Chronic Respiratory Disease Research Articles

Effect of azithromycin combined with fluticasone propionate aerosol inhalation on immune function in children with chronic cough caused by Mycoplasma pneumoniae infection.

Azithromycin dry suspension combined with fluticasone propionate aerosol inhalation in children with chronic cough due to MP infection reduces inflammatory factors, improves immune function, and enhances treatment efficacy. • The addition of oral azithromycin has demonstrated significant efficacy in treating cough caused by chronic respiratory disease, and inhaling fluticasone propionate has a more significant systemic impact than other corticosteroids. • Azithromycin dry suspension combined with fluticasone propionate aerosol inhalation in children with chronic cough due to MP infection reduces inflammatory factors, improves immune function, and enhances treatment efficacy.

SRAGE as a Prognostic Biomarker in ARDS: Insights from a Clinical Cohort Study

Background and Objectives: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury with high mortality, characterized by hypoxemic respiratory failure and diffuse lung damage. Despite advancements in care, no definitive biomarkers have been established for ARDS diagnosis and prognostic stratification. Soluble receptor for advanced glycation end-products (sRAGE), a marker of alveolar epithelial injury, has shown promise as a prognostic indicator in ARDS. This study evaluates sRAGE’s utility in predicting 28-day mortality. Materials and Methods: A retrospective cohort study was conducted at a tertiary care ICU in Serbia from January 2021 to June 2023. Adult patients meeting the Berlin definition of ARDS were included. Exclusion criteria included pre-existing chronic respiratory diseases and prolonged mechanical ventilation before diagnosis. Serum sRAGE levels were measured within 48 h of ARDS diagnosis using enzyme-linked immunosorbent assay (ELISA). Clinical severity scores, laboratory markers, and ventilatory parameters were recorded. Logistic regression and survival analyses were used to assess the prognostic value of sRAGE for 28-day mortality. Results: A cohort of 121 patients (mean age 55.5 years; 63.6% male) was analyzed. Non-survivors exhibited higher median sRAGE levels than survivors (5852 vs. 4479 pg/mL, p = 0.084). The optimal sRAGE cut-off for predicting mortality was >16,500 pg/mL (sensitivity 30.4%, specificity 86.9%). Elevated sRAGE levels were associated with greater disease severity and an increased risk of 28-day mortality in ARDS patients, highlighting its potential as a prognostic biomarker. The main findings, while indicative of a trend toward higher sRAGE levels in non-survivors, did not reach statistical significance. Conclusions: The main findings, while indicative of a trend toward higher sRAGE levels in non-survivors, did not reach statistical significance (p = 0.084). sRAGE demonstrates potential as a prognostic biomarker in ARDS and has moderate correlation with 28-day mortality. Integrating sRAGE with other biomarkers could enhance risk stratification and guide therapeutic decisions. The retrospective design limits the ability to establish causation, underscoring the need for multicenter prospective studies.

Temperament traits as predictors of depression and anxiety in patients with asthma and COPD

Introduction: The aim of this study was to determine the relationship between individual temperament traits among patients with chronic respiratory diseases and the risk of developing symptoms of anxiety and depression in an adult population. Material and methods: A total of 150 subjects (72 women and 78 men) were enrolled in the study after obtaining their informed written consent. The age of the women in the study was 50.35 ± 15.84 and the mean age of the men was 52.14 ± 18.39 years. Patients were suffering from asthma and/or COPD (chronic obstructive pulmonary disease). The study used a diagnostic survey method utilizing 3 questionnaires. The Formal Behavioural Characteristics Temperament Questionnaire (FCZ-KT), allowed the individual severity of temperament traits to be determined. The Beck Depression Inventory (BDI) was used to assess the severity of depressive symptoms, while the State-Trait Anxiety Inventory (STAI) questionnaire measured anxiety as a state and trait. Results: The results indicate that, of the temperament traits studied, briskness and emotional reactivity are significant for the development of depressive symptoms. High levels of emotional reactivity are a risk factor for the development of depression and anxiety, while high crankiness is a protective factor reducing the risk of developing depression and anxiety. Conclusions: The results presented here show the potential of temperament trait analysis in patients with chronic respiratory diseases in the early diagnosis and prevention of depressive disorders allowing for better control and effectiveness of treatment of chronic somatic conditions.

