Chronic Respiratory Conditions Research Articles

The Cost of Medications at a Student-Run Free Clinic in New Haven, Connecticut, 2021–2023

The Cost of Medications at a Student-Run Free Clinic in New Haven, Connecticut, 2021–2023

Elucidating the association of obstructive sleep apnea with brain structure and cognitive performance

BackgroundObstructive sleep apnea (OSA) is a pervasive, chronic sleep-related respiratory condition that causes brain structural alterations and cognitive impairments. However, the causal association of OSA with brain morphology and cognitive performance has not been determined.MethodsWe conducted a two-sample bidirectional Mendelian randomization (MR) analysis to investigate the causal relationship between OSA and a range of neurocognitive characteristics, including brain cortical structure, brain subcortical structure, brain structural change across the lifespan, and cognitive performance. Summary-level GWAS data for OSA from the FinnGen consortium was used to identify genetically predicted OSA. Data regarding neurocognitive characteristics were obtained from published meta-analysis studies. Linkage disequilibrium score regression analysis was employed to reveal genetic correlations between OSA and related traits.ResultsOur MR study provided evidence that OSA was found to significantly increase the volume of the hippocampus (IVW β (95% CI) = 158.997 (76.768 to 241.227), P = 1.51e-04), with no heterogeneity and pleiotropy detected. Nominally causal effects of OSA on brain structures, such as the thickness of the temporal pole with or without global weighted, amygdala structure change, and cerebellum white matter change covering lifespan, were observed. Bidirectional causal links were also detected between brain cortical structure, brain subcortical, cognitive performance, and OSA risk. LDSC regression analysis showed no significant correlation between OSA and hippocampus volume.ConclusionsOverall, we observed a positive association between genetically predicted OSA and hippocampus volume. These findings may provide new insights into the bidirectional links between OSA and neurocognitive features, including brain morphology and cognitive performance.

Human nasal microbiota shifts in healthy and chronic respiratory disease conditions

BackgroundAn increasing number of studies investigate various human microbiotas and their roles in the development of diseases, maintenance of health states, and balanced signaling towards the brain. Current data demonstrate that the nasal microbiota contains a unique and highly variable array of commensal bacteria and opportunistic pathogens. However, we need to understand how to harness current knowledge, enrich nasal microbiota with beneficial microorganisms, and prevent pathogenic developments.ResultsIn this study, we have obtained nasal, nasopharyngeal, and bronchoalveolar lavage fluid samples from healthy volunteers and patients suffering from chronic respiratory tract diseases for full-length 16 S rRNA sequencing analysis using Oxford Nanopore Technologies. Demographic and clinical data were collected simultaneously. The microbiome analysis of 97 people from Lithuania suffering from chronic inflammatory respiratory tract disease and healthy volunteers revealed that the human nasal microbiome represents the microbiome of the upper airways well.ConclusionsThe nasal microbiota of patients was enriched with opportunistic pathogens, which could be used as indicators of respiratory tract conditions. In addition, we observed that a healthy human nasal microbiome contained several plant- and bee-associated species, suggesting the possibility of enriching human nasal microbiota via such exposures when needed. These candidate probiotics should be investigated for their modulating effects on airway and lung epithelia, immunogenic properties, neurotransmitter content, and roles in maintaining respiratory health and nose-brain interrelationships.

TFEB regulates dendritic cell antigen presentation to modulate immune balance in asthma

