Risk Factor For Respiratory Morbidity Research Articles

Occupational respiratory morbidity and associated factors among hairdressers in Ethiopia: a cross-sectional study

ObjectiveThis study was designed to determine the prevalence and factors associated with occupational respiratory morbidity among hairdressers in Northwestern Ethiopia.DesignA cross-sectional study was conducted from 6 July 2022 to 17...

COMPARISON OF PERINATAL RISK FACTORS IN NEONATES OF DIFFERENT GESTATIONAL AGE ADMITTED WITH RESPIRATORY MORBIDITY.

Background: Respiratory disorders are most common cause of neonatal admissions in both term and preterm. Factors associated with neonatal respiratory morbidity (RM) are poorly described. To compare Objective: the frequency and risk factors for respiratory morbidity at different gestational age Hospital based cros Methods: s sectional study over 15 months. Neonates with onset of respiratory distress within 72 hours of birth enrolled and divided into early preterm, late preterm and full term groups. Comparison was done to nd the association of RM with neonatal, maternal and pregnancy related factors among three groups. Chi- square/ Annova/ Fisher's exact test was applied for Statistical signifance. 150 neonates were analysed. The fre Results: quency of respiratory morbidity was 35%, 29% and 25% for group I, II & III respectively. Statistically signicant neonatal factors were lower gestational age (p < 0.001), lower birth weight (p < 0.001), SGA especially late preterm & term SGA (p<0.001), male gender (p=0.043) especially term male (0.019) and late preterm/ term with low APGAR score (0.0033). Statistically signicant maternal factors were young maternal age (< 20 year) in late preterm neonates (p 0.00028) and maternal gestational diabetes in term group (p 0.012). Pregnancy related factor analysis showed PIH (p =0.01), Placenta previa (p =0.02), Cord Prolapse (p =0.02), PROM > 24 hour (p =0.03), MSL (p <0.001) and LSCS delivery (p = 0.01) as signicant risk factors for RM. Early and late Conclusion: gestation RM differs in term of potential perinatal factors. The gestational age and birth weight had inverse relationship with occurrence of RM. Risk factors such as PROM, placenta previa with early gestation; SGA,PIH, LSCS and young maternal age with late preterm while male gender, gestational DM, MSL and cord prolapse were signicantly associated with term gestation RM.

Association between bronchopulmonary dysplasia and early respiratory morbidity in children with respiratory distress syndrome: a case–control study using nationwide data

Bronchopulmonary dysplasia (BPD) can cause respiratory morbidity beyond the neonatal period. We aimed to analyze the association of BPD on childhood lower respiratory illness (LRI) and asthma among patients diagnosed with respiratory distress syndrome (RDS). This case–control study analyzed data between 2002 and 2015 from a nationwide database. We included 55,066 children with RDS. Two-year LRI and asthma at ages 3 and 5 were assessed. Readmission for LRIs within 2 years of birth occurred in 53.9% and 37.9% of the BPD (n = 9470) and non-BPD (n = 45,596) cases, respectively. In the BPD group, the median number of hospitalizations, mechanical ventilation and oxygen use rates were significantly higher, while the hospitalization duration was significantly longer (P < 0.001 for all). The relative risk of BPD was 1.42 (1.39–1.45) on total readmission and 6.53 (5.96–7.15) on intensive care unit readmission. Asthma prevalence was significantly higher in BPD group (57.6% vs. 48.9% at age 3 and 44.3% vs. 38.2% at age 5, P < 0.001). In children with RDS, BPD could affect repetitive and worse LRI as an independent risk factor for respiratory morbidity during the first 2 years of life. BPD may also be a crucial risk factor for asthma in preschoolers.

