Pre-existing Respiratory Disease Research Articles

Device-assessed physical activity and sleep quality of post-COVID patients undergoing a rehabilitation program

BackgroundAn infection with SARS-CoV-2 can lead to persistent symptoms more than three months after the acute infection and has also an impact on patients’ physical activity behaviour and sleep quality. There is evidence, that inpatient post-COVID rehabilitation can improve physical capacity and mental health impairments, but less is known about the change in physical behaviour and sleep quality.MethodsThis longitudinal observational study used accelerometery to assess the level of physical activity and sleep quality before and after an inpatient rehabilitation program. The study sample consists of 100 post-COVID patients who acquired COVID-19 in the workplace. Group differences related to sex, age, COVID-19 severity, and pre-existing diseases were also analysed.ResultsLevel of physical activity and sleep quality didn’t increase after rehabilitation. Overall, there is a high extent of inactivity time and poor sleep quality at both measurement points. Regarding group differences, male patients showed a significantly higher inactivity time before rehabilitation, and younger patients (< 55 years) spend significant more time in vigorous physical activity than older patients. Post-COVID patients with pre-existing cardiovascular, respiratory, and metabolic disease show slightly less physical activity than post-COVID patients without these comorbidities. Female patients and younger patients showed better sleep quality in some sleep parameters at both measurement points. However, no differences could be detected related to COVID-19 severity.ConclusionsOngoing strategies should be implemented to address the high amount of inactivity time and the poor sleep quality in post-COVID patients.

Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19.

Risk factors for progression to critical illness in hospital-acquired coronavirus disease 2019 (COVID-19) remain unknown. Here, we assessed the incidence and risk factors for progression to critical illness and determined their effects on clinical outcomes in patients with hospital-acquired COVID-19. This retrospective cohort study analyzed patients admitted to the tertiary hospital between January 2020 and June 2022 with confirmed hospital-acquired COVID-19. The primary outcome was the progression to critical illness of hospital- acquired COVID-19. Patients were stratified into high-, intermediate-, or low-risk groups by the number of risk factors for progression to critical illness. In total, 204 patients were included and 37 (18.1%) progressed to critical illness. In the multivariable logistic analysis, patients with preexisting respiratory disease (OR, 3.90; 95% CI, 1.04-15.18), preexisting cardiovascular disease (OR, 3.49; 95% CI, 1.11-11.27), immunocompromised status (OR, 3.18; 95% CI, 1.11-9.16), higher sequential organ failure assessment (SOFA) score (OR, 1.56; 95% CI, 1.28-1.96), and higher clinical frailty scale (OR, 2.49; 95% CI, 1.62-4.13) showed significantly increased risk of progression to critical illness. As the risk of the groups increased, patients were significantly more likely to progress to critical illness and had higher 28-day mortality. Among patients with hospital-acquired COVID-19, preexisting respiratory disease, preexisting cardiovascular disease, immunocompromised status, and higher clinical frailty scale and SOFA scores at baseline were risk factors for progression to critical illness. Patients with these risk factors must be prioritized and appropriately isolated or treated in a timely manner, especially in pandemic settings.

Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON).

The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). Six hundred three patients (mean 54.0years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001). The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. The cohort is registered at www. gov under NCT04768998.

Impact of Earthquakes on Lung Health.

Earthquakes are catastrophic natural disasters that cause extensive damage to infrastructure and disrupt the lives of millions worldwide. Beyond the immediate physical and psychological damage caused by earthquakes, these events can significantly impact respiratory health. The inhalation of dust, smoke, particulates, toxic gases, and asbestos exposure can lead to various respiratory health pathologies. These include respiratory infections, exacerbations of pre-existing respiratory diseases, chest traumas, and pulmonary and venous thromboembolism. Longitudinal studies are necessary to assess the long-term respiratory health effects in affected populations. By addressing these knowledge gaps, future mitigation strategies and preparedness measures can be developed to minimize the respiratory health impacts of earthquakes and improve the well-being of affected communities. Robust building infrastructure and comprehensive earthquake preparedness are emerging as the most important determinants for not only mitigating building collapse but also significantly reducing the potential health impacts that follow. This comprehensive review aims to provide a systematic overview of the lung health impacts of earthquakes. It highlights the need for further research to identify specific pollutants, air contaminants, and environmental factors contributing to respiratory health issues following earthquakes.

