Chronic Respiratory Conditions Research Articles

Patient autonomy in self-managing their bronchial asthma exacerbation and its associated factors, 2024

IntroductionAsthma, a global chronic respiratory condition, varies in patient autonomy due to limited resources, health literacy, and cultural beliefs, emphasizing the importance of understanding this autonomy for improved asthma management.MethodsA cross-sectional study was conducted at Jimma University Comprehensive Specialized Hospital, involving face-to-face interviews with 175 patients. Data was collected on sociodemographic characteristics, clinical factors, and autonomy levels using a validated Patient Autonomy Preference Index. Descriptive statistics and binary logistic regression analysis were used.ResultsA total of 175 participants were recruited, out of them 41.7% (95% CI: 31.19, 40.41)) of participants were autonomous in managing their asthma exacerbation. 127 (72.6%) of study participants were female, with a mean age of 47.51 (SD ± 13.96), 101(57.7%) were live in urban areas, 54 (30.9%) had no formal education, 140 (80%) were married, 112 (64%) had health insurance, and 102(83.3%) obtained health information about their condition from healthcare workers. Reside in an urban area (AOR = 3.24; 95% CI: 1.40–7.49, p < 0.006), have health insurance (AOR = 4.30; 95% CI: 1.76–10.51, p < 0.001), those doing regular exercise (AOR = 4.79; 95% CI: 1.69–13.64, p < 0.003), have family history (AOR = 7.47; 95% CI: 1.61–34.60, p < 0.01), have a duration above five years since diagnosis (AOR = 0.44; 95% CI: 1.04–1.26, p < 0.003), and participants with a high level of health literacy (AOR = 1.10; 95% CI: 1.00–1.20, p < 0.042) become associated with being autonomous in managing asthma exacerbation.Conclusion and recommendationOnly around forty-two percent of study participants were autonomous in managing their asthma exacerbation. Thus healthcare providers should give due attention to those who reside in rural areas, are not insured, recently diagnosed with asthma, and with low health literacy to enhance patient autonomy and self-management practices, ultimately improving health outcomes for individuals with asthma.

Inhibition of long non-coding RNA NEAT1 suppressed the epithelial mesenchymal transition through the miR-204-5p/Six1 axis in asthma.

Asthma, a prevalent chronic respiratory condition, is characterized by airway remodeling. Long non-coding RNA (lncRNA) NEAT1 has been demonstrated to participate in airway fibrosis. Furthermore, the miR-204-5p/Six1 axis significantly influences epithelial mesenchymal transition (EMT). However, the function of NEAT1/miR-204-5p/Six1 in asthmatic EMT remains unclear. This study intends to elucidate the function of NEAT1/miR-204-5p/Six1 axis in asthmatic EMT. TGF-β1 was used to induce the EMT model in BEAS-2B cells. Immunofluorescence and western blot were executed to verify the establishment of the EMT model. NEAT1, miR-204-5p, and Six1 expression levels were evaluated using RT-qPCR. The role of NEAT1 in EMT in vitro was explored by CCK8 assays and flow cytometry. The luciferase reporter assay was performed to validate the interaction between NEAT1 and miR-204-5p/Six1. NEAT1 expression was increased during EMT. Functional experiments showed that the knockdown of NEAT1 suppressed cell proliferation and promoted cell apoptosis in vitro. Furthermore, inhibition of NEAT1 decreased the expression of N-cadherin, vimentin, and α-SMA and increased the expression of E-cadherin. Mechanistically, NEAT1 was identified as a sponge for miR-204-5p, and Six1 was found to be a direct target of miR-204-5p. Down-regulation of NEAT1 reduced the Six1 expression via targeting miR-204-5p to inhibit the process of EMT in asthma. This study may provide new insight to reveal the underlying mechanisms of asthma.

