Common Chronic Respiratory Diseases Research Articles

Overlapping of Asthma and Chronic Obstructive Pulmonary Disease: A Literature Review

: Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory diseases with significant morbidity in the world. Although these diseases have different characteristics, some patients share symptoms and clinical findings of both diseases, so-called asthma-COPD overlap syndrome (ACOS). Although there is no gold standard for the diagnosis of ACOS, it is usually defined as an increased variability of airflow in the respiratory tract. Patients with ACOS are identified with distinct phenotypes such as the increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and the increased reaction to inhaled corticosteroids compared to COPD patients. The evidence indicates that ACOS patients are likely to have more dyspnea and cough, more serious symptoms, more hospital admissions, and higher mortality rate. Despite these complex conditions, ACOS patients have been eliminated from clinical trials of asthma and COPD and there is little evidence about their clinical decisions. The current study was conducted to review the epidemiology, clinical symptoms, diagnosis, and treatment of ACOS as the first stage of correct diagnosis and appropriate management of this syndrome in databases such as PubMed, Elsevier, Google Scholar, SID, Magiran, Google search engine, and so on.

Role of a Community Pharmacy Service in Care of Bronchial Asthma Patients in Lithuania.

Bronchial asthma is one of the most common chronic respiratory diseases, and its care is often complex. In this research, we tested the proposal that participation of pharmacists in the management of bronchial asthma can improve patient outcomes. A two-stage study was constructed consisting of a training element and a service element, using the Asthma Control Test and a structured questionnaire about the patients' disease condition (based on the results of a qualitative study). The study was conducted in 21 pharmacies in Lithuania and involved 338 asthmatic patients (age 18–88 years). It was found that before the pharmacy service was provided, the average number of mistakes patients made in administration of asthma medications was 2.03; this number decreased to 1.12 after the service was provided (p < 0.05). Disease control paralleled the improvement in number of mistakes: 26.1% of patients who previously exerted no control over the disease symptoms began to exert sufficient control over their asthma symptoms (Asthma Control Test >20) after the service was provided (p < 0.05). The reduced number of mistakes probably can be attributed to the positive effects of the provided services. By reducing the number of patient mistakes, pharmacists may improve the outcomes of asthmatic patients.

Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed.

IntroductionChronic obstructive pulmonary disease (COPD) and asthma are the most common chronic respiratory diseases worldwide. At the moment, there is no information about the preferences of Polish specialists as regards the treatment of asthma and COPD or factors influencing the choice of particular treatment regimens.AimTo determine the treatment options most commonly used by experienced pulmonologists and allergists for asthma and COPD and to identify the factors affecting the choice of a particular therapy.Material and methodsThe survey included 224 doctors (pulmonologists and allergists) across Poland and concerned patients diagnosed with asthma (n = 4358) and COPD (n = 3062).ResultsIn the case of asthma, the most common therapy applied was inhaled glucocorticosteroids and long-acting β2 agonists. According to 27.2% of doctors, combination therapy was used in 70–80% of patients while 23.7% declared that the proportion of patients receiving such a treatment exceeded 80%. In the case of COPD, anticholinergics were most frequently prescribed when inhaled glucocorticosteroids and long-acting β2 agonists had proved insufficient. According to 21% of specialists, the percentage of patients treated so was 41–50%, while 19% declared the use of this treatment in 71–80% of patients.ConclusionsThe most common treatments for asthma and COPD in Poland are inhaled glucocorticosteroids and long-acting β2 agonists. The main factors influencing treatment decisions are the current GINA and GOLD recommendations as well as patients’ age, comorbidities, and price of treatment.

Asthma disease as cause of admission to hospitals due to exposure to ambient oxidants in Mashhad, Iran.