Optimising pirfenidone dosage regimens in idiopathic pulmonary fibrosis: towards a guide for personalised treatment

Idiopathic Pulmonary Fibrosis (IPF) is a chronic respiratory disorder for which pirfenidone is the recommended first-line anti-fibrotic treatment. While pirfenidone has demonstrated efficacy in slowing the progression of IPF, its use is associated with several challenges and unresolved issues that impact patient outcomes. Pirfenidone administration can result in gastrointestinal side effects, photosensitivity reactions, and significant drug interactions, particularly in patients with hepatic impairment. For those who experience intolerable side effects, dose reductions or temporary discontinuations are frequently employed. However, there is limited data on the efficacy of reduced doses, creating uncertainty about the balance between tolerability and therapeutic benefit. The aim of this study is to evaluate the currently proposed dosage adjustments and to develop new dosage regimens tailored to the needs of patients. Simulations were conducted to explore pirfenidone pharmacokinetics under various challenging conditions, including dose titration, withdrawal, retitration, moderate and severe hepatic impairment, co-administration of moderate (e.g. omeprazole) and strong (e.g. smoking) inducers of the CYP1A2 enzyme, gastrointestinal adverse events, and photosensitivity reactions. Simulations led to specific recommendations for physicians regarding dosage regimens in each condition. The recommended dosage adjustments are designed to maintain concentrations within acceptable levels, ensuring both safe and effective treatment.

Healthcare worker views on antimicrobial resistance in chronic respiratory disease

Background and objectiveAntimicrobial resistance (AMR) is a global crisis, however, relatively little is known regarding its impact in chronic respiratory disease and the specific challenges faced by healthcare workers across the world in this field. We aimed to assess global healthcare worker views on the challenges they face regarding AMR in chronic respiratory disease.MethodsAn online survey was sent to healthcare workers globally working in chronic respiratory disease through a European Respiratory Society clinical research collaboration (AMR-Lung) focussed on AMR in chronic lung disease. Responses from different geographic regions were analysed.Results279 responses were received across 60 countries. 54.5% of respondents encountered AMR in chronic respiratory disease weekly. There were differences in perceived high-priority diseases and species with AMR burden between Europe, Asia and Africa. 76.4% of respondents thought that inappropriate antimicrobial prescribing in chronic respiratory disease was common. However, only 43.4% of respondents thought that there were adequate antimicrobial stewardship programmes in their area for chronic respiratory disease, with limited availability in outpatient (29.0%) and ambulatory settings (24.7%). Developing rapid diagnostics for antimicrobial susceptibility (59.5%) was perceived to be the most common challenge in implementing antimicrobial stewardship, with an improved understanding of regional epidemiology of AMR strains the most important factor to improve outcome (55.2%).ConclusionsAMR has significant perceived burden in chronic respiratory disease by healthcare professionals globally. However, current implementation of antimicrobial stewardship is limited, with significant challenges related to the availability of rapid diagnostics and understanding of regional epidemiology of AMR strains.

