Presence Of Respiratory Symptoms Research Articles

Stated Benefits from Urban Afforestation in an Arid City: A Contingent Valuation in Mexicali, Baja California, Mexico

The pervasiveness of particulate matter in arid cities has yet to be discussed and tackled. Given that urban trees have been documented to provide air-filtering and dry deposition services, this study documents the stated benefits from an urban afforestation scenario in Mexicali –an arid city located northwest Mexico at the US-Mexico border. Our double-bounded dichotomous contingent valuation protocol yields an estimated average annual willingness to pay (WTP) of USD 88 per household. Variations in the WTP are associated with perception of air quality and presence of respiratory symptoms in the respondent’s household. The smallest WTP (USD 75) is reported by respondents perceiving poor air quality in their neighborhood and with no household members affected by respiratory symptoms. In contrast, respondents perceiving good air quality and with at least one household member facing respiratory symptoms reported a WTP of USD 99. The average stated benefits represent around 0.8% of the annual household income.

How to reduce the antibacterial load in the treatment of acute tonsillitis and pharyngitis? Possible tactics and practical approaches

Acute tonsillopharyngitis is one of the most frequent reasons for visiting a doctor and prescribing inappropriate antibiotic therapy (ABT). There are several reasons for this - from the difficulties of etiological diagnosis and the development of relapses and possible severe complications to the personal attitude of doctors and patients to the choice of treatment. At the same time, the issue of antibiotic resistance and other aspects associated with the prescription of ABT is one of the most important problems of modern healthcare worldwide. The purpose of this review is to demonstrate the best practical approaches to the choice of treatment tactics for acute tonsillitis (AT) in the treatment of children and adults, with an emphasis on reducing the load of ABT. The review examines the indications and disadvantages of clinical and laboratory diagnosis of AT. There are no highly sensitive clinical and laboratory instruments that differentiate viral and bacterial AT. Exudativeis AT in children is not an underlying symptom of streptococcal etiology. Despite the limitations, the modified Centor/McIsaac score ≥3 (taking into account age and the presence of respiratory symptoms) should be used as an indication for ABT in conjunction with a rapid streptotest and subsequent bacteriological culture for S. pyogenes if the screening test is negative. Additional examinations (determination of leukocytosis, CRP and procalcitonin test) are not required for most patients. ABT should not be given to low-risk patients for the treatment and prevention of rheumatic fever and acute glomerulonephritis. Prevention of purulent complications (paratonsillitis and retropharyngeal abscess, acute otitis media, cervical lymphadenitis, mastoiditis, or acute sinusitis) is not a specific indication for ABT in AT and is not required in most patients. The strategy of «delayed antibiotic prescriptions» with monitoring the patient's condition for 2-3 days is appropriate and highly effective in doubtful cases. The drugs of choice for treatment of AT are amoxicillin and oral forms of I and II generation cephalosporins. Macrolides are not indicated as first-line treatment for AT. The course of ABT for streptococcal AT is 10 days, which reduces the risk of recurrent episode. Topical drugs can be the only means of etiopathogenetic treatment with viral AT, or additional for bacterial AT. Their use not only relieves sore throat, but also shortens the duration of the disease, and also improves the patients prognosis. Benzalkonium chloride + tyrothricin + benzocaine (Dorithyrcin) may be a rational drug of choice for topical therapy due to the available clinical evidence. There is a significant reserve for reducing the load of ABT during AT. Further clinical trials are needed to assess the efficacy of short courses of ABT in the treatment of AT in high-income countries and provide a basis for strong recommendations for topical drug use. This can reduce the frequency of ABT prescribing and increase the level of interaction between specialists and patients.

Foreign body removal using cryoprobe in a child

Foreign body (FB) inhalation is a frequently encountered event in children. The diagnosis is reached by the presence of a clinical history of aspiration and the presence of respiratory symptoms. Management involves confirmation by flexible bronchoscopy, which may be both diagnostic and therapeutic. However, in certain situations including those with large FB, FB embedded in granulation tissue, or FB with very smooth margins, rigid bronchoscopy may be a better substitute. An alternative to rigid bronchoscopy may be the use of cryoprobe. Herein, we describe a child with tracheobronchial FB causing hyperinflated right middle and lower lobes with mild atelectasis. The FB was successfully extracted using a cryoprobe, obviating the need for rigid bronchoscopy.

