Respiratory Department Research Articles

A retrospective cohort study based on propensity score matching evaluated the effect of bronchoalveolar lavage on the clinical prognosis of children with macrolide drug-resistant Mycoplasma pneumoniae pneumonia

To evaluate the effect of bronchoalveolar lavage (BAL) on the clinical prognosis of children with macrolide drug-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in a retrospective cohort study based on propensity score matching (PSM).A retrospective cohort study based on propensity score matching retrospectively collected the clinical data of hospitalized patients diagnosed with mycoplasma macrolide drug-resistant pneumonia (MRMPP) in Respiratory Department of Hunan Children's Hospital from January 2020 to August 2023. According to whether bronchoalveolar lavage (BAL) was performed during hospitalization, the children were divided into BAL group and non-BAL group, and the baseline information of the two groups was matched by propensity scores, and the clinical prognosis was compared. A total of 302 children were screened, and 150 cases were successfully matched, including 59 cases in the BAL group and 91 cases in the non-BAL group. The results showed that the differences between the non-BAL group and the BAL group before PSM(P<0.05) were significantly different in age [(4.60±2.97)years vs (5.41±3.02) years, t=-2.273, P=0.024], shortness of breath (9.4% vs 22.5%, χ2=9.864, P=0.002), and radiographic manifestations [lung interstitial changes (29.8% vs 15.3%, χ2=8.009, P=0.005), lung consolidation (17.3% vs 55.9%, χ2=48.457, P<0.001), spotted flaky infiltrates (52.4% vs 27.9%, χ2=17.056, P<0.001)], bacterial infection (3.2% vs 9.2%, χ2=4.845, P=0.028), duration of azithromycin or doxycycline use [4(2, 5) days vs 5(3, 6) days, Z=-2.374, P=0.018], White Blood Cell Count at admission [7.94 (6.25, 10.34)×109/L vs 7.21 (5.65, 9.01)×109/L, Z=-2.445, P=0.014], D Dimer [0.58 (0.44, 0.83) μg/ml vs 0.80 (0.52, 1.12) μg/ml, Z=-3.154, P=0.002], but there was no significant difference between the two groups in the above indexes after PSM (P>0.05). The duration of hospitalization, cough relief, disappearance of rales and fever in the BAL group was shortened in the BAL group compared with that in the non-BAL group [5 (4, 7) days vs 7 (5, 8) days, Z=-2.373, P=0.018], and the difference was statistically significant (P<0.05). Linear regression analysis of PSM cohort study showed that BAL was negatively correlated with fever time (β=-4.369, 95%CI:-8.600--0.138, P<0.05). In conclusion, BAL can shorten the fever time of MRMPP, and early BAL in addition to conventional treatment has a positive effect on the prognosis of children.

Application of Case-based Learning in Respiratory Medicine Nursing Education

Objective: To explore the application effects of case-based learning in respiratory medicine nursing education. Methods: 60 nursing interns in the respiratory medicine department of our hospital from January 2023 to December 2023 were selected and randomly divided into a control group and an observation group, with 30 students in each group. The control group adopted traditional teaching methods, while the observation group adopted case-based learning based on traditional teaching methods. The differences in theoretical knowledge, operational skills, clinical thinking ability, and learning interest between the two groups were compared. Results: The scores of theoretical knowledge, operational skills, clinical thinking ability, and learning interest of the observation group were significantly higher than those of the control group, and the differences were statistically significant (P &lt; 0.05). The satisfaction score of the observation group was significantly higher than that of the control group, with a significant difference (P &lt; 0.05). Conclusion: Case-based learning can effectively improve the teaching effect of respiratory medicine nursing, cultivate students’ comprehensive abilities, and is worthy of promotion and application.

A Study on the Correlation Between Sarcopenia and Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a disease that affects the entire body. Sarcopenia, one of the adverse manifestations of the whole body, can lead to a variety of adverse outcomes. The worldwide studies have shown that sarcopenia was associated with COPD. This article aims to further enrich this research direction by focusing on the relationship between sarcopenia and COPD in Chinese inpatients. The subjects of this study were patients hospitalized in the Department of Respiratory and Critical Care Medicine of Rongchang People&amp;apos;s Hospital of Chongqing from July 2022 to May 2024. After bioelectrical impedance analysis (BIA), test of 6 m walking speed, and tests for upper grip strength were accomplished, the sarcopenia can be diagnosed. According to the presence of chronic airflow limitation, which assessed by post-bronchodilator spirometry, we diagnosed COPD. COPD and sarcopenia as two variables, simple correlation analysis was adopted for them. The subjects were classified into sarcopenia group and non-sarcopenia group. And then, the correlation between sarcopenia and COPD was assessed with binary logistic regression analysis. Finally we get the results. Spearman&amp;apos;s correlation coefficient for sarcopenia and COPD was 0.166 (p&amp;lt;0.05). While, COPD was not an independent risk factor to sarcopenia in the binary logistic regression analysis. Therefore, this study draws conclusions that COPD and sarcopenia is associated, but not linked independently.

