Sexual activity and respiratory disease: A systematic review

CONTEXT

Sex and gender are related concepts, but they have distinct meanings and implications. Respiratory diseases are a major driver of morbi-mortality. It is frequent that respirologists, primary care doctors, or other specialists, when dealing with respiratory patients, and aiming for a holistic management of their patients, they all skip any question or matter associated with sexual activity or behavior.

OBJECTIVES

To review how sexual activity is explored in respiratory patients.

METHODS

To conduct this review, we endorse PRISMA guidance for reporting systematic reviews, and also the sex and gender equity in research (SAGER) guidelines.

RESULTS

Compared to other conditions such as heart disease, mental disorders, Alzheimer's, or even COVID-19, to date there is no review focused on sexual activity and respiratory health and disease. Asthma, COPD and other respiratory patients can have their sexual activity and behaviors affected by their disease, but also limitations in sex might be the sentinel event of an incident respiratory disease. Asking on sexual desire and related sex issues should not be considered taboo in any respiratory consultation. Importantly, any marketed stereotypes on cigarettes after any sexual activity should be counteracted. Many clinical trials of respiratory drugs keep recruiting few or no women, so research on women's sexual desire and satisfaction lags behind that of men's. By using the available objective tools and validated questionnaires summarized in this review, these important domains of respiratory patients and their partners can be properly identified and managed.

CONCLUSIONS

Sexual activity, depending on age and individual specific conditions, is a fundamental driver of overall health, and therefore of lung health.

Interactions between inhalable aged microplastics and lung surfactant: Potential pulmonary health risks

The relationship between microplastics (MPs) and human respiratory health has garnered significant attention since inhalation constitutes the primary pathway for atmospheric MP exposure. While recent studies have revealed respiratory risks associated with MPs, virgin MPs used as plastic surrogates in these experiments did not represent the MPs that occur naturally and that undergo aging effects. Thus, the effects of aged MPs on respiratory health remain unknown. We herein analyzed the interaction between inhalable aged MPs with lung surfactant (LS) extracted from porcine lungs vis-à-vis interfacial chemistry employing in-vitro experiments, and explored oxidative damage induced by aged MPs in simulated lung fluid (SLF) and the underlying mechanisms of action. Our results showed that aged MPs significantly increased the surface tension of the LS, accompanied by a diminution in its foaming ability. The stronger adsorptive capacity of the aged MPs toward the phospholipids of LS appeared to produce increased surface tension, while the change in foaming ability might have resulted from a variation in the protein secondary structure and the adsorption of proteins onto MPs. The adsorption of phospholipid and protein components then led to the aggregation of MPs in SLF, where the aged MPs exhibited smaller hydrodynamic diameters in comparison with the unaged MPs, likely interacting with biomolecules in bodily fluids to exacerbate health hazards. Persistent free radicals were also formed on aged MPs, inducing the formation of reactive oxygen species such as superoxide radicals (O2•-), hydrogen peroxide (HOOH), and hydroxyl radicals (•OH); this would lead to LS lipid peroxidation and protein damage and increase the risk of respiratory disease. Our investigation was the first-ever to reveal a potential toxic effect of aged MPs and their actions on the human respiratory system, of great significance in understanding the risk of inhaled MPs on lung health.

Impaired lung function in adolescents with pulmonary tuberculosis during treatment and following treatment completion

Background

Little is known about post-tuberculosis lung disease in adolescents. We prospectively assessed lung function in adolescents with microbiologically confirmed pulmonary tuberculosis during treatment and after treatment completion.

Methods

In a prospective study, we enrolled adolescents diagnosed with microbiologically confirmed tuberculosis and healthy tuberculosis-exposed household controls, between October 2020 and July 2021 in Cape Town, South Africa. Spirometry, plethysmography, diffusion capacity lung function tests and 6-min walking test (6MWT) were completed according to international guidelines 2 months into treatment and following treatment completion. Abnormal lung function was defined as abnormal spirometry (z-score < -1.64 for forced expiratory volume in 1 s (FEV1) and/or forced vital capacity (FVC) and/or FEV1/FVC), plethysmography (total lung capacity (TLC) < 80% of predicted, residual volume over TLC of >45%) and/or diffusion capacity (DLCO z-score < -1.64).

