Risk Of Pulmonary Disease Research Articles

Systolic blood pressure, chronic obstructive pulmonary disease and cardiovascular risk

ObjectiveIn individuals with complex underlying health problems, the association between systolic blood pressure (SBP) and cardiovascular disease is less well recognised. The association between SBP and risk of cardiovascular events...

A Rising Endemic within a Pandemic: Impact of Inflation on Mental Health

Madam, Inflation describes the increment in the cost of living over a certain period, occurring in light of extreme events that impact the economy. The current wave of inflation results from the coalition of events mainly stemming from the COVID-19 pandemic, producing a myriad of economic disruptions. Rising food insecurity, hikes in electricity prices, and fuel costs leave families facing an unprecedented financial crisis. Moreover, the turmoil created by the recent flooding due to record-breaking rainfall affecting Sindh, Balochistan, and Khyber Pakhtunkhwa has fuelled the current inflation wave in Pakistan. The impact of such issues can be devastating in multiple respects. The convulsion of the economy has given rise to mental health disorders nationwide, resulting in a decline in physical health. Those suffering from mental illnesses are more likely to suffer from chronic physical conditions, including Alzheimer’s disease, diabetes mellitus, thyroid disorders, and more1. A survey conducted by the American Psychological Association (APA) illustrated that 9 in 10 individuals perceive financial hardships as a major source of stress – notably greater than the perception during the pre-pandemic era2. Furthermore, it is common for stressed individuals to resort to unhealthy coping mechanisms, such as smoking3 – increasing the risk of pulmonary diseases and cancers, providing the evident association between mental and physical health. This shows the undeniable impact of the pandemic on financial constraints across the world. Pakistan’s overall disregard for mental health has recently been corroborated. The World Health Organization (WHO) introduced the “Comprehensive Mental Health Action Plan 2013-2020” to improve mental health globally. However, as per WHO’s “World Mental Health Report” analysis, most countries, including Pakistan, did not adhere to the plan, highlighting the lack of consideration towards mental health4. Moreover, Pakistan lacks sufficient resources to handle an endemic wave of mental disorders. Having one of the lowest psychiatrist-to-patient ratios worldwide – with only 500 psychiatrists serving a colossal population of 220 million. These statistics substantiate the urgency to emphasize the indispensability of psychiatry as a career opportunity5. Local authorities must invest in effective relief programs, especially for the impoverished disproportionately affected by the economic crisis. As a nation, it is paramount to possess readiness for intervention at times of psychological distress, and if left rampant, may enter a vicious cycle of deteriorating mental health, precipitating to deteriorating physical health, further crippling the economy.

Багатофакторна модель прогнозування тяжкого перебігу та ураження органів і систем при Лайм-бореліозі в дітей

Lyme disease (tick-borne borreliosis, Lyme borreliosis - LB) is a multisystem zoonotic disease transmitted by the bite of infected ticks. Purpose - to develop a mathematical model for predicting the risk of severity of the course (PRSC) of LB by the risk factor for the development of disseminated LB in children who have had a tick attack. Materials and methods. To build a model for PRSC of LB using multivariate regression analysis, 121 children with LB aged 13±3 years (from 1 to 18 years) were examined, including 51 boys and 70 girls. Groups of patients: 78 children with erythema migrans, 16 - with Lyme arthritis, 27 - with nervous system lesions. The quality of the prognostic model was checked by the Neigelkerk criterion (R2), and the acceptability of the model was assessed using ANOVA analysis of variance. Serological examination of patients bitten by ticks was performed by enzyme-linked immunosorbent assay. To detect immunoglobulins of classes M (IgM) and G (IgG) to B. burgdorferi s.l. complex, test systems from Euroimmun AG (Germany) were used. IgM antibodies were determined by the test system Anti-Borrelia burgdorferi ELISA, IgG - by Anti-Borrelia plus VIsE ELIS. Blood samples with intermediate and positive results of the first stage of work were examined by immune blotting: IgM antibodies were detected using the system Anti-Borrelia EUROLINE Borrelia RN-AT (IgM), and IgG antibodies - Anti-Borrelia EUROLINE RN-AT. Results. The method of multivariate regression analysis for predicting the severe course and damage to organs and systems in children with LB, taking into account the factors and variants of the disease itself, allows to develop a mathematical model of PRSC of LB and to improve the effectiveness of treatment. Thus, all prerequisites have been created for high-quality preventive measures and reducing the risk of severe pulmonary disease. The initial data for predicting the severity of pulmonary disease were 28 factors. According to the results of the regression analysis, 24 factors were included in the model for predicting the severity of the course of pulmonary disease. Conclusions. For the first time, a multivariate regression model for PRSC of LB for pulmonary fibrosis in children was built. The weighting coefficients of each of the factors of the onset and progression of LB were taken into account: 0-10 points indicate the development of a localized stage (primary effect stage), while 11 or more points indicate a disseminated (generalized) stage. The results of the study make it possible to further develop standardized scales of the severity of LB and possible organ and system damage. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