Exploring the Role of Narrative Medicine in the Cultivation of Humanistic Spirit among Respiratory Medicine Interns

Objective: To explore the role of narrative medicine in cultivating the humanistic spirit of respiratory medicine interns. Methods: Thirty interns were selected, all of whom were received by the respiratory department of our hospital from September 2023 to June 2024 and underwent narrative medicine teaching. Scores on narrative medicine knowledge, empathy ability, humanistic care ability, and teaching recognition were compared before and after the internship. Results: Compared to before the internship, the interns’ scores on narrative medicine knowledge were significantly higher after the internship, as were their empathy and humanistic care scores (P &lt; 0.05). Among the 30 interns, 25 expressed interest in narrative medicine, and 29 were willing to continue with the narrative medicine teaching model. Conclusion: The application of narrative medicine in respiratory medicine internship teaching is highly effective. It cultivates the humanistic spirit of interns, improves their empathy and humanistic care abilities, and is worthy of wider implementation.

Respiratory syncytial virus (RSV) vaccine effectiveness against RSV-associated hospitalisations and emergency department encounters among adults aged 60 years and older in the USA, October, 2023, to March, 2024: a test-negative design analysis

Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years. We conducted a test-negative design analysis in an electronic health records-based network in eight states in the USA, including hospitalisations and emergency department encounters with respiratory syncytial virus-like illness among adults aged at least 60 years who underwent respiratory syncytial virus testing from Oct 1, 2023, to March 31, 2024. Respiratory syncytial virus vaccination status at the time of the encounter was derived from electronic health record documentation, state and city immunisation registries, and, for some sites, medical claims. Vaccine effectiveness was estimated by immunocompromise status, comparing the odds of vaccination among respiratory syncytial virus-positive case patients and respiratory syncytial virus-negative control patients, and adjusting for age, race and ethnicity, sex, calendar day, social vulnerability index, number of underlying non-respiratory medical conditions, presence of respiratory underlying medical conditions, and geographical region. Among 28 271 hospitalisations for respiratory syncytial virus-like illness among adults aged at least 60 years without immunocompromising conditions, vaccine effectiveness was 80% (95% CI 71-85) against respiratory syncytial virus-associated hospitalisations, and vaccine effectiveness was 81% (52-92) against respiratory syncytial virus-associated critical illness (ICU admission or death, or both). Among 8435 hospitalisations for respiratory syncytial virus-like illness among adults with immunocompromising conditions, vaccine effectiveness was 73% (48-85) against associated hospitalisation. Among 36 521 emergency department encounters for respiratory syncytial virus-like illness among adults aged at least 60 years without an immunocompromising condition, vaccine effectiveness was 77% (70-83) against respiratory syncytial virus-associated emergency department encounters. Vaccine effectiveness estimates were similar by age group and product type. Respiratory syncytial virus vaccination was effective in preventing respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years in the USA during the 2023-24 respiratory syncytial virus season, which was the first season after respiratory syncytial virus vaccine was approved. The Centers for Disease Control and Prevention.

The application effect of a pulmonary rehabilitation program based on empowerment theory for patients with COPD combined with heart failure.

Chronic obstructive pulmonary disease (COPD) and heart failure are often coexisting conditions that can severely impact patients' cardiopulmonary function and quality of life. Pulmonary rehabilitation programs, particularly those based on empowerment theory, may improve clinical outcomes by enhancing self-efficacy and promoting patient engagement. A total of 70 patients with COPD and heart failure admitted to our hospital's respiratory department from January 1, 2023, to April 31, 2024, were randomly assigned to either a control group (n = 35) or an observation group (n = 35). The control group received routine care, while the observation group underwent an empowerment-based pulmonary rehabilitation program in addition to routine care for 4 weeks. Lung function (forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation), arterial blood gas levels (partial pressure of carbon dioxide, partial pressure of oxygen, and arterial oxygen saturation), cardiac function (left ventricular ejection fraction and serum brain natriuretic peptide), cardiopulmonary function (heart rate, respiratory rate, and 6-minute walk test), self-efficacy, and rehabilitation compliance were measured before and after the intervention. There were no significant differences between the groups before the intervention (P > 0.05). After the intervention, the observation group exhibited significant improvements in lung function, arterial blood gas levels, cardiac and cardiopulmonary function, and self-efficacy scores compared with the control group (P < 0.05). Rehabilitation compliance was also significantly higher in the observation group (P < 0.05). An empowerment-based pulmonary rehabilitation program effectively improves rehabilitation compliance, lung and heart function, and self-efficacy in COPD patients with heart failure, suggesting it has strong potential for clinical application.

