Pakistan

ObjectivesTo determine pattern and predictors for respiratory illnesses and symptoms and lung function among textile workers in Karachi, Pakistan.MethodsThis was a cross-sectional survey of 372 adult male textile workers from...

The Cost of Persistent Asthma in Europe: An International Population-Based Study in Adults

Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30–54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30–54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.

Self-Selection Bias in an Epidemiological Study of Respiratory Health of a Rural Population

ABSTRACT A common source of bias in epidemiological studies is self-selection or volunteer bias. The self-selection into cohorts for further investigation or for participation in a substudy may be an important source of selection bias. The objectives of this paper were to identify differences in selected demographic characteristics, individual and contextual factors, and variables related to respiratory health between study participants who were willing to participate in subsequent clinical and allergy testing and those who were not willing to participate. One hundred and fourteen households (207 individuals) from a small town and 54 households (99 individuals) from a nearby rural municipality participated in this study. One key informant from each household provided information about each adult in that household. The question being studied was: “We wish to find out more about respiratory health of rural people. We would like to invite you to perform breathing and allergy tests. Would you be willing to be contacted for breathing and allergy tests in a nearby location?” One hundred and four participants said “Yes” they would participate in the clinical studies, 144 said “No” they would not participate in the clinical studies, and 52 said “Would like more information” about the clinical studies. More than one half (53.8%) of male participants and 46.2% of female participants indicated that they would like to participate in breathing and allergy tests. A higher proportion of study participants (26.1% males, 30.8% females) in the lowest income category requested more information compared to those answering either “Yes” (15.7% for males, 20.5% for females) or “No” (18.5% males, 23.3% females) to the question being studied. Study participants who were willing to participate in further breathing and allergy tests had a higher proportion of self-reported chronic phlegm and ever had allergic reaction to things eaten than those who either said “No” or “Would like more information.” Among male study participants who said “Yes” to further participation, a higher proportion was exposed to one of the occupational exposures of interest compared to those who said either “No” or “Would like more information.” This pattern was not observed for females.

Respiratory Symptoms in Fish Processing Workers on the Adriatic Coast of Croatia

This article describes respiratory symptoms and lung function in 98 fish processing female workers employed in a fish processing plant located on the Croatian Adriatic coast and 95 matching controls. The study included chronic and acute respiratory symptoms which developed during the shifts. Lung function measurements included forced vital capacity (FVC), one-second forced expiratory volume (FEV(1)) and maximal expiratory rates at 50 % and the last 25 % (FEF(50), FEF(25)). Chronic respiratory symptoms were significantly dominant in fish processing workers compared to controls. The most common chronic symptoms were hoarseness (57.1 %), nasal catarrh (51.0 %), chronic cough (42.9 %), chronic phlegm (34.7 %), and frequent chest cold (35.7 %). Exposed smokers and nonsmokers had a similar prevalence of chronic respiratory symptoms. Acute symptoms over the work shift were high, with headache in lead (smokers: 62.5 %; nonsmokers: 56.1 %). Most of the ventilatory capacity parameters were significantly lower than predicted, FEF(25) in particular, indicating obstructive changes predominantly in the smaller airways. These findings suggest that fish processing workers are prone to developing acute and chronic respiratory symptoms as well as to lung function changes. This calls for medical and technical preventive measures to be introduced in the work environment of the fish processing plant.

Doctor–patient relationship: A resource to improve respiratory diseases management

BackgroundMany respiratory diseases are chronic conditions that are strongly linked with the patient-physician relationship, disease perception and therapy adherence. The aim of the present study was to evaluate patient's viewpoint about the different aspects involved in their respiratory diseases. MethodsThis is a prospective observational survey. 46 Italian medical centres were involved and equally distributed. The interviews were carried out and were performed by means of a questionnaire which consisted of 32 questions regarding lung disease, modality of access to medical facilities, therapy and level of medical assistance. Results1116 patients were enrolled and the most important respiratory symptoms referred were: dyspnoea (69%), chronic phlegm (28%), cough (13%). During programmed visits 98.3% and 98.8% of interviewed patients knew were aware of asthma and COPD respectively, percentage that dropped, during emergency accesses, to 1.7% and 1.1% knew to have asthma and COPD respectively. Primarily were prescribed 1.67 spirometry/patient/year while only the 2% of patients referred to have performed a blood gas analysis. The 18% of patients spontaneously discontinued the therapy, considering it too complex. The average time that patients identified as being used by the doctor to perform the visit was of 22 minutes, with an high mean medical assistance satisfaction score. DiscussionThere has been little research examining what factors may influence patient acceptance and participation of chronic respiratory diseases. Our national survey demonstrated that a good patient-physician relationship represents one of the first points in the successful management of respiratory diseases.

