Case-crossover study for the association between increased hospital admissions for respiratory diseases and the increase in atmospheric PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa

Outdoor PM2.5 was sampled in Pretoria, 18 April 2017 to 28 February 2020. A case-crossover epidemiology study was associated for increased PM2.5 and trace elements with increased hospital admissions for respiratory disorders (J00-J99). The results included a significant increase in hospital admissions, with total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg·m-3 increase. For the trace elements, Ca of 4.0% (95% CI: 1.4%-6.8%), Cl of 0.7% (95% CI: 0.0%-1.4%), Fe of 3.3% (95% CI: 0.5%-6.1%), K of 1.8% (95% CI: 0.2-3.5) and Si of 1.3% (95% CI: 0.1%-2.5%). When controlling for PM2.5, only Ca of 3.2% (95% CI: 0.3, 6.1) and within the 0-14 age group by 5.2% (95% CI: 1.5, 9.1). Controlling for a co-pollutant that is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis.

The health and economic burden of dust pollution in the textile industry of Faisalabad, Pakistan

BACKGROUND

Exposure to dust in textile mills adversely affects workers' health. We collected epidemiological data on textile workers suffering from respiratory diseases and assessed work absence associated with illnesses in Faisalabad, Pakistan.

METHODS

We recruited 206 workers using multistage sampling from 11 spinning mills in Faisalabad, Pakistan. The data were collected using 2-week health diaries and face-to-face interviews. The data pertains to socio-demographics, occupational exposures, the state of the workers' health, and other attributes. A theoretical framework of the health production function was used to estimate the relationship between cotton dust exposure and respiratory illnesses. We also estimated functional limitations (e.g., work absence) associated with dust exposure. STATA 12 was used to calculate descriptive statistics, an ordered probit for byssinosis, a probit model for chronic cough, and three complementary log-log models for blood phlegm, bronchitis, and asthma to measure dose-response functions. A Tobit model was used to measure the sickness absence function.

RESULTS

We found that cotton dust exposure causes a significant health burden to workers, such as cough (35%), bronchitis (17%), and different grades of byssinosis symptoms (22%). The regression analysis showed that smoking cigarettes and working in dusty sections were the main determinants of respiratory diseases. Dusty work sections also cause illness-related work absences. However, the probability of work absence decreases with the increased use of face masks.

CONCLUSION

The study's findings imply the significance of promoting occupational safety and health culture through training and awareness among workers or implementing the use of safety gadgets. Promulgating appropriate dust standards in textile mills is also a need of the hour.

Association of Interleukin-4 Receptor α Chain I50V Gene Variant (rs1805010) and Asthma in Iranian Population: A Case-control Study

Background

Asthma is one of the respiratory disorders caused by chronic airway inflammation. IL-4 has been identified as one of the participating interleukins in the severity of asthma.

Objective

A case-control study was conducted to determine the association of rs1805010, a single nucleotide polymorphism in the interleukin 4 receptor α chain, with asthma and immunoglobulin E and IL-17A serum levels in Iranian populations.

Methods

ELISA was used to investigate the relationship between three different varieties of SNP I50V and serum IL-17A levels, as well as total IgE levels. Based on GINA criteria, patients were classified into mild, moderate, and severe groups based on the association between SNP I50V, IL-17A, and total IgE. In order to analyze the data, the student-t-test and the one-way ANOVA were used.

Results

The SNP I50V was associated with asthma in a significant way (p = 0.001). IL-17A and total IgE levels were significantly higher in asthmatic patients than in control participants (p 0.05 and p 0.021, respectively), but neither showed any association with SNP I50V in the asthmatic patients.

Conclusion

Asthma patients have a higher prevalence of the I allele, reflecting the significance of Th2 cells. Although total IgE and IL-17A levels increased in both disease subgroups, total IgE level augmentation correlates directly with disease severity, while IL-17A level enhancement does not.

Strong opioids-induced cardiac, neurologic, and respiratory disorders: a real-world study from 2004 to 2023 based on FAERS

Opioids are mainly used as adjuncts to the induction and maintenance of general anesthesia, postoperative analgesia, and treating moderate to severe cancer pain and chronic pain. However, the hazards of these drugs to various organ organs still need to be further explored. This study used the US FDA Adverse Event Reporting System (FAERS) database to determine whether commonly receiving opioids was higher than the baseline risk for all other medications. FAERS was asked about adverse events (AEs) for the opioids "morphine," "fentanyl," "oxycodone," "hydromorphone," "sufentanil," and "remifentanil" from the first quarter of 2004 (2004Q1) through the second quarter of 2023 (2023Q2). Disproportionality signaling analysis was performed by calculating reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM). AEs with system organ classes (SOCs) of "cardiac disease," "neurologic disease," and "respiratory, thoracic, and mediastinal disease" were then screened. The statistical analysis included 12,819,518 reports in the FAERS database from 2004Q1 to 2023Q2, of which 236,619 AEs were reported as "primary suspect" for the six drugs mentioned above, which were selected as "cardiac disorders," "nervous system disorders," and "respiratory, thoracic and mediastinal disorders." Some AEs identified in this study are consistent with the drug labeling, such as bradycardia, respiratory depression, and somnolence. In addition, some unexpected and significant acute adverse drug reactions (ADRs), such as toxic leukoencephalopathy and coma, may occur. This study identified potential new and unexpected ADRs for opioids, providing valuable evidence for safety studies of opioids.