Prevalence of respiratory symptoms and lung function evaluation in local foundry workers in Kano State, Nigeria

IntroductionAluminium foundry for kitchen utensils production is a major employer in Kano State, Nigeria. We hypothesized that significant occupational hazard such as presence of respiratory symptoms and impairment in lung function might be prevalent among the workers. The study assessed respiratory symptoms and lung function in foundry workers.MethodsThe cross-sectional survey involved 83 male foundry workers and applied the convenience sampling method. Respiratory symptoms were evaluated with the American Thoracic Society (ATS-dLd-78) questionnaire. Lung function was assessed by using an MSo4 spirometer. The data obtained were summarized by descriptive statistics. Spearman rank order correlation and chi-square were determined between the variables of interest (<i>p</i> < 0.05).ResultsThe participants’ mean age was 24.8 ± 6.7 years, with 10–19 years of exposure in the majority (43; 51.8%). The prevalence of respiratory symptoms was as follows: phlegm: 69.9%, cough: 33.7%, chest pain: 27.7%, wheeze: 16.9%, haemoptysis: 4.8%. Lung function (FVC: 0.000; FEV1: 0.000) was significantly lower than normative. The association between occupational exposure duration and respiratory symptoms was significant for phlegm production (<i>p</i> = 0.008), wheeze (<i>p</i> = 0.008), and chest pain (<i>p</i> = 0.01). Lung function showed no significant association with exposure duration (<i>p</i> = 0.71 for FVC and <i>p</i> = 0.45 for FEV1). Weak negative relationship existed between respiratory symptoms and lung function; phlegm, chest pain, and haemoptysis presented a weak positive relationship.ConclusionsRespiratory symptoms and impaired lung function are common among foundry workers in Kano State. Exposure duration was a determinant of some respiratory symptoms.

Review on role of CD4 T-cells in patients with respiratory illness and human immunodeficiency virus infection

Human immunodeficiency virus (HIV) infection is now considered as a chronic disease in a population having a higher prevalence of several commodities. Infection with HIV has now emerged as the strongest risk factor for the development of active tuberculosis, asthma, chronic obstructive pulmonary disorder, and lung cancer. Several studies have investigated the presence of respiratory symptoms in the HIV-infected population. HIV infects CD4+ T-lymphocytes selectively and causes the destruction of CD4+ T-cells directly as well as indirectly, which leads to gradual loss of the CD4+ T-cell numbers in peripheral circulation. In immune response, CD4+ T-lymphocytes play a central regulatory role. The decrease in numbers of CD4+ T-cell can compromise the normal immune functions of the body. CD4+ T-cell numbers in circulation can provide important information about the immune competence of an individual since early detection and appropriate management of the disease is a priority, in order to improve patients' prognosis and to improve the quality of life.

Exposure to Indoor Endocrine-Disrupting Chemicals and Childhood Asthma and Obesity