ObjectiveAsthma stands as one of the most prevalent chronic respiratory conditions in children, with its pathogenesis tied to the actived antigen presentation by dendritic cells (DCs) and the imbalance within T cell subgroups. This study seeks to investigate the role of the transcription factor EB (TFEB) in modulating the antigen presentation process of DCs and its impact on the differentiation of T cell subgroups.MethodsBone marrow dendritic cells (BMDCs) were activated using house dust mites (HDM) and underwent RNA sequencing (RNA-seq) to pinpoint differentially expressed genes. TFEB mRNA expression levels were assessed in the peripheral blood mononuclear cells (PBMCs) of both healthy children and those diagnosed with asthma. In an asthma mouse model induced by HDM, the TFEB expression in lung tissue DCs was evaluated. Further experiments involved LV-shTFEB BMDCs co-cultured with T cells to explore the influence of TFEB on DCs’ antigen presentation, T cell subset differentiation, and cytokine production.ResultsTranscriptomic sequencing identified TFEB as a significantly differentially expressed gene associated with immune system pathways and antigen presentation. Notably, TFEB expression showed a significant increase in the PBMCs of children diagnosed with asthma compared to healthy counterparts. Moreover, TFEB exhibited heightened expression in lung tissue DCs of HDM-induced asthmatic mice and HDM-stimulated BMDCs. Silencing TFEB resulted in the downregulation of MHC II, CD80, CD86, and CD40 on DCs. This action reinstated the equilibrium among Th1/Th2 and Th17/Treg cell subgroups, suppressed the expression of pro-inflammatory cytokines like IL-4, IL-5, IL-13, and IL-17, while augmenting the expression of the anti-inflammatory cytokine IL-10.ConclusionTFEB might have a vital role in asthma’s development by impacting the antigen presentation of DCs, regulating T cell subgroup differentiation, and influencing cytokine secretion. Its involvement could be pivotal in rebalancing the immune system in asthma. These research findings could potentially unveil novel therapeutic avenues for treating asthma.

Precision medicine for respiratory diseases: A current viewpoint.

In the realm of respiratory illnesses, despite the immense costs and efforts invested in diagnosis and treatment, numerous patients with chronic respiratory conditions or malignancies do not respond well to existing therapies. Delayed diagnoses and inadequate treatments contribute to these challenges, along with adverse reactions or treatment limitations due to side-effects. However, recent advancements in understanding respiratory diseases have paved the way for personalized medical treatments, considering individual genetic, molecular and environmental factors. Precision medicine, which accommodates individual differences in disease susceptibility and response to treatments, aims to improve patient care by aligning medical research with tailored therapies. Innovative technologies, such as genomic sequencing and biomarker identification contribute to this approach, allowing for customized treatments and the identification of effective therapies. Additionally, the application of precision medicine in lung cancer treatment exemplifies the forefront of individualized care within respiratory medicine. Several studies have explored the role of precision medicine in managing respiratory infectious diseases, asthma and idiopathic pulmonary fibrosis, aiming to categorize diseases more accurately and design targeted therapies. The ultimate goal is to enhance treatment effectiveness, minimize adverse events, and shift towards a patient-centered approach to managing respiratory conditions. Despite limitations, precision medicine holds promise for improving patient outcomes and emphasizing personalized care in respiratory medicine.

Prévalence de l’asthme et ses conséquences en milieu scolaire à Brazzaville

IntroductionAsthma is the most common chronic respiratory condition in children, affecting 7–10% of the school-age population. The objective of this study was to determine the prevalence and describe the consequences of asthma on the academic course of asthmatic children in Congo. Patients and MethodsWe conducted a cross-sectional study from February 14 to June 30, 2022, in Brazzaville. One class each from the primary and secondary cycles was randomly selected without replacement from 12 institutions, totaling 700 students. Each surveyed student completed a questionnaire and underwent a physical examination and spirometry before and after an exercise challenge. Reversibility testing was performed in cases of identified obstructive syndrome. ResultsThe prevalence of asthma was 7%. The frequency of exercise-induced bronchoconstriction was 10.2% in asthmatics versus 3.2% in non-asthmatics (OR=0.29 [0.07–0.29], P<0.001). Atopy was found in 75.5% of asthmatic cases versus 32% in non-asthmatics (OR=0.15 [0.07–0.29], P<0.001). A significant number of students (42.8%) exhibited persistent and uncontrolled asthma. Our study revealed that 49% (n=24) of asthmatics had at least one absence per year compared to 1.1% (7 cases/651) in non-asthmatics (P<0.001). Asthma motivated the discontinuation of all sports activities in 34.7% (n=17) of cases. Academic delay was observed in 24.5% of asthmatics. ConclusionThe prevalence of asthma in the school environment is significant and has a real impact on the academic trajectory of students. The implementation of an Individualized Action Plan (IAP) would be beneficial to enhance their integration.