Machine learning potential predictor of idiopathic pulmonary fibrosis

IntroductionIdiopathic pulmonary fibrosis (IPF) is a severe chronic respiratory disease characterized by treatment challenges and poor prognosis. Identifying relevant biomarkers for effective early-stage risk prediction is therefore of critical importance.MethodsIn this study, we obtained gene expression profiles and corresponding clinical data of IPF patients from the GEO database. GO enrichment and KEGG pathway analyses were performed using R software. To construct an IPF risk prediction model, we employed LASSO-Cox regression analysis and the SVM-RFE algorithm. PODNL1 and PIGA were identified as potential biomarkers associated with IPF onset, and their predictive accuracy was confirmed using ROC curve analysis in the test set. Furthermore, GSEA revealed enrichment in multiple pathways, while immune function analysis demonstrated a significant correlation between IPF onset and immune cell infiltration. Finally, the roles of PODNL1 and PIGA as biomarkers were validated through in vivo and in vitro experiments using qRT-PCR, Western blotting, and immunohistochemistry.ResultsThese findings suggest that PODNL1 and PIGA may serve as critical biomarkers for IPF onset and contribute to its pathogenesis.DiscussionThis study highlights their potential for early biomarker discovery and risk prediction in IPF, offering insights into disease mechanisms and diagnostic strategies.

Knowledge, attitudes and practices regarding pulmonary rehabilitation among patients with chronic respiratory diseases: a cross-sectional questionnaire-based study in a tertiary hospital in China

ObjectivesThis study aimed to evaluate the knowledge, attitudes and practices (KAP) of patients with chronic respiratory diseases towards pulmonary rehabilitation.DesignCross-sectional, web-based questionnaire study.SettingTertiary healthcare hospital in Taiyuan, Shanxi Province, China.ParticipantsA...

Physical health in young males and risk of chronic musculoskeletal, cardiovascular, and respiratory diseases by middle age: A population-based cohort study.

Cardiovascular, respiratory, and musculoskeletal disease are among the leading causes of disability in middle-aged and older people. Health and lifestyle factors in youth have known associations with cardiovascular or respiratory disease in adulthood, but largely unknown associations with musculoskeletal disease. We included approximately 40,000 18-year-old Swedish males, who completed their conscription examination in 1969 to 1970, followed up until age of 60 years. Exposures of interest were physical health: body mass and height, blood pressure, pulse at rest, muscle strength, cardiorespiratory fitness, and hematocrit; self-reported lifestyle: smoking, alcohol, and drug use; self-reported health: overall, headache and gastrointestinal. We followed the participants through the Swedish National Patient Register for incidence of common musculoskeletal (osteoarthritis, back pain, shoulder lesions, joint pain, myalgia), cardiovascular (ischemic heart disease, atrial fibrillation), and respiratory diseases (asthma, chronic obstructive pulmonary disease, bronchitis). We analyzed the associations using general estimating equations Poisson regression with all exposures included in one model and adjusted for parental education and occupation. We found that higher body mass was associated with higher risk of musculoskeletal (risk ratio [RR] per 1 standard deviation [SD] 1.12 [95% confidence interval, CI 1.09, 1.16]), cardiovascular (RR 1.22 [95% CI 1.17, 1.27] per 1 SD) and respiratory diseases (RR 1.14 [95% CI 1.05, 1.23] per 1 SD). Notably, higher muscle strength and cardiorespiratory fitness were associated with higher risk of musculoskeletal disease (RRs 1.08 [95% CI 1.05, 1.11] and 1.06 [95% CI 1.01, 1.12] per 1 SD difference in exposure), while higher cardiorespiratory fitness was protective against both cardiovascular and respiratory diseases (RRs 0.91 [95% CI 0.85, 0.98] and 0.85 [95% CI 0.73, 0.97] per 1 SD exposure, respectively). We confirmed the adverse effects of smoking, with risk ratios when comparing 11+ cigarettes per day to non-smoking of 1.14 (95% CI 1.06, 1.22) for musculoskeletal, 1.58 (95% CI 1.44, 1.74) for cardiovascular, and 1.93 (95% CI 1.60, 2.32) for respiratory diseases. Self-reported headache (category "often" compared to "never") was associated with musculoskeletal diseases (RR 1.38 [95% CI 1.21, 1.58]) and cardiovascular diseases (RR 1.29 [95% CI 1.07, 1.56]), but had an inconclusive association with respiratory diseases (RR 1.13 [95% CI 0.79, 1.60]). No large consistent associations were found for other exposures. The most notable associations with specific musculoskeletal conditions were for cardiorespiratory fitness and osteoarthritis (RR 1.23 [95% CI 1.15, 1.32] per 1 SD) and for muscle strength and back pain (RR 1.18 [95% CI 1.12, 1.24] per 1 SD) or shoulder diseases (RR 1.27 [95% CI 1.19, 1.36] per 1 SD). The main limitations include lack of adjustment for genetic factors and environmental exposures from childhood, and that the register data were available for males only. While high body mass was a risk factor for all 3 studied groups of diseases, high cardiorespiratory fitness and high muscle strength in youth were associated with increased risk of musculoskeletal disease in middle age. We speculate that these associations are mediated by chronic overload or acute trauma.