Nowadays, asthma is one of the most common chronic respiratory diseases, worldwide. Many reports have emphasized the correlation between the short-term exposure to the ambient air pollutants and acute respiratory diseases, especially among children with asthmatic symptoms. The aim of this study was to evaluate the relationship between the exposure to three atmospheric antioxidants (NO2, SO2, and O3) and hospital admission due to asthmatic disease (HAAD) in the city of Mashhad, Iran. The concentrations of atmospheric antioxidants were obtained from the real-time monitoring stations located in the city. The collected data were employed for developing predictive models in the AirQ software. In order to investigate the association between short-term exposure to air pollutants and HAAD, the study participants were categorized into two age groups: less than 15 and from 15 to 64years old. The results indicated that in people less than 15years increase in NO2 (attributable proportion (AP)=3.775%, 95% CI 0.897-6.883%), SO2 (AP=3.649%, 95% CI 1.295-5.937%), and O3 (AP=0.554%,95% CI 0.00-3.321) results in increase in HAAD. While for those aged between 15 and 64years, the AP was 4.192% (95% CI 0.450-7.662%) for NO2; 0.0% (95% CI 0.00-1.687%) for SO2; and 0.236% (95% CI 0.00-1.216%) for O3. The number of asthmatic cases who were less than 15years admitted to the hospitals during the study period was higher than that of those within the age groups between 15 and 64years as a consequence of exposure to NO2 (101 vs. 75), SO2 (98 vs. 0), and O3 (15 vs. 3), respectively. To the best of our knowledge, the AirQ model has not been applied before to estimate the effect of atmospheric antioxidant exposure on hospital admission because of asthma disease. Eventually, this model is proposed to be applicable for other cities around the world.

O-41 Pharmacogenomic studies of corticosteroid effectiveness in paediatric asthma: a systematic review

Background Genetic variations has the potential to al-ter therapeutic efficacy. The aim of the study is to analyse polymorphisms associated with variation in response to corticosteroid treatment in paediatric asthma patients. Asthma is one of the most common chronic respiratory diseases in childhood, with about 300 million asthmatic patients worldwide and a sharp increase in their preva-lence. Despite corticosteroids being highly effective for the chronic treatment of asthma, there are variations in therapeutic responsiveness. These variations can be at-tributed to a degree of heterogeneity, which is associated in part to genetic variation. This provide the rationale for pharmacogenetic studies of corticosteroids. Methods Relevant literature was identified through CENTRAL, CINAHL, MEDLINE and Scopus. Studies in which pharmacogenetic methods, such as genome-wide association studies, candidate gene studies and genome sequencing, were used to identify and repeatedly vali-date the effect of one or more single nucleotide polymor-phisms on the efficacy of inhaled corticosteroids. Results The search returned 341 studies, with 23 full text articles assessed for eligibility. We excluded 14 full text articles with the remaining 9 studies included (incorpo-rating analysis of 210 SNPs and including in over 7000 children). Variants that enhanced response to cortico-steroids include CRHR1 (rs1876828), T gene (rs3127412 and rs6456042), TBX21 gene (rs2240017) in TXB21 gene, ORMDL3 (rs2872507). Genes containing polymorphisms predictive of reduced response to corticosteroids were FCER2 (rs28364072) and ST13 (rs138335 and sr138337), and GLCCI1 (rs37972). Successful replication of CRHR1 and FCER2 in additional publications has been achieved, but GLCCI1 was not successfully replicated. Various out-come measures were used across the studies. Conclusion Numerous SNPs that alter the effectiveness of corticosteroid treatment in asthma have been identi-fied, but external replication has been limited to date, and application into clinical practice is not routine.

Bronquite crônica canina – revisão

Canine chronic bronchitis (CCB) is considered to be one of the most common chronic respiratory diseases of dogs. The hallmark of CCB is chronic and progressive cough that leads to poor life quality of the dog. Severe cases may progress to respiratory insufficiency and death. The cause is an inflammatory process of unknown origin. The disease is most common in adult and older dogs of small animal breeds. In severe cases, this chronic inflammatory process progresses to irreversible structural changes in the airways, resulting in respiratory failure. Despite this, information about the disease is extremely limited in the literature, and the recommended treatment is based on poor scientific evidence. Thus, the aim of this study is to review the subject and describe the etiology, pathophysiology, clinical features, complementary diagnosis and treatment of CCB.

