Management Of Respiratory Diseases Research Articles

Patient-centred digital biomarkers for allergic respiratory diseases and asthma: the ARIA-EAACI approach.

Biomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the centre of the health system and is likely to optimise the practice of allergy. ARIA (Allergic Rhinitis and its Impact on Asthma) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomised controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, were embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of-life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.

Biomarkers of particulate matter exposure in patients with chronic obstructive pulmonary disease: a systematic review.

In recent years, ambient particulate matter (PM) exposure has been strongly linked with health effects. Elevated levels of PM in polluted air have been correlated with the onset and development of chronic obstructive pulmonary disease (COPD). This systematic review was conducted to evaluate biomarkers that could reflect the effects of PM exposure in patients with COPD. We performed a systematic review of studies published on biomarkers associated with PM exposure in patients with COPD between January 01, 2012 and June 30, 2022 in PubMed/MEDLINE, EMBASE, and Cochrane databases. Studies that included data on biomarkers with COPD exposed PM were eligible for inclusion. Biomarkers were classified into 4 groups according to their mechanisms. Of the 105 studies identified, 22 were included in this study. Nearly 50 biomarkers have been proposed in the studies included in this review, and the most studied in relation to PM are several interleukins. Various mechanisms have been reported by which PM induces and aggravates COPD. Six studies related to oxidative stress, one related to direct effect of innate and adaptive immune systems, 16 associated with genetic regulation of inflammation, and two related to epigenetic regulation of physiology and susceptibility were found. Biomarkers related to these mechanisms were detected in serum, sputum, urine, exhaled breath concentration (EBC), and showed various correlations with PM in COPD. Various biomarkers have shown potential in predicting the extent of PM exposure in COPD patients. Future studies are needed to establish recommendations for regulation to reduce airborne PM, which could be used to develop strategies for prevention and management of environmental respiratory diseases.

A versatile nanofibrous facemask filter for triboelectric nanogenerator-based self-powered respiratory monitoring with efficient filtration and excellent antibacterial capacities

Respiration, as a basic human physiological process, can be used as a vital indicator for early disease diagnosis. Moreover, the prevention of respiratory diseases caused by particulate matter and bacteria is of great importance. Herein, a smart face mask with self-powered real-time respiratory monitoring, efficient filtration and excellent antibacterial activity was fabricated by electrospinning. By applying polyvinylidene fluoride (PVDF)/ε-poly (L-lysine)(ε-PL) and poly (ε-caprolactone)(PCL)/gelatin nanofibrous membranes as contact electrification pairs, the triboelectric nanogenerator assembled into a face mask could detect different breathing frequencies and intensities without external power supply. The electrical output performance was increased with the increment of PVDF concentration and the introduction of gelatin. Efficient filtration of particulate matter was achieved under a low pressure drop. Furthermore, PVDF/ε-PL nanofibrous membrane also exhibited excellent antibacterial activity, thus reducing the risk of respiratory infection. The prepared smart face mask is hopeful for personal healthcare management and prevention of respiratory diseases.

Abstracts from The Aerosol Society Drug Delivery to the Lungs 33.

Abstracts from The Aerosol Society Drug Delivery to the Lungs 33.

Genetic insights into lung function inform better management of respiratory diseases

Shrine etal.1 conducted the largest multi-ancestry genome-wide meta-analysis of lung function and identified 1,020 signals associated with lung function. These provide novel insights into the genetic underpins of lung function and may inform better clinical management of respiratory disorders.

Healthcare Resource Utilization Among Patients With Activated PI3Kδ Syndrome in the United States: A Real-world Assessment by Patient Age