To assess the association between the exposure of endocrine-disrupting chemicals (EDCs) and childhood asthma and obesity. Data regarding the extent to which adverse health effects arise from exposure to EDCs are limited, particularly in the pediatric population.The study included a cross-sectional study of 815 children from 20 primary schools and 71 classrooms in Porto, Portugal.A questionnaire that encompassed social, demographic, and behavioral characteristics; respiratory and/or allergic health; and current symptoms for the previous 3 months was provided to caregivers of participants. Anthropometry, clinical assessments, spirometry, fractional exhaled nitrogen oxide, and pupillometry were performed. Researchers in this study measured the concentrations of 15 EDCs in 71 classrooms throughout 1 week in the winter, when indoor volatile organic compound concentration is known to be higher. Major EDC patterns were identified by using principal component analysis based on the 15 individual compounds. The effect of EDCs on asthma, the presence of respiratory symptoms in the previous 6 months, obesity, and body composition of the children were measured by using generalized linear models and multinomial logistic regression models.In classrooms having more children with asthma and obesity, individual and combined EDC levels were found to be increased. Obesity was associated with higher levels of hexane, styrene, cyclohexanone, butylated hydroxytoluene, and 2-butoxyethoanol. Higher numbers of children with asthma were found in classrooms with higher levels of o-xylene, m/p-xylene, ethylbenzene, benzene, and 2-ethyl-1-hexano. Nasal obstruction was found to be significantly associated with toluene, o-xylene, m/p-xylene, and ethylbenzene. Parasympathetic dysautonomia was observed with exposure to individual or combined EDCs.The researchers in the study found that increased exposure to EDCs is associated with childhood asthma and obesity, even at low levels of EDC exposure. Of interest, parasympathetic dysautonomia was also observed, suggesting that EDCs increase parasympathetic activity, which may result in increased risk of asthma and obesity.Although many chemicals are known to interfere with the endocrine system, the data from this study add valuable information regarding the extent of their adverse effects on childhood asthma and obesity. This study adds important information to the body of literature regarding the effects of chemicals, not only on the respiratory health of children, but also on body weight. These findings can assist in formulating action plans to reduce EDC exposure and improve indoor air quality and, ultimately, improve children’s overall health.

Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children

BackgroundThe initial episode of angioedema in children can be potential life-threatening due to the lack of prompt identification and treatment. We aimed to analyze the factors predicting the severity and outcomes of the first attack of acute angioedema in children.MethodsThis was a retrospective study with 406 children (< 18 years) who presented in the emergency department (ED) with an initial episode of acute angioedema and who had subsequent follow-up visits in the out-patient department from January 2008 to December 2014. The severity of the acute angioedema was categorized as severe (requiring hospital admission), moderate (requiring a stay in the short-term pediatric observation unit [POU]), or mild (discharged directly from the ED). The associations among the disease severity, patient demographics and clinical presentation were analyzed.ResultIn total, 109 (26.8%) children had severe angioedema, and the majority of those children were male (65.1%). Most of the children were of preschool age (56.4%), and only 6.4% were adolescents. The co-occurrence of pyrexia or urticaria, etiologies of the angioedema related to medications or infections, the presence of respiratory symptoms, and a history of allergies (asthma, allergic rhinitis) were predictors of severe angioedema (all p < 0.05). Finally, the duration of angioedema was significantly shorter in children who had received short-term POU treatment (2.1 ± 1.1 days) than in those who discharged from ED directly (2.3 ± 1.4 days) and admitted to the hospital (3.5 ± 2.0 days) (p < 0.001).ConclusionThe co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema. More importantly, short-term POU observation and prompt treatment might be benefit for patients who did not require hospital admission.

1756. Role of Human bocavirus Respiratory Tract Infection in Hematopoietic Cell Transplant Recipients

BackgroundLimited data exist regarding the impact of human bocavirus (BoV) in hematopoietic cell transplant (HCT) recipients. We examined incidence and disease spectrum of BoV respiratory tract infection (RTI) in HCT recipients.MethodsIn a longitudinal surveillance study of viral RTIs among allogeneic HCT recipients, pre-HCT and weekly post-HCT nasal washes and symptom surveys were collected through day 100, then every 3 months, and whenever respiratory symptoms occurred through 1-year post-HCT. Samples were tested by multiplex semi-quantitative PCR for RSV, parainfluenza virus 1–4, influenza A/B, adenovirus, human metapneumovirus, rhinovirus, coronavirus, and BoV. Plasma samples from BoV+ subjects were analyzed by PCR. In addition, we conducted a retrospective review of HCT recipients with BoV detected in bronchoalveolar lavage or lung biopsy.ResultsAmong 469 patients in the prospective cohort, 21 distinct BoV RTIs (3 pre-HCT and 18 post-HCT) were observed by 1-year post-HCT in 19 patients (median 42 years old, range 0–67) without apparent seasonality. BoV was more frequently detected in the latter half of the first 100 days post-HCT (Figure 1). The frequencies of respiratory symptoms in patients with BoV detected did not appear to be higher than those without any virus detected, with the exception of watery eyes (P < 0.01) (Figure 2). Univariable models among patients with BoV RTI post-HCT showed higher peak viral load in nasal samples (P = 0.04) and presence of respiratory copathogens (P = 0.03) were associated with presence of respiratory symptoms; however, BoV detection in plasma was not (P = 0.8). Retrospective review identified 6 allogeneic HCT recipients (range 1–64 years old) with BoV detected in lower respiratory tract specimens [incidence rate of 0.4% (9/2,385) per sample tested]. Although all 6 cases presented with hypoxemia, 4 had significant respiratory copathogens or concomitant conditions that contributed to respiratory compromise. No death was attributed mainly to BoV lower RTI.ConclusionBoV is infrequently detected in respiratory tract in HCT recipients. Our studies did not demonstrate convincing evidence that BoV is a significant pathogen in either upper or lower respiratory tracts. Watery eyes were associated with BoV detection. Disclosures All authors: No reported disclosures.