1,8-cineole (eucalyptol): A versatile phytochemical with therapeutic applications across multiple diseases

1,8-cineole (Eucalyptol), a naturally occurring compound derived from botanical sources such as eucalyptus, rosemary, and camphor laurel, has a long history of use in traditional medicine and exhibits an array of biological properties, including anti-inflammatory, antioxidant, antimicrobial, bronchodilatory, analgesic, and pro-apoptotic effects. Recent evidence has also indicated its potential role in managing conditions such as Alzheimer's disease, neuropathic pain, and cancer. This review spotlights the health advantages of 1,8-cineole, as demonstrated in clinical trials involving patients with respiratory disorders, including chronic obstructive pulmonary disease, asthma, bronchitis, and rhinosinusitis. In addition, we shed light on potential therapeutic applications of 1,8-cineole in various conditions, such as depression, epilepsy, peptic ulcer disease, diarrhea, cardiac-related heart diseases, and diabetes mellitus. A comprehensive understanding of 1,8-cineole's pharmacodynamics and safety aspects as well as developing effective formulations, might help to leverage its therapeutic value. This thorough review sets the stage for future research on diverse health benefits and potential uses of 1,8-cineole in tackling complex medical conditions.

An ethno-botanical study of medicinal plants used for the management of respiratory tract disorders in northern parts of Palestine

BACKGROUND

The medicinal application of natural plant remedies is well established. These medicinal plants are still in use within the Palestinian community to treat several illnesses. This research is intended to study the use of natural plants to treat different types of respiratory tract disorders.

METHOD

This ethno botanical study focused on the medicinal plants that are used to treat respiratory diseases in the northern part of Palestine; Nablus, Tulkarm, Qalqilia, and Jenin. A questionnaire was distributed to 120 respondents. The data obtained included names of the plants used, the parts used, the diseases for which the products were applied, as well as the method of preparation. To evaluate results, percentages (%), Fic (factor of informant consensus), and FL (fidelity-level) were calculated.

RESULTS

A total of 120 participants were selected for the final analysis. The highest percentage of herbal use was reported for flu 85.8% (103 participants) followed by cough 83.3%, while the lowest percentage of users was for bronchitis with 54.1%. The study showed that 31 plant species of 19 families were used for respiratory disorders treatment. Six species were from the Lamiaceae family, three species from the Apiaceae family, two species from Amaryllidaceae, Fabaceae, Myrtaceae, Rutaceae and Zingiberaceae, and one plant species for each of the rest of families. Leaves and fruits were the most commonly used parts of plants. Decoction was the method of preparation and was taken as a hot drink. Chamomile, mint, sage, lemon, and ginger were in the recipes for the five respiratory diseases.

CONCLUSION

In Palestine, patients with respiratory diseases rely heavily on the use of herbal remedies. Leaves and fruits were the most commonly used plat elements. Age and marriage were significantly associated with the use of botanical remedies. Whereas there was no significant association between the source of information about medicinal plants and the location where medicinal plants were purchased. It is vital to conduct comprehensive clinical investigations and pharmacological assessments of these herbal remedies, in order to identify their efficacy, safety, and toxicity levels.

Lung Microbiome as a Treatable Trait in Chronic Respiratory Disorders

Once thought to be a sterile environment, it is now established that lungs are populated by various microorganisms that participate in maintaining lung function and play an important role in shaping lung immune surveillance. Although our comprehension of the molecular and metabolic interactions between microbes and lung cells is still in its infancy, any event causing a persistent qualitative or quantitative variation in the composition of lung microbiome, termed "dysbiosis", has been virtually associated with many respiratory diseases. A deep understanding of the composition and function of the "healthy" lung microbiota and how dysbiosis can cause or participate in disease progression will be pivotal in finding specific therapies aimed at preventing diseases and restoring lung function. Here, we review lung microbiome dysbiosis in different lung pathologies and the mechanisms by which these bacteria can cause or contribute to the severity of the disease. Furthermore, we describe how different respiratory disorders can be caused by the same pathogen, and that the real pathogenetic mechanism is not only dependent by the presence and amount of the main pathogen but can be shaped by the interaction it can build with other bacteria, fungi, and viruses present in the lung. Understanding the nature of this bacteria crosstalk could further our understanding of each respiratory disease leading to the development of new therapeutic strategies.

Medicinal plants used for the management of respiratory diseases in Zimbabwe: Review and perspectives potential management of COVID-19

Respiratory diseases have in the recent past become a health concern globally. More than 523 million cases of coronavirus disease (COVID19), a recent respiratory diseases have been reported, leaving more than 6 million deaths worldwide since the start of the pandemic. In Zimbabwe, respiratory infections have largely been managed using traditional (herbal) medicines, due to their low cost and ease of accessibility. This review highlights the plants' toxicological and pharmacological evaluation studies explored. It seeks to document plants that have been traditionally used in Zimbabwe to treat respiratory ailments within and beyond the past four decades. Extensive literature review based on published papers and abstracts retrieved from the online bibliographic databases, books, book chapters, scientific reports and theses available at Universities in Zimbabwe, were used in this study. From the study, there were at least 58 plant families comprising 160 medicinal plants widely distributed throughout the country. The Fabaceae family had the highest number of medicinal plant species, with a total of 21 species. A total of 12 respiratory ailments were reportedly treatable using the identified plants. From a total of 160 plants, colds were reportedly treatable with 56, pneumonia 53, coughs 34, chest pain and related conditions 29, asthma 25, tuberculosis and spots in lungs 22, unspecified respiratory conditions 20, influenza 13, bronchial problems 12, dyspnoea 7, sore throat and infections 5 and sinus clearing 1 plant. The study identified potential medicinal plants that can be utilised in future to manage respiratory infections.

Tobacco use profiles by respiratory disorder status for adults in the wave 1-wave 4 population assessment of tobacco and health (PATH) study

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Exclusive ENDS use is associated with a prior COPD diagnosis.

