Evaluation Of Respiratory Symptoms Research Articles

Respiratory viruses in the pre and post-pandemic periods in an Italian tertiary hospital.

We have appreciated the article published by Bardsley and colleagues describing the seasonal circulation of respiratory syncytial virus (RSV) in UK children, and we hope to contribute to increase information on this intriguing and elusive topic. We describe our epidemiological trend with the aim to add a small brick to the current knowledge regarding respiratory infections due to RSV and other respiratory viruses in an era that is changing due to a radical change in the evaluation of respiratory symptoms following the pandemic event.

Respiratory manifestations in the Ehlers-Danlos syndromes.

Persons with the Ehlers-Danlos syndromes (EDS) report a wide range of respiratory symptoms, most commonly shortness of breath, exercise limitation, and cough. Also reported are noisy breathing attributed to asthma, difficulty with deep inhalation, and inspiratory thoracic pain. The literature consists of case reports and small cross-sectional and cohort studies. One case-control study estimated twofold to threefold greater respiratory disease burden among persons with EDS as compared to controls. The differential diagnosis for symptoms is broad. Structural alterations include pectus deformities, scoliosis, recurrent rib subluxations, and tracheobronchomalacia, associated with varying degrees of physiologic impairment. Those with vascular EDS have an increased risk of pneumothorax, intrapulmonary bleeding, cysts, and nonmalignant fibrous nodules. Functional aerodigestive manifestations such as inducible laryngeal obstruction may be misdiagnosed as asthma, with gastro-esophageal dysmotility and reflux as common contributing factors. Inflammatory manifestations include costochondritis, bronchiectasis, and localized respiratory allergic and nonallergic mast cell activation. Cranio-cervical instability can dysregulate respiratory control pathways. There is a need for careful phenotyping using standardized clinical tools and patient-reported outcomes and continuing collaboration with aerodigestive specialists including otolaryngologists and gastroenterologists. Also needed is further evaluation of respiratory symptoms in persons with hypermobility spectrum disorders. Personalized monitoring strategies are invaluable for interpretation and long-term management of respiratory symptoms.

First 100 Persons with COVID-19 - Zambia, March 18-April 28, 2020.

Zambia is a landlocked, lower-middle income country in southern Africa, with a population of 17 million (1). The first known cases of coronavirus disease 2019 (COVID-19) in Zambia occurred in a married couple who had traveled to France and were subject to port-of-entry surveillance and subsequent remote monitoring of travelers with a history of international travel for 14 days after arrival. They were identified as having suspected cases on March 18, 2020, and tested for COVID-19 after developing respiratory symptoms during the 14-day monitoring period. In March 2020, the Zambia National Public Health Institute (ZNPHI) defined a suspected case of COVID-19 as 1) an acute respiratory illness in a person with a history of international travel during the 14 days preceding symptom onset; or 2) acute respiratory illness in a person with a history of contact with a person with laboratory-confirmed COVID-19 in the 14 days preceding symptom onset; or 3) severe acute respiratory illness requiring hospitalization; or 4) being a household or close contact of a patient with laboratory-confirmed COVID-19. This definition was adapted from World Health Organization (WHO) interim guidance issued March 20, 2020, on global surveillance for COVID-19 (2) to also include asymptomatic contacts of persons with confirmed COVID-19. Persons with suspected COVID-19 were identified through various mechanisms, including port-of-entry surveillance, contact tracing, health care worker (HCW) testing, facility-based inpatient screening, community-based screening, and calls from the public into a national hotline administered by the Disaster Management and Mitigation Unit and ZNPHI. Port-of-entry surveillance included an arrival screen consisting of a temperature scan, report of symptoms during the preceding 14 days, and collection of a history of travel and contact with persons with confirmed COVID-19 in the 14 days before arrival in Zambia, followed by daily remote telephone monitoring for 14 days. Travelers were tested for SARS-CoV-2, the virus that causes COVID-19, if they were symptomatic upon arrival or developed symptoms during the 14-day monitoring period. Persons with suspected COVID-19 were tested as soon as possible after evaluation for respiratory symptoms or within 7 days of last known exposure (i.e., travel or contact with a confirmed case). All COVID-19 diagnoses were confirmed using real-time reverse transcription-polymerase chain reaction (RT-PCR) testing (SARS-CoV-2 Nucleic Acid Detection Kit, Maccura) of nasopharyngeal specimens; all patients with confirmed COVID-19 were admitted into institutional isolation at the time of laboratory confirmation, which was generally within 36 hours. COVID-19 patients were deemed recovered and released from isolation after two consecutive PCR-negative test results ≥24 hours apart. A Ministry of Health memorandum was released on April 13, 2020, mandating testing in public facilities of 1) all persons admitted to medical and pediatric wards regardless of symptoms; 2) all patients being admitted to surgical and obstetric wards, regardless of symptoms; 3) any outpatient with fever, cough, or shortness of breath; and 4) any facility or community death in a person with respiratory symptoms, and 5) biweekly screening of all HCWs in isolation centers and health facilities where persons with COVID-19 had been evaluated. This report describes the first 100 COVID-19 cases reported in Zambia, during March 18-April 28, 2020.