The effect of industry-related air pollution on lung function and respiratory symptoms in school children

Heavy industry emits many potentially hazardous pollutants into the air which can affect health. However, the effects of air pollution from heavy industry on lung function and respiratory symptoms have been investigated scarcely. Our aim was to investigate the associations of long-term air pollution from heavy industry with lung function and respiratory symptoms in school children. A cross-sectional lung function study was conducted among school children (7–13 years) in the vicinity of an area with heavy industry. Lung function measurements were conducted during school hours. Parents of the children were asked to complete a questionnaire about the health of their children. A dispersion model was used to characterize the additional individual-level exposures to air pollutants from the industry in the area. Associations between PM2.5 and NOX exposure with lung function and presence of respiratory symptoms were investigated by linear and/or logistic regression analysis. Participation in the lung function measurements and questionnaires was 84% (665/787) and 77% (603/787), respectively. The range of the elevated PM2.5 and NOX five years average concentrations (2008–2012) due to heavy industry were 0.04–1.59 μg/m3 and 0.74–11.33 μg/m3 respectively. After adjustment for confounders higher exposure to PM2.5 and NOX (per interquartile range of 0.56 and 7.43 μg/m3 respectively) was associated with lower percent predicted peak expiratory flow (PEF) (B -2.80%, 95%CI -5.05% to − 0.55% and B -3.67%, 95%CI -6.93% to − 0.42% respectively). Higher exposure to NOX (per interquartile range of 7.43 μg/m3) was also associated with lower percent forced vital capacity (FVC) and percent predicted forced expiration volume in 1 s (FEV1) (B -2.30, 95% CI -4.55 to − 0.05 and B -2.73, 95%CI -5.21 to − 0.25 respectively). No significant associations were found between the additional exposure to PM2.5 or NOX and respiratory symptoms except for PM2.5 and dry cough (OR 1.40, 95%CI 1.00 to 1.94). Exposure to PM2.5 and NOX from industry was associated with decreased lung function. Exposure to PM2.5 was also associated with parents’ reports of dry cough among their children.

Lung evaluation in 10year survivors of pediatric allogeneic hematopoietic stem cell transplantation.

There is little data on the long-term respiratory development of children after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We describe the respiratory assessment 10years after allo-HSCT of 35 children transplanted between 2000 and 2004. During this period, 90 children were transplanted at our center. Twenty-five children died, thirty were lost to follow-up, and thirty-five came to have a pulmonary investigation. The thirty-five participants answered a questionnaire asking if they had pulmonary symptoms, and pulmonary function tests (PFTs) were performed. The median age of these children 10years after the transplant was 16years old. Just over a third of them had pulmonary symptoms. Among them, 5/13 (38%) had bronchiolitis obliterans syndrome (BOS). The majority of children (62.8%) did not have respiratory symptoms. PFTs were abnormal in one-third of asymptomatic children, revealing restrictive lung disease that was always mild to moderate (p = 0.02).Conclusion: In the long term, research at the time of the medical examination for the presence of chronic cough, shortness of breath on exertion, or wheezing helps to guide the clinician as to the need for further lung exploration. Similarly, informing patients and their families about these symptoms, which can be underestimated, should allow for more specific management.What is Known:• Pulmonary complications are a major cause of hematopoietic stem cell transplantation (HSCT) morbidity and mortality.• A long time after allogeneic HSCT, pulmonary function tests abnormalities may occur in children, but it is not always related to symptoms.What is New:• The occurrence of respiratory symptoms: cough, dyspnea on exertion, chronic bronchitis, and wheezing should be systematically investigated in the follow-up of allografted patients, even at a distance.• The presence of respiratory symptoms should lead to a respiratory functional investigation to detect the presence of an obstructive syndrome.

