Severity Of Respiratory Symptoms Research Articles

Neuroradiological Features of Mild and Severe SARS-CoV-2 Infection

Rationale and ObjectivesAn increasing number of neurological complications and corresponding radiological findings have been reported in patients with COVID-19 infection. The purpose of this study is to systematically review the current literature on COVID-19-associated neuroradiological findings and examine the prevalence of different findings in patients with both severe and mild COVID-19 infection.Materials and MethodsA comprehensive literature search of the PubMed and Embase databases was performed. Any studies reporting CT or MRI neuroimaging findings in patients with confirmed COVID-19 infection were included. Patient demographics, main radiological findings, neurological symptoms, and severity of COVID-19 infection were tabulated and quantified according to infection severity.ResultsSixty-one studies published between 2019 and 2020 comprising 711 patients were analyzed according to severity of respiratory symptoms. The main neuroradiological findings for patients with mild classification were cranial nerve abnormalities, ischemic infarction, and white matter abnormalities, while the main findings in patients with severe classification were white matter abnormalities, ischemic infarction, and hemorrhagic events.ConclusionNeuroradiological manifestations in COVID-19 infection are highly heterogeneous and differ based on the severity of COVID-19 infection. Cranial nerve abnormalities appear exclusive to mild infection, with a high degree of olfactory tract involvement, while hemorrhagic events are more common in severe infection. Notably, ischemic infarction was equally prevalent in both mild and severe COVID-19 infection. Healthcare providers treating COVID-19 patients should be aware of these potential complications and consider neurological assessment and neuroimaging studies when indicated.

The Ethics of Feeding the Aspirating Child in an Age of Increasing Patient Complexity.

The Ethics of Feeding the Aspirating Child in an Age of Increasing Patient Complexity.

Exclusive E-Cigarette Users Report Lower Levels of Respiratory Symptoms Relative to Dual E-Cigarette and Cigarette Users.

IntroductionExclusive e-cigarette use has been shown to be associated with reduced levels of respiratory symptoms relative to smoking combustible cigarettes; this association has been less frequently studied in smokers using advanced-generation e-cigarette devices. Advanced-generation devices generate denser vapor than either early generation or pod-style devices, and engender longer inhalations; these vaping topography patterns may contribute to respiratory symptoms.MethodsIn a single-session, cross-sectional study of exclusive e-cigarette users (N = 59) and dual users of e-cigarettes and cigarettes (N = 54), participants completed questionnaires, including the American Thoracic Society Questionnaire (ATSQ) and were videotaped vaping their own device in the lab for 1 hour. Using a hierarchical regression method, we examined whether topography variables, level of nicotine concentration used in their e-cigarette device in the past month, e-cigarette dependence, amount of e-cigarette use in the past month, and smoking status (any smoking in the last month vs. none) predicted ATSQ score severity.ResultsThere was a significant mean difference in ATSQ score across smoking status, with greater ATSQ scores for vapers who also smoked cigarettes (19.0, SD = 6.7) than for exclusive vapers (13.4, SD = 5.3). In the final model, of the predictors of interest, only cigarette smoking status predicted significantly greater ATSQ scores (overall F = 2.51, p = .006; R2 = .26; smoking status β = 0.39, p < .0001).ConclusionsFindings suggest that differences in respiratory symptoms between dual and exclusive e-cigarette users appear to be attributable to combustible cigarette smoking, rather than more intense or frequent e-cigarette use across groups.ImplicationsIn this comparison of exclusive advanced-generation vape device users (N = 59) versus dual users of these devices and combustible cigarettes (N = 54), we set out to determine the extent to which smoking status and e-cigarette use variables predicted self-reported respiratory symptom severity. We found that dual users showed greater respiratory symptom severity (ATSQ scores) than exclusive vapers. Despite examining vaping topography and other variables, smoking status and race were the only significant predictor of respiratory symptoms. We conclude that combustible cigarette use, not individual vaping topography, likely accounts for differences in respiratory symptoms between dual users and exclusive vapers.

Excess Soluble fms-like Tyrosine Kinase 1 Correlates With Endothelial Dysfunction and Organ Failure in Critically Ill Coronavirus Disease 2019 Patients.