Impact of Bronchopulmonary Dysplasia on Early Life Respiratory Morbidity in Children with Respiratory Distress Syndrome: A Nationwide Population-Based Study

Background: Bronchopulmonary dysplasia (BPD) can cause respiratory morbidity beyond the neonatal period. We aimed to analyze the influence of BPD on childhood lower respiratory illness (LRI) and asthma among patients diagnosed with neonatal respiratory distress syndrome (RDS). Methods: This case–control study analyzed data of children born between 2002 and 2015 retrieved from a nationwide database. We included 55066 children diagnosed with RDS. Patients with major congenital anomalies or who died during the initial admission period were excluded. The main outcomes were 2-year childhood LRI and asthma at ages 3 and 5. Findings: Readmission for LRIs within 2 years of birth occurred in 53·9% and 37·9% of the BPD (n=9470) and non-BPD (n=45596) cases, respectively. In the BPD group, the median number of hospitalizations was significantly higher (2 [1–40] vs. 1 [1–29], p<0·001), hospital stay duration was significantly longer (13 [6–30] vs. 8 [5–15] days, p<0·001), mechanical ventilation (3·9% vs. 0·5%, p<0·001) and oxygen use (41·0% vs. 14·5%, p<0·001) rates were significantly higher than in the non-BPD group. The relative risk of BPD was 1.42 (95% CI, 1·39–1·45) on total readmission and 6·53 (95% CI, 5·96–7·15) on intensive care unit readmission, consistent with the subgroup analysis of very low birth weight population. Asthma prevalence in the BPD group was significantly higher (57·6% vs. 48·9% at age 3 and 44·3% vs. 38.2% at age 5, p<0·001) than in the non-BPD group, and three times higher than in the general population. Interpretation: In children with RDS, BPD could affect repetitive, prolonged, and worse LRI as an independent risk factor for respiratory morbidity during the first 2 years of life. BPD was also a crucial risk factor for asthma in preschoolers. Funding: This study was supported by a Severance Hospital Research fund for Clinical excellence (SHRC) (C-2020-0014). Declaration of Interest: All authors have no conflict of interest. Ethical Approval: This study protocol was reviewed and approved by the Institutional Review Board of Severance Hospital (approval No. 4-2019-0383). As this was an observational study without intervention and the presentation of any identifying data, the requirement for informed consent was waived.

Respiratory health of workers exposed to polyacrylate dust.

Background:Polyacrylate (PA) powder dust formed in PA manufacturing units is fine sized, i.e., in nanosize. Although several previous studies reported possible significant adverse effects of nanomaterials, studies on the harmful effect of small-sized PA particles on the respiratory health of the workers are scarce. The present study was carried out to assess the effect of PA on respiratory health and lung volumes/rates among the workers of PA manufacturing unit.Materials and Methods:The present cross-sectional study included 84 workers of PA manufacturing unit. Using interview technique as a tool for data collection, demographic, occupational, and clinical details of the workers were recorded on the predesigned pro forma. This was followed by detailed clinical examination, spirometry, chest X-ray (posteroanterior [PA] view), and high-resolution computed tomography (HRCT) examination of each worker.Results:On the basis of clinical examination, chest radiography, and HRCT, 17.9% of the workers were found to have fibrotic and cavitarychanges in lung parenchyma. The production department workers had a higher proportion of respiratory morbidities as compared to supervisory or office staff. Age, gender, smoking habit, and duration of exposure were nonsignificant risk factors for respiratory morbidity. The overall mean forced vital capacity, forced expiratory volume in 1sts, Peak Expiratory Flow Rate (PEFR), (Maximal Mid Expiratory Flow Rate) MMEFR0.2–1.2, and MMEFR25%–75% were 3.19 ± 0.77 L, 2.72 ± 0.67 L, 6.82 ± 1.86 L/s, 5.79 ± 2.03 L/s, and 3.16 ± 1.19 L/s, respectively. Females and those having respiratory morbidity had significantly lower values of all spirometric parameters as compared to their counterparts.Conclusions:The workers exposed to engineered fine dust of PA may be at risk of respiratory ill-health.