Prevalence of and factors associated with cognitive frailty in elderly patients with chronic obstructive pulmonary disease: A cross-sectional study.

The status of cognitive frailty in elderly patients with chronic obstructive pulmonary disease (COPD) and its influencing factors in China remains unclear. This study aimed to investigate the prevalence of and factors associated with cognitive frailty in elderly patients with COPD. This cross-sectional study enrolled elderly patients with stable COPD between May and November 2022 from the Respiratory Department of the First Affiliated Hospital of Zhengzhou University and the Fifth Affiliated Hospital of Zhengzhou University. Convenience sampling method was adopted. Frailty Phenotype scale, Montreal Cognitive Assessment scale, Geriatric Depression Scale, and Clinical Dementia Rating scale were used to assess the prevalence of cognitive frailty in elderly patients with COPD. Multivariable logistic regression analysis was used to explore the associated factors. A total of 406 valid questionnaires were collected, and 173 patients (35.6%) had cognitive frailty. Binary logistic regression analysis showed that sex (odds ratio [OR] = 0.009; 95%CI: 0.001-0.770; P = .038), depression (OR = 17.780; 95%CI: 1.092-289.478; P = .043), modified Medical Research Council grade 1-3 (OR = 28.394-4095.683; 95%CI: 1.086-4,592,652.211; P < .05), global initiative for chronic obstructive lung disease grade 2 and 3 (OR = 32.508-282.072; 95%CI: 1.101-12,516.874; P < .05), and frequencies of acute exacerbations of COPD and hospitalizations within 1 year of 2 times (OR = 21.907; 95%CI: 4.587-104.622; P < .001) were independently associated with cognitive frailty. The prevalence of cognitive frailty in elderly patients with stable COPD was high. Female, depression, modified Medical Research Council grade, global initiative for chronic obstructive lung disease grade, and frequencies of acute exacerbations of COPD and hospitalizations within 1 year might be the factors independently associated with cognitive frailty, educational level might be a protective associated factor for cognitive frailty.

Monitoring of adverse effects of antituberculosis drugs: case study of hepatic cytolysis and skin reactions

Introduction. Tuberculosis remains a major public health issue worldwide. Progress in treatment, particularly with the emergence of anti-tuberculosis drugs, has been significant. However, identifying the drugs responsible for adverse effects is crucial to establish a practical approach in clinical situations, including the assessment and monitoring of these effects. Methods. This case study describes the monitoring and management of adverse effects of anti-tuberculosis drugs in patients at the Tuberculosis and Respiratory Diseases Control Department (SCTMR) in Sidi Bel Abbes (Algeria). Results. The observed effects include nine cases of hepatic cytolysis and two cases of skin reactions. This work revealed a predominantly high intrinsic imputability of anti-tuberculosis drugs, with a rating of I3 (C2S2) for six cases and I5 (C2S3) for five cases. The therapeutic interventions implemented and their compliance with international recommendations are discussed. Discussion. SCTMR specialists generally follow international recommendations to manage adverse effects of antituberculosis drugs. However, the high imputability of anti-tuberculosis drugs indicates that they are strongly incriminated in the occurrence of these adverse effects. Conclusion. Adverse effects of anti-tuberculosis treatment are not rare, requiring rigorous clinical, biological and pharmacovigilance monitoring. These surveillances can reduce mortality and morbidity associated with tuberculosis treatment. A government commitment is essential to revitalize the national pharmacovigilance center and improve the detection of serious adverse effects.