Impact of urban outdoor thermal conditions on selected hospital admissions in Novi Sad, Serbia

Climate change has been recognized as an important issue in public health, with particular concerns being raised about the effects of heat and cold extremes on health, and about seasonal changes over the year and their associations with increased mortality and hospitalizations. This paper explored the relationship between physiological equivalent temperature (PET) and cardiovascular and respiratory hospital admissions in Novi Sad (Serbia) with the aim of assessing the impact of urban outdoor thermal conditions on health. Analysis was performed using daily data on cardiovascular and respiratory hospital admissions by gender covering the period from January 1, 2016 to December 31, 2017. For the same period, PET was calculated using data from two urban meteorological network stations. The association between PET and hospital admissions was examined using a generalized additive model (GAM) combined with a distributed lag non-linearmodel (DLNM). The study found a non-linear relationship between PET and cardiovascular and respiratory hospital admissions, with a larger impact during the cold period of the year. The findings also indicated that under conditions of high PET, the cumulative RR increased for cardiovascular admissions (for males) and respiratory admissions (for females). People with pre-existing respiratory diseases were found to be more vulnerable under conditions of extremely low and moderately low PET, with a greater effect at lag 0–14 days. By contrast, for people with cardiovascular diseases, low PET was linked to a decrease in hospital admissions, with the risk being lowest at lag 0 and 0–3 days.

Improving Wildfire Readiness Among Patients With Chronic Obstructive Pulmonary Disease and Asthma: Applying a Population Health Approach to Climate Change.

As a result of climate change, wildfire frequency, duration, and severity are increasing in the United States. Exposure to wildfire-related air pollutants can lead to negative health outcomes, particularly among patients with pre-existing respiratory diseases (eg, asthma and chronic obstructive pulmonary disease) and those who are at higher risk for developing these conditions. Underserved communities are disproportionately affected for multiple reasons, including lack of financial and social resources, increased exposure to air pollutants at home and at work, and impaired access to healthcare. To best serve clinically high-risk and underserved populations, health systems must leverage community public health data, develop and mobilize a wildfire preparedness action plan to identify populations at high risk, and implement interventions to mitigate the consequences of poor air quality. University of California, Davis Health, located at the epicenter of the largest wildfires in California's history, has developed the 5 pillar Wildfire Population Health Approach: (1) identify clinically at-risk and underserved patient populations using well-validated, condition-targeted registries; (2) assemble multidisciplinary care teams to understand the needs of these communities and patients; (3) create custom analytics and wildfire-risk stratification; (4) develop care pathways based on wildfire-risk tiers by disease, risk of exposure, and healthcare access; and (5) identify outcome measures tailored to interventions with a commitment to continuous, iterative improvement efforts. The Wildfire Population Health Approach provides an action plan for health systems and care teams to meet the needs of clinically at-risk and underserved patients affected by the increasing health threat posed by climate change-related wildfires.

Direct impact of 2 years of COVID-19 on chronic disease patients: a population-based study in a large hard-hit Italian region

ObjectivesWe aimed to provide a region-wide comprehensive account of the direct effects of COVID-19 on chronic disease patients, in terms of disease incidence, severity and mortality, over a 2-year pandemic...

53 The Role of Body Mass Index in Hospitalized Burn Patients

Abstract Introduction Body mass index (BMI) has been identified as an independent risk factor for morbidity and mortality in hospitalized patients. The objective of this study was to investigate what role BMI played in hospitalized burn patients. Methods Registry data for all burn patients over the age of 18 admitted to our ABA verified burn center between July 1, 2015 to December 31, 2020 was analyzed. Patients were categorized based on the World Health Organization’s definition of BMI. Age, gender, co-morbidities, race, ethnicity, total body surface area (TBSA) and mechanism of injury were included. Total length of stay, ICU length of stay, the need for a ventilator, and hospital disposition were also analyzed. Categorical variables were compared using chi-square, and continuous using one-way ANOVA with post-hoc analysis. A multivariate logistic regression model was fit to generate adjusted odds ratios for the likelihood in-patient mortality with a p-value of &amp;lt; 0.05 was considered significant Results A total of 1106 patients were included for analysis. Mean age was 48.8 years. Mean BMI was 27.7. 785 (71%) were male. The most common burn mechanism was flame (551, 49.8 %). The following was the distribution based on BMI: underweight 50 (4.5%), normal weight 381 (34.4%), overweight 337 (30.5%), Class 1 obesity 198 (17.9%), Class 2 obesity 81 (7.3%), and Class 3 obesity 59 (5.3%). All classes of obese patients were more likely to have hypertension (P &amp;lt; 0.001). Class 2 and 3 obese patients were more likely to have diabetes mellitus (P &amp;lt; 0.001). Underweight patients were more likely to have pre-existing cardiovascular disease (P&amp;lt; 0.001) and respiratory disease (P = 0.003). Age (P &amp;lt; 0.001) and TBSA (P&amp;lt; 0.001) were the only independent variables that demonstrated a statistically significant higher likelihood of death. Being underweight conferred an odds ratio of 2.569 with respect to mortality but it did not rise to statistical significance. Obesity was not an independent risk factor for increased mortality. Underweight patients were more likely be discharged to a rehabilitation or skilled nursing facility and less likely to be sent home (P=0.002). There was no difference in TBSA, total length of stay, ICU or ventilator days amongst the six groups. Conclusions Having a low or high BMI does not increase the mortality rate of hospitalized burn patients. However, being underweight is a risk factor for a hospital disposition other than home. Applicability of Research to Practice Abnormal BMI alone does not confer an increased mortality risk in burn patients. More studies need to be performed to investigate other adverse events related to BMI.