Respiratory Morbidities in Preterm Neonates During the First Year of Life: A Prospective Observational Study

Background: Infants born preterm develop numerous short- and long-term respiratory morbidities. However, there are scanty data available from India. Aims: The study was conducted to determine the incidence of hospitalization due to respiratory morbidities during the 1st year of life in preterm neonates (<37 completed weeks). The secondary aim was to determine the impact of respiratory morbidity on growth and need for nebulization. Patients and Methods: This prospective study was conducted in a level III neonatal intensive care unit. Data regarding maternal and neonatal history and examination were collected in the study proforma. Follow-up was done at predetermined intervals, and details of subsequent outpatient and inpatient treatments were recorded. Statistical analysis – Chi-square test/Fisher's exact test, unpaired t-test, and multivariate logistic regression were used for statistical analysis. P < 0.05 was considered as statistically significant. Results: Three hundred and forty-four infants (192 – male and 121 – inborn) were included. Fifty-eight (16.8%) infants were readmitted – 84% bronchiolitis, 12% pneumonia, and 27.5% as wheeze-associated lower respiratory tract infection. On multivariate analysis, growth status at birth, presence of hemodynamically significant patent ductus arteriosus (PDA), lower socioeconomic status (SES), and lack of exclusive breastfeeding were associated with risk of readmission. 12.2% (42/344) of the admitted preterm neonates needed nebulization with bronchodilators during follow-up. Growth was hampered in those requiring readmissions. Conclusion: 16.8% of the preterm neonates were admitted for respiratory morbidities at 1-year follow-up. Small for gestational age, presence of hemodynamically significant PDA needing medical closure, lack of exclusive breastfeeding for 6 months, and lower SES were risk factors for respiratory morbidity in infancy.

Secondary Analysis of Premature Respiratory Outcomes Program (PROP) Clinical Trial to Identify Correlations of Risk Factors for Respiratory Morbidity and Mortality in Premature Infants

BackgroundThe Premature Respiratory Outcomes Program (PROP) was a collaborative, multi‐disciplinary clinical study that sought to analyze the factors that could predict future risk for respiratory morbidity and mortality for 835 premature infants with gestational ages 23 0/7 to 28 6/7 weeks. PROP investigators conducted physiologic challenges called Room Air Challenges (RAC) and Hypoxic Challenges Tests (HCT) to determine whether the premature infants could maintain their SpO2 in the target range of ≥90% and to assess pulmonary reserve in former premature infants without Bronchopulmonary Dysplasia(BPD) at 36 weeks’ premenstrual age (PMA). This project was funded by the National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute (NHLBI) for 5 years through a $18.5 million research initiative.ObjectiveWe are interested in understanding the relationship between brain imaging data and respiration outcomes, and infection or chorioamnionitis and respiration outcomes. In addition, the RAC and HCT provides the opportunity to analyze the outcomes of physiologic challenges in preterm infants compared to term infants undergoing the same challenges in studies that conducted preflight HCT.Statement of the methodsWe utilized machine learning tools such as random forest, support vector machines, gradient boosted machines, and logistic regression to generate predictive models of the aforementioned features.Summary of resultsPreliminary data analysis of key variables to be included in our future data analytics includes standard deviations for birth weight (gm) (235.98), the baby’s head circumference (cm) (83.05), APGAR for one minute (scored 1–10) (2.47), and APGAR 5 minutes (2.10).Statement of conclusionsThis PROP clinical study encapsulates an immense amount of multidisciplinary data from 835 premature infants, which is an extremely special population to include in research as approximately 1 out of every 9 births in the United States occurs prematurely.Support or Funding InformationR01HL132355

In utero exposure to pre-eclampsia as an independent risk factor for long-term respiratory disease.