Evaluation of Clinical Distribution and Antimicrobial Resistance of Klebsiella Pneumoniae

Purpose: This paper aims to analyze the clinical distribution and drug resistance changes of Klebsiella Pneumoniae (KPN) from 2017 to 2021 in the Beijing Hospital of Integrated Traditional Chinese and Western Medicine to provide a reference for the clinical rational use of antibiotics. Methods: We collected Klebsiella Pneumoniae isolated from various clinical specimens in 2017-2021, analyzed the isolation rate, specimen distribution, and department distribution characteristics during the five years, and statistically analyzed their drug sensitivity tests and multiple drug resistance. Zhuhai Deere DL-96 full-automatic microbial analyzer was used for bacterial identification and drug sensitivity tests. The drug sensitivity test was interpreted according to the standards recommended by the American Clinical and Laboratory Standards Institute (CLSI). Results: A total of 1057 strains of Klebsiella Pneumoniae were identified between 2017 and 2021, with proportions of 18.6%, 15.7%, 15.4%, 15.1%, and 15.0% in each respective year. Specimen distribution included sputum (66.0%), urine (17.9%), throat swab (9.4%), secretion (2.4%), pus (0.7%), venous blood (0.6%), vaginal swab (0.4%), and other sources (2.6%). Distribution by the department revealed specimens originating from the respiratory department (21.2%), cardiology department (17.8%), neurology department (13.4%), oncology department (13.0%), nephrology department (12.2%), acupuncture department (10.1%), and other departments (12.3%). In terms of drug susceptibility testing, Klebsiella Pneumoniae exhibited high resistance rates to ceftriaxone, cefotaxime, ceftazidime, and ampicillin/sulbactam, with rates of 50.8%, 46.8%, 46.3%, and 43.6% respectively. Conversely, resistance rates to minocycline, amikacin, imipenem, and meropenem were relatively low, at 8.6%, 16.5%, 8.5%, and 9.4% respectively. Resistance rates to cefepime/- sulbactam and piperacillin/tazobactam were 29.9% and 28.9%, respectively, while cephalosporin resistance rates ranged from 36.1% to 50.8%. Regarding multidrug resistance, the detection rates of ESBL-producing Klebsiella Pneumoniae were 8.2%, 10.9%, 4.5%, 10.6%, and 6.4% from 2017 to 2021, with an average detection rate of 7.9%. The detection rates of CR-Kp were 12.1%, 11.7%, 5.8%, 9.9%, and 8.9% respectively, averaging 9.6% over the five-year period. Conclusion: The sputum specimen of Klebsiella Pneumoniae exhibits the highest detection rate among specimen distributions, signifying its significance as a pathogenic bacterium in respiratory tract infections. Notably, the respiratory department demonstrates the highest detection rate, underscoring the necessity to enhance the monitoring and management of Klebsiella Pneumoniae infections in respiratory patients. Over the past five years, our hospital has observed a decreasing trend in the overall drug resistance rate of Klebsiella Pneumoniae to 17 antibiotics. While imipenem and meropenem exhibit minimal resistance rates, these carbapenem antibiotics serve as crucial agents for treating gram-negative bacilli, particularly in critically ill patients, and are thus not recommended as first-line choices for routine clinical use. Conversely, minocycline, amikacin, ceftazidime/ sulbactam, and piperacillin/tazobactam showcase relatively low resistance rates, enabling their empirical use based on clinical experience. Combination therapy with other antibiotics is advised for amikacin. Conclusion: Nevertheless, cephalosporins display a relatively high resistance rate, necessitating a reduction in their clinical utilization. Regarding multidrug resistance, the detection of ESBLs-producing Klebsiella Pneumoniae (KP) and Carbapenem-Resistant KP (CR-Kp) has exhibited a declining trend over the past three years. Despite this positive trend, the issue of multidrug resistance in Klebsiella Pneumoniae remains severe, with instances of complete drug resistance reported. Clinicians are urged to judiciously administer antibiotics guided by drug sensitivity test results and resistance rate variations, restrict the use of broad-spectrum antibiotics, and manage the emergence and spread of ESBLs-producing and CR-Kp bacteria.

Associations between wildfire smoke PM2.5 and respiratory emergency department (ED) visits in the Western United States, 2007 to 2018

Associations between wildfire smoke PM2.5 and respiratory emergency department (ED) visits in the Western United States, 2007 to 2018

Chronic Airway Obstruction in the Post-COVID-19 Era: Is There a Cause or Effect?

