Severity Of Respiratory Symptoms Research Articles

Bronchiolitis clinics and medical treatment.

Bronchiolitis is the most common acute lower respiratory tract infection in infants and the first cause of hospitalization in this age group. Despite it has been studied for over 70 years, its management remains controversial and nowadays the treatment is only supportive. Pediatricians should be well acquainted with the clinical course of the disease. In particular, they should know that the severity of respiratory symptoms peaks between days 3-7 of the disease and dehydration is a key sign to consider for the management. In this review, we will discuss the most controversial points in the management of bronchiolitis according to six evidence-based guidelines, six clinical practice guidelines and five consensus-based reviews.

Childhood respiratory allergies and symptoms in highly polluted area of Central Europe

ABSTRACTThe study investigated the associations between the prevalence of the childhood respiratory diseases and the long-term exposure to air pollution in the burdened area of Moravian–Silesian Region in the Czech Republic. The health data were collected during 2014 in 7,239 children 5, 9, 13 and 17 years of age. Exposure to PM10 and NO2 in the residence addresses was based on dispersion models and GIS based traffic-related indicators. PM10 levels were positively associated with both lifetime (OR 1.35; 95%CI 1.09–1.67) and current (OR 1.32; 95%CI 1.05–1.67) allergic rhinitis; current asthma was associated negatively. The associations between traffic indicator and respiratory health were not found. On the other hand, marked positive associations were found between the respiratory diseases and symptom severity structured into ordinal variables, and PM10 and NO2. Modelled long-term exposure to air pollution was associated with childhood allergic rhinitis and deterioration of the respiratory symptoms.

GENDER PECULIARITIES OF SMOKING STATUS, LEVEL OF THE NICOTINE DEPENDENCE, RESPIRATORY SYMPTOMS AND MOTIVATION TO TOBACCO CESSATION

Introduction. According to WHO data, COPD is the 4th cause of death in the world. The important problems of COPD are frequent exacerbations, comorbid conditions and late diagnosis. One of the most important factors in the formation of COPD is smoking. Recently, special attention is paid to the peculiarities of the course of COPD in women.The objective of this study was to reveal the peculiarities of smoking status in people of different sexes with different severity of respiratory symptoms in order to further creating the groups of patients on tobacco cessation.Material and methods. 108 smoking patients aged 20 to 60 years were examined in real outpatient practice. Besides the questionnaire, all examined underwent spirometry and CO determination (ppm) in exhaled air.Results. Analysis of the results of the study showed that women started smoking later than men. The number of day-today smoked cigarettes, the smoking index, and the degree of nicotine addiction in women were significantly less that was naturally accompanied by a significantly lower content of CO in the exhaled air. Broncho obstructive syndrome was found in 56% of men and 44% of women; the degree of nicotine addiction and respiratory symptoms were interrelated only in women (r=0.50, p<0.01). The period of withdrawal from tobacco smoking was significantly longer in women despite of the almost equal motivation to smoking cessation and the number of attempts of getting rid of tobacco addiction.Conclusions. Significant gender peculiarities of smoking status the degree of motivation to smoking cessation, their relationship with respiratory symptoms were revealed which requires the introduction of different approaches to the programs of healthy lifestyle in people of different sexes.