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Dual ENDS/cigarette use is associated with prior diagnoses of COPD and bronchitis.

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Analyses adjusted for behavioral health symptoms and other respiratory disorders.

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Complete tobacco cessation is most beneficial in reducing respiratory complications.

Limited evidence exists on the association between electronic nicotine delivery systems (ENDS) and chronic respiratory disorders. This study examines the association of combustible tobacco and ENDS use with chronic respiratory disorders among US adults. Public-use data from the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013–2014), Wave 2 (2014–2015), Wave 3 (2015–2016), and Wave 4 (2016–2018) were pooled. Analyses focused on adults with W1–W4 respiratory disorder data and current tobacco use at W4, as well as youth entering the adult cohort at W2 through W4 (N = 26,072). We fit weighted multivariable logistic regression models for each respiratory outcome (asthma, COPD, bronchitis) using W4 longitudinal weights. Cigarette smokers (adjusted odds ratio [AOR] = 0.8, 95 % CI 0.7–0.9) were less likely to report an asthma diagnosis (p = 0.013). In contrast, ENDS users (AOR = 6.5, 95 % CI 3.7–11.5), cigarette smokers (AOR = 6.1, 95 % CI 4.0–9.1), dual users of cigarettes and ENDS (AOR = 5.4, 95 % CI 3.4–8.7), current users of non-cigarette combustible, smokeless, and polytobacco products (AOR = 4.4, 95 % CI 3.1–6.4), and former users of any product (AOR = 3.0, 95 % CI 1.9–4.7) had significantly elevated odds of reporting a diagnosis of COPD (p < 0.001). Similar patterns to COPD were observed for bronchitis (p < 0.001). Current and former tobacco use, including ENDS, were significantly associated with prevalence of self-reported COPD and bronchitis after controlling for demographic and psychosocial confounders.

Role of Inspiratory Muscle Training on Pulmonary Rehabilitation in Patients with COVID-19: A Pilot Study

Background

Inspiratory muscle training has been introduced as one of the effective methods in pulmonary rehabilitation, and attention to this technique in patients with COVID-19 is still being studied.

Materials and Methods

In the present study 52 patients who have undergone the period of the COVID-19 disease were randomly divided into two groups. In the control group, in addition to the routine treatment prescribed by a specialist physician, rehabilitation was performed by performing diaphragmatic breathing exercises, pursed-lips breathing, chest expansion, and simple stretching exercises. In the intervention group in addition to the rehabilitation program provided to the control group, patients used an inspiratory muscle training device. This pulmonary rehabilitation program was performed twice a day and 30 repetitions each time with a two-minute rest after every 10 exercises. After 4 weeks, patients in both groups were referred to the hospital for reassessment of the distance of the 6-minute walk test, SF-12 questionnaire results, dyspnea, and S-index. To compare quantitative variables between the two groups we utilized a student t-test. Type one error was put at P≤0.05.

Results

The comparison of 6MWT values shows that the mean of this index in the intervention group is significantly higher than the control group (p = 0.002). Also, the S-index of the two groups showed a significant difference (p=0.024). Results show a significant increase in the SF-12 quality of life questionnaire in patients using IMT (p=0.001).

Conclusion

IMT improves pulmonary functions, 6MWT, and SF-12 Questionnaire in recovered COVID-19 patients.

The additional value of lung cancer screening program in identifying unrecognized diseases

Background

A systematic examination of low-dose CT (LDCT) scan, beside lung nodules, may disclose the presence of undiagnosed diseases, improving the efficacy and the cost/efficacy of these programs. The study was aimed at evaluating the association between LDCT scan findings and non-oncologic and oncologic diseases.

Methods

The LDCT scan of participants to the “Un Respiro per la vita”^® lung cancer screening program were checked and abnormal findings, beside lung nodules, recorded. First admission to the acute care because of cardiovascular (CD), respiratory (RD) and oncological diseases (OD) in the following three years were retrieved. The association of LDCT scan abnormal findings with CD, RD and OD was assessed through univariable and multivariable logistic regression models.

Results

Mean age of 746 participants was 62 years (SD:5), 62% were male. 11 (1.5%) received a diagnosis of lung cancer. 16.1% participants were admitted to the acute care in the following three years: 8.6% for CD, 4.3% for RD and 5.2% for OD. Valve calcification (OR 2.02, p:0.02) and mucus plugs (OR 3.37, p:0.04) were positively associated with CD, while sub-pleural fibrosis had a protective role (OR 0.47, p:0.01). Lung nodules > 8 mm (OR 5.54, p: < 0.01), tracheal deviation (OR 6.04, p:0.01) and mucus plugs (OR 4.00, p:0.04) were positively associated with OD admissions. Centrilobular emphysema OR for RD admissions was 1.97 (p:0.06).

Conclusions

The observed association between selected LDCT findings and ensuing CD, RD and OD suggests that the information potential of LCDT goes beyond the screening of lung cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01826-1.

COVID-19 outbreak in Iraqi Kurdistan: The first report characterizing epidemiological, clinical, laboratory, and radiological findings of the disease

INTRODUCTION

On March 11, 2020, the novel coronavirus was declared a global pandemic. The disease was named COVID-19 standing for coronavirus disease 2019. The objectives were to determine the epidemiological, clinical, laboratory, and radiological characteristics of COVID-19 patients.

METHODS

In this prospective descriptive study, 15 confirmed hospitalized cases of COVID-19 between 18th March and April 7, 2020 were followed-up till discharge.