480 Efficacy of a Novel “UES Assist Device” in Management of Supraesophageal Complications of Reflux Disease: the Results of a Limited Clinical Trial

Background:Management of supraesophageal reflux disease complications of poses a significant clinical challenge. Acid suppressive therapy does not prevent volume refluxate into the pharynx and as such in a substantial percentage of these patients outcome of medical management has been disappointing. The efficacy of a novel “UES Assist Device” in preventing of simulated pharyngeal reflux in experimental setting have been recently reported. (Shaker et al. DDW 2010) The aim of the present study was to test the efficacy of the “UES Assist Device” in management of supraesophageal symptoms of reflux disease in a clinical trial. Method: We studied 14 patients with a variety of supraesophageal symptoms most notably chronic cough, excess phlegm and throat clearing referred from GI clinic in our institution. Participants filled out a detailed symptom questionnaire at baseline and following application of the device with randomly applied therapeutic and sub-therapeutic pressure assist. Symptoms were quantified using a 5-pont Likert scale. Each therapeutic modality was tested randomly for 7 days. Result: All patients tolerated the device well and completed the study. There were no complications or complaints for the use of the device. The global symptoms severity and impact score for therapeutic and sub-therapeutic pressure assist was significantly lower than that of the baseline. In addition, therapeutic pressure assist resulted in a significantly lower symptom severity compared to sub-therapeutic pressure assist (p=0.003 ANOVA) . (Figure) Furthermore, therapeutic pressure assist significantly decreased the most bothersome symptom compared to sub-therapeutic pressure assist (p<0.05). Conclusion: “UES Assist Device” is safe and effective in management of supraesophageal complications of reflux disease.

The Impact of Cigarette Smoking on Asthma: A Population-Based International Cohort Study

Background: The prevalence rates of smoking in subjects with asthma have frequently been reported as similar to those in the general population; however, available data are not up-to-date. There is only limited and somewhat conflicting information on the long-term effects of smoking on health outcomes among population-based cohorts of subjects with asthma. We aimed to investigate changes in smoking habits and their effects on forced expiratory volume in 1 s (FEV₁) in subjects with asthma in comparison with the rest of the population, focusing on the healthy smoker effect. Methods: We studied 9,092 subjects without asthma and 1,045 with asthma at baseline who participated in both the European Community Respiratory Health Survey I (20–44 years old in 1991–1993) and II (1999–2002). Results: At follow-up, smoking was significantly less frequent among subjects with asthma than in the rest of the population (26 vs. 31%; p < 0.001). Subjects with asthma who were already ex-smokers at the beginning of the follow-up in the 1990s had the highest mean asthma score (number of reported asthma-like symptoms, range 0–5), probably as a result of the healthy smoker effect (2.80 vs. 2.44 in never smokers, 2.19 in quitters and 2.24 in smokers; p < 0.001). The influence of smoking on FEV₁ decline did not depend on asthma status. Smokers had the highest proportion of subjects with chronic cough/phlegm (p < 0.01). Conclusion: One out of 4 subjects with asthma continues smoking and reports significantly more chronic cough and phlegm than never smokers and ex-smokers. This stresses the importance of smoking cessation in all patients with asthma, even in those with less severe asthma.

Occupation and three-year incidence of respiratory symptoms and lung function decline: the ARIC Study

BackgroundSpecific occupations are associated with adverse respiratory health. Inhalation exposures encountered in these jobs may place workers at risk of new-onset respiratory disease.MethodsWe analyzed data from 8,967 participants from the Atherosclerosis Risk in Communities (ARIC) study, a longitudinal cohort study. Participants included in this analysis were free of chronic cough and phlegm, wheezing, asthma, chronic bronchitis, emphysema, and other chronic lung conditions at the baseline examination, when they were aged 45-64 years. Using data collected in the baseline and first follow-up examination, we evaluated associations between occupation and the three-year incidence of cough, phlegm, wheezing, and airway obstruction and changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) measured by spirometry. All associations were adjusted for age, cigarettes per day, race, smoking status, and study center.ResultsDuring the approximately three-year follow-up, the percentage of participants developing chronic cough was 3%; chronic phlegm, 3%; wheezing, 3%; and airway obstruction, defined as FEV1 < lower limit of normal (LLN) and FEV1/FVC < LLN, 2%. The average annual declines in FEV1 and FVC were 56 mL and 66 mL, respectively, among men and 40 mL and 52 mL, respectively, among women. Relative to a referent category of managerial and administrative support occupations, elevated risks of new-onset chronic cough and chronic phlegm were observed for mechanics and repairers (chronic cough: RR: 1.81, 95% CI: 1.02, 3.21; chronic phlegm: RR: 2.10, 95% CI: 1.23, 3.57) and cleaning and building service workers (chronic cough: RR: 1.85, 95% CI: 1.01, 3.37; chronic phlegm: RR: 2.28, 95% CI: 1.27, 4.08). Despite the elevated risk of new-onset symptoms, employment in cleaning and building services was associated with attenuated lung function decline, particularly among men, who averaged annual declines in FEV1 and FVC of 14 mL and 23 mL, respectively, less than the declines observed in the referent population.ConclusionsEmployment in mechanic and repair jobs and cleaning and building service occupations are associated with increased incidence of respiratory symptoms. Specific occupations affect the respiratory health of adults without pre-existing respiratory health symptoms and conditions, though long-term health consequences of inhalation exposures in these jobs remain largely unexplored.