ImportanceDespite the known morbidity associated with activated PI3Kδ syndrome (APDS), little is understood about the healthcare resource utilization (HRU) attributable to this condition. ObjectiveTo describe HRU and treatment patterns of patients with APDS by age group (≤11 and ≥12 yrs). MethodsPatients with APDS were identified via genetic testing and tokenized to the Symphony Health Integrated Dataverse database comprising medical/pharmacy claims (10/1/2015–3/31/2021). HRU rates (hospitalizations, emergency room [ER], outpatient, and other visits) per person-year, main reason for HRU visit, and treatment patterns were assessed from the start of patients’ clinical activity to the earliest of end of clinical activity or data availability (observation period). ResultsOf 31 patients with APDS identified, 14 were ≤11 yrs and 17 were ≥12 yrs. The mean±SD observation period was 3.9 ±2.1 and 5.2 ± 1.8 yrs, respectively; mean age was 3.9 ± 2.7 and 29.4 ± 13.1 yrs, respectively. Common clinical manifestations in ≤11 yrs included lymphoproliferation (71.4%), fever (64.3%), allergy (57.1%), otitis media (50.0%), diarrhea (21.4%), and lymphoma (7.1%). Common clinical manifestations in ≥12 yrs included sinusitis (58.8%), bronchitis (58.8%), allergy (47.1%), diarrhea (23.5%), and lymphoma (17.6%). Outpatient visit rates were high overall; ER visits and hospitalization rates were low in both groups, whereas other visit rates were high in ≥12 yrs (Figure 1). Immunoglobulin replacement therapy (IRT)-related HRU accounted for 14.4% and 17.9% of outpatient visits in ≤11 yrs and ≥12 yrs, respectively, and 36.6% and 34.3% of other visits in ≤11 yrs and ≥12 yrs, respectively. Reasons for outpatient visits included enlarged lymph nodes and otitis media in ≤11 yrs and long-term drug therapy, common variable immunodeficiency, and acute sinusitis in ≥12 yrs. IRT was used by 42.9% and 70.6% in ≤11 yrs and ≥12 yrs, respectively. Antibiotic, corticosteroid, and mTor inhibitors were used by 92.9% and 88.2%, 78.6% and 76.5%, and 21.4% and 11.8% in ≤11 yrs and ≥12 yrs, respectively; no rituximab use was observed. [Display omitted] ConclusionsAPDS presents with various complex clinical manifestations requiring intervention. Among patients analyzed, outpatient and other visits were the most commonly used healthcare resources and were often associated with respiratory disease and immunodeficiency management. To our knowledge, this is the first study to assess HRU among patients with APDS using administrative claims data.

Home-based Pulmonary Rehabilitation in Patients with COVID-19: The Efficiency in Pulmonary Function

Background: Coronavirus disease (COVID-19) is a viral disease that mostly affects the respiratory system and leads to respiratory failure. Alongside, pulmonary rehabilitation is one of the most important components in the management of respiratory system diseases and can rehabilitate persons after lung-damaged disease. Objectives: The present study aimed to determine the efficiency of Home-Based Pulmonary Rehabilitation in pulmonary function in patients with COVID-19 Methods: This simple randomized interventional study was conducted on 70 COVID-19 patients in Kerman, Iran. They were assigned to two equal groups of control and intervention. In the control group, patients received only routine post-discharge care, and in the intervention group, patients received home-based pulmonary rehabilitation procedures containing some movements to improve pulmonary function for four weeks after discharge. Results: Forced expiratory volume in 1 second (P<0.001), vital capacity (P<0.001) and these two parameters ratio (P<0.02), peak expiratory flow (P<0.001), in four weeks after discharge from the hospital in the intervention group was significantly higher than in the control group. Moreover, 6-min walk distance (P<0.001) was significantly increased, and the severity of dyspnea (P<0.001) was significantly reduced in the intervention group. As well, the number of patients with severe dyspnea decreased significantly (P<0.001). Conclusion: It seems that our home-based program can result in a marked improvement in vital capacity and other pulmonary function tests, as well as a reduction in dyspnea after discharge. In conclusion, this rehabilitation procedure is effective in pulmonary recovery in COVID-19 patients and can be used as a treatment procedure for recovery in these patients.

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.

The association between sleep duration, respiratory symptoms, asthma, and COPD in adults.

The association between sleep duration and cough, wheezing, and dyspnea was unclear. This research aimed to test this relationship. Research data were obtained from people who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2012. We used weighted logistic regression analysis and fitted curves to explore the association between sleep and respiratory symptoms. In addition, we investigated the association between sleep duration, chronic obstructive pulmonary disease (COPD), and asthma. The stratified analysis is used to analyze inflection points and specific populations. The 14,742 subjects are weighted to reflect the 45,678,491 population across the United States. Weighted logistic regression and fitted curves show a U-shaped relationship between sleep duration and cough and dyspnea. This U-shaped relationship remained in people without COPD and asthma. The stratified analysis confirmed that sleep duration before 7.5 h was negatively associated with cough (HR 0.80, 95% CI 0.73-0.87) and dyspnea (HR 0.82, 95% CI 0.77-0.88). In contrast, it was positively associated with cough and (HR 1.30, 95% CI 1.14-1.48) dyspnea (HR 1.12, 95% CI 1.00-1.26) when sleep duration was >7.5 h. In addition, short sleep duration is associated with wheezing, asthma, and COPD. Both long and short sleep duration are associated with cough and dyspnea. And short sleep duration is also an independent risk factor for wheezing, asthma, and COPD. This finding provides new insights into the management of respiratory symptoms and diseases.