BREATHING TECHNIQUES FOR PULMONARY REHABILITATION

Pulmonary rehabilitation (PR) programs, enriched by interdisciplinary approaches, play a pivotal role in enhancing the well-being of subjects with chronic respiratory conditions. Breathing techniques within these programs emerge as key components. Daily deep breathing exercises (DBE) and meditation practices stand out among these techniques. The role of these breathing techniques in addressing depression and anxiety among the elderly is particularly noteworthy, underscoring their potential as valuable non-pharmacological interventions. Employing a comprehensive search strategy, our research integrates evidence from diverse databases and delves into the benefits of breathing techniques in elderly populations, including those with multimorbidities. The findings reveal positive outcomes not only in pulmonary function but also in mental health. This underscores the critical role of such techniques in the holistic well-being of the elderly, shedding light on their potential as impactful elements in comprehensive healthcare strategies.

Root Cause Analysis of Gaps in Non-communicable Disease Monitoring in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative.

Introduction Non-communicable diseases (NCDs) present a significant public health challenge globally, and India is deeply affected. With the largest population in the world, India struggles with a high burden of NCDs, encompassing cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. These ailments contribute substantially to morbidity and mortality, placing a strain on healthcare systems. Despite efforts through public health initiatives, NCD monitoring and management remain deficient, especially at grassroots levels. Methods At a sub-district hospital in Tamil Nadu, India, a quality improvement initiative targeted diabetes and hypertension, prevalent NCDs. Utilizing Fishbone analysis and process flow diagrams, we identified gaps in NCD monitoring. Employing the Plan-Do-Study-Act model and reorienting the patient flow, we enhanced NCD monitoring by optimizing patient health record maintenance within the hospital. Results Root cause analysis identified a lack of patient record protocols and patient loss of records as key hindrances in NCD monitoring. We revamped patient flow and implemented a robust record-keeping system, boosting access to patient health records. This initiative was embraced by healthcare providers, enhancing NCD management. Leveraging these records, we assessed control rates of diabetes and hypertension patients effectively. Conclusion The research underscores the importance of maintaining comprehensive patient health records in healthcare centers for enhancing NCD monitoring. These records serve as valuable tools for healthcare providers, aiding in the monitoring and treatment of patients with diabetes and hypertension. By leveraging these records, healthcare providers can achieve better disease control outcomes, thereby improving the overall management of NCDs.

Potential of Ciplukan Leaf (Physalis Angulate L.) Infusion as A Bronchodilator in Pulmonary Histopathology of Sprague Dawley White Rats

Ciplukan leaves contain alkaloid compounds and exhibit pharmacological activity as bronchodilators. Bronchodilators are utilized in chronic inflammatory respiratory conditions such as asthma, involving various cell types such as mast cells, eosinophils, and epithelial cells. The objective of this study was to evaluate the effectiveness of administering Ciplukan leaf infusion as a bronchodilator. A total of 24 Sprague Dawley rats were divided into 6 groups: normal control (K1), negative control (K2), positive control (K3), 200 mg/kg BW dose (K4), 400 mg/kg BW dose (K5), and 800 mg/kg BW dose (K6). On days 1 and 8, rats were sensitized with 0.35 mg OVA + 1 mg AlOH3 in 0.9% NaCl (i.p). On days 15, 17, and 19, rats were re-sensitized with inhaled OVA. From day 20 to 28, K1 and K2 received no treatment, K3 received 2 mL/day of salbutamol, and the dose groups were administered 2 mL/day of Ciplukan leaf infusion; all treatments were carried out simultaneously. On day 29, rats were dissected, and their lung organs were collected for histopathological preparation. Research findings revealed a reduction in bronchiolar epithelial thickness across groups in the following order: 495.05; 584.95; 334.69; 421.70; 482.81; 484.95 µm. The sequential lung eosinophil counts were 19; 44; 37; 23; 17; and 27, and mast cell counts were 9; 22; 13; 15; 13; and 7. Statistical analysis demonstrated significant differences at the 200 mg/kg BW dose for the parameters of bronchiolar epithelial thickness and eosinophil count, as well as significant differences in mast cell counts at the 800 mg/kg BW dose and negative control group.