Burden of bacterial exacerbation in bronchial asthma in Assiut University Hospitals, Egypt

BackgroundAsthma is one of the most common chronic respiratory diseases. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity and mortality on patients and constitute a major burden on healthcare resources.ObjectiveThis study aimed to determine the associations between bacterial infections and adult asthma exacerbations, together with detection of antibiotic resistance patterns in clinical practice.Patients and methodsSputa were collected from 60 adult asthmatic patients recruited from both Internal Medicine Department and Chest Disease Department and their critical care units during exacerbation attacks. Patients underwent thorough clinical examination, laboratory investigations, and pulmonary function tests. Bacterial isolates were identified using the standard diagnostic methods. Susceptibilities of the isolated bacterial strains were determined using disk diffusion method.ResultsSignificant bacterial growth was detected in 47 (78%) patients. Single etiological agent was detected among 44 (73%) patients, whereas mixed infection was found in three (5%) patients. A total of 52 bacterial strains were isolated from our asthmatic patients. The predominant bacterial strains were as follows in decreasing order: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa. Gram-negative bacilli constituted 52% (27 isolates) of the total bacterial isolates during the exacerbation attacks. Non-multidrug-resistant bacteria were 15 (30%) in number, 22 (44%) bacterial isolates were multidrug resistant, six (12%) bacterial isolates were extensively drug resistant, and seven (14%) isolates were pandrug resistant.ConclusionAcute exacerbation of asthma was associated with infection in most patients. Gram-negative bacteria and S. pneumoniae form a relevant part of the microbial pattern of exacerbation of asthma. Antibiotic resistance among bacterial strains remains a challenge for the management of asthma exacerbations in clinical settings.

Roles of roflumilast, a selective phosphodiesterase 4 inhibitor, in airway diseases.

Asthma and chronic obstructive pulmonary disease (COPD) are common chronic respiratory diseases. Both diseases have incompletely distinct pathophysiology, clinical manifestation, and treatment responsiveness. Pulmonary and systemic inflammations are the hallmarks of COPD. Most asthma responds to inhaled corticosteroid (ICS) treatment. In contrast, COPD is a corticosteroid-resistant disease. Bronchodilators are a preferred treatment method of COPD, with the aim of improving symptoms and preventing exacerbation. In addition, corticosteroid insensitivity is an underlying mechanism in severe asthma. An overlap of features between asthma and COPD, which was described as asthma-COPD overlap syndrome (ACOS) is not uncommon in practice. Novel nonsteroidal therapies focusing on inflammation in asthma and COPD have been developed. Selective phosphodiesterase 4 (PDE4) inhibitor is a promising class of drugs that has been studied for the treatment of COPD. Selective PDE4 inhibitor is different from xanthine in terms of mechanisms and pharmacokinetic profiles. This review focuses on clinical data on PDE4 inhibitors and its future roles in asthma, COPD, bronchiectasis, ACOS and other chronic non-pulmonary diseases.

Linking sources to early effects by profiling urine metabolome of residents living near oil refineries and coal-fired power plants

