Differential diagnosis of adult asthma

Association of Electronic Cigarette Use with Respiratory Symptom Development among U.S. Young Adults

Rationale: Electronic cigarette (e-cigarette) use is highly prevalent among young adults. However, longitudinal data assessing the association between e-cigarette use and respiratory symptoms are lacking. Objectives: To determine whether e-cigarette use is associated with the development of respiratory symptoms in young adults. Methods: Data are derived from the PATH (Population Assessment of Tobacco and Health) study waves 2 (2014-2015), 3 (2015-2016), 4 (2016-2018), and 5 (2018-2019). Young adults aged 18-24 years at baseline with no prevalent respiratory disease or symptoms were included in the analyses. Binary logistic regression models with a generalized estimating equation were used to estimate time-varying and time-lagged associations of e-cigarette use during waves 2-4, with respiratory symptom development approximately 12 months later at waves 3-5. Measurements and Main Results: The per-wave prevalence of former and current e-cigarette use was 15.2% and 5.6%, respectively. Former e-cigarette use was associated with higher odds of developing any respiratory symptom (adjusted odds ratio [aOR], 1.20; 95% confidence interval [CI], 1.04-1.39) and wheezing in the chest (aOR, 1.41; 95% CI, 1.08-1.83) in multivariable adjusted models. Current e-cigarette use was associated with higher odds for any respiratory symptom (aOR, 1.32; 95% CI, 1.06-1.65) and wheezing in the chest (aOR, 1.51; 95% CI, 1.06-2.14). Associations persisted among participants who never smoked combustible cigarettes. Conclusions: In this nationally representative cohort of young adults, former and current e-cigarette use was associated with higher odds of developing wheezing-related respiratory symptoms, after accounting for cigarette smoking and other combustible tobacco product use.

Deep learning facilitates the diagnosis of adult asthma

BACKGROUND

We explored whether the use of deep learning to model combinations of symptom-physical signs and objective tests, such as lung function tests and the bronchial challenge test, would improve model performance in predicting the initial diagnosis of adult asthma when compared to the conventional machine learning diagnostic method.

METHODS

The data were obtained from the clinical records on prospective study of 566 adult out-patients who visited Kindai University Hospital for the first time with complaints of non-specific respiratory symptoms. Asthma was comprehensively diagnosed by specialists based on symptom-physical signs and objective tests. Model performance metrics were compared to logistic analysis, support vector machine (SVM) learning, and the deep neural network (DNN) model.

RESULTS

For the diagnosis of adult asthma based on symptom-physical signs alone, the accuracy of the DNN model was 0.68, whereas that for the SVM was 0.60 and for the logistic analysis was 0.65. When adult asthma was diagnosed based on symptom-physical signs, biochemical findings, lung function tests, and the bronchial challenge test, the accuracy of the DNN model increased to 0.98 and was significantly higher than the 0.82 accuracy of the SVM and the 0.94 accuracy of the logistic analysis.

CONCLUSIONS

DNN is able to better facilitate diagnosing adult asthma, compared with classical machine learnings, such as logistic analysis and SVM. The deep learning models based on symptom-physical signs and objective tests appear to improve the performance for diagnosing adult asthma.

Fractional Exhaled Nitric Oxide Testing: Diagnostic Utility in Asthma, Chronic Obstructive Pulmonary Disease, or Asthma-chronic Obstructive Pulmonary Disease Overlap Syndrome

Asthma and chronic obstructive pulmonary disease (COPD) can present as unique conditions or as a combination known as asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). These condition(s) can be categorized as obstructive conditions, causing inflammation of small airways leading to decrease airflow, mucus production, and bronchoconstriction. Asthma and COPD affect every age, gender, ethnicity, and socioeconomic status, thus increasing mortality and morbidity burden in our society. Fractional exhaled nitric oxide (FeNO) is an endogenous gaseous molecule which can be measured in the human breath test because of airway inflammation. It has been studied extensively as a marker of inflammation and has been incorporated into an algorithm for asthma management. The purpose of this study was to investigate whether FeNO testing can lead to a change in the diagnosis. A retrospective chart review of 95 patients with asthma, COPD, and ACOS was performed, and FeNO levels were recorded. Out of 95 patients, 36%, 24%, and 22% of the patients had an initial diagnosis of asthma, COPD, and ACOS, respectively. After the FeNO testing, the number of patients with the final diagnosis of asthma and ACOS increased, and COPD decreased. Our results support the utility of FeNO as a viable marker in diagnosing and managing complex cases of asthma, COPD, and ACOS.

Confounders of severe asthma: diagnoses to consider when asthma symptoms persist despite optimal therapy

Asthma can often be challenging to diagnose especially when patients present with atypical symptoms. Therefore, it is important to have a broad differential diagnosis for asthma to ensure that other conditions are not missed. Clinicians must maintain a high index of suspicion for asthma mimickers, especially when patients fail to respond to conventional therapy. The purpose of this review is to briefly review some of the more common causes of asthma mimickers that clinicians should consider when the diagnosis of asthma is unclear.

Moving toward consensus on diagnosis and management of severe asthma in adults

Asthma is a considerable health problem with an increasing global prevalence. The burden of severe asthma is expected to notably increase in the following years. Some misleading concepts that sometimes appear in the literature can drive the physician responsible for a patient's management to make incorrect decisions. Furthermore, some of the concepts that appear in the literature and in the guidelines may not be clear to understand, follow or adapt to regional and local realities. This could again drive the physicians responsible for a patient's management to make incorrect clinical judgments. In this article, we review the definition, prevalence and immunopathology of severe asthma, describe the asthma phenotypes, clinical features and comorbidities, the diagnosis of severe asthma and personalized asthma treatment. At the end, we offer a treatment approach based on literature publications, personalized medicine and marketed biologic treatment options.

