Respiratory Department Research Articles

The association between air pollution parameters and emergency department visits and hospitalizations due to cardiovascular and respiratory diseases: a time-series analysis.

In this study, the association between cardiovascular and respiratory Emergency Department (ED) visits and hospitalizations and Sulfur Dioxide (SO2) and particulate matter with an aerodynamic diameter ≤ 10µm (PM10) was determined. The records of a total of 632,223 people diagnosed with cardiovascular diseases (ICD-10 code I00-I99) and respiratory diseases (ICD-10 code J00-J99) at and over the age of 18 between 2012 and 2018 in three hospitals in Karaman in Turkey were examined in the present study. The daily 24-h averages for SO2 and PM10 concentrations were acquired in National Air Quality Monitoring. A time-series analysis with Poisson Generalized Linear Model was used. Among the air pollution parameters, the mean ± standard deviation of SO2 and PM10 were 16.2 ± 22.1 and 75.8 ± 48.2μg/m3, respectively. An increase of 10μg/m3 in SO2 was associated with a 3% [Relative Risk (RR), 95% Confidence Interval (CI): 2-4)] increase in cardiovascular ED visit and 2% (RR, 95% CI 2-3) increase in respiratory ED visit, and 1% (RR, 95% CI 1-3) increase in respiratory hospitalizations. An increase of 10μg/m3 in PM10 was associated with a 1% (RR, 95% CI 1-2) increase in cardiovascular hospitalizations. Increases in SO2 are a risk factor for cardiovascular and respiratory ED visits, and respiratory hospitalizations. Increases in PM10 are a risk factor for cardiovascular hospitalizations.

P59.32 Physician Attitudes Toward Genetic Testing and Targeted Therapy for Advanced NSCLC Patients in China: A Nationwide Survey

The purpose of this survey is to explore the situation of genetic testing and targeted therapy in advanced non-small cell lung cancer (NSCLC) patients in China. The survey was conducted in oncology, respiratory and thoracic surgery departments between May 2020 and September 2020 across 135 cities in China. The participating physicians had >5 years of clinical experience in NSCLC diagnosis and treatment. Among 450 participating physicians, 361(80.2%) and 89 (19.8%) were from the tertiary and non-tertiary hospitals, respectively. For newly diagnosed patients, epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) rearrangement, and ROS proto-oncogene 1 (ROS1) fusion testing were recommended by 83.4%, 72.9% and 68.3% of physicians, respectively. For patients who had not received any tyrosine kinase inhibitor (TKI) therapy, who had received one line, and who had received ≥2 lines of TKI therapy, the recommended percentage of genetic testing by physicians declined gradually, which were 81%, 56% and 45%, respectively. Similarly, with the increasing number of TKIs treatment lines, the genetic testing rate of patients decreased gradually, which were 77.9%, 59.5% and 46.7%. Patients refused genetic testing either because their incomprehension or it was costly. The accessibilities of genetic testing of EGFR, ALK and ROS1 in respective pathology departments were 81.9%, 75.5% and 65.6%, respectively. Among the newly diagnosed patients with EGFR mutation, 77% received TKI therapy during first-line treatment, of which 49% were treated with Gefitinib. Furthermore, among patients with ALK rearrangement, 71% received TKI therapy during first-line treatment, of which 64% were treated with Crizotinib. Among patients with ROS1 fusion, 65% received TKI therapy during first-line treatment, of which 88% patients were treated with Crizotinib. The recommended percentage of physicians, the percentage of patients’ genetic testing and the proportion of TKIs use were all higher numerically in tertiary hospitals. Although driver gene mutation is common in Asian NSCLC patients, some newly diagnosed Chinese patients failed to undergo timely testing and consequent targeted therapy, especially for ROS1 fusion. Compared to the tertiary hospitals, the physicians' awareness of genetic testing, accessibility of genetic testing of the hospital, and patients’ genetic testing rate were lower in non-tertiary hospitals. Patients with EGFR mutation or ALK rearrangement received more targeted therapy than those with ROS1 fusion. Thus, imparting education on ALK and ROS1 to physicians and patients is imperative to increase the recommended percentage of genetic testing and the proportion of targeted drug therapy.

Impact of COVID-19 on TB epidemiology in South Korea.

SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.