Evaluation of Respiratory Symptoms Among Youth e-Cigarette Users

Use of e-cigarettes (ECs) among youths has increased in recent years. e-Cigarette aerosol contains chemical constituents, such as diacetyl or benzaldehyde, which are known to affect the respiratory system. To examine the association between EC use and self-reported wheezing in a cohort of US adolescents. This cohort study used data from waves 3 and 4 (October 19, 2015, to January 3, 2018) of the Population Assessment of Tobacco and Health (PATH) study, a longitudinal, nationally representative cohort survey. Adolescent respondents aged 12 to 17 years who did not have asthma were included. e-Cigarette use during the previous year. Self-reported wheezing in the past 12 months (yes or no) and EC use (no use in past year or never use, use in past year, use in past 30 days, and use in past 7 days). Survey-weighted logistic regression models adjusted for demographic characteristics and other risk factors. Among 7049 adolescents without asthma from waves 3 and 4 of the PATH study, 49.9% were female and 54.4% were non-Hispanic White. In unadjusted models, the odds of wheezing in the past 12 months were higher for youths who had used ECs in the past year compared with those who had not (odds ratio, 1.74; 95% CI, 1.22-2.48; P = .003). In the adjusted model, after controlling for the variables of race/ethnicity, household rules about the use of tobacco, contact with a smoker in the previous 7 days, and current use of combustible tobacco products, the association of EC use with wheezing was not significant (adjusted odds ratio for EC use in the past year, 1.37 [95% CI, 0.91-2.05]; in the past 30 days, 1.35 [95% CI, 0.63-2.88]; in the past 7 days, 0.74 [95% CI, 0.28-1.97]; P = .33). In this cohort study, use of ECs alone was not associated with increased odds of experiencing wheezing episodes. Future studies incorporating the use of objective data appear to be needed to more accurately understand the potential respiratory harms associated with vaping among adolescents.

Disease control in patients with asthma and respiratory symptoms (wheezing, cough) during sleep

IntroductionThe Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients’ satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime performance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. The aim of this study is to present a new method for automated wheeze and cough detection during sleep and to assess the actual level of asthma control by the Asthma Control Test (ACT).MethodsRespiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Patients were asked to assess their level of asthma subjectively with the ACT. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m2. Most of the patients had been taking an ICS/LABA combination and would resort to a SABA as their rescue medication.Results60% of the participants were classed as having controlled, and 40% were classed as having partially- or uncontrolled asthma. During sleep wheezing was found in 8 of the 55 asthma patients (14.5%) and coughing was found in 30 patients (54.5%). The median ACT score in wheezing-patients was 14, while in non-wheezing patients it was 21. Uncontrolled asthma was found in 6 of the 8 wheezing-patients. Coughing versus non-coughing patients did not show a significant difference in the ACT-score (20, 22 respectively).ConclusionWheezing is a sign of uncontrolled asthma. The ACT-score in wheezing patients is worse compared to patients without wheezing. LEOSound proofed to be a useful tool in providing an objective evaluation of respiratory symptoms, like coughing and wheezing. In clinical practice, this may allow an improvement in asthma therapy.

Prevalence of pulmonary hypertension in myelofibrosis.

Pulmonary hypertension (PH) has been described in myelofibrosis (MF), but it is rare and typically found in advanced disease. Although the etiology of PH in MF is unclear, early predictors may be detected by echocardiogram. The goals of our study were to evaluate the prevalence of PH as determined by echocardiography in a cohort of MF patients and to identify clinical risk factors for PH. We performed a retrospective review of MF patients from October 2015 to May 2017 at MD Anderson Cancer Center in the ambulatory clinic, and those with echocardiogram were included. Clinical, echocardiographic, and laboratory data were reviewed. Patients with and without PH were compared using a chi-square or Fisher's exact test, and logistic regression was performed with an outcome variable of PH. There were 143 patients with MF who underwent echocardiogram, and 20 (14%) had echocardiographic findings consistent with PH. Older age, male gender, hypertension, hyperlipidemia, coronary artery disease, dyspnea, hematocrit, brain natriuretic peptide (BNP), and N-terminal prohormone BNP (NT-proBNP) were significantly different between those without PH and those with PH (p < 0.05). Female gender was protective (OR 0.21, 95% CI 0.049-0.90, p = 0.035), and NT-proBNP was a significant clinical predictor of PH (OR 1.07, CI 1.02 = 1.12, p = 0.006). PH in MF is lower than previously reported in our MF cohort, but many patients had cardiac comorbidities. PH due to left-sided heart disease may be underestimated in MF. Evaluation of respiratory symptoms and elevated NT-proBNP should prompt a baseline echocardiogram. Early detection of PH with a multidisciplinary approach may allow treatment of reversible etiologies.