Retrospective cross-sectional study on bronchiectasis in adult Aboriginal Australians: disease characteristics and comparison with ethnically diverse global bronchiectasis registry cohorts

BackgroundGlobally, adult Indigenous people, including Aboriginal Australians, have a high burden of chronic respiratory disorders, and bronchiectasis is no exception. However, literature detailing bronchiectasis disease characteristics among adult Indigenous people...

Matrix metalloproteinase 7 (MMP7) as a molecular target for Mycoplasma gallisepticum (MG) resistance in chickens.

Mycoplasma gallisepticum (MG) causes chronic respiratory disease (CRD), posing a significant threat to global poultry production. Current preventive strategies face limitations, emphasizing the need for alternative approaches such as breeding for disease resistance. This study identifies the matrix metalloproteinase 7 (MMP7) gene as a key factor in CRD resistance. Analysis of high-throughput sequencing data revealed MMP7's association with MG infection at tissue and cellular levels. Overexpression of MMP7 in avian type II alveolar epithelial cells (AECII) and macrophages (HD11) inhibited MG adhesion, modulated immune responses, and suppressed MG-induced cell proliferation and apoptosis, though MG replication remained unaffected. Conversely, MMP7 inhibition enhanced MG infection. Experimental infections in commercial (Jingfen Layer No.6, Hy-Line White) and local Chinese chicken breeds (Guangxi Indigenous, Tianlu Partridge, Cyan Shank Partridge) validated Tianlu Partridge chickens' relative resistance and Jingfen Layers' susceptibility. MMP7 expression levels correlated positively with reduced chick weight, air sac damage, tracheal mucosal thickness, and MG lung loads. These findings highlight MMP7 as a molecular target for assessing MG susceptibility and breeding resistant chickens while demonstrating the utility of local Chinese breeds in resistance-focused breeding programs.

Non-Communicable Diseases Among Orang Asli in Malaysia: A Scoping Review of Prevalence and Associated Factors

Non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer, pose significant public health challenges globally and in Malaysia. The Orang Asli, an indigenous community in Malaysia, faces unique health challenges due to socioeconomic disparities and lifestyle changes. This scoping review synthesizes existing literature on the prevalence and determinants of NCDs among the Orang Asli, aiming to identify research gaps and inform public health strategies. We conducted a systematic search across databases including PubMed, Scopus, Google Scholar, and Web of Science, identifying 15 relevant studies from an initial pool of 573 records, following PRISMA guidelines. The review reveals significant variability in the prevalence of hypertension (3.3% to 57.2%), diabetes mellitus (0.8% to 25%), and dyslipidaemia (1.5% to 41.4%) among the Orang Asli. Other conditions such as gout and asthma were noted with prevalences of 2.7% and 0.4%, respectively. Factors associated with NCD prevalence include older age, female gender, lower education levels, poor dietary habits, physical inactivity, smoking, obesity, genetic predispositions, and the impacts of urbanization and modernization. Addressing the NCD burden requires multifaceted strategies, including culturally sensitive health promotion, improved healthcare access, and the preservation of traditional practices. This review underscores the urgent need for targeted interventions to mitigate the rising NCD burden in this vulnerable population.

Protocol for the enhanced management of multimorbid patients with COPD and severe asthma: role of indoor air quality

IntroductionReducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of...

