Management Of Chronic Respiratory Diseases Research Articles

Implementation and effect analysis of training of full-time educator for the management of chronic respiratory diseases

Implementation and effect analysis of training of full-time educator for the management of chronic respiratory diseases

Viral-induced asthma exacerbations

The COVID-19 pandemic has once again brought to the attention of researchers and medical practitioners the issue of viral infections in the management of chronic respiratory diseases, especially bronchial asthma. Viral infections, especially rhinovirus, are an important risk factor for asthma exacerbations. Asthma exacerbations are a major cause of asthma morbidity and mortality, leading to a progressive decline in lung function in some patients. The increased risk of exacerbation is a consequence of either a deficient antiviral response of the asthmatic patient, or the ability of some viruses to increase the Th2 inflammatory response, specific to the asthma phenotype. Understanding the pathophysiological mechanisms and clinico-epidemiological features of each viral infection may be crucial in developing a targeted therapy for the most common viral pathogens to effectively prevent asthmatic exacerbations.

An Observational Pilot Study of a Tailored Environmental Monitoring and Alert System for Improved Management of Chronic Respiratory Diseases

An Observational Pilot Study of a Tailored Environmental Monitoring and Alert System for Improved Management of Chronic Respiratory Diseases

Pre-conference workshop on pulmonary rehabilitation and smoking cessation – NATCON 2022

The 77th National Conference of Tuberculosis and Chest Diseases was held on 27th February 2023. The workshop on Pulmonary rehabilitation and smoking cessation was conducted as a part of the various pre-conference workshops being conducted on the occasion. It helped the participants to know regarding the role, efficacy and benefits of pulmonary rehabilitation and smoking cessation for the management of Chronic respiratory diseases.

Nurses in China lack knowledge of inhaler devices: A cross-sectional study.

Objective: To understand the level of knowledge about inhaler devices among medical staff. Methods: This study evaluated the knowledge of inhalation therapy and the use of inhaler devices among nurses in China. We administered a new self-designed online questionnaire to 1,831 nurses. The questionnaire comprised 11 questions, including the storage location of inhaler devices, steps involved in using inhaler devices, and common errors when using various devices. Results: Among the 1,831 participants, 816(44.57%), 122(6.66%), and 893(48.77%) nurses worked in community, secondary, and tertiary hospitals, respectively. Adequate knowledge of inhaler devices was demonstrated by 20.10%, 8.20%, and 13.10% of nurses working in community, secondary, and tertiary hospitals, respectively. Of the nurses working in community hospitals, 27.70% knew the key points for using inhalers compared to 15.57% in secondary hospitals and 23.18% in tertiary hospitals (p < 0.01). Only 9.50%-26.00% of participants chose correct answers to the 9 questions about the use of inhalers. The accuracy rate of the responses was generally low, and the highest accuracy rate was 26.00%. Conclusion: Knowledge of inhalation therapy was better among nurses working in community hospitals than among those working in high-level hospitals. This is because of the clearer division of work and higher workload in high-level hospitals. Overall, nurses' knowledge of inhalation therapy is low. Furthermore, knowledge about inhaler devices should be strengthened among nurses in Chinese hospitals. It is necessary to create training opportunities for nurses in China to increase their awareness and knowledge regarding the management of chronic respiratory diseases.

The national COPD screening programme in China: rationale and design.

COPD is the most prevalent chronic respiratory disease in China. It is estimated that there is a large, as-yet undetected, high-risk population who will develop in COPD in future. In this context, a nationwide COPD screening programme was launched on 9 October 2021. This multistage sequential screening programme incorporates a previously validated questionnaire (i.e. COPD Screening Questionnaire) and pre- and post-bronchodilator spirometry to target the COPD high-risk population. The programme plans to recruit 800 000 participants (eligible age 35-75 years) from 160 districts or counties of 31 provinces, autonomous regions or municipalities across China. The filtered COPD high-risk population and early-detected COPD patients will receive integrated management and be followed-up for ≥1 year. This is the first large-scale prospective study to determine the net benefit of mass screening for COPD in China. Whether the smoking cessation rate, morbidity, mortality and health status of individuals at high risk of COPD could be improved along with this systematic screening programme will be observed and validated. Moreover, the diagnostic accuracy, cost-effectiveness and superiority of the screening programme will also be assessed and discussed. The programme marks a remarkable achievement in the management of chronic respiratory disease in China.

