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Ari A, Raghavan N, Diaz M, Rubin BK, Fink JB. Individualized aerosol medicine: Integrating device into the patient. Paediatr Respir Rev 2024; 49:14-23. [PMID: 37739833 DOI: 10.1016/j.prrv.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 09/24/2023]
Abstract
Pulmonary drug delivery is complex due to several challenges including disease-, patient-, and clinicians-related factors. Although many inhaled medications are available in aerosol medicine, delivering aerosolized medications to patients requires effective disease management. There is a large gap in the knowledge of clinicians who select and provide instructions for the correct use of aerosol devices. Since improper device selection, incorrect inhaler technique, and poor patient adherence to prescribed medications may result in inadequate disease control, individualized aerosol medicine is essential for effective disease management and control. The components of individualized aerosol medicine include: (1) Selecting the right device, (2) Selecting the right interface, (3) Educating the patient effectively, and (4) Increasing patient adherence to therapy. This paper reviews each of these components and provides recommendations to integrate the device and interface into the patient for better clinical outcomes.
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Affiliation(s)
- Arzu Ari
- Texas State University, Department of Respiratory Care, USA.
| | | | - Martha Diaz
- Latin American Board of Certification in Respiratory Therapy, Colombia
| | - Bruce K Rubin
- Virginia Commonwealth University School of Medicine, USA.
| | - James B Fink
- Texas State University, Department of Respiratory Care, USA; Aerogen Pharma, USA.
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2
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Clark G, Fitzgerald DA, Rubin BK. Cough medicines for children- time for a reality check. Paediatr Respir Rev 2023; 48:30-38. [PMID: 37718235 DOI: 10.1016/j.prrv.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
Cough medicines have been in use for over a century to treat the common and troublesome, but often helpful, symptoms of cough in children. They contain various combinations of "anti-tussive" drugs including opioids, antihistamines, herbal preparations, mucolytics, decongestants and expectorants. Whilst theoretically attractive for symptom relief when children are suffering, as time has passed these popular over the counter medicines have been shown to lack efficacy, delay more serious underlying diagnoses, and can cause complications and sometimes death. This has resulted in clinician concerns, a citizen petition to the American Food and Drug Association in 2007, some self-regulation from manufacturers and escalating restrictions on their use from regulatory agencies across the world over the last twenty years. This article will review the protective role of cough, juxtapose the conflicting treatment goals of suppressing a dry cough and promoting expectoration for a wet cough, consider the evidence basis for prescribing cough medicines in comparison to other more specific treatments such as for asthma [beta agonists] or infection [antibiotics], regulatory interventions, and conclude with the view that over counter cough medicines should not be used in children, especially young children.
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Affiliation(s)
- Gene Clark
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, NSW, Australia
| | - Bruce K Rubin
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA; The Children's Hospital of Richmond at VCU, Richmond, VA, USA.
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Davis MD, Brockbank J, Hayden R, Schechter MS, Rubin BK. Nocturnal High-Flow Nasal Cannula Therapy and Sinonasal Symptoms During Cystic Fibrosis Exacerbations. Respir Care 2023; 68:1527-1531. [PMID: 37253609 PMCID: PMC10589103 DOI: 10.4187/respcare.09890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Both nasal obstruction and sleep disturbance are common in patients with cystic fibrosis (CF). In patients with obstructive sleep apnea (OSA), studies suggest that these conditions are related and that nasal congestion improves with CPAP therapy. We hypothesized that subjects admitted to hospital for therapy of an exacerbation of CF would have both nasal symptoms and sleep disturbance and that these would improve with the initiation of nocturnal high-flow nasal cannula therapy (HFNC). METHODS Twenty-five subjects with an exacerbation of CF were enrolled to randomly receive either 5 d of nocturnal HFNC at 20 L/min in the treatment group or 5 L/min of nocturnal nasal cannula air at ambient temperature and humidity in the low-flow group. On the first and last day of the study, the Sino-Nasal Outcome Test (SNOT-20) was administered to evaluate nasal symptoms, and sleep quality was measured using the Actiwatch 2. RESULTS Fifteen subjects completed the study (6 HFNC, 9 low flow). We confirmed that subjects had significant sleep disturbance that did not improve over the 5 d of the study. Subjects also had disturbing nasal symptoms that significantly improved only in those receiving HFNC (pre 14 [20] vs post 6 [13], P = .027). CONCLUSIONS Similar to what has been reported in older subjects with OSA, nocturnal HFNC improves sinonasal symptoms in subjects with an exacerbation of CF. There was no measurable effect on sleep quality, which may be due to the short duration of the study, or to subjects being evaluated while being treated in a hospital setting.
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Affiliation(s)
- Michael D Davis
- Herman B. Wells Center for Pediatric Research/Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, Indiana; and Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
| | - Justin Brockbank
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Ryan Hayden
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Michael S Schechter
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
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4
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Rubin BK. Plastic bronchitis: Casting a wider net. Pediatr Pulmonol 2023; 58:3001-3002. [PMID: 37750595 DOI: 10.1002/ppul.26707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Bruce K Rubin
- Pediatrics and Biomedical Engineering, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Davis MD, Saunders JL, Crandall CN, Engberg RJ, Zhao Y, DiBlasi R, Rubin BK. In vitro-in vivo correlation of aerosol deposition before and after metered-dose inhaler coaching in healthy children. J Breath Res 2023; 17. [PMID: 36996807 DOI: 10.1088/1752-7163/acc8f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023]
Abstract
Although pressurized metered dose inhaler (pMDI) education is a routine part of childhood asthma management and encouraging "optimal breathing patterns" (i.e., slowly, deeply, completely, and with a mouth seal on the mouthpiece) is an integral part of recommended pMDI education, there is currently no quantifiable way to determine if a child is inhaling their medication correctly or optimally through a valved holding chamber (VHC). The TipsHaler™ (tVHC) is a prototype VHC device that measures inspiratory time, flow, and volume without changing the properties of the medication aerosol. The measurements in vivo recorded by the tVHC can be downloaded and transferred to a spontaneous breathing lung model to simulate the inhalational patterns in vitro and also determine the deposition of inhaled aerosol mass with each pattern. We hypothesized that pediatric patients' inhalational patterns when using a pMDI would improve after active coaching via tVHC. This would increase the pulmonary deposition of inhaled aerosols in an in vitro model. To test this hypothesis, we conducted a single-site, prospective, pilot, pre-and-post intervention study paired with a bedside-to-bench experiment. Healthy, inhaler-naïve subjects used a placebo inhaler in conjunction with the tVHC before and after coaching and recorded inspiratory parameters. These recordings were then implemented into a spontaneous breathing lung model during albuterol MDI delivery, and pulmonary deposition of albuterol was quantified. In this pilot study, active coaching resulted in a statistically significant increase in inspiratory time (n = 8, p = 0.0344, 95%CI: 0.082 to ∞). tVHC recorded inspiratory parameters obtained from patients were successfully implemented in the in vitro model, which demonstrated that both inspiratory time (n = 8, r = 0.78, p < 0.001, 95%CI: 0.47 to 0.92) and volume (n = 8, r = 0.58, p = 0.0186, 95%CI: 0.15 to 0.85) strongly correlate with pulmonary deposition of inhaled drugs.
