Respiratory Symptoms In Patients Research Articles

Treatment Recommendation for Dyspnea in Patients with Advanced Disease: Revised Clinical Guidelines from the Japanese Society for Palliative Medicine.

Dyspnea is one of the most common and distressing symptoms in patients with cancer and noncancer advanced diseases. The Japanese Society for Palliative Medicine revised previous guidelines for the management of respiratory symptoms in patients with cancer and newly developed clinical guidelines for managing dyspnea in patients with advanced disease, based on the result of systematic reviews for each clinical question and consensus among experts. We describe the recommendations of the guidelines as well as provide insights into the reasoning behind the recommendations and their development process. There has been a paucity of evidence regarding the interventions for dyspnea in patients with advanced disease. Thus, more clinical research that includes not only randomized controlled trials but also real-world observational studies is warranted.

A Novel Common Canister Protocol for Albuterol Sulfate Metered Dose Inhalers: Conservation Strategy and Clinical Outcomes Amid COVID-19 Pandemic

The COVID-19 pandemic led to unprecedented shortages of albuterol sulfate metered dose inhalers (MDIs) utilized in the supportive management of respiratory symptoms in patients with SARS-CoV-2 infections. The risk of generating infective aerosols in nebulized treatments increased the demand for metered dose delivery, leading to a worldwide shortage of albuterol sulfate MDIs. Previous common canister protocols involve the recycling and cleaning of canisters for multiple patient use, however have not undergone quality control studies on viral cross-contamination. Torrance Memorial Medical Center utilized an off-label method of common canister administration through spacer devices, forgoing the need for sterilization while conserving albuterol sulfate during a public health emergency. A retrospective review of this emergency department protocol was conducted on 329 patients receiving this novel albuterol sulfate common canister method over a 10-month period between 3/23/2020 to 1/23/2021. Results showed 265 patients (80.5%) had improved aeration determined by breath sounds evaluation by the respiratory therapist and patient interview. Purchasing records reviewed since 3/1/2020 show purchases were sufficient to sustain albuterol sulfate MDI supply so that no treatments were delayed omitted during the 10-month evaluation period. This novel approach to common canister delivery offers a promising measure to conserve a vital inhaled medication during a public health emergency and could serve as a basis for future development of conservation and quality control studies.

Symptom burden and its associations with clinical characteristics in patients with COPD: a clustering approach.

Symptom burden in patients with COPD is often under-recognised. In this cross-sectional analysis, we aimed to study the severity of a variety of (non-)respiratory symptoms in patients with and without COPD and to explore the associations between clusters based on symptom severity and other clinical characteristics. Characteristics were assessed in 538 patients with COPD from primary, secondary and tertiary care and 116 non-COPD participants. The severity of 20 symptoms was measured using a visual analogue scale (VAS), ranging from 0 mm (no symptom) to 100 mm (maximum severity). K-means cluster analysis was applied to symptom severity in the patient sample only. People with COPD were comparable with non-COPD participants in terms of gender (58% versus 55% male, p=0.132) and age (64±9 years versus 63±6 years, p=0.552) and had a reduced forced expiratory volume in 1 s (57±23% predicted versus 111±17% predicted, p<0.001). The COPD group had higher VAS scores for most symptoms (p<0.05). The most severe symptoms in patients with COPD were dyspnoea, fatigue and muscle weakness while non-COPD participants mainly experienced insomnia and micturition. Three clusters were identified in the patient sample. Health status and care dependency differed between all clusters, while functional mobility, exacerbation history and lung function differed between cluster 1 and the other two clusters (p<0.05). People with COPD report a high burden of respiratory as well as non-respiratory symptoms. Cluster analysis demonstrated a co-occurrence of different levels of symptom severity, highlighting the heterogeneity of symptoms experience. Identifying clusters of patients with shared symptom experiences will help us to understand the impact of the disease and define integrated, multidimensional treatment strategies.