Pre-eclampsia has a considerable effect on the intrauterine environment, yet not much is understood about how this impacts the respiratory health of the offspring. The aim of the present study is to determine if pre-eclampsia correlates with a higher incidence of respiratory disease in the offspring. This cohort study assessed the differences in respiratory disease patterns between singletons born to mothers with and without pre-eclampsia. The study was conducted between 1991 and 2014 in a regional tertiary medical center. A generalized estimating equation (GEE) model was used to control for confounders and maternal clusters. 253 808 deliveries were included in the study. Of these, 3.0% were to mothers diagnosed with pre-eclampsia (n = 7660), 0.9% with severe pre-eclampsia (n = 2366), and 0.03% with eclampsia (n = 81). A significant linear association was noted between the severity of the pre-eclampsia (no pre-eclampsia, mild, severe pre-eclampsia, and eclampsia) and respiratory disease of the offspring (5.7%, vs 6.0% vs 7.3% vs 9.9%, respectively; P = .003). The offspring of mothers who developed pre-eclampsia had significantly higher rates of asthma (1.1%, vs 1.3% vs 1.4% vs 1.2% correspondingly; P = .018). In the GEE model, controlling for gestational diabetes, maternal age, gestational age, and length of follow up, pre-eclampsia was found to be an independent risk factor for respiratory morbidity in the offspring (adjusted odds ratio = 1.32; 95% confidence interval, 1.21-1.45). Exposure to maternal pre-eclampsia is an independent risk factor for long-term respiratory morbidity in the offspring. Specifically, the prenatal exposure to pre-eclampsia was significantly associated with asthma of the offspring.

Özofagus Atrezisi ve/veya Trakeoözofageal Fistül Cerrahisi Sonrası Solunum Sistemi Erken ve Geç Dönem Komplikasyonlarının İncelenmesi

INTRODUCTION: Esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) is one of the common developmental anomalies of the foregut. Despite advances in surgical techniques and postoperative care, respiratory system complications affect the quality of life of patients. We planned to evaluate our patients in terms of the general features, the risk factors for respiratory morbidity and short- and long-term respiratory complications after surgical treatment. METHODS: Thirty-six patients with EA and/or TEF and followed after surgical treatment between 2002 and 2019 were retrospectively enrolled in the study. RESULTS: The most common symptom was chronic cough (77.7%) and wheezing (41.6%). Recurrent pulmonary infections were present in the majority. The number of pulmonary infections was high in patients who had dilatation due to stricture(N=14) and in patients with recurrent TEF(N=6) and malacia(N=10). Bronchiectasis was present in 8 patients and hospital admission due to infections was high. Aeroallergen sensitivity was detected in four patients and food allergy in five patients. Scoliosis was present in 33.3% of the patients all of whom had recurrent pulmonary infections. Pulmonary function tests were performed in 10 patients. Five patients had impaired pulmonary function. Medical treatment for reflux was given to the majority of patients (N=30), while fundoplication was performed in 10 patients. Most of the patients had a significant decrease in the frequency of pulmonary infections after the procedure. DISCUSSION AND CONCLUSION: The etiology of pulmonary complications is multifactorial and many factors affect each other. Evaluation and management of the patients for each complication will improve the quality of life and comfort of the patients.

EP1.18-04 Do Tumor-Related Factors Predict Postoperative Pulmonary Complications in Patients Undergoing Curative Surgery for Lung Cancer?

The purpose of the present study is to identify preoperative risk factors related to pulmonary complications with a focus on tumor-related factors. The authors conducted a retrospective review of the clinical records of all patients operated at the thoracic department of the Lviv State Oncological Regional Treatment and Diagnostic Center in 2010-2011. Tumor-related factors (histological type of lung cancer, tumor localization, TNM classification, past medical history of different cancer types) were analyzed. Postoperative pulmonary morbidity was defined as: respiratory failure, atelectasis, air leak more than 7 days, prolonged intubation (>72hours), pleural effusion, pleural empyema, chylothorax, and pneumothorax. The study included patients meeting the following criteria: age under 70, absence of neoadjuvant chemo- and/or radiotherapy, benign lung lesions, lung metastases, and non-curative lung resection. Logistic regression was performed using IBM SPSS Statistics 22 program. The result was considered statistically significant when p<0.05. 144 patients underwent surgery for primary lung cancer at our institution. Lobectomy was performed in 36.1%, pneumonectomy – in 59%, lung resection – in 4.9% of patients. Histological examination showed that 84 patients had squamous cell carcinoma, 31 patients – adenocarcinoma, 6 patients – large cell carcinoma, 6 patients – small cell carcinoma, 8 patients – NET and 9 patients – other histological types. 12 (8.3%) patients had a medical history of a different type of cancer. The 30-day postoperative mortality rate was 3.47%, postoperative morbidity was 36.8%. The analysis showed that presence of a different type of cancer in past medical history (p<0.05) remained a significant risk factor for respiratory morbidity after lung cancer surgery while the presence of NET reduces the risk of postoperative pulmonary complications (p<0.05). Presence of a different type of cancer in past medical history constitutes a significant risk factor for respiratory postoperative morbidity in lung cancer patients. Patients with NET have a lower risk of postoperative pulmonary complications. We suggest that this result requires confirmation by further research.