Impact of the COVID-19 Pandemic on the Prescribing of Antiasthmatic Treatments in Portugal: A Nationwide Study

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on everyday life, the environment, and health care services. A shift from in-person medical appointments to telemedicine was a main adjustment. Such changes can have repercussions on the control and management of chronic respiratory diseases, such as asthma. The available data suggest that there was an overall decrease in asthma-related morbidities during the first year of the pandemic. Therefore, the goal of this study was to quantify the effects of the pandemic on the prescribing of antiasthmatic treatments in outpatient care (public and private health care). MethodsThis before–after study used a time series approach based on data from monthly prescriptions of antiasthmatic drugs (anti-inflammatory drugs and bronchodilators) dated between April 2018 and March 2021. An interrupted time series (ITS) design was used for assessing changes in antiasthmatic prescribing patterns in the short and long terms after COVID-19 was recognized as a pandemic. The results are complemented with seasonal autoregressive integrated moving average (sARIMA) models. FindingsThe ITS analysis showed a non-significant increase in antiasthmatic prescribing in the short term. In the long term, after the pandemic was declared, a statistically significant decrease was observed in the prescribing of antiasthmatics (in anti-inflammatory drugs and, more pronounced, in bronchodilators). In the sARIMA model, the mean monthly volume of antiasthmatic prescriptions was 18.1% lower than predicted. The numbers of months outside of the 95% CIs were different between anti-inflammatory drugs (1 month) and bronchodilators (7 months). ImplicationsThe prescribing of antiasthmatic drugs in the long term was significantly decreased with the COVID-19 pandemic, with a greater effect in the case of bronchodilators.

Respiratory care therapists in chronic respiratory care: The need of the hour

Chronic respiratory diseases are one of the main causes of morbidity and mortality, not only in the world at large, but also in India. The healthcare infrastructure at present remains insufficient to cope with the present and rising burden of chronic respiratory diseases. Insufficient and lack of skilled assistance has played a key role in the poor management of cases of chronic respiratory diseases. However, a second tier of healthcare providers, empowered with sufficient knowledge and skill sets for chronic respiratory disease management, can help in managing these patients better. Respiratory care therapists have made a significant difference in the management of acute and critical care in respiratory medicine. With chronic respiratory diseases comprising the greater burden, respiratory care therapists are in a position to make a greater impact in the management of these cases. This article is an endeavour to highlight the growing burden of chronic respiratory diseases and a possible solution to tackle the issue with efficient disease management. This is an extensive, raw and untapped opportunity for respiratory care therapists; an opportunity to unite with physicians in making lungs the heart of their scope of work. Together with physicians, respiratory care therapists can create this much pivotal change in efficient delivery of respiratory healthcare in India. This will help improve survival and therefore ensure a better quality of life for patients suffering from chronic respiratory diseases.

Expanded central role of the respiratory physiotherapists in the community setting.

The development of community hubs through the Slaintecare initiative will rely on respiratory physiotherapists and clinical nurse specialists for the management of chronic respiratory diseases. The role of the respiratory physiotherapist has evolved dramatically over the last decade. We review the increasing scope of practice of the physiotherapist and the evidence base for same. We pay particular attention to the role of the physiotherapist in areas such as pulmonary rehabilitation, sputum clearance, neuromuscular disease, chronic respiratory failure, ambulatory oxygen assessments and dysfunctional breathing. We give an in depth review of sputum clearance techniques. We also address areas of potential future expansion for the role of the physiotherapist such as prescription and initiation of non-invasive ventilation.

A Predictive Machine Learning Tool for Asthma Exacerbations: Results from a 12-Week, Open-Label Study Using an Electronic Multi-Dose Dry Powder Inhaler with Integrated Sensors.