BackgroundThis study aims at identifying metabolic changes linking external exposure to industrial air toxics with oxidative stress biomarkers. MethodsWe classified 252 study subjects as 111 high vs. 141 low exposure subjects by the distance from their homes to the two main emission sources, oil refineries and coal-fired power plants. We estimated individual's external exposure to heavy metals and polycyclic aromatic hydrocarbons (PAHs) by dispersion and kriging models, respectively. We measured urinary levels of heavy metals and 1-hydroxypyrene (1-OHP) as biomarkers of internal exposure, and 8-OHdG, HNE-MA, 8-isoPGF2α, and 8-NO2Gua as biomarkers of early health effects. We used two-dimensional gas chromatography time-of-flight mass spectrometry to identify urine metabolomics. We applied “meet-in-the-middle” approach to identify potential metabolites as putative intermediate biomarkers linking multiple air toxics exposures to oxidative stress with plausible exposures-related pathways. ResultsHigh exposure subjects showed elevated ambient concentrations of vanadium and PAHs, increased urine concentrations of 1-OHP, vanadium, nickel, copper, arsenic, strontium, cadmium, mercury, and thallium, and higher urine concentrations of all four urine oxidative stress biomarkers compared to low exposure subjects. We identified a profile of putative intermediate biomarkers that were associated with both exposures and oxidative stress biomarkers in participants. Urine metabolomics identified age-dependent biological pathways, including tryptophan metabolism and phenylalanine metabolism in children subjects (aged 9–11), and glycine, serine, and threonine metabolism in elderly subjects (aged>55), that could associate multiple exposures with oxidative stress. ConclusionBy profiling urine biomarkers and metabolomics in children and elderly residents living near a petrochemical complex, we can link their internal exposure to oxidative stress biomarkers through biological pathways associated with common complex chronic diseases and allergic respiratory diseases. The internal exposure may possibly be traced to multiple air toxics emitted from specific sources of oil refineries and coal-fired power plants.

Oligonucleotide Therapy for Obstructive and Restrictive Respiratory Diseases.

Inhaled oligonucleotide is an emerging therapeutic modality for various common respiratory diseases, including obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD) and restrictive airway diseases like idiopathic pulmonary fibrosis (IPF). The advantage of direct accessibility for oligonucleotide molecules to the lung target sites, bypassing systemic administration, makes this therapeutic approach promising with minimized potential systemic side effects. Asthma, COPD, and IPF are common chronic respiratory diseases, characterized by persistent airway inflammation and dysregulated tissue repair and remodeling, although each individual disease has its unique etiology. Corticosteroids have been widely prescribed for the treatment of asthma, COPD, and IPF. However, the effectiveness of corticosteroids as an anti-inflammatory drug is limited by steroid resistance in severe asthma, the majority of COPD cases, and pulmonary fibrosis. There is an urgent medical need to develop target-specific drugs for the treatment of these respiratory conditions. Oligonucleotide therapies, including antisense oligonucleotide (ASO), small interfering RNA (siRNA), and microRNA (miRNA) are now being evaluated both pre-clinically and clinically as potential therapeutics. The mechanisms of action of ASO and siRNA are highly target mRNA specific, ultimately leading to target protein knockdown. miRNA has both biomarker and therapeutic values, and its knockdown by a miRNA antagonist (antagomir) has a broader but potentially more non-specific biological outcome. This review will compile the current findings of oligonucleotide therapeutic targets, verified in various respiratory disease models and in clinical trials, and evaluate different chemical modification approaches to improve the stability and potency of oligonucleotides for the treatment of respiratory diseases.

The problem of obstructive sleep apnea syndrome in asthmatic patients

Asthma and obstructive sleep apnea syndrome (OSAS) are one of the most common chronic respiratory diseases. These have common risk factors that include obesity, gastroesophageal reflux disease (GERD) and impaired nasal breathing (allergic rhinitis, sinusitis). At the same time, experimental evidence demonstrates common pathophysiological mechanisms of these diseases, such as involvement in the process of the respiratory tract, a systemic inflammatory response, and implementation of neuromechanical reflexes. Thus, there is an obvious synergism between these conditions, which affects symptoms, response to therapy, and prognosis. The available data allow discussion on whether there is a need to identify and treat OSAS in asthmatic patients. By keeping in mind the high incidence of OSAS in patients with severe asthma, it may be suggested that treatment for OSAS can reduce the number of exacerbations, improve the quality of life, and decline the number of obstinate asthma cases. It is very important for general practitioners to assess risk factors, such as body weight, nasal stuffiness, and GERD, and to utilize screening tools for more efficient use of healthcare resources. Considering the known positive effects of CPAP therapy in short-term studies, future investigations should focus on the impact of CPAP therapy on asthma symptoms in the long-term, as well as on the effects of asthma drugs on the course of OSAS.

