History Of Respiratory Symptoms Research Articles

Screening for Chronic Obstructive Pulmonary Disease in Patients with Coronary Artery Disease at a Tertiary Care Hospital

Chronic Obstructive Pulmonary Disease is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious gases or particles and influenced by host factors, including abnormal lung development. COPD was the 4th most common cause of death globally, and it was anticipated to rise to the 3rd position by 2020 or sooner. Over 80% of these patients go undiagnosed. COPD and CAD frequently co-exist and interact due to various reasons like similar risk factors and pathogenesis. Although there are global studies on the prevalence of COPD in CAD patients, data from India are scarce. This study aims to find the prevalence of COPD among CAD patients and find the correlation between the occurrence of COPD and cardiac status. This study was conducted as a prospective observational cross-sectional study at Chettinad Hospital and Research Institute in India. 293 patients with angiographically proven CAD underwent pulmonary function evaluation by spirometry to assess the prevalence of COPD. Recent 2D-ECHO was also correlated. The study found that 18.77% of 293 Coronary Artery Disease (CAD) patients had COPD and 3.07% had PRISM( preserved ratio impaired spirometry, a new term coined), making it one of the few studies to report the prevalence of PRISM among CAD patients. Outside of India, studies have found that COPD prevalence ranges from 7% to 33.6% among ischemic heart disease patients. Impairment of spirometry positively correlated with the severity of CAD. Our study found a considerable frequency of missed COPD diagnoses. Hence, we recommend that when CAD is diagnosed, the initial evaluation should include a complete history of respiratory symptoms, clinical examination, and spirometry to assess pulmonary function, particularly in those who have risk factors such as smoking and the use of biomass fuel so as to identify COPD at an early stage and treat it. Identifying PRISM can help prevent its progression to COPD by making the required lifestyle modifications. A multidisciplinary approach is advised for all those diagnosed to have CAD.

Asma casi fatal: reporte de un caso en emergencia del hospital santa rosa

Introduction: Asthma, classically, is defined as a chronic inflammatory disease of the airways; characterized by a history of respiratory symptoms, such as wheezing, shortness of breath, chest tightness, and cough, that vary over time and in intensity. Near-fatal asthma are situations in which asthma exacerbations can lead to cardiorespiratory arrest, orotracheal intubation and mechanical ventilation, admission to an intensive care unit (ICU); Knowing the characteristics and risk factors that predict this situation in a patient who arrives at the emergency room is very important for early action. Clinical case: We present a 23-year-old patient with a history of asthma since he was 5 years old and irregular treatment; with a stay in the ICU and on mechanical ventilation for almost fatal asthma 8 months before; the clinical signs and the arterial blood gas analysis predicted an almost fatal asthma condition, which is why it was decided to intubate and mechanically ventilate the patient, and then transfer to the ICU with a favorable evolution and discharge 9 days after admission. Conclusion: Patient who already had a previous admission for almost fatal asthma and admission to the ICU, persistence of desaturation in the face of rescue treatment for said pathology; determining factors for deciding rapid sequence orotracheal intubation and transfer to the intensive care unit; with remission of the admission clinical picture and prompt discharge of the patient.

An analysis of exogenous harmful substance exposure as risk factors for COPD and hypertension co-morbidity using PSM.