Evaluation of respiratory symptoms and lung function disorders of farmers and non farmers in Yazd Province

Respiratory disorders are common problems in farmers which have a high mortality rate in Yazd city. The aim of this study was to evaluate and compare respiratory parameters as well as the prevalence of respiratory symptoms in three age groups in farmers and non-farmers.&#x0D; Methods:&#x0D; This case-control study was conducted on 300 farmers and 300 non-farmers in Yazd. Questionnaires including cognitive knowledge and symptoms of respiratory diseases were completed for all participants and lung function tests were also performed. Data were analyzed using independent T-t test, Chi square test or Fisher's exact test with spss24.&#x0D; Results:&#x0D; Spirometry results showed a significant reduction in respiratory capacity in the farmer group compared to non-farmer. In all three age groups, the prevalence of respiratory symptoms in farmers were higher than non-farmer groups and as the age increased, the prevalence of symptoms also increased. In the age group over 55, the risk of cough, phlegm, dyspnea and wheezing were 17,10.78,3.58 and 6.61 times more than non-farmers respectively. Among the symptoms of respiratory, cough had the highest and shortness of breath had the lowest prevalence.&#x0D; Discussion and conclusion:&#x0D; Regarding the prevention of high prevalence of respiratory disorders in farmers, the mechanization of agricultural practices, the promotion of health awareness of farmers by health professionals, appropriate implementation of training programs by the health department and assistance of Jihad-e-Agriculture are necessary

Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis

Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent’s quality of life was assessed as secondary outcome. In 36 children (2–8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children’s Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed.What is Known:• Cough and wheezing are the predominant symptoms of acute bronchitis.• There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies.What is New:• Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.

Evaluation of Respiratory Symptoms, Spirometric Lung Patterns and Metal Fume Concentrations among Welders in Indoor Air-Conditioned Building at Malaysia

Welding is one of the fundamental processes for metal joining in automotive industries and there is an increasing concern over occupational lung disease among welder due to exposure towards welding fumes. A lung disease questionnaire (ATS-DLD-78) was used to record the presence of respiratory symptoms among welders and in assessing lung function assessment, FEV1, FVC and FEV1/FVC are considered for identifying the lung condition; normal, obstructive or restrictive. The data were tabulated and subjected to logistic and multivariate analyses. Meanwhile, in order to trace metal in welders’ body, this study utilized a non-invasive approach of toenail as a biomarker. Lung functions decrement was established in linear regression for FEV1 and FEV1/FVC respectively although not statistically significant. Analysis conducted revealed the presence of the following trace elements concentration in ascending sequence: As < Al < Cu < Mn < Cr < Ni < Co < Fe (in the toenail) and Co < Al < Cu < Ni < As < Cr < Fe < Mn (in the cassette), respectively. The results validated the postulation that toenail metals composition shared a similar route of exposure with an anthropogenic source of activity. It is suggested a longer follow-up study is required to assess individual effects on lung function systems and the incidence of respiratory diseases among welders and this study indicates that toenail is a reliable biomarker of metal-workplace pollution and suitable for acquiring chronological information of welding fumes exposure.

009. Evaluation of respiratory symptoms in the emergency department

Objective To evaluate the prevalence of respiratory symptoms and comorbidities, the final diagnosis and the management of patients reviewed in the emergency department of a district hospital of Kavala.

Evaluation of Respiratory Symptoms and Respiratory Protection Behavior Among Poultry Workers in Small Farming Operations

ABSTRACTAgricultural workers who work in enclosed poultry operations are at increased risk of respiratory exposure to atmospheric contaminants, including dusts, endotoxins, particulate from feathers, ammonia, and hydrogen sulfide from animal excrement. Given the relatively large number of small, family-run poultry farms in North Carolina, there has been relatively little research in the area documenting human lung function and perception of using respiratory protection among poultry workers. This study assesses respiratory health, knowledge, and perception of wearing respiratory protection among a sample of poultry workers attending a regional farm show in North Carolina. Lung function (spirometry), airway inflammation (exhaled nitric oxide), self-reported respiratory symptoms, and behavior of wearing respiratory protection were evaluated. Overall, mean lung function values were slightly lower than normal predicted values. The majority of participants ranked using respiratory protection as very important (51.9%); however, actual self-reported behavior was low (16.7%). In bivariate analysis, associations between the importance of wearing respiratory protection and the number of poultry houses (P = .04), as well as using a respirator and the number of poultry houses (P = .01) were statistically significant. Improved educational opportunities, including fit-testing and proper respiratory selection, should be emphasized for workers at small, poultry farm operations.