Influence of Vitamin D and Cotinine on T-Regulatory Cells and Asthma Severity in Children.

Asthma is a common chronic respiratory diseases in children. Understanding the immune mechanisms of epigenetic factors may contribute to a better control of asthma. This study seeks to determine the effects of serum vitamin D and urine cotinine on asthma severity and on T regulatory cells (Tregs) and other immune-related factors such as CD3, CD4, CD8, CD19, CD16/56, and anti-CD3 HLA-DR3. The study involved 34 children with asthma. Disease severity was assessed with the Asthma Control Test, spirometry, and the fractional exhaled nitric oxide (FeNO). The control group consisted of 18 healthy children. We found a significantly lower proportion of Tregs in the serum of asthmatic children compared with the control group (p<0.002). There were no significant differences in the other immunological factors investigated. Nor was there any appreciable association between vitamin D or cotinine and the course of asthma, FeNO, Tregs, and the other immune factors. However, the percentage of Tregs was positively associated with the level of FeNO (p<0.02). In conclusion, the study shows a role of T regulatory cells in the pathogenesis of asthma in children, but fails to show any influence of serum vitamin D or urine cotinine on disease course.

Unmet Primary Physicians' Needs for Allergic Rhinitis Care in Korea.

Allergic rhinitis (AR) is one of the most common chronic allergic respiratory diseases worldwide. Various practical guidelines for AR have been developed and updated to improve the care of AR patients; however, up to 40% patients remain symptomatic. The unmet need for AR care is one of the greatest public health problems in the world. The gaps between guideline and real-world practice, and differences according to the region, culture, and medical environments may be the causes of unmet needs for AR care. Because there is no evidence-based AR practical guideline reflecting the Korean particularity, various needs are increasing. The purpose of the study was to evaluate whether existing guidelines are sufficient for AR patient management in real practice and whether development of regional guidelines to reflect regional differences is needed in Korea. A total of 99 primary physicians comprising internists, pediatricians, and otolaryngologists (n=33 for each) were surveyed by a questionnaire relating to unmet needs for AR care between June 2 and June 16 of 2014. Among 39 question items, participants strongly agreed on 15 items that existing guidelines were highly insufficient and needed new guidelines. However, there was some disagreement according to specialties for another 24 items. In conclusion, the survey results demonstrated that many physicians did not agree with the current AR guideline, and a new guideline reflecting Korean particularity was needed.

Health benefits of Practical Approach to Lung health (PAL) experienced by patients with chronic respiratory diseases – Results from PAL pilot project in primary health care setting in Kerala, India

Government of Kerala state had implemented a pilot project of the World Health Organisation recommended Practical Approach to Lung health (PAL) strategy, with an intention to improve the quality of diagnosis, treatment and management of common chronic respiratory diseases (CRD) in primary health care settings. The current study was done as a part of implementation of PAL pilot project and was intended to assess the benefits of PAL for the individual patients with CRDs accessing services from primary health institutions. Exit interviews were conducted at the baseline and for impact assessment after six months of pilot project by interviewing patients with CRD attending primary health institutions implementing PAL and control institutions. A total of 94 and 100 CRD patients were interviewed at baseline and after six months in the PAL implementing institutions, and 88 and 96 CRD patients were interviewed at the control institutions. Reduction in number of medical consultation, hospital admissions and exacerbations among CRD patients were 5.03, 3.20 and 2.24 times higher in PAL implementing institutions as compared to the control institutions. PAL pilot project in India implemented in an area with a reasonably sound primary health care system has proved that it might be beneficial for the patients with CRD as it reduces frequency of exacerbations, hospital visits and frequency of medical consultations.