An Agent-Based "Virtual Clinical Trial" for the Analysis and Evaluation of COPD Patients Cohorts Behavior

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms such as shortness of breath, coughing, and chest tightness. Treatment typically involves lifestyle adjustments, medication, and pulmonary rehabilitation to improve lung function and quality of life. This study presents a model examining COPD patient behavior within cohort-based strategies, focusing on how environmental factors impact vital signs across the entire cohort. We developed a comprehensive virtual clinical trial model that encompasses study protocol design, participant recruitment, virtual data collection, outcome analysis, and conclusions. This includes remote symptom monitoring, virtual healthcare consultations, treatment adherence assessments, and research data collection. Additionally, we explore the influence of external variables such as environmental conditions, comorbidities, and lifestyle factors on chronic disease symptoms and disease stability. We used an Agent-Based Model(ABM) to incorporate these factors to assess COPD progression and treatment efficacy. Individual agents represent COPD patients, each characterized by attributes such as age, smoking history, lung function, comorbidities, and treatment plans.

Regulation of Airway Epithelial-Derived Alarmins in Asthma: Perspectives for Therapeutic Targets.

Asthma is a chronic respiratory condition predominantly driven by a type 2 immune response. Epithelial-derived alarmins such as thymic stromal lymphopoietin (TSLP), interleukin (IL)-33, and IL-25 orchestrate the activation of downstream Th2 cells and group 2 innate lymphoid cells (ILC2s), along with other immune effector cells. While these alarmins are produced in response to inhaled triggers, such as allergens, respiratory pathogens or particulate matter, disproportionate alarmin production by airway epithelial cells can lead to asthma exacerbations. With alarmins produced upstream of the type 2 inflammatory cascade, understanding the pathways by which these alarmins are regulated and expressed is critical to further explore new therapeutics for the treatment of asthmatic patients. This review emphasizes the critical role of airway epithelium and epithelial-derived alarmins in asthma pathogenesis and highlights the potential of targeting alarmins as a promising therapeutic to improve outcomes for asthma patients.

Degree of Airway Obstruction and Contributing Factors, Exploring Potential Mismatches and Pitfalls

BACKGROUND: The study investigates asthma, a chronic inflammatory respiratory condition that poses diagnostic challenges due to its variable symptoms, highlighting the importance of accurate documentation and interpretation. It aims to explore the demographic and clinical profiles of asthma patients, particularly focusing on the relationships among airway obstruction severity, spirometric measurements, atopic history, and family history to reveal the complex factors influencing asthma. AIMS: Employing a retrospective descriptive-analytic design, the research analyzes medical records of 107 patients treated at the Outpatient Installation of the Lung Polyclinic at Wlingi General Hospital in Blitar Regency from 2021 to 2022. The analysis incorporates descriptive statistics for demographic and clinical variables alongside Spearman correlation tests. METHOD: Results indicate a significant prevalence of smoking history among asthma patients, with 22.4% being active smokers and 52.3% passive smokers; however, no significant correlation with asthma control was found. Environmental risk factors such as dust and cold air were common but did not consistently correlate with asthma exacerbations. Spirometric analysis revealed a significant relationship between airway obstruction severity and parameters like FEV1, FVC, FEV1/FVC, PEF, FEF 25, FEF 50, and FEF 75, emphasizing the link between airflow obstruction and reduced lung function. Furthermore, no significant correlation was observed between stable asthma diagnosis and atopic or family history, suggesting that asthma control is influenced by various complex factors. CONCLUSION: Our research reveals critical pitfalls in the current understanding of asthma, advocating for a comprehensive evaluation of all contributing factors to enhance diagnostic accuracy and treatment efficacy. Recognizing these complexities is essential for improving asthma management and ensuring better health outcomes for patients.

Impact of bacterial co-isolation on treatment initiation and long-term prognosis of patients with nontuberculous mycobacterial pulmonary disease: analysis of a prospective cohort study.