Liraglutide Enhances the Activity of the ACE-2/Ang(1-7)/Mas Receptor Pathway in Lungs of Male Pups from Food-Restricted Mothers and Prevents the Reduction of SP-A.

In utero growth restriction and being born small for gestational age are risk factors for respiratory morbidity. IUGR (in utero growth retardation) is associated to overall reduction in lung weight, surfactant content and activity, impaired maturation of the alveolar type II cells, and decreased alveolar formation. The renin-angiotensin system (RAS) may be a key target underlying pathophysiological lung alterations. GLP-1 and agonists of its receptor modulate the expression levels of different components of RAS and also are very important for lung maturation and the production of surfactant proteins. The aim of this study was to elucidate the effects of IUGR induced by perinatal food restriction of the mother in the lung function of pups at early stages of life (PD21) and to determine if liraglutide had any effect during gestational period. Sprague-Dawley pregnant rats were randomly assigned to 50% food restriction (MPFR) or ad libitum control (CT) groups at day of pregnancy 12 (GD12). From GD14 to parturition, pregnant MPFR and CT rats were treated with liraglutide or vehicle. At postnatal day 21 and before weaning, 20 CT and 20 FR male pups were sacrificed and lungs were analyzed by RT-PCR. Liraglutide restored surfactant protein A (SP-A) mRNA expression in pup lungs from food-restricted mothers. Surfactant protein B (SP-B) mRNA expression is not affected by neither IUGR nor liraglutide treatment. Moreover, liraglutide modulated different elements of RAS, increasing angiotensin-converting enzyme 2 (ACE2) and MasR mRNA expression only in pups from food-restricted mothers (MPFR), despite food restriction had not any direct effect at this early stage. Liraglutide also increased endothelial nitric oxide synthase (eNOS) expression in MPFR lungs, reflecting the activation of MasR by angiotensin 1–7. In conclusion, liraglutide prevented the alteration in lung function induced by IUGR and promoted the positive effects of ACE2-Ang(1–7)-MasR in restoring lung function.

Diet Pattern and Respiratory Morbidity in the Atherosclerosis Risk in Communities Study.

Dietary intake is a potential risk factor for respiratory morbidity in adult populations. Few studies capture the effect of dietary patterns, representative of the combination of nutrients consumed, on self-reported respiratory morbidity in combination with objective measures of lung function. To evaluate patterns of dietary intake in relation to respiratory morbidity and objective measures of lung function in a U.S. The ARIC (Atherosclerosis Risk in Communities) study investigators enrolled 15,792 participants from four U.S. communities between 1987 and 1989 and collected data using a validated food frequency questionnaire to assess diet. Principal component analysis was applied, and patterns representative of "Western" and "Prudent" diets emerged. We investigated cross-sectional associations between dietary patterns and pulmonary assessments that included asthma and chronic obstructive pulmonary disease (COPD) diagnosis, respiratory symptoms, and lung function. Multivariable Poisson regression models included quintiles of dietary patterns and potential confounders. Interaction of dietary patterns with obesity, sex, and smoking status was assessed in relation to all outcomes. Higher scores in the "Western" dietary pattern (quintile 5 vs. quintile 1) were associated with higher prevalence of COPD (prevalence ratio [PR], 1.62; 95% confidence ratio [CI], 1.33-1.97), wheeze (PR, 1.37; 95% CI, 1.11-1.69), cough (PR, 1.32; 95% CI, 1.32-1.59), and phlegm (PR, 1.27; 95% CI, 1.05-1.54) and lower percent predicted forced expiratory volume in 1 second (FEV1), percent predicted forced vital capacity (FVC), and FEV1/FVC ratio. Higher scores in the "Prudent" dietary pattern (quintile 5 vs. quintile 1) were associated with lower prevalence of COPD (PR, 0.82; 95% CI, 0.70-0.95) and cough (PR, 0.77; 95% CI, 0.67-0.89) and higher percent predicted FEV1 and FEV1/FVC ratio. The prevalence of asthma was not related to dietary intake. A "Western" dietary pattern was associated with respiratory symptoms, lower lung function, and COPD in ARIC participants.