RESULTS

There were 15 reported patients infected by 3 imported index cases from Europe. The mean age of the patients was 28.06 (SD: 16.42 years). The patients' age stratification was as follows: 0-5 (2, 13.3%); 6-18 (2, 13.3); 19-50 (10, 66.7%), and 51-64 years (1, 6.7%). The patients were male (9, 60.0%) and female (6, 40.0%). Most of the patients had mild disease severity (13, 86.7%), followed by mild-moderate (1, 6.7%) and moderate-severe (1, 6.7%). The study revealed that 6 patients were asymptomatic, and 9 patients were symptomatic. The most common symptoms were: fever (n = 8; 53.3%), cough (n = 7; 46.7%), shortness of breath (n = 3; 20.0%), fatigue (n = 3; 20.0%), and taste and smell disorders (n = 4; 26.7%). All patients were recovered and discharged over a median of 8 between 8 and 21 days. The mean and Std. deviation values of the hematological were: WBC: 6.57 (1.86); neutrophil count: 3.75 (1.26); lymphocyte count: 1.87 (0.41); Hb: 13.89 (1.26); platelet count: 207.67 (52.21).

CONCLUSION

All COVID-19 cases were linked to foreign visits with few local transmissions to close contacts without community transmission. The majority of cases were mild illnesses with full recovery.

Prevalence of urinary cotinine levels in children under 5 years of age during consultations for acute respiratory disease at the emergency department of the Universidad de La Sabana clinic

BACKGROUND

Several environmental factors favour the occurrence of acute respiratory disease, which is the main reason for paediatric consultations in our country (Colombia). Tobacco smoke is considered a significant environmental pollutant with a great impact on health. The objective of this study is to estimate the prevalence of cotinine levels measured in urine, in children between 1 to 60 months of age who attended an emergency department with acute respiratory disease.

METHODS

A cross-sectional study was conducted that included children between 1 and 60 months of age with acute respiratory disease who were admitted to the emergency department of the Universidad de La Sabana Clinic between April and July 2016.

RESULTS

We included 268 patients and 36% were female. Of the total population examined, 33.96% showed positive results for urinary cotinine, of whom 97.8% had values between 10 and 100 ng/ml, which is considered positive for exposure to second-hand smoke. The principal pathology was recurrent wheezing in 43.96% of these cases. Regarding the presence of smokers at home, it is important to mention that in 54.95% of the children with positive urinary cotinine test was no related with smokers at home. And in 45.05% of positive urinary cotinine was evidence of smokers at home, being associated with the positive result P <  0.001 and smoking within the house P = 0.018; smoking when children were present did not have significant P = 0.105. The activities performed after smoking such as hand washing, change of clothes, eating, brushing teeth, did not influence the test result P = 0.627.

CONCLUSIONS

A high prevalence of urinary cotinine was observed, which is associated with the presence of a smoker at home, and this relationship was independent of the activities performed by the smoker after smoking. In addition, a positive test for urinary cotinine was presented in some children without documented exposure to cigarette smoke inside the home, which may be explained by the presence of environmental cotinine. Therefore, it is necessary to perform educational interventions aimed at parents and caregivers who smoke.

Genetics of Equine Respiratory Disease

Genetic factors influence the development of guttural pouch tympany, recurrent laryngeal neuropathy, severe equine asthma, exercise-induced pulmonary hemorrhage, and possibly also some malformations and infectious diseases of the respiratory tract. The current data suggest that most of these diseases are complex, resulting from the interaction between several genes and environmental factors. To date, no specific genes or causative mutations have been identified that would allow the development of practical genetic tests. In the future, genetic profiling panels, based on multiple genetic markers and environmental risk factors, may allow identification of individuals with an increased genetic risk.

Plants derived therapeutic strategies targeting chronic respiratory diseases: Chemical and immunological perspective

The apparent predicament of the representative chemotherapy for managing respiratory distress calls for an obligatory deliberation for identifying the pharmaceuticals that effectively counter the contemporary intricacies associated with target disease. Multiple, complex regulatory pathways manifest chronic pulmonary disorders, which require chemotherapeutics that produce composite inhibitory effect. The cost effective natural product based molecules hold a high fervor to meet the prospects posed by current respiratory-distress therapy by sparing the tedious drug design and development archetypes, present a robust standing for the possible replacement of the fading practice of poly-pharmacology, and ensure the subversion of a potential disease relapse. This study summarizes the experimental evidences on natural products moieties and their components that illustrates therapeutic efficacy on respiratory disorders.

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Plant derived therapeutics for managing chronic respiratory disorders.

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Activity of natural product based molecules on key regulatory pathways of COPD.

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Preclinical evidence for the efficacy of natural product moieties.

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Clinical significance of plant derived molecules in pulmonary distress.

Negative influence of maternal smoking during pregnancy on infant outcomes

BACKGROUND

According to the INPES 2014 health barometer, the prevalence of smoking in pregnant women in France is the highest in Europe : 17.8% of expectant mothers who smoke continue to do so during pregnancy. Several epidemiological studies have confirmed multiple risks for tobacco-exposed infants (low birth weight; digestive, respiratory, neurological, and psychological disorders; obesity; type 1 diabetes).

PURPOSE

This study compared a cohort of infants exposed to tobacco in utero (T+) with those unexposed (T-). Birth weight, diet, presence of colic (ROME III criteria) and regurgitations (Vandenplas scale) were specifically analyzed.

METHODS

This observational, cross-sectional, and multicenter survey was conducted in France by pediatricians and general practitioners from September 2016 to February 2017. Infants with a chronic pathology and those with parents under 18 years of age were excluded. The data were collected by the physician and by the mother through a self-administered questionnaire.