An inverse causal association between genetically predicted vitamin D and chronic obstructive pulmonary disease risk.

Observational studies have reported that levels of vitamin D were associated with the incidence of chronic obstructive pulmonary disease (COPD), but the relationship between them may have been confounded in previous studies. In this study, we aimed to determine the relationship between the levels of 25-hydroxyvitamin D (25OHD) and the risk of COPD by two-sample Mendelian randomization (MR) analysis. Summary statistics for 25OHD and COPD in this study were obtained from the EBI (n = 496,946) consortium and Finn (n = 187,754) consortium. MR was adopted to explore the effect of the genetically predicted levels of 25OHD on the risk of COPD. Based on three assumptions of MR analysis, inverse variance weighting was used as the main analysis. To make our results more robust and reliable, MR Egger's intercept test, Cochran's Q test, funnel plot, and "leave-one-out" sensitivity analysis were used to assess the potential pleiotropy and heterogeneity in this study. Then, colocalization analysis and MR Steiger approaches were used to estimate the possible directions of estimates between them. Finally, we analyzed the causal associations between the four core genes (DHCR7, GC, CYP2R1, and CYP24A1) of vitamin D and the levels of 25OHD or the risk of COPD. Our results showed that each 1 standard deviation (SD) increase in the genetically predicted 25OHD level was associated with a 57.2% lower relative risk of COPD [odds ratio (OR): 0.428, 95% Cl: 0.279-0.657, p = 1.041 × 10-4], and the above association was also verified by maximum likelihood (OR: 0.427, 95% Cl: 0.277-0.657, p = 1.084 × 10-4), MR-Egger (OR: 0.271, 95% CI: 0.176-0.416, p = 2.466 × 10-4), MR-PRESSO (OR: 0.428, 95% Cl: 0.281-0.652, p = 1.421 × 10-4) and MR-RAPS (OR: 0.457, 95% Cl: 0.293-0.712, p = 5.450 × 10-4). Furthermore, colocalization analyses (rs3829251, PP.H4 = 0.99) and MR Steiger ("TRUE") also showed a reverse association between them. Besides, the core genes of vitamin D also showed similar results except for CYP24A1. Our findings provide evidence for a reverse association between genetically predicted 25OHD levels and COPD risk. Taking measures to supplement 25OHD may help reduce the incidence of COPD.

Acute pulmonary embolism immediately after cesarean section despite dilatation of the left ventricle: a case report and literature review

Abstract Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium. Compared with vaginal delivery, the risk of pulmonary disease is almost twice as high with cesarean section. However, diagnosing a pulmonary embolism can be challenging. Case presentation A 31-year-old nulliparous woman underwent cesarean section. Postoperatively, the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly. Venous ultrasonography confirmed thrombosis of the left common iliac vein. Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale. An acute pulmonary embolism was confirmed by pulmonary angiography. Catheter-directed thrombus fragmentation and thrombolysis were then performed. Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism. In extreme emergencies, when acute pulmonary embolism is the most likely diagnosis and life-threatening, catheter-directed angiography may be preferred over other approaches.

Suggestive evidence of genetic association of IL23R polymorphisms with chronic obstructive pulmonary disease risk in the Chinese population.