The Role of Physiotherapy in Managing Chronic Respiratory Conditions: A Comprehensive Review

Chronic respiratory conditions, including Chronic Obstructive Pulmonary Disease (COPD) and interstitial lung disease, present persistent challenges to respiratory function and holistic well-being. This paper acknowledges the complexity of these conditions and underscores the essential role of physiotherapy interventions within multidisciplinary care approaches. To provide a comprehensive understanding of the management of chronic respiratory conditions, this review explores key physiotherapy interventions such as breathing exercises, airway clearance techniques, and pulmonary rehabilitation programs. The analysis aims to illuminate how these interventions contribute to enhancing respiratory health and overall quality of life. Additionally, this paper briefly outlines its structure, focusing on the evolving landscape of physiotherapeutic strategies. By emphasizing their significance in the comprehensive care paradigm, this review guides individuals navigating the complexities of chronic respiratory diseases towards improved well-being.

Non-Invasive Positive Pressure Ventilation Use-Practice Recommendations of the Slovak Society of Pulmonology and Phthisiology.

Non-invasive positive pressure ventilation (NIPPV) is increasingly used as a treatment method for patients with respiratory failure. The first recommendations for the use of NIPPV in Slovakia were developed by the Slovak Society of Pulmonology and Phthisiology in 2007 and were partially revised in 2015. New scientific evidence prompted the present update, which is based on widely accepted international guidelines and was adapted to address local needs. Important features of the present update include a classification of acute indications for NIPPV into three categories based on the level of supporting evidence, namely 1. definite indications for in-hospital use of NIPPV; 2. possible indications for in-hospital use of NIPPV; and 3. disorders and states in which in-hospital use of NIPPV is not recommended. The current update also reflects the importance of comorbid sleep-related breathing disorders and other chronic respiratory conditions, as well as the use and limitations of continuous positive airway pressure therapy. Since oxygen therapy is often administered along with NIPPV, guidance on the safe use of oxygen in NIPPV-treated patients has also been included. Also, the present update extends the range of its users, addressing the needs of specialists in pediatric respiratory medicine as a novelty.

Compatibility study of formoterol fumarate-lactose dry powder inhalation formulations: Spray drying, physical mixture and commercial DPIs

Formoterol fumarate (FF) is a long-acting beta-adrenergic receptor agonist that is administered as a dry powder inhaler (DPI) for chronic respiratory conditions. In most DPI formulations, the drug substance and the carrier are the two major components. Lactose is the most common carrier, which can undergo a Maillard reaction in the presence of primary and secondary amines. FF contains a secondary amine. Since the potential for Maillard reaction in DPI formulations has not been investigated yet, this study aims to investigate any potential reaction between lactose and FF. The formulations were prepared using a tubular mixer and spray drying techniques. FF and lactose were blended using a tubular mixer (TM FF-Lac). In the spray drying method, FF and lactose were dissolved in distilled water: MeOH and then spray dried (SD FF-Lac). The samples were stored at both ambient conditions and elevated temperature and humidity (40 °C ± 2, 75% ± 5 RH), and subsequently analyzed to identify any signs of incompatibilities. Differential scanning calorimetry (DSC), field emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), thin-layer chromatography (TLC), high-performance liquid chromatography (HPLC), and liquid chromatography-mass spectrometry (LC-MS-MS) were employed for sample analysis. The in vitro aerosolization performance was evaluated using a next-generation impactor (NGI). The results showed that the colour of the DPI formulations changed from white to brown after storage at elevated temperature and humidity. Although the SD FF-Lac had better aerosolization properties, it was more vulnerable to degradation due to its amorphous nature. The FF-lactose adduct was formed in all samples. Interestingly, adduct compounds were also detectable before the storage for stability and stress tests. Incompatibility was confirmed by HPLC-PDA analysis. The mass spectra revealed the m/z of the adduct compound and confirmed the Millard reaction. Browning occurred in the prepared DPI formulations following storage at elevated temperature and humidity. Moreover, adduct compounds were also found in DPI formulations kept at ambient conditions and commercial DPI. Overall, mass spectroscopy was capable of detecting the incompatibility.

Role of the Fungus Pneumocystis in IL1β Pathway Activation and Airways Collagen Deposition in Elastase-Induced COPD Animals.