Nontuberculous mycobacterial pulmonary disease (NTM-PD), a chronic respiratory condition, presents a growing challenge globally. Uncertainties exist regarding the impact of concurrent bacterial co-isolation on treatment initiation and long-term prognosis. This study analysed data from participants enrolled in an ongoing prospective observational cohort study on NTM-PD (NCT01616745) between 1 July 2011, and 31 December 2022, who provided sputum samples for bacterial culture at enrolment. Identification of potential pathogenic microorganisms (PPMs) was defined as a positive bacterial culture. Clinical characteristics were compared between NTM-PD patients with Pseudomonas, non-pseudomonal PPMs, and those without PPM co-isolation. Cox proportional hazard regression models were employed to assess the association of bacterial co-isolation with rates of NTM-PD treatment initiation and all-cause mortality. Overall, 453 patients (median age, 62 years; 30% male) were included in the analysis. PPMs were co-isolated in 77 patients (17%), including 13 with Pseudomonas species. Co-isolation of Pseudomonas was associated with a significantly higher erythrocyte sedimentation rate (P = 0.02) and St. George's Respiratory Questionnaire score (P = 0.01). Non-pseudomonal PPM co-isolation was significantly associated with a higher likelihood of NTM-PD treatment initiation (adjusted hazards ratio [aHR], 1.56, 95% confidence interval [CI], 1.03-2.36, P = 0.036), whereas co-isolation of Pseudomonas was independently correlated with increased all-cause mortality (aHR, 3.25, 95% CI, 1.08-9.84, P = 0.037). Our findings emphasize the importance of microbial surveillance, as bacterial co-isolation affects treatment initiation and prognosis in patients with NTM-PD.

Asthma Care Chatbot

Asthma is a chronic respiratory condition affecting millions of people worldwide, characterized by inflammation and narrowing of the airways, leading to symptoms such as coughing, wheezing, and shortness of breath. Managing asthma effectively requires timely intervention and personalized care to alleviate symptoms and prevent exacerbations. In this context, the Asthma Care Chatbot serves as an innovative solution to assist individuals in managing their asthma symptoms more efficiently. Leveraging advancements in technology and machine learning, this chatbot provides personalized recommendations based on user-reported symptoms, age, and gender. By integrating a user-friendly graphical interface, the chatbot aims to enhance accessibility and usability for individuals seeking guidance on managing their asthma condition. This project utilizes a machine learning model trained on a dataset comprising asthma severity data to predict the severity of symptoms reported by users. Through an intuitive interface, users can input their symptoms, demographic information, and receive real-time predictions regarding the severity of their asthma symptoms. Based on the predicted severity level, the chatbot offers tailored recommendations, ranging from self-care measures to prompt medical intervention. Furthermore, the chatbot's performance is evaluated using various metrics such as accuracy, precision, recall, and F1 score, ensuring its reliability and effectiveness in providing accurate predictions. By continuously refining its recommendations based on user feedback and data-driven insights, the Asthma Care Chatbot aims to empower individuals to take proactive steps in managing their asthma condition and improving their quality of life. Asthma Care Chatbot represents a pioneering approach towards personalized asthma management, bridging the gap between individuals and accessible healthcare solutions through the integration of technology and machine learning. By offering personalized guidance and support, the chatbot endeavours to empower individuals in effectively managing their asthma symptoms and promoting better.

Developing Model-Agnostic Meta-Learning Enabled Lightbgm Model Asthma Level Prediction in Smart Healthcare Modeling

Millions of people across the world suffer from the chronic respiratory condition known as asthma. Predicting the severity of asthma based on a variety of personal and environmental characteristics might yield useful information for preventative measures. LightGBM model is a gradient-boosted model with the potential for great accuracy, but it requires careful hyperparameter adjustment to reach its full potential. Common tuning techniques have a hard time generalizing to new data distributions. The dataset was used, and its many subsets were used to represent various demographics and geographic areas. LightGBM was configured with hyperparameters, trained on a sample dataset, and then verified for each job. To quickly adjust to new tasks, the MAML method sought to find the optimal values for its hyperparameters. After the meta-training step was complete, the generalizability of the hyperparameters was tested on new data. After including MAML for hyperparameter adjustment, the Light- GBM model showed a gain of 7% in accuracy, coming in at 98.5%. Predictions of severe asthma had a crucially high 97.8 percent degree of accuracy. The model’s recall rate for severe asthma levels was 97.4%, demonstrating its capacity to reliably detect and anticipate important instances. An F1-score of 97.1%, a metric that averages the accuracy and recall of a model, is indicative of good overall performance.. For gradient-boosted model applications like asthma level prediction, MAML provides a viable path for hyperparameter adjustment. Although there are obstacles to be overcome, this method has the potential to greatly improve the flexibility and precision of predictive healthcare models. More effective implementations and a wider range of applications can be explored in future studies.