Chronic obstructive pulmonary disease (COPD) is a worldwide public health problem. Previous genetic association studies have identified several susceptibility loci in the interleukin genes that may participate in the nosogenesis of COPD. This study aimed to evaluate the relationship between IL23R loci and COPD susceptibility in the Chinese population. Agena MassARRAY technology was applied to genotype five single nucleotide polymorphisms (SNPs) in the IL23R gene in 498 COPD patients and 498 healthy people. The association between IL23R SNPs and COPD risk was calculated by logistic regression analysis, with odds ratios and 95% confidence intervals. The false-positive report probability analysis was noteworthy for evaluating the significant results. Also, haplotype analysis was performed among IL23R variants, and multifactor dimensionality reduction analysis was performed to assess the SNP-SNP interactions to predict the risk of COPD. Overall analysis showed that rs7517847 had a significant association with an increased risk of COPD. Age-stratified analysis revealed that rs7517847 was significantly related to an increased risk of COPD in people aged over 68 years old. Sex-stratified analysis illustrated a significant association between rs2295359 and rs7517847 and COPD risk in the female population. The significant association of COPD risk with IL23R SNPs was assessed by false-positive report probability values. Additionally, we observed that the haplotypes AAC and GGA formed by rs2201841, rs12743974 and rs10889677 were associated with a reduced risk of COPD (p = 0.009, p = 0.026). Also, the five-loci interaction model formed by rs2295359, rs7517847, rs2201841, rs12743974 and rs10889677 became the best predictor of COPD, with 10/10 cross-validation consistency and 52.4% testing balance accuracy. The research indicated a remarkable association between IL23R variants and COPD susceptibility in the Chinese population. Larger samples and functional research are required to ascertain the relationship between IL23R variants and COPD susceptibility.

Multi-ancestry genome-wide association analyses improve resolution of genes and pathways influencing lung function and chronic obstructive pulmonary disease risk

Lung-function impairment underlies chronic obstructive pulmonary disease (COPD) and predicts mortality. In the largest multi-ancestry genome-wide association meta-analysis of lung function to date, comprising 588,452 participants, we identified 1,020 independent association signals implicating 559 genes supported by ≥2 criteria from a systematic variant-to-gene mapping framework. These genes were enriched in 29 pathways. Individual variants showed heterogeneity across ancestries, age and smoking groups, and collectively as a genetic risk score showed strong association with COPD across ancestry groups. We undertook phenome-wide association studies for selected associated variants as well as trait and pathway-specific genetic risk scores to infer possible consequences of intervening in pathways underlying lung function. We highlight new putative causal variants, genes, proteins and pathways, including those targeted by existing drugs. These findings bring us closer to understanding the mechanisms underlying lung function and COPD, and should inform functional genomics experiments and potentially future COPD therapies.

SERPINA1 and More? A Putative Genetic Contributor to Pulmonary Dysfunction in Alpha-1 Antitrypsin Deficiency

Alpha-1 antitrypsin deficiency (AATD) is a common inherited disorder associated with an increased risk of pulmonary disease. Its clinical presentation, including the nature and severity of organ involvement, is highly variable and unpredictable and is not as strongly linked to genotype and environmental exposure (e.g., smoking history) as might be expected. Significant differences were observed within matched populations of severe AATD patients regarding risk of complications, age at onset, and disease course, including the dynamics of lung function decline. Genetic factors are among the putative modifiers contributing to the clinical variability in AATD, yet their role remains elusive. Here, we review and summarise our current understanding of epigenetic and genetic modifiers of pulmonary dysfunction in subjects with AATD.

Development and Internal Validation of Risk Assessment Models for Chronic Obstructive Pulmonary Disease in Coal Workers.