HAEMODIALYSIS: A KING OR A CLOWN FOR COVID POSITIVE PATIENTS WITH PRE-EXISTING PULMONARY DISEASES!

Background: COVID-19 infection in patients with pre-existing respiratory diseases, manifesting as ARDS, while simultaneously affecting multiple organs severely worsened the outcome, raising the need to explore various treatment modalities. To study the impact of haemodialysis on outcomes of COVID-19 pati Objective: ents with pre-existing pulmonary diseases. Methods: Data of patients with known pulmonary comorbities admitted to COVID wards, undergoing haemodialysis for AKI at tertiary care centre, was collected from July 2020 to January 2022. The demographics, baseline parameters and outcomes were recorded. Total 61 Results: patients were included in this retrospective observational study. The percentage of different pre-existing pulmonary pathologies (COPD, Asthma, ILD, and Pulmonary Tuberculosis) were equally distributed among survivors(n=47) and non-survivors(n=14). The non-survivors were older(p=0.003), and had a higher percentage of males (p=0.02), higher percentage of smokers (p=0.02) and alcohol consumers(p=0.011), a lower mean systolic blood pressure, higher pulse rate, higher respiratory rate and lower SpO2. The non-survivors had a lower mean hemoglobin, platelet count, and a higher mean TLC, NLR, and D-dimer levels. On admission, the non-survivors had a higher mean blood urea level and serum creatinine level (p&lt;0.001). The number of hemodialysis done was signicantly higher(p=0.041) in the survivors as compared to non-survivors. Conclusion: Our study strongly suggests that haemodialysis can be used as a life saving treatment modality for AKI in COVID positive patients with pre-existing pulmonary disease. Also protocols need to be redened for early initiation and increased frequency of haemodialysis in patients with acute on chronic multisystem insult.

Using the Experience of Natural Disasters to Prevent Health Hazards in Shelters

Introduction:The number of deaths from natural disasters that have occurred in Japan since 1989 is in the order of (1) the Great East Japan Earthquake, (2) the Great Hanshin-Awaji Earthquake, and (3) the Kumamoto Earthquake, but the ratio of related deaths to the total number of deaths was highest for the Kumamoto earthquake.Method:In the case of the Kumamoto earthquake, an inland earthquake of the same scale as the Great Hanshin-Awaji Earthquake, direct deaths due to the earthquake were suppressed, but related deaths are thought to have increased due to the effects of evacuation life and other factors. According to a report by Kumamoto Prefecture, the majority of direct deaths from the Kumamoto earthquake were caused by trauma such as excessive pressure or asphyxiation. As for related deaths, most of the victims were aged 60 years or older, more than 80% of them had pre-existing medical conditions, and respiratory and circulatory system diseases were the most common causes of death.Results:A survey of victims transported by ambulance from evacuation centers to medical institutions after the Kumamoto earthquake showed that a large number of victims were transported in the acute phase after the disaster. The reasons for transport are diverse injuries and illnesses, including trauma from falls, dyspnea, impaired consciousness, and fever, suggesting that stress from the earthquake and problems in the living environment of the evacuation centers had an impact on the deterioration of health conditions.Conclusion:It is important to identify issues and consider countermeasures based on past experiences in order to prevent health hazards in evacuation centers.

Impact of impaired pulmonary function on clinical outcomes in survivors of severe COVID-19 without pre-existing respiratory disease.