RESULTS

A total of 452 physicians recruited 759 T+ and 741 T- infants in the study. The mean birth weight of T+ infants was significantly lower (3.1±0.5 kg [WHO z-score -0.476±1.081]) than that of T- infants (3.3±0.5 kg [0.033±0.965]; P<0.001). At the time of leaving the maternity facility, 47.7% of T+ infants were breastfed by their mother compared with 70.1% of T- infants. The median reported duration of breastfeeding was 1 month vs. 2 months for T+ and T- infants, respectively. Colic was significantly more common in T+ than in T- infants: 25.6% vs. 12.3% according to the ROME III criteria, and 45.7% vs. 29.7% according to the doctor's opinion (P<0.001 for both). In the T+ group, cases of regurgitation (63.6% vs. 56.5%; P=0.005), respiratory disorder (6.3% vs. 2.4%, P<0.001), and bronchiolitis (6.5% vs. 3.0%; P=0.001) were also more frequent.

CONCLUSION

This study confirms that maternal smoking during pregnancy is associated with health risks; exposed infants had significantly more digestive/respiratory symptoms and lower birth weight than unexposed infants. Preventive and educational actions need to be further strengthened in the face of this public health problem.

Effects of levothyroxine on lung inflammation, oxidative stress and pathology in a rat model of Alzheimer's disease

BACKGROUND

In this study, the effect of levothyroxine (L-T4) on tracheal responsiveness, lung inflammation, oxidative stress and pathological features in a rat model of Alzheimer's disease (AD), was evaluated.

METHODS

An animal model of AD was established by intracerebroventricular injection of streptozotocin (STZ) (3 mg/kg) in rats. The rats were then treated for 3 weeks with L-T4 (10 and 100 μg/kg).

RESULTS

In AD animals, tracheal responsiveness to methacholine and ovalbumin (p < 0.05), white blood cell (WBC) count (p < 0.05 to p < 0.01), malondialdehyde (MDA) concentration (p < 0.05) and inflammation score (p < 0.01) were increased, but superoxide dismutase (SOD) activity and total thiol content (for both cases p < 0.05) were decreased compared to the controls. Tracheal responsiveness to methacholine and MDA concentration (p < 0.05) were decreased in AD animals treated with T4 compared to the AD group. Bronchial inflammation in terms of total and some differential WBC in the BALF and inflammatory score, was significantly worsened in AD animals treated with high dose of T4 (p < 0.05 to p < 0.001) compared to the controls.

CONCLUSION

Alzheimer's disease may cause lung inflammation and treatment with low dose of T4 improved MDA level and lung inflammation.

Exposure to traffic air pollutants in taxicabs and acute adverse respiratory effects: A systematic review

INTRODUCTION

Taxi drivers could be at risk regarding their respiratory health due to their constant exposure to traffic related air pollutants (TRAP) inside their vehicles. Therefore, we aimed to review pollutants exposure inside taxi vehicles and its determinants as well as its acute adverse respiratory effects.

METHODS

The literature search was done in Pubmed and in Embase. For additional resources we searched manually articles from the reference lists of the selected papers and from Google Scholar. We included only studies in French or in English language meeting the following eligibility criteria: design: observational and quasi-experimental; study population: taxi drivers or taxi commuters, outcome: pollutants levels in taxicabs and/or acute adverse respiratory effects. Data was extracted using tabulation according to the type of the study (exposure or epidemiological).

RESULTS

Out of 1753 articles, 21 studies were included. Exposure studies underlined that TRAP concentrations inside taxicabs were higher than their urban background levels and even exceeded those recorded in buses, in trains and when commuting by active transport modes. Overall, their concentrations varied widely between studies depending on the characteristics of the urban environment and the vehicle fleet of each location. Meteorological parameters and ventilation settings appeared to influence pollutants concentrations inside each vehicle. Otherwise, deficiency in epidemiological studies and inconsistencies in their findings restrain our ability to determine the association between acute respiratory effects and exposure to TRAP inside taxicabs.

CONCLUSION

Although studies are heterogeneous, results have shown a high but variable occupational exposure of taxi drivers to TRAP inside their vehicles. However, future researches are required to study short respiratory impact of taxi drivers' exposure to TRAP inside their vehicles.

Macrolide prescription in Dutch children: compliance with guidelines

For reasons of antibiotic resistance and side effects, macrolides should be prescribed with care in the pediatric population. We evaluated the adherence to Dutch guidelines of macrolide prescription in children and estimated the risk of Mycoplasma pneumoniae-associated pneumonia based on Fischer's decision tree. In this retrospective study, we included children aged 0-18 years who were treated with azithromycin or clarithromycin for pulmonary disease in four settings from general practice to hospital ward for (1) the prescriptions not in accordance with the guideline of the Dutch Association of Pediatrics and (2) the risk of M. pneumoniae in patients with community-acquired pneumonia (CAP) according to Fischer's decision tree. The latter suggests that children older than three years with a fever lasting more than two days are at high risk for M. pneumoniae and that it is therefore justified to treat them with macrolides. In total, 189 macrolide prescriptions from 2015 until 2017 were analyzed: 139 children used macrolides for a pulmonary indication (75%); 18% (n = 25) of the prescriptions were not in accordance with Dutch guidelines. Only 9.1% of patients with CAP were classified as having a high risk of M. pneumoniae according to Fischer's decision tree. A significant proportion of macrolide prescriptions for Dutch children with a pulmonary disease appears not to be in accordance with the guidelines. Most patients with CAP treated with a macrolide actually had a low risk of having M. pneumoniae according to Fischer's decision tree. Both observations suggest overuse of macrolides in children.