Effectiveness of Immunotherapy in Non-Small Cell Lung Cancer Patients with a Diagnosis of COPD: Is This a Hidden Prognosticator for Survival and a Risk Factor for Immune-Related Adverse Events?

The interplay between the immune system and chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) is complex and multifaceted. In COPD, chronic inflammation and oxidative stress can lead to immune dysfunction that can exacerbate lung damage, further worsening the respiratory symptoms. In NSCLC, immune cells can recognise and attack the cancer cells, which, however, can evade or suppress the immune response by various mechanisms, such as expressing immune checkpoint proteins or secreting immunosuppressive cytokines, thus creating an immunosuppressive tumour microenvironment that promotes cancer progression and metastasis. The interaction between COPD and NSCLC further complicates the immune response. In patients with both diseases, COPD can impair the immune response against cancer cells by reducing or suppressing the activity of immune cells, or altering their cytokine profile. Moreover, anti-cancer treatments can also affect the immune system and worsen COPD symptoms by causing lung inflammation and fibrosis. Immunotherapy itself can also cause immune-related adverse events that could worsen the respiratory symptoms in patients with COPD-compromised lungs. In the present review, we tried to understand the interplay between the two pathologies and how the efficacy of immunotherapy in NSCLC patients with COPD is affected in these patients.

12-month risk factor evaluation for persistent pulmonary symptoms in long COVID-19 patients

BackgroundKnowledge of the sequelae of new coronavirus disease 2019 (COVID-19) is still limited owing to the relative recent onset of the disease. However, the study of other different types of coronavirus infections prior to COVID-19 infection reports that the patients may experience persistent symptoms following the infection.The aim of this studyAssessment and follow-up of persistent respiratory symptoms in patients recovered from acute COVID-19 infection.MethodsIn this prospective cohort study, COVID-19 patients diagnosed at Beni-Suef University hospital and followed up prospectively at 3, 6, and 12 months after discontinuation of quarantine. Patients were interviewed for persistent respiratory symptoms then underwent assessment by physical examination and routine labs.ResultsSeventy-one patients were evaluated and participated in this study. The mean age of the patients was 47 years and 46 (64%) of them were females. After 3 months, 77.5% of the patients had persistent dyspnea, 57.7% persistent fatigue, 15.5% persistent cough, and 8.5% persistent chest pain. At the 6th month, dyspnea and fatigue persisted in 33.8% and 22.5% of cases respectively while at the 12th month dyspnea persisted in 22.5% of cases. Old age, smoking, diabetes mellitus, severity of the disease, and hypoxemia on admission were associated factors with persistent symptoms.ConclusionOur result added to the growing evidence that there are pulmonary sequelae in COVID-19 survivors, which may become a significant chronic global pulmonary health problem.

The role of exercise therapy in reducing respiratory symptoms in patients with COVID-19: a systematic review

Background/Aims Respiratory-related complaints such as dyspnoea, shortness of breath and inability to perform their activities of daily living have been reported by people who have contracted COVID-19. Physiotherapy can play a vital role in management of these symptoms. The aim of this review study was to systematically evaluate the role of exercise therapy in reducing respiratory symptoms in patients with COVID-19. Methods A search of PubMed, Cochrane, ScienceDirect, Web of Science, Scopus, and ProQuest databases was conducted from December 2019 to November 2022. Studies were included if: the study design was a randomised controlled trial or quasi-experimental; participants had COVID-19 disease; the intervention was exercise therapy; and respiratory symptoms were evaluated as outcome measures. The quailty of included studies was independently evaluated by two authors using the PEDro scale. Results A total of 11 articles were selected for final analysis, which included both face-to-face therapy and telerehabilitation. Without considering their scientific rigour, the findings of the studies reported that exercise therapy, such as breathing exercises, strengthening exercises, aerobic exercises, lower limb muscle strength exercises and stretching exercises, had significant effects in reducing dyspnoea and increasing physical capacity and lung function. Conclusions Exercise therapy interventions could be effective in improving respiratory symptoms including lung function, dyspnoea and physical capacity. While some studies examined face-to-face exercise therapy and showed improvement in symptoms, it is suggested that the effect of telerehabilitation should be investigated in future studies. Implications for practice Physiotherapists can use exercise therapy alongside other physical therapy interventions for patients with COVID-19 and other similar respiratory viruses.