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Affiliation(s)
- Michael D Davis
- Pulmonary Medicine, Herman B Wells Center for Pediatric Research, 1044 West Walnut Street R4-472, Indianapolis, Indiana, 46202, UNITED STATES
| | - Jessica L Saunders
- Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, Indiana, 46202, UNITED STATES
| | - Coral N Crandall
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington, 98101-1309, UNITED STATES
| | - Rebecca J Engberg
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington, 98101-1309, UNITED STATES
| | - Yi Zhao
- Biostatistics, Indiana University School of Medicine, 340 W. 10th Street, Indianapolis, Indiana, 46202-5114, UNITED STATES
| | - Rob DiBlasi
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington, 98101-1309, UNITED STATES
| | - Bruce K Rubin
- Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, 1001 E. Marshall Street, Richmond, Virginia, 23298, UNITED STATES
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Pangeni R, Meng T, Poudel S, Sharma D, Hutsell H, Ma J, Rubin BK, Longest W, Hindle M, Xu Q. Airway mucus in pulmonary diseases: Muco-adhesive and muco-penetrating particles to overcome the airway mucus barriers. Int J Pharm 2023; 634:122661. [PMID: 36736964 PMCID: PMC9975059 DOI: 10.1016/j.ijpharm.2023.122661] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Airway mucus is a complex viscoelastic gel that provides a defensive physical barrier and shields the airway epithelium by trapping inhaled foreign pathogens and facilitating their removal via mucociliary clearance (MCC). In patients with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), non-CF bronchiectasis, and asthma, an increase in crosslinking and physical entanglement of mucin polymers as well as mucus dehydration often alters and typically reduces mucus mesh network pore size, which reduces neutrophil migration, decreases pathogen capture, sustains bacterial infection, and accelerates lung function decline. Conventional aerosol particles containing hydrophobic drugs are rapidly captured and removed by MCC. Therefore, it is critical to design aerosol delivery systems with the appropriate size and surface chemistry that can improve drug retention and absorption with the goal of increased efficacy. Biodegradable muco-adhesive particles (MAPs) and muco-penetrating particles (MPPs) have been engineered to achieve effective pulmonary delivery and extend drug residence time in the lungs. MAPs can be used to target mucus as they get trapped in airway mucus by steric obstruction and/or adhesion. MPPs avoid muco-adhesion and are designed to have a particle size smaller than the mucus network, enhancing lung retention of particles as well as transport to the respiratory epithelial layer and drug absorption. In this review, we aim to provide insight into the composition of airway mucus, rheological characteristics of airway mucus in healthy and diseased subjects, the most recent techniques to study the flow dynamics and particle diffusion in airway mucus (in particular, multiple particle tracking, MPT), and the advancements in engineering MPPs that have contributed to improved airway mucus penetration, lung distribution, and retention.
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Affiliation(s)
- Rudra Pangeni
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Tuo Meng
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sagun Poudel
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Divya Sharma
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hallie Hutsell
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Ma
- Department of Pediatrics, Children's Hospital of Richmond, Richmond, VA, USA
| | - Bruce K Rubin
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA; Department of Pediatrics, Children's Hospital of Richmond, Richmond, VA, USA
| | - Worth Longest
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA; Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Qingguo Xu
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA; Department of Ophthalmology, Massey Cancer Center, Center for Pharmaceutical Engineering, and Institute for Structural Biology, Drug Discovery & Development (ISB3D), Virginia Commonwealth University, Richmond, VA, USA.
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7
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Rubin BK. Race, bias, disparities, and pulmonary medicine. Paediatr Respir Rev 2023; 45:1. [PMID: 36681550 DOI: 10.1016/j.prrv.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
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8
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Dodson KM, Indeyeva YA, Ma J, Yopp MA, Tokita E, Rubin BK. The effect of oral guaifenesin on pediatric chronic rhinitis: A pilot study. Am J Otolaryngol 2023; 44:103787. [PMID: 36706714 DOI: 10.1016/j.amjoto.2023.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate the effectiveness of guaifenesin in the relief of nasal symptoms in children with chronic rhinitis (CR). We hypothesized that guaifenesin use over a 14-day study period would improve subjective nasal complaints in pediatric patients with chronic rhinitis, as measured by the SinoNasal-5 (SN-5) survey. We also hypothesized improvement in nasal volume and cross-sectional area with guaifenesin. STUDY DESIGN Randomized, placebo-controlled, parallel group, masked clinical trial. METHODS The study consisted of a 14-day, randomized, placebo-controlled, parallel group, masked clinical trial of oral guaifenesin for CR in children aged 7-18 years. A 2:1 ratio of subjects on active medication to placebo was used. The study was approved by the Western Institutional Review Board. On initial enrollment and at the conclusion of therapy, the SN-5 was completed by parents, acoustic rhinometry measurements performed, and mucus sampling for rheology was obtained. RESULTS 30 subjects were enrolled in the study, with 20 receiving guaifenesin and 10 placebo. Treatment with guaifenesin for 14 days produced a significant mean change towards clinical improvement in SN-5 scores compared with placebo (p = 0.013). There was no significant difference in quality of life assessment scores between the two groups or in any of the acoustic rhinometry parameters. Many of the study subjects had difficulty producing a mucus sample sufficient for analysis. CONCLUSIONS Based upon our pilot data, it appears that guaifenesin treatment may produce objective improvements in pediatric patients with CR. Further research with larger samples sizes, inclusion of children younger than 6, and biophysical mucus analyses is warranted. LEVEL OF EVIDENCE Level 2b.
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Affiliation(s)
- Kelley M Dodson
- Department of Otolaryngology/Head and Neck Surgery, Children's Hospital of Richmond at Virginia Commonwealth University Health System, 1000 E. Broad St, Pod 4F, Box 980146, Richmond, VA 23298, United States of America.
| | - Yula A Indeyeva
- Facial Plastic Surgery of Austin, Austin, TX, United States of America
| | - Jonathan Ma
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, VA, United States of America
| | - Melissa A Yopp
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, VA, United States of America
| | - Erika Tokita
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, VA, United States of America
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9
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Cohen MB, Aban I, Artman M, Binney G, Blake A, Boney C, First L, Gessouroun M, Rubin BK, Taylor M, Emmanuel P. Pediatric Chair Turnover and Demographics. J Pediatr 2022; 242:4-7.e3. [PMID: 34390691 DOI: 10.1016/j.jpeds.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mitchell B Cohen
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
| | - Inmaculada Aban
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Artman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Geoffrey Binney
- Department of Pediatrics, Tufts Children's Hospital, Boston, MA
| | | | - Charlotte Boney
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Lewis First
- Department of Pediatrics, The Robert Larner, MD College of Medicine at The University of Vermont and University of Vermont Children's Hospital, Burlington, VT
| | - Morris Gessouroun
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Mary Taylor
- Department of Pediatrics, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
| | - Patricia Emmanuel
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL
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10
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McGarvey L, Rubin BK, Ebihara S, Hegland K, Rivet A, Irwin RS, Bolser DC, Chang AB, Gibson PG, Mazzone SB. Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report. Chest 2021; 160:1413-1423. [PMID: 33905678 PMCID: PMC8692102 DOI: 10.1016/j.chest.2021.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the American College of Chest Physicians (CHEST) 2006 guideline on global physiology and pathophysiology of cough. STUDY DESIGN AND METHODS A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 using prespecified search terms. RESULTS We describe the demographics of typical patients with cough in the clinical setting, including how cough characteristics change across age. We summarize the effect of common clinical conditions impacting cough mechanics and the physical properties of mucus on airway clearance. INTERPRETATION This is the second of a two-part update to the 2006 CHEST cough guideline; it complements part one on basic phenomenology of cough by providing an extended clinical picture of cough along with the factors that alter cough mechanics and efficiency in patients. A greater understanding of the physiology and pathophysiology of cough will improve clinical management.
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Affiliation(s)
- Lorcan McGarvey
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Satoru Ebihara
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Karen Hegland
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL
| | - Alycia Rivet
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA
| | - Donald C Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, FL
| | - Anne B Chang
- Division of Child Health, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland's University of Technology, Brisbane, QLD, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart B Mazzone
- Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
The Covid-19 pandemic has disrupted organised sport in the community as authorities cancelled, greatly modified or postponed sporting participation as part of a strategy to reduce transmission of the virus. This had a significant impact on young athletes and their families in relation to their psycho-social, physical and career progression considerations. The disruption is likely to continue for some years, considering the constraints of lockdowns, the need to overcome dysfunctional national logistics for delivery of medical care, fund and implement an efficacious vaccine programme locally, nationally and worldwide, develop sufficient herd immunity and create an environment of confidence in the safety of returning to sports for participants, coaches, umpires, administrators and observers. This article will consider the interim challenges regarding the physical and psychosocial importance of maintaining an active sporting programme for young athletes, reflect on safety measures for modifying sporting equipment and environmental protections to allow safest participation in training and competition and provide advice on protocols for a gradual return to sport for the young athlete after infection with Covid-19.