Rapid antigen test for adenovirus in children: Age and onset of symptoms are important

IntroductionRespiratory infection is the most common human adenovirus (HAdV) disease accounting for 7–8% of viral respiratory diseases in children less than 5 years. Differentiation of bacterial infections and viral infections is a common clinical problem. Material and methodsOne hundred oropharyngeal swabs obtained from October 2019 to November 2020 from patients attending the paediatric emergency room with suspicion of upper respiratory tract infection and negative results in influenza and RSV tests were included. Oropharyngeal swabs specimens were rapidly processed with STANDARD™ F Adeno Respi Ag FIA and the results were confirmed by RealStar® Adenovirus PCR Kit 1.0 (Altona diagnostics). ResultsSTANDARD™ F Adeno Respi Ag FIA had sensitivity and specificity values of 71.93% and 100% respectively. The performance of the test was higher in samples from children younger than 24 months and taken less than 72h since the beginning of symptoms. In this subgroup the test had 88.8% sensitivity and 100% specificity. ConclusionSTANDARD™ F Adeno Respi Ag FIA may improve the management of respiratory diseases in children younger than 24 months and less than 72h since the beginning of symptoms in paediatric emergency rooms.

Investigating attitudes and insights into the global warming impact of inhalers.

Inhalers are commonly used in the management of respiratory diseases. The propellants used in pressurised metered dose inhalers (pMDIs) are potent greenhouse gases and carry a substantial global warming potential. Dry powder inhalers (DPIs) are propellant-free alternatives that have fewer consequences on the environment, while being equally effective. In this study, we assessed patients' and clinicians' attitudes towards choosing inhalers that have a lesser environmental impact. Surveys of patients and practitioners were undertaken in primary and secondary care settings in Dunedin and Invercargill. Fifty-three patient and 16 practitioner responses were obtained. Sixty-four percent of patients were using pMDIs, while 53% were using DPIs. Sixty-nine percent of patients believed that the environment is an important consideration when switching inhalers. Sixty-three percent of practitioners were aware of the global warming potential of inhalers. Despite this, 56% of practitioners predominantly prescribe or recommend pMDIs. The 44% of practitioners who mostly prescribe DPIs were more comfortable doing so based on environmental impact alone. Most respondents believe global warming is an important issue and would consider changing their inhaler to a more environmentally friendly type. Many people were not aware that pressurised metered dose inhalers have a substantial carbon footprint. Greater awareness of their environmental impacts may encourage the use of inhalers with lower global warming potential.

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.

A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments.

Our aim was to compare some of the health outcomes and costs associated with value of care in emergency departments (ED) and walk-in clinics for ambulatory patients presenting with an acute respiratory disease. A health records review was conducted from April 2016 through March 2017 in one ED and one walk-in clinic. Inclusion criteria were: (i) ambulatory patients at least 18years old, (ii) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Primary outcome was the proportion of patients returning to any ED or walk-in clinic within three and seven days of the index visit. Secondary outcomes were the mean cost of care and the incidence of antibiotic prescription for URTI patients. The cost of care was estimated from the Ministry of Health's perspectives using time-driven activity-based costing. The ED group included 170 patients and the walk-in clinic group 326 patients. The return visit incidences at three and seven days were, respectively, 25.9% and 38.2% in the ED vs. 4.9% and 14.7% in the walk-in clinic (adjusted relative risk (arr) of 4.7 (95% CI 2.6-8.6) and 2.7 (1.9-3.9)). The mean cost ($Cdn) of the index visit care was 116.0 (106.3-125.7) in the ED vs. 62.5 (57.7-67.3) in the walk-in clinic (mean difference of 56.4 (45.7-67.1)). Antibiotic prescription for URTI was 5.6% in the ED vs. 24.7% in the walk-in clinic (arr 0.2, 0.01-0.6). This study is the first in a larger research program to compare the value of care between walk-in clinics and the ED. The potential advantages of walk-in clinics over EDs (lower costs, lower incidence of return visits) for ambulatory patients with respiratory diseases should be considered in healthcare planning.

Normal values of respiratory oscillometry in South African children and adolescents.