Lung function development after preterm birth in relation to severity of Bronchopulmonary dysplasia

BackgroundBronchopulmonary dysplasia (BPD) is a strong risk factor for respiratory morbidity in children born preterm. Our aims were to evaluate lung function in adolescents born preterm with and without a history of BPD, and to assess lung function change over time from school age.MethodsFifty-one individuals born in Stockholm, Sweden between gestational ages 24 to 31 weeks (23 neonatally diagnosed with respiratory distress syndrome (RDS) but not BPD, and 28 graded as mild (n = 17), moderate (n = 7) or severe (n = 4) BPD) were examined in adolescence (13–17 years of age) using spirometry, impulse oscillometry (IOS), plethysmography, and ergospirometry. Comparison with lung function data from school age (6–8 years of age) was also performed.ResultsAdolescents with a history of BPD had lower forced expiratory volume in 1 s (FEV1) compared to those without BPD (−0.61 vs.-0.02 z-scores, P < 0.05), with lower FEV1 values significantly associated with BPD severity (P for trend 0.002). Subjects with severe BPD had higher frequency dependence of resistance, R5–20, (P < 0.001 vs. non-BPD subjects) which is an IOS indicator of peripheral airway involvement. Between school age and adolescence, FEV1/FVC z-scores decreased in all groups and particularly in the severe BPD group (from −1.68 z-scores at 6–8 years to −2.74 z-scores at 13–17 years, p < 0.05 compared to the non-BPD group).ConclusionsOur results of spirometry and IOS measures in the BPD groups compared to the non-BPD group suggest airway obstruction including involvement of peripheral airways. The longitudinal result of a decrease in FEV1/FVC in the group with severe BPD might implicate a route towards chronic airway obstruction in adulthood.

Twenty Years of Anesthetic and Perioperative Management of Patients With Tetralogy of Fallot With Absent Pulmonary Valve

Review the authors' institutional experience of the induction and perioperative airway management of children with tetralogy of Fallot with an absent pulmonary valve. Retrospective chart review. Large academic children's hospital. Patients with the diagnosis of tetralogy of Fallot with absent pulmonary valve undergoing primary cardiac repair over a 20-year period. None. Forty-four patients were identified with tetralogy of Fallot with an absent pulmonary valve from January 1995 through August 2014. Forty-two patients (95%) required surgery in their first year of life. Sixteen patients (36%) required mechanical ventilation preoperatively, including 11 neonates. Of the 28 patients not intubated preoperatively, only 1 (3.8%) exhibited minor airway obstruction following induction that was managed uneventfully. All intubations in the operating room were performed in the supine position. Five patients who were mechanically ventilated preoperatively in a lateral or prone position were supinated in the operating room without significant cardiopulmonary compromise. There were no patients who suffered cardiopulmonary arrest or required mechanical circulatory support. The median time to extubation was 2 days (range 1-13 days) in those patients who were not mechanically ventilated prior to their surgery. Ultimately, 5 patients required tracheostomy and 1 patient underwent lobectomy. Although, there was no mortality at 30 days, 4 children died within 1 year of their surgery. All the children who died had a genetic syndrome and required mechanical ventilation preoperatively. While there are theoretical concerns specific to the induction and airway management of tetralogy of Fallot with an absent pulmonary valve, there were no episodes of cardiorespiratory arrest or extracorporeal membrane oxygenation in the authors' series. Neonatal age at the time of surgery, preoperative need for mechanical ventilation, and concomitant genetic syndromes are risk factors for respiratory morbidity. Mortality in this study was low compared to historic reports, likely reflecting improvement in surgical technique and intensive care management.