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Affiliation(s)
- Hugh T Fitzgerald
- Exercise Physiology, School of Medical Sciences, University of New South Wales, Kensington, NSW 2052, Australia
| | - Sam T Rubin
- Biomedical Engineering, Clemson University, Clemson, SC, USA
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital at Westmead Clinical School, Faculty of Health Sciences, University of Sydney, Westmead 2145, Australia
| | - Bruce K Rubin
- Jessie Ball duPont Distinguished Professor, Dept. of Pediatrics Professor of Biomedical Engineering Virginia Commonwealth University School of Medicine Virginia Eminent Scholar in Pediatrics 1000 East Broad St.Richmond, VA 23298 USA.
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12
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Rubin BK. The guardians of the airway. Paediatr Respir Rev 2021; 38:1. [PMID: 34020907 DOI: 10.1016/j.prrv.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Bruce K Rubin
- Jessie Ball duPont Distinguished Professor, Dept. of Pediatrics, Professor of Biomedical Engineering, Virginia Commonwealth University School of Medicine, Virginia Eminent Scholar in Pediatrics, 1000 East Broad St, Richmond, VA 23298 USA.
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Kummarapurugu AB, Zheng S, Pulsipher A, Savage JR, Ma J, Rubin BK, Kennedy TP, Voynow JA. Polysulfated Hyaluronan GlycoMira-1111 Inhibits Elastase and Improves Rheology in Cystic Fibrosis Sputum. Am J Respir Cell Mol Biol 2021; 64:260-267. [PMID: 33264072 DOI: 10.1165/rcmb.2020-0157oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cystic fibrosis (CF) lung disease is marked by high concentrations of neutrophil elastase (NE) and DNA polymers; both factors contribute to airway disease. Although inhaled recombinant human dornase alfa reduces the frequency of CF pulmonary exacerbations, it also increases free NE activity in the sputum. There are no approved anti-NE therapies for patients with CF. We investigated whether synthetic, low-molecular weight polysulfated hyaluronan GlycoMira-1111 (GM-1111) would be effective as an anti-NE drug using ex vivo CF sputum. Anti-NE activity of GM-1111 was tested in CF sputum in the presence or absence of dornase alfa and/or hypertonic saline using a spectrophotometric assay specific for human NE and was compared with unfractionated heparin. We tested whether GM-1111 disaggregated DNA from CF sputum (using gel electrophoresis analysis) or modified CF sputum viscoelastic properties (using a dynamic rheometer). GM-1111 and unfractionated heparin had near equivalent anti-NE activity in CF sputum in the presence of dornase alfa. Both GM-1111 and unfractionated heparin retained anti-NE activity in hypertonic saline but with decreased activity. GM-1111 increased the release of soluble DNA in CF sputum, resulting in improved depolymerization efficacy of dornase alfa. GM-1111 decreased CF sputum elasticity. GM-1111 inhibited NE activity, enhanced DNA depolymerization by deoxyribonuclease, and decreased viscoelastic properties of CF sputum, similar to effects reported previously for unfractionated heparin. Unlike heparins, GM-1111 is synthetic, with minimal anticoagulant activity, and is not derived from animal products. These key attributes provide advantages over unfractionated heparin as a potential therapeutic for CF.
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Affiliation(s)
- Apparao B Kummarapurugu
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Shuo Zheng
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Jonathan Ma
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Bruce K Rubin
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Thomas P Kennedy
- GlycoMira Therapeutics, Salt Lake City, Utah; and.,Department of Medicine, Tulane Medical Center, New Orleans, Louisiana
| | - Judith A Voynow
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
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Yoshikawa H, Komiya K, Yamamoto T, Fujita N, Oka H, Okabe E, Yamasue M, Umeki K, Rubin BK, Hiramatsu K, Kadota JI. Quantitative assessment of erector spinae muscles and prognosis in elderly patients with pneumonia. Sci Rep 2021; 11:4319. [PMID: 33619334 PMCID: PMC7900176 DOI: 10.1038/s41598-021-83995-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/05/2021] [Indexed: 11/09/2022] Open
Abstract
Erector spinae muscle (ESM) size has been reported as a predictor of prognosis in patients with some respiratory diseases. This study aimed to assess the association of ESM size on all-cause in-hospital mortality among elderly patients with pneumonia. We retrospectively included patients (age: ≥ 65 years) admitted to hospital from January 2015 to December 2017 for community-acquired pneumonia who underwent chest computed tomography (CT) on admission. The cross-sectional area of the ESM (ESMcsa) was measured on a single-slice CT image at the end of the 12th thoracic vertebra and adjusted by body surface area (BSA). Cox proportional hazards regression models were used to assess the influence of ESMcsa/BSA on in-hospital mortality. Among 736 patients who were admitted for pneumonia, 702 patients (95%) underwent chest CT. Of those, 689 patients (98%) for whom height and weight were measured to calculate BSA were included in this study. Patients in the non-survivor group were significantly older, had a greater frequency of respiratory failure, loss of consciousness, lower body mass index, hemoglobin, albumin, and ESMcsa/BSA. Multivariate analysis showed that a lower ESMcsa/BSA independently predicted in-hospital mortality after adjusting for these variables. In elderly patients with pneumonia, quantification of ESMcsa/BSA may be associated with in-hospital mortality.
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Affiliation(s)
- Hiroki Yoshikawa
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.,Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan.,Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street, KMSB, Room 215, Richmond, VA, 23298, USA
| | - Kosaku Komiya
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. .,Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan.
| | - Takashi Yamamoto
- Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan
| | - Naoko Fujita
- Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan
| | - Hiroaki Oka
- Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan
| | - Eiji Okabe
- Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, Oita, 879-7761, Japan
| | - Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kenji Umeki
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street, KMSB, Room 215, Richmond, VA, 23298, USA
| | - Kazufumi Hiramatsu
- Department of Medical Safety Management, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.,Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
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15
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Linssen RS, Chai G, Ma J, Kummarapurugu AB, van Woensel JBM, Bem RA, Kaler L, Duncan GA, Zhou L, Rubin BK, Xu Q. Neutrophil Extracellular Traps Increase Airway Mucus Viscoelasticity and Slow Mucus Particle Transit. Am J Respir Cell Mol Biol 2021; 64:69-78. [PMID: 33095650 DOI: 10.1165/rcmb.2020-0168oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mucus obstruction is a key feature of many inflammatory airway diseases. Neutrophil extracellular traps (NETs) are released upon neutrophil stimulation and consist of extracellular chromatin networks studded with cytotoxic proteins. When released in the airways, these NETs can become part of the airway mucus. We hypothesized that the extracellular DNA and/or oxidative stress (e.g., by the release of reactive oxygen species and myeloperoxidase during NETs formation in the airways) would increase mucus viscoelasticity. We collected human airway mucus from endotracheal tubes of healthy patients admitted for elective surgery and coincubated these samples with NETs from phorbol 12-myristate 13-acetate-stimulated neutrophils. Unstimulated neutrophils served as controls, and blocking experiments were performed with dornase alfa for extracellular DNA and the free radical scavenger dimethylthiourea for oxidation. Compared with controls, the coincubation of mucus with NETs resulted in 1) significantly increased mucus viscoelasticity (macrorheology) and 2) significantly decreased mesh pore size of the mucus and decreased movement of muco-inert nanoparticles through the mucus (microrheology), but 3) NETs did not cause visible changes in the microstructure of the mucus by scanning EM. Incubation with either dornase alfa or dimethylthiourea attenuated the observed changes in macrorheology and microrheology. This suggests that the release of NETs may contribute to airway mucus obstruction by increasing mucus viscoelasticity and that this effect is not solely due to the release of DNA but may in part be due to oxidative stress.