Traditional medicinal plants used for respiratory disorders in Pakistan: a review of the ethno-medicinal and pharmacological evidence

Respiratory disorders are a common cause of malady and demise in Pakistan due to its remoteness, cold and harsh climatic conditions as well as scarce health care facilities. The people rely upon the indigenous plant resources to cure various respiratory disorders. The primary objective of this review was to assemble all available ethno-medicinal data of plants used for respiratory disorders in Pakistan. Pharmacological activity of these plants (based upon published scientific research), distribution, diversity, use, preparation methods, economical value, conservation status and various available herbal products of some plants have also been explored. This study scrutinized various electronic databases for the literature on medicinal plants used in Pakistan to treat respiratory disorders. A total of 384 species belonging to 85 families used to treat respiratory disorders in Pakistan has been documented. Cough was the disorder treated by the highest number of species (214) followed by asthma (150), cold (57) and bronchitis (56). Most of the plants belongs to Asteraceae (32) and Solanaceae family (32) followed by moraceae (17), Poaceae (13), and Amaranthaceae (13) with their habit mostly of herb (219) followed by Shrub (112) and tree (69). Traditional healers in the region mostly prepare ethno medicinal recipes from leaves (24%) and roots (11%) in the form of decoction. Among the reported conservation status of 51 plant species, 5 were endangered, 1 critically endangered, 11 vulnerable, 14 rare, 16 least concern, 3 infrequent and 1 near threatened. We found only 53 plants on which pharmacological studies were conducted and 17 plants being used in herbal products available commercially for respiratory disorders. We showed the diversity and importance of medicinal plants used to treat respiratory disorders in the traditional health care system of Pakistan. As such disorders are still causing several deaths each year, it is of the utmost importance to conduct phytochemical and pharmacological studies on the most promising species. It is also crucial to increase access to traditional medicine, especially in rural areas. Threatened species need special attention for traditional herbal medicine to be exploited sustainably.

I-Cell Disease (Mucolipidosis II): A Case Series from a Tertiary Paediatric Centre Reviewing the Airway and Respiratory Consequences of the Disease

BACKGROUND

Inclusion cell disease (I-cell) is a rare autosomal recessive metabolic disease involving multiple organ systems, associated with a severely restricted life expectancy. No curative therapy is currently available, with management aimed at symptom palliation.

METHODS

We present a retrospective, single-centre, case series of children referred to a tertiary paediatric metabolic service. The clinical presentation, demographics, genetics and natural history of the condition are investigated.

RESULTS

Five patients with I-cell disease were referred over a 10-year period. All patients were born with dysmorphic features and had a family history of I-cell disease on further exploration. Phenotypic variation was seen within patients with the same genetic profile. Airway problems were common with 100% of the documented sleep oximetry studies suggesting sleep-disordered breathing. Of the two patients who had tracheal intubation anaesthetic difficulties we encountered, one required intraoperative reintubation, and one suffered a failed intubation with subsequent death. All five patients required oxygen therapy with the use of CPAP and BiPAP also seen. Feeding issues were almost universal with four of the five patients requiring nasogastric feeding. Four patients had died in the 10-year period with a mean life expectancy of 36 months. Cause of death for three of the four patients was respiratory failure.

CONCLUSIONS

Airway problems, including sleep-disordered breathing, were ubiquitous in this cohort of children. Any intervention requiring a general anaesthetic needs careful multidisciplinary consideration due to significant associated risks and possibly death. Management as a result is generally non-surgical and symptomatic. This case series demonstrates universal involvement of the airway and respiratory systems, an important consideration when selecting meaningful outcomes for future effectiveness studies of novel therapies.

Obstructive sleep apnea syndrome and olfactory perception: An OERP study

Obstructive Sleep Apnea Syndrome (OSA) is characterized by snoring associated with repeated apnea and/or obstructive hypopnea. The nasal airways of OSA patients, measured via acoustic rhinometry, could be significantly narrower than healthy subjects and this reduced nasal structure can impair olfactory function. The relationship between nasal structure and olfactory function, assessed via behavioral test results, indicates that there is a high prevalence of nasal airflow problems. Based on these assumptions, the purpose of this study was to carry out an assessment of olfactory perception in OSA patients through the Chemosensory Event-Related Potentials (CSERP), investigating the N1 component and the Late Positive Component (LPC). Twelve OSA patients, non-smokers, were recruited in the Pulmonary Rehabilitation Unit, scored with the Epworth Sleepiness Scales, after Polygraphic Recording, Apnea Hypopnea Index and Body Mass Index evaluation. The control group consisted of twelve healthy controls, non-smokers, recruited as volunteers. Subjects, during an EEG recording, performed an oddball olfactory recognition task based on two scents: rose and eucalyptus. Main results highlighted differences in N1 and LPC between OSA and controls. OSA patients presented faster N1 latencies and greater amplitude. The same trend was found in LPC, where OSA showed decreased latency and increased amplitude during rose stimulation, in the right inferior frontal cortex. and faster latencies in left centroparietal cortex OERP results can suggest an impairment in endogenous components. This result could be the consequence of the exogenous perceptual difficulty highlighted in N1 component. The increased arousal could also be related to the respiratory activity involved during the olfactory task.