The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries.

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) are common chronic inflammatory respiratory diseases, which impose a substantial burden on healthcare systems and society. Fixed-dose combinations (FDCs) of inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA), often administered using dry powder inhalers (DPIs), are frequently prescribed to control persistent asthma and COPD. Use of DPIs has been associated with poor inhalation technique, which can lead to increased healthcare resource use and costs.MethodsA model was developed to estimate the healthcare resource use and costs associated with asthma and COPD management in people using commonly prescribed DPIs (budesonide + formoterol Turbuhaler® or fluticasone + salmeterol Accuhaler®) over 1 year in Spain, Sweden and the United Kingdom (UK). The model considered direct costs (inhaler acquisition costs and scheduled and unscheduled healthcare costs), indirect costs (productive days lost), and estimated the contribution of poor inhalation technique to the burden of illness.ResultsThe direct cost burden of managing asthma and COPD for people using budesonide + formoterol Turbuhaler® or fluticasone + salmeterol Accuhaler® in 2015 was estimated at €813 million, €560 million, and €774 million for Spain, Sweden and the UK, respectively. Poor inhalation technique comprised 2.2–7.7 % of direct costs, totalling €105 million across the three countries. When lost productivity costs were included, total expenditure increased to €1.4 billion, €1.7 billion and €3.3 billion in Spain, Sweden and the UK, respectively, with €782 million attributable to poor inhalation technique across the three countries. Sensitivity analyses showed that the model results were most sensitive to changes in the proportion of patients prescribed ICS and LABA FDCs, and least sensitive to differences in the number of antimicrobials and oral corticosteroids prescribed.ConclusionsThe cost of managing asthma and COPD using commonly prescribed DPIs is considerable. A substantial, and avoidable, contributor to this burden is poor inhalation technique. Measures that can improve inhalation technique with current DPIs, such as easier-to-use inhalers or better patient training, could offer benefits to patients and healthcare providers through improving disease outcomes and lowering costs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1482-7) contains supplementary material, which is available to authorized users.

Leading causes of bronchial asthma exacerbation

Introduction: Bronchial asthma is one of the most common chronic respiratory diseases. The frequency of occurrence differs from country to country, ranging from 1-18%.Purpose: The purpose of this study was to investigate the causes leading to exacerbation of bronchial asthma.Material and Methods: Α prospective observational study. The studied sample consisted of 82 patients who attended the emergency department or hospitalized in pulmonary clinics of Athens General Hospital, due to exacerbation of bronchial asthma. For data collection a specific registration form was used. Data analysis was performed with the statistical package Statistical Package for Social Sciences (SPSS).Results: Twenty two patients (26.8%) were male. The majority of patients (37.8%, n=31) were aged 46-65 years old. There were no statistically significant differences among patients admitted to the hospital for asthma exacerbation, during the last year and factors such as smoking, type of occupation, place of residence and pet ownership. Statistically significant correlation was found between patients who were trained for taking their medication, those who comply with medical orders and history of asthma exacerbation during the last year, (p&lt;0.05).Conclusions: Patients suffering from bronchial asthma education is an integral part of disease prevention and treatment strategies with a view to comply with medication treatment.