Acquisition of respiratory viruses and presence of respiratory symptoms in French pilgrims during the 2016 Hajj: A prospective cohort study.

BackgroundViral respiratory tract infections are frequent among Hajj pilgrims. However, it is still not known whether viruses are responsible for the symptoms observed in sick pilgrims or whether they only colonize sick and asymptomatic pilgrims.Patients and methodsA prospective cohort study was conducted among French Hajj pilgrims in 2016. Medical follow-up and systematic nasal swabbing were performed pre- and post-Hajj. Additional samples were obtained per-Hajj, at symptom onset in ill pilgrims. Viruses were identified using the BioFire FilmArray® Respiratory multiplex qualitative PCR panel.Results109 pilgrims were included. 83.5% presented respiratory symptoms during Hajj and 39.5% were still symptomatic on return. 5.5% of pre-Hajj, 95.2% of per-Hajj (at symptom onset) and 46.5% of post-Hajj samples tested positive (p < 0.0001). Acquisition rates of rhinovirus/enterovirus, coronavirus 229E and influenza A virus were respectively 38.6%, 19.8% and 2.0%. Although rhinovirus/enterovirus, coronavirus 229E and influenza A clearance were respectively 70.6%, 71.4% and 100% on return, overall virus carriage proportion on return was 75.0% in pilgrims with influenza-like illness and 44.0% in those who have never experienced this symptoms or resolved it (OR = 4.05, 95% CI [1.02–16.02]).ConclusionsViruses likely play some role in the pathogenesis of the respiratory tract infections at the Hajj. Point of care-rapid multiplex PCR assays are valuable diagnosis tools in this context when used at respiratory symptom onset or soon after.

Prevalence and factors associated with respiratory symptoms among civil construction workers: an occupational health surveillance proposal.

The civil construction industry is associated with the some of the highest morbidity and mortality rates in Brazil. Despite their epidemiological relevance, occupational health surveillance actions within the primary care setting still exhibit weaknesses. To analyze the prevalence of and factors associated with respiratory symptoms among civil construction workers in Cuiaba, Mato Grosso, Brazil. Cross-sectional analytic study conducted with 545 civil construction workers to analyze occupational health surveillance actions. Presence of respiratory symptoms was investigated by means of the British Medical Research Council questionnaire on respiratory symptoms. The Mantel-Haenszel χ 2 test was used for bivariate analysis and Poisson regression for multivariate analysis. The significance level was set to 5%. Most participants were young adults and almost half exhibited respiratory symptoms. The odds to develop cough were higher for the participants exposed to chemicals (PR=1.70; 95%CI 1.22-2.37). The odds to develop wheezing were higher for the participants who had not undergone pre-employment spirometry (PR=1.57; 95%CI 1.17-2.10). Biological monitoring of civil construction workers might be useful to improve occupational health surveillance actions within the primary care setting.