Structural elucidation and anti-asthmatic effects of semi-crystalline polysaccharides from Lignosus rhinocerotis (Cooke) Ryvarden.

Asthma is a chronic respiratory disease characterized by airway inflammation. Lignosus rhinocerotis (LR), a medicinal mushroom rich in polysaccharide, has been traditionally used to treat various diseases, including asthma. This study aimed to fractionate, characterize and evaluate the anti-asthmatic effects of polysaccharides from LR (LRP). LRP was isolated and characterized using high-performance liquid chromatography (HPLC), x-ray diffraction analysis (XRD), fourier transform infrared spectrometry (FTIR) and nuclear magnetic resonance (NMR) spectroscopy. In an OVA-induced asthma model, BALB/c mice were sensitized, challenged, and intranasally treated with LRP. Experimental findings demonstrated that LRP exhibits a semi-crystalline nature with predicted structure of → 4)-α-D-Glcp-(1 → and → 3)-β-D-Glcp-(1→. LRP significantly reduced eosinophilia, Th2 cytokines, and IgE levels. Histological analysis revealed LRP's ability to decrease epithelial damage and epithelial and smooth muscle thickness in lung. Reductions in inflammatory cell infiltration, mucus production, and transforming growth factor (TGF)-β1 expression were observed, although not statistically significant. Gene expression analysis indicated that LRP significantly downregulated the inducible nitric oxide synthase (iNOS) expression. This study highlights a detailed structural analysis of LRP and its potential as an alternative for the management of asthma. Further research is needed to elucidate the precise mechanisms of action and optimize its therapeutic application.

Understanding the determinants and outcomes of education in pulmonary rehabilitation: moving towards person-centered care.

Education and psychosocial support are essential components of pulmonary rehabilitation (PR). However, the delivery of education often follows a one-size-fits-all approach, with individual factors that influence learning rarely considered. Moreover, education-related outcomes are frequently overlooked in PR assessments, and inconsistent use of these outcomes has limited our understanding of the impact of education on people with chronic respiratory diseases. There is a clear need for practical guidance to identify key learning determinants and define which education-related outcomes in PR should be targeted to optimize the intervention and establish quality standards. Cognitive function, health literacy, psychological status, and social connection can impact an individual's ability to learn. Without proper consideration and assessment, these factors can otherwise become barriers to education and effective self-management. Education in PR should aim to a) improve individuals' knowledge, to foster informed and active participants; b) develop their skills, to enable autonomy and competence; and c) enhance their confidence, to apply this knowledge and skills in daily life. This review emphasizes the importance of person-centered education in PR, provides a framework for understanding which education-related outcomes to target, and highlights the need for future research to enhance this essential component.

Impact of physical activity on respiratory diseases

Chronic respiratory diseases, including COPD, asthma, lung cancer, and COVID-19, significantly impact global health, quality of life, and healthcare systems. Physical activity is increasingly recognized for its preventive and therapeutic roles. Regular exercise enhances lung function, mitigates disease progression, and improves psychological well-being. Studies demonstrate that physical activity benefits patients with COPD, asthma, and lung cancer, promoting spirometric improvements, endurance, and post-operative recovery. Moreover, tailored exercise regimens during and after COVID-19 infection aid rehabilitation and immune resilience. Environmental considerations, such as pollution, must be addressed to maximize exercise benefits. Comprehensive pulmonary rehabilitation programs incorporating aerobic, resistance, and breathing exercises yield significant health improvements. This evidence underscores the critical role of physical activity in managing respiratory diseases, advocating its integration into patient care and public health strategies to enhance overall outcomes.