A prospective study on lung parenchymal changes in ingestional poisoning

Abstract Introduction:The ingestion of poison constitutes a critical medical emergency necessitating immediate attention in the emergency department. Respiratory symptoms associated with ingested poisons may manifest through aspiration, cardiopulmonary effects, or direct lung toxicity resulting from alveolar epithelium injury. In the emergency setting, chest imaging, including chest radiographs and CT scans, is commonly employed to assess such symptoms. This study aims to observe and document radiological changes in lung parenchyma among cases of ingestional poisoning admitted to GGH Kakinada. Material and Methods : A prospective observational study was conducted, encompassing cases of ingestional poisoning admitted to GGH Kakinada from January 1st, 2023, to June 1st, 2023. Results: Our findings revealed a predominance of males (71.2%), with the most common age group being 31-40 years (36.6%). Paraquat emerged as the most frequently consumed poison (39.39%). Radiological changes were most prevalent in paraquat poisoning cases (66.67%), and the mortality rate was 39.39%. Conclusion: Paraquat poisoning demonstrates substantial and delayed lung involvement, likely linked to aspiration. All cases resulted in mortality. Early chest X-ray assessment is vital in the emergency department for prompt detection and intervention, anticipating respiratory symptoms in patients with radiological changes.

Surgical revision of the postesophagectomy gastric conduit to address poor emptying

IntroductionThe configuration of the gastric conduit after esophagectomy can lead to chronic gastrointestinal and respiratory issues. Surgical revision of the gastric conduit has been described in small series but appears to be infrequently used. We investigated outcomes of revising dilated or redundant conduit in patients with severe quality-of-life issues. MethodsWe identified all patients from 2016 to 2022 at our institution who underwent gastric conduit revision after previous esophagectomy either at our or another institution. Chart review was performed to assess prerevision course and perioperative outcomes. Pre- and postrevision imaging was compared for all patients to assess the impact of surgery on anatomic configuration. Patient-reported gastrointestinal and respiratory issues before and after surgery were examined. ResultsThe use of right thoracotomy combined with laparotomy to reduce redundancy and improve gastric emptying was performed in 8 patients. The symptoms necessitating reoperation included intolerance to oral intake and poor gastric emptying associated with both acute and chronic aspiration episodes. The median length of stay was 8 [4, 25] days, and there were no perioperative mortalities. Seven (87.5%) patients were tolerating oral intake at discharge. All patients had improvement in their prerevision symptoms on follow-up. ConclusionsGastric conduit revision can improve severe postesophagectomy gastrointestinal and respiratory symptoms in patients with dilated/redundant conduits with limited perioperative morbidity.

Inhalation Surfactant Therapy within Comprehensive Treatment of HIV-Infected Patients with Multiple Drug Resistant Tuberculosis

The objective: to evaluate the main eff ects of surfactant inhalations during the intensive phase of chemotherapy with the regimen containing bedaquiline and linezolid in HIV-infected patients with multiple drug resistant tuberculosis.Subjects and Methods. A single-center, open-label, controlled prospective cohort study was conducted. 80 patients with MDR-TB/HIV were enrolled in the study and randomized into two groups: ST+ Group included 40 patients who in addition to anti-tuberculosis therapy containing bedaquiline and linezolid during the intensive phase received inhalation of the suspension of Surfactant-BL according to a certain regimen. The course of 28 inhalations took 2 months, the total dose of surfactant was 700 mg. ST- Group included 40 patients who received anti-tuberculosis therapy only. To assess the severity of respiratory symptoms in patients, we used our own scoring. All patients also received antiretroviral therapy.Results. In the ST+ Group versus ST- Group, there was a decrease in the severity of tuberculosis clinical manifestations and timing of their relief, higher frequency of cavity healing by 21.2%, and faster sputum conversion by 28.6%. These rates are higher than in ST- Group and this is a short period of 10 weeks. None of the patients developed adverse reactions to surfactant inhalations. Patients tolerated well the combination of surfactant therapy, MDR TB chemotherapy containing bedaquiline and linezolid, and ART.

Correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with chronic obstructive pulmonary disease in stable stage

Objective: To explore the correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with stable chronic obstructive pulmonary disease (COPD). Methods: A total of 186 patients with COPD in stable stage who visited in the outpatient department of Beijing Hospital from March 2021 to February 2022 were prospectively included. Demographic data, respiratory symptoms and lung function were collected. The original DICOM data of high-resolution CT (HRCT) were processed using the FACT medical imaging information system and the pulmonary emphysema index pixel index-950 (PI-950) and the airway wall thickness (4-6 T) and the percentage of airway area (4-6 WA%) of the 4-6 generation bronchi which represent the segmental and subsegmental bronchi were measured automatically. According to the modified British medical research council dyspnea scale (mMRC, 0-1 point for low score group, 2-4 points for high score group), chronic obstructive pulmonary disease assessment test (CAT, score<10 points for low score group,≥10 points for high score group), cough, expectoration and wheezing (asymptomatic group and symptomatic group), they were divided into two groups as dependent variables. The relationship between imaging parameters and the above symptoms was evaluated using a logistic regression model. Results: The study ultimately included 186 patients who met the inclusion criteria, including 162 males and 24 females, aged (68.9±9.3) years old. There were 83 patients in the high mMRC group, 120 patients in the high CAT group, 146 patients in the cough group, 154 patients in the expectoration group, and 65 patients in the wheezing group. The age and emphysema parameter PI-950 in the high score group of mMRC were higher than those in the low score group, while the percentage of the forced expiratory volume in 1 second (FEV1) predicted value (FEV1 pred) after medication, the percentage of carbon monoxide diffusion volume (DLCO) predicted value (DLCO pred), and the percentage of the maximum midexpiratory flow (MMEF) predicted value (MMEF pred) after medication were lower than those in the low score group (all P<0.05). The age of the high CAT group was higher than that of the low score group, while FEV1 pred and MMEF pred after medication were lower than those of the low score group (all P<0.05). The proportion of males, patients with smoking history, and smoking index in the cough group were higher than those in the non cough group, while the 4 WA% was lower than that in the non cough group (all P<0.05). The proportion of males, patients with smoking history, smoking index, and PI-950 in the expectoration group were higher than those in the non expectoration group, while FEV1 pred after medication and 4 WA% were lower than those in the non expectoration group (all P<0.05). The 5 WA% and 6 WA% of the wheezing group were higher than those of the non wheezing group, while MMEF pred after medication was lower than that of the non wheezing group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for demographic characteristics, smoking, combined diseases, lung function and other confounding factors, for every 10% increase in PI-950, the likelihood of developing more severe dyspnea for the patients (high score group according to mMRC) increased by 67.3% (OR=1.673, 95%CI: 1.052-2.658); Every 10% increase in 6WA% increased the likelihood of wheezing by 3.189 times (OR=4.189, 95%CI: 1.070-16.395). No correlation was found between various imaging indicators and cough, expectoration, and CAT scores (P>0.05). Conclusion: Quantitative CT measurement indicators in stable COPD patients can explain the presence and severity of respiratory symptoms, the pulmonary emphysema indicator is associated with dyspnea, and the percentage of proximal airway wall area is associated with wheezing.