Correlation between Vitamin A Deficiency and the Severity of Mycoplasma Pneumoniae Pneumonia in Children

Mycoplasma pneumoniae pneumonia is a problem that has attracted the attention of children’s respiratory department in recent years. The relationship between vitamin A deficiency (VA) and the severity of Mycoplasma disease (MPP) in children was studied. In this paper, the hospitalized children with Mycoplasma pneumoniae pneumonia (MPP) in our hospital were selected as the research objects, and they were divided into common type and refractory type (RMPP) for comparative experiment. The VA and immunoglobulin levels of the two groups were compared. Attention should be paid to the normal ratio of VA deficiency (CVAD) and sub deficiency (svad) in the two groups. In this paper, the relationship between infection, immunoglobulin level and VA level was analyzed. The results showed that CVAD was 27.27% in MPP group and 63.75% in RMPP group. Comparison of immunoglobulin levels between the two groups: the levels of IgM, IgA and IgG in the normal MPP group were significantly lower than those in the RMPP group. On the other hand, the detection rate of CVAD was 81.48% in RMPP with infection and 54.72% in RMPP without infection. The detection rate of CVAD in patients with infection was significantly higher than that in patients without infection. There was a correlation between VA Deficiency and MPP classification.

Practice and Effect Evaluation of Drug Reorganization in Patients with Chronic Obstructive Pulmonary Disease

Objective: To explore the feasibility of drug reorganization in clinical practice through the drug reorganization service of clinical pharmacists for patients with chronic obstructive pulmonary disease (COPD) in respiratory and critical care department, and to evaluate the effect of the service in multiple dimensions. Methods: a total of 100 patients with COPD admitted from January to July 2021 were randomly divided into two groups with 50 patients in each group. One group was treated with drug reforming intervention and the other group was not treated with intervention. Statistics and data analysis were carried out from three aspects: patient compliance, satisfaction and medication deviation. Results: (1) compliance: 48h after admission, there was no significant difference between the two groups (P&gt;0.05); According to the data statistics on the day of discharge and after one month, the compliance of the two groups was statistically significant (P&lt;0.05), which was higher in the reorganization group. (2) Satisfaction: There was no significant difference between the two groups after admission. However, after drug reforming intervention by pharmaceutical staff, the results of reforming group were better and statistically significant (P&lt;0.05). (3) Medication deviation: There were 50 deviations in the reorganization group, of which drug omission accounted for 52%, which was the main factor. After communicating with clinicians, the clinicians’ acceptance rate of the reorganization scheme reached 94.12%. Conclusion: The implementation of drug reorganization service can effectively prevent the medication deviation of COPD patients, save the cost of patients, improve the satisfaction and compliance, and ensure the medication safety of patients.

Nursing Research on Patients with Chronic Obstructive Pulmonary Disease and Respiratory Failure Based on Big Data.

This work organically integrates a systematic and individualized nursing plan with big data technology and applies it to the care of patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (RF) and explores the continuous care model based on modern big data technologies to improve COPD and RF. It aims to relieve the symptoms of COPD and RF, reduce the number of acute episodes of COPD and RF and the number of hospitalizations, and improve the quality of life of patients. One hundred COPD and RF patients hospitalized in the respiratory medicine department of a tertiary hospital were selected and were categorized into control and experimental group. The nursing mode of the patients in the control group was the original telephone follow-up in the department, and the contents of the follow-up were determined according to the questions of the patients on the telephone at that time. Based on the original nursing in the department, the experimental group adopted individualized continual nursing plans based on the Internet and big data techniques for patients to conduct a pulmonary rehabilitation-related functional assessment, functional exercise guidance, and health guidance. Experimental results show that, compared with traditional continuous care, individualized continuous care combined with big data techniques can improve the lung function of patients with stable COPD and RF, reduce the number of acute COPD and RF attacks and the number of readmissions, and improve self-management ability and quality of life. The method can be applied and implemented in continuous nursing care.

A retrospective safety study on screening of the samples in the clinical biobank of Beijing Hospital

To investigate whether the laboratory specimens preserved in Beijing Hospital Biobank during a specific period had been contaminated by SARS-Cov-2 through a cross-sectional study, and to establish a retrospective biobank safety screening system. Laboratory specimens were collected from the Department of Respiratory and Critical Care Medicine and the Fever Clinic of Beijing Hospital from November 1, 2019 to January 22, 2020, nucleic acid and serological antibody testing were performed for SARS-CoV-2 in these specimens (including 79 serum, 20 urine, 42 feces and 21 bronchoalveolar lavage fluid specimens). The safety of the stored samples during this period was defined by negative and positive results. Both the nucleic acid test and serological antibody test showed negative for SARS-CoV-2, indicating that these specimens were safely stored in the biobank. High-risk specimens collected in our hospital during the early stage of the COVID-19 outbreak are free of SARS-CoV-2, and a safety screening strategy for the clinical biobank is established to ensure the biosafety of these samples.