Findings

One-hundred adolescents were enrolled; 50 (50%) with tuberculosis and 50 (50%) healthy tuberculosis-exposed controls. Of the 50 adolescents with tuberculosis, ten had multidrug-resistant tuberculosis. Mean age of the group was 14.9 years (SD 2.7), 6 (6.0%) were living with HIV and 9 (9.0%) were previously treated for tuberculosis. Lung function improved over time; during treatment abnormal lung function was found in 76% of adolescents with tuberculosis, compared to 65% after treatment completion. Spirometry indices were lower in adolescents with tuberculosis compared to controls, both at 2 months and after treatment completion. Plethysmography in adolescents with tuberculosis showed that air-trapping was more common during treatment than in controls (12% vs 0%, respectively, p = 0.017); which improved following treatment completion. Adolescents with tuberculosis both during and after treatment completion walked a shorter distance than controls.

Interpretation

Adolescents with tuberculosis have impaired lung function even after treatment completion. It is crucial to include adolescents in trials on the prevention and treatment of tuberculosis-associated respiratory morbidity.

Funding

EDCTP, National Institute of Health, Medical Research Council, BMBF.

UMOYA: a prospective longitudinal cohort study to evaluate novel diagnostic tools and to assess long-term impact on lung health in South African children with presumptive pulmonary TB-a study protocol

BACKGROUND

Despite a high paediatric tuberculosis (TB) burden globally, sensitive and specific diagnostic tools are lacking. In addition, no data exist on the impact of pulmonary TB on long-term child lung health in low- and middle-income countries. The prospective observational UMOYA study aims (1) to build a state-of-the-art clinical, radiological, and biological repository of well-characterised children with presumptive pulmonary TB as a platform for future studies to explore new emerging diagnostic tools and biomarkers for early diagnosis and treatment response; and (2) to investigate the short and long-term impact of pulmonary TB on lung health and quality of life in children.

METHODS

We will recruit up to 600 children (0-13 years) with presumptive pulmonary TB and 100 healthy controls. Recruitment started in November 2017 and is expected to continue until May 2023. Sputum and non-sputum-based samples are collected at enrolment and during follow-up in TB cases and symptomatic controls. TB treatment is started by routine care services. Intensive follow-up for 6 months will allow for TB cases to retrospectively be classified according to international consensus clinical case definitions for TB. Long-term follow-up, including imaging, comprehensive assessment of lung function and quality of life questionnaires, are done yearly up to 4 years after recruitment.

DISCUSSION

The UMOYA study will provide a unique platform to evaluate new emerging diagnostic tools and biomarkers for early diagnosis and treatment response and to investigate long-term outcomes of pulmonary TB and other respiratory events on lung health in children.

Potential health risks of the interaction of microplastics and lung surfactant

Microplastics (MPs), as pollutants of environmental concern, are correlated with increased risk of various respiratory diseases. Nevertheless, whether or not MPs have adverse influences on the interfacial properties of lung surfactant (LS), and its effect on the generation of reactive oxygen species are poorly understood. In the present study, natural LS extracted from porcine lungs was used to investigate the interaction with polystyrene as a representative MPs. The results showed that the phase behavior, surface tension, and membrane structure of the LS were altered in the presence of polystyrene. Adsorption experiments demonstrated that in the mixed system of polystyrene and LS (the main active ingredients are phospholipids and proteins), adsorption of phospholipid components by polystyrene was notably higher than that of proteins. Moreover, polystyrene can accelerate the conversion between ascorbic acid and deoxyascorbic acid, thereby producing hydrogen peroxide (HOOH) in simulated lung fluid (containing LS) and further giving rise to an increase in the content of hydroxyl radicals (•OH). This work provides new insight into the potential hazard of MPs in human respiratory system, which is helpful for deeply understanding the unfavorable physicochemical effects of MPs exposure and the role of inhaled MPs on lung health.

Evaluation of the permeability and potential toxicity of polycyclic aromatic hydrocarbons to pulmonary surfactant membrane by the parallel artificial membrane permeability assay model

Polycyclic aromatic hydrocarbons (PAHs) can penetrate and accumulate in the pulmonary surfactant (PS) membranes, leading to abnormalities of biological macromolecules and the destruction of membrane structure and properties. In the present study, the bioavailability, apparent permeability, effective permeability and residual coefficient of 10 PAHs on PS membrane was assessed by the parallel artificial membrane permeability assay (PAMPA). The influence of various forces on permeability is obtained by analyzing the correlation between parameters and physicochemical properties. Research shows that octanol-water partition coefficient (K_ow) cannot directly predict permeability, and permeability has no significant relationship with polarity. Dispersion, induction, coupling/polarization promote permeation, while hydrogen bonded acid and n-n electron pair inhibit permeation. Further surface pressure-area (π-A) isotherms test and Brewster angle microscope observation manifested that there are huge differences in the transmembrane ability and effects on the membrane of PAHs with different structures. This work has considerable significance that will help to evaluate the bioavailability and human health risk of PAHs.