Joint association of systemic immune-inflammation index and phenotypic age acceleration with chronic respiratory disease: a cross-sectional study

BackgroundChronic respiratory diseases (CRD) represents a series of lung disorders and is posing a global health burden. Systemic inflammation and phenotypic ageing have been respectively reported to associate with certain CRD. However, little is known about the co-exposures and mutual associations of inflammation and ageing with CRD. Here, we aim to systematically elucidate the joint and mutual mediating associations of systemic immune-inflammation index (SII) and phenotypic age acceleration (PhenoAgeAccel) with CRD based on data from National Health and Nutrition Examination Survey (NHANES).MethodsData for this study was obtained from NHANES 2007–2010 and 2015–2018. The single and combined associations of SII and PhenoAgeAccel with CRD were analyzed using multivariable logistic regression models. The dose-response relationship between exposures and outcomes was determined by restricted cubic splines (RCS) regression. Subgroup and mediation analyses were further conducted.ResultsTotally, 15,075 participants were enrolled in this study including 3,587 CRD patients. Compare with controls, CRD patients tended to be older, females and present higher SII and PhenoAgeAccel values. Single-index analysis indicated that either SII or PhenoAgeAccel demonstrated a significantly positive association with CRD via logistic regressions and RCS curves. Furthermore, the joint-indexes analysis revealed that compared to individuals with lower SII and PhenoAgeAccel, those with higher SII and PhenoAgeAccel exhibited remarkably stronger associations with CRD (adjusted OR [aOR], 1.56; 95% CI, 1.31–1.85; P < 0.001), chronic obstructive pulmonary disease (aOR, 1.56; 95% CI, 1.22-2.00; P = 0.001) and asthma (aOR, 1.40; 95% CI, 1.16–1.70; P = 0.001), which were predominant among those aged above 40 years, females and smokers. Eventually, mediation analyses suggested the mutual mediating effects of SII and PhenoAgeAccel on CRD and PhenoAgeAccel mediated SII resulting in CRD more significantly.ConclusionThis study confirmed the coexposure effect and mutual mediation between SII and PhenoAgeAccel on CRD. We recommend that the joint assessment may conduce to the accurate identification for populations susceptible to CRD and early prevention of chronic respiratory diseases.

Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study.

Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid's medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07% in 2014; it decreased to 0.03% in 2020. CHF followed at 0.06% in 2014 and 0.03% in 2020. APE had a prevalence of 0.01% in 2014, decreasing to 0.005% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of €2,726,893 (which equals to US $2,864,628). COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was €58,791,031 (US $61,832,879).

Length of Hospital Stay and Its Predictions Among Patients With Exacerbations of Chronic Respiratory Diseases.

Chronic respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD) may deteriorate into acute exacerbations requiring hospitalization. Assessing the predictors of prolonged hospital stays could help identify potential interventions to reduce the burden on patients and healthcare systems. This study aimed to identify the risk factors attributed to prolonged hospital stays among patients admitted with acute exacerbations of chronic respiratory disorders in Jordan. A retrospective cohort study was conducted by reviewing the demographic and clinical characteristics of hospitalized patients with asthma and COPD exacerbations between January 2017 and July 2021. The recorded variables were checked for their independence. Simple and stepwise multivariate linear regressions were then performed to identify variables associated significantly with a longer hospital length of stay (LOS). A total of 896 cases were evaluated. The mean ± SD stay was 5.66 ± 3.40 days, whereas the median (IQR) was 5.00 (4.00) days. Variables associated significantly with prolonged LOS in the multivariate analysis were female gender (β = 0.089, p = 0.011), pulmonary hypertension (β = 0.093, p = 0.004), allergic rhinitis (β = 0.086, p = 0.007), ICU admission (β = 0.096, p = 0.003), requirement for mechanical ventilation (β = 0.102, p = 0.002), higher total number of medications (β = 0.281, p < 0.001) and the number of exacerbation-related medications (β = 0.200, p < 0.001). However, smoking (β = -0.091, p = 0.008) was significantly associated with a shorter LOS. Gender, pulmonary hypertension, allergic rhinitis, ICU admission, mechanical ventilation, the number of medications and smoking were significantly related to LOS. These findings emphasize the importance of patients' demographics and their clinical status in determining LOS, hence providing protective interventions to shorten it.