Excess soluble fms-like tyrosine kinase 1 (sFlt-1), a soluble inhibitor of the vascular endothelial growth factor pathway, has been demonstrated to promote endothelial dysfunction. Here we demonstrate that sFlt-1 plasma levels correlate with respiratory symptoms severity, expression of endothelial dysfunction biomarker and incidence of organ failure in COVID-19 patients.

A viral infection explanation for Kawasaki disease in general and for COVID-19 virus-related Kawasaki disease symptoms.

SARS-CoV-2, a new virus that appeared in Wuhan, China, in 2019 has approximately an 80% genomic match to the Severe Acute Respiratory Symptom (SARS) virus, which is known to come from a bat virus. Symptoms of Kawasaki disease in general and incomplete Kawasaki disease have been seen in a subset of pediatric patients having a current or previous infection of SARS-CoV-2. A viral infection, such as a SARS-CoV-2 virus infection, could result in extensive antigen–antibody immune complexes that cannot be quickly cleared in a subset of patients and thus create a type III hypersensitivity immune reaction and cause Kawasaki disease or Kawasaki disease symptoms (also known as multisystem inflammatory syndrome) in a subset of patients. Extensive binding of antibodies to viral antigens can create antigen–antibody immune complexes, which, if not eliminated in certain individuals having dysfunctional complement systems, can start inflammatory type III hypersensitivity symptoms, including protease releases that can disrupt epithelium, mesothelium, and endothelium basement membranes, and induce pervasive inflammation throughout the body. This could continue after SARS-CoV-2 infections end if the first wave of protease attacks on basement membranes created new secondary autoantibodies and new uncleared antigen–antibody immune complexes.

CXCR2 antagonist for patients with chronic obstructive pulmonary disease with chronic mucus hypersecretion: a phase 2b trial

BackgroundOral CXC chemokine receptor 2 (CXCR2) antagonists have been shown to inhibit neutrophil migration and activation in the lung in preclinical and human models of neutrophilic airway inflammation. A previous study with danirixin, a reversible CXCR2 antagonist, demonstrated a trend for improved respiratory symptoms and health status in patients with COPD.MethodsThis 26-week, randomised, double-blind, placebo-controlled phase IIb study enrolled symptomatic patients with mild-to-moderate COPD at risk for exacerbations. Patients received danirixin 5, 10, 25, 35 or 50 mg twice daily or placebo in addition to standard of care. Primary end-points were the dose response of danirixin compared with placebo on the incidence and severity of respiratory symptoms (Evaluating Respiratory Symptoms in COPD [E-RS:COPD] scores) and safety. Secondary end-points included the incidence of moderate-severe exacerbations, health status (COPD Assessment test, CAT) and health-related quality of life HRQoL (St. George Respiratory Questionnaire-COPD, SGRQ-C).ResultsA total of 614 participants were randomized to treatment. There were no improvements in E-RS:COPD, CAT or SGRQ-C scores in participants treated with any dose of danirixin compared to placebo; a larger than expected placebo effect was observed. There was an increased incidence of exacerbation in the danirixin-treated groups and an increased number of pneumonias in participants treated with danirixin 50 mg.ConclusionsThe robust placebo and study effects prohibited any conclusions on the efficacy of danirixin. However, the absence of a clear efficacy benefit and the observed increase in exacerbations in danirixin-treated groups suggests an unfavorable benefit-risk profile in patients with COPD.Trial registrationThis study was registered with clinicaltrials.gov, NCT03034967.