Some occupational and environmental exposures could increase the risk of chronic obstructive pulmonary disease (COPD) and hypertension in various work and living environments. However, the effect of exposure to multiple exogenous harmful substances on COPD and hypertension co-morbidities remains unclear. Participants were selected from eight hospitals in five provinces in China using a multistage cluster sampling procedure. Participants' demographic, exposure, and disease information were collected through questionnaires, spirometry, and blood pressure examinations. Demographic data were used as matching factors, and 1:1 matching between the exposed and non-exposed groups was performed by employing propensity score matching (PSM) to minimize the influence on the results. A one-way chi-squared analysis and multifactorial logistic regression were used to analyze the association between the exposure to exogenous harmful substances (metals and their compound dust, inorganic mineral dust, organic chemicals, and livestock by-products) and the co-morbidity of COPD and hypertension. There were 6,610 eligible participants in the final analysis, of whom 2,045 (30.9%) were exposed to exogenous harmful substances. The prevalence of co-morbidities of COPD and hypertension (6.0%) in the exposure group was higher than their prevalence in the total population (4.6%). After PSM, exogenous harmful substance exposure was found to be a risk factor for the co-morbidity of COPD and hypertension [odds ratio (OR) = 1.347, 95% confidence interval (CI): 1.011-1.794], which was not statistically significant before PSM (OR = 1.094, 95% CI: 0.852-1.405). Meanwhile, the results of different outcomes showed that the association between hypertension and exogenous harmful substance exposure was not statistically significant (OR = 0.965, 95% CI: 0.846-1.101). Smoking (OR = 4.702, 95% CI: 3.321-6.656), history of a respiratory disease during childhood (OR = 2.830, 95% CI: 1.600-5.006), and history of respiratory symptoms (OR = 1.897, 95% CI: 1.331-2.704) were also identified as risk factors for the co-morbidity of COPD and hypertension. The distribution of exogenous harmful substance exposure varies in the population, and the prevalence of co-morbidities is generally higher in susceptible populations. Exposure to exogenous harmful substances was found to be a key risk factor after adjusting for demographic confounders.

Problems in diagnosing pre-COPD (case report)

Cigarette smoke is a key risk factor for developing COPD (GOLD, 2024). One of the factors responsible for tissue damage and bronchial remodeling in the early stages of the disease is patients’ hypersensitivity to nicotine and components of cigarette smoke. Because of early life adversity combined with environmental and genetic interactions, pulmonary function measures alone may not be appropriate for the early recognition and diagnosis of COPD. It seems necessary to identify biomarkers of the risk of developing pre-COPD to identify the early stage of the disease. In the article we describe the clinical case of patient M., 21 years old, a smoker with a history of respiratory symptoms, who has signs of chronic obstructive pathology with the formation of bronchial hypersensitivity and persistent obstruction that does not reach the threshold for COPD, which reflects a common clinical problem. Сertainly, the formation of the concept of pre-COPD and the development of clinical and instrumental diagnostic criteria are necessary. Previously, we developed and tested a prick-prick test method with nicotine. We propose to use skin testing with a nicotine solution as one of the diagnostic biomarkers to identify hypersensitivity at the first stage of tissue damage.

Could an electronic tool to assess asthma control with a 1-day timeframe be useful for clinical management?

Could an electronic tool to assess asthma control with a 1-day timeframe be useful for clinical management?

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

The role of endothelial microparticles in children with asthma: Does it promote atherosclerosis progress?

Background: Asthma is a chronic inflammatory airway disease that has been linked to enhanced risks for atherosclerosis. The impact of asthma on cardiovascular disease risk in children is less well established. Asthma is defined by a history of respiratory symptoms and accompanied by airflow limitation, with heterogeneous clinical manifestations, and variability in the intensity of airway inflammation and remodeling. Endothelial microparticles (EMP) are biomarkers of endothelial dysfunction in several chronic diseases. Endothelial microparticles initiate an event of atherosclerotic plaque formation. Our study aimed to evaluate the role of endothelial microparticles in children with asthma. Methods: A cross-sectional study was performed on a total of 50 children with asthma aged seven‒17 years. Children with asthma exacerbations, infections, and steroid use were excluded. Endothelial microparticles were measured with beads, and the fluorescence signal was measured using a flow cytometer. Pro-inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA) method. Results: Based on the results from 50 asthmatic children, it was found that most children had a normal nutritional status, intermittent, and allergic asthma. The results of this study also showed that the circulation of asthmatic children found that the mean levels (µL) of CD31+/CD62E+, CD31+/CD62E-, and CD62E+/CD31- were 2,392.99 ± 7,787.94; 922.14 ± 1,554.03; 198.97 ± 387.68, with the average ratio of CD31+/CD62E+, which was ≤1.0 and identifies apoptosis. Path analysis results found that IL-6, TNF-α, and CD31+/CD62E- EMP played a role in peak expiratory flow rate (%PEFR, p = 0.02; p = 0.003; p = 0.04) in children with allergic asthma. Conclusions: Endothelial microparticles play a role on peak expiratory flow rate (PEFR) in children with allergic asthma. Further study is needed to investigate the role of these biomarkers and their correlation with pro-inflammatory cytokines in the mechanism of atherosclerosis progression.