Senėjimo sąlygoti astmos patogenezės pokyčiai

Senėjimas - natūralus procesas, prasidedantis vos gimus, kuris apima visą organizmą, įskaitant ir kvėpavimo takus. Amžiniai kvėpavimo sistemos anatominiai, fiziologiniai ir imuniniai pokyčiai gali turėti įtakos plaučių funkcijai bei įvairių kvėpavimo sistemos ligų eigai. Astma - viena labiausiai paplitusių lėtinių kvėpavimo takų ligų visame pasaulyje, todėl organizmo senėjimo poveikis šios ligos patogenezei itin aktualus. Pasaulinės sveikatos organizacijos (PSO) duomenimis, sparčiai auga astmos paplitimas vyresnio amžiaus žmonių grupėje, būdinga sunkensė eiga, mažesnis standartinių gydymo metodų veiksmingumas, blogesnės baigtys. Pastebėti astmos (ypač sunkios) patogenezės ir natūraliai sveikuose plaučiuose žmogui senstant vykstančių procesų panašumai. Norint kuo geriau suprasti astmos patogenezės mechanizmus, pastarąjį dešimtmetį didėjo domėjimasis pagrindinių ligos patogenezėje dalyvaujančių uždegimo ląstelių sąveika su struktūriniais apatinių kvėpavimo takų elementais. Manoma, kad etapinis kvėpavimo takų remodeliacijos procesų blokavimas galėtų pristabdyti struktūrinių pokyčių progresavimą ir sąlygoti geresnį gydymo efektą.

Biomass smoke exposure and chronic lung disease.

Approximately 3 billion people worldwide rely on coal and biomass fuel for cooking and heating. Biomass smoke exposure is associated with several chronic lung diseases, including chronic obstructive pulmonary disease (COPD), asthma-COPD overlap syndrome, usual interstitial pneumonitis, hut lung, and bronchial anthracofibrosis. Household air pollution primarily from biomass smoke is the biggest risk factor for COPD worldwide. Despite the significant burden of biomass smoke-related respiratory disease, the exposure is still underappreciated worldwide, especially in high-income countries. Recent literature highlights the immunoinflammatory differences between biomass smoke-related COPD and tobacco smoke-related COPD that may lead to better understanding of the differences in the clinical phenotypes between the two entities, suggests an association with the recently recognized asthma-COPD overlap syndrome, and elucidates the burden of disease in high-income countries. The current review focuses on the association between biomass smoke and common chronic respiratory diseases, discuss differences between biomass smoke-related COPD and tobacco smoke-related COPD, highlights chronic respiratory diseases that are specific for biomass smoke exposure such as hut lung and bronchial anthracofibrosis, and discusses the known impact of beneficial interventions.

Effect of Reflexology on Quality of Life of Preschool Children Suffering from Bronchial Asthma

Bronchial asthma is one of the most common chronic respiratory diseases that affect children. Children with bronchial asthma symptoms have significantly lower health related quality of life scores. The nurse can play an important role in management of asthma by applying a safe and an effective assistant method beside the standard medical care as reflexology that can promote well-being, relaxation and improve asthma severity symptoms. The present study aimed to evaluate the effect of reflexology on quality of life of preschool children suffering from bronchial asthma. Materials and Method: The study was conducted at Inpatient Pediatric Chest Unit at Tanta University Hospital. Sixty preschool children suffering from asthma and their mothers were included in the study. They were divided into two equal groups. The study group received the routine hospital medical care plus reflexology. Data were collected by using a structure interview sheet, the basic reflexology technique and outcome measurement scales Results: The present study revealed that applying reflexology beside medical care for study group children improved their overall quality oflife 3days and one month post-program in a degree more than that of applying medical care only for control group children. The study recommended in-service training programs and workshops should be conducted periodically and regularly for nurses working in Pediatric Chest Unit about skills of applying reflexology for asthmatic children.

Toll-like receptor and airway remodeling in asthma

Bronchial asthma is one of the most common chronic respiratory diseases in children.Airway remodeling that makes asthma difficult to control is an important pathological progress of asthma.Toll-like receptors (TLR), a kind of pattern recognition receptors, are expressed in a variety of human airway structure cells, such as airway epithelial cells, smooth muscle cells, mucus gland cells, etc.It is reported that TLRs play important roles in the regulation of airway remodeling in asthma.This article briefly summarizes the role of TLR in airway remodeling of asthma. Key words: Asthma; TLR; Airway remodeling