Association between Serum Hyponatremia and Severity of Respiratory Symptoms in Infants with Respiratory Syncytial Virus Infection

Association between Serum Hyponatremia and Severity of Respiratory Symptoms in Infants with Respiratory Syncytial Virus Infection

Quality of life of patients with chronic obstructive pulmonary disease with different risk of exacerbations

Aim. To study the quality of life (QoL) in patients with COPD depending on the exacerbation risk category and the phase of the disease in correlation with respiratory symptoms. Materials and methods . The study involved 53 patients with COPD who were divided into two groups. The group 1 included the patients of the low risk category of exacerbations (n=22), the group 2 had the patients in the high risk category (n=31). The frequency of exacerbations per year, the severity of respiratory symptoms, QoL using the CAT test and the mMRC scale were included in this analysis. Results. The level of QoL (according to the CAT test) in group 1 during exacerbation is significantly worse by 16.5% (p<0.05) than with stable COPD. In group 2, QoL was significantly lower than in group 1 at both points of the study (p <0.001). In most patients of group 1, the severity of dyspnea by mMRC was <2 points, in group 2 it was ≥ 2 points. Moreover, in group 1, the indicator was significantly lower than in group 2 (p<0.001). In patients of both groups during exacerbation, positive associations were found between the CAT test, severity of cough (r=0.31; p<0.05) and sputum (r=0.31; p<0.05). It was revealed that the risk of frequent symptoms with stable COPD in group 2 was significantly higher than in group I (RR=0.33; 95% CI [0.18-0.61]) and it increased in the period of exacerbation by 19% (RR=0.52; 95% CI [0.34-0.79]). Conclusion. Based on the data obtained, it was found out that QoL in patients with COPD is associated with a risk category of exacerbations and a phase of the disease. Regardless of the risk category, QoL, according to the CAT test, is associated with the severity of respiratory symptoms. The risk of frequent symptoms is increased in patients with COPD of the high risk category both during exacerbation and during the stable course of the disease, and is significantly higher than in patients of the low risk category.

Efficacy of Pleuran (β-Glucan from Pleurotus ostreatus) in the Management of Herpes Simplex Virus Type 1 Infection.

One of the highly prevalent viral pathogens among children and adults causing infection, clinically presenting as herpes labialis, is herpes simplex virus type 1 (HSV-1). The long-term administration of acyclovir, a standard regimen for therapy against HSV-1 infections, can cause viral resistance against this drug. Therefore, the development of natural drugs with low toxicity that are able to enhance host antiviral defense against HSV infection is needed. β-Glucans represent a type of biologically active molecules possessing antiviral properties. The goal of this study was to investigate the clinical and immunomodulatory effect of β-glucan pleuran (insoluble β-1,3/1,6-D-glucan isolated from Pleurotus ostreatus) based supplements on the duration and intensity of herpes symptoms and on the incidence rate and duration of acute respiratory symptoms and intercurrent diseases in HSV-1 positive patients. Ninety patients were randomised into active and placebo groups. Active treatment with pleuran in systemic application caused a significantly shorter duration of herpes simplex symptoms compared to the placebo group. During the preventive phase (120 days), the duration and severity of respiratory symptoms were lower in the active group compared to the placebo group; however, a significant difference was found only in the case of cough. No significant side effects were observed during both phases of the clinical trial (acute and preventive). Obtained results suggest that the use of pleuran seems to be a promising approach in the treatment of acute HSV-1 with beneficial effect on the respiratory tract symptoms and infections.

Detection of the SARS-CoV-2 humanized antibody with paper-based ELISA.

This work reports the development of a rapid, simple and inexpensive colorimetric paper-based assay for the detection of the severe acute respiratory symptom coronavirus 2 (SARS-CoV-2) humanized antibody. The paper device was prepared with lamination for easy sample handling and coated with the recombinant SARS-CoV-2 nucleocapsid antigen. This assay employed a colorimetric reaction, which is followed by horseradish peroxidase (HRP) conjugated detecting antibody in the presence of the 3,3',5,5'-tetramethylbenzidine (TMB) substrate. The colorimetric readout was evaluated and quantified for specificity and sensitivity. The characterization of this assay includes determining the linear regression curve, the limit of detection (LOD), the repeatability, and testing complex biological samples. We found that the LOD of the assay was 9.00 ng μL-1 (0.112 IU mL-1). The relative standard deviation was approximately 10% for a sample number of n = 3. We believe that our proof-of-concept assay has the potential to be developed for clinical screening of the SARS-CoV-2 humanized antibody as a tool to confirm infected active cases or to confirm SARS-CoV-2 immune cases during the process of vaccine development.