Imaging in Asthma Management.

Asthma is a heterogeneous disease characterized by chronic airway inflammation that affects more than 300 million people worldwide. Clinically, asthma has a widely variable presentation and is defined based on a history of respiratory symptoms alongside airflow limitation. Imaging is not needed to confirm a diagnosis of asthma, and thus the use of imaging in asthma has historically been limited to excluding alternative diagnoses. However, significant advances continue to be made in novel imaging methodologies, which have been increasingly used to better understand respiratory impairment in asthma. As a disease primarily impacting the airways, asthma is best understood by imaging methods with the ability to elucidate airway impairment. Techniques such as computed tomography, magnetic resonance imaging with gaseous contrast agents, and positron emission tomography enable assessment of the small airways. Others, such as optical coherence tomography and endobronchial ultrasound enable high-resolution imaging of the large airways accessible to bronchoscopy. These imaging techniques are providing new insights in the pathophysiology and treatments of asthma and are poised to impact the clinical management of asthma.

Biologics in severe asthma – a molecular perspective

Asthma is a heterogeneous disease defined by a history of respiratory symptoms that vary in time and intensity, and by a variable limitation of airflow, which can become persistent. Despite a wide range of treatments available for asthma, 5-10% of patients have a poor response to inhaled corticosteroids and require high doses of systemic corticosteroids to control symptoms. Patients who do not respond to conventional asthma therapy may benefit from new biologic therapies, such as anti-IgE, anti-IL-5, and anti-IL-4/IL-13 monoclonal antibodies to control asthma symptoms. For this reason, understanding the immunopathology of asthma is essential. The recent identification of fundamental inflammatory endotypes has facilitated a more granular approach to asthma. The emphasis has shifted to the precise delineation of molecular pathways that cause diseases, and the theoretical basis of endotyping corresponds to the current interest in personalized medicine. With the emergence of a constantly expanding repertoire of biologics, an appropriate classification system with significant biomarkers is needed to capitalize on molecular data and adapt treatment decisions. Therefore, stratification by inflammatory endotype is now considered a central component of the severe asthma management algorithm. This article summarizes the immunopathology of asthma, especially severe asthma, cytokines or receptors targeted by current biologic therapies, and potential new therapeutic targets.

Epiglottitis in four – year- old boy caused by COVID-19 infection

Introduction: Epiglottitis is an inflammatory disease involving the epiglottis, vallecula, aritenoid cartilage, and aryepiglottic wrinkles. Acute epiglottitis is relatively rare but can quickly lead to life-threatening airway obstruction. Diagnosis of epiglottitis is clinical, but radiography and direct vision of the epiglottis can also help with the diagnosis. Clinical manifestations of epiglottitis include fever, sore throat, and in the event of imminent airway obstruction, also may present with muffled sound, falls, tripod position, and stridor. Epiglottitis can be caused by some bacterial agents or viruses such as adenovirus and measles.COVID-19 was first detected in December 2019 in a group of patients with severe respiratory symptoms in Hubei Province, China. Common symptoms include fever, cough, fatigue, difficulty breathing, and loss of smell and taste. Although COVID-19 disease has a variety of manifestations, only one case of epiglottitis following COVID-19 disease has been reported in adults. Case presentation: The patient, a 4-year-old boy, came to our center and the patient's family complained of shortness of breath and progressive lethargy of the child 10 days ago. Since last week, he has been sleeping in a sitting position due to the aggravation of shortness of breath. On physical examination, respiratory distress, tachypnea, subcostal retraction, tail stridor, and crackle was heard in both lungs. Diagnosed with suspected bronchoscopy epiglottitis, a large, swollen, and cherry-red epiglottis was observed. Based on the patient's history of respiratory symptoms and the prevalence of COVID-19, a reverse pharyngeal polymerase (RT-PCR) transcript test was requested for COVID-19 and the COVID-19 infection was positive. Conclusion: In this article, we reported an 4-year-old child with epiglottitis in the context of COVID19.