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Affiliation(s)
- Rosalie S Linssen
- Pediatric Intensive Care Unit, Emma Children's Hospital, and.,Amsterdam Reproduction & Development Research Department, University Medical Center Amsterdam, Academic Medical Center (AMC), Amsterdam, the Netherlands.,Department of Pediatrics, Children's Hospital of Richmond
| | | | - Jonathan Ma
- Department of Pediatrics, Children's Hospital of Richmond
| | | | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, and.,Amsterdam Reproduction & Development Research Department, University Medical Center Amsterdam, Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, and.,Amsterdam Reproduction & Development Research Department, University Medical Center Amsterdam, Academic Medical Center (AMC), Amsterdam, the Netherlands
| | | | - Gregg A Duncan
- Biophysics Program and.,Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
| | | | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond.,Department of Physiology, and
| | - Qingguo Xu
- Department of Pharmaceutics.,Department of Physiology, and.,Department of Ophthalmology, Center for Pharmaceutical Engineering, and Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia; and
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16
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Abstract
Electronic cigarettes (e-cigarettes) are noncombustible tobacco products that have been promoted as safer alternatives to conventional cigarettes and beneficial tools for smoking cessation. However, e-cigarettes have been shown to produce aerosols with high concentrations of propylene glycol, glycerol, volatile organic compounds, and free radicals, which can lead to lung damage. Furthermore, e-cigarettes can deliver nicotine at concentrations higher than traditional combustibles, making them highly addictive. As delivery devices became smaller, less expensive, and refillable, the use of e-cigarettes dramatically increased, especially among adolescents and young adults in the United States. This rise in popularity of noncombustible products led to an outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the fall of 2019. In this article, we review the history of e-cigarettes and its prevalence among American youth, the EVALI outbreak and clinical presentation of EVALI patients, and recent legislative efforts to regulate e-cigarette use.
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Affiliation(s)
- Meagan Shinbashi
- Virginia Commonwealth University, Department of Pediatrics and the Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Bruce K Rubin
- Virginia Commonwealth University, Department of Pediatrics and the Children's Hospital of Richmond at VCU, Richmond, VA, United States.
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17
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Abstract
Many airway diseases in children, notably bronchiolitis, cystic fibrosis (CF), non-CF bronchiectasis including primary ciliary dyskinesia, pneumonia, and severe asthma are associated with retention of airway secretions. Medications to improve secretions clearance, the mucoactive medications, are employed to treat these diseases with varying degrees of success. This manuscript reviews evidence for the use of these medications and future directions of study.
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Affiliation(s)
- R S N Linssen
- Pediatric Intensive Care Unit, Amsterdam UMC, Emma Children's Hospital, Location AMC, Amsterdam, the Netherlands
| | - J Ma
- Pediatric Pulmonary Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, United States
| | - R A Bem
- Pediatric Intensive Care Unit, Amsterdam UMC, Emma Children's Hospital, Location AMC, Amsterdam, the Netherlands
| | - B K Rubin
- Pediatric Pulmonary Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, United States.
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18
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Affiliation(s)
- Bruce K Rubin
- The Children's Hospital of RichmondVirginia Commonwealth UniversityRichmond, Virginia
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19
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Affiliation(s)
- Dominic A. Fitzgerald
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia,Discipline of Child & Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, NSW 2145, Australia,Corresponding author at: Department of Respiratory Medicine, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
| | - Joanna Maclean
- Stollery Children’s Hospital, Edmonton, AB, Canada,Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Bruce K. Rubin
- Children’s Hospital of Richmond at VCU, USA,Virginia Commonwealth University School of Medicine, Dept. of Pediatrics, Richmond, VA 23298, USA
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20
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Abstract
For decades, there have been government funded services to provide healthcare telephonically to remote sites both on the earth and in the air. This capability has evolved into what we now know as telehealth. The use of telehealth dramatically accelerated as a result of concerns for patient and healthcare provider safety during the SARS-CoV2 pandemic. Similarly, concerns regarding transmission of infection have required medical schools to provide robust, easily accessible virtual education options. At short notice, faculties have had to develop new telehealth focused curriculum components. However, telehealth, online education, and internet enabled research should not be simply a new way to do traditional jobs but rather, an opportunity to take advantage of how technology can best be used to develop new and better ways to provide care, educate health care providers, and support research.
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Affiliation(s)
- N. Romesh Wijesooriya
- Department of Pediatrics and the Children’s Hospital of Richmond, Virginia Commonwealth University, USA
| | - Vimal Mishra
- Department of Internal Medicine, Virginia Commonwealth University, USA
| | - Paul L.P. Brand
- Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
| | - Bruce K Rubin
- Department of Pediatrics and the Children's Hospital of Richmond, Virginia Commonwealth University, USA.
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21
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Suzaki I, Hirano K, Maruyama Y, Kobayashi H, Rubin BK. IL-13-induced periostin production from human bronchial epithelial cells and human nasal epithelial cells. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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Curran E, Porée T, Rubin BK. Real-Time Analysis of the Respiratory Flow Through a Valved Holding Chamber. J Aerosol Med Pulm Drug Deliv 2020; 33:205-213. [PMID: 32101063 DOI: 10.1089/jamp.2019.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The ability of patients to take, correctly and regularly, aerosol treatments is a key for good control of asthma and chronic obstructive pulmonary disease. Devices that help to improve inhalation technique could train the patient to take their medication properly, reducing risk of exacerbations. In this study we evaluate a new device that by recording real-time respiratory flow into the valved holding chamber (VHC) mouthpiece, could be used to improve patient technique. Methods and Results: Using computational fluid dynamics analysis we demonstrated that compared to a mouthpiece with no flow probe, the presence of a probe modifies the flow profile and velocity regardless of the probe shape or position. During flow measurement using a SDP610 pressure sensor (Sensirion, Switzerland), all probes can accurately record adult and child respiratory patterns. Resistance was determined from the back pressure generated by the VHC with or without probes; and resistance was not impacted by the probes. Aerodynamic particle size distribution and drug delivery measurement were assessed using the United States Pharmacopeia throat model (Copley Scientific, UK), next generation impactor (NGI; Copley Scientific), and a breath simulator (BRS200; Copley Scientific). To test different formulations, these experiments were performed with fluticasone propionate (Flixotide®; GSK, UK), salbutamol (Ventolin®; GSK), and beclomethasone dipropionate (BDP) (QvarSpray®; GSK). Depending on the molecule or the probe configuration, we noticed a decrease of the emitted doses, fine particle deposition, mass median aerodynamic diameter, but no significant change in the mass of drug delivered. A decrease in the fine particle fraction (FPF) was observed in most testing conditions. However, a slight increase was noticed for two conformations with BDP (round and close [Rc] and diamond and far [Df]) and salbutamol (Rc and round and far [Rf]). Conclusion: By inserting a flow probe directly into the mouthpiece of a VHC we could perform real-time analysis of respiratory flow during the VHC use without disturbing drug delivery, or increasing resistance.
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Affiliation(s)
| | | | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine and the Children's Hospital of Richmond, Richmond, Virginia
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23
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Chang AB, Oppenheimer JJ, Kahrilas PJ, Kantar A, Rubin BK, Weinberger M, Irwin RS. Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report. Chest 2019; 156:131-140. [PMID: 31002783 DOI: 10.1016/j.chest.2019.03.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/24/2019] [Accepted: 03/29/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus. RESULTS Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P = .78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines. CONCLUSIONS The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.
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Affiliation(s)
- Anne B Chang
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia; Respiratory and Sleep Department, Queensland Children's Hospital, Queensland University of Technology, Brisbane, QLD, Australia.
| | - John J Oppenheimer
- Division of Allergy and Immunology, Department of Medicine, New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, NJ
| | - Peter J Kahrilas
- Department of Medicine, Northwestern University's Feinberg School of Medicine, Chicago, IL
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Miles Weinberger
- University of California San Diego, Rady Children's Hospital, San Diego, CA
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA
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24
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Abstract
INTRODUCTION Cystic fibrosis (CF) is a multisystem illness caused by abnormalities in the CF transmembrane conductance regulator (CFTR) gene and protein. CFTR is an ion channel regulating transport of chloride, bicarbonate, and water, and influencing sodium resorption. It is inherited as an autosomal recessive disorder, and with about 70,000 CF patients worldwide, it is the most common life shortening disease among persons of European descent. CFTR disease-causing mutations have been organized into six classes. : AREAS COVERED Recently, small molecule targeted therapy for specific classes of CFTR abnormalities have included CFTR correctors that decrease protein degradation and CFTR potentiators that increase channel open probability enhancing chloride transport. EXPERT OPINION Although there are many novel medications in preclinical and clinical testing, there is need for safe and effective CFTR modulating drugs and immunomodulatory medications to decrease the abundant neutrophilic inflammation response in the airway without unwanted adverse effects. Thymosin alpha 1 treatment of airway cells isolated from phe508del CF patients and from CF knockout mice, decreased inflammation, increased CFTR maturation, and facilitated translocation of CFTR protein to the plasma membrane increasing channel activity. If similar results are seen in humans with CF, thymosin alpha 1 has the unique potential to be a single molecule therapy for treating CF airway disease.