CXCL9 and CXCL10 are differentially associated with systemic organ involvement and pulmonary disease severity in sarcoidosis.

Sarcoidosis is a granulomatous inflammatory disease with limited blood markers to predict outcomes. The interferon-gamma (IFN-γ)-inducible chemotactic cytokines (chemokines), CXCL9 and CXCL10, are both increased in sarcoidosis patients, yet they possess important molecular differences. Our study determined if serum chemokines correlated with different aspects of disease severity. We measured CXCL9 and CXCL10 serum levels at initial study visits and longitudinally in sarcoidosis subjects using ELISA. We examined these chemokines' relationships with pulmonary and organ involvement outcomes, their gene expression, peripheral blood immune cell populations, and immunosuppression use. Higher CXCL10 levels negatively correlated with FVC, TLC, and DLCO at subjects' initial visit and when measured repeatedly over two years. CXCL10 also positively correlated with longitudinal respiratory symptom severity. Additionally, for every log10(CXCL10) increase, the risk of longitudinal pulmonary function decline increased 8.8 times over the 5-year study period (95% CI 1.6-50, p=0.014, log10(CXCL0) range 0.84-2.7). In contrast, CXCL9 levels positively correlated with systemic organ involvement at initial study visit (1.5 additional organs involved for every log10(CXCL9) increase, 95% CI 1.1-2.0, p=0.022, log10(CXCL9) range 1.3-3.3). CXCL10, not CXCL9, positively correlated with its own blood gene expression and monocyte level. Immunosuppressive treatment was associated with lower levels of both chemokines. In sarcoidosis subjects, serum CXCL9 levels correlated with systemic organ involvement and CXCL10 levels strongly correlated with respiratory outcomes, which may ultimately prove helpful in clinical management. These differing associations may be due to differences in cellular regulation and tissue origin.

Analysis of the impact of vaccination of pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with diabetes

The article presents data on the evaluation of the clinical efficacy of using a conjugated pneumococcal vaccine in patients with COPD in combination with 2-type diabetes during a 3-year follow - up period. The study included 309 patients with an isolated course of COPD and in combination with diabetes. The main parameters for evaluating the effectiveness were: the dynamics of clinical symptoms - shortness of breath on the mMRC scale, CAT test, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia, the state of carbohydrate metabolism (HbA1c) and the lipid profile. For vaccine prevention 13-valent conjugated pneumococcal vaccine Prevenar-13 was used. The use of PСV13 helps to reduce the severity of respiratory symptoms, reduce the number and duration of exacerbations of COPD, reduce the number of pneumonia. Both in isolated course of COPD and in combination with diabetes. Vaccination PCV13 in patients with comorbid course contributes to the compensation of carbohydrate metabolism and improve the lipid profile.

