History Of Obstructive Lung Disease Research Articles

Association of serum level and gene expression of IL-25 in a sample of Iraqi asthmatic patients

Asthma is an increasingly common disease characterized by allergic airway inflammation, hyperresponsiveness, mucus overproduction, and peribronchial fibrosis. The epithelial cytokines IL25 have been implicated in asthma pathogenesis because they promote Th2-type cytokine synthesis. The current study aimed to assess IL-25 expression and measure the serum level of this cytokine in asthmatic Iraqi patients. The study was conducted on sixty (60) asthmatic patients (32 female and28 male) and thirty as apparently healthy subjects (control) (16 female and 14 male) with ages ranging from 15-60 years recruited Alzahra’a Center for Asthma and Allergy in Baghdad during the period between November /2021 to March /2022. Written informed consent was obtained from all patients and a healthy control group. Moreover, the study design was approved by the Institute of Genetic Engineering and Biotechnology for Postgraduate Studies/ University of Baghdad. All patients were diagnosed according to clinical examination by a chest physician and selected according to the global initiative of asthma criteria. The healthy control group are non-smoking subjects with no history of obstructive lung disease or atopy. The RNA was extracted from the whole blood of asthma patients and healthy control without Trizol subjects using the protocol in Easy Pure t® blood RNA Kit (ER-401). The acceptable purity of asthmatic patients and control healthy group RNA ranges between 1.84 and 1.99. IL-25 gene expression showed the Ct of asthma patient group (25.179) and control group (27.393), and the2-ΔΔCt of asthma patient group (288.81) and control group (58.48) and the fold of gene expression was statistically significantly (P≤0.01) the calculation of the gene expression it was significant in the patient group than control group4.938 times with ratio (4.938:1) . ELISA estimated IL-25concentration, the results were statistically significant (P≤0.001), the level of IL-25 in asthma patient group (29.30± 5.107317pg/ml) while the level of IL-23 in Control group (15.16±0.085248pg/ml). Keywords: IL-25, gene expression, Elisa, Asthma

Bronchodilator reversibility testing in morbidly obese non-smokers: fluticasone/salmeterol efficacy versus salbutamol bronchodilator

A positive response in reversibility testing is widely used to diagnose patients with airway limitations. However, despite its simple procedure, it doesn’t accurately reflect the exact airway irreversibility. This study aimed to investigate the efficacy of a bronchodilation reversibility test using salbutamol and fluticasone/salmeterol combination in obese non-smoker subjects.The study included patients without a history of obstructive lung disease or bronchodilators. A sub-classification of patients based on body mass index (BMI) was carried out into normal (< 24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (BMI ≥ 30). Spirometry measurements were performed before and after salbutamol or fluticasone/salmeterol administration.The study included 415 (49.9% male) patients with a mean age of 40.92 ± 10.86 years. Obese subjects showed a high prevalence of restrictive patterns (23.4%), with non-significantly lower spirometric values compared to normal and overweight subjects (p > 0.05). The magnitude of bronchodilation, as identified by spirometry, following fluticasone/salmeterol was higher in all participants, with a significant increase in obese subjects with a p-value of 0.013, 0.002, and 0.035 for FEV1, FEV1% predicted, and FEV1/FVC, respectively.Fluticasone/salmeterol combination increases FEV1, FEV1% of predicted, and FEV1/FVC ratio than the conventional test using salbutamol inhaler, and it can be a potential candidate for assessment of airway obstruction using reversibility test, especially among the obese population.

Comparison of ventilation defects quantified by Technegas SPECT and hyperpolarized 129Xe MRI.