Late-Onset Asthma: A Review

Asthma is a chronic respiratory condition with a growing global prevalence, affecting millions of individuals annually. While asthma can develop at any age, late-onset asthma is a specific phenotype that begins in adulthood, as recognized by the Global Initiative for Asthma (GINA) in its 2024 guidelines. This form of asthma is often associated with several predisposing factors, including gender, obesity, occupational exposure, rhinitis, respiratory infections, smoking, stress, and diminished lung function. Unlike early-onset asthma, which frequently involves a history of allergies, late-onset asthma tends to lack allergic triggers, making it a distinct and challenging form of the disease. Managing late-onset asthma is often more complex, as it typically requires higher doses of corticosteroids and demonstrates a reduced responsiveness to standard steroid treatments. The exact mechanisms and pathophysiological processes contributing to the increased severity and poorer clinical outcomes in late-onset asthma remain largely unclear. This uncertainty often leads to underdiagnosis and inadequate management, further complicating patient care. Phenotypic analysis is recommended to improve treatment outcomes. This includes assessing clinical features and utilizing biomarkers, such as inflammatory markers and immunoglobulin E (IgE) levels, to guide targeted therapy when conventional steroid treatments are insufficient. However, there is a significant need for further research to elucidate the underlying mechanisms of late-onset asthma. This literature review is essential to develop more effective, personalized treatment strategies that can address the unique challenges posed by this asthma phenotype, ultimately leading to better management and improved patient outcomes.

Optimising Outcomes For Those With Chronic Respiratory Disease: Detecting Frailty In The Respiratory OPD

Abstract Background Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital. Methods A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of >5. Results A total of 25 patients were included in the study. Frailty (CFS score of >5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients. Conclusion This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.

Evaluating Health Policy Effectiveness in Reducing the Economic Burden of Non-Communicable Diseases in Bangladesh

Non-communicable diseases (NCDs) represent a significant and growing public health challenge in Bangladesh, contributing to a substantial economic burden. Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, chronic kidney disease, cancers, and chronic respiratory conditions, represent a major health challenge in Bangladesh, contributing to substantial morbidity, mortality, and economic burden. The economic impact is profound, affecting both individuals and the broader economy through healthcare costs, loss of productivity, and long-term financial strain. This review aims to evaluate the effectiveness of health policies in mitigating the economic burden of NCDs in Bangladesh. The article begins with an overview of the prevalence and risk factors associated with NCDs, followed by an examination of the national health policies aimed at prevention, treatment, and management. The evaluation considers both successes and challenges, with a focus on policy implementation, healthcare financing, and access to care. Case studies highlight specific policy interventions that have demonstrated measurable success in reducing NCD prevalence and associated costs. The findings suggest that while significant progress has been made in policy formulation, challenges remain in ensuring comprehensive implementation and equitable access to healthcare services. Cost-effective strategies, such as scaling up preventive measures and improving healthcare infrastructure, are essential for reducing the economic burden of NCDs. The review concludes with recommendations for strengthening existing policies and exploring innovative approaches to sustain and enhance the impact of health policies on NCD management in Bangladesh.

A comprehensive review of Mycoplasma pneumoniae infection in chronic lung diseases: recent advances in understanding asthma, COPD, and bronchiectasis.

This review summarizes the research progress over the past 30 years on the relationship between Mycoplasma pneumoniae infection and chronic respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, particularly in children and young adults. Key findings from recent studies indicate that M. pneumoniae infection is associated with a higher risk of asthma exacerbations and may contribute to the development of bronchiectasis in susceptible individuals. Additionally, emerging evidence suggests that M. pneumoniae-induced immune dysregulation plays a crucial role in the pathogenesis of chronic lung diseases. This review aims to summarize the current understanding of the potential links between M. pneumoniae pneumonia and various chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. We discuss the epidemiological data, pathogenic mechanisms, clinical manifestations, and long-term consequences of M. pneumoniae-related respiratory illnesses. Additionally, we highlight the challenges in diagnosis and treatment, as well as future research directions in this field.