CHILDHOOD RESPIRATORY MORBIDITY AND COOKING PRACTICES AMONG HOUSEHOLDS IN A PREDOMINANTLY RURAL AREA OF GHANA

Background:Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking.Materials and Method:A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of respiratory symptoms and their associated risk factors. Household cooking practices were also assessed as part of the survey.Results:Household heads of twelve thousand, three hundred and thirty-three households were interviewed. Fifty-seven percent (7006/12333) of these households had at least one child less than five years of age. The prevalence of symptoms of acute lower respiratory infections (ALRI) was 13.7% (n= 957, 95% CI 12.8 – 15.5%). A majority (77.8%, 95% CI, 77.7 - 78.5%) of households used wood as their primary fuel. Majority of respondents who used wood as their primary fuel obtained them by gathering wood from their neighborhood (95.6%, 9177/9595) and used a 3-stone local stove for cooking (94.9%, 9101/9595). In a randomly selected subset of respondents, females were the persons who mostly gathered firewood from the fields (90.8%, 296/326) and did the cooking (94.8%, 384/406) for the household.Conclusion:Symptoms of ALRI reported by caregivers is high in the Kintampo area of Ghana where biomass fuel use is also high. There is the need to initiate interventions that use improved cook stoves and to test the health benefits of such interventions.

Respiratory morbidity in late preterm infants.

Late preterm delivery (74% of all preterm births) increases the incidence of respiratory pathology, namely respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN) and the need of ventilator support when compared to term delivery. The aim is to evaluate the respiratory morbimortality in late preterm infants and the risk factors associated with RDS and TTN. Descriptive retrospective study of all newborns of 34+0 to 36+6 weeks of gestational age, born at our center between September 1, 2012 and August 31, 2015. Those with major malformations, chromosomopathies, hydrops fetalis and congenital TORCH infection were excluded. A total of 498 newborns were studied, 44 (8.83%) of them with either RDS or TTN. Respiratory morbidity was significantly associated with lower gestational age, male gender, caesarean section, exposure to peripartum antibiotics, overweighed and nulliparous mothers. RDS newborns had a significantly higher need for resuscitation, endotracheal intubation, oxygen therapy, early invasive ventilation, parenteral nutrition and a longer NICU stay when compared to newborns with TTN. 55% of the patients with RDS had 35+0 to 36+6 weeks of gestational age, moderate or severe RDS and required mechanical ventilation; six needed surfactant. Caesarean section and resuscitation with ETT were independent risk factors for respiratory morbidity. Late preterm remain at risk for adverse respiratory outcomes, particularly newborns delivered after 35 weeks, whose mothers are not given ACS and still have considerable morbidity. Growing evidence supports the possibility of extending the management window further into the LPT period. Caesarean section was an independent risk factor for respiratory morbidity and efforts should be undertaken to reduce the procedure rate.

Risk factors for bronchiolitis, recurrent wheezing, and related hospitalization in preterm infants during the first year of life.

Airway diseases are highly prevalent in infants and cause significant morbidity. We aimed to determine the incidence and risk factors for respiratory morbidity in a Spanish cohort of moderate-to-late preterm (MLP) infants prospectively followed during their first year of life. SAREPREM is a multicenter, prospective, longitudinal study. Preterm infants born at 32-35weeks of gestation with no comorbidities were enrolled within 2weeks of life and followed at 2-4weeks, 6, and 12months of age. Multivariate mixed-models were performed to identify independent risk factors associated with (i) development of bronchiolitis, (ii) recurrent wheezing, or (iii) related hospital admissions. Overall, 977 preterm infants were included, and 766 (78.4%) completed follow-up. Of those, 365 (47.7%) developed bronchiolitis during the first year, 144 (18.8%) recurrent wheezing, and 48 (6.3%) were hospitalized. While low birthweight, day care attendance (DCA) and school-age siblings were significantly and independently associated with both the development of bronchiolitis and recurrent wheezing, lower maternal age increased the risk for bronchiolitis and respiratory-related hospitalizations. Lastly, mechanical ventilation was associated with a higher risk of bronchiolitis and history of asthma in any parent increased the likelihood of developing recurrent wheezing. In this study, several non-modifiable parameters (family history of asthma, low birthweight, need for mechanical ventilation) and modifiable parameters (young maternal age, DCA, or exposure to school-age siblings) were identified as significant risk factors for the development of bronchiolitis and recurrent wheezing during the first year of life in MLP infants.