Introduction: The ideal contrast agents for ventilation SPECT and MRI are Technegas and 129Xe gas, respectively. Despite increasing interest in the clinical utility of ventilation imaging, these modalities have not been directly compared. Therefore, our objective was to compare the ventilation defect percent (VDP) assessed by Technegas SPECT and hyperpolarized 129Xe MRI in patients scheduled to undergo lung cancer resection with and without pre-existing obstructive lung disease. Methods: Forty-one adults scheduled to undergo lung cancer resection performed same-day Technegas SPECT, hyperpolarized 129Xe MRI, spirometry, and diffusing capacity of the lung for carbon monoxide (DLCO). Ventilation abnormalities were quantified as the VDP using two different methods: adaptive thresholding (VDPT) and k-means clustering (VDPK). Correlation and agreement between VDP quantified by Technegas SPECT and 129Xe MRI were determined by Spearman correlation and Bland-Altman analysis, respectively. Results: VDP measured by Technegas SPECT and 129Xe MRI were correlated (VDPT: r = 0.48, p = 0.001; VDPK: r = 0.63, p < 0.0001). A 2.0% and 1.6% bias towards higher Technegas SPECT VDP was measured using the adaptive threshold method (VDPT: 23.0% ± 14.0% vs. 21.0% ± 5.2%, p = 0.81) and k-means method (VDPK: 9.4% ± 9.4% vs. 7.8% ± 10.0%, p = 0.02), respectively. For both modalities, higher VDP was correlated with lower FEV1/FVC (SPECT VDPT: r = -0.38, p = 0.01; MRI VDPK: r = -0.46, p = 0.002) and DLCO (SPECT VDPT: r = -0.61, p < 0.0001; MRI VDPK: r = -0.68, p < 0.0001). Subgroup analysis revealed that VDP measured by both modalities was significantly higher for participants with COPD (n = 13) than those with asthma (n = 6; SPECT VDPT: p = 0.007, MRI VDPK: p = 0.006) and those with no history of obstructive lung disease (n = 21; SPECT VDPT: p = 0.0003, MRI VDPK: p = 0.0003). Discussion: The burden of ventilation defects quantified by Technegas SPECT and 129Xe MRI VDP was correlated and greater in participants with COPD when compared to those without. Our observations indicate that, despite substantial differences between the imaging modalities, quantitative assessment of ventilation defects by Technegas SPECT and 129Xe MRI is comparable.

Association between the prevalence of obstructive lung disease and the use of aspirin in a diabetic population

Many diabetic patients take a daily low-dose of aspirin because they are two to three times more likely to suffer from heart attacks and strokes, but its role in obstructive lung diseases is less clear.A total of 1,003 subjects in community practice settings were interviewed at home. Patients self-reported their personal and clinical characteristics, including any history of obstructive lung disease (including COPD or asthma). Current medications were obtained by the direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess for a possible association between obstructive lung disease history and the use of aspirin.In a multivariate logistic regression model, a history of obstructive lung disease was significantly associated with the use of aspirin even after correcting for potential confounders, including gender, low income (<USD 30,000/year), number of comorbidities, number of medications, cigarette smoking, and alcohol problems (adjusted odds ratio = 0.67, P = 0.03, 95% confidence interval = 0.47, 0.97). The opposite was found with aspirin and that for diabetic individuals that use insulin. A secondary analysis discovered a significant interaction between aspirin use and insulin: aspirin was associated with lower rates of lung disease except among those taking both drugs where the prevalence is significantly higher.These data suggest a negative correlation between the use of aspirin and obstructive lung disease prevalence in patients with diabetes but not for those that use insulin. Further studies are required to determine if this association is causal.

Association between prevalence of obstructive lung disease and obesity: results from The Vermont Diabetes Information System

BackgroundThe association of obesity with the development of obstructive lung disease, namely asthma and/or chronic obstructive pulmonary disease, has been found to be significant in general population studies, and weight loss in the obese has proven beneficial in disease control. Obese patients seem to present with a specific obstructive lung disease phenotype including a reduced response to corticosteroids. Obesity is increasingly recognized as an important factor to document in obstructive lung disease patients and a critical comorbidity to report in diabetic patients, as it may influence disease management. This report presents data that contributes to establishing the relationship between obstructive lung disease in a diabetic cohort, a population highly susceptible to obesity.MethodsA total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any history of obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory, and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease history and obesity.ResultsIn a multivariate logistic regression model, a history of obstructive lung disease was significantly associated with obesity (body mass index ≥30) even after correcting for potential confounders including gender, low income (<$30,000/year), number of comorbidities, number of prescription medications, cigarette smoking, and alcohol problems (adjusted odds ratio (OR) = 1.58, P = 0.03, 95% confidence interval (CI) = 1.05, 2.37). This association was particularly strong and significant among female patients (OR = 2.18, P = < 0.01, CI = 1.27, 3.72) but not in male patients (OR = 0.97, P = 0.93, CI = 0.51, 1.83).ConclusionThese data suggest an association between obesity and obstructive lung disease prevalence in patients with diabetes, with women exhibiting a stronger association. Future studies are needed to identify the mechanism by which women disproportionately develop obstructive lung disease in this population.