Kawasaki disease in a five-month-old infant

Introduction: Kawasaki disease, an acute self-limited vasculitis of small and medium arteries of unknown etiology, is the leading cause of heart disease in children in most developed countries. If untreated, it can lead to coronary artery dilatation and aneurysm, placing patients at risk for coronary thrombosis, myocardial infarction, or sudden death. Case Report: A previously healthy five-month-old boy presented with a history of respiratory symptoms and fever, being admitted for respiratory syncytial virus bronchiolitis. He maintained fever for five days associated with progressive clinical worsening and sequential development of conjunctival injection, cracked lips, swelling of hands and feet, and polymorphous rash of the limbs. Diagnostic procedures showed increased levels of inflammatory markers, hyponatremia, hypoalbuminemia, sterile pyuria, and aseptic meningitis. Despite an initial normal echocardiogram, Kawasaki disease was suspected and the boy started intravenous immunoglobulin on the fifth day. On the seventh day, echocardiogram showed signs of pancarditis and mild coronary artery ectasia and acetylsalicylic acid was started. The boy was discharged, but eight days later echocardiogram revealed major and diffuse coronary artery ectasia in a follow-up consultation and he was readmitted to start corticosteroid therapy. After five months, the boy displayed normalization of cardiac changes, without further complications. Comments: Kawasaki disease below six months of age is rare and associated with a high risk of coronary artery aneurysm. It is important to recognize the clinical and laboratory criteria associated with this entity and start early treatment, avoiding cardiac complications.

A clinical case of late diagnosis of PAP with good response to whole lung lavage

Pulmonary Alveolar Proteinosis (PAP) is a rare syndrome characterized by the accumulation of surfactant in alveoli and terminal airways resulting in respiratory failure. PAP comprises part of a spectrum of disorders of surfactant homeostasis (clearance and production). We describe the case of a 54 years-old woman hospitalized in March 2017 with diagnosis of acute hypoxemic respiratory failure secondary to pulmonary interstitial disease. In our case, the patient arrived at our observation after developing a severe respiratory insufficiency although a long term history of respiratory symptoms. This diagnostic delay suggests that alveolar proteinosis should always be considered as a possible diagnosis in patients with dyspnea, cough and crazy paving at HRTC. In spite of this the disease resolved with a cycle of total lung lavage and the symptomatology has improved with the resolution of the radiological picture without any other therapeutic approach.

Clinical Characteristics and Outcomes of Patients with Asthma-COPD Overlap in Japanese Patients with COPD.

PurposeAsthma–COPD overlap (ACO) has been reported as an association with a lower quality of life, frequent exacerbations, and higher mortality than those with COPD alone. However, clinical characteristics and outcomes of ACO remain controversial.Patients and MethodsWe conducted a prospective observational study analyzing data of patients with stable COPD enrolled from the Ishinomaki COPD Network Registry. Patients with features of asthma who had a history of respiratory symptoms that vary over time and intensity, together with documented variable expiratory airflow limitation, were identified, and then defined as having ACO. The characteristics, frequency of exacerbations, and mortality during the 3-year follow-up were compared between patients with ACO and patients with COPD alone.ResultsAmong 387 patients with COPD, 41 (10.6%) were identified as having ACO. Patients with ACO tended to be younger, have higher BMI, have a shorter smoking history, and use more respiratory medications, especially inhaled corticosteroids. Inflammatory biomarkers including fractional exhaled nitric oxide, blood eosinophil count, total immunoglobulin E (IgE) level, and presence of antigen-specific IgE were significantly higher in patients with ACO than in those with COPD alone. Lung function, mMRC score, CAT score, and comorbidity index were not different between the groups. The annual rate of all exacerbations and severe exacerbations required hospital admission were not different between ACO and COPD alone (0.20 vs 0.14, 0.12 vs 0.10, events per person, respectively). Mortality was significantly higher in patients with COPD alone compared with those with ACO during the study period (P=0.037).ConclusionThe results of our study indicate that ACO is not associated with poor clinical features nor outcomes in an outpatient COPD cohort receiving appropriate treatment.