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Affiliation(s)
- Bruce K Rubin
- a Children's Hospital of Richmond , Virginia Commonwealth University , Richmond , VA , USA
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25
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Irwin RS, Heffner JE, Maxwell L, French CL, Augustyn N, Frantsve-Hawley J, Barnes PJ, Brightling CE, Davidson BL, Gutterman DD, Hall JB, Hill NS, Johnson RG, Manaker S, Mehra R, Moss J, Murin S, O’Byrne PM, Rubin BK, Schwarz MI, Anderson B, Lipsey L, Miller C, Goorsky P, Musacchio R, de Hon FD, Poppalardo P, Adamitis K, Clark C, Fournier E, Nightlinger M, Nuttall S, Richardson M, Rolya N, Schottenfeld D, Segal-Isaacson A, Tomasheski M, Poppalardo P, Goorsky P, Rice J, Welch S. Spread the Word About CHEST in 2019. Chest 2019; 155:1-4. [DOI: 10.1016/j.chest.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/01/2022] Open
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26
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Rubin BK, Thornton DJ. Dropping acid: why is cystic fibrosis mucus abnormal? Eur Respir J 2018; 52:52/6/1802057. [PMID: 30523208 DOI: 10.1183/13993003.02057-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Bruce K Rubin
- Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - David J Thornton
- Wellcome Trust Centre for Cell-Matrix Research and Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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27
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Abstract
Obstructive lung diseases, including asthma and COPD, are characterized by air-flow limitation. Bronchodilator therapy can often decrease symptoms of air-flow obstruction by relaxing airway smooth muscle (bronchodilation), decreasing dyspnea, and improving quality of life. In this review, we discuss the pharmacology of the β agonist and anticholinergic bronchodilators and their use, particularly in asthma and COPD. Expanding knowledge of receptor subtypes and G-protein signaling, agonist and antagonist specificity, and drug delivery have led to the introduction of safer medications with fewer off-target effects, medications with longer duration of action that may improve adherence, and more effective and efficient aerosol delivery devices.
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Affiliation(s)
- Dennis M Williams
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Bruce K Rubin
- The Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
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28
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Davis MD, Suzaki I, Kawano S, Komiya K, Cai Q, Oh Y, Rubin BK. Tissue Factor Facilitates Wound Healing in Human Airway Epithelial Cells. Chest 2018; 155:534-539. [PMID: 30359615 DOI: 10.1016/j.chest.2018.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tissue factor (TF) canonically functions as the initiator of the coagulation cascade. TF levels are increased in inflamed airways and seem to be important for tumor growth and metastasis. We hypothesized that airway epithelia release TF as part of a wound repair program. OBJECTIVES The goal of this study was to evaluate whether airway epithelia release TF in response to pro-inflammatory stimuli and to investigate roles of TF in cell growth and repair. METHODS Airway epithelial cells were exposed to 10 μg/mL of lipopolysaccharide or 1 ng/mL of transforming growth factor β (TGF-β). TF and TGF-β messenger RNA and protein were measured in cell lysate and culture media, respectively. Signaling pathways were evaluated by using selective agonists and inhibitors. Airway epithelia were mechanically injured in the presence of TF and tissue factor pathway inhibitor to investigate their roles in wound repair. RESULTS TF protein levels increased in cell media after exposure to lipopolysaccharide (P < .01) but only in growing cells, and this action was blocked when exposed to an extracellular signal-regulated kinase inhibitor or a "small" worm phenotype and mothers against Decapentaplegic inhibitor. TF protein also increased in the presence of TGF-β (P < .05). Exposure to TF pathway inhibitor decreased the rate of cell growth by 60% (P < .05), and exposure to TF increased the rate of airway healing after injury by 19% (P < .05). CONCLUSIONS Growing airway epithelia release TF when exposed to lipopolysaccharide or TGF-β. TF reduces wound-healing time in airway epithelia and therefore may be important to airway recovery after injury.
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Affiliation(s)
- Michael D Davis
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Isao Suzaki
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Shuichi Kawano
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Kosaku Komiya
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Qing Cai
- Division of Cellular and Molecular Pathogenesis, Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Youngman Oh
- Division of Cellular and Molecular Pathogenesis, Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.
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29
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Karandashova S, Kummarapurugu A, Zheng S, Kang L, Sun S, Rubin BK, Voynow JA. Neutrophil elastase correlates with increased sphingolipid content in cystic fibrosis sputum. Pediatr Pulmonol 2018; 53:872-880. [PMID: 29624923 PMCID: PMC6566867 DOI: 10.1002/ppul.24001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/07/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Sphingolipids are associated with the regulation of pulmonary inflammation. Although sphingolipids have been investigated in the context of cystic fibrosis (CF), the focus has been on loss of CF transmembrane conductance regulator (CFTR) function in mice, and in CF human lung epithelial cell lines. The sphingolipid content of CF sputum and the potential link between ceramide and airway inflammation in CF remain relatively unexplored. METHODS Fifteen patients with CF provided two spontaneously expectorated sputum samples, one collected during a hospitalization for an acute pulmonary exacerbation and one from an outpatient visit at a time of clinical stability. Sputum was processed, and the supernatant assessed for active neutrophil elastase (NE) using a chromogenic microplate assay and sphingolipid content using reverse phase high-performance liquid chromatography/electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS). Relevant demographic data including age, sex, CF genotype, FEV1 % predicted, and sputum bacteriology were assessed as possible modifying factors that could influence the correlation between NE and sputum sphingolipids. Data were analyzed for linear correlation, with statistical significance pre-defined as P < 0.05. RESULTS There was a significant association between the concentration of active NE and ceramide, sphingomyelin, and monohexosylceramide moieties as well as sphingosine-1-phosphate. The presence of Methicillin-resistant Staphylococcus aureus (MRSA), FEV1 % predicted, and female gender further strengthened the association of NE and sphingolipids, but Pseudomonas aeruginosa had no effect on the association between NE and sphingolipids. CONCLUSIONS These data suggest that NE may increase pro-inflammatory sphingolipid signaling, and the association is strengthened in female patients and patients with MRSA.
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Affiliation(s)
- Sophia Karandashova
- Center for Clinical and Translational Research at Virginia Commonwealth University (VCU), Richmond, Virginia
| | - Apparao Kummarapurugu
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Shuo Zheng
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Le Kang
- Department of Biostatistics, VCU, Richmond, Virginia
| | - Shumei Sun
- Department of Biostatistics, VCU, Richmond, Virginia
| | - Bruce K Rubin
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Judith A Voynow
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia
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30
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Kummarapurugu AB, Afosah DK, Sankaranarayanan NV, Navaz Gangji R, Zheng S, Kennedy T, Rubin BK, Voynow JA, Desai UR. Molecular principles for heparin oligosaccharide-based inhibition of neutrophil elastase in cystic fibrosis. J Biol Chem 2018; 293:12480-12490. [PMID: 29903912 DOI: 10.1074/jbc.ra118.002644] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/12/2018] [Indexed: 11/06/2022] Open
Abstract
Cystic fibrosis (CF) is a multifactorial disease in which dysfunction of protease-antiprotease balance plays a key role. The current CF therapy relies on dornase α, hypertonic saline, and antibiotics and does not address the high neutrophil elastase (NE) activity observed in the lung and sputum of CF patients. Our hypothesis is that variants of heparin, which potently inhibit NE but are not anticoagulant, would help restore the protease-antiprotease balance in CF. To realize this concept, we studied molecular principles governing the effectiveness of different heparins, especially 2-O,3-O-desulfated heparin (ODSH), in the presence of sputum components and therapeutic agents. Using sputa from CF patients and an NE activity assay, we found that heparins are ineffective if used in the absence of dornase. This is true even when mucolytics, such as DTT or N-acetylcysteine, were used. Computational modeling suggested that ODSH and DNA compete for binding to an overlapping allosteric site on NE, which reduces the anti-NE potential of ODSH. NE inhibition of both DNA and ODSH is chain length-dependent, but ODSH chains exhibit higher potency per unit residue length. Likewise, ODSH chains exhibit higher NE inhibition potential compared with DNA chains in the presence of saline. These studies suggest fundamental differences in DNA and ODSH recognition and inhibition of NE despite engaging overlapping sites and offer unique insights into molecular principles that could be used in developing antiprotease agents in the presence of current treatments, such as dornase and hypertonic saline.