Interfacial interaction between benzo[a]pyrene and pulmonary surfactant: Adverse effects on lung health

Inhaled polycyclic aromatic hydrocarbons (PAHs) can directly interact with the lung surfactant (PS) lining of alveoli, thereby affecting the normal physiological functions of PS, which is a serious threat to lung health. In spite of the extensive study of benzo[a]pyrene (BaP, a representative of PAHs), its potential biophysical influence on the natural PS is still largely unknown. In this study, the interfacial interaction between PS (extracted from porcine lungs) and BaP is investigated in vitro. The results showed that the surface tension, phase behavior, and interfacial structure of the PS monolayers were obviously altered in the presence of BaP. A solubilization test manifested that PS and its major components (dipalmitoyl phosphatidylcholine, DPPC; bovine serum albumin, BSA) could in turn accelerate the dissolution of BaP, which followed the order: PS > DPPC > BSA, and mixed phospholipids were significantly responsible for the solubilization of BaP by PS. In addition, solubilization of BaP also enhanced the consumption of hydroxyl radicals (·OH) in the simulated lung fluid, which could disturb the balance between oxidation and antioxidation.

Automatic Lung Health Screening Using Respiratory Sounds

Significant changes have been made on audio-based technologies over years in several different fields. Healthcare is no exception. One of such avenues is health screening based on respiratory sounds. In this paper, we developed a tool to detect respiratory sounds that come from respiratory infection carrying patients. Linear Predictive Cepstral Coefficient (LPCC)-based features were used to characterize such audio clips. With Multilayer Perceptron (MLP)-based classifier, in our experiment, we achieved the highest possible accuracy of 99.22% that was tested on a publicly available respiratory sounds dataset (ICBHI17) (Rocha et al. Physiol. Meas. 40(3):035,001 20) of size 6800+ clips. In addition to other popular machine learning classifiers, our results outperformed common works that exist in the literature.

Interaction of industrial smelting soot particles with pulmonary surfactant: Pulmonary toxicity of heavy metal-rich particles

Inhalable particles can influence the interfacial behavior of pulmonary surfactant (PS) resulting in various pulmonary diseases. However, the effects of actually airborne particles on the interfacial behavior of PS and its role in the alteration for soluble metal fraction in particles are entirely unexplored. Herein, we investigated the interaction of PS extracted from porcine lungs with smelting soot fine particles as a model of inhaled heavy metal-rich particles. Our results showed that the phase behavior and foamability of PS were obviously altered in the presence of smelting soot fine particles. In addition, the soluble heavy metals in smelting soot fine particles notably increased in the presence of PS as compared to that of saline solution. Further experiments conducted by adding PS's major components (dipalmitoylphosphatidylcholine, DPPC; bovine serum albumin, BSA) demonstrated that comparison of DPPC, adsorbed BSA is beneficial for the dissolution of heavy metals in smelting soot fine particles. Dynamic light scattering experiments verified that the well dispersion of smelting soot fine particles in the presence of BSA may be responsible for the higher solubility of heavy metals. These findings indicate that PS's interfacial behavior change and PS-enhanced solubilization release of metal components may increase the potentially pulmonary risk in the exposure of airborne fine particles enriched with heavy metals.

RESPIRATORY IMPACT OF ELECTRONIC CIGARETTES AND "LOW-RISK" TOBACCO

Electronic cigarettes, handheld devices that generate an aerosol that may contain nicotine by heating a solution or e-liquid, have been increasingly used especially in the young population. The aerosol's composition is determined by temperature, and by the substances contained in the heated liquid: glycerin, propylene glycol, nicotine in variable concentrations, flavoring agents, and other non-nicotine compounds. >80 compounds (including known toxics, e.g., formaldehyde, acetaldehyde, metallic nanoparticles, and acrolein) have been found in e-liquid and aerosols. Airway irritation, mucus hypersecretion, and inflammatory response, including systemic changes, have been observed after the exposure to e-cigarettes, leading to an increase in respiratory symptoms and changes in respiratory function and the host defense mechanisms. E-cigarette has been linked with an increase of symptoms in individuals with asthma, cystic fibrosis, and chronic obstructive pulmonary disease. One of the major concerns in public health is the rise in e-cigarette experimentation among never-smokers, especially children and adolescents, which leads to nicotine addiction and increases the chances of becoming with time a conventional smoker. There is an urgent need to regulate e-cigarettes and electronic nicotine delivery systems, at least with the same restrictions to those applied to tobacco products, and not to consider them as harmless products.