A trial of type 12 purinergic (P2Y12) receptor inhibition with prasugrel identifies a potentially distinct endotype of patients with aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) is characterized by asthma, recurrent nasal polyposis, and respiratory reactions on ingestion of COX-1 inhibitors. Increased numbers of platelet-leukocyte aggregates are present in the sinus tissue and blood of patients with AERD compared with that of aspirin-tolerant patients, and platelet activation can contribute to aspirin-induced reactions. We sought to determine whether treatment with prasugrel, which inhibits platelet activation by blocking the type 12 purinergic (P2Y12) receptor, would attenuate the severity of sinonasal and respiratory symptoms induced during aspirin challenge in patients with AERD. Forty patients with AERD completed a 10-week, double-blind, placebo-controlled crossover trial of prasugrel. All patients underwent oral aspirin challenges after 4weeks of prasugrel and after 4weeks of placebo. The primary outcome was a change in the provocative dose of aspirin that would elicit an increase in Total Nasal Symptom Score (TNSS) of 2 points. Changes in lung function, urinary eicosanoids, plasma tryptase, platelet-leukocyte aggregates, and platelet activation were also recorded. Prasugrel did not significantly change the mean increase in TNSS of 2 points (79±15 for patients receiving placebo and 139±32 for patients receiving prasugrel, P=.10), platelet-leukocyte aggregates, or increases in urinary leukotriene E4 and prostaglandin D2 metabolite levels during aspirin-induced reactions in the study population as a whole. Five subjects (responders) reacted to aspirin while receiving placebo but did not have any reaction to aspirin challenge after the prasugrel arm. In contrast to prasugrel nonresponders (35 subjects), the prasugrel responders had smaller reaction-induced increases in TNSS; did not have significant aspirin-induced increases in urinary leukotriene E4, prostaglandin D2 metabolite, or thromboxane B2 levels; and did not display increases in serum tryptase levels during aspirin reactions on the placebo arm, all of which were observed in the nonresponders. In the overall study population, prasugrel did not attenuate aspirin-induced symptoms, possibly because it failed to decrease the frequencies of platelet-adherent leukocytes or to diminish aspirin-induced mast cell activation. In a small subset of patients with AERD who had greater baseline platelet activation and milder upper respiratory symptoms during aspirin-induced reactions, P2Y12 receptor antagonism with prasugrel completely inhibited all aspirin-induced reactionsymptoms, suggesting a contribution from P2Y12 receptor signaling in this subset.

Application of probiotics for acute respiratory tract infections

We have reviewed the currently published results on a role of the gut microflora in a prevention of acute respiratory infections. The main biological properties of probiotic bacteria are presented in a context of their modulating activity on an inflammatory immune response. Available data on the reduction of a possible risk, duration, and severity of respiratory infection symptoms during a probiotic medication intake were analyzed. Potential antiviral probiotic mechanisms have been reviewed and discussed.

The Short-term Impact of Symptom-defined COPD Exacerbation Recovery on Health Status and Lung Function.

Background: This study examined the short-term effects of symptom-defined exacerbation recovery on health status and pulmonary function in moderate to severe chronic obstructive pulmonary disease (COPD) patients. Methods: Secondary analyses of pooled data from two 12-week Phase II international, randomized controlled trials using the EXAcerbations of Chronic Pulmonary Disease Tool (EXACT) to identify symptom-defined exacerbations were conducted. Recovery was categorized as recovered, unrecovered (persistent worsening), or censored. Multiple regression analyses were used to test the effect of recovery status on change in the St George's Respiratory Questionnaire (SGRQ) and forced expiratory volume in 1 second (FEV1) from baseline to Week 12. Evaluating Respiratory Symptom scale (E-RS) scores were used to evaluate change in stable-state respiratory symptoms from baseline to Week 12. Results: Of 1346 eligible patients, 414 (31%) experienced ≥1 symptom-defined exacerbation; 260 patients recovered from their events, 80 experienced an unrecovered event (persistent worsening), 74 patients had only censored events (excluded). Groups were similar at baseline, with the recovered group reporting significantly worse symptoms (p<0.01). Recovery group and baseline SGRQ were significant predictors of change in health status over 12 weeks (p=0.04; p<0.01); no effects were observed for lung function. Significant between-group differences in change in respiratory symptom severity from baseline to Week 12 were observed (p<0.01), with the persistent worsening group experiencing clinically meaningful deterioration in breathlessness and chest symptoms. Conclusions: Results suggest some patients have difficulty recovering from symptom-defined exacerbations, leading to a deterioration in health status, dyspnea, and chest symptoms without short-term effects on lung function. Further study of symptom-defined exacerbation recovery and health outcomes is warranted.