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Affiliation(s)
- Apparao B Kummarapurugu
- From the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia 23298
| | - Daniel K Afosah
- the Department of Medicinal Chemistry, Virginia Commonwealth University, Richmond, Virginia 23298.,the Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23298, and
| | - Nehru Viji Sankaranarayanan
- the Department of Medicinal Chemistry, Virginia Commonwealth University, Richmond, Virginia 23298.,the Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23298, and
| | - Rahaman Navaz Gangji
- the Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23298, and
| | - Shuo Zheng
- From the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia 23298
| | - Thomas Kennedy
- the Tulane University Medical Center, New Orleans, Louisiana 70112
| | - Bruce K Rubin
- From the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia 23298
| | - Judith A Voynow
- From the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia 23298,
| | - Umesh R Desai
- the Department of Medicinal Chemistry, Virginia Commonwealth University, Richmond, Virginia 23298, .,the Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23298, and
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Komiya K, Akaba T, Kozaki Y, Kadota JI, Rubin BK. A systematic review of diagnostic methods to differentiate acute lung injury/acute respiratory distress syndrome from cardiogenic pulmonary edema. Crit Care 2017; 21:228. [PMID: 28841896 PMCID: PMC6389074 DOI: 10.1186/s13054-017-1809-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) is often challenging. This systematic review examines studies using biomarkers or images to distinguish ALI/ARDS from CPE. METHODS Three investigators independently identified studies designed to distinguish ALI/ARDS from CPE in adults. Studies were identified from PubMed, and the Cochrane Central Register of Controlled Trials database until July 3, 2017. RESULTS Of 475 titles and abstracts screened, 38 full texts were selected for review, and we finally included 24 studies in this systematic review: 21 prospective observational studies, two retrospective observational studies, and one retrospective combined with prospective study. These studies compared various biomarkers to differentiate subjects with ALI/ARDS and in those with CPE, and 13 calculated the area under the receiver operator characteristic curve (AUC). The most commonly studied biomarker (four studies) was brain natriuretic peptide (BNP) and the discriminatory ability ranged from AUC 0.67-0.87 but the timing of measurement varied. Other potential biomarkers or tools have been reported, but only as single studies. CONCLUSIONS There were no identified biomarkers or tools with high-quality evidence for differentiating ALI/ARDS from CPE. Combining clinical criteria with validated biomarkers may improve the predictive accuracy.
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Affiliation(s)
- Kosaku Komiya
- Children's Hospital of Richmond at Virginia Commonwealth, Richmond, VA, 23298, USA. .,Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. .,Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, 879-7761, Japan.
| | - Tomohiro Akaba
- Children's Hospital of Richmond at Virginia Commonwealth, Richmond, VA, 23298, USA
| | - Yuji Kozaki
- Children's Hospital of Richmond at Virginia Commonwealth, Richmond, VA, 23298, USA
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth, Richmond, VA, 23298, USA
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Chang AB, Oppenheimer JJ, Weinberger M, Grant CC, Rubin BK, Irwin RS. Etiologies of Chronic Cough in Pediatric Cohorts: CHEST Guideline and Expert Panel Report. Chest 2017. [PMID: 28645463 DOI: 10.1016/j.chest.2017.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is no published systematic review on the etiologies of chronic cough or the relationship between OSA and chronic cough in children aged ≤ 14 years. We thus undertook a systematic review based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. The KQs follow: Among children with chronic (> 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children? METHODS We used the CHEST Expert Cough Panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus. RESULTS Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent. Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies. CONCLUSIONS There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.
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Affiliation(s)
- Anne B Chang
- Division of Child Health, Menzies School of Health Research, Lady Cilento Children's Hospital, Qld Uni of Technology Queensland, Australia; Respiratory and Sleep Department, Lady Cilento Children's Hospital, Qld Uni of Technology Queensland, Australia.
| | - John J Oppenheimer
- Division of Allergy and Immunology, Department of Medicine, New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, NJ
| | - Miles Weinberger
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego, CA
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Bruce K Rubin
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA
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Affiliation(s)
- Bruce K Rubin
- Department of Pediatrics Children's Hospital of Richmond Virginia Commonwealth University Richmond, Virginia
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Rubin BK. Translational research in pediatric pulmonary disease, 2017. Clin Transl Med 2017; 6:12. [PMID: 28251572 PMCID: PMC5332313 DOI: 10.1186/s40169-017-0142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/18/2017] [Indexed: 11/23/2022] Open
Abstract
As readers of this journal know, translational research is the application of basic science findings to improve clinical care; a process that was once called “bench-to-bedside” research. In my field of pediatric pulmonary disease, the rapid advancement of basic science understanding into improved clinical care has been, to use an appropriate term, breathtaking. In this perspective article, I will describe a few of these advances, as they relate to specific pulmonary diseases.
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Affiliation(s)
- Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond, 1000 East Broad St., Richmond, VA, 23298, USA.
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Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Weir K, Grant CC, Irwin RS. Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report. Chest 2017; 151:875-883. [PMID: 28104362 DOI: 10.1016/j.chest.2016.12.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/19/2016] [Accepted: 12/23/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. METHODS We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading. RESULTS Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed. CONCLUSIONS Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed).
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Affiliation(s)
- Anne B Chang
- Menzies School of Health Research, Respiratory Department, Lady Cilento Children's Hospital, and Queensland University of Technology, QLD, Australia.
| | - John J Oppenheimer
- New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ
| | - Miles M Weinberger
- Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Kelly Weir
- Lady Cilento Children's Hospital, Brisbane, Australia
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Hara Y, Shinkai M, Kanoh S, Fujikura Y, K Rubin B, Kawana A, Kaneko T. Arterial Carboxyhemoglobin Measurement Is Useful for Evaluating Pulmonary Inflammation in Subjects with Interstitial Lung Disease. Intern Med 2017; 56:621-626. [PMID: 28321059 PMCID: PMC5410469 DOI: 10.2169/internalmedicine.56.7418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective The arterial concentration of carboxyhemoglobin (CO-Hb) in subjects with inflammatory pulmonary disease is higher than that in healthy individuals. We retrospectively analyzed the relationship between the CO-Hb concentration and established markers of disease severity in subjects with interstitial lung disease (ILD). Methods The CO-Hb concentration was measured in subjects with newly diagnosed or untreated ILD and the relationships between the CO-Hb concentration and the serum biomarker levels, lung function, high-resolution CT (HRCT) findings, and the uptake in gallium-67 (67Ga) scintigraphy were evaluated. Results Eighty-one non-smoking subjects were studied (mean age, 67 years). Among these subjects, (A) 17 had stable idiopathic pulmonary fibrosis (IPF), (B) 9 had an acute exacerbation of IPF, (C) 44 had stable non-IPF, and (D) 11 had an exacerbation of non-IPF. The CO-Hb concentrations of these subjects were (A) 1.5±0.5%, (B) 2.1±0.5%, (C) 1.2±0.4%, and (D) 1.7±0.5%. The CO-Hb concentration was positively correlated with the serum levels of surfactant protein (SP)-A (r=0.38), SP-D (r=0.39), and the inflammation index (calculated from HRCT; r=0.57) and was negatively correlated with the partial pressure of oxygen in the arterial blood (r=-0.56) and the predicted diffusion capacity of carbon monoxide (r=-0.61). The CO-Hb concentrations in subjects with a negative heart sign on 67Ga scintigraphy were higher than those in subjects without a negative heart sign (1.4±0.5% vs. 1.1±0.3%, p=0.018). Conclusion The CO-Hb levels of subjects with ILD were increased, particularly during an exacerbation, and were correlated with the parameters that reflect pulmonary inflammation.