The use of a direct bronchial challenge test in primary care to diagnose asthma

Many asthmatics in primary care have mild symptoms and lack airflow obstruction. If variable expiratory airflow limitation cannot be determined by spirometry or peak expiratory flow, despite a history of respiratory symptoms, a positive bronchial challenge test (BCT) can confirm the diagnosis of asthma. However, BCT is traditionally performed in secondary care. In this observational real-life study, we retrospectively analyze 5-year data of a primary care diagnostic center carrying out BCT by histamine provocation. In total, 998 primary care patients aged ≥16 years underwent BCT, without any adverse events reported. To explore diagnostic accuracy, we examine 584 patients with a high pretest probability of asthma. Fifty-seven percent of these patients have a positive BCT result and can be accurately diagnosed with asthma. Our real-life data show BCT is safe and feasible in a suitably equipped primary care diagnostic center. Furthermore, it could potentially reduce diagnostic referrals to secondary care.

A Cross-Sectional Study Examining the Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Antibodies in a University Student Population

PurposeThe aim of the study was to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in a university student population. MethodsThis was a cross-sectional survey study based on the World Health Organization population-based seroepidemiological investigational protocol for SARS-CoV-2 conducted between April 29, 2020, and May 8, 2020, examining SARS-CoV-2 antibody prevalence among 790 university students in Los Angeles, CA. Participants completed a questionnaire on potential risk factors before blood sampling. Samples were analyzed using the EUROIMMUN Anti-SARS-CoV-2 ELISA (IgG) for the qualitative detection of IgG class antibodies to SARS-CoV-2 in human serum or plasma. ResultsThe estimated prevalence of SARS-CoV-2 antibody was 4.0% (3.0%, 5.1%). Factors associated with having a positive test included history of anosmia and/or loss of taste (95% CI: 1.4–9.6). A history of respiratory symptoms, with or without fever, was not associated with a positive antibody test. ConclusionsPrevalence of SARS-CoV-2 antibodies in the undergraduate and graduate student university population was similar to community prevalence.

Assessing the Response of a Sample of Iraqi Asthmatic Patients to Different Medication Regimens

Asthma is a chronic inflammatory disease of respiratory airways characterized by distinctive history of respiratory symptoms due to variable airflow obstruction which reverses either spontaneously or in response to certain medications. Acetylcholine is a parasympathetic neurotransmitter which plays fundamental roles in the development of persistent asthma. Treatment guidelines recommend using medium doses of inhaled corticosteroids in addition to another controller bronchodilator instead of using high doses inhaled steroid alone for treatment of moderate to severe persistent asthma. The inhaled long acting muscarinic antagonist, tiotropium, was approved recently to control unresponsive asthma to inhaled corticosteroid with or without a long acting ?-2 agonist. The aim of this study was to assess and compare the responses of a sample of Iraqi asthmatic patients to three different medication regimens.

Management of community-acquired pneumonia: essential tips for the physician on call.

Community-acquired pneumonia is a common clinical problem requiring admission to hospital, with a particularly high incidence in the elderly population and those with significant comorbidities. Diagnosis is made on the combination of a short history of respiratory symptoms and systemic ill-health with new examination and/or radiological features of consolidation. Multiple other infective and non-infective conditions can mimic community-acquired pneumonia, leading to misdiagnosis in 5-17% of cases. The CURB-65 score can identify patients with community-acquired pneumonia with a higher risk of mortality, but is insensitive at identifying patients requiring intensive care support and needs to be combined with clinical markers of potential severity. Both high admission levels of C-reactive protein and the failure of levels of C-reactive protein to decline by >50% by day 4 after admission are associated with higher risk of complications, need for ventilation or inotropic support, and mortality. Empirical antibiotic therapy for most patients admitted to hospital is combination of a ß-lactam and a macrolide. Short courses of antibiotics do not result in significantly different outcomes to longer courses unless the patient has developed complications such as a complex parapneumonic effusion. Implementation of a community-acquired pneumonia care bundle into clinical practice reduces mortality, and should be a high priority for all acute hospitals.