Very Rare Case of Pulmonary Lepidic Adenocarcinoma at a Young Age Man

Introduction: Lung cancer remains one of the higher prevalence of cancer and leading cause of death in the world. Smoking and genetic factors are two important etiologies in lung cancer. Adenocarcinoma is the most common type of non-small cell lung carcinoma. Lepidic predominant adenocarcinoma is one type of adenocarcinoma that has a good prognosis. Case Illustration: A 24-year-old male came with chronic cough and chest pain. He had a history of smoking and no prior family history of cancer. Plain chest Xray and Thorax computed tomography (CT) showed pleural effusion and presence of lung mass with suggestion of bone and liver involvement, respectively. The cytology from pleural effusion and bronchial lavage initially found no malignancy cell. Later thoracostomy biopsy and pathology study suggested lepidic adenocarcinoma. Discussion: Lung cancer is still one of the leading causes of death in men. Even though rarely found in young male, patients with a history of smoking or genetic factor with clinical manifestation suggestive chronic respiratory condition with weight loss should be suspected of the diagnosis. Adenocarcinoma, as the most common non-small cell lung carcinoma, could be later divided into several subtypes. Lepidic adenocarcinoma is distinguished by the pathology finding of a large invasion focus of stromal, lymphatic, vascular, or pleural space. Considered one of the most favorable, lepidic predominant adenocarcinoma has a very high rate of 5 year survival when diagnosed early and responds well to lobe resection. Advanced state however has poor outcome due to limited choice of therapy. Promising trial of targeted chemotherapy have been reported and could improve outcome in the future. Conclusion: Lung cancer in young male is a rare disease but should be suspected in those with chronic cough, chest pain and weight loss. The history of smoking and family history are crucial for this suspicion. Lepidic predominant adenocarcinoma has a good prognosis when diagnosed early. Studies in the future could enhance overall survival in these patients.

Regulations of Immune Response by Astragalus in Animal Asthma Models: A Meta-analysis

Background Asthma is a chronic respiratory condition by airway inflammation. Traditional Chinese medicine, is commonly used to treat it. Astragalus is known for its immunoregulation, anti-inflammatory, and antioxidant effects. Purpose To systematically evaluate the efficacy of Astragalus in asthma animal models using meta-analysis methods. Methodology A systematic search was performed in various databases, such as China National Knowledge Infrastructure (CNKI), WanFang Data, PubMed, Web of Science, and Cochrane Library databases for animal studies on Astragalus intervention in asthma models, with the search period extending up to September 2023. Two researchers performed independent literature screening and data extraction. The quality of the included studies was assessed by the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) animal experiment bias risk assessment tool. Meta-analysis was performed with RevMan (version 3.6.1). Results A total of 25 experiments were included. Meta-analysis indicated that Astragalus can significantly reduce total leukocytes, neutrophils, lymphocytes, and eosinophils in animal models of asthma. It also downregulated the expression levels of interleukin-4 and interleukin-5, while upregulation of interferon-γ and interleukin-10 expression was observed; however, the impact on macrophages was found to be not statistically significant ( p > 0.05). Conclusion Our systemic review suggested the potential efficiency of Astragalus in asthma treatment in China, although its mechanism is still unclear. The functions of Astragalus may be associated with attenuating airway inflammation through the regulation of immune response.

COPD 2024: Applying the Canadian Thoracic Society (CTS) 2023 Chronic Obstructive Pulmonary Disease (COPD) Guideline for Preventing Exacerbations, Improving Health Status, and Preventing Mortality

Chronic Obstructive Pulmonary Disease (COPD) is a common, chronic respiratory condition that is associated with the risk of morbidity and mortality. Approximately 2 million Canadians live with COPD, and as many as 1 million suffer while remaining undiagnosed and untreated. COPD exacerbations represent the most expensive cause of hospitalization with the highest likelihood of hospital readmission. Exacerbations are the primary driver of mortality in patients with COPD. These exacerbations are the second leading cause of hospitalization in Canada with an average length of stay of 7 days. In fact, 1 in 5 patients with COPD will die within 1 year of their first hospitalization due to an exacerbation. For those 65 or older in Ontario, the overall 365-day mortality stands at nearly 28% following their first hospitalization due to an exacerbation. The best indicator of the risk of future exacerbations is a history of exacerbations. The time has come to end the stepwise pharmacologic escalation that has defined the treatment paradigm in COPD. The call to action is to shift from the slow promotion of inhaled pharmacotherapy based on exacerbations to a direct escalation to inhaled pharmacotherapy with demonstrated evidence to prevent the exacerbations.