Noninvasive measurement of respiratory impedance by oscillometry can be used in young children aged from 3 years and those unable to perform forced respiratory manoeuvres. It can discriminate between healthy children and those with respiratory disease. However, its clinical application is limited by the lack of reference data for African paediatric populations. The aim of the present study was to develop reference equations for oscillometry outcomes in South African children and adolescents. Healthy subjects, enrolled in the Drakenstein Child Health Study, HIV-uninfected adolescents in the Cape Town Adolescent Antiretroviral Cohort and healthy children attending surgical outpatient clinics at Red Cross War Memorial Children's Hospital were measured with conventional spectral (6-32 Hz) and intra-breath (10 Hz) oscillometry. Stepwise linear regression was used to assess the relationship between respiratory variables and anthropometric predictors (height, sex, ancestry) to generate reference equations. A total of 692 subjects, 48.4% female, median age of 5.2 years (range: 3-17 years) were included. The median (interquartile range (IQR)) for weight for age z-score and height for age z-score was -0.42 (-1.11-0.35) and -0.65 (-1.43-0.35), respectively. Stepwise regression demonstrated that all the variables were significantly dependent on height only. Comparison to previous reference data indicated slightly higher resistance and lower compliance values in the smallest children. We established the first respiratory oscillometry reference equations for African children and adolescents, which will facilitate use in early identification and management of respiratory disease. Our results suggest differences in oscillometry measures by ancestry but also highlight the lack of standardisation in methodology.

Impact of the COVID-19 pandemic on the prevalence of influenza A and respiratory syncytial viruses elucidated by wastewater-based epidemiology

Since the COVID-19 pandemic, a decrease in the prevalence of Influenza A virus (IAV) and respiratory syncytial virus (RSV) has been suggested by clinical surveillance. However, there may be potential biases in obtaining an accurate overview of infectious diseases in a community. To elucidate the impact of the COVID-19 on the prevalence of IAV and RSV, we quantified IAV and RSV RNA in wastewater collected from three wastewater treatment plants (WWTPs) in Sapporo, Japan, between October 2018 and January 2023, using highly sensitive EPISENS™ method. From October 2018 to April 2020, the IAV M gene concentrations were positively correlated with the confirmed cases in the corresponding area (Spearman's r = 0.61). Subtype-specific HA genes of IAV were also detected, and their concentrations showed trends that were consistent with clinically reported cases. RSV A and B serotypes were also detected in wastewater, and their concentrations were positively correlated with the confirmed clinical cases (Spearman's r = 0.36–0.52). The detection ratios of IAV and RSV in wastewater decreased from 66.7 % (22/33) and 42.4 % (14/33) to 4.56 % (12/263) and 32.7 % (86/263), respectively in the city after the COVID-19 prevalence. The present study demonstrates the potential usefulness of wastewater-based epidemiology combined with the preservation of wastewater (wastewater banking) as a tool for better management of respiratory viral 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.

Sichen Formula Ameliorates Lipopolysaccharide-Induced Acute Lung Injury via Blocking the TLR4 Signaling Pathways.

Sichen (SC) formula is a classic prescription of Tibetan medicine. Due to its potential anti-inflammatory effect, the SC formula has been clinically used to treat respiratory diseases for many years in the Chinese Tibet region. The present study aimed to investigate the anti-inflammatory effect of SC and explore the underlying mechanisms. SC formula was characterized by HPLC analysis. The acute lung injury (ALI) mouse model was induced by direct intratracheal lipopolysaccharide (LPS) instillation, and bronchoalveolar lavage fluid (BALF) and lung tissues were collected. Meanwhile, RAW264.7 macrophages were stimulated by LPS. The contents of inflammatory mediators in the culture medium were determined by ELISA. Protein levels were determined by immunohistochemical staining or Western blotting. Nuclear localization of NF-κB, AP-1, and IRF3 was performed using immunofluorescence and Western blotting. In the LPS-induced ALI mouse model, SC treatment suppressed the secretion of inflammatory mediators (TNF-α, IL-6, IL-1β, MCP-1, MIP-1α, and RANTES) in BALF. SC treatment hindered the recruitment of macrophages. SC treatment also inhibited the expression of CD68, p-p65, and TLR4 in the lung tissue. In the LPS-exposed RAW264.7 cells, the cell viability was not changed up to 400 μg/mL of SC. SC concentration-dependently suppressed the production of nitric oxide, prostaglandin E2, TNF-α, IL-6, MCP-1, MIP-1α, and RANTES in LPS-challenged RAW264.7 cells. The expression levels of iNOS, COX-2, p-p38, p-JNK, p-ERK, p-TBK1, p-IKKα/β, p-IκB, p-p65, p-c-Jun, and p-IRF3 were decreased after SC treatment. Moreover, the nuclear translocation of p65, c-Jun, and IRF3 was also blocked by SC treatment. SC treatment inhibited the inflammatory responses in LPS-induced ALI mouse model/RAW264.7 macrophages. The underlying mechanism of this action may be closely associated with the suppression of TLR4 signaling pathways. These research findings provide further pharmacological justifications for the medicinal use of SC in the management of respiratory diseases.