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Affiliation(s)
- Yu Hara
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Japan
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Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, Aoki N, Tsukada H, Noguchi S, Shime N, Takahashi O, Kohno S. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis. Sci Rep 2016; 6:38097. [PMID: 27924871 PMCID: PMC5141412 DOI: 10.1038/srep38097] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022] Open
Abstract
Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP. Exposure: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to be at high risk for oral aspiration. Outcomes: mortality, hospital readmission or recurrent pneumonia. Three investigators independently identified published cohort studies from PubMed, CENTRAL database, and EMBASE. Nineteen studies were included for this systematic review. Aspiration pneumonia increased in-hospital mortality (relative risk, 3.62; 95% CI, 2.65–4.96; P < 0.001, seven studies) and 30-day mortality (3.57; 2.18–5.86; P < 0.001, five studies). In contrast, aspiration pneumonia was associated with decreased ICU mortality (relative risk, 0.40; 95% CI, 0.26–0.60; P < 0.00001, four studies). Although there are insufficient data to perform a meta-analysis on long-term mortality, recurrent pneumonia, and hospital readmission, the few reported studies suggest that aspiration pneumonia is also associated with these poor outcomes. In conclusion, aspiration pneumonia was associated with both higher in-hospital and 30-day mortality in patients with CAP outside ICU settings.
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Affiliation(s)
- Kosaku Komiya
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street: KMSB, Room 215 Richmond, Virginia 23298, USA.,Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.,Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, 879-7761, Japan
| | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street: KMSB, Room 215 Richmond, Virginia 23298, USA
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomohiro Akaba
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street: KMSB, Room 215 Richmond, Virginia 23298, USA
| | - Hiroshi Moro
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 757 Asahi-machi, Chuo-ku, Niigata, 951-8510, Japan
| | - Nobumasa Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 757 Asahi-machi, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiroki Tsukada
- Department of Respiratory Medicine/Infectious Disease, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, 1-1 Idaigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical &Health Sciences, Hiroshima University Advanced Emergency and Critical Care Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's Life Science Institute, 10-1 Akashicho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Nakagawa NK, Athanazio R, Rubin BK. Response. Chest 2016; 150:750-1. [DOI: 10.1016/j.chest.2016.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022] Open
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Suzaki I, Kawano S, Komiya K, Tanabe T, Akaba T, Asano K, Suzaki H, Izuhara K, Rubin BK. Inhibition of IL-13-induced periostin in airway epithelium attenuates cellular protein expression of MUC5AC. Respirology 2016; 22:93-100. [DOI: 10.1111/resp.12873] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/31/2016] [Accepted: 06/15/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Isao Suzaki
- Department of Pediatrics; Virginia Commonwealth University School of Medicine; Richmond Virginia USA
- Department of Otorhinolaryngology, School of Medicine; Showa University; Tokyo Japan
| | - Shuichi Kawano
- Department of Pediatrics; Virginia Commonwealth University School of Medicine; Richmond Virginia USA
| | - Kosaku Komiya
- Department of Pediatrics; Virginia Commonwealth University School of Medicine; Richmond Virginia USA
| | - Tsuyoshi Tanabe
- Department of Pediatrics; Virginia Commonwealth University School of Medicine; Richmond Virginia USA
| | - Tomohiro Akaba
- Department of Pediatrics; Virginia Commonwealth University School of Medicine; Richmond Virginia USA
| | - Kazuhito Asano
- Division of Physiology, School of Nursing and Rehabilitation Sciences; Showa University; Yokohama Japan
| | - Harumi Suzaki
- Nasal and Paranasal Sinus Disease and Allergy Institute; Tokyo General Hospital; Tokyo Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences; Saga Medical School; Saga Japan
| | - Bruce K. Rubin
- Department of Pediatrics; Virginia Commonwealth University School of Medicine; Richmond Virginia USA
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Abstract
Airway mucus hypersecretion and secretion retention can result from inflammation, irritation, stimulation, or mucus-producing tumors. Secretion clearance can be furthered hampered by ciliary dysfunction and by weakness or restrictive lung disease, leading to an ineffective cough. There are a number of different mucoactive medications that have been used to reduce hypersecretion, make secretions easier to transport, or increase the efficiency of cough or mucus clearance. In this paper, I review the pathophysiology of secretory hyper-responsiveness and mucus hypersecretion and discuss the different aerosol medications that can be used to augment secretion clearance.
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Affiliation(s)
- Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, and the Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
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Abstract
Between January 1, 2015, and the end of October, there were >6,500 peer-reviewed papers listed in PubMed on asthma. Of necessity, those that have been selected for inclusion for this Year in Review represent a few that have caught the reviewer's interest, organized by themes. Not unexpectedly, some of these papers are in conflict with each other, whereas others raise more questions then they appear to answer. All in all, it has been a busy year in the asthma world and with new medications reaching the market in coming years, it is unlikely that this interest will abate.
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Affiliation(s)
- Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond, Richmond, Virginia.
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Tanabe T, Rubin BK. Airway Goblet Cells Secrete Pro-Inflammatory Cytokines, Chemokines, and Growth Factors. Chest 2016; 149:714-20. [DOI: 10.1378/chest.15-0947] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/24/2015] [Accepted: 09/01/2015] [Indexed: 12/29/2022] Open
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Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS. Children With Chronic Wet or Productive Cough--Treatment and Investigations: A Systematic Review. Chest 2016; 149:120-42. [PMID: 26757284 DOI: 10.1378/chest.15-2065] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/14/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks' duration) wet or productive cough not related to bronchiectasis: KQ1-How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2-When should they be referred for further investigations? METHODS The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English. RESULTS Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the RCTs (KQ1), the number needed to treat for benefit was 3 (95% CI, 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent, but there were minor variations. CONCLUSIONS There is high-quality evidence that in children aged ≤ 14 years with chronic (> 4 weeks' duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high-quality evidence that when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland Uni of Technology, Children's Health Queensland, Queensland, Australia.
| | - John J Oppenheimer
- New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, NJ
| | - Miles Weinberger
- Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
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Chang AB, Oppenheimer JJ, Weinberger M, Weir K, Rubin BK, Irwin RS. Use of Management Pathways or Algorithms in Children With Chronic Cough: Systematic Reviews. Chest 2016; 149:106-19. [PMID: 26356242 DOI: 10.1378/chest.15-1403] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/13/2015] [Accepted: 08/06/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Use of appropriate cough pathways or algorithms may reduce the morbidity of chronic cough, lead to earlier diagnosis of chronic underlying illness, and reduce unnecessary costs and medications. We undertook three systematic reviews to examine three related key questions (KQ): In children aged ?14 years with chronic cough (> 4 weeks' duration), KQ1, do cough management protocols (or algorithms) improve clinical outcomes? KQ2, should the cough management or testing algorithm differ depending on the duration and/or severity? KQ3, should the cough management or testing algorithm differ depending on the associated characteristics of the cough and clinical history? METHODS We used the CHEST expert cough panel's protocol. Two authors screened searches and selected and extracted data. Only systematic reviews, randomized controlled trials (RCTs), and cohort studies published in English were included. RESULTS Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-analyses flowcharts and summary tabulated. Nine studies were included in KQ1 (RCT = 1; cohort studies = 7) and eight in KQ3 (RCT = 2; cohort = 6), but none in KQ2. CONCLUSIONS There is high-quality evidence that in children aged ?14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes and cough management or the testing algorithm should differ depending on the associated characteristics of the cough and clinical history. It remains uncertain whether the management or testing algorithm should depend on the duration or severity of chronic cough. Pending new data, chronic cough in children should be defined as > 4 weeks' duration and children should be systematically evaluated with treatment targeted to the underlying cause irrespective of the cough severity.