ROMANIAN AWARENESS CAMPAIGNS FOR EARLY DETECTION OF OBSTRUCTIVE LUNG DISEASE

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Obstructive Lungs Diseases are a major health problem and knowing its prevalence is extremely useful in health services planning. On World Asthma and COPD Days, Romanian Society of Pneumology (SRP) organized awareness campaigns consisting of press conference, radio campaign, dedicated website, free testing (spirometry) for general public. The aims of the study were (1) to identify subjects with airflow limitation, (2) to assess the relationships between the presence and severity of respiratory symptoms and spirometry values. METHODS: Spirometry and questionnaire has been performed in 2017. The questionnaire has 17 questions and addresses different issues, like possible suggestive symptoms, risk factors (smoking, noxious exposure, history of allergy), previous lung function tests, known obstructive lung disease, history of exacerbations, existence of any check-up or respiratory therapy. Statistical analysis has been done using Microsoft Office Excel 2007. RESULTS: A total of 650 persons with mean age = 60.4 ± 15.2 years were screened by spirometry, of which 33.3% (217) had lung function impairment with mean FEV1 = 67.6 ± 14%. From symptomatic ones 53.5% (239) had dyspnea, 66.2% (294) cough, 40.5% (181) chest tightness and 41.2% (184) wheezing. Although 31.7% (206) were symptomatic with smoking history, only 17% (35) of them had performed spirometry in the last 6 months. Moreover, 44% (286) were symptomatic with normal lung function and 23.7% (154) previously undiagnosed patients were detected with abnormal spirometry. Even if 20.6% (134) cases had diagnosis of lung disorder (37-asthma, 21-COPD, 5-emphysema, 71-bronchitis) only 52 had treated their disease and 24 had performed spirometry in the last 6 months. CONCLUSIONS: Disease severity: 73.7% (479) had at least an exacerbation/year, 28.2% received antibiotic treatment, 7% presented to the emergency room, 2.7% required hospitalization.Treating obstructive lung disease is still deficitary in Romania, pulmonologists was responsible for managing these disorders in less than 50% of cases. Atopies are more frequent in women, as well as tendency to be treated and seeing by physicians on regularly basis, for assessing asthma control. CLINICAL IMPLICATIONS: Epidemiological data on Obstructive Lung Disease prevalence are limited in Romania. Despite being a major health problem, its expected burden will increase in the coming decades, mostly due to continued exposure to risk factors, missed or delayed diagnosis, social and economical conditions. The campaigns were usefully for detecting new cases, but also for already diagnosed cases, who were not followed up properly, regarding treatment or assessing control. DISCLOSURES: No relevant relationships by Florin Mihaltan, source=Web Response No relevant relationships by RAMONA ELENA NEDELCU, source=Web Response No relevant relationships by Roxana Maria Nemes, source=Web Response No relevant relationships by Ruxandra Ulmeanu, source=Web Response

BURDEN OF RESPIRATORY SYMPTOMS IN STABLE COPD PATIENTS FROM CENTRAL EASTERN EUROPE: RESULTS FROM A LARGE OBSERVATIONAL STUDY

SESSION TITLE: Wednesday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Since 2011, the Global Initiative for Obstructive Lung Disease (GOLD) has included symptom burden in the multidimensional assessment of patients with chronic obstructive pulmonary disease (COPD). The prevalence and severity of 24-hour respiratory symptoms in COPD patients from Central Eastern Europe (CEE) is less known. METHODS: This was a multinational cross-sectional study (NCT03031769) in stable COPD patients from 11 countries. Out of 2162 patients enrolled, 1422 were from 5 CEE countries: Romania (RO) n=406, Poland (PL) n=356, Serbia (SB) n=250, Bulgaria (BG) n=210, and Slovakia (SK) n=200. All patients had COPD with duration of at least 1 year. Stable disease was defined as no exacerbation history or changes in maintenance treatment in the last 2 months before enrolment. Respiratory symptoms over the last 24 hours were evaluated using specific questionnaires: Night-time Symptoms of COPD Instrument-NiSCI, Early Morning Symptoms of COPD Instrument-EmSCI and the derivative questionnaire for stable patients from Evaluating Respiratory Symptoms in COPD (E-RS™:COPD) for daytime symptoms. COPD Assessment Test (CAT) was also used. RESULTS: The percentages of patients reporting at least one respiratory symptom in each period of the day in each country were as follows. Night-time (NT) symptoms: BG 84.8%, PL 61.8%, RO 71.4%, SK 77.5%, SB 66.8%; early morning (EM) symptoms: BG 93.8%, PL 89.6%, RO 87.7%, SK 92.0%, SB 80.4%; day-time (DT) symptoms: BG 99.5%, PL 94.7%, RO 92.6%, SK 95.5%, SB 90.8%. Across countries, mean severity scores between 0.6 and 1 for NT and between 0.8 and 1.1 for EM indicated mild symptoms. Mean severity scores for DT symptoms were: BG 14.7, PL 13.2, RO 12.5, SK 11.4 and SB 9.8 – out of a maximum of 40, with higher scores representing more severe symptoms. The impact of symptoms was most apparent for night awakenings (BG 39.5%, PL 28.7%, RO 36.0%, SK 34.0%, SB 27.2%) and tiredness during the day (BG 81.0%, PL 70.7%, RO 79.0%, SK 60.0%, SB 66.2%). Mean CAT scores ranged from 15 in SK and SB to almost 17 in PL, 19 in RO, and 19.2 in BG. The distribution of low burden (A/C) vs. high burden (B/D) symptom categories by GOLD 2017 report differed at country level: 27.2% vs. 72.8% in BG, 35.9% vs. 64.1% in PL, 27.6% vs. 72.4% in RO, 32.5% vs. 67.5% in SK and 48.4% vs. 51.6% in SB. The majority of patients received COPD maintenance treatment: 98.8% in PL and SB, 99% in RO and SK and 100% in BG. CONCLUSIONS: Despite regular treatment, symptoms place a high burden in stable COPD patients from CEE countries. Symptoms are variable and impact daily life of patients. CLINICAL IMPLICATIONS: Comprehensive assessment of respiratory symptoms can prove beneficial towards a more personalized treatment of patients with COPD. DISCLOSURES: Employee relationship with AstraZeneca Please note: $1001 - $5000 Added 03/10/2019 by Silviu Alecu, source=Web Response, value=Salary No relevant relationships by Adam Antczak, source=Web Response Employee relationship with AstraZeneca Please note: $1001 - $5000 Added 03/14/2019 by Yunqin Chen, source=Web Response, value=Salary No relevant relationships by Florin Mihaltan, source=Web Response No relevant relationships by Vesna Radulović, source=Web Response