Inflammation and mucus production are prevalent characteristics of chronic respiratory conditions, such as asthma and chronic chronic obstructive pulmonary disease (COPD). Biological co-factors, including bacteria, viruses, and fungi, may exacerbate these diseases by activating various pathways associated with airway diseases. An example is the fungus Pneumocystis, which is linked to severe COPD in human patients. Recent evidence has demonstrated that Pneumocystis significantly enhanced inflammation and mucus hypersecretion in a rat model of elastase-induced COPD. The present study specifically aims to investigate two additional aspects associated with the pathology induced by Pneumocystis infection: inflammation and collagen deposition around airways. To this end, the focus was to investigate the role of the IL-1β pro-inflammatory pathway during Pneumocystis infection in COPD rats. Several airway pathology-related features, such as inflammation, mucus hypersecretion, and fibrosis, were evaluated using histological and molecular techniques. COPD animals infected with Pneumocystis exhibited elevated inflammation levels, including a synergistic increase in IL-1β and Cox-2. Furthermore, protein levels of the IL-1β-dependent transcription factor cAMP response element-binding (CREB) showed a synergistic elevation of their phosphorylated version in the lungs of COPD animals infected with Pneumocystis, while mucus levels were notably higher in the airways of COPD-infected animals. Interestingly, a CREB responsive element (CRE) was identified in the Muc5b promoter. The presence of CREB in the Muc5b promoter was synergistically increased in COPD animals infected with Pneumocystis compared to other experimental groups. Finally, an increment of deposited collagen was identified surrounding the airways of COPD animals infected with Pneumocystis compared with the other experimental animal groups and correlated with the increase of Tgfβ1 mRNA levels. These findings emphasize the role of Pneumocystis as a potential biological co-factor in chronic respiratory diseases like COPD or asthma, warranting new perspectives in the treatment of chronic respiratory diseases.

N-acetylcysteine Treatment in Chronic Obstructive Pulmonary Disease (COPD) and Chronic Bronchitis/Pre-COPD: Distinct Meta-analyses

IntroductionN-acetylcysteine (NAC) is a mucolytic agent with antioxidant properties. Oxidative stress is a key pathogenic mechanism in chronic respiratory conditions such as COPD and chronic bronchitis (CB). In these meta-analyses we investigated the efficacy of NAC in subjects with COPD or CB, the latter being a potential pre-COPD condition (CB/pre-COPD). MethodsThe meta-analyses were conducted according to PRISMA guidelines. Exacerbations were assessed using total number of exacerbations. Improvement in patients’ respiratory symptoms and/or patients quality of life (QoL) were measured by validated tools or assessed at the end of the study. ResultsTwenty studies were included, of which seven evaluated NAC in patients with symptoms of CB/pre-COPD as entry criterion.NAC treated patients showed a significant reduction of the incidence of exacerbations as compared to placebo both in COPD (IRR=0.76; 95% confidence interval (CI) 0.59–0.99) and CB/pre-COPD (IRR=0.81; 95% CI 0.69–0.95). Sensitivity analyses in studies with duration higher than 5 months, confirmed the overall results.CB/pre-COPD patients treated with NAC were significantly more likely to experience an improvement in symptoms and/or QoL compared to placebo (odds ratio (OR)=3.47; 95% CI 1.92–6.26). A similar trend was observed in the few COPD studies evaluable.Sensitivity analyses showed a significant association of NAC with improvement in symptoms and/or QoL both in CB/pre-COPD and COPD patients. ConclusionsThese findings provide novel data of NAC on the improvement in symptoms and QoL in addition to prevention of exacerbations in COPD and CB/pre-COPD.PROSPERO registry no. CRD42023468154.

START CARE: a protocol for a randomised controlled trial of step-wise budesonide-formoterol reliever-based treatment in children.