RWD59 Association of Time of Loss of Ambulation with Severity of Respiratory Symptoms in Patients with Nonsense Mutation Duchenne Muscular Dystrophy (NMDMD)

Age at loss of ambulation (AALoA) and respiratory symptoms for nmDMD have been compared between patients receiving ataluren from the STRIDE registry and standard of care (SoC) from the CINRG study. A 4-year delay in loss of ambulation (LoA) was demonstrated for ataluren-treated patients. However, estimating treatment effects on respiratory function is challenging due to data limitations. This study aimed to assess the association between LoA and respiratory function - defined by predicted forced vital capacity (pFVC).

COPD Patients' Behaviour When Involved in the Choice of Inhaler Device.

Inhaler therapy plays a crucial role in controlling respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD). Incorrect or partially correct use of inhaler devices causes many chronic obstructive pulmonary disease (COPD) patients to continue to have respiratory symptoms due to poor drug deposition in the airways as a result of poor inhaler technique, leading to increased healthcare costs due to exacerbations and multiple emergency room presentations. Choosing the right inhaler device for each individual patient is a bigger challenge for doctors and chronic obstructive pulmonary disease (COPD) patients. The type of inhaler device and the correct inhaler technique depends on the control of symptoms in chronic obstructive pulmonary disease (COPD). Physicians treating patients with chronic obstructive pulmonary disease (COPD) play a central role in educating patients about the correct use of inhalation devices. The steps for the correct use of inhalation devices should be taught to patients by doctors in the presence of the family so that if the patient has difficulties handling the device correctly, the family can support them. Our analysis included 200 subjects divided into two groups-recommended group (RG) and chosen group (CG)-and aimed primarily to identify the behaviour of chronic obstructive pulmonary disease (COPD) patients when faced with deciding which type of inhaler device is most suitable for them. The two groups were monitored three times during the 12-month follow-up period. Monitoring required the physical presence of the patient at the investigating physician's office. The study included patients who were smokers, ex-smokers, and/or with significant exposure to occupational pollutants, aged over 40 years diagnosed with chronic obstructive pulmonary disease (COPD), risk group B and C according to the GOLD guideline staging, and on inhaled ICS+LABA treatment, although they had an indication for LAMA+LABA dual bronchodilation treatment. Patients presented for consultation on their own initiative for residual respiratory symptoms under background treatment with ICS+LABA. The investigating pulmonologist who offered consultations to all scheduled patients, on the occasion of the consultation, also checked the inclusion and exclusion criteria. If the patient did not meet the study entry criteria, they were assessed and received the appropriate treatment, and if the study entry criteria were met, the patient signed the consent and followed the steps recommended by the investigating pulmonologist. As a result, patient entry into the study was randomised 1:1, meaning that the first patient was recommended the inhaler device by the doctor and the next patient entered into the study was left to decide for themselves which type of device was most suitable for them. In both groups, the percentage of patients who had a different choice of inhaler device from that of their doctor was statistically significant. Compliance to treatment at T12 was found to be low, but compared to results previously published on compliance, in our analysis, compliance was higher and the only reasons identified as responsible for the better results were related to the selection of the target groups and the regular assessments, where, in addition to reviewing the inhaler technique, patients were encouraged to continue treatment, thus creating a strong bond between patient and doctor. Our analysis revealed that empowering patients by involving them in the inhaler selection process increases adherence to inhaler treatment, reduces the number of mistakes in inhaler use of the inhaler device, and implicitly the number of exacerbations.