Recent Advances in Allergic Rhinitis: A Narrative Review.

Allergic rhinitis (AR) is a prevalent chronic respiratory condition characterized by nasal inflammation, sneezing, congestion, and itching, significantly impacting quality of life. Over recent years, considerable advancements have been made in understanding the pathophysiology, diagnosis, and management of AR. This narrative review aims to synthesize these recent developments, providing a comprehensive overview of key areas. Emerging insights into AR pathophysiology have elucidated the complex interplay between genetic predisposition, environmental factors, and immune system dysregulation. Notably, the role of the epithelial barrier and the microbiome in AR pathogenesis has garnered increasing attention, offering potential targets for novel therapies. Advances in diagnostic technologies, such as component-resolved diagnostics and molecular allergology, have enhanced the precision of allergy identification, enabling more personalized treatment approaches. In terms of management, significant progress has been made in pharmacological and non-pharmacological treatments. Novel biologics targeting specific pathways involved in AR, including monoclonal antibodies against immunoglobulin (Ig)E and interleukin (IL)-4/13, have shown promise in reducing symptoms in refractory cases. Additionally, there has been a resurgence in interest in non-pharmacological strategies, including allergen avoidance, immunotherapy, and complementary therapies, which offer holistic options for patient care. The integration of digital health tools and mobile applications in AR management has further empowered patients, allowing for real-time symptom tracking and personalized treatment adjustments. Recent guidelines emphasize a multidisciplinary approach to AR management, promoting integrated care models that involve collaboration between allergists, primary care providers, and other specialists. These guidelines also highlight the importance of patient-centered care, advocating for shared decision-making and tailored treatment plans based on individual patient profiles. In conclusion, the landscape of allergic rhinitis management is rapidly evolving, with ongoing research and innovation paving the way for improved outcomes. This review underscores the importance of staying abreast of these advances to optimize the care and quality of life for individuals affected by allergic rhinitis.

Construction of circRNA-mediated ceRNA network and immunoassay for investigating pathogenesis of COPD.

The chronic respiratory condition known as chronic obstructive pulmonary disease (COPD) was one of the main causes of death and disability worldwide. This study aimed to explore and elucidate new targets and molecular mechanisms of COPD by constructing competitive endogenous RNA (ceRNA) networks. GSE38974 and GSE106986 were used to select DEGs in COPD samples and normal samples. Cytoscape software was used to construct and present protein-protein interaction (PPI) network, mRNA-miRNA co-expression network and ceRNA network. The CIBERSORT algorithm and the Lasso model were used to screen the immune infiltrating cells and hub genes associated with COPD, and the correlation between them was analyzed. COPD cell models were constructed in vitro and the expression level of ceRNA network factors mediated by hub gene was detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). In this study, 852 differentially expressed genes were screened in the GSE38974 dataset, including 439 upregulated genes and 413 downregulated genes. Gene clustering analysis of PPI network results was performed using the Minimum Common Tumor Data Element (MCODE) in Cytoscape, and seven hub genes were screened using five algorithms in cytoHubba. CCL20 was verified as an important hub gene based on mRNA-miRNA co-expression network, GSE106986 database validation and the analysis of ROC curve results. Finally, we successfully constructed the circDTL-hsa-miR-330-3p-CCL20 network by Cytoscape. Immune infiltration analysis suggested that CCL20 can co-regulate immune cell migration and infiltration through chemokines CCL7 and CXCL3. In vitro experiments, the expression of circDTL and CCL20 was increased, while the expression of hsa-miR-330-3p was decreased in the COPD cell model. By constructing the circDTL-hsa-miR-330-3p-CCL20 network, this study contributes to a better understanding of the molecular mechanism of COPD development, which also provides important clues for the development of new therapeutic strategies and drug targets.