Coal workers are more likely to develop chronic obstructive pulmonary disease due to exposure to occupational hazards such as dust. In this study, a risk scoring system is constructed according to the optimal model to provide feasible suggestions for the prevention of chronic obstructive pulmonary disease in coal workers. Using 3955 coal workers who participated in occupational health check-ups at Gequan mine and Dongpang mine of Hebei Jizhong Energy from July 2018 to August 2018 as the study subjects, random forest, logistic regression, and convolutional neural network models are established, and model performance is evaluated to select the optimal model, and finally a risk scoring system is constructed according to the optimal model to achieve model visualization. The training set results show that the logistic, random forest, and CNN models have sensitivities of 78.55%, 86.89%, and 77.18%; specificities of 85.23%, 92.32%, and 87.61%; accuracies of 81.21%, 85.40%, and 83.02%; Brier scores of 0.14, 0.10, and 0.14; and AUCs of 0.76, 0.88, and 0.78, respectively, and similar results are obtained for the test set and validation set, with the random forest model outperforming the other two models. The risk scoring system constructed according to the importance ranking of random forest predictor variables has an AUC of 0.842; the evaluation results of the risk scoring system shows that its accuracy rate is 83.7% and the AUC is 0.827, and the established risk scoring system has good discriminatory ability. The random forest model outperforms the CNN and logistic regression models. The chronic obstructive pulmonary disease risk scoring system constructed based on the random forest model has good discriminatory power.

Longitudinal Effects of 1-Year Smoking Cessation on Human Bronchial Epithelial Transcriptome

Longitudinal Effects of 1-Year Smoking Cessation on Human Bronchial Epithelial Transcriptome

Polycyclic aromatic hydrocarbon exposure burden: Individual and mixture analyses of associations with chronic obstructive pulmonary disease risk

Accumulating data demonstrate that polycyclic aromatic hydrocarbons (PAH) exposure is linked to compromised respiratory diseases. This study aimed to analyze urinary PAH metabolites and their associations with chronic obstructive pulmonary disease (COPD) in a sample size of 3015 subjects from a total population of 50,588 from the National Health and Nutrition Examination Survey (NHANES) in 2007–2016. Results showed that the most predominant metabolite was 1-Hydroxynaphthalene (1-NAP, 84%) with a geometric mean concentration of 50,265 ng/L, followed by its homologue 2-NAP (10%), both of which arose from sources including road emission, smoking and cooking. Multiple logistic regression showed that seven of the ten major PAH metabolites were correlated with increased COPD risk: including 1-NAP (OR: 1.83, 95%CI: 1.25, 2.69), 2-Hydroxyfluorene (2-FLU, OR: 2.29, 95%CI: 1.42, 3.68) and 1-Hydroxyphenanthrene (1-PHE, OR: 2.79, 95%CI: 1.85, 4.21), when compared to the lowest tertile after adjusted for covariates. Total exposure burden per PAH congener sub-group demonstrated persistent positive correlation with COPD for ∑PHE (OR: 1.80, 95%CI: 1.34, 2.43) and ∑FLU (OR: 2.74, 95%CI: 1.77, 4.23) after adjusted for covariates. To address the contribution of PAH exposure as mixture towards COPD, weighted quantile sum (WQS) regression analyses revealed that 1-NAP, 9-Hydroxyfluorene (9-FLU), 3-Hydroxyfluorene (3-FLU) and 1-PHE were among the top contributors in the associations with COPD. Our results demonstrate the contemporary yet ongoing exposure burden of PAH exposure for over a decade, particularly towards NAPs and FLUs that contribute significantly to COPD risk, calling for more timely environmental regulation.

Causal association between iron deficiency anemia and chronic obstructive pulmonary disease: A bidirectional two-sample Mendelian randomization study

BackgroundObservational studies have found an association between iron deficiency anemia (IDA) and chronic obstructive pulmonary disease (COPD) risk. However, whether IDA plays a role in COPD development remains unclear. ObjectivesThis study was performed to explore the causal association between IDA and COPD. MethodsWe obtained summary statistics for IDA from 6087 cases and 211,115 controls of European ancestry in an open genome-wide association study (GWAS) to select strongly associated single nucleotide polymorphisms that could serve as instrumental variables for IDA (P < 5 × 10–8). Additional summary statistics for COPD were obtained from 6915 COPD cases and 186,723 controls of European ancestry from a publicly available GWAS. A bidirectional Mendelian randomization analysis was performed using inverse variance weighting as the primary method of analysis. The reliability of the results was verified by heterogeneity and sensitivity analysis. ResultsIDA increased the risk of COPD, with an odds ratio (OR) of 1.15 (95% confidence interval (CI: 1.04–1.25, p = 0.002). There was no evidence of a causal effect of COPD on IDA risk, with an OR of 0.99 (95% CI: 0.87–1.13, p = 0.91). The sensitivity analysis showed no evidence of heterogeneity or horizontal pleiotropy. ConclusionsWe found that IDA increases the risk of COPD. Additionally, there was no evidence that COPD increases the risk of IDA. Therefore, IDA should be considered in future COPD risk studies and reintroduced as a potential therapeutic target. The relationship between COPD and IDA risk requires further study using indirect mechanisms.