Machine learning models informed by sensor data inputs have the potential to provide individualized predictions of asthma deterioration. This study aimed to determine if data from an integrated digital inhaler could be used to develop a machine learning model capable of predicting impending exacerbations. Adult patients with poorly controlled asthma were enrolled in a 12-week, open-label study using ProAir® Digihaler®, an electronic multi-dose dry powder inhaler (eMDPI) with integrated sensors, as reliever medication (albuterol, 90 µg/dose; 1-2 inhalations every 4 hours, as needed). Throughout the study, the eMDPI recorded inhaler use, peak inspiratory flow (PIF), inhalation volume, inhalation duration, and time to PIF. A model predictive of impending exacerbations was generated by applying machine learning techniques to data downloaded from the inhalers, together with clinical and demographic information. The generated model was evaluated by receiver operating characteristic area under curve (ROC AUC) analysis. Of 360 patients included in the predictive analysis, 64 experienced a total of 78 exacerbations. Increased albuterol use preceded exacerbations; the mean number of inhalations in the 24-hours preceding an exacerbation was 7.3 (standard deviation 17.3). The machine learning model, using gradient-boosting trees with data from the eMDPI and baseline patient characteristics, predicted an impending exacerbation over the following 5 days with an ROC AUC of 0.83 (95% confidence interval: 0.77-0.90). The feature of the model with the highest weight was the mean number of daily inhalations during the 4 days prior to the day the prediction was made. A machine learning model to predict impending asthma exacerbations using data from the eMDPI was successfully developed. This approach may support a shift from reactive care to proactive, preventative, and personalized management of chronic respiratory diseases.

Consensus of Chinese experts on product principles, quality control and clinical application of portable spirometer

Compared with the traditional laboratory spirometer, the portable spirometer has obvious advantages, e.g., small size, portability, simple operation and low cost. The portable spirometer is a supplementary instrument in the primary health institutions when the laboratory spirometer is unavailable or inapplicable. However, there is still a lack of guidance in documents regarding the application of portable spirometer in China. This consensus elaborated the specific details of portable spirometer, such as the equipment hardware, the equipment quality requirement, the operation protocols, the quality control, the clinical application and the personnel training. The portable spirometer consists of a spirometer and a computer system. Its core component is the flow sensor, which retains the core functions of the traditional spirometer, i.e., regular pulmonary function and bronchodilation test, but does not have the ability to measure the total lung volume, residual volume and diffusion capacity. In addition, the portable spirometer needs to pass the quality inspection of the national and international authorities and needs to meet the standard of ISO26782 of 2009. The quality control for a portable spirometer includes equipment quality control, process quality control and report quality control, and its technical details are consistent with the quality control requirements of the laboratory spirometer. It can be widely used for screening of respiratory diseases, epidemiological investigation and regular physical check-up, clinical trials, management of chronic respiratory diseases, and examination on the disability. The training courses for the portable spirometer contain theory and practice curriculums, mostly for primary and community healthcare workers with various and flexible options. Furthermore, the portable spirometer has integrated many high-tech technologies that surpass the similar functions in the laboratory spirometer such as intelligent data transmission, cloud database, big data management, biosensors, etc. With the development of the high-tech, portable spirometer has become more and more intelligent and diversified, and is able to greatly improve the management model for chronic respiratory diseases in the future.

Editorial: Advanced therapeutic delivery for the management of chronic respiratory diseases

EDITORIAL article Front. Med., 09 August 2022Sec. Pulmonary Medicine https://doi.org/10.3389/fmed.2022.983583

What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries

ObjectivesChronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD...

Chronic respiratory disease in low-income and middle-income countries: From challenges to solutions

In 2019, the British Thoracic Society (BTS) launched a Global Health Group in partnership with the Pan African Thoracic Society (PATS). Each year, this group proposes a symposium at the BTS Winter meeting exploring issues of respiratory disease and care which are most relevant to respiratory health across the life course in low- and middle-income countries (LMICs). The first symposium, offered in February 2021, described the burden of five key respiratory exposures/diseases of interest in LMICs, including childhood pneumonia, air pollution, post-TB lung diseases, asthma, and chronic obstructive pulmonary disease, and a summary of the discussion has previously been published in the PATS journal. The second symposium, conducted in November 2021, discussed barriers to the management of chronic respiratory diseases (CRDs) in LMICs, with perspectives presented from Malaysia, The Gambia, Kenya, and sub-Saharan Africa more broadly. These presentations highlighted the challenges of chronic respiratory care in LMICs, while a presentation from the World Health Organization (WHO) officer for CRDs described the role and remit of the WHO in providing leadership and guidance in this area. A summary of this second symposium is presented here, and we discuss the pathways from challenges to solutions for CRD care in low- and middle-income countries.

Concepts of advanced therapeutic delivery systems for the management of remodeling and inflammation in airway diseases.

Chronic respiratory disorders affect millions of people worldwide. Pathophysiological changes to the normal airway wall structure, including changes in the composition and organization of its cellular and molecular constituents, are referred to as airway remodeling. The inadequacy of effective treatment strategies and scarcity of novel therapies available for the treatment and management of chronic respiratory diseases have given rise to a serious impediment in the clinical management of such diseases. The progress made in advanced drug delivery, has offered additional advantages to fight against the emerging complications of airway remodeling. This review aims to address the gaps in current knowledge about airway remodeling, the relationships between remodeling, inflammation, clinical phenotypes and the significance of using novel drug delivery methods.

Management of chronic respiratory diseases during viral pandemics: A concise review of guidance and recommendations.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute respiratory disease that can lead to respiratory failure and death. Although anticipated that patients with chronic respiratory diseases would be at increased risk of SARS-CoV-2 infection and more severe presentations of COVID-19, it is striking that these diseases appear to be underrepresented in the comorbidities reported for patients with COVID-19. The first wave of COVID-19 has taught us important lessons concerning the enormous burden on the hospitals, shortage of beds, cross infections and transmissions, which we coped together. However, with the subsequent waves of COVID-19 or any other viral pandemic, to ensure that patients with respiratory illnesses receive adequate management for their diseases while minimizing their hospital visits for their own safety. Hence, we prepared an evidence-based summary to manage outpatients and inpatients suspected or diagnosed with COPD, asthma and ILD based on the experience of the first wave of COVID-19 and recommendations by expert societies and organizations.

GUÍAS DE REHABILITACIÓN RESPIRATORIA EN NIÑOS CON ENFERMEDADES RESPIRATORIAS CRÓNICAS: ACTUALIZACIÓN 2016

Pulmonary rehabilitation (PR) is an essential tool in the management of chronic respiratory diseases in childhood. PR improve symptoms, physical performance, quality of life and social integration in children who have limitations in their daily activities. Health professionals have a key role in identifying those children who are candidates for pulmonary rehabilitation programs, in the initial evaluation and in the implementation of therapeutic strategies for training and education. This document is intended as a reference guide for all those professionals who are dedicated to the care of children with chronic respiratory diseases.

Effects of environmental air pollutants on CFTR expression and function in human airway epithelial cells

The airway epithelium is exposed to a variety of air pollutants, which have been associated with the onset and worsening of respiratory diseases. These air pollutants can vary depending on their composition and associated chemicals, leading to different molecular interactions and biological effects. Mucociliary clearance is an important host defense mechanism against environmental air pollutants and this process is regulated by various ion transporters including the cystic fibrosis transmembrane conductance regulator (CFTR). With evidence suggesting that environmental air pollutants can lead to acquired CFTR dysfunction, it may be possible to leverage therapeutic approaches used in cystic fibrosis (CF) management. The aim of our study was to test whether environmental air pollutants tobacco smoke extract, urban particulate matter, and diesel exhaust particles lead to acquired CFTR dysfunction and whether it could be rescued with pharmacological interventions. Human airway epithelial cells (Calu-3) were exposed to air pollutant extracts for 24 h, with and without pharmacological interventions, with readouts of CFTR expression and function. We demonstrate that both tobacco smoke extract and diesel exhaust particles led to acquired CFTR dysfunction and that rescue of acquired CFTR dysfunction is possible with pharmacological interventions in diesel exhaust particle models. Our study emphasizes that CFTR function is not only important in the context of CF but may also play a role in other respiratory diseases impacted by environmental air pollutants. In addition, the pharmacological interventions approved for CF management may be more broadly leveraged for chronic respiratory disease management.

Music and dance in respiratory disease management in Uganda: a qualitative study of patient and healthcare professional perspectives

IntroductionMusic and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in...

Genetic Determinants of Poor Response to Treatment in Severe Asthma.

Severe asthma is a multifactorial disorder with marked phenotypic heterogeneity and complex interactions between genetics and environmental risk factors, which could, at least in part, explain why during standard pharmacologic treatment, many patients remain poorly controlled and at an increased risk of airway remodeling and disease progression. The concept of “precision medicine” to better suit individual unique needs is an emerging trend in the management of chronic respiratory diseases. Over the past few years, Genome-Wide Association Studies (GWAS) have revealed novel pharmacogenetic variants related to responses to inhaled corticosteroids and the clinical efficacy of bronchodilators. Optimal clinical response to treatment may vary between racial/ethnic groups or individuals due to genetic differences. It is also plausible to assume that epigenetic factors play a key role in the modulation of gene expression patterns and inflammatory cytokines. Remarkably, specific genetic variants related to treatment effectiveness may indicate promising pathways for novel therapies in severe asthma. In this review, we provide a concise update of genetic determinants of poor response to treatment in severe asthma and future directions in the field.