Asthma is the most common chronic childhood respiratory condition globally. Inhaled corticosteroid (ICS)-formoterol reliever-based regimens reduce the risk of asthma exacerbations compared with conventional short-acting β2-agonist (SABA) reliever-based regimens in adults and adolescents. The current limited evidence for anti-inflammatory reliever therapy in children means it is unknown whether these findings are also applicable to children. High-quality randomised controlled trials (RCTs) are needed. The study aim is to determine the efficacy and safety of budesonide-formoterol reliever alone or maintenance and reliever therapy (MART) compared with standard therapy: budesonide or budesonide-formoterol maintenance, both with terbutaline reliever, in children aged 5 to 11 years with mild, moderate and severe asthma. A 52-week, multicentre, open-label, parallel group, phase III, two-sided superiority RCT will recruit 400 children aged 5 to 11 years with asthma. Participants will be randomised 1:1 to either budesonide-formoterol 100/6 µg Turbuhaler reliever alone or MART; or budesonide or budesonide-formoterol Turbuhaler maintenance, with terbutaline Turbuhaler reliever. The primary outcome is moderate and severe asthma exacerbations as rate per participant per year. Secondary outcomes are asthma control, lung function, exhaled nitric oxide and treatment step change. Assessment of Turbuhaler technique and cost-effectiveness analysis are also planned. This will be the first RCT to compare the efficacy and safety of a step-wise budesonide-formoterol reliever alone or MART regimen with conventional inhaled ICS or ICS-long-acting β-agonist maintenance plus SABA reliever in children. The results will provide a much-needed evidence base for the treatment of asthma in children.

A protocol for adapting a clinical practice guideline for the treatment of paediatric asthma for the Egyptian Pediatric Clinical Practice Guidelines Committee

AbstractIntroductionPaediatric asthma is a prevalent and chronic respiratory condition affecting children worldwide. This protocol outlines the methodology for developing a clinical practice guideline (CPG) for the management of paediatric asthma. The goal of this guideline is to provide evidence‐based recommendations for healthcare professionals, improving the quality of care and health outcomes for paediatric patients with asthma.MethodsWe will use the ‘Adapted ADAPTE’ adaption method, a systematic approach to adapt existing guidelines, which consists of three phases (setup, adaptation and finalisation phases), nine modules and 24 steps, with adaptations to the process and tools to suit the Egypt healthcare context and resources.QuestionsClinical questions were prepared using the patient population, interventions, professionals, outcomes and healthcare context (PIPOH) model. This CPG protocol addresses critical clinical questions at the heart of effective asthma management in children. It focuses on the diagnosis of paediatric asthma, considering age‐specific clinical presentations and diagnostic tests, assessment of asthma severity, control medications like inhaled corticosteroids, long‐acting β‐agonists and others, with an emphasis on appropriate tools and criteria. The CPG also delves into the realm of long‐term control treatment, exploring the effectiveness and safety of pharmacological and nonpharmacological interventions, while considering individualised needs. Furthermore, it examines strategies for monitoring and adjusting treatment plans over time, ensuring optimal care. These clinical questions form the foundation of the CPG, facilitating evidence‐based care delivery and enhancing health outcomes for paediatric asthma patients.

Prevalence of Bronchial Asthma among Secondary School Students

Background: Bronchial asthma, a prevalent chronic respiratory condition, poses a significant health concern among secondary school students in Bangladesh, particularly in the bustling urban centers with associated environmental challenges. Objective: This study aimed to determine the prevalence of bronchial asthma and its associated factors among secondary school students. Method: This cross-sectional study, conducted from January to June 2023, aimed to assess the prevalence of bronchial asthma among 250 secondary school students (aged 10-15 yrs) in Bangladesh. The study employed a structured questionnaire, including the International Study of Asthma and Allergies in Childhood (ISAAC) asthma questionnaire, to collect socio-demographic details and assess asthma prevalence. Results: The findings revealed a mean age of 12.9 years, with an equal distribution of males and females. Notably, 11.6% had been diagnosed with asthma by a doctor. Factors such as sex, age, monthly family income, history of childhood pneumonia, and passive smoking exposure showed significant associations with bronchial asthma. Logistic regression analysis identified being male (OR=2.32, p=0.042), a history of childhood pneumonia (OR=3.10, p=0.007), and maternal asthma (OR=2.739, p=0.032) as predictors of bronchial asthma. The prevalence was higher in males and those with a history of childhood pneumonia or maternal asthma. Conclusion: This study emphasizes the need for comprehensive health initiatives targeting the identified risk factors to mitigate the impact of bronchial asthma on the health and academic performance of secondary school students in Bangladesh. Addressing childhood pneumonia and reducing passive smoking exposure are crucial strategies for preventing the development of bronchial asthma in this vulnerable population.