Intensified Training Period Increases Salivary IgA Responses But Does Not Affect the Severity of Upper Respiratory Tract Infection Symptoms in Prepuberal Rhythmic Gymnasts

This study examined the effect of a 4-week intensified training (IT) period, followed by a 2-week tapering period (TP), on salivary immunoglobulin A (SIgA), salivary cortisol, and the severity of upper respiratory tract infection symptoms in 23 rhythmic gymnasts [12.1 (2.6) y; 143.9 (13.7) cm; 37.2 (9.4) kg]. Saliva sampling was conducted at pre- and post-IT, and post-TP (analyzed using enzyme-linked immunosorbent assay). The Wisconsin Upper Respiratory Symptom Survey (WURSS-21) questionnaire was completed daily to analyze the severity of upper respiratory tract infection symptoms. The session rating of the perceived exertion was used to determine the internal training load and the acute:chronic workload ratio. A higher SIgA concentration [SIgAabs (μg/mL); F = 7.6; P = .001] for post-IT [234 (104)] versus pre-IT [173 (91)], and post-TP [182 (70)], and a higher SIgA secretion rate [SIgArate (μg/min); F = 3.4; P = .04] for post-IT [69 (28)] versus pre-IT [55 (27)], and post-TP [58 (22)] were observed. No significant change was observed for cortisol (F = 0.81; P = .45) or for the severity of upper respiratory tract infection symptoms (χ2 = 2.81; P = .24). Internal training load was higher during IT (vs TP; effect size = 2.37). The acute:chronic workload for the IT weeks varied from 1.2 (0.3) to 1.4 (0.3). These results suggest that a 4-week IT may temporarily augment the oral mucosal immunity, and an acute:chronic workload of 1.2-1.4 seems to be a safe approach to periodized training loads in youth rhythmic gymnasts.

Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection

Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics. Corticosteroids are increasingly used but without sufficient evidence. To assess the effects of oral corticosteroids for acute lower respiratory tract infection in adults without asthma. Multicenter, placebo-controlled, randomized trial (July 2013 to final follow-up October 2014) conducted in 54 family practices in England among 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment and with no history of chronic pulmonary disease or use of asthma medication in the past 5 years. Two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once daily for 5 days. The primary outcomes were duration of moderately bad or worse cough (0 to 28 days; minimal clinically important difference, 3.79 days) and mean severity of symptoms on days 2 to 4 (scored from 0 [not affected] to 6 [as bad as it could be]; minimal clinically important difference, 1.66 units). Secondary outcomes were duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and adverse events. Among 401 randomized patients, 2 withdrew immediately after randomization, and 1 duplicate patient was identified. Among the 398 patients with baseline data (mean age, 47 [SD, 16.0] years; 63% women; 17% smokers; 77% phlegm; 70% shortness of breath; 47% wheezing; 46% chest pain; 42% abnormal peak flow), 334 (84%) provided cough duration and 369 (93%) symptom severity data. Median cough duration was 5 days (interquartile range [IQR], 3-8 days) in the prednisolone group and 5 days (IQR, 3-10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P = .36 at an α = .05). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, -0.20; 95% CI, -0.40 to 0.00; P = .05 at an α = .001). No significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or nonserious adverse events. There were no serious adverse events. Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity. ISRCTN.com Identifier: ISRCTN57309858.

Public spirometry campaign in chronic obstructive pulmonary disease screening - hope or hype?

Underdiagnosis of COPD seems to be a relevant clinical and social problem. We hypothesized that active public spirometry campaign may help identify subjects with airflow limitation consistent with COPD. The aim of the study was (1) to evaluate the willingness of random smokers to undergo public spirometry, (2) to assess the ability to obtain an acceptable quality spirometry during a public campaign, and (3) to assess the relationships between the presence and severity of respiratory symptoms and readiness to undergo spirometry. Pedestrians aged > 40 years and a smoking history >10 pack-years were recruited by medical students to fill a questionnaire and perform spirometry. Those with obstructive or borderline ventilatory insuffciency were invited and encouraged to undergo stationary spirometry in a pulmonary outpatient department. Nine hundred and five subjects meeting the inclusion criteria were invited to the study. Only 178 subjects agreed to complete the questionnaire and undergo spirometry. Airway obstruction and borderline spirometry result (classified as possible airway obstruction) were found in 22 and 37 subjects, respectively. Of these, only 15 patients attended follow-up visit to verify public spirometry results. Extrapolation of the limited data showed the incidence of newly diagnosed airway obstruction as 10.7%. Public spirometry campaign does not seem to be an effective way of COPD screening. Smokers are reluctant to undergo complimentary spirometry even in the presence of pronounced respiratory symptoms. Our observations may be helpful in elaborating future screening programs for COPD.