Troglostrongylus brevior: a feline lungworm of paediatric concern

The immature immune system of cats in their paediatric age (i.e., first six months of life) favours the establishment of infectious respiratory tract diseases mainly caused by well recognized viruses and bacteria species. Conversely, lungworm infections are less investigated during respiratory disorders in kittens. In the last decade, Troglostrongylus brevior has been found affecting the respiratory tract of cats, along with the better-known Aelurostrongylus abstrusus. Given the scant data available on the epidemiology of feline troglostrongylosis, faecal samples from 575 domestic animals living in three Italian municipalities (i.e., Bari, Messina and Siena) were screened for lungworm infection by Baermann and molecular tecniques. Animals were grouped according to their age as ≤6 months (i.e., paediatric patients), 6-24 months, or >24 months. Paediatric cats were further sub-divided in infant (2-6 weeks), weanling (6-12 weeks) and juvenile (3-6 months). Of the 575 animals tested, 241 (42.0%) were younger than 6 months, 188 (33%) were 6-24-month-old and 146 (25%) were older than 24 months. Lungworm infection was diagnosed in 84 (14.6%) of the examined cats. Of the 49 (20.3%) paediatric animals positive for lungworms, T. brevior was the nematode species most frequently diagnosed (n = 44; 89.8%), followed by A. abstrusus (n = 2; 4.1%), and three cats (6.1%) were co-infected by both species. The diagnosis of T. brevior infection was significantly associated with animals aging ≤6 months (18.2%; P < 0.01) than elder cats. Indeed, the prevalence of infection by T. brevior decreased in animals aging 6-24 months (3.2%) being not detected in cats older than two years. Results of this study indicate that paediatric cats are at higher risk of T. brevior infection compared to adults (P < 0.01).

Recent Progress in the Discovery and Development of TRPA1 Modulators

TRPA1 is a well-validated therapeutic target in areas of high unmet medical need that include pain and respiratory disorders. The human genetic rationale for TRPA1 as a pain target is provided by a study describing a rare gain-of-function mutation in TRPA1, causing familial episodic pain syndrome. There is a growing interest in the TRPA1 field, with many pharmaceutical companies reporting the discovery of TRPA1 chemical matter; however, GRC 17536 remains to date the only TRPA1 antagonist to have completed Phase IIa studies. A key issue in the progression of TRPA1 programmes is the identification of high-quality orally bioavailable molecules. Most published TRPA1 ligands are commonly not suitable for clinical progression due to low lipophilic efficiency and/or poor absorption, distribution, metabolism, excretion and pharmaceutical properties. The recent TRPA1 cryogenic electron microscopy structure from the Cheng and Julius labs determined the structure of full-length human TRPA1 at up to 4Å resolution in the presence of TRPA1 ligands. This ground-breaking science paves the way to enable structure-based drug design within the TRPA1 field.

Efficacy of inspiratory muscle training as a practical and minimally intrusive technique to aid functional fitness among adults with obesity

OBJECTIVE

To examine the efficacy of inspiratory muscle training (IMT) as a non-intrusive and practical intervention to stimulate improved functional fitness in adults with obesity. As excess adiposity of the chest impedes the mechanics of breathing, targeted re-training of the inspiratory muscles may ameliorate sensations of breathlessness, improve physical performance and lead to greater engagement in physical activity.

METHODS

Sixty seven adults (BMI=36±6.5) were randomized into either an experimental (EXP: n=35) or placebo (PLA: n=32) group with both groups undertaking a 4-week IMT intervention, comprising daily use of a inspiratory resistance device set to 55% (EXP), or 10% (PLA) of maximum inspiratory effort.

RESULTS

Inspiratory muscle strength was significantly improved in EXP (19.1 cmH₂0 gain; P<0.01) but did not change in PLA. Additionally, the post training walking distance covered was significantly extended for EXP (P<0.01), but not for PLA. Bivariate analysis demonstrated a positive association between the change (%) of performance in the walking test and BMI (r=0.78; P<0.01) for EXP.

CONCLUSION

The findings from this study suggest IMT provides a practical, self-administered intervention for use in a home setting. This could be a useful strategy to improve the functional fitness of obese adults and perhaps lead to better preparedness for engagement in physical activity initiatives.

[Review of reimbursement for instrumental techniques used for assisted coughing and thoracic expansion. A French National Health Authority assessment (HAS)]

INTRODUCTION

In France, children with neuromuscular diseases and patients with traumatic spinal cord injuries receive reimbursement for home use of intermittent positive-pressure breathing and mechanical in-exsufflators devices. The aim of the study was to update the indications for reimbursement for these both devices.

METHODS

A literature review was conducted with several bibliographic databases using the main keywords: intermittent positive-pressure breathing, mechanical insufflation, mechanically-assisted cough, airway clearance. Nine health professionals were interviewed during two meetings. One health professional was interviewed via a questionnaire. An estimation of the population treated with in-exsufflators or intermittent positive-pressure breathing was undertaken from consumer data available for all beneficiaries of the health insurance system.

STATE OF THE ART

The review identified 111 references which included 14 clinical practice guidelines, two systematic reviews and one randomized controlled trial. Some clinical data were available. Clinical practice guidelines were in favor of using intermittent positive-pressure breathing and in-exsufflators in patients with neuromuscular disease and spinal cord injuries. The healthcare professionals emphasized the need to reimburse the patient for home use of intermittent positive-pressure breathing and in-exsufflators. The patient population treated in the identified clinical situations was estimated at 3100 per year.

CONCLUSIONS

Despite the low level of evidence and after interviewing healthcare professionals, the Haute Autorité de santé (HAS) recommended reimbursement of the costs of in-exsufflators (assisted coughing) and intermittent positive-pressure breathing (thoracic expansion) devices in adults and children with neurological and neuromuscular disease, including spinal cord injury.

Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure

BACKGROUND

In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established.

METHODS

A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy.

RESULTS

Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≧60 months, infants of 0-2 months had a 93% lower odds of bCPAP failure (odds ratio 0·07, 95% confidence interval 0·004-1·02, P  =  0·05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P  =  0·0006), and mean oxygen saturation increased from 92·1% to 96·1% (P  =  0·02).

CONCLUSIONS

bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources.