The Prognostic Value of Biomarkers on Detecting Non-Small Cell Lung Cancer in a Chinese Elderly Population.

BackgroundSurvival in non-small cell lung cancer (NSCLC) remains poor. Early detection of NSCLC is of great significance to provide a chance to improve survival.AimWe constructed predictive models to evaluate the predictive value of four tumor biomarkers by including serum human epididymis protein 4 (HE4), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCCA), and cytokeratin 19 fragment (CY21-1) on detecting NSCLC in a Chinese elderly population.MethodsA total of 363 patients with NSCLC and 433 subjects without cancer (healthy control group) were admitted to the respiratory department in our hospital. We assessed serum levels of these four tumor biomarkers in the two groups and then the predictive value of predictive models was evaluated.ResultsSerum median values of HE4 (143.3 pmol/L), CEA (4.60 ng/mL), SCCA (1.52 ng/mL), and CY21-1 (5.36 ng/mL) in patients with NSCLC were significantly higher than the healthy control group, respectively (all P<0.05). A multivariate logistic regression model showed that HE4 (OR=2.10, 95% CI=1.22–4.42, P=0.013), CEA (OR=2.30, 95% CI=1.44–4.53, P=0.004), SCCA (OR=2.20, 95% CI=1.29–4.55, P=0.011), and CY21-1 (OR=2.60, 95% CI=1.56–6.25, P<0.001) were significantly and independently associated with increased risk of NSCLC on admission after confounding factors were corrected. Importantly, the ROC curve suggested HE4 had a good value on predicting NSCLC in the Chinese elderly population. Additionally, the predictive model (CEA+SCCA+CY21-1+HE4) had better idea capability to detecting the existence of NSCLC (AUC=0.954, 95% CI=0.927–0.999, P<0.001).ConclusionOur study showed that several lung cancer-related biomarkers were used to build prediction models, which has good value for early prediction of NSCLC.

Common Nursing Problems of Elderly Patients in Respiratory Department and Analysis of Symptomatic Nursing Intervention Effect

Common Nursing Problems of Elderly Patients in Respiratory Department and Analysis of Symptomatic Nursing Intervention Effect

Analysis of Clinical Treatment of Severe Asthma in Respiratory Department

Analysis of Clinical Treatment of Severe Asthma in Respiratory Department

Assessing the Risk of Respiratory-Related Healthcare Visits Associated with Wildfire Smoke Exposure in Children 0-18 Years Old: A Systematic Review.

Wildfires are increasing in frequency, size, and intensity, and increasingly affect highly populated areas. Wildfire smoke impacts cardiorespiratory health; children are at increased risk due to smaller airways, a higher metabolic rate and ongoing development. The objective of this systematic review was to describe the risk of pediatric respiratory symptoms and healthcare visits following exposure to wildfire smoke. Medical and scientific databases and the grey literature were searched from inception until December 2020. Included studies evaluated pediatric respiratory-related healthcare visits or symptoms associated with wildfire smoke exposure. Prescribed burns, non-respiratory symptoms and non-pediatric studies were excluded. Risk of bias was evaluated using the National Toxicology Program’s Office of Health Assessment and Translation Risk of Bias Rating Tool. Data are presented narratively due to study heterogeneity. Of 2138 results, 1167 titles and abstracts were screened after duplicate removal; 65 full text screens identified 5 pre-post and 11 cross-sectional studies of rural, urban and mixed sites from the USA, Australia, Canada and Spain. There is a significant increase in respiratory emergency department visits and asthma hospitalizations within the first 3 days of exposure to wildfire smoke, particularly in children < 5 years old.

Application of Humanized Service in Nursing Work of Respiratory Department

Application of Humanized Service in Nursing Work of Respiratory Department

Quality Management in Respiratory Care.