Discharge in Pandemic: Suspected Covid-19 patients returning to the Emergency Department within 72 hours for admission.

IntroductionCoronavirus disease 2019 (Covid-19) has led to unprecedented healthcare demand. This study seeks to characterize Emergency Department (ED) discharges suspected of Covid-19 that are admitted within 72 h.MethodsWe abstracted all adult discharges with suspected Covid-19 from five New York City EDs between March 2nd and April 15th. Those admitted within 72 h were then compared against those who were not using descriptive and regression analysis of background and clinical characteristics.ResultsDischarged ED patients returning within 72 h were more often admitted if suspected of Covid-19 (32.9% vs 12.1%, p < .0001). Of 7433 suspected Covid-19 discharges, the 139 (1.9%) admitted within 72 h were older (55.4 vs. 45.6 years, OR 1.03) and more often male (1.32) or with a history of obstructive lung disease (2.77) or diabetes (1.58) than those who were not admitted (p < .05). Additional associations included non-English preference, cancer, heart failure, hypertension, renal disease, ambulance arrival, higher triage acuity, longer ED stay or time from symptom onset, fever, tachycardia, dyspnea, gastrointestinal symptoms, x-ray abnormalities, and decreased platelets and lymphocytes (p < .05 for all). On 72-h return, 91 (65.5%) subjects required oxygen, and 7 (5.0%) required mechanical ventilation in the ED. Twenty-two (15.8%) of the study group have since died.ConclusionSeveral factors emerge as associated with 72-h ED return admission in subjects suspected of Covid-19. These should be considered when assessing discharge risk in clinical practice.

Prediction of Airflow Obstruction and the Risk of Complications in Morbidly Obese Patients Undergoing Bariatric Surgery

Morbidly obese subjects with airflow obstruction who underwent laparoscopic bariatric surgery appear to have the greatest risk to develop complications. In a retrospective cohort study, we identified a waist circumference ≥ 120cm, smoking history ≥5PY and history of obstructive lung disease as statistically significant predictors of airflow obstruction. The resulting algorithm, aimed to identify subjects with airflow obstruction before bariatric surgery, was validated in a prospective study. The algorithm was found to be effective in identifying patients with low risk of airflow obstruction (negative predictive value 94.7%). Airflow obstruction, however, was not associated with post-operative complications as we expected. In contrast, inspiratory capacity and the Epworth Sleepiness scale were more promising predictors for post-operative complications in subjects undergoing bariatric surgery.

Crown of Thorns: A Case of Dental Crown Ingestion During Cardiothoracic Surgery

Dental trauma is a well-known complication during anesthesia in operating rooms. However, ingestion of teeth or other foreign body after trauma from anesthesia is less common. Although most ingested foreign bodies pass through the digestive tract spontaneously, foreign body ingestion can be associated with significant complications including bowel perforation, obstruction, respiratory compromise and abscess formation, among others. We report a case of a 69-year-old female with a history of obstructive lung disease and diverticulosis who presented with shortness of breath. She was found to have a spontaneous left pneumothorax treated with pigtail catheter insertion in the emergency department resulting in partial re-expansion of her lung. After failed chemical pleurodesis with bleomycin, she underwent left-sided talc pleurodesis via thoracoscopy in the OR. After evaluation by the anesthesiologist in PACU, she was noted to be missing dental construct with evidence of a clean break from dental injury. A chest x-ray and upright abdominal film were ordered which revealed the dental hardware located in right upper quadrant of the abdomen. A CT of the abdomen revealed the foreign body to be present in a loop of small bowel 15 cm from the ileocecal valve. Gastroenterology was consulted for evaluation and recommended serial x-rays as the foreign body had been progressing. Because of the location, endoscopic removal was not possible. Nonoperative management was attempted with aggressive bowel regimen to aid the progression of the ingested foreign body. The patient received senna, polyethylene glycol, and magnesium citrate over the course of four days. Finally, she was given 4 liter of polyethylene glycol electrolyte solution without successful passage of the foreign body after several bowel movements. A repeat CT abdomen did not demonstrate significant progression past the ileocecal valve. As a result, the patient was taken to the OR for surgical removal via exploratory laparotomy. This case demonstrates the importance of complete assessment of dental prosthetics and hardware prior to anesthesia interventions to prevent serious complications from foreign body ingestion.