Pulmonary rehabilitation: promising nonpharmacological approach for treating asthma?

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation with a history of respiratory symptoms that vary over time and in intensity, together with variable expiratory airflow limitation. The goal of asthma treatment is to reach symptoms control, reduction in future risk and improvement in quality of life (QoL). Guideline-based pharmacologic therapies and the effect of inhaled steroids and bronchodilators have been widely studied over the past decades. We provide an overview of the available evidence on pulmonary rehabilitation as a nonpharmacologic therapy in asthmatic patients. Recently, some studies have highlighted the promising role of nonpharmacologic therapies in asthma, such as pulmonary rehabilitation demonstrating that a pulmonary rehabilitation programme consisting of exercise training, breathing retraining, educational and psychological support, improve exercise capacity, asthma control and QoL and reduce dyspnea, anxiety, depression and bronchial inflammation at any step of the disease. Pulmonary rehabilitation shows positive results on exercise tolerance, respiratory symptoms and QoL in asthmatic patients at any steps of the diseases. However, additional information is required to better characterize rehabilitation programmes in order to improve clinical care in asthma.

Detection of bovine herpes virus (BOHV-1) infection in respiratory tract of bovines

Infectious bovine rhinotracheitis (IBR) is considered commonest form of BoHV-1 respiratory tract infection. The current work was designed to study the incidence of IBR using molecular technique and antigen detection sandwich ELISA. In the present study, nasal swab samples (100) and tracheal lavages (6) were collected from bovines, which were showing respiratory symptoms from clinics of College of Veterinary Science, GADVASU, Ludhiana. Four lung tissues were also collected from dead animals. All nasal samples were tested for IBR virus antigen by using commercial sandwich ELISA kit. The antigenic incidence of BoHV-1 was reported to be 1% in tested animals. For molecular detection of BoHV-1 in respiratory tract, the DNA was extracted from all samples (nasal swabs, tracheal lavages and lung tissues) and subjected to gI gene specific PCR by using published primers. The overall incidence of BoHV-1 in nasal swabs of animals with the history of respiratory symptoms was found to be 3% and rest of the samples were found negative for IBR virus in PCR. Species wise evaluation of BoHV-1 infection revealed that out of 75 cattle, 3 (4.0%) cattle were found positive in PCR where as none of the buffaloes were found positive in present study. The animals older than 3 year of age showed the higher incidence (4.2%) than animal up to 3 years of age (2.8%). In this study, all positive cattle were crossbred females. According to sex wise status, it was observed that females are more prone to infection, which may be because of production stress in female animals.

The Perceived Availability of Online Social Support: Exploring the Contributions of Illness and Rural Identities in Adults with Chronic Respiratory Illness.

Joining an online social support group may increase perceived membership to a community, but it does not guarantee that the community will be available when it is needed. This is especially relevant for adults with Chronic Obstructive Pulmonary Disease (COPD), many of whom reside in rural regions and continually negotiate their illness identity. Drawing from social support literature and communication theory of identity, this cross-sectional study explored how COPD illness and geographic identities interact to influence patients’ perceived availability of online social support. In April 2018, 575 adults with a history of respiratory symptoms completed an online survey. Patients with a COPD diagnosis reported greater availability of online support. This was partially mediated by a positive degree of COPD illness identity (i.e., being diagnosed with COPD, a history of tobacco use, severe respiratory symptoms, high disease knowledge, and low income but high education). The relationship between COPD illness identity and the availability of online support was strongest among those with low rural identity; however, at lower levels of COPD illness identity, participants with high rural identity reported the greatest degree of available online support. Results have important implications for tailored education approaches across the COPD care continuum by illness and geographic identities.