The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been considered to be specific to the care provided. However, this specific perspective is transitioning toward a broader concept after the evolution of quality-improvement projects and quality frameworks at the organizational level. Respiratory therapy departments have been identified as an essential part of any hospital because the key nature of discipline for respiratory therapists is widely understood. Due to their professional accountability and professional values, respiratory therapists often have administrative roles in infection control practices and quality-improvement projects. Therefore, it would be ideal to have a core team of respiratory therapists trained in quality management and to initiate quality-improvement processes at the departmental level. Every respiratory therapy department should have its own quality-improvement team to assist with the process of training, implementation, and analysis. Thus, this article aimed to discuss the role of respiratory therapists and respiratory therapy departments in quality-improvement processes and projects to set benchmarks and enhance outcomes.

Streptococcus Pharyngitis with Anaerobes Infection Misdiagnosed as Mycobacterium Tuberculosis Infection: A Case Report

Introduction: Pulmonary infection is a common disease in respiratory department. Different pathogens may lead to the same clinical symptoms and imaging changes, and the same pathogen may also lead to different clinical symptoms and imaging changes. It is often difficult to identify specific pathogens in pulmonary infection. Sometimes the patient’s condition is delayed due to the doctor’s inability to judge the specific pathogen well and the failure to carry out targeted treatment. We share this case and hope that doctors can enhance their understanding of this disease, minimize misdiagnosis and enhance the accuracy of disease diagnosis. Case report: This case reported a patient with recurrent fever, which was misdiagnosed as Mycobacterium tuberculosis infection and developed high fever after diagnostic anti-tuberculosis treatment. The posterior pleural effusion next-generation sequencing (NGS) confirmed that the patient was empyema caused by streptococcus pharyngitis combined with anaerobic infection. After anti-infection with teicoplanin and levofloxacin, the patient's body temperature was normal, lung shadow and pleural effusion were completely absorbed. Discussion/Conclusions: In clinical work, we should be vigilant against false positive T cell spot test (T-SPOT.TB), make rational use of NGS and other detection methods, identify specific pathogens as soon as possible, and carry out reasonable targeted treatment.

Health outcomes: Towards the accreditation of respiratory medicine departments

National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.

Establishment and validation of a predictive model for nontuberculous mycobacterial infections in acid-fast bacilli smear-positive patients.

IntroductionNontuberculous mycobacteria (NTM) and pulmonary tuberculosis (PTB) are difficult to distinguish in initial acid‐fast bacilli (AFB) smear‐positive patients.ObjectivesEstablish a predictive model to identify more effectively NTM infections in initial AFB patients.MethodsConsecutive AFB smear‐positive patients in the Respiratory Department of Shanghai Pulmonary Hospital from January 2019 to February 2020 were retrospectively analysed. A multivariate regression was used to determine the independent risk factors for NTM. A receiver operating characteristic (ROC) curve was used to determine the model's predictive discrimination. The model was validated internally by a calibration curve and externally for consecutive AFB smear‐positive patients from March to June 2020 in this institution.ResultsPresenting with haemoptysis, bronchiectasis, a negative QuantiFERON tuberculosis (QFT) test and being female were characteristics significantly more common in patients with NTM (P ≤ 0.001), when compared with PTB. The involvement of right middle lobe, left lingual lobe and cystic change was more commonly seen on chest high‐resolution computed tomography (HRCT) in patients with NTM (P < 0.05), compared with PTB. Multivariate regression showed female, bronchiectasis, negative test for QFT and right middle lobe lesion were independent risk factors for NTM (P < 0.05). A ROC curve showed a sensitivity and specificity of 85.9% and 93.4%, respectively, and the area under the curve (AUC) was 0.963. Moreover, internal and external validation both confirmed the effectiveness of the model.ConclusionsThe predictive model would be useful for early differential diagnosis of NTM in initial AFB smear‐positive patients.

Promoting Effect of Clinical Pharmacy Intervention on Rational Use of Antibiotics in Respiratory Department

Promoting Effect of Clinical Pharmacy Intervention on Rational Use of Antibiotics in Respiratory Department

Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study.