Endotracheal Intubation after Acute Drug Overdoses: Incidence, Complications, and Risk Factors

BackgroundDrug overdose is the leading cause of injury-related fatality in the United States, and respiratory failure remains a major source of morbidity and mortality. ObjectivesWe aimed to identify the incidence and risk factors for endotracheal intubation after acute drug overdose. MethodsThis secondary data analysis was performed on a 5-year prospective cohort at two urban tertiary-care hospitals. The present study analyzed adult patients with suspected acute drug overdose to derive independent clinical predictors of endotracheal intubation. ResultsWe analyzed 2497 patients with acute drug overdose, of whom 87 (3.5%) underwent endotracheal intubation. Independent clinical risk factors for endotracheal intubation were: younger age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96–0.98), and history of obstructive lung disease (OR 6.6, 95% CI 3.5–12.3); however, heart failure had no association. Patients with obstructive lung disease had significantly more hypercapnia (mean difference 6.8 mm Hg, 95% CI 2.3–11.3) and a higher degree of acidemia (mean pH difference 0.04, 95% CI 0.01–0.07) than patients without obstructive lung disease. Lack of rapid sequence sedative/paralytic was associated with in-hospital fatality. Early complications of endotracheal intubation itself included desaturation (3.4%) and bradycardia (1%). ConclusionsEndotracheal intubation was infrequently performed on patients with acute drug overdose, and complications were rare when performed. Risk factors associated with endotracheal intubation included younger age and prior obstructive lung disease.

Incidence of Restless Legs Syndrome and Its Correlates

Restless legs syndrome (RLS) is a common sensorimotor disorder whose incidence is not known. The aim of the study was to determine the incidence and correlates of RLS in a population-based sample. We obtained data from the Tucson Cohort of the Sleep Heart Health Study, a prospective multicenter study. This cohort included 535 participants aged ≥ 40 years, who answered questions regarding RLS on the 2002 and 2006 sleep surveys. For this study, RLS was defined as the presence of all 4 International RLS Study Group criteria, with symptoms occurring ≥ 5 days/month and associated with at least moderate distress. Mean age of the predominantly Caucasian (90.8%) participants on the 2002 survey was 59.8 ± 9.7 years; 52.2% were women. RLS prevalence was 4.1% in 2002 and 7.7% in 2006. The yearly incidence of RLS was 1.7% (6.6% over 4 years). Multivariate analyses demonstrated that estrogen use (OR = 2.5, 95% CI: 1.17-5.10) and self-reported obstructive lung disease (OR = 2.8, 95% CI: 1.37-5.83) were independent risk factors predicting incident RLS. Incident RLS was associated with higher prevalence of insomnia (26.5% vs. 7.6%, p = 0.001), increased sleepiness (38.2% vs. 22%, p = 0.036); and higher sleeping pill use in 2006 (23.5% vs. 9.7%, p = 0.019). The incidence of RLS in this population sample was 1.7% per year. Use of estrogen and history of obstructive lung disease were associated with a significantly higher incidence of RLS. RLS, in turn, was associated with insomnia and increased sleepiness.

Scoring System and Clinical Application of COPD Diagnostic Questionnaires

In most primary care settings, spirometric screening of all patients at risk is not practical. In prior work, we developed questionnaires to help identify COPD in two risk groups: (1) persons with a positive smoking history but no history of obstructive lung disease (case finding), and (2) patients with prior evidence of obstructive lung disease (differential diagnosis). For these questionnaires, we now present a scoring system for use in primary care. Scores for individual questions were based on the regression coefficients from logistic regression models using a spirometry-based diagnosis of obstruction as the reference outcome. Receiver operator characteristic analysis was used to determine performance characteristics for each questionnaire. Several simplified scoring systems were developed and tested. For both scenarios, we created a scoring system with two cut points intended to place subjects within one of three zones: persons with a high likelihood of having obstruction (high predictive value of a positive test result); persons with a low likelihood of obstruction (high predictive value of a negative test result); and an intermediate zone. Using these scoring systems, we achieved sensitivities of 54 to 82%, specificities of 58 to 88%, positive predictive values of 30 to 78%, and negative predictive values of 71 to 93%. These questionnaires can be used to help identify persons likely to have COPD among specific risk groups. The use of a simplified scoring system makes these tools beneficial in the primary care setting. Used in conjunction with spirometry, these tools can help improve the efficiency and accuracy of COPD diagnosis in primary care.