Allergen Avoidance in Allergic Asthma.

Allergic asthma is the most frequent disease among the chronic respiratory disorders in pediatric age with an important social impact. In the last years, many efforts have been made to identify effective preventive approaches to get a better control of symptoms and to obtain the best future outcomes for the patients. In patients with allergic asthma triggered by the exposure to indoor allergens, the avoidance is the first intervention to prevent the appearance or the worsening of bronchial symptoms. This review article summarized the most recent evidence from literature about the efficacy of specific control interventions for the most important allergens. Even if a wide spectrum of interventions has been suggested and may help to reduce exposure to trigger allergy for sensitized patients suffering from respiratory allergy, evidence supporting the efficacy of these approaches is still weak and subject of controversy. However, the exposure control to specific airborne allergens is still widely recommended and may be effective as part of a holistic approach to reduce the severity of allergic respiratory symptoms in sensitized individuals.

Colds as predictors of the onset and severity of COPD exacerbations.

RationaleCommon colds are associated with acute respiratory symptom exacerbations in COPD patients.ObjectiveTo determine exacerbation risk and severity in COPD patients with/without coincident self-reported colds.MethodsGlobal initiative for chronic Obstructive Lung Disease stage I–IV COPD patients electronically transmitted respiratory symptom diaries to research staff daily between December 2006 and April 2009. Respiratory symptom worsening prompted contact by a study nurse and patient assessment to determine if a cold was present or an exacerbation underway. A composite daily symptom score was derived for each subject from diarized symptom data. The exacerbation/cold/virus relation was examined using a Poisson regression model, the relation of colds to respiratory symptom severity using generalized estimating equation models.ResultsDaily diary transmission compliance of >97% enabled detection of all possible exacerbations. Among 262 exacerbations meeting Anthonisen criteria, 218 (83%) had cold-like symptoms present at their inception, but respiratory viruses were detected in only 106 (40%). Within-subject exacerbation risk was 30 times (95% confidence interval [CI]: 20, 47; P<0.001) greater with colds present. Compared to cold- and virus-negative exacerbations (n=57), the mean increase in composite symptom score in those cold and virus positive (n=79) was 0.93 (95% CI: 0.61, 1.25; P<0.001), cold-positive and virus-negative exacerbations (n=100) 0.51 (95% CI: 0.21, 0.81; P<0.001), cold-negative and virus-positive exacerbations (n=26) 0.58 (95% CI: 0.23, 0.94; P<0.001).ConclusionThis study emphasizes the importance of colds in COPD exacerbation risk and severity, even in the absence of virus detection. COPD patients should act promptly when cold symptoms appear to facilitate early intervention for exacerbation prevention or management.

Rhinovirus-specific antibody responses in preschool children with acute wheeze reflect severity of respiratory symptoms.

Some children with rhinovirus (RV) infections wheeze, but it is unknown whether this is due to more virulent strains of virus or differences in host immune responses. The aim of this study was to investigate the RV species-specific antibody responses measured at a follow-up visit in preschool children in relation to reported time with respiratory symptoms and the presence of different RV species during an acute episode of wheeze. Nasopharyngeal swabs and blood samples were taken among 120 preschool children (<4 years of age) at an acute episode of wheeze and at a follow-up visit (median 11 weeks later). Nested PCR was used to detect different RV strains, and serum levels of IgG1 against purified recombinant VP1 proteins from representatives of the three RV species (RV-A, RV-B, and RV-C) were measured by ELISA. Rhinovirus was detected in 74% (n = 80/108) of the children at the acute visit, and RV-C was the most common subtype (n = 59/80, 74%). An increase in RV-specific IgG1 was seen in 61% (n = 73) of the children at follow-up, most frequently against RV-A (n = 61/73, 86%) irrespective of the RV strains detected by PCR. Increases in RV-specific IgG1 against RV-A or against RV-A and RV-C were significantly associated with more respiratory symptoms (p = 0.03, p = 0.007). Antibody response to recombinant RV VP1 proteins was associated with longer time with respiratory symptoms.

School attendance and daily respiratory symptoms in children: influence of moisture damage.