Spinal muscular atrophy with respiratory distress type 1: A multicenter retrospective study

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a rare autosomal recessive neuromuscular disorder characterized by progressive motor and respiratory decline during the first year of life. Early and late-onset cases have recently been reported, although not meeting the established diagnostic criteria, these cases have been genotyped. We thus conducted a national multicenter observational retrospective study to determine the prognosis of children with SMARD1 according to their phenotype. We recorded all known French pediatric cases with mutations identified on the immunoglobulin μ-binding protein 2 gene and the presence of respiratory symptoms. Thirty centers provided 22 observations. A diaphragmatic palsy was diagnosed 1.5 months (p = 0.02) after first respiratory symptoms, and hypotonia preceded areflexia by 4 months (p = 0.02). Early onset of symptoms leading to specialist consultation before the age of 3 months was associated with a significantly worse prognosis (p < 0.01). Among the 6 patients who were still alive, all were tracheostomized. Only one case survived beyond 2 years without artificial ventilation. The remaining patients died at a median age of 7 months. Our results may help pediatricians to provide medical information to parents and improve the decision-making process of setting up life support.

A scoring system to detect fixed airflow limitation in smokers from simple easy-to-use parameters

No validated screening method currently exists for Chronic Obstructive Pulmonary Disease (COPD) in smokers. Therefore, we constructed a predictive model with simple parameters that can be applied for COPD screening to detect fixed airflow limitation. This observational cross-sectional study included a random sample of 222 smokers with no previous diagnosis of COPD undertaken in a Spanish region in 2014–2016. The main variable was fixed airflow limitation by spirometry. The secondary variables (COPD factors) were: age, gender, smoking (pack-years and Fagerström test), body mass index, educational level, respiratory symptoms and exacerbations. A points system was developed to predict fixed airflow limitation based on secondary variables. The model was validated internally through bootstrapping, determining discrimination and calibration. The system was then integrated into a mobile application for Android. Fifty-seven patients (25.7%) presented fixed airflow limitation. The points system included as predictors: age, pack-years, Fagerström test and presence of respiratory symptoms. Internal validation of the system was very satisfactory, both in discrimination and calibration. In conclusion, a points system has been constructed to predict fixed airflow limitation in smokers with no previous COPD. This system can be integrated as a screening tool, though it should be externally validated in other geographical regions.

Nasal mucosa and blood cell transcriptome profiles do not reflect respiratory symptoms associated with moisture damage.

Upper and lower respiratory symptoms and asthma are adverse health effects associated with moisture-damaged buildings. Quantitative measures to detect adverse health effects related to exposure to dampness and mold are needed. Here, we investigate differences in gene expression between occupants of moisture-damaged and reference buildings. Moisture-damaged (N=11) and control (N=5) buildings were evaluated for dampness and mold by trained inspectors. The transcriptomics cohort consisted of nasal brushings and peripheral blood mononuclear cells (PBMCs) from 86 teachers, with/without self-perceived respiratory symptoms. Subject categories comprised reference (R) and damaged (D) buildings with (S) or without (NS) symptoms, that is, R-S, R-NS, DS, and D-NS. Component analyses and k-means clustering of transcriptome profiles did not distinguish building status (R/D) or presence of respiratory symptoms (S/NS). Only one nasal mucosa gene (YBX3P1) exhibited a significant change in expression between D-S and D-NS. Nine other nasal mucosa genes were differentially expressed between R-S and D-S teachers. No differentially expressed genes were identified in PBMCs. We conclude that the observed mRNA differences provide very weak biological evidence for adverse health effects associated with subject occupancy of the specified moisture-damaged buildings. This emphasizes the need to evaluate all potential factors (including those not related to toxicity) influencing perceived/self-reported ill health in moisture-damaged buildings.

Factors associated with recovery delay in a sample of patients diagnosed by MERS-CoV rRT-PCR: A Saudi Arabian multicenter retrospective study.