Evaluation of Respiratory Symptoms in Workers of a Rubber Factory

Aim: In this study, our objective was to investigate whether there is any relationship between working in the rubber industry and having respiratory symptoms. Method: This study was performed on 141 workers of a rubber factory. Anamnesis, physical examination and pulmonary function tests (PFT) were evaluated. Peak Expiratory Flow (PEF) follow-up and skin Prick Test were administered to the patients according to the results of respiratory system complaints, physical examination and PFT. Result: One hundred and forty one workers who accepted to participate in the study consisted of 116 (82.3%) males and 25 females (17.7%). In the comparison group with greater exposure results were obtained in the normal range, however the parameters of FEV1/FVC and FEF25-75(%) were lower in the greater exposure group. This difference was statistically significant (p<0.05). Variability was greater than 20% in 9 (6.3%) workers in the evaluation of PEF-meter follow-up forms. Conclusion: In conclusion, our study has demonstrated that exposure to dust and smoking in rubber industry seem to be associated with the development of occupational respiratory symptoms and diseases. That’s why, control of dust exposure and cessation of smoking is important in prevention of this situations.

The Cincinnati childhood allergy and air pollution study (CCAAPS): Evaluation of respiratory symptoms at age 1

The Cincinnati childhood allergy and air pollution study (CCAAPS): Evaluation of respiratory symptoms at age 1

Obesity Is Associated with Bronchial Hyper-Responsiveness in Women

The study's objective was to compare the bronchial hyper-responsiveness (BHR) between those with normal and increased weight and evaluate if the association was sex-specific. In this cross-sectional review of methacholine challenge test results of 1,141 adults for evaluation of respiratory symptoms, logistic regression analysis was conducted to adjust for covariates. When compared to normal weight, overweight or obese women showed a higher prevalence of symptomatic BHR with odds ratios of 1.63 (95% C.I. 1.16–2.29). This association was not seen in men, with a significant sex-specific interaction. This study shows a sex-specific association between symptomatic BHR and overweight or obese status.

Importancia de los síntomas en la EPOC

Chronic obstructive pulmonary disease (COPD) is a major public health problem, due to its high prevalence. Furthermore, the prevalence of COPD has increased in the last years. The GOLD initiative has defined COPD as a disease state characterised by airflow limitation that is not fully reversible and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Consequently, demonstration of airflow limitation by means of forced spirometry is mandatory for stablishing the diagnosis of COPD. Spirometry is also required for the classification of severity and follow-up of patients with COPD. Since airflow limitation is almost irreversible, evaluation of respiratory symptoms is important in COPD management. The main symptoms are dyspnea, cough and sputum production. In many cases, treatment will be aimed to control symptoms and improve quality of life, but without significant improvement in lung function parameters. Bronchodilator medications are central to the symptomatic management of COPD and inhalation should be the preferred route of administration. Conversely to asthma, anticholinergic drugs are, at least, as effective as beta-2 agonists. Treatment with inhaled corticosteroids is only appropriate for symptomatic COPD patients with a documented spirometric response, or for those with severe disease and repeated exacerbations. New perspectives for treatment exist with the development of a new long-acting inhaled anticholinergic, tiotropium bromide, which provides a potent bronchodilator activity with a single daily dose. This and other new drugs under development will offer new alternatives for treatment of this frequent disease.

Prognostic value of methacholine challenge in patients with respiratory symptoms

Background: The objective was to study the current clinical status of 78 adults with respiratory symptoms, who were referred 3 to 10 years ago for diagnostic methacholine challenge. We tested the hypothesis that methacholine hyperresponsiveness would be associated on follow-up with increased symptoms of chest tightness, dyspnea, wheezing, cough, and more frequent use of selected treatment modalities. Methods: Current symptoms were evaluated by means of interview questionnaire, and methacholine challenge was repeated during follow-up examination. Comparisons were made between patients who were and those who were not hyperresponsive to methacholine at initial and follow-up challenges by using specific symptoms and calculated symptom and treatment scores. Results: We found that subjects who had positive methacholine challenge results on initial challenge (n = 37) were significantly more likely than those with negative results (n = 41) to have nonexertional chest tightness, wheezing, and dyspnea, but not cough. A high proportion of both groups had current symptoms. Two thirds of the patients continued to have positive (n = 25) or negative (n = 27) methacholine challenge results, and one third had a change in status (n = 26). Significant correlations were also found between follow-up methacholine responsiveness and concurrent symptoms, again with the exception of cough. Conclusions: Methacholine challenge warrants cautious interpretation in the individual patient as an aid to diagnosis and prognosis in the evaluation of respiratory symptoms, especially cough. (J ALLERGY CLIN IMMUNOL 1994;94:77-87.)