We investigated the effect of weekends and school holidays on the daily frequency and severity of respiratory and other symptoms among children attending schools with (index) or without (reference) moisture damage in Spain, the Netherlands, and Finland. Throughout 1year, parents of 419 children with a respiratory condition attending index (n=15) or reference (n=10) primary schools completed three symptom diaries. We assessed associations between lower respiratory tract, upper respiratory tract or allergy, and other symptom scores and school day, weekend, or summer holiday using mixed regression models stratified by country and moisture damage. We evaluated interactions between moisture damage and type of day. We combined country-specific estimates (incidence rate ratios [IRRs] and 95% confidence interval [CI]) in meta-analyses. Symptom scores were lower during weekends and holiday. Lower respiratory tract symptoms were statistically significantly less common during holiday with strongest effect in index schools (IRR=0.7; CI=0.6-0.8). Reporting of other symptoms was more reduced during holiday in index (IRR=0.6; CI=0.4-0.9) than in reference (IRR=0.95; CI=0.8-1.2) schools (interaction P<.01). In conclusion, symptoms were less frequent and/or severe during summer holiday and weekends. This pattern was stronger among children attending moisture-damaged schools, suggesting potential improvement in moisture damage-related symptoms during school breaks.

The effect of aclidinium bromide on daily respiratory symptoms of COPD, measured using the Evaluating Respiratory Symptoms in COPD (E-RS: COPD) diary: pooled analysis of two 6-month Phase III studies.

BackgroundReducing the severity of respiratory symptoms is a key goal in the treatment of chronic obstructive pulmonary disease (COPD). We evaluated the effect of aclidinium bromide 400 μg twice daily (BID) on respiratory symptoms, assessed using the Evaluating Respiratory Symptoms in COPD (E-RS™: COPD) scale (formerly EXACT-RS).MethodsData were pooled from the aclidinium 400 μg BID and placebo arms of two 24-week, double-blind, randomized Phase III studies evaluating aclidinium monotherapy (ATTAIN) or combination therapy (AUGMENT COPD I) in patients with moderate to severe airflow obstruction. Patients were stratified by Global initiative for chronic Obstructive Lung Disease (GOLD) Groups A–D. Change from baseline in E-RS scores, proportion of responders (patients achieving pre-defined improvements in E-RS scores), and net benefit (patients who improved minus patients who worsened) were analyzed.ResultsOf 1210 patients, 1167 had data available for GOLD classification. Mean (standard deviation) age was 63.2 (8.6) years, 60.7 % were male, and mean post-bronchodilator forced expiratory volume in 1 s was 54.4 % predicted. Compared with placebo, aclidinium 400 μg BID significantly improved RS-Total (2.38 units vs 0.79 units, p < 0.001) and domain scores (all p < 0.001) at Week 24, and doubled the likelihood of being an RS-Total score responder (p < 0.05), irrespective of GOLD group. The net benefit for RS-Total (Overall: 56.9 % vs 19.4 %; A + C: 65.7 % vs 6.3 %; B + D: 56.0 % vs 20.8 %, for aclidinium 400 μg BID and placebo respectively; all p < 0.05) and domain scores (all p < 0.05) was significantly greater with aclidinium compared with placebo, in both GOLD Groups A + C and B + D.ConclusionsAclidinium 400 μg BID significantly improved respiratory symptoms regardless of the patients’ level of symptoms at baseline. Net treatment benefit was similar in patients with low or high levels of symptoms.Trial registrationATTAIN (ClinicalTrials.gov identifier: NCT01001494) and AUGMENT COPD I (ClinicalTrials.gov identifier: NCT01437397).Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0372-1) contains supplementary material, which is available to authorized users.

Species-specific and individual differences in Nipah virus replication in porcine and human airway epithelial cells.

Highly pathogenic Nipah virus (NiV) causes symptomatic infections in pigs and humans. The severity of respiratory symptoms is much more pronounced in pigs than in humans, suggesting species-specific differences of NiV replication in porcine and human airways. Here, we present a comparative study on productive NiV replication in primary airway epithelial cell cultures of the two species. We reveal that NiV growth substantially differs in primary cells between pigs and humans, with a more rapid spread of infection in human airway epithelia. Increased replication, correlated with higher endogenous expression levels of the main NiV entry receptor ephrin-B2, not only significantly differed between airway cells of the two species but also varied between cells from different human donors. To our knowledge, our study provides the first experimental evidence of species-specific and individual differences in NiV receptor expression and replication kinetics in primary airway epithelial cells. It remains to be determined whether and how these differences contribute to the viral host range and pathogenicity.