High potential of the genus Allanblackia (Guttiferae): Phytochemistry, pharmacology, and traditional uses over the past half-century

The genus Allanblackia is part of the flowering plants of the Guttiferae family, with all its ten species growing across the rainforest belts of West, Central and East Africa. Allanblackia species have the largest fruits of all plants in the African rainforest. They are evergreen, dioecious, and medium-sized trees with average heights in the range 25–40 m and can produce more than 250 fruits per year. Their stem barks are reddish-brown, with small circular or rectangular scales over small red pits. The trunk is straight, cylindrical, without buttresses but sometimes basally thickened; with numerous branches and longitudinal grooves. Leaves are opposite, simple and entire; while flowers are unisexual, fragrant, and of pink/red or white/cream colour. Fruits are large, ellipsoid berries 10–50 cm × 15 cm in size, with five longitudinal ridges, while seeds are ovoid 3 cm × 2 cm × 1.5 cm. In addition to the numerous uses of Allanblackia in traditional medicine, the consumption and commercial exploitation of its seed oils are of great current interest. However, to date, there is no literature review collating the traditional uses, phytochemistry and biological activities of this genus. Therefore, the present review aims to provide a current, relevant and comprehensive summary of the botany, ethnomedicinal uses, phytochemistry, and biological activities of plants of the genus Allanblackia over the past half-century (1971 to 2021). To this end, a review of all published literature was conducted using various online scientific databases. According to the findings, the Allanblackia species are mostly used in folk medicine for the management of infectious and respiratory diseases. Chemical analysis of the genus Allanblackia revealed that xanthones and biflavonoids represent 51% and 16% of the total secondary metabolites, respectively and could therefore be considered as taxonomic markers of the genus. Extracts and isolates from some species of this genus were reported to exhibit promising antimicrobial, antileishmanial, anticholinesterase and cytotoxic activities, and therefore are vital enough to deserve further attention in new drug discovery.

Nanomedicine - a boon for respiratory disease management

Respiratory diseases affect the lungs and other parts of the respiratory system. The respiratory disease affects hundreds of millions of humans, and premature death is observed in nearly four million people yearly. The major cause of the increase in this disease is the increased level of air pollution and higher tobacco usage in public places.We have used the search engines PubMed and Google Scholar for the keywords Respiratory diseases, Nanomaterials, diagnosis, Nanomedicine, and Target drug delivery; recent and relevant articles are selected for reviewing this paper.Nanomedicine is a recent field of research that deals with monitoring, repairing, theragnosis, and development of human biological systems at the sub-atomic level, where we utilize engineered nanodevices and nanostructures. The conventional therapeutic strategies designed for respiratory diseases have limited solubility and bioavailability. Moreover, the robust effect of the drugs led to adverse side effects due to their high dose requirement. The local delivery of therapeutic Nanoparticles (NPs) or drug-loaded nano vehicles to the lung is a safe technique for managing various respiratory tract-related diseases like chronic obstructive pulmonary diseases, cystic fibrosis, lung cancer, tuberculosis, asthma, and infection. To overcome the difficulties of conventional treatment with antibiotics and anti-inflammatory drugs, nano-enabled drug delivery, nanoformulations of drugs as well as drug nanoencapsulation have been used recently. In this mini-review, we will discuss the importance and application of nanomedicine for diagnosis, treatment and clinical research involved in the different types of respiratory diseases.Nanomedicine provides an alternative delivery of drugs with the help of various nanocarriers, which enhances controlled drug delivery at the pulmonary region and can be used for treating and diagnosing respiratory diseases in vivo and in vitro studies. Further experiments followed by clinical examination are warranted to prove the potential application of nanomedicine in treating respiratory disease.This mini-review will help the readers and budding scientists apply new methods for developing highly efficient drugs with low side effects and improved targeted sites of action.

Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective.

The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis (RA), which is reported to occur in up to 60% to 80% of RA patients. Respiratory complications are the second leading cause of death due to RA. Although there is a wide spectrum of RA-associated respiratory diseases, interstitial lung disease is the most common manifestation and it impacts the prognosis of RA. There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and RA-associated respiratory diseases recently, for example, opportunistic pulmonary infectious diseases and toxicity from RA therapies. From a chest physicians' perspective, we will update the diagnosis and treatment of RA-associated ILD, methotrexate-associated lung disease, and the complication of Pneumocystis jiroveci pneumonia in RA in this review.