To investigate the impact of impaired pulmonary function on patient-centered outcomes after hospital discharge due to severe COVID-19 in patients without preexisting respiratory disease. This is an ongoing prospective cohort study evaluating patients (> 18 years of age) 2-6 months after hospital discharge due to severe COVID-19. Respiratory symptoms, health-related quality of life, lung function, and the six-minute walk test were assessed. A restrictive ventilatory defect was defined as TLC below the lower limit of normal, as assessed by plethysmography. Chest CT scans performed during hospitalization were scored for the presence and extent of parenchymal abnormalities. At a mean follow-up of 17.2 ± 5.9 weeks after the diagnosis of COVID-19, 120 patients were assessed. Of those, 23 (19.2%) reported preexisting chronic respiratory diseases and presented with worse lung function and exertional dyspnea at the follow-up visit in comparison with their counterparts. When we excluded the 23 patients with preexisting respiratory disease plus another 2 patients without lung volume measurements, a restrictive ventilatory defect was observed in 42/95 patients (44%). This subgroup of patients (52.4% of whom were male; mean age, 53.9 ± 11.3 years) showed reduced resting gas exchange efficiency (DLCO), increased daily-life dyspnea, increased exertional dyspnea and oxygen desaturation, and reduced health-related quality of life in comparison with those without reduced TLC (50.9% of whom were male; mean age, 58.4 ± 11.3 years). Intensive care need and higher chest CT scores were associated with a subsequent restrictive ventilatory defect. The presence of a restrictive ventilatory defect approximately 4 months after severe COVID-19 in patients without prior respiratory comorbidities implies worse clinical outcomes.

25, 50 and 75 years ago

25, 50 and 75 years ago

Long COVID in the Belgian Defence forces: prevalence, risk factors and impact on quality of daily functioning

IntroductionLong COVID (LC) is a medical condition first described and documented through anecdotes on social media by patients prior to being recognised by WHO as a disease. Although >50 prolonged...

Diesel exhaust PM2.5 greatly deteriorates fibrosis process in pre-existing pulmonary fibrosis via ferroptosis

Fine particulate matter (PM2.5) has been widely reported to contribute to the pathogenesis of pulmonary diseases. The direct hazardous effect of PM2.5 on the respiratory system at high concentrations in vitro and in vivo have been well identified. However, its effect on the pre-existing respiratory diseases of patients at environment-related concentrations remains unclear. Diesel exhaust PM2.5 as a primary representative of ambient PM2.5 fine particles were used to investigated the effect of PM2.5 on the fibrosis progression of existing pulmonary fibrosis disease models. This study reported that PM2.5 could result in the enhanced sensitivity to fibrotic response, which may be ascribed to ferroptosis induced by PM2.5 in damaged lung areas. Proteomic analysis revealed that the upregulation of HO-1 as a key mechanism in the ferroptosis and exacerbation of pulmonary fibrosis induced by PM2.5. As a result, HO-1 degraded heme-containing protein and released iron in fibrotic cells, leading to generation of mitochondrial ROS and impaired mitochondrial function. Transmission electron microscopic assay verified that PM2.5 entered the mitochondria of fibrotic cells and was accompanied by significant mitochondrial morphological changes characterized by increased mitochondrial membrane density and reduced mitochondrial size. The HO-1 inhibitor zinc protoporphyrin and mitochondrion-targeted antioxidant Mito-TEMPO significantly attenuated PM2.5-induced ferroptosis and exacerbation of fibrosis. In addition, AMPK-ULK1 axis-triggered autophagy activation and NCOA4-mediated degradation of ferritin by autophagy were found to be related to the PM2.5-induced ferroptosis of fibrotic cells. As evidenced by the inhibition of autophagy with 3-methyladenine or AMPK inhibitor, NCOA4 knockdown decreased intracellular iron accumulation and lipid peroxidation, thereby relieving PM2.5-induced epithelial–mesenchymal transition and cell death in fibrotic cells. Overall, this study provided experimental support for the idea that PM2.5 greatly deteriorates fibrosis process in pre-existing pulmonary fibrosis, and HO-1-mediated mitochondrial dysfunction and NCOA4-mediated ferritinophagy are jointly required for the PM2.5-induced ferroptosis and enhanced fibrosis effects.