ABSTRACT Introduction: Chronic airway obstruction (CAO) is the terminology used to address chronic obstructive airway diseases, namely bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), bronchiectasis, and posttuberculosis (TB) COPD. We studied the profile of the CAO at the respiratory medicine department post the COVID-19 lockdown to understand any cause or effect of past COVID-19. Materials and Methods: This prospective observational study enrolled 164 cases of CAO. Clinical and radiological details of the two groups of CAO with and without a past history of COVID-19 were noted. Results: Of 164, 101 (61.59%) were men and 63 (38.41%) were women. Thirty-nine had a history of COVID-19. Of the 164 cases, 39 (23.7%) had BA, 51 (31.09%) had COPD, 61 (37.19%) had post-TB COPD, and 13 (7.92%) had bronchiectasis. In patients with a history of COVID-19, 9 (23.1%) had BA, 9 (23.1%) had COPD, 15 (38.5%) had post-TB COPD, and 6 (15.3%) had bronchiectasis. Eight had normal lung functions, 4 had mild obstructions, 75 had moderate obstruction, and 74 had severe obstructions. The clinical and spirometry differences in those with and without a history of COVID-19 were statistically insignificant. On high-resolution computed tomography thorax, 46 (28.1%) had emphysema, 16 (9.7%) had air trapping, 65 (39.7%) had fibrobronchiectasis, and 37 (22.5%) were normal. In patients with a history of COVID-19, 6 (15.3%) had emphysema, 2 (5.2%) had air trapping, 23 (58.9%) had fibrobronchiectasis, and 8 (20.5%) were normal. The difference in radiological findings was statistically significant and more in the group with a history of COVID-19 (P = 0.029). Conclusion: COVID-19 did not affect the distribution, clinical characteristics of CAO, however, impacted radiological findings significantly.

Clinical Profile and Treatment Outcome of H-mono/Polydrug-resistant Tuberculosis: A Single-center Retrospective Study

ABSTRACT Background: Isoniazid-monoresistant tuberculosis (Hr-TB) is the most prevalent drug-resistant TB. It often precedes multidrug-resistant TB (MDR-TB) and poses a major threat in the fight against TB control. The treatment outcome in Hr-TB and polydrug-resistant TB (PDR-TB) other than MDR still remains unclear. Aim: The aim of the study is to determine the clinical characteristics and treatment outcome in H-mono/PDR-TB under programmatic conditions. Materials and Methods: The study design was retrospective observational. It was conducted at the respiratory medicine department of a tertiary care institute in Mumbai. The medical records for bacteriologically confirmed TB patients diagnosed between July 2021 and December 2022 were reviewed. A total of 827 patients were enrolled and among them 46 patients with H-mono/PDR-TB were analyzed. The demographic data, clinical characteristics, and treatment outcomes were recorded. Results: Among 46 patients of isoniazid mono-resistant/PDR-TB analyzed from 827 bacteriologically confirmed TB, 24 were women with a mean age of 30.5 years. Twenty-five (54.34%) were resistant to isoniazid and the remaining 21 (45.66%) were PDR-TB. Primary Hr-TB was detected in 43 (93%) patients. The KatG mutation in 30 (65.2%) patients was the most common form of isoniazid (INH) mono resistance followed by inhA mutation 16 (34.8%). The fluoroquinolone (FQ)-based treatment regime as per national program guidelines had favorable outcomes in 42 (91.3%). However, unfavorable outcome with progression to MDR was observed in 3 (6.52%) and death in 1 (2.18%) patients. Conclusion: H-mono/PDR-TB is the most prevalent DRTB and most of them have primary resistance to isoniazid. Availability of first and SL LPA and limited DST with FQ-based regime under the national program has improved treatment outcomes in Hr-TB/PDR-TB.

Hepatotoxicity during anti tuberculosis chemotherapy

Introduction: Despite their efficacy in tuberculosis treatment, side-effects of anti-tuberculosis drugs can be serious or fatal. The aim of our study is to determine the prevalence of hepatic toxicities associated with anti-tuberculosis drugs, their evolutionary aspects, and their management. Patients and methods: A retrospective descriptive study including 82 patients having received antituberculosis treatment and who pre-sented a hepatic cytolysis, collected at the Tuberculosis and Respiratory Diseases Control Department of Batna- Algeria between 2016 -2023. The aim of our study is to determine the prevalence of hepatic toxicities of anti-tuberculosis drugs, their evolutionary aspects, as well as the modalities of their management. Results: 82 out of 119 (69.23%) patients who experienced other adverse events were recruited between 2016 and 2023, aged between 15 and 86 years, with an average age of 43 years and a female predominance of 63.41%. Cholestasis syndrome was noted in 21 patients and frank jaundice in 4. Cytolysis was discovered incidentally in 68% of patients; it was mild in 56 (68.29%), moderate in 16 (19.51%) and severe in 10 (12.19%). Transaminase disturbance appeared within 3 months in 76.82% of cases, whereas a delay of 30 days was noted for normalisation of the liver function test after cessation of anti-tuberculosis treatment in 62 (76%) patients. Definitive discontin-uation of isoniazid (INH) was adopted in 17 (20%) patients, while a reduction in the doses of rifampicin and isoniazid was decided in 65 (80%) patients. Conclusion: Drug-induced hepatitis is one of the major side-effects of anti-tuberculosis drugs and can be lethal, hence the need for rapid and appropriate management. Healthcare professionals need to be informed about the types of suspected adverse drug reactions, they should report in subjects at risk.

Influential factors of adherence to inhalation drug therapy in patients with stable chronic obstructive pulmonary disease.

This study aimed to investigate the influential factors of adherence to inhalation drug therapy (IDT) in patients with stable chronic obstructive pulmonary disease (COPD). A total of 243 patients with stable COPD who visited the chronic disease clinic of the respiratory department of our hospital between April 2022 and October 2022 were selected as participants using the convenience sampling method. Relevant information about all participants was collected by questionnaire for investigation, including basic information, clinical characteristics, inhaled drug names, situational awareness, dose and frequency. Univariate analysis revealed positive correlations between the following factors: (1) the total score of drug adherence and the total scores of the COPD knowledge questionnaire (COPD-Q), social support, subjective support, objective support and support utilisation, (2) the total score of dosage adherence and the total scores of COPD-Q, objective support and support utilisation and (3) the total score of technical standardisation and the total scores of social support, subjective support and objective support (p < 0.05). Multifactorial analysis showed that COPD health literacy, number of acute exacerbations in the past year and social support factors collectively accounted for 37.4% of the variable of patient adherence to IDT, as did COPD health literacy, modified Medical Research Council (mMRC) grading, duration of COPD, utilisation of support and marital status collectively account for 47.4% of the variable of patient dosage adherence. The goodness-of-fit of age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy to the patients' inhalation technical standardisation in the model was 47.4%. Dose adherence was predominantly influenced by COPD health literacy, mMRC grading, duration of COPD, utilisation of support and marital status. Inhalation technical standardisation was substantially limited by age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy.

PM2.5 and its components and respiratory disease healthcare encounters – Unanticipated increased exposure-response relationships in recent years after environmental policies

Prior studies reported excess rates (ERs) of cardiorespiratory events associated with short-term increases in PM2.5 concentrations, despite implementation of pollution-control policies. In 2017, Federal Tier 3 light-duty vehicle regulations began, and to-date there have been no assessments of population health effects of the policy. Using the NYS Statewide Planning and Research Cooperative System (SPARCS) database, we obtained hospitalizations and ED visits with a principal diagnosis of asthma or chronic obstructive pulmonary disease (COPD) for residents living within 15 miles of six urban PM2.5 monitoring sites in NYS (2014–2019). We used a time-stratified case-crossover design and conditional logistic regression (adjusting for ambient temperature, relative humidity, and weekday) to estimate associations between PM2.5, POC (primary organic carbon), SOC (secondary organic carbon), and rates of respiratory disease hospitalizations and emergency department (ED) visits from 2014 to 2019. We evaluated demographic disparities in these relative rates and compared changes in ERs before (2014–2016) and after Tier 3 implementation (2017–2019). Each interquartile range increase in PM2.5 was associated with increased ERs of asthma or COPD hospitalizations and ED visits in the previous 7 days (ERs ranged from 1.1%–3.1%). Interquartile range increases in POC were associated with increased rates of asthma ED visits (lag days 0–6: ER = 2.1%, 95% CI = 0.7%, 3.6%). Unexpectedly, the ERs of asthma admission and ED visits associated with PM2.5, POC, and SOC were higher during 2017–2019 (after Tier 3) than 2014–2016 (before Tier-3). Chronic obstructive pulmonary disease analyses showed similar patterns. Excess Rates were higher in children (<18 years; asthma) and seniors (≥65 years; COPD), and Black, Hispanic, and NYC residents. In summary, unanticipated increases in asthma and COPD ERs after Tier-3 implementation were observed, and demographic disparities in asthma/COPD and PM2.5, POC, and SOC associations were also observed. Future work should confirm findings and investigate triggering of respiratory events by source-specific PM.

A clinical study to monitor prescription patterns, clinical outcomes, and adverse drug reactions among patients of various interstitial lung diseases attending respiratory medicine outpatient department at tertiary care hospital in Northern India.