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Affiliation(s)
- Anne B Chang
- Menzies School of Health Research; and Respiratory Deptartment, Lady Cilento Children's Hospital, Queensland University of Technology, Queensland, Australia.
| | - John J Oppenheimer
- Division of Allergy and Immunology, UMDNJ-New Jersey Medical School, Cedar Knolls, NJ
| | - Miles Weinberger
- Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA
| | - Kelly Weir
- Speech Pathology Deptartment, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Bruce K Rubin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Richard S Irwin
- Division of Pulmonary, Allergy & Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
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Mishina K, Shinkai M, Shimokawaji T, Nagashima A, Hashimoto Y, Inoue Y, Inayama Y, Rubin BK, Ishigatsubo Y, Kaneko T. HO-1 inhibits IL-13-induced goblet cell hyperplasia associated with CLCA1 suppression in normal human bronchial epithelial cells. Int Immunopharmacol 2015; 29:448-453. [PMID: 26507166 DOI: 10.1016/j.intimp.2015.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
Mucus hypersecretion and goblet cell hyperplasia are common features that characterize asthma. IL-13 increases mucin (MUC) 5AC, the major component of airway mucus, in airway epithelial cells. According to the literature, IL-13 receptor activation leads to STAT6 activation and consequent induction of chloride channel accessory 1 (CLCA1) gene expression, associated with the induction of MUC5AC. Heme oxygenase-1 (HO-1) is an enzyme that catalyzes oxidation of heme to biliverdin, and has anti-inflammatory and anti-oxidant properties. We examined the effects of HO-1 on mucin production and goblet cell hyperplasia induced by IL-13. Moreover, we assessed the cell signaling intermediates that appear to be responsible for mucin production. Normal human bronchial epithelial (NHBE) cells were grown at air liquid interface (ALI) in the presence or absence of IL-13 and hemin, a HO-1 inducer, for 14 days. Protein concentration was analyzed using ELISA, and mRNA expression was examined by real-time PCR. Histochemical analysis was performed using HE staining, andWestern blotting was performed to evaluate signaling transduction pathway. Hemin (4 μM) significantly increased HO-1 protein expression (p b 0.01) and HO-1 mRNA expression (p b 0.001). IL-13 significantly increased goblet cells, MUC5AC protein secretion (p b 0.01) and MUC5AC mRNA (p b 0.001), and these were decreased by hemin by way of HO-1. Tin protoporphyrin (SnPP)-IX, a HO-1 inhibitor, blocked the effect of hemin restoring MUC5AC protein secretion (p b 0.05) and goblet cell hyperplasia. Hemin decreased the expression of CLCA1 mRNA (p b 0.05) and it was reversed by SnPP-IX, but could not suppress IL-13-induced phosphorylation of STAT6 or SAM pointed domain-containing ETS transcription factor (SPDEF) and Forkhead box A2 (FOXA2) mRNA expression. In summary, HO-1 overexpression suppressed IL-13-induced goblet cell hyperplasia and MUC5AC production, and involvement of CLCA1 in the mechanism was suggested.
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Affiliation(s)
- Kei Mishina
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaharu Shinkai
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Tadasuke Shimokawaji
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Akimichi Nagashima
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hashimoto
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoriko Inoue
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiaki Inayama
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University, Richmond, USA
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Bennett WD, Kala A, Duckworth H, Zeman KL, Wu J, Henderson A, Yopp M, Rubin BK. Effect of a single 1200 Mg dose of Mucinex® on mucociliary and cough clearance during an acute respiratory tract infection. Respir Med 2015; 109:1476-83. [PMID: 26462765 DOI: 10.1016/j.rmed.2015.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/21/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Observational studies suggest that orally administered guaifenesin (GGE) may thin lower respiratory tract secretions but none have examined its effects on mucociliary and cough clearance (MCC/CC) during a respiratory tract infection (RTI). The current study was a randomized, parallel-group, double-blind, placebo-controlled study in non-smoking adults who suffered from an acute upper RTI. METHODS We assessed the effects of a single dose of Mucinex(®) 1200 mg (2 × 600 mg extended release tablets) (ER GGE) on 1) MCC/CC by assessing the rate of removal from the lung of inhaled radioactive tracer particles (Tc99m-sulfur colloid), 2) sputum dynamic rheology by stress/strain creep transformation over the linear part of the curve, 3) sessile drop interfacial tension by the deNouy ring technique, and 4) subjective symptom measures. MCC was measured during the morning (period 1) and compared to that in the afternoon 4 h later (period 2) immediately following either drug (n = 19) or placebo (n = 19). For both period 1 and 2 subjects performed 60 voluntary coughs from 60 to 90 min after inhalation of radio-labeled aerosol for a measure of CC. Sputum properties were measured from subjects who expectorated sputum during the cough period post treatment (n = 8-12 for each cohort). RESULTS We found no effect of ER GGE on MCC or CC compared to placebo. MCC through 60 min for period 1 vs. 2 = 8.3 vs. 11.8% (placebo) and = 9.7 vs. 11.1% (drug) (NS) and CC for period 1 vs. 2 was 9.9 vs. 9.1% (placebo) and 10.8 vs. 5.6% (drug) (NS). There was no significant difference in sputum biophysical properties after administration of drug or placebo. CONCLUSIONS There was no significant effect of a single dose of ER GGE on MCC/CC or on sputum biophysical properties compared to placebo in this population of adult patients with an acute RTI. ClinicalTrials.gov Identifier: NCT01114581.
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Affiliation(s)
- W D Bennett
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, USA; Dept of Medicine, University of North Carolina at Chapel Hill, USA.
| | - A Kala
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, USA
| | - H Duckworth
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, USA
| | - K L Zeman
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, USA
| | - J Wu
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, USA
| | - A Henderson
- Dept of Medicine, University of North Carolina at Chapel Hill, USA
| | - M Yopp
- Children's Hospital of Virginia, Virginia Commonwealth University, USA
| | - B K Rubin
- Children's Hospital of Virginia, Virginia Commonwealth University, USA
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49
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Vertigan AE, Murad MH, Pringsheim T, Feinstein A, Chang AB, Newcombe PA, Rubin BK, McGarvey LP, Weir K, Altman KW, Weinberger M, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning BJ, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Feinstein A, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lim K, Malesker MA, Mazzone P, Mazzone S, McCrory DC, McGarvey L, Molasiotis A, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Vertigan AE, Wang G, Weinberger M, Weir K, Wiener RS. Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report. Chest 2015; 148:24-31. [PMID: 25856777 DOI: 10.1378/chest.15-0423] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. METHODS We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. RESULTS The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. CONCLUSIONS Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.
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50
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Tanabe T, Shimokawaji T, Kanoh S, Rubin BK. Secretory phospholipases A2 are secreted from ciliated cells and increase mucin and eicosanoid secretion from goblet cells. Chest 2015; 147:1599-1609. [PMID: 25429648 DOI: 10.1378/chest.14-0258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Secretory phospholipases A2 (sPLA2) initiate the biosynthesis of eicosanoids, are increased in the airways of people with severe asthma, and induce mucin hypersecretion. We used IL-13-transformed, highly enriched goblet cells and differentiated (ciliary cell-enriched) human bronchial epithelial cell culture to evaluate the relative contribution of ciliated and goblet cells to airway sPLA2 generation and response. We wished to determine the primary source(s) of sPLA2 and leukotrienes in human airway epithelial cells. METHODS Human bronchial epithelial cells from subjects without lung disease were differentiated to a ciliated-enriched or goblet-enriched cell phenotype. Synthesis of sPLA2, cysteinyl leukotrienes (cysLTs), and airway mucin messenger RNA and protein was measured by real-time-polymerase chain reaction and an enzyme-linked immunosorbent assay, and the localization of mucin and sPLA2 to specific cells types was confirmed by confocal microscopy. RESULTS sPLA2 group IIa, V, and X messenger RNA expression was increased in ciliated-enriched cells (P < .001) but not in goblet-enriched cells. sPLA2 were secreted from the apical (air) side of ciliated-enriched cells but not goblet-enriched cells (P < .001). Immunostaining of sPLA2 V was strongly positive in ciliated-enriched cells but not in goblet-enriched cells. sPLA2 released cysLTs from goblet-enriched cells but not from ciliated-enriched cells, and this result was greatest with sPLA2 V (P < .05). sPLA2 V increased goblet-enriched cell mucin secretion, which was inhibited by inhibitors of lipoxygenase or cyclooxygenase (P < .02). CONCLUSIONS sPLA2 are secreted from ciliated cells and appear to induce mucin and cysLT secretion from goblet cells, strongly suggesting that airway goblet cells are proinflammatory effector cells.
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Affiliation(s)
- Tsuyoshi Tanabe
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA.
| | - Tadasuke Shimokawaji
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Soichiro Kanoh
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA
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