Trial of thromboxane receptor inhibition with ifetroban: TP receptors regulate eicosanoid homeostasis in aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) is the triad of asthma, nasal polyposis, and respiratory reactions to COX-1 inhibitors. Overproduction of cysteinyl leukotrienes and underproduction of prostaglandin E2 (PGE2) are hallmarks of AERD. Amouse model predicted a key role for the thromboxane-prostanoid (TP) receptor in AERD. Our aim was to determine whether ifetroban, a TP receptor antagonist, attenuates aspirin-induced respiratory symptoms in patients with AERD. A total of 35 patients with AERD completed a 4-week double-blinded, placebo-controlled trial of ifetroban and underwent an oral aspirin challenge. The primary outcome was change in the provocative dose of aspirin that caused a 2-point increase in Total Nasal Symptom Score. Changes in lung function, eicosanoid levels, and platelet and mast cell activation were assessed. Cultured human nasal fibroblasts were stimulated with or without the TP agonist U46619 and assayed for prostanoid production. Ifetroban was well tolerated in AERD and did not change the mean 2-point increase in Total Nasal Symptom Score (P= .763). Participants taking ifetroban had greater aspirin-induced nasal symptoms and a greater decline in FEV1 value than did participants receiving placebo (-18.8%± 3.6% with ifetroban vs -8.4%± 2.1% with placebo [P= .017]). Four weeks of ifetroban significantly increased urinary leukotriene E4 levels and decreased nasal PGE2 levels compared with placebo. Peak aspirin-induced urinary thromboxane levels correlated with peak urinary leukotriene E4 and prostaglandin D2 metabolite levels in participants taking ifetroban. U46119 significantly potentiated the production of PGE2 by cultured nasal fibroblasts from subjects with AERD but not by cultured nasal fibroblasts from controls without polypoid sinusitis. Contrary to our hypothesis, TP receptor blockade worsened aspirin-induced reactions in AERD, possibly by exacerbating dysregulation of the eicosanoid system. TP signaling on stromal cells may be critical to maintaining PGE2 production when COX-2 function is low.

Comparison of 300 mg versus 600 mg daily maintenance doses of aspirin treatment after desensitization in N-ERD: A three-year multicentre experience

Background: Aspirin treatment after desensitization (ATAD) is effective in preventing nasal polyps recurrence as well as respiratory symptoms in patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory diseases (N-ERD). However, there is no consensus on effective daily maintenance doses in ATAD. Therefore, we aimed to compare the effects of two different maintenance doses of aspirin on clinical outcomes for 1-3 years of ATAD. Methods: This was a retrospective, multicenter study that involved four tertiary centers. The maintenance doses of daily aspirin were 300 mg in one center and 600 mg in the remaining three. The data of patients who were on ATAD for 1-3 years were included. Study outcomes (nasal surgeries, sinusitis, asthma attacks, hospitalization, oral corticosteroid use, and medication uses) were assessed in a standardized way and recorded from case files. Results: The study initially included 125 subjects, 38 and 87 were receiving 300 and 600 mg daily aspirin for ATAD, respectively. Number of nasal polyp surgeries decreased after 1 -3 years compared with before ATAD in both groups (group 1, baseline: 0.44 ± 0.07 versus first year: 0.08 ± 0.05; p < 0.001 and baseline: 0.44 ± 0.07 versus 3rd year: 0.01 ± 0.01; p < 0.001; and group 2, baseline 0.42 ± 0.03 versus first year: 0.02 ± 0.02; p < 0.001 and baseline: 0.42 ± 0.03 versus 3rd year: 0.07 ± 0.03; p < 0.001). Conclusion: Given the comparable effects of 300 mg and 600 mg aspirin daily as maintenance treatment of ATAD on both asthma and sinonasal outcomes in N-ERD, our results suggest using 300 mg of aspirin daily in ATAD owing to its better safety profile.

Kronik obstrüktif akciğer hastalığında gevşeme egzersizlerinin dispne ve uyku kalitesine etkisi