Interaction of pulmonary surfactant with silica and polycyclic aromatic hydrocarbons: Implications for respiratory health

Understanding the interaction between pulmonary surfactant (PS) and inhalable pollutants is vital for risk assessment of respiratory health. Here, PS extracted from porcine lung (EPS) was used to investigate the interaction of PS with nano-silica particles and polycyclic aromatic hydrocarbons (PAHs). Our results demonstrated that silica significantly affected the phase behavior and foaming ability of EPS; EPS and its major components (dipalmitoyl phosphatidylcholine, DPPC; bovine serum albumin, BSA) exhibited great enhancing effect on PAHs solubility, which follows the order: EPS > DPPC > BSA, and it was positively correlated with the hydrophobicity of PAHs. Further experiments demonstrated that mixed phospholipids of EPS were largely responsible for the solubilization of EPS on PAHs. In the presence of EPS, DPPC or BSA, adsorption of PAHs by silica was notably inhibited, indicating competitive adsorption between PAHs and PS components on silica. These findings provide evidence for the surface chemistry by which PS facilitates the solubilization of PAHs and reducing the adsorption of PAHs on silica, which may be helpful for deeply understanding the effects of particulate matter and PAHs on lung health.

Pulmonary function and respiratory health after successful treatment of drug-resistant tuberculosis

Background:

Post-treatment morbidity among subjects with drug-resistant tuberculosis (DR-TB) is unclear.

Methods:

This was a cross-sectional study of patients from Tbilisi, Georgia with cavitary DR-TB and an outcome of cure. Participants had a chest X-ray (CXR), St. George Respiratory Quality (SGRQ) survey, and pulmonary function tests (PFTs) performed. Correlations between SGRQ and PFT results and factors associated with pulmonary impairment were examined.

Results:

Among 58 subjects (median age 31 years), 40% used tobacco, 59% had prior TB, and 47% underwent adjunctive surgical resection. The median follow-up time was 41 months. Follow-up CXR revealed fibrosis in 30 subjects (52%) and bronchiectasis in seven (12%). The median forced expiratory volume (FEV₁)/forced vital capacity (FVC) ratio was 0.72, with 24 subjects (41%) having a ratio of ≤0.70. Significant correlations existed between PFT measures and overall and component SGRQ scores. In linear regression, age, prior TB, and CXR fibrosis or bronchiectasis were significantly associated with decreased pulmonary function. Adjunctive surgery was significantly associated with a higher percent predicted FEV₁ and FVC.

Conclusions:

A high proportion of DR-TB subjects had residual pulmonary impairment, particularly with recurrent TB and severe radiological disease. The association of surgical resection with improved lung function deserves further study. PFTs and SGRQ may both be useful to evaluate lung health.

Interaction of nano carbon particles and anthracene with pulmonary surfactant: The potential hazards of inhaled nanoparticles

Understanding the alteration of the air-liquid interfacial properties of pulmonary surfactant (PS) in the presence of nanoparticles (NPs) and polycyclic aromatic hydrocarbons (PAHs) is particularly important for pulmonary risk assessment. Here, we investigated the interaction of natural PS (extracted from pig's lungs) with nano carbon particles (NCPs) and anthracene as a representative PAH. Our results showed that PS exhibited a significant solubilization effect on anthracene. Solubilization experiment for the substructures of PS demonstrated that the mixed phospholipid components of PS played the primary role in the solubilization of PS for anthracene. Adsorption experiment indicated that in the mixed system of PS, NCPs, and anthracene, PS can inhibit the adsorption of anthracene on NCPs due to the solubilization, agglomeration, and competitive adsorption. In addition, the surface tension, phase behavior, and foaming ability of PS were obviously altered in the presence of NCPs. These findings indicate that the solubilization effect of PS on anthracene, the inhibitive effect of PS for the adsorption of anthracene on NCPs, and the alternation of air-liquid interfacial properties of PS containing NCPs may increase the pulmonary risk in the exposure of atmospheric environment containing both PAHs and NCPs.