A Comprehensive Metagenome Study Identifies Distinct Biological Pathways in Asthma Patients: An In-Silico Approach.

Asthma is a multifactorial disease with phenotypes and several clinical and pathophysiological characteristics. Besides innate and adaptive immune responses, the gut microbiome generates Treg cells, mediating the allergic response to environmental factors and exposure to allergens. Because of the complexity of asthma, microbiome analysis and other precision medicine methods are now widely regarded as essential elements of efficient disease therapy. An in-silico pipeline enables the comparative taxonomic profiling of 16S rRNA metagenomic profiles of 20 asthmatic patients and 15 healthy controls utilizing QIIME2. Further, PICRUSt supports downstream gene enrichment and pathway analysis, inferring the enriched pathways in a diseased state. A significant abundance of the phylum Proteobacteria, Sutterella, and Megamonas is identified in asthma patients and a diminished genus Akkermansia. Nasal samples reveal a high relative abundance of Mycoplasma in the nasal samples. Further, differential functional profiling identifies the metabolic pathways related to cofactors and amino acids, secondary metabolism, and signaling pathways. These findings support that a combination of bacterial communities is involved in mediating the responses involved in chronic respiratory conditions like asthma by exerting their influence on various metabolic pathways.

Managing Pediatric Asthma Exacerbations: The Role of Timely Systemic Corticosteroid Administration in Emergency Care Settings-A Multicentric Retrospective Study.

Asthma is the most prevalent chronic respiratory condition in children. An asthma exacerbation (AE) is a frequent reason for emergency department (ED) visits. An important step in the management of a moderate to severe AE is the administration of systemic corticosteroids (SCS) within 1 h after ED presentation. This study aimed to determine the timing of SCS administration and correlate this with the length of stay and oxygen therapy duration and to explore factors predicting timely administration. This study used a retrospective multicenter observational design based on electronic medical records review. Children aged < 18 years, presenting to the ED with a moderate to severe AE were included. 205 patients were included. Only 28 patients received SCS within 60 min after ED arrival. The median time to SCS administration was 169 min (Q1 92-Q3 380). A correlation was found between timing and oxygen treatment duration (r = 0.363, p < 0.001) and length of stay (r = 0.368, p < 0.001). No patient characteristics predicted timely SCS administration. Three in four children who presented with a moderate to severe AE at the ED did not receive SCS within the first hour. A prolonged timing of SCS administration correlated with a prolonged length of stay and extended need for oxygen support.

A survey on awareness of the disease and pulmonary rehabilitation in bronchial asthma patients in the United Arab Emirates.

Asthma, a prevalent and severe chronic respiratory condition, can be significantly managed and controlled through informed awareness about the disease and pulmonary rehabilitation strategies, thereby enhancing patients' health-related quality of life. To determine the knowledge and awareness of Bronchial asthma and pulmonary rehabilitation among asthma-diagnosed patients in the United Arab Emirates. Utilizing a cross-sectional study design, 237 asthma patients, aged 18 and above, were recruited from the Royal NMC Hospital, Sharjah. A comprehensive questionnaire was administered, focusing on two critical domains: understanding of the disease and knowledge about pulmonary rehabilitation. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 26. The majority of participants (31.6%) reported the onset of asthma before reaching two years of age. Bronchodilators emerged as the most used medication, utilized by 31.6% of the respondents. Weather conditions (34.6%) were identified as the most prevalent risk factor. Chi-square tests revealed no significant correlations between gender and knowledge about asthma (p = 0.278) or pulmonary rehabilitation awareness (p = 0.929). A negative correlation was found between age and knowledge about asthma (p<0.001), but not with pulmonary rehabilitation awareness (p = 0.731). Education demonstrated no significant association with either knowledge about asthma (p = 0.974) or awareness of pulmonary rehabilitation (p = 0.676). The study implies that most people have a basic understanding of asthma. However, there are still significant gaps in their knowledge. For instance, many aren't sure how asthma is influenced by exercise or which parts of the body are affected. Also, understanding about therapies such as lung rehabilitation, and the contributions physical therapists can make in addressing lung problems, is only average. Interestingly, these knowledge gaps are not related to a person's age or their educational background.