In patients treated with noninvasive ventilation, sleep-related breathing changes can modify patient-ventilator interactions, which could reduce its effectiveness. The aim of this prospective observational study was to determine the impact of sleep/wake state on leaks, upper airway obstructive events, and asynchronies in patients treated by long-term noninvasive ventilation. Stable patients adapted to noninvasive ventilation were considered for nocturnal polysomnography. Unintentional leaks, upper airway obstructive events, and asynchronies were compared between sleep and awake periods. Twenty-eight patients were enrolled. Underlying diagnoses were neuromuscular disease (n = 11), chest wall disease (n = 8), and obesity-hypoventilation (n = 9). Leaks were more frequent in sleep than in awake periods, with a median of 10% (interquartile range [IQR], 0%-75%) vs 1% (IQR, 0%-9%) of time (P < .001), respectively. During sleep, asynchronies with and without associated leak affected 27% of breaths (IQR, 16%-39%) compared with non-leak-related asynchronies that were recorded in 8% (IQR, 3%-25%) of breaths (P < .001). Asynchronies affecting more than 10% of total breaths were more frequent in sleep (25 patients, 89%) than in awake time (8 patients, 29%; P = .25). Eleven patients (39%) presented with 5 or more upper airway obstructive events without reduction in ventilatory drive per hour of sleep. In patients adapted to home noninvasive ventilation, leaks, asynchronies, and upper airway obstructive events are frequent during the night and are concentrated in sleep periods. Asynchronies are often associated with leaks. These findings may have clinical implications considering that in patients with low sleep efficiency respiratory events could be underestimated if sleep is not evaluated. Martí S, Ferré A, Sampol G, etal. Sleep increases leaks and asynchronies during home noninvasive ventilation: a polysomnographic study. J Clin Sleep Med. 2022;18(1):225-233.

Respiratory Emergency Department Visit Associations with Exposures to Fine Particulate Matter Mass, Constituents, and Sources in Dhaka, Bangladesh Air Pollution.

Rationale: To date, there is no published local epidemiological evidence documenting the respiratory health effects of source-specific air pollution in South Asia, where particulate matter ⩽2.5 μm in aerodynamic diameter (PM2.5) composition is different from past studies. Differences include more biomass and residue crop-burning emissions, which may have differing health implications. Objectives: We assessed PM2.5 associations with respiratory emergency department (ED) visits in a biomass-burning-dominated high-pollution region and evaluated their variability by pollution source and composition. Methods: Time-series regression modeling was applied to daily ED visits from January 2014 through December 2017. Air pollutant effect sizes were estimated after addressing long-term trends and seasonality, day of week, holidays, relative humidity, ambient temperature, and the effect modification by season, age, and sex. Results: PM2.5 yielded a significant association with increased respiratory ED visits (0.84%; 95% confidence interval, 0.33-1.35%) per 10-μg/m3 increase. The PM2.5 health effect size varied with season, the highest being during monsoon season, when fossil-fuel combustion sources dominated exposures. Results from a source-specific health effect analysis were also consistent with fossil-fuel PM2.5 having a larger effect size per 10 μg/m3 than PM2.5 from other sources (fossil-fuel PM2.5: 2.79% [0.33-5.31%], biomass-burning PM2.5: 1.27% [0-2.54%], and other PM2.5: 0.95% [0.06-1.85%]). Age-specific associations varied, with children and older adults being disproportionately affected by the air pollution, especially by the combustion-related particles. Conclusions: This study provided novel and important evidence that respiratory health in Dhaka is significantly affected by particle air pollution, with a greater health impact by fossil-fuel combustion-derived PM2.5.

Acceptability of applying asthma action plan for asthma patients at a hospital in Hochiminh City, Vietnam: an implementation research

Objectives: The asthma management strategy at respiratory departments in Vietnam so far does not include the implementation of an asthma action plan (AAP). This study aimed to implement an AAP in the hospital and analyze the acceptability for the implementation procedures of patients, clinicians and asthma management units. Methods: The implementation consisted of 2 phases. Phase 1 was a cross-sectional design that combined quantitative and qualitative methods to assess the asthma control and analyse potential obstacles of the hospital for AAP implementation. Phase 2 was a pre-experimental design to assess the acceptability in implementing the APP. Asthma control was assessed by GINA’s criteria. Implementation strategies included interventions at both organization (issued a procedure and a guideline of consulting the AAP for patients) and individual levels (trained doctors in counseling and monitoring of AAP for patients; provided instruction leaflets of APP for patients). Results: The proportion of asthma sufficient control was 59%, partial control was 30.8%, and insufficient control was 10.2%. Most of obstacles related to asthma management and control were of health facility, such as no concrete procedures in monitoring, insufficiency of infrastructure, overload of patients. Implementation strategies of AAP in this study got the acceptability of patients, clinicians and asthma management units. Conclusion: The study showed the importance of deployment of AAP for asthma patients in Vietnam hospitals. It is essential to provide more staffs for the asthma and COPD management units, especially trained nurses. Keywords: Asthma Action Plan; implementation research; Vietnam acceptability; asthma control.