Effect of cigarette smoking on blood parameters in young smokers

This study set out to evaluate the detrimental impact of cigarette smoking on the metabolic characteristics of smokers, looking at how smoking altered physiological factors differently for both smokers and nonsmokers. The results showed a significant difference in hemoglobin content, a gauge of blood oxygenation, between smokers and non-smokers. The findings of the current investigation enable us to reach the following judgment: Leukocytes, average erythrocyte volume, and average hemoglobin content in erythrocytes are all increased by smoking cigarettes on a regular basis. These changes could raise the risk of cardiovascular disease, polycythemia, pulmonary disease, and/or atherosclerosis. According to the number of years of smoking, the groups of smokers in the analysis were divided, with smoking periods of 10 years or longer being the longest

Associations of the inflammatory diet index and smoking status with the risk of chronic obstructive pulmonary disease and lung cancer.

It remains unknown whether a low-inflammatory diet could modify the chronic obstructive pulmonary disease (COPD) and lung cancer risk related to smoking. To investigate the association between a low-inflammatory diet, smoking status, and the risk of COPD and lung cancer. A total of 171 050 COPD-free and lung cancer-free (mean age: 55.80) individuals were included in this study. COPD and lung cancer were defined as hospital admission. An inflammatory diet index (IDI) was developed based on C-reactive protein levels and was a weighted sum of 34 food groups. Participants were grouped into tertiles corresponding to IDI scores (lowest, middle, and highest). Over 2 091 071 person-years of follow-up, a total of 4007 individuals developed COPD (person-years: 2 075 579), and 1049 developed lung cancer. In comparison with the highest tertile of the IDI score, hazard ratios (HRs) and 95% confidence intervals (CIs) of COPD and lung cancer related to a low-inflammatory diet were 0.66 (0.61, 0.72) and 0.76 (0.65, 0.89), respectively. A low-inflammatory diet may prolong COPD onset by 1.88 (1.50, 2.27) years and lung cancer onset by 1.05 (0.45, 1.65) years. In joint effect analyses, participants with the lowest/middle IDI score and smoking had a significant 37% decrease in COPD risk and a 35% decrease in lung cancer risk compared to the participants with the highest IDI score and smoking. Replacing each standard deviation unit (≈1080.426 g day-1) of pro-inflammatory foods with anti-inflammatory foods was associated with a 30% lower COPD risk. Our findings suggest that a low-inflammatory diet may significantly mitigate the risk of smoking on COPD development, and delay the COPD onset by about 2 years. However, a low-inflammatory diet is associated with a reduced risk of lung cancer among only smokers. Substituting equal intake of pro-inflammatory foods with anti-inflammatory foods is related to a decreased risk of COPD, but not lung cancer.

Prevalence of chronic obstructive pulmonary disease and its risk factors among residents of Saint Petersburg and Arkhangelsk (based on the RESPECT project)