Microbiological characterization of 3193 French dwellings of Elfe cohort children

Although exposure to indoor microorganisms in early life has already been associated with respiratory illness or allergy protection, only a few studies have performed standardized samplings and specific microbial analysis. Moreover, most do not target the different groups of microorganisms involved in respiratory diseases (fungi, bacteria, dust mites). In our study, ten specific qPCR targets (6 fungal species, 1 family and 2 genera of bacteria, 1 house dust mite) were used to analyze the microorganism composition of electrostatic dust fall collector (EDC) from 3193 dwellings of the Elfe French cohort study. Multivariate analyses allowed us to show that the microbial composition of dwellings, assessed with simultaneous analysis of 10 microorganisms, can be characterized by four entities: three bacteria, house dust mite Dermatophagoïdes pteronyssinus, fungi Alternaria alternata, and five other molds. Some dwellings' intrinsic characteristics (occupational ratio, type of dwelling and presence of pets) clearly influence microorganism distribution, and six different profiles of dwellings, characterized by their composition in microorganisms, have been described across France. The use of these clusters seems promising in the evaluation of allergic risk. Allergic respiratory diseases will develop in the near future in some children of the Elfe cohort and will indicate to what extent our approach can be predictive of respiratory disease.

Ethnobotanical uses of medicinal plants for respiratory disorders among the inhabitants of Gallies - Abbottabad, Northern Pakistan

ETHNOPHARMACOLOGICAL RELEVANCE

Rich accessibility of medicinal plants in the study area provides low cost health care for respiratory disorders to local communities. This first report survey was commenced with an aim to document ethnic knowledge regarding the use of folk herbal medicine for respiratory diseases among the local communities of Gallies Abbottabad, Northern Pakistan using quantitative ethnobotanical approaches.

METHOD

Field survey was carried out over the period of 2 years i.e., March 2012-March 2014 in study area. The ethnomedicinal data was collected through interviews among the local communities. Documented data was evaluated using use value (UV) and Relative Frequency Citation (RFC).

RESULTS

A total of 120 species of plants belonging to 90 genera of 51 families were reported to be used ethnomedicinally for the treatment of 25 different respiratory disorders. Leaves were the most commonly used plant parts and most of the herbal medicines were prepared in the form of decoctions and administered orally. The most significant species according to their use value were Solanum virginianum (5.00), Althea officinalis (3.00), Inula obtusifolia (3.00), Saxifraga hirculus (3.00) and Sisymbrium erysimoides (3.00).

CONCLUSION

This study reported traditional herbal medicines for the first time to be used against respiratory disorders in the Gallies, Northern Pakistan are still in common practice by the local communities. Some of the new ethnobotanical claims documented in this investigation should need to be further explore clinically. The medicinal plants with highest use values recorded in this study may signpost the probable existence of valuable phytochemical compounds that requires a search for prospective new drugs to cure many respiratory disorders.

Plasma oxidant-antioxidant status in different respiratory disorders

This study confirms the fact that in different respiratory disorders, the status of plasma oxidants and antioxidants shifts from normal. The status of oxidants in plasma as represented by malondialdehyde (MDA) levels increased significantly in the conditions of chronic obstructive pulmonary disease (COPD), emphysema, bronchiectasis and bronchial asthma. The two vitamin antioxidants vitamin C and vitamin E showed decreased levels than in controls. In patients with COPD the endogenous antioxidant viz. reduced glutathione (GSH) estimated from whole blood was comparable to that of control group, whereas in patients with emphysema, bronchiectasis and bronchial asthma, GSH concentration was increased to that of control group. The activity of enzyme superoxide dismutase (SOD) was significantly decreased in all study groups. Pulmonary function tests were found to have no correlation with MDA and antioxidants.

Respiratory findings in dental laboratory technicians in rasht (north of iran)

BACKGROUND

There are several occupations that can expose people to some air pollutants. Dental technicians are exposed to inorganic dust and chemical vapors when making dental prosthesis that can put them at risk for respiratory problems. This study was performed to assess respiratory dysfunction in a group of dental technicians.

MATERIALS AND METHODS

This was a cross-sectional study designed to ascertain the prevalence of respiratory disorders in dental laboratory technicians in Rasht, a city located in north of Iran. A Structured questionnaire was adapted according to the European Community Respiratory Health Survey questionnaire and used to elicit information regarding sociodemographic characteristics and medical status of the study participants. The ventilation status, protective measures and direct exposure to materials in the laboratories were directly observed by the observers and subjects underwent respiratory tests and chest x-ray.

RESULTS

The mean age of dental technicians was 31.31 yrs (range 18-56 years) and 83% were males with a mean dental work experience of 9.04 years. In 54.8% of cases, the work environment did not have air conditioning system. The most common signs and symptoms were cough (38.1%) and wheezing (16.7%). There was a significant correlation between smoking and respiratory signs. Restrictive airway pattern and air trapping were two prevalent findings which were observed in 85.7% and 33.3% of the subjects. Cigarette smoking had a negative effect on FEV1, FEF25%-75%, and TLC causing a significant reduction in all three parameters (p < 0.05). The most prevalent finding was interstitial opacity which was observed in 10 individuals (23.8%). This finding was not significantly associated with age, gender, cigarette smoking, or daily work hours. However, there was a significant statistical association between work experience and interstitial opacity.

CONCLUSION

The prevalence of respiratory dysfunction and chest x-ray findings were high as in several similar studies. In order to reduce the hazards of respiratory disorders in risky occupations and provide dental workers with technical preventive measures, a more comprehensive study should be conducted throughout the country and further evaluations through biopsy and CT-scan need to be performed in suspicious cases when necessary.