Effects of Breastfeeding on Respiratory Symptoms in Infancy

To assess the impact of potential risk factors on the development of respiratory symptoms and their specific modification by breastfeeding in infants in the first year of life. We prospectively studied 436 healthy term infants from the Bern-Basel Infant Lung Development cohort. The breastfeeding status, and incidence and severity of respiratory symptoms (score) were assessed weekly by telephone interview during the first year of life. Risk factors (eg, pre- and postnatal smoking exposure, mode of delivery, gestational age, maternal atopy, and number of older siblings) were obtained using standardized questionnaires. Weekly measurements of particulate matter <10μg were provided by local monitoring stations. The associations were investigated using generalized additive mixed model with quasi Poisson distribution. Breastfeeding reduced the incidence and severity of the respiratory symptom score mainly in the first 27weeks of life (risk ratio 0.70; 95% CI 0.55-0.88). We found a protective effect of breastfeeding in girls but not in boys. During the first 27weeks of life, breastfeeding attenuated the effects of maternal smoking during pregnancy, gestational age, and cesarean delivery on respiratory symptoms. There was no evidence for an interaction between breastfeeding and maternal atopy, number of older siblings, child care attendance, or particulate matter <10μg. This study shows the risk-specific effect of breastfeeding on respiratory symptoms in early life using the comprehensive time-series approach.

Molecular epidemiology and evolutionary histories of human coronavirus OC43 and HKU1 among patients with upper respiratory tract infections in Kuala Lumpur, Malaysia.

BackgroundDespite the worldwide circulation of human coronavirus OC43 (HCoV-OC43) and HKU1 (HCoV-HKU1), data on their molecular epidemiology and evolutionary dynamics in the tropical Southeast Asia region is lacking.MethodsThe study aimed to investigate the genetic diversity, temporal distribution, population history and clinical symptoms of betacoronavirus infections in Kuala Lumpur, Malaysia between 2012 and 2013. A total of 2,060 adults presented with acute respiratory symptoms were screened for the presence of betacoronaviruses using multiplex PCR. The spike glycoprotein, nucleocapsid and 1a genes were sequenced for phylogenetic reconstruction and Bayesian coalescent inference.ResultsA total of 48/2060 (2.4 %) specimens were tested positive for HCoV-OC43 (1.3 %) and HCoV-HKU1 (1.1 %). Both HCoV-OC43 and HCoV-HKU1 were co-circulating throughout the year, with the lowest detection rates reported in the October-January period. Phylogenetic analysis of the spike gene showed that the majority of HCoV-OC43 isolates were grouped into two previously undefined genotypes, provisionally assigned as novel lineage 1 and novel lineage 2. Sign of natural recombination was observed in these potentially novel lineages. Location mapping showed that the novel lineage 1 is currently circulating in Malaysia, Thailand, Japan and China, while novel lineage 2 can be found in Malaysia and China. Molecular dating showed the origin of HCoV-OC43 around late 1950s, before it diverged into genotypes A (1960s), B (1990s), and other genotypes (2000s). Phylogenetic analysis revealed that 27.3 % of the HCoV-HKU1 strains belong to genotype A while 72.7 % belongs to genotype B. The tree root of HCoV-HKU1 was similar to that of HCoV-OC43, with the tMRCA of genotypes A and B estimated around the 1990s and 2000s, respectively. Correlation of HCoV-OC43 and HCoV-HKU1 with the severity of respiratory symptoms was not observed.ConclusionsThe present study reported the molecular complexity and evolutionary dynamics of human betacoronaviruses among adults with acute respiratory symptoms in a tropical country. Two novel HCoV-OC43 genetic lineages were identified, warranting further investigation on their genotypic and phenotypic characteristics.Electronic supplementary materialThe online version of this article (doi:10.1186/s12985-016-0488-4) contains supplementary material, which is available to authorized users.