Update in environmental and occupational lung diseases 2013.

In this update, recent publications within the field of environmental and occupational medicine, from this journal and others, are highlighted. Effects of ambient air pollution on a diverse range of airways disease continue to be discovered, reiterating the impressive potency of this near-ubiquitous and largely anthropogenic toxicant. Air pollution is now recognized as the third leading cause of disability-adjusted life years due to chronic respiratory disease globally (1). Studies in the past year have significantly strengthened the link between air pollution exposure and adverse health outcomes including mortality (2–4), lung cancer (4–6), infections (7–9), and obstructive lung disease (including asthma) (10, 11). Important underlying mechanistic details were illuminated in several animal models (12–17). The association between poor indoor air quality and lung diseases is a topic of increasing interest and was investigated in several reports in 2013 (18–21). Controlled human exposure experiments were in the spotlight, in part because of ethical concerns about the justification of this approach. An important position paper by leading researchers and a biomedical ethicist strongly supports the usefulness of controlled exposures, which continue to provide new insights into adverse health effects of different pollutants (22). Asbestos exposure is a well-recognized risk factor for pleural mesothelioma, and two epidemiology studies were published that explored the interaction between exposure to asbestos, other mineral fibers, and cigarette smoking in mesothelioma, asbestosis, and lung cancer (23, 24). Arsenic is increasingly recognized as a groundwater contaminant, with potential effects on lung development and function. An important paper provided strong evidence that even low levels of arsenic exposure are associated with reduced lung function (25). The adverse health effects of global warming are becoming apparent, and one paper provided a sobering reminder that elevated ambient temperatures are a strong risk factor for respiratory morbidity (26). Unfortunately, the adverse effects of environmental and occupational exposures on lung health occur disproportionately in ethnic minorities and those with lower socioeconomic status, underscoring the urgent need to address these important health disparities (27). Although our understanding of the adverse effects of environmental and occupational exposures on lung health continues to expand, more research is needed to understand mechanisms involved and discover the optimal public health measures to mitigate risk.

Factors Associated With Elevated Exhaled Nitric Oxide Fraction in Infants With Recurrent Respiratory Symptoms

A Kotaniemi-Syrjanen, LP Malmberg, K Malmstrom, AS Pelkonen, MJ Makela. Eur Respir J. 2013;41(1):189–194 To evaluate the relationship between exhaled nitric oxide fraction (FeNO) and increased airway responsiveness, and to clarify whether there are any associations between these measures and risk factors for respiratory morbidity in infants with recurrent lower respiratory tract symptoms. Studied subjects were 444 children aged <3years with recurrent lower respiratory tract symptoms including wheeze, dry or productive cough, and/or shortness of breath. Subjects were assessed for FeNO, lung function tests, and the …

Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

The aim of this study was to describe the incidence and risk factors for respiratory morbidity during the 12-month period following the first respiratory syncytial virus (RSV) season in 242 preterm infants [<33 weeks gestational age (GA)] without bronchopulmonary dysplasia and 201 full-term infants (39-41 weeks GA) from the French CASTOR study cohort. Preterm infants had increased respiratory morbidity during the follow-up period compared to full-terms; they were more likely to have wheezing (21% vs. 11%, P = 0·007) and recurrent wheezing episodes (4% vs. 1%, P = 0·049). The 17 infants (14 preterms, three full-terms) who had been hospitalized for RSV-confirmed bronchiolitis during their first RSV season had significantly more wheezing episodes during the follow-up period than subjects who had not been hospitalized for RSV-confirmed bronchiolitis (odds ratio 4·72, 95% confidence interval 1·71-13·08, P = 0·003). Male gender, birth weight <3330 g and hospitalization for RSV bronchiolitis during the infant's first RSV season were independent risk factors for the development of wheezing episodes during the subsequent 12-month follow-up period.