Cold Weather Viruses.

1. Asif Noor, MD* 2. Theresa Fiorito, MD* 3. Leonard R. Krilov, MD*,† 1. *Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY 2. †Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY * Abbreviations: AAP: : American Academy of Pediatrics Adv: : adenovirus CDC: : Centers for Disease Control and Prevention FDA: : Food and Drug Administration hMPV: : human metapneumovirus PCR: : polymerase chain reaction PIV: : parainfluenza virus RSV: : respiratory syncytial virus RV: : rhinovirus Clinicians must learn to identify viral infections in children during the winter months and must practice caution with the use of unnecessary medications in such cases. Recognition of the clinical pattern of viral infection (eg, bronchiolitis) in conjunction with judicious use of viral tests (either office-based immunoassays or newer molecular tests) may assist in epidemiological monitoring, cohorting patients in the hospital, withholding unnecessary therapies, and providing a definitive diagnosis. After completing this article, readers should be able to: 1. Review the epidemiological aspects and clinical signs and symptoms of common cold weather viruses. 2. Recognize situations in which viral testing is indicated. 3. Recognize situations in which treatment is indicated. In early November you are evaluating a 9-month-old boy born at 33 weeks of gestation. The infant presents with 2 days of fevers (101°F–102°F [38.3°C–38.8°C]), copious rhinorrhea, and 1 day of coughing with difficulty breathing. He is otherwise feeding well and has had adequate urination. His 4-year-older sister has an upper respiratory tract infection. On physical examination, the infant has a respiratory rate of 45 breaths/min without chest wall retractions. On auscultation there is good air entry with scattered rhonchi bilaterally. What is the most appropriate next step in management? 1. Obtain respiratory syncytial virus (RSV) and influenza antigen testing. 2. Obtain a chest radiograph to look for focal infiltrate. 3. Provide supportive care with nasal …

Perimenstrual Asthma in Aspirin-Exacerbated Respiratory Disease

Aspirin-exacerbated respiratory disease (AERD) is a condition of the upper and lower respiratory tract characterized by reactions to nonsteroidal anti-inflammatory drugs. The Severe Asthma Research Program reported a strong association between perimenstrual asthma (PMA) and aspirin-sensitive asthma. To evaluate the prevalence and characteristics of PMA among a cohort of patients with AERD. Women 18 years and older enrolled in the Brigham and Women's AERD registry were surveyed about their reproductive, asthma, and sinus history. Subjects reporting the development of asthma before menopause were included. Continuous and categorical variables were compared between those reporting menstruation as a trigger for asthma symptoms and those who did not. Covariates expected a priori to have a positive effect on the odds of PMA were included in a multivariate logistic regression model to test associations between PMA and clinical factors. Among females of childbearing potential, 369 of 695 responded to the survey and 322 met inclusion criteria. Twenty-four percent of subjects (n= 74) reported PMA. Earlier age of AERD onset, concurrent worsening of sinus symptoms the week before or during menstruation, increased emergency department visits for asthma, and a change in the severity of respiratory symptoms at menopause were more common in PMA. Earlier age at first nonsteroidal anti-inflammatory drug-induced respiratory reaction and emergency department visits increased the odds of reporting PMA. PMA and increased sinus symptoms with menstruation are common in females with AERD. Females with AERD should be counseled about upper and lower respiratory symptom deterioration with menstruation.