Pulmonary Function Testing (PFT) after Photon and Proton Radiotherapy for Stage II-III Breast Cancer

<h3>Purpose/Objective(s)</h3> The Breast Cancer Lung Late Effects (BELLE) study prospectively enrolled patients with breast cancer who received adjuvant photon (XRT) or proton (PT) radiotherapy (RT) to evaluate potential early markers of induced lung injury, including pulmonary function tests (PFTs). <h3>Materials/Methods</h3> Patients ≥18 years with AJCC 8^th edition anatomic stage II-III or greater breast cancer were enrolled into the BELLE study between May 27, 2016 and May 26, 2020. All patients underwent clinical evaluation, computed tomography imaging, PFTs, and QoL questionnaires at baseline, 6 months, and 12 months relative to RT start. Fisher's exact tests and Kruskal-Wallis rank sum tests were used to compare the XRT and PT groups. <h3>Results</h3> A total of 37 patients were included in the final analysis (XRT, n=21; PT, n=16). Median age at diagnosis was 51 years (range, 31-76); 26 patients identified as white (70.3%), 8 as Black (21.6%), and 3 other (7.1%). Most patients did not have pre-existing respiratory disease (83.8%) or prior smoking history (62.2%), while 35.1% were former smokers and 1 was a current smoker (2.7%). The median BMI was 29.4 (range, 18.9-44.2). Most patients received chemotherapy (75.7%) and regional nodal irradiation (RNI; 78.4%). Median lung V20 was 25.3% (range, 5.6-39.7) and median lung V5 was 59.6% (range, 29.7-86.4). XRT patients had more pre-existing respiratory disease and were less likely to receive RNI (p=0.027 and p=0.006, respectively). There was no statistically significant difference between the XRT and PT cohorts for median lung V20 or V5. The median FEV1/FVC ratio at baseline, 6 months, and 12 months were not significantly different between the XRT and PT cohorts (80.2 % vs 81.5%, p=0.81; 79.3% vs 81.3%, p=0.95; and 80.6% vs 79.4% p>0.99, respectively). Similarly, the median FVC values at baseline, 6 months, and 12 months were not significantly different between the XRT and PT cohorts (3.4 L vs 3.1 L, p=0.76; 3.2 L vs 3.0 L, p=0.38; and 3.5 L vs 3.0 L, p=0.23, respectively). While the median DLCO at baseline was significantly worse for the PT cohort (91% vs 76%, p=0.005), there was no difference between cohorts at 6 and 12 months (79.0% vs 78.0%, p=0.38; 89.0% vs 84.0%, p=0.80, respectively). Four patients developed radiation pneumonitis (RP) within a year of RT including 3 with transient grade 1 (n=1 PT; n=2 XRT) and 1 with grade 3 (XRT). <h3>Conclusion</h3> Despite high variability among patients across all PFT parameters, the median FEV1/FVC ratio and FVC were stable over time and did not cross the threshold for concern of restrictive lung disease in either cohort. Although DLCO decreased at 6 months in the XRT cohort, both cohorts showed improvement at one year without diagnosis of restrictive lung disease. Utilizing PFTs as an early marker of RT-induced lung injury, neither patients treated with XRT nor PT exhibited sustained PFT abnormalities with 1 year of follow-up.

A Review of the Respiratory Health Burden Attributable to Short-Term Exposure to Pollen.

Respiratory diseases such as asthma, allergic rhinitis (AR) and chronic obstructive pulmonary disease (COPD) affect millions worldwide and pose a significant global public health burden. Over the years, changes in land use and climate have increased pollen quantity, allergenicity and duration of the pollen season, thus increasing its impact on respiratory disease. Many studies have investigated the associations between short-term ambient pollen (i.e., within days or weeks of exposure) and respiratory outcomes. Here, we reviewed the current evidence on the association between short-term outdoor pollen exposure and thunderstorm asthma (TA), asthma and COPD hospital presentations, general practice (GP) consultations, self-reported respiratory symptoms, lung function changes and their potential effect modifiers. The literature suggests strong evidence of an association between ambient pollen concentrations and almost all respiratory outcomes mentioned above, especially in people with pre-existing respiratory diseases. However, the evidence on sub-clinical lung function changes, COPD, and effect modifiers other than asthma, hay fever and pollen sensitisation are still scarce and requires further exploration. Better understanding of the implications of pollen on respiratory health can aid healthcare professionals to implement appropriate management strategies.