The aim of this study was to monitor prescription patterns, clinical outcomes, and adverse drug reactions (ADR) among patients of various interstitial lung diseases (ILDs). This prospective study was conducted in the Department of Pharmacology and Therapeutics in collaboration with the Department of Respiratory Medicine, King George's Medical University, Lucknow, for a period of 12 months (October 2020-September 2021). A total of 77 patients were enrolled after satisfying the inclusion and exclusion criteria. The prescriptions were collected, and necessary details were noted on the case report form. After completion of the study, the data were analyzed for prescription patterns, clinical outcomes, and quality of life with the help of a validated questionnaire-King's Brief ILD (KBILD) questionnaire. At the same time, ADRs, if any, were assessed using Hartwig's Severity Assessment Scale and Naranjo Causality Assessment Scale. The most common ILD was acute/chronic hypersensitivity pneumonitis (HP). Average number of drugs per encounter was 4.45. Crepitations were the most common clinical signs. Clubbing and rhonchi were reported maximum in idiopathic pulmonary fibrosis. It was found that psychological, breathlessness and activities, chest symptoms, and total KBILD reduced significantly after 3 months as compared to baseline with a statistically significant difference as P < 0.01. ADRs were found in 23.38% (18) of the subjects. Maximum ADR reported was gastritis (9.09%), followed by hepatitis (3.90%). The high proportion of patients clinically diagnosed with HP in our study highlights the importance of a detailed environmental exposure history in the diagnostic evaluation of patients with ILD to avoid inaccurate diagnoses. ADR-related hospital admissions are a significant problem in the health-care system.

The Experience of Social Alienation in Elderly Lung Cancer Patients: A Qualitative Study

PurposeThe aim of this study was to understand the experience of social alienation in elderly lung cancer patients, to explore its causes, and to propose targeted intervention strategies. MethodsFrom July to August 2023, 16 elderly lung cancer patients attending the respiratory department of a tertiary hospital in Changsha City, Hunan Province, were selected for semi-structured interviews using a purposive sampling method. The Colaizzi 7-step method was used to analyze the data. ResultsA total of four themes were distilled: the experience of social alienation in elderly lung cancer patients (pessimistic feelings, inferiority complex, and heavy psychological burden), subjective causes (disease-included shame, avoidant social behavior, and stigmatized labels), objective causes (isolated social states, and reduced amount of socialization), and rehabilitation support. ConclusionThe causes of social alienation in elderly lung cancer patients include multiple aspects of personal, family, and social support, and symptom management and psychological guidance should be strengthened for this population to construct a hospital–society–family triple-linkage care program to help patients recover.

CLINICAL PROFILE OF PATIENTS WITH HEMOPTYSIS AT A TERTIARY CARE CENTRE IN CENTRAL INDIA: A RETROSPECTIVE STUDY OF 47 CASES

Background: Hemoptysis, the expectoration of blood from the respiratory tract, is a symptom with a wide spectrum of underlying causes, ranging from benign to life-threatening conditions. Understanding the clinical characteristics of these patients is vital for prompt diagnosis and effective management, particularly in tertiary care centers where complex cases are prevalent. Objective: To analyze the clinical presentations, diagnostic findings, and outcomes of patients presenting with hemoptysis at a tertiary care center. Materials and Methods: This retrospective observational study was conducted from January 2022 to December 2023 in the respiratory medicine department of a tertiary care center. A total of 47 patients aged over 18 years with confirmed hemoptysis were included. Data were collected from medical records, covering demographic details, clinical presentation, laboratory and radiological findings, bronchoscopy results, treatment methods, and outcomes. Descriptive statistics were employed to summarize the data. Results: The study cohort consisted of 47 patients with a mean age of 52 ± 14 years 60% were male. Acute hemoptysis was observed in 64% of cases. Hemoptysis severity was categorized as mild in 43%, moderate in 32%, and massive in 25% of patients. Common associated symptoms included cough (85%), fever (60%), weight loss (32%), chest pain (26%), and dyspnea (53%). Smoking history was present in 60% of patients. The predominant underlying conditions were COPD (30%), bronchiectasis (21%), tuberculosis (15%), lung cancer (11%), cardiovascular diseases (11%), and other conditions (13%). Abnormalities were detected in 74% of chest X-rays and 89% of CT scans, which included findings such as consolidation, cavitation, masses, and bronchiectasis. Bronchoscopy was performed in 51% of patients, with a diagnostic yield of 64%, revealing endobronchial lesions, bleeding sites, and inflammation. Management and Outcomes: Medical management included antibiotics (43%), bronchodilators (32%), steroids (19%), antitubercular therapy (15%), and anticoagulant reversal (6%). Interventional procedures, such as bronchial artery embolization, were performed in 11% of patients, and surgical resection was referred for 4% of patients. Hemoptysis resolution was achieved in 81% of cases, with a recurrence rate of 11% and a mortality rate of 6%. Discussion: COPD and bronchiectasis were the leading causes of hemoptysis, highlighting the prevalence of chronic respiratory diseases in the studied population. The significant diagnostic yield of CT chest and bronchoscopy underscores their importance in evaluating hemoptysis. Effective medical management was achieved in most cases, while interventional procedures were critical for controlling massive hemoptysis. The study identifies challenges in managing massive and recurrent hemoptysis and suggests the need for standardized management protocols. Conclusion: Hemoptysis in a tertiary care setting is frequently associated with chronic respiratory diseases such as COPD and bronchiectasis. Comprehensive diagnostic approaches, particularly CT chest and bronchoscopy, are crucial for effective management. Early identification and treatment of the underlying causes are essential for improving patient outcomes. The findings underscore the need for developing clinical guidelines and conducting further research on innovative diagnostic and therapeutic strategies.