Aim: Sleep disorders is one of the most common problems after respiratory symptoms in patients with COPD. The probability of sleep disorders increases at the same rate with the severity of COPD symptoms. The aim of our study is to evaluate the effect of relaxation exercises on dyspnea and sleep quality in COPD patients receiving optimal bronchodilator therapy. Material and Method: This is a randomized controlled clinical study. The study was conducted with 67 voluntary patients with COPD who admitted to the Muğla Traininng and Research Hospital Chest Dieseases Outpatient Clinic. The study was planned as pretest and posttest clinical trial which included COPD patients with severe dyspnea and patients were randomly distributed to the intervention and control groups. Patients in the intervention group (n=34) were given relaxation exercises to be practiced at home for six weeks. Patients in the control group (n=33) were given breathing exercises. During this period, all patients continued to receive routine medical treatments. At baseline and after the intervention dypsnea and sleep quality was assessed.Results: There was a significant decrease in the posttest Modified Borg Scale-MBS, Modified Medical Research Council Scale-mMRC medians (p&amp;lt;0.001) in intervention group. Additionally a significant improvement in Global Pittsburgh Sleep Quality Index (PSQI) (p&amp;lt;0.001) and also some sleep quality subscales including subjective sleep quality (p&amp;lt;0.001), sleep latency (p=0.029), sleep duration (p&amp;lt;0.001), sleep efficiency (p=0.047) and daytime dysfunction (p&amp;lt;0.001) were found in the intervention group.Conclusion: We think that relaxation exercise, which is simple and an easy-to-apply method would provide a decrease in the dyspnea severity and an improvement in sleep quality of the patients with COPD when added to the optimal medical treatment.

Aspirin desensitization in nonsteroidal anti-inflammatory exacerbated respiratory disease: The first prospective cohort in Chile.

Nonsteroidal anti-inflammatory exacerbated respiratory disease (N-ERD) is characterized by the Samter triad: chronic rhinosinusitis with nasal polyps, asthma, and nonallergic hypersensitivity to NSAIDs. Its diagnosis is based on a complete clinical history and an aspirin (ASA) challenge test. Medical treatments include biological drugs and ASA desensitization. This study aims to evaluate the clinical response of patients with N-ERD undergoing functional endoscopic surgery (FES), followed by ASA desensitization and maintenance treatment, being the first prospective cohort study carried out in Chile. We conducted 1-year follow-up of 12 patients with N-ERD treated with FES, desensitization, and maintenance with ASA. For each control, the medication score, sinonasal symptomatology (SNOT-22), PEF (peak expiratory flow), nasal polyposis (Lildholdt score), and the appearance of adverse effects were recorded. Computed tomography (CT) of the paranasal cavities was performed at baseline and at the 12-month follow-up to calculate the Lund-Mackay score. Patients presented a reduction of SNOT-22 after the FES, which was maintained at 12 months (p = 0.002); the symptoms that showed the greatest reduction were feeling embarrassed and nasal obstruction. The Lildholdt score was also significantly reduced (p = 0.001); in only three patients, the nasal polyps recurred, and all were small. The PEF showed a slight nonsignificant increase of 3.3%. In total, 75% of patients had an adverse effect, the most frequent being abdominal pain (66.7%), but none of the 12 patients required discontinuation of aspirin treatment in 1-year follow-up. The Lund-Mackay score had a significant reduction of 6.6 points (p < 0.001). ASA desensitization is safe and effective in reducing upper and lower respiratory symptoms in patients with N-ERD and delays the reappearance of nasal polyps, although it is not exempt from adverse effects, with the vast majority being mild.

Long-term sequelae of different COVID-19 variants: The original strain versus the Omicron variant.

Although Omicron appears to cause less severe acute illness than the original strain, the potential for large numbers of patients to experience long COVID is a major concern. Little is known about the recovery phase in cases of Omicron, highlighting the importance of dynamically monitor long COVID in those patients. Subjects of the current study were patients available for a three-month follow-up who were admitted from January 13 to May 22, 2020 (period of the original strain) and from January 1 to May 30, 2022 (period of Omicron). Twenty-eight-point-four percent of patients infected with the original strain had long-term symptoms of COVID-19 and 5.63% of those infected with the Omicron strain had such symptoms. The most common symptom was a cough (18.5%), followed by tightness in the chest (6.5%), in patients infected with the original strain. Fatigue (2.4%) and dyspnea (1.7%) were the most commonly reported symptoms in patients infected with the Omicron strain. The respiratory system is the primary target of SARSCoV-2. Supportive treatment is the basis for the treatment of respiratory symptoms in patients with COVID-19. Quality sleep and good nutrition may alleviate fatigue and mental issues. Further knowledge about a long-term syndrome due to Omicron needs to be discussed and assembled so that healthcare and workforce planners can rapidly obtain information to appropriately allocate resources.