Clinical efficacy of two vaccination strategies against Mycoplasma hyopneumoniae in a pig herd suffering from respiratory disease

Background

A randomised field trial was conducted on an Austrian farrow-to-finish farm for one year to compare the efficacy of two commercial Mycoplasma hyopneumoniae vaccines. 585 piglets either received the one-shot formulation in group 1 (Hyogen®, 23.9 days of age) or a two-shot vaccine (Stellamune® Mycoplasma, 4.3 and 24.0 days of age) in group 2. Assessment of vaccine efficacy was evaluated by regression analyses through cough monitoring from nursery to slaughter, average daily weight gain from inclusion to slaughter, antibiotic treatment rate (ATR), mortality rate, and lung lesion scoring at slaughter.

Results

In general, coughing was more frequent during late nursery and finishing. No significant differences were found in the coughing index (0.02 vs 0.03) and mean average daily weight gain (560 vs 550 g) between the two groups. ATR was higher in group 2 (3.8 vs 9.6%). At the slaughterhouse check, significant differences in the prevalence of bronchopneumonia (62.9 vs 71.2%) could be found. Extension of lung lesions was also significantly lower in group 1 in terms of enzootic pneumonia (EP) values (p = 0.000, z = − 4.269). There were no significant differences in the rate of scarred lungs (20.0 vs 24.0%) or those affected by dorsocaudal pleurisy (36.8 vs 34.3%).

Conclusions

This trial demonstrated that Hyogen® was superior to Stellamune® Mycoplasma in reducing (I) the prevalence of bronchopneumonic lungs and those affected by cranioventral pleurisy, (II) the extension and severity of EP-like lung lesions, and (III) the rate of antibiotically treated animals against respiratory disease.

Lung health in era of climate change and dust storms

Dust storms are strong winds which lead to particle exposure over extensive areas. These storms influence air quality on both a local and global scale which lead to both short and long-term effects. The frequency of dust storms has been on the rise during the last decade. Forecasts suggest that their incidence will increase as a response to the effects of climate change and anthropogenic activities. Elderly people, young children, and individuals with chronic cardiopulmonary diseases are at the greatest risk for health effects of dust storms. A wide variety of infectious and non-infectious diseases have been associated with dust exposure. Influenza A virus, pulmonary coccidioidomycosis, bacterial pneumonia, and meningococcal meningitis are a few examples of dust-related infectious diseases. Among non-infectious diseases, chronic obstructive pulmonary disease, asthma, sarcoidosis and pulmonary fibrosis have been associated with dust contact. Here, we review two molecular mechanisms of dust induced lung disease for asthma and sarcoidosis. We can also then further understand the mechanisms by which dust particles disturb airway epithelial and immune cells.

The impact of oil spill to lung health--Insights from an RNA-seq study of human airway epithelial cells

The Deepwater Horizon oil spill (BP oil spill) in the Gulf of Mexico was a unique disaster event, where a huge amount of oil spilled from the sea bed and a large volume of dispersants were applied to clean the spill. The operation lasted for almost 3 months and involved >50,000 workers. The potential health hazards to these workers may be significant as previous research suggested an association of persistent respiratory symptoms with exposure to oil and oil dispersants. To reveal the potential effects of oil and oil dispersants on the respiratory system at the molecular level, we evaluated the transcriptomic profile of human airway epithelial cells grown under treatment of crude oil, the dispersants Corexit 9500 and Corexit 9527, and oil-dispersant mixtures. We identified a very strong effect of Corexit 9500 treatment, with 84 genes (response genes) differentially expressed in treatment vs. control samples. We discovered an interactive effect of oil-dispersant mixtures; while no response gene was found for Corexit 9527 treatment alone, cells treated with Corexit 9527+oil mixture showed an increased number of response genes (46 response genes), suggesting a synergic effect of 9527 with oil on airway epithelial cells. Through GO (gene ontology) functional term and pathway-based analysis, we identified upregulation of gene sets involved in angiogenesis and immune responses and downregulation of gene sets involved in cell junctions and steroid synthesis as the prevailing transcriptomic signatures in the cells treated with Corexit 9500, oil, or Corexit 9500+oil mixture. Interestingly, these key molecular signatures coincide with important pathological features observed in common lung diseases, such as asthma, cystic fibrosis and chronic obstructive pulmonary disease. Our study provides mechanistic insights into the detrimental effects of oil and oil dispersants to the respiratory system and suggests significant health impacts of the recent BP oil spill to those people involved in the cleaning operation.