BackgroundResearch evidence exists that poor prognosis is common in Middle East respiratory syndrome coronavirus (MERS‐CoV) patients.ObjectivesThis study estimates recovery delay intervals and identifies associated factors in a sample of Saudi Arabian patients admitted for suspected MERS‐CoV and diagnosed by rRT‐PCR assay.MethodsA multicenter retrospective study was conducted on 829 patients admitted between September 2012 and June 2016 and diagnosed by rRT‐PCR procedures to have MERS‐CoV and non‐MERS‐CoV infection in which 396 achieved recovery. Detailed medical charts were reviewed for each patient who achieved recovery. Time intervals in days were calculated from presentation to the initial rRT‐PCR diagnosis (diagnosis delay) and from the initial rRT‐PCR diagnosis to recovery (recovery delay).ResultsThe median recovery delay in our sample was 5 days. According to the multivariate negative binomial model, elderly (age ≥ 65), MERS‐CoV infection, ICU admission, and abnormal radiology findings were associated with longer recovery delay (adjusted relative risk (aRR): 1.741, 2.138, 2.048, and 1.473, respectively). Camel contact and the presence of respiratory symptoms at presentation were associated with a shorter recovery delay (expedited recovery) (aRR: 0.267 and 0.537, respectively). Diagnosis delay is a positive predictor for recovery delay (r = .421; P = .001).ConclusionsThe study evidence supports that longer recovery delay was seen in patients of older age, MERS‐CoV infection, ICU admission, and abnormal radiology findings. Shorter recovery delay was found in patients who had camel contact and respiratory symptoms at presentation. These findings may help us understand clinical decision making on directing hospital resources toward prompt screening, monitoring, and implementing clinical recovery and treatment strategies.

The effect of industry-related air pollution on lung function and respiratory symptoms in school children

BackgroundHeavy industry emits many potentially hazardous pollutants into the air which can affect health. However, the effects of air pollution from heavy industry on lung function and respiratory symptoms have been investigated scarcely. Our aim was to investigate the associations of long-term air pollution from heavy industry with lung function and respiratory symptoms in school children.MethodsA cross-sectional lung function study was conducted among school children (7–13 years) in the vicinity of an area with heavy industry. Lung function measurements were conducted during school hours. Parents of the children were asked to complete a questionnaire about the health of their children. A dispersion model was used to characterize the additional individual-level exposures to air pollutants from the industry in the area. Associations between PM2.5 and NOX exposure with lung function and presence of respiratory symptoms were investigated by linear and/or logistic regression analysis.ResultsParticipation in the lung function measurements and questionnaires was 84% (665/787) and 77% (603/787), respectively. The range of the elevated PM2.5 and NOX five years average concentrations (2008–2012) due to heavy industry were 0.04–1.59 μg/m3 and 0.74–11.33 μg/m3 respectively. After adjustment for confounders higher exposure to PM2.5 and NOX (per interquartile range of 0.56 and 7.43 μg/m3 respectively) was associated with lower percent predicted peak expiratory flow (PEF) (B -2.80%, 95%CI -5.05% to − 0.55% and B -3.67%, 95%CI -6.93% to − 0.42% respectively). Higher exposure to NOX (per interquartile range of 7.43 μg/m3) was also associated with lower percent forced vital capacity (FVC) and percent predicted forced expiration volume in 1 s (FEV1) (B -2.30, 95% CI -4.55 to − 0.05 and B -2.73, 95%CI -5.21 to − 0.25 respectively). No significant associations were found between the additional exposure to PM2.5 or NOX and respiratory symptoms except for PM2.5 and dry cough (OR 1.40, 95%CI 1.00 to 1.94).ConclusionExposure to PM2.5 and NOX from industry was associated with decreased lung function. Exposure to PM2.5 was also associated with parents’ reports of dry cough among their children.

Rethinking Chronic Obstructive Pulmonary Disease. Chronic Pulmonary Insufficiency and Combined Cardiopulmonary Insufficiency.