Post–Acute COVID-19 Respiratory Symptoms in Patients With Asthma: An Electronic Health Records–Based Study

Post-viral respiratory symptoms are common among patients with asthma. Respiratory symptoms after acute COVID-19 are widely reported in the general population, but large-scale studies identifying symptom risk for patients with asthma are lacking. To identify and compare risk for post-acute COVID-19 respiratory symptoms in patients with and without asthma. This retrospective, observational cohort study included COVID-19-positive patients between March 4, 2020, and January 20, 2021, with up to 180 days of health care follow-up in a health care system in the Northeastern United States. Respiratory symptoms recorded in clinical notes from days 28 to 180 after COVID-19 diagnosis were extracted using natural language processing. Cohorts were stratified by hospitalization status during the acute COVID-19 period. Univariable and multivariable analyses were used to compare symptoms among patients with and without asthma adjusting for demographic and clinical confounders. Among 31,084 eligible patients with COVID-19, 2863 (9.2%) had hospitalization during the acute COVID-19 period; 4049 (13.0%) had a history of asthma, accounting for 13.8% of hospitalized and 12.9% of nonhospitalized patients. In the post-acute COVID-19 period, patients with asthma had significantly higher risk of shortness of breath, cough, bronchospasm, and wheezing than patients without an asthma history. Incident respiratory symptoms of bronchospasm and wheezing were also higher in patients with asthma. Patients with asthma who had not been hospitalized during acute COVID-19 had additionally higher risk of cough, abnormal breathing, sputum changes, and a wider range of incident respiratory symptoms. Patients with asthma may have an under-recognized burden of respiratory symptoms after COVID-19 warranting increased awareness and monitoring in this population.

Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil.

To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. Retrospective study. Tertiary level craniofacial hospital. 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.

Comparative analysis of clinical and laboratory features in patients with chronic obstructive pulmonary disease depending on the presence of an exacerbation or a novel coronavirus infection

Aim. To analyze of the severity of respiratory symptoms in patients with chronic obstructive pulmonary disease (COPD), depending on the presence of an exacerbation or novel coronavirus infection (NCVI), taking into account the activity of acute phase blood parameters.Materials and methods. The medical documentation of 162 patients with COPD was studied, which were divided into 3 groups: group 1 (n=61) ‒ COPD and NCVI, group 2 (n=53) – stable COPD, group 3 (n=48) ‒ COPD exacerbation. The severity of respiratory symptoms was assessed using points. To assess the activity of inflammation the following biochemical indicators were used ‒ C-reactive protein (CRP) and fibrinogen (g/L).Results. According to the severity of cough and the intensity of dyspnea on the mMRC scale, the first, second and third groups did not differ statistically (p=0.07). Patients of the first group (82.5%) characterized by the absence of classical criteria for exacerbation of COPD. In terms of the severity of sputum production, the first, second and third groups are statistically different (p=0.0001). The first, second and third groups differ significantly in the level of serum CRP (p=0.0001) and fibrinogen (p=0.009). According to the results of the correlation analysis, some relationships found between respiratory symptoms and the level of CRP and fibrinogen.Conclusion. The clinical feature of the associated course of stable COPD and NCVI is the presence of severe dyspnea and the absence of classic criteria for exacerbation of COPD. Systemic inflammation in NCVI and stable COPD are more pronounced than in isolated stable COPD or exacerbation and correlates with cough and dyspnea. Practitioners for the differential diagnosis of NCVI in stable COPD can use the data obtained.