Trends, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia: time series analysis

ObjectiveThis study analyzed the trend, seasonal variations and forecasting of chronic respiratory disease morbidity in charcoal producing areas, northwest Ethiopia, aiming to provide evidences in planning, designing strategies, and decision-makings for preparedness and resource allocation to prevent CRD and reduce public health burden in the future.Materials and methodsThe trend, seasonal variation, and forecasting for CRD were estimated using data collected from the three zones of Amhara region annual reports of DHIS2 records. Smoothing decomposition analysis was employed to demonstrate the trend and seasonal component of CRD. The ARIMA (2, 1, 2) (0, 0, 0) model was used to forecast CRD morbidity. The model's fitness was checked based on Bayesian information criteria. The stationarity of the data was assessed with a line chart and statistically with the Ljung-Box Q-test. SPSS version 27 was utilized for statistical analysis.ResultsThe annual morbidity rate of CRD has shown an increasing trend in both sexes over a seven-year period among people aged 15 years and older. Seasonal variation in CRD morbidity was observed. The smoothing decomposition analysis depicted that the seasonal component was attributed to 44.47% and 19.16% of excess CRD cases in the period between September to November, and June to August, respectively. A substantial difference among the three zones of the Amhara region in CRD morbidity rate was noted, with the highest observed in the Awi zone. Forecasting with the ARIMA model revealed that CRD-related morbidity will continue to increase from 2020 to 2030.ConclusionThe study revealed that the CRD morbidity rate has shown an increasing trend from 2013 to 2019. Seasonal variation in the CRD morbidity rate was observed, with the highest peak from September to November. The morbidity attributed to CRD will continue to increase for the next ten years (2020–2030). Therefore, this study could potentially play a groundbreaking role. Further study is warranted to understand the risk factors and facility readiness through a further understanding of seasonality and future trends.

CAD-Q (COPD-Asthma Differentiation Questionnaire): Performance of a new diagnostic score to differentiate between COPD and asthma in adults

BackgroundChronic obstructive pulmonary disease (COPD) and asthma are the two most prevalent chronic respiratory diseases, significantly impacting public health. Utilizing clinical questionnaires to identify and differentiate patients with COPD and asthma for further diagnostic procedures has emerged as an effective strategy to address this issue. We developed a new diagnostic tool, the COPD-Asthma Differentiation Questionnaire (CAD-Q), to differentiate between COPD and asthma in adults.MethodsA cross-sectional study with diagnostic test analysis was done. Relevant clinical variables for diagnosing COPD and asthma were identified through crude Odds Ratios (OR) and a logistic regression model provided adjusted ORs. The CAD-Q, including sensitivity, specificity, predictive values, likelihood ratios, and ROC-curve, was compared to the LFQ, CDQ, PUMA, “Could it be COPD,” and COPD-PS questionnaires.Results235 (52.9%) patients had COPD and 209 (47.1%) had asthma. A score ≥ 20 on the CAD-Q questionnaire showed a ROC-curve of 70% (95% CI: 65–75; p < 0.001) with a sensitivity of 83.8% (95% CI: 81.1–86.6), specificity of 47.8% (95% CI: 44.1–51.6), positive predictive value of 37.8% (95% CI: 34.2–41.5), negative predictive value of 88.7% (95% CI: 86.3–91), LR + of 1.61 (95% CI: 1.447–1.786), LR − of 0.34 (95% CI: 0.304–0.376) for diagnosing COPD. When comparing CAD-Q with other questionnaires for differentiating COPD and asthma, CAD-Q and CDQ had the highest sensitivity (83.8% and 77.9%). PUMA and “Could it be COPD” had the highest specificity (62.7% and 62.6%). CAD-Q and COPD-PS showed the highest negative predictive values (88.7% and 62.1%). CAD-Q, LFQ, and CDQ had the highest a ROC-curve (70%, 66%, and 66%).ConclusionThe CAD-Q questionnaire effectively discriminated between COPD and asthma, outperforming previous tools. These findings support further research and refinement of diagnostic tools and call for validation in diverse clinical settings.