BACKGROUND: The study of the true prevalence of chronic obstructive pulmonary disease remains a significant area of research, as there is still a large gap between the official record of detected cases of the disease and epidemiological data. AIM: To study the prevalence of chronic obstructive pulmonary disease and its risk factors in two cities in the North-West region of Russia. MATERIALS AND METHODS: A random sample of respondents (2121 residents of Saint Petersburg, 1012 residents of Arkhangelsk); 2974 received qualitative results of spirometry (including 2388 with a bronchodilator test). The questionnaire included demographic, socioeconomic indicators, and risk factors for chronic obstructive pulmonary disease. RESULTS: The average age (54.9 9.2 and 52.3 9.2 years) and the proportion of respondents with higher education (37.4% and 29.7%) were higher in Saint Petersburg (compared to Arkhangelsk, p 0.0001). The proportion of ever smokers (49.5% and 44.4 %, p = 0.008), as well as the prevalence of chronic obstructive pulmonary disease (7.6% and 5.4%, p = 0.044), were higher in Saint Petersburg. In Arkhangelsk, exposure to biomass fuel and occupational hazards were more often noted. The prevalence of chronic obstructive pulmonary disease was higher in smokers and increased with age; the prevalence of smoking and chronic obstructive pulmonary disease was higher in men. CONCLUSIONS: The analysis of chronic obstructive pulmonary disease risk factors allows us to better understand not only the prevalence but also the structure and significance of each risk factor in different populations, which will improve the early diagnosis of the disease.

Die menschliche Gesundheit und der Zustand unserer globalen Umwelt sind eng miteinander verbunden

The scientific community agrees that we are in a phase of global warming and that we can expect an increase in extreme weather events in the future. According to the Intergovernmental Panel on Climate Change (IPCC), the main cause of this is human activity that heats up the atmosphere, oceans, and land masses. Thereby widespread damage to the environment and humans, beyond natural climate variability is caused. The impacts of climate change on human health are already present and could become more drastic in the future. Higher temperatures could lead to heat-related conditions, especially in the elderly population, small children and patients with chronic diseases. In addition, climate change increases pollen allergies, spreading of infectious diseases and, in combination with pollution, can raise the risk of cardiovascular and pulmonary diseases. Moreover, extreme climatic conditions as well as thinking of the thread imposed by climate change can have a psychological impact. Human health and the state of our global environment are closely linked. It is an urgent need to halt climate change as quickly as possible and thus mitigate its negative effects on human health. This requires comprehensive measures at the political, scientific, economic, industrial and personal levels.

The impact of Hospital Readmission Reduction Program on chronic obstructive pulmonary disease risk factors: a systematic review

Background: The objective of this systematic review is to summarize and assess the risk factors associated with chronic obstructive pulmonary disease (COPD) readmission following the enactment of the Patient Protection and Affordable Care Act and the Center for Medicare and Medicaid Services’ Hospital Readmission Reduction Program in 2015. Before the enactment of the Act, addressing the rising rate of COPD-related readmission was a quality improvement effort. However, the Act allowed for the creation of financial penalties to incentivize these improvements and set the reduction of readmission as a priority.

Prevalence and clinical characteristics of the dense fine speckled pattern: Indirect immunofluorescence‐antinuclear antibody screening in the Chinese population

AbstractTo investigate the prevalence and clinical significance of the dense fine speckled (DFS) pattern in a large‐scale cohort of Chinese patients. Data on the antinuclear antibody (ANA) and extractable nuclear antigen (ENA) autoantibody obtained from 165 498 patients who attended Peking Union Medical College Hospital from January 2019 to December 2021 were retrospectively analysed. The prevalence of the DFS pattern was 1.14%, and it mainly appeared in young patients (≤24 years old). A higher positive rate of the DFS pattern was observed in patients with dermatosis (18.12%) and systemic autoimmune rheumatic diseases (SARDs) (13.53%). The DFS pattern titre was mostly low or medium (≤1:160). A higher titre was associated with an increased risk of SARDs (p &lt; .001), dermatosis (p = .015) and pulmonary disease (p = .016). In 37 patients with ENA autoantibody positivity, anti‐SSA antibody was the most common (2.55%). If the low titre (&lt;1:160) or the DFS pattern with negative ENA autoantibody were to be used as exclusion criteria for SARDs, the diagnosis would have been missed in 42 or 77 patients, respectively. The prevalence of the DFS pattern was low in ANA test samples and was more common in patients with dermatosis and SARDs, but the titre was usually higher in patients with SARDs. There was no evidence that the DFS pattern could be used as an exclusion criterion for SARDs diagnosis. The DFS pattern was associated with certain pathological states, which may inform the clinical significance of the DFS pattern.