Reliability, validity and responsiveness of E-RS:COPD in patients with spirometric asthma-COPD overlap

BackgroundThe Evaluating Respiratory Symptoms in Chronic Obstructive Pulmonary Disease (E-RS:COPD) is a patient-reported diary that assesses respiratory symptoms in stable COPD.MethodsThis post hoc analysis of a randomized, double-blind, parallel-arm trial (GSK ID: 200699; NCT02164539) assessed the structure, reliability, validity and responsiveness of the E-RS, and a separate wheeze item, for use in patients with a primary diagnosis of asthma or COPD, but with spirometric characteristics of both (fixed airflow obstruction and reversibility to salbutamol; a subset of patients referred to as spirometric asthma-COPD overlap [ACO]; N = 338).ResultsFactor analysis demonstrated that E-RS included Cough and Sputum, Chest Symptoms, and Breathlessness domains, with a Total score suitable for quantifying overall respiratory symptoms (comparative fit index: 0.9), consistent with the structure shown in COPD. The wheeze item did not fit the model. Total and domain scores were internally consistent (Cronbach’s alpha: 0.7–0.9) and reproducible (intra-class correlations > 0.7). Moderate correlations between RS-Total and RS-Breathlessness scores were observed with St George’s Respiratory Questionnaire (SGRQ) Total and Activity domain scores at baseline (r = 0.43 and r = 0.48, respectively). E-RS scores were sensitive to change when a patient global impression of change and SGRQ change scores were used to define responders, with changes of ≥ − 1.4 in RS-Total score interpreted as clinically meaningful.ConclusionsE-RS:COPD scores were reliable, valid and responsive in this sample, suggesting the measure may be suitable for evaluating the severity of respiratory symptoms and the effects of treatment in patients with asthma and COPD that exhibit spirometric characteristics of both fixed airflow obstruction and reversibility. Further study of this instrument and wheeze in new samples of patients with ACO is warranted.

Gulf War Illness and Inflammation: Association of symptom severity with C-reactive protein

Gulf War Illness (GWI) is a chronic multi-system condition that has affected one-third of U.S. veterans who served in the Persian Gulf. Although GWI etiology remains unclear, mounting evidence points to immune system involvement and inflammation, in particular, as underlying the host of symptoms associated with the condition. Here we investigated the association between GWI symptoms and C-reactive protein (CRP), a marker of inflammation, in 76 veterans with GWI. Results indicated a highly significant positive association between CRP and mean GWI symptom severity. At the symptom domain level, CRP was significantly and positively associated with Pain, Neurocognitive/Mood, Fatigue, and Respiratory symptom severity but not with Skin or Gastrointestinal symptom severity. These results support the premise that GWI symptoms, particularly those implicating brain involvement, are a result of neuroinflammation. The cause for inflammation is not known. We have hypothesized that at the root of GWI are harmful persistent antigens stemming from environmental exposures associated with service during the Gulf War that could not be successfully eliminated due to lack of specific immunity1,2. Work is underway in our laboratory to identify and eliminate persistent antigens in veterans with GWI which we anticipate will result in reduced inflammation and reduced GWI symptoms.

Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASS II): study protocol for a cluster randomised controlled trial of a community-based smoke-free homes intervention, with or without Indoor Air Quality feedback

BackgroundSecond-hand smoke (SHS) is a serious health hazard costing 890,000 lives a year globally. Women and children in many economically developing countries are worst affected as smoke-free laws are only partially implemented and homes remain a major source of SHS exposure. There is limited evidence on interventions designed to reduce SHS exposure in homes, especially in community settings. Following a successful pilot, a community-based approach to promote smoke-free homes in Bangladesh, a country with a strong commitment to smoke-free environments but with high levels of SHS exposure, will be evaluated. The study aims to assess the effectiveness and cost-effectiveness of a community-based intervention, Muslims for better Health (M4bH), with or without Indoor Air Quality (IAQ) feedback, in reducing non-smokers’ exposure to SHS in the home.Methods/designBased on behaviour-change theories, M4bH and IAQ feedback are designed to discourage people from smoking indoors. M4bH consists of a set of messages couched within mainstream Islamic discourse, delivered weekly by faith leaders (imams and khatibs) in mosques over 12 weeks (one message each week). The messages address key determinants of current smoking behaviours including lack of knowledge and misconceptions on specific harms associated with SHS exposure. IAQ feedback consists of personalised information on IAQ measured by a particulate matter (PM2.5) monitor within the home. Following adaptation of M4bH and IAQ feedback for the Bangladeshi context, a three-arm cluster randomised controlled trial will be conducted in Dhaka. Forty-five mosques and 1800 households, with at least one smoker and one non-smoker, will be recruited. Mosques will be randomised to: M4bH and IAQ feedback; M4bH alone; or usual services only. The primary outcome is 24-h mean household concentration of indoor fine particulate matter (PM2.5) at 12 months post randomisation. Secondary outcomes are 24-h mean household PM2.5 at 3 months post randomisation, frequency and severity of respiratory symptoms, health care service use and quality of life. A cost-effectiveness analysis and process evaluation will also be conducted.DiscussionThe MCLASS II trial will test the potential of a community-based intervention to reduce second-hand smoke exposure at home and improve lung health among non-smokers in Bangladesh and beyond.Trial registrationISRCTN, ISRCTN49975452. Registered on 11 January 2018.

Lung Function in Users of a Smoke-Free Electronic Device With HeatSticks (iQOS) Versus Smokers of Conventional Cigarettes: Protocol for a Longitudinal Cohort Observational Study.

BackgroundChronic obstructive pulmonary disease (COPD) is a global public health problem. It is the third-leading cause of death in the world, the fourth leading cause of death in Kazakhstan, and is strongly associated with smoking. Smoking cessation reduces the severity of respiratory symptoms and COPD exacerbations. Heated tobacco products, such as HeatSticks heated by the iQOS device, a smoke-free electronic device, may serve as less risky alternatives to conventional combustible cigarettes.ObjectiveThe purpose of this study is to evaluate frequency of exacerbations, respiratory symptoms, physical exercise intolerance, and abnormal lung functions, as well as other parameters and comorbidities among men and women aged 40-59 residing in Almaty, Kazakhstan, who use iQOS with HeatSticks compared to smokers of conventional cigarettes.MethodsThis is a 5-year single-center cohort observational study. It includes two cohorts of participants consisting of men and women aged 40-59 residing in the city of Almaty, Kazakhstan: (1) smokers of combustible cigarettes (control group) and (2) users of iQOS with HeatSticks (exposure group). The study has baseline and periodic (ie, annual) comprehensive clinical assessments, as well as continuous COPD case-finding activities and registration of acute respiratory exacerbations over the course of the 5-year observation period. Study measures include spirometry, chest computed tomography, electrocardiography, physical exams, laboratory testing of serum for biomarkers of inflammation and metabolic syndrome, anthropometry, and the 6-minute walk test. Information about COPD symptoms will be collected using the COPD Assessment Test.ResultsParticipant recruitment began December 2017, and enrollment is expected to last until late summer 2018.ConclusionsThis is the first cohort observational study in Kazakhstan to assess differences in lung function between users of the heated tobacco product, iQOS with HeatSticks, and smokers of conventional combustible cigarettes. The study results will add to knowledge on whether switching from combustible cigarettes to iQOS with HeatSticks affects respiratory symptoms and diseases, including the development and progression of COPD.Trial RegistrationClinicalTrials.gov NCT03383601; https://clinicaltrials.gov/ct2/show/NCT03383601 (Archived by WebCite at http://www.webcitation.org/72BYoAKxa)International Registered Report Identifier (IRRID)PRR1-10.2196/10006