Telemedicine in Pediatric Respiratory Care: Benefits, Challenges, and Future Directions

This study explores the impact of telemedicine on pediatric respiratory care, focusing on its benefits, challenges, and future directions. A mixed-methods approach was employed, involving 150 pediatric patients with chronic respiratory conditions such as asthma and cystic fibrosis, who were randomly assigned to either telemedicine or traditional care groups. The telemedicine group used a digital platform for video consultations, remote monitoring, and health management over a 12-month period. Quantitative data on clinical outcomes, including emergency department visits and hospitalizations, were collected from electronic health records, while patient-reported outcomes were assessed through surveys. Qualitative data were gathered via semi-structured interviews with patients and caregivers. Results indicated that the telemedicine group experienced significantly fewer emergency visits and hospitalizations, higher quality of life scores, better treatment adherence, and greater patient satisfaction compared to the traditional care group. Average oxygen saturation and peak flow rates were also higher in the telemedicine group, and more frequent monitoring alerts were noted.

545. HIATAL HERNIA RECURRENCE: IS OBSTRUCTIVE SLEEP APNEA A RISK FACTOR?

Abstract Background A plausible mechanism explaining how obstructive sleep apnea (OSA) triggers gastroesophageal reflux disease (GERD) through hiatal hernia (HH) has been proposed but also ignored in clinical practice. We sought to determine if there were differences in the prevalence of OSA between patients undergoing redo-HH repair and a matched cohort undergoing primary HH repair. Methods After IRB approval, we conducted a single-center retrospective cohort study. A prospectively maintained database was queried to retrieve clinical information of all the patients who underwent HH repair by a foregut surgeon between September 2016 and July 2023. The first group included patients who underwent redo-HH repair due to HH recurrence, and the second group included patients who underwent primary HH repair. Matching was performed in a 1:2 ratio using a propensity-score method based on age, sex, body mass index (BMI), history of chronic respiratory conditions other than OSA, history of smoking, and alcohol abuse. Results During the study period, 63 patients underwent redo-HH repair, and 370 underwent primary HH repair. After matching, 57 patients in the redo-HH repair and 114 in the primary HH repair were included, and all covariates showed adequate balance (Table 1). Patients undergoing redo-HH repair had a slightly higher prevalence of OSA compared to those who underwent primary repair (22.8% [CI95:11.91-33.7%] vs. 14.0% [CI95:7.7-20.4%], χ2 = 2.076, p=0.150). Conclusion Despite not reaching statistical significance, a relatively higher prevalence of OSA among patients undergoing redo-HH was found. Our study was limited by the retrospective design and inability to characterize the severity of OSA as well as patient compliance to treatment. Future prospective studies assessing this potential causality should be undertaken.

The Effect of Parents’ Perceived Stimulant Factors that Induce Asthma on the Quality of Life of their Children: A Cross-Sectional Study in Babylon, Iraq

Background: Asthma is a chronic respiratory condition that causes wheezing, dyspnea, and coughing. Asthma symptoms can be increased by a variety of stimulants for each asthma subtype, affecting children's quality of life. Objectives: To assess the quality of life of children with asthma, identify parents' perceived stimulant factors that influence quality of life for asthmatic children, and determine relationships between quality of life, parents' perceived stimulant factors, and demographic data for asthmatic children and their parents. Methods: From October 4, 2023, to July 1, 2024, a descriptive study was done on parents of asthmatic children in Hillah City. A nonprobability purposive sample of 155 parents of school-aged asthmatic children was obtained using a specially designed method for the study. Results: The average age of the children was 8.8±2.1 years. The majority of the children were males from rural areas, and they were diagnosed between 4 and 5 years old. Parents identified weather as the most stimulating factor, followed by infections, irritants, exercise, emotions, obesity, allergens, and some drugs. The study found that the majority of asthmatic children had a decent quality of life, while parents with a higher perception of stimulant variables have a lower quality of life. Conclusions: A high level of parents' perceived stimulant variables was negatively linked with quality of life among asthmatic children; additionally, residence, monthly income, and age of diagnosis were connected with quality of life.