Almost 70 years ago, Drs. Baldwin, Cournand, and Richards defined chronic pulmonary insufficiency by the presence of respiratory symptoms, radiologic evidence of pulmonary emphysema on chest radiography, and physiologic gas trapping. A decade later, airflow obstruction on spirometry was added to the definition and insufficiency became a disease. Contemporary studies are reviving the diagnostic approach described by these early luminaries, with researchers finding that symptomatic smokers with preserved spirometry have increased exacerbations and that smokers and non-smokers with normal spirometry but emphysema on chest computed tomography have increased mortality. Hence, the Baldwin-Cournand-Richards concept of disease defined by respiratory symptoms, radiologic findings, and physiology-regardless of spirometric criteria-is being rediscovered. Baldwin, Cournand, and Richards also stated that "functionally, it is obvious that the pulmonary and circulatory apparatus are one unit," and they defined combined cardiopulmonary insufficiency as chronic pulmonary insufficiency with (left or right) cardiac and pulmonary artery enlargement. They appreciated the complexity of these interactions, which include the potential role of gas trapping in heart failure with reduced ejection fraction; the impact of emphysema on blood flow in heart failure with preserved ejection fraction; multiple contributions to cor pulmonale with increased pulmonary artery pressure; and cor pulmonale parvus in emphysema; all of which may be amenable to specific therapeutic interventions. Given the complexity of heart-lung interactions originally identified by Baldwin, Cournand, and Richards and the potentially large therapeutic opportunities, large-scale studies are still warranted to find specific therapies for subphenotypes of combined cardiopulmonary insufficiency.

Prevalence and Predictors of Asthma in the Megacity of Pakistan: Findings from the Adult Asthma Study-Karachi

Background/Aim: Scarce data is available regarding burden of asthma from spirometry-based epidemiological surveys, especially from low and middle income countries. This study was conducted to determine the prevalence and predictors of asthma among adults in Karachi, Pakistan. Methods: A multi-stage, community based cross-sectional survey was conducted from May 2014-August 2015 comprising of 1630 adults (≥ 18 years) from 75 randomly selected (out of 9400) clusters in Karachi. From each cluster, 25 households were randomly selected and all eligible participants were recruited. Data were collected through questionnaire-based interviews in Urdu, consisting of respiratory health related questions (American Thoracic Society (ATS) questionnaire), socio-demographic characteristics and risk factors for asthma. Pre and post-bronchodilator spirometry was performed according to the ATS criteria. The prevalence of asthma was calculated considering presence of respiratory symptoms with reversibility on spirometry (≥ 12% increase, post-bronchodilator) and/or history of physician-diagnosed asthma. Results: The overall prevalence of asthma was 6.6% (n=61; 95% CI: 5.0-8.1) among 930 participants with acceptable spirometry data. Asthma was less likely among the younger age group (AOR: 0.2, 95% CI: 0.1-0.6) and those having birds and animals at home (AOR: 0.5, 95% CI: 0.2-0.9). Asthma was more likely to occur among participants with history of allergies (AOR: 2.8, 95% CI: 1.6-4.9) and those exposed to passive smoking at home (AOR: 1.9, 95% CI: 1.1-3.4). Conclusions: This is the first robust epidemiological assessment regarding actual burden of asthma among adults in Pakistan, reporting a high burden in the country.

Cryptococcosis and cryptococcal meningitis: New predictors and clinical outcomes at a United States academic medical centre.

As the diagnosis of cryptococcosis is challenging in low-prevalence settings, uncovering predictive factors can improve early diagnosis and timely treatment. The aim of the study was to relate clinical outcomes to predictive variables for the presence of cryptococcosis. A retrospective case-control study matched by collection date, age and gender at a 1:2 ratio (55 cases and 112 controls) was performed in case patients diagnosed with Cryptococcus infection at the University of Colorado Hospital between 2000 and 2017 (n=167). A bivariate and a forward, stepwise multivariable logistic regression model were performed to identify predictors of cryptococcosis infection. In an adjusted multivariable model, cryptococcal infection was significantly associated with the presence of respiratory symptoms, hyponatremia, lung disease or corticosteroids. Additionally, cryptococcal meningitis was associated with headaches, corticosteroids or increased CSF protein. Conversely, a reduced risk of cryptococcosis was associated with hypertension or peripheral monocytosis. Cryptococcal meningitis leads to subsequent hearing impairment (16% vs 4% (control), P=.013), muscle weakness (40% vs 20%, P=.021), cognitive deficits (33% vs 6%, P=.0001) or any adverse outcome (84% vs 29%, P=.0001). We uncovered novel clinical predictors for the presence of cryptococcal infection or cryptococcal meningitis. This study in patients at a low-prevalence US medical centre underscores the importance of early diagnosis in this population.