Comparison of two scores for short-term outcomes in patients with COPD exacerbation in the emergency department: the Ottawa COPD Risk Scale and the DECAF score.

While clinical decision rules have been developed to evaluate exacerbations and decisions on hospitalisation and discharge in emergency departments (EDs) in patients with chronic obstructive pulmonary disease (COPD), these rules are not widely used in EDs. In this study, we compare the predictive efficacy of the Ottawa Chronic Obstructive Pulmonary Disease Risk Scale (OCRS) and the Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score in estimating the short-term poor outcome of patients in our ED with exacerbations of COPD. This single-centre prospective observational study was conducted over 6 months. Patients with acute exacerbations of COPD admitted to the ED during the study period were included in the study. A poor outcome was defined as any of the following: readmission and requiring hospitalisation within 14 days of discharge, requiring mechanical ventilation on the first admission, hospitalisation for longer than 14 days on the first admission, or death within 30 days. The sensitivity and specificity of the OCRS and the DECAF score for a poor outcome and for mortality were calculated. Of the 385 patients who participated in the study, 85 were excluded based on the exclusion criteria. 66% of the patients were male, and the mean age was 70.15±10.36 years. A total of 20.7% of all patients (n=62) experienced poor outcomes. The sensitivity of an OCRS score <1 for predicting a poor outcome in patients was 96.8% (95% CI 88.8-99.6%) and the specificity was 18.5% (95% CI 13.8-24.0%). The sensitivity and specificity of an OCRS score <2 were 83.3% (95% CI 35.9-99.6%) and 65.5% (95% CI 59.6-70.7%), respectively. The sensitivity and specificity of a DECAF score <1 were 88.7% (95% CI 78.1-95.3%) and 34.5% (95% CI 28.4-40.9%), respectively. When the DECAF score was <2, sensitivity and specificity were 69.3% (95% CI 56.4-80.4%) and 74.8% (95% CI 68.8-80.2%), respectively. Our physicians achieved high specificity but low sensitivity in predicting a poor outcome. The OCRS is the more sensitive of the two tools, while the DECAF score is more specific in predicting a poor outcome when all threshold values are evaluated. While both tools may results in unnecessary hospitalisation, they can reduce the incidence of hospital discharge of patients with exacerbations of COPD who will develop poor outcomes in the ED.

A risk of pulmonary diseases in miners while using dust respirators

Purpose. To determine magnitudes of the occupational risks of respiratory disease (pneumoconiosis) occurrence in miners while using filter respirators on the basis of an exposure dust dose with the consideration of work experience. Methodology. To assess occupational risks, a new approach proposed by the Research Institute of Complex Hygiene and Occupational Diseases is used. The approach is based on determining an exposure dose of a hazardous substance entering the workers lungs during their professional contact with it taking into account the volume of pulmonary ventilation, the number of shifts, and work experience. Findings. Use of dust respirators reduces the risk of occupational respiratory diseases but does not eliminate it completely. It has been established that with more than three-year work experience and coal dust concentrations of more than 50 mg/m3, use of dust filter respirators does not ensure a minimal degree of the occupational disease risks. At the same time, it has been identified that if work experience is less than 3 years with the use of filter respirators, the risk of occupational diseases will be minimal. It has been proved that the risk assessment should involve using the minimal value of a protection factor of a respirator, which is fixed in the production environment. It has been shown that working within the areas with dust concentrations higher than 100 mg/m3 is dangerous for miners; over time, with the accumulation of sufficient dust in the lungs it will lead to the development of silicosis. Originality. It consists in scientific substantiation of the magnitude of occupational risk of respiratory diseases in miners, taking into account a real protection factor of respirators, which is determined at the workplace based on the calculation of an exposure dose and time of professional contact with hazardous substances. Practical value. The experience of safe operation in mine workings with and without using filter respirators has been substantiated, basing on a safe value of coal dust concentration, at which a low level of occupational risk of respiratory diseases is recorded. Recommendations for determining the dust load taking into account a protection factor of respirators at the workplace have been developed.