A study on human perception in aircraft cabins and its association with volatile organic compounds

More than 8 million people fly on commercial aircraft each day with approximately 5% having a pre-existing respiratory disease. Thus it is necessary to provide high air quality in aircraft to protect public health. Volatile organic compounds (VOCs) present in aircraft cabins are suspected to contribute to the reported complaints. We investigated concentrations of VOCs, air temperature, relative humidity, and CO2 concentrations in a total of 46 flights, including 26 Chinese domestic flights and 20 international flights. We focused on the data from the cruising phase without meal serving in which the air supply and air recirculation were steady. A total of 284 passengers (i.e., 101 on international flights and 183 on Chinese domestic flights) were invited to participate in questionnaire surveys in this phase. We performed a linear mixed model analysis by controlling for potential confounders (age, gender, smoke habits, and history of allergy) to study associations between VOCs exposures and passengers' complaints. Xylene was significantly associated with irritations of the eyes, nose, and throat on both international and domestic flights, with antilog beta values from 1.12 to 1.28 (p < 0.05). The association of some aldehydes (i.e., nonanal, decanal, and heptanal), which are potential oxidation products with ozone, with passengers’ sensory irritations was also significant, especially during international flights (antilog beta values: 1.19–1.22). It indicates that VOCs, especially xylene and aldehydes, in aircraft cabins may influence the perceived indoor air quality and complaints among passengers.

Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study.

ObjectiveTo assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy.DesignObservational cohort study.SettingEmergency telephone triage provided by Yorkshire Ambulance Service (YAS) National Health Service (NHS) Trust.Participants12 653 adults who contacted EMS telephone triage services provided by YAS between 2 April 2020 and 29 June 2020 assessed by COVID-19 telephone triage pathways were included.OutcomeAccuracy of call handler decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from first contact with the telephone triage service.ResultsCallers contacting EMS dispatch services had an 11.1% (1405/12 653) risk of death or needing organ support. In total, 2000/12 653 (16%) of callers did not receive an emergency response and they had a 70/2000 (3.5%) risk of death or organ support. Ambulances were dispatched to 4230 callers (33.4%) who were not conveyed to hospital and did not deteriorate. Multivariable modelling found variables of older age (1 year increase, OR: 1.05, 95% CI: 1.04 to 1.05) and presence of pre-existing respiratory disease (OR: 1.35, 95% CI: 1.13 to 1.60) to be predictors of false positive triage.ConclusionTelephone triage can reduce ambulance responses but, with low specificity. A small but significant proportion of patients who do not receive an initial emergency response deteriorated. Research to improve accuracy of EMS telephone triage is needed and, due to limitations of routinely collected data, this is likely to require prospective data collection.

Saponin attenuates diesel exhaust particle (DEP)-induced MUC5AC expression and pro-inflammatory cytokine upregulation via TLR4/TRIF/NF-κB signaling pathway in airway epithelium and ovalbumin (OVA)-sensitized mice

BackgroundDiesel exhaust particle (DEP) is a harmful kind of particulate matter known to exacerbate pre-existing respiratory diseases. Although their adverse effects on airway pathologies have been widely studied, the mechanistic analysis of signaling pathways and potential targets in reducing DEP-induced mucin secretion and pro-inflammatory cytokine production remain elusive. We, for the first time, investigated the effects of Korean Red Ginseng (KRG) extracts on mucin overproduction and airway inflammation induced by DEP. MethodsThe effects of KRG and saponin on DEP-induced expression of MUC5AC and interleukin (IL)-6/8 were examined by real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) in human airway epithelial NCI–H292 cells. We conducted Western blotting analysis to analyze the associated signaling pathways. To evaluate the effects of saponin treatment on DEP-induced MUC5AC expression and inflammatory cell infiltrations in ovalbumin (OVA)-sensitized mice, immunohistochemical (IHC) staining and real-time PCR were implemented. ResultsThe KRG extracts markedly attenuated DEP-induced MUC5AC expression in vitro by inhibiting the TLR4/TRIF/NF-κB pathway. Furthermore, KRG and saponin inhibited DEP-induced pro-inflammatory cytokine IL-6/8 production. The in vivo study revealed that saponin blocked DEP-induced inflammation, mucin production and MUC5AC expression. ConclusionOur study revealed that KRG extracts have inhibitory effects on DEP-induced expression of MUC5AC and the production of pro-inflammatory cytokines. This finding provides novel insights into the mechanism by which saponin alleviates diesel-susceptible airway inflammation, elucidating its potential as a phytotherapeutic agent for inflammatory pathologies of airway.

This Month in Anesthesiology

This Month in Anesthesiology