Breathlessness and Exercise in Spinal Cord Injury

After spinal cord injury (SCI), breathlessness during daily activities is common. In 308 individuals with SCI, the authors measured pulmonary function and administered a survey regarding health status, participation in wheelchair athletics, and breathlessness during different activities. The following questions were included: A. Are you troubled by shortness of breath when hurrying on the level or going up a slight hill?; B. Do you have to go slower than people of your own age on the level because of breathlessness?; C. Do you ever have to stop for breath when going at your own pace on the level?; and D. Do you ever have to stop for breath after going about 100 yards on the level? The analysis was restricted to 183 subjects with neurologically motor complete or incomplete SCI who, to get around, used hand-propelled wheelchairs more than 50% of the time. Of these, 56 (31%) reported breathlessness during some types of activities. Subjects with neurologically motor complete cervical or high thoracic SCI (T-6 and above) were more likely to report breathlessness than others (39% compared with 25%, p = .039). Among wheelchair athletes, the prevalence of breathlessness was 8/49 (16%) versus 48/1 34 (36%) for non-athletes (p = .011). Adjusting for smoking, neurological level, and history of obstructive lung disease, non-athletes were 2.3 times more likely to report breathlessness than athletes were (p = .049 to .075, depending on regression model). This relationship persisted when adjusted for percent predicted forced expiratory volume (FEVi) and maximal expiratory and inspiratory pressures. Therefore in SCI, wheelchair athletes are less likely to report breathlessness than non-athletes, but the mechanism does not appear to be improvement in respiratory muscle performance or pulmonary function.

Clenbuterol-Induced Tardive Dyskinesia

A 73-year-old man with a history of obstructive lung disease who received clenbuterol 20 mg b.i.d. over 5 years developed dyskinetic movements mainly of the respiratory muscles, closely resembling neuroleptic-induced dyskinesias. Despite drug withdrawal, abnormal movements persisted unchanged. Treatment with reserpine successfully controlled the dyskinetic movements. Clinicians should be aware of this potentially harmful effect of long-term clenbuterol therapy.

Reevaluation of Tests of Small Airways Function

Because of the current, and recurrent, interest in the prognostic potential of tests of peripheral lung function, we have reassessed the results of using the single breath closing volume test in conjunction with measurements derived from the forced vital capacity (FVC) maneuver. Data were obtained as a part of the prospective longitudinal study of the natural history of obstructive lung disease based on a random sample of the population of Tucson, Arizona. 1 Lebowitz MD Knudson RJ Burrows B Tucson epidemiologic study of obstructive lung diseases. I: Methodology and prevalence of disease. Am J Epidemiol. 1975; 102: 137-152 PubMed Google Scholar The study began in 1972. Survey data included spirometric and flow-volume measurements. 2 Knudson RJ Slatin RC Lebowitz MD et al. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis. 1976; 113: 587-600 PubMed Google Scholar , 3 Knudson RJ Burrows B Lebowitz MD The maximal expiratory flow-volume curves: Its use in the detection of ventilatory abnormalities in a population study. Am Rev Respir Dis. 1976; 114: 871-879 PubMed Google Scholar The single breath test was employed in the second survey year, 4 Knudson RJ Lebowitz MD Burton AP et al. The closing volume test: Evaluation of nitrogen and bolus methods in a random population. Am Rev Respir Dis. 1977; 115: 423-434 PubMed Google Scholar and the fifth survey year was completed in the spring of 1979. The limit of normal was the “normal 95th percentile” for each measurement as previously described. 2 Knudson RJ Slatin RC Lebowitz MD et al. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis. 1976; 113: 587-600 PubMed Google Scholar , 4 Knudson RJ Lebowitz MD Burton AP et al. The closing volume test: Evaluation of nitrogen and bolus methods in a random population. Am Rev Respir Dis. 1977; 115: 423-434 PubMed Google Scholar

Reevaluation of Tests of Small Airways Function

Because of the current, and recurrent, interest in the prognostic potential of tests of peripheral lung function, we have reassessed the results of using the single breath closing volume test in conjunction with measurements derived from the forced vital capacity (FVC) maneuver. Data were obtained as a part of the prospective longitudinal study of the natural history of obstructive lung disease based on a random sample of the population of Tucson, Arizona.1 The study began in 1972. Survey data included spirometric and flow-volume measurements.