Comorbidities associated with COPD in the Middle East and North Africa region: association with severity and exacerbations.

ObjectiveTo assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations.Materials and methodsThis was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life.ResultsA total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2%) than subjects without COPD (39.1%, P<0.0001), most frequently cardiovascular diseases. In subjects who screened positively for COPD, the presence of comorbidities was significantly (P=0.03) associated with a COPD Assessment Test score ≥10 and with antecedents of COPD exacerbations in the previous 6 months (P=0.03).ConclusionComorbidities are frequent in COPD and associated with more severe respiratory symptoms. This highlights the importance of identification and appropriate management of comorbidities in all subjects with a diagnosis of COPD.

Clinical significance of different virus load of human bocavirus in patients with lower respiratory tract infection.

To assess the impact of human bocavirus (HBoV) virus load on epidemiologic and clinical characteristics in children with lower respiratory tract infection (LRTI). Clinical records of a total of 654 patients with HBoV infection during January 2013 and December 2014 were retrospectively reviewed. Patients with high HBoV virus load infection had a similar age distribution with the total HBoV infection, which had a peak age group of 6–24 months. Patients with high virus load are significantly younger (P < 0.01) than those with low load. The patients who had wheeze and tachypnea/dyspnea at presentation were more strongly affiliated with the patients with high virus load (both P < 0.01). Co-infection was found significantly more frequently among patients with low virus load than those with high virus load (57.0% vs 38.9%; P < 0.01). High virus load was a significant predictor of severe LRTI (P < 0.05). HBoV infections are found in an important proportion of the hospitalized children with respiratory illnesses (8.85% in our series). A high HBoV virus load could be an etiologic agent for LRTI, which may lead to more severe lower respiratory tract symptom and severe disease.

Asthma is a risk factor for new onset chronic migraine: Results from the American migraine prevalence and prevention study.

To test the hypothesis that in persons with episodic migraine (EM), asthma is a risk factor for the onset of chronic migraine (CM). Migraine and asthma are comorbid chronic disorders with episodic attacks thought to involve inflammatory and neurological mechanisms. Herein, we assess the influence of asthma on the clinical course of EM. To be eligible for this observational cohort study, AMPP Study participants had to meet criteria for EM in 2008, complete the validated six-item asthma questionnaire from the European Community Respiratory Health Survey (ECRHS) in 2008, and provide follow-up data in 2009. Using the ECRHS, we defined asthma as a binary variable (present or absent) based on an empirical cut score and developed a Respiratory Symptom Severity Score (RSSS) based on the number of positive responses (no severity = 0 positive responses, low severity = 1-2 positive responses, moderate severity = 3-4 positive responses, high severity = 5-6 positive responses). Chronic migraine was the primary outcome measure and was defined as those with ≥15 headache days per month on the 2009 AMPP Study survey. We used logistic regression in separate models to assess the influence of asthma as a binary variable (Model 1) and RSSS score categories (Model 2 using no respiratory symptoms as the reference) on CM onset after adjusting for sociodemographic factors, headache day frequency, migraine preventive medication use, and medication overuse. The eligible sample for this study included 4446 individuals with EM in 2008 of whom 17% had asthma. This group had a mean age of 50.4 and was 80.8% female. In 2009, new onset CM developed in 2.9% (131/4446) of the 2008 EM cohort, including 5.4% (40/746) of the asthma subgroup and 2.5% (91/3700) of the non-asthma subgroup. In comparison to those without asthma, the adjusted odds for individuals with asthma and EM in 2008 to develop CM in 2009 were greater than two (adjusted odds ratio [aOR] 2.1; 95% CI: 1.4-3.1). Using the RSSS, the aOR for CM onset increased with the number of asthma symptoms, but only those in the high RSSS category showed a statistically significant increase in the odds of chronic migraine onset in comparison with the no RSSS reference group (aOR 3.3; 95% CI 1.7-6.2). Asthma is associated with an increased risk of new onset CM 1 year later among individuals with EM, with the highest risk being among those with the greatest number of respiratory symptoms. The exact mechanisms underlying this association are unknown, but could suggest mast cell degranulation, autonomic dysfunction, or shared genetic or environmental factors.