Prevalence of over-/misdiagnosis of asthma in patients referred to an allergy clinic

OBJECTIVE

Increasing asthma incidence may be due to an overall increase in asthma awareness by physicians, potentially resulting in overdiagnosis. One of the unique features of asthma is bronchial hyperresponsiveness, which can be assessed by methacholine bronchial challenge (MBC). Overdiagnosis may result in over- or mistreatment. The aims of this study were to describe the prevalence of the over-/misdiagnosis of asthma and the use of anti-asthmatic drugs in patients with asthma-like symptoms who had not yet undergone a respiratory function assessment to confirm the diagnosis of asthma.

METHODS

This was a retrospective study analyzing all MBCs performed by our Outpatient Allergy Clinic in a two-year period to confirm/exclude the diagnosis of asthma in patients referred by general practitioners and complaining of asthma-like symptoms. Anti-asthmatic medications used by the patients until the MBC date were recorded.

RESULTS

43.8% of the reviewed MBCs were positive and 37.4% of the patients with a positive MBC were previously taking anti-asthmatic drugs (568.8 ± 76.4 mcg mean beclomethasone equivalents), compared to 51.2% of those patients with a negative MBC (464.8 ± 57.8 mcg). No differences were found in the daily doses of inhaled corticosteroids or other anti-asthmatic drugs, or in the duration of treatment before the assessment of bronchial hyperresponsiveness.

CONCLUSIONS

A sizeable percentage of subjects who reported physician-diagnosed asthma had a negative MBC. Nevertheless, a greater proportion of negative MBC patients were taking anti-asthmatic drugs compared to those with a confirmed diagnosis of asthma, illustrating that the overdiagnosis of asthma may lead to over- and mistreatment of respiratory symptoms.

Developing an Intelligent System for Diagnosis of Asthma Based on Artificial Neural Network

Introduction:

Lack of proper diagnosis and inadequate treatment of asthma, leads to physical and financial complications. This study aimed to use data mining techniques and creating a neural network intelligent system for diagnosis of asthma.

Methods:

The study population is the patients who had visited one of the Lung Clinics in Tehran. Data were analyzed using the SPSS statistical tool and the chi-square Pearson’s coefficient was the basis of decision making for data ranking. The considered neural network is trained using back propagation learning technique.

Results:

According to the analysis performed by means of SPSS to select the top factors, 13 effective factors were selected, in different performances, data was mixed in various forms, so the different modes was made for training the data and testing networks and in all different modes, the network was able to predict correctly 100% of all cases.

Conclusion:

Using data mining methods before the design structure of system, aimed to reduce the data dimension and the optimum choice of the data, will lead to a more accurate system. So considering the data mining approaches due to the nature of medical data is necessary.

Asthma in adolescents and adults

OVERVIEW

More than 16 million U.S. adults have asthma, a condition that prompts 2 million ED visits and nearly half a million hospital admissions annually. Management of this potentially deadly, chronic inflammatory disease depends on early diagnosis, accurate classification, appropriate treatment, and targeted patient education. This article outlines current guideline recommendations for asthma and reviews what clinicians need to teach patients about its pathophysiology, pharmacotherapy, self monitoring, and environmental control. The authors discuss the classic clinical presentation of the disease, describe how to assess severity and control, and explain how such assessments can guide management.

A wheezing child: breath sounds or bowel sounds?

Many children are brought to the emergency department because of respiratory symptoms including wheezing. Asthma is the most common but not the only cause of wheezing in children. There are many conditions, both pulmonary and extrapulmonary, which may cause recurrent wheezing. The diagnosis in children with congenital diaphragmatic hernia may be delayed. The late presentation of congenital diaphragmatic hernia poses a considerable diagnostic challenge. We report an 18-month-old child with congenital diaphragmatic hernia who presented with recurrent respiratory symptoms and localized physical findings. This case underscores the need to consider alternative diagnoses including congenital diaphragmatic hernia in the evaluation of recurrent respiratory symptoms; this is especially true if the presentation is not consistent with asthma or there are asymmetric findings on auscultation.

The relationship between psychogenic cough and the diagnosis and misdiagnosis of asthma: a review

The differential diagnoses of persistent nonproductive cough include numerous pulmonary and nonpulmonary organic disorders as well as functional illnesses. Many diseases can cause cough, and several studies have shown asthma among the most common etiologies associated with chronic cough in adult nonsmokers, as well as children. Psychogenic cough and its relationship to asthma and other asthma-like illnesses is complex since distinct maladies with similar features may coexist individually or in combination in any given patient. While chronic cough may occur as a sole presenting manifestation of bronchial asthma in all age groups, recent findings suggest that most children with persistent cough without other respiratory symptoms do not have asthma. Since several organic, as well as functional diseases, may present with persistent cough as their sole manifestation in either adults or children, cough should not be used as a single or major determinant to diagnose and treat asthma, especially when empirically focused therapy trials fail. Given the range of illnesses causing cough, no single management guideline can be expected to be universally effective.

Dental management of patients with obstructive pulmonary diseases

Many dental patients have obstructive pulmonary disease, such as chronic bronchitis, emphysema, and bronchial asthma. These diseases have different etiologies but may have overlapping signs and symptoms. Diagnosis and treatment are becoming more sophisticated so that morbidity and mortality are improving. Most dental patients with these morbidity and mortality are improving. Most dental patients with these disease can be treated safely with only minor adjustments to procedures. Cigarette smoking is a common risk factor that dental health care providers can address with a simple program called the five A's.