Challenges of Using Publicly-Available Hospital Data to Quantify Health Effects from Wildfire Plumes in the East San Francisco Bay Area Communities of California, USA

In the summer and fall of 2018 and 2020, major wildfires in Northern California (USA) impacted the San Francisco Bay Area. The remote 2018 and 2020 wildfires produced the highest PM2.5 concentrations experienced in the Tri-Valley of the East Bay Area during those two years. The Tri-Valley is composed of the San Ramon, Amador, and Livermore Valleys, surrounded by local terrain that creates a small airshed. In 1967, the California Air Resources Board created 15 Air Basins defined by regional geography, topographic and meteorological conditions. Airshed is sometimes synonymous with an urban-scale component of an Air Basin. We use airshed as a Tri-Valley component of the Bay Area Air Basin. This airshed spans across two counties (Contra Costa and Alameda) and encompasses four cities: San Ramon, Dublin, Pleasanton, and Livermore. PurpleAir (PA) sensors provided good geographic coverage of variation in PM2.5 in the Tri-Valley airshed. Several studies have established significant health effects from wildfire plumes by associating daily hospital visits with PM2.5 air quality data at local and regional scales. We hypothesize that during the wildfire smoke periods of 2018 and 2020 in the Tri-Valley area, there was an increase in hospitalizations and ED visits for respiratory (asthma and COPD-related) health effects, as compared to the same time periods during years with less fire activity. The primary goal of this study was to confirm health effects from wildfire plumes on a community scale using 5 years of publicly-available health data. However, with only monthly hospitalization data available, directly linking respiratory hospital and emergency department (ED) visits with PM2.5 concentrations was unsuccessful. Also, because COVID-19 masked all other causes of hospital visits in 2020, that year was ultimately eliminated from this study. However, visits during November 2018 being much higher than any other November in 2016, 2017, and 2019 implied a potential cause and effect. Daily hospitalization and air quality data are required to quantify any relationship by regression analysis. These findings help inform future studies on the health effects of air quality at community scales. KEYWORDS: PM2.5 Air Quality; Air Pollutant Exposure; Air Quality Monitoring; Wildfire Smoke; Respiratory Health; PurpleAir Sensors

Prospective profile of bacterial pathogens in hospitalized adult patients with community-acquired pneumonia: insights from multiplex real-time PCR and traditional culture techniques

Hospitalized community-acquired pneumonia (CAP) is mainly caused by bacteria and plays its role as primary bacteria alone or combined. The study aimed to determine the proportion of bacterial pathogens causing CAP in hospitalized adult patients and to examine the combination of these bacteria. This study was a cross-sectional descriptive design in prospect conducted on 341 adult patients with CAP hospitalized at the Respiratory Department of Nguyen Tri Phuong Hospital, Nhan Dan Gia Dinh Hospital, and University Medical Center from April 2021 to March 2023. Sputum samples were collected, assessed for reliability (according to the Barlett scale), and transported to Nam Khoa Company’s laboratory to perform traditional culture techniques and multiplex real-time PCR (MPL-rPCR). Male sex and age over 60 were 62.5% and 73.0%, respectively. Bacterial pathogens were detected by MPL-rPCR and traditional culture techniques at rates of 67.7% and 46.0%, respectively (p&lt;0.001). More than one strain of bacteria was commonly found in each sputum. Klebsiella pneumoniae was detected by multiplex real-time PCR and traditional culture techniques at a high rate (18.5% &amp; 13.5%), Acinetobacter baumannii (17.3% &amp; 12.9%), Streptococcus pneumoniae (16.4% &amp; 0.6%), H. influenzae (14.1% &amp; 0.6%) and P. aeruginosa (4.4% &amp; 3.8%). Atypical bacteria were only Mycoplasma, with 6.2%, and occurred as a combined bacteria. The rate of bacterial combination was 77.1%, and two or more combined bacteria was 58.4%. Bacterial pathogens are detected at 67.7% by MPL-rPCR and 46.0% by traditional culture techniques (p&lt;0.001). Bacterial pathogens are multiform and increase in Gram-negative bacilli.