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Therapeutische Umschau. Revue... Aug 2023Dyspnea is one of the most common symptoms in patients with lung diseases. The term "dyspnea" refers to the subjective sensation of uncomfortable breathing, which is... (Review)
Review
Dyspnea is one of the most common symptoms in patients with lung diseases. The term "dyspnea" refers to the subjective sensation of uncomfortable breathing, which is experienced and described very differently between individuals. Because of this, diagnosis can be very challenging and similar to pain, no true objective measurement parameters of dyspnea exist. A detailed symptom history and clinical examination are critical in establishing the diagnosis, but the severity of pulmonary functional impairment does not always correlate with the clinical picture. The diagnosis of lung diseases is led by pulmonary function tests and imaging techniques, which measure the response to therapy and assess the prognostic course of the disease. The purpose of this article is to review the causes of pulmonary dyspnea, present a guide to diagnostic work-up, and introduce common differential diagnoses.
Topics: Humans; Dyspnea; Lung; Lung Diseases
PubMed: 37855528
DOI: No ID Found -
BMC Pulmonary Medicine Jul 2023Previous observational studies have found an association between gastroesophageal reflux disease (GERD) and chronic respiratory diseases, but it remains uncertain...
BACKGROUND
Previous observational studies have found an association between gastroesophageal reflux disease (GERD) and chronic respiratory diseases, but it remains uncertain whether GERD causally influences these diseases. In this study, we aimed to estimate the causal associations between GERD and 5 chronic respiratory diseases.
METHODS
88 GERD-associated single nucleotide polymorphisms (SNPs) identified by the latest genome-wide association study were included as instrumental variables. Individual-level genetic summary data of participants were obtained from corresponding studies and the FinnGen consortium. We applied the inverse-variance weighted method to estimate the causality between genetically predicted GERD and 5 chronic respiratory diseases. Furthermore, the associations between GERD and common risk factors were investigated, and mediation analyses were conducted using multivariable MR. Various sensitivity analyses were also performed to verify the robustness of the findings.
RESULTS
Our study demonstrated that genetically predicted GERD was causally associated with an increased risk of asthma (OR 1.39, 95%CI 1.25-1.56, P < 0.001), idiopathic pulmonary fibrosis (IPF) (OR 1.43, 95%CI 1.05-1.95, P = 0.022), chronic obstructive disease (COPD) (OR 1.64, 95%CI 1.41-1.93, P < 0.001), chronic bronchitis (OR 1.77, 95%CI 1.15-2.74, P = 0.009), while no correlation was observed for bronchiectasis (OR 0.93, 95%CI 0.68-1.27, P = 0.645). Additionally, GERD was associated with 12 common risk factors for chronic respiratory diseases. Nevertheless, no significant mediators were discovered.
CONCLUSIONS
Our study suggested that GERD was a causal factor in the development of asthma, IPF, COPD and chronic bronchitis, indicating that GERD-associated micro-aspiration of gastric contents process might play a role in the development of pulmonary fibrosis in these diseases.
Topics: Humans; Bronchitis, Chronic; Genome-Wide Association Study; Mendelian Randomization Analysis; Gastroesophageal Reflux; Asthma; Respiration Disorders; Idiopathic Pulmonary Fibrosis
PubMed: 37403021
DOI: 10.1186/s12890-023-02502-8 -
American Journal of Physiology. Lung... Feb 2024With continued smoking of tobacco products and expanded use of nicotine delivery devices worldwide, understanding the impact of smoking and vaping on respiratory health... (Review)
Review
With continued smoking of tobacco products and expanded use of nicotine delivery devices worldwide, understanding the impact of smoking and vaping on respiratory health remains a major global unmet need. Although multiple studies have shown a strong association between smoking and asthma, there is a relative paucity of mechanistic understanding of how elements in cigarette smoke impact the airway. Recognizing that nicotine is a major component in both smoking and vaping products, it is critical to understand the mechanisms by which nicotine impacts airways and promotes lung diseases such as asthma. There is now increasing evidence that α7 nicotinic acetylcholine receptors (α7nAChRs) are critical players in nicotine effects on airways, but the mechanisms by which α7nAChR influences different airway cell types have not been widely explored. In this review, we highlight and integrate the current state of knowledge regarding nicotine and α7nAChR in the context of asthma and identify potential approaches to alleviate the impact of smoking and vaping on the lungs.
Topics: Humans; Receptors, Nicotinic; Nicotine; alpha7 Nicotinic Acetylcholine Receptor; Lung; Asthma; Respiration Disorders; Tobacco Products
PubMed: 38084408
DOI: 10.1152/ajplung.00268.2023 -
Clinics in Chest Medicine Sep 2023Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances.... (Review)
Review
Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.
Topics: Humans; Occupational Diseases; COVID-19; Pulmonary Disease, Chronic Obstructive; Asthma; Respiration Disorders; Occupational Exposure
PubMed: 37517841
DOI: 10.1016/j.ccm.2023.03.016 -
Expert Review of Respiratory Medicine Dec 2023Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung... (Review)
Review
INTRODUCTION
Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease.
AREAS COVERED
This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations.
EXPERT OPINION
Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Asthma
PubMed: 38198636
DOI: 10.1080/17476348.2024.2304065 -
Current Opinion in Critical Care Oct 2023Disparities are common within healthcare, and critical illness is no exception. This review summarizes recent literature on health disparities within respiratory... (Review)
Review
PURPOSE OF REVIEW
Disparities are common within healthcare, and critical illness is no exception. This review summarizes recent literature on health disparities within respiratory failure, focusing on race, ethnicity, socioeconomic status, and sex.
RECENT FINDINGS
Current evidence indicates that Black patients have higher incidence of respiratory failure, while the relationships among race, ethnicity, and mortality remains unclear. There has been renewed interest in medical device bias, specifically pulse oximetry, for which data demonstrate patients with darker skin tones may be at risk for undetected hypoxemia and worse outcomes. Lower socioeconomic status is associated with higher mortality, and respiratory failure can potentiate socioeconomic inequities via illness-related financial toxicity. Literature on sex-based disparities is limited; however, evidence suggests males receive more invasive care, including mechanical ventilation.
SUMMARY
Most studies focused on disparities in incidence and mortality associated with respiratory failure, but few relied on granular clinical data of patients from diverse backgrounds. Future studies should evaluate processes of care for respiratory failure that may mechanistically contribute to disparities in order to develop interventions that improve outcomes.
Topics: Male; Humans; Respiration, Artificial; Respiratory Insufficiency
PubMed: 37641499
DOI: 10.1097/MCC.0000000000001079 -
JAMA Sep 2023The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified.
OBJECTIVE
To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age.
DESIGN, SETTING, AND PARTICIPANTS
Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022.
INTERVENTIONS
Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment.
MAIN OUTCOMES AND MEASURES
The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years.
RESULTS
Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]).
CONCLUSIONS AND RELEVANCE
In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life.
TRIAL REGISTRATION
anzctr.org.au Identifier: ACTRN12611000916943.
Topics: Female; Humans; Infant; Infant, Newborn; Dyspnea; Follow-Up Studies; Infant, Premature; Lipoproteins; Pulmonary Surfactants; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Respiratory Sounds; Surface-Active Agents; Catheterization; Minimally Invasive Surgical Procedures; Continuous Positive Airway Pressure; Male; Child, Preschool
PubMed: 37695601
DOI: 10.1001/jama.2023.15694 -
The Science of the Total Environment Dec 2023Asthma, the second leading cause of death from chronic respiratory diseases, is associated with climate change, especially temperature changes. It is currently unclear...
BACKGROUND
Asthma, the second leading cause of death from chronic respiratory diseases, is associated with climate change, especially temperature changes. It is currently unclear about the relationship between long-term temperature variability and the incidence of asthma on a global scale.
METHODS
We used asthma incidence, demographic and socioeconomic data from the Global Burden of Disease (GBD) Results Database, and environmental and geographical statistics from TerraClimate between 1990 and 2019 to determine the association between maximum temperature variability and asthma incidence. We also predicted the incidence of heat-related asthma in the future (2020-2100) under four shared socioeconomic pathways (SSPs: 126, 245, 370, and 585).
RESULTS
Between 1990 and 2019, the global median incidence of asthma was 402.0 per 100,000 with a higher incidence (median: 1380.3 per 100,000) in children under 10 years old. We found that every 1 °C increase in maximum temperature variability increased the risk of asthma globally by 5.0 %, and the effect was robust for individuals living in high-latitude areas or aged from 50 to 70 years. By 2100, the average incidence of asthma is estimated to be reduced by 95.55 %, 79.32 %, and 40.02 % under the SSP126, SSP245, and SSP370 scenarios, respectively, compared to the SSP585 at latitudes >60°.
CONCLUSION
Our study provides evidence that maximum temperature variability is associated with asthma incidence. These findings suggest that implementing stricter mitigation and adaptation strategies may be importment in reducing asthma cases caused by climate change.
Topics: Child; Humans; Global Burden of Disease; Temperature; Incidence; Asthma; Respiration Disorders; Climate Change
PubMed: 37659541
DOI: 10.1016/j.scitotenv.2023.166726 -
Therapeutische Umschau. Revue... Aug 2023Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its...
Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its status as «normal», essential element of conditio humana, to representing a symptom of another (somatic or mental) illness and to constituting a psychiatric disorder of its own. In any case of acute dyspnoea it is important to «normalize» the patient's anxiety, i.e. to contextualize it as a comprehensible reaction to the stressing experience and not as proof of personal weakness. If dyspnoea and anxiety occur in a patient with a preexisting psychiatric disorder, defining the appropriate therapeutic steps will be more complex and demanding, especially with regard to a targeted interdisciplinary cooperation (consultation liaison psychiatry). The paper highlights the principles of psychopharmacological and psychotherapeutical interventions, a stable therapeutical relationship always defining the center of any treatment procedure.
Topics: Humans; Anxiety; Anxiety Disorders; Emotions; Dyspnea; Psychiatry; Referral and Consultation
PubMed: 37855533
DOI: No ID Found -
Continuum (Minneapolis, Minn.) Aug 2023Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing. This article describes advances in the diagnosis, testing, treatment, and monitoring...
OBJECTIVE
Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing. This article describes advances in the diagnosis, testing, treatment, and monitoring of OSA.
LATEST DEVELOPMENTS
Home sleep apnea testing and in-laboratory polysomnography are the most commonly used diagnostic tools in the identification and monitoring of OSA, but new methods for diagnosis and at-home monitoring of treatment response are being developed and validated. While the apnea-hypopnea index is regularly used to define OSA severity, recognition is increasing of its inability to risk-stratify patients. Other sleep study data including arousal threshold, hypoxic burden, and pulse rate variability as well as clinical characteristics can help with risk stratification. The most effective treatment is continuous positive airway pressure (CPAP), which can be limited by adherence and tolerance in some patients. Newer masks and comfort features including heated tubing and expiratory pressure relief may improve tolerance to positive airway pressure (PAP) therapy. Additional treatment options include other PAP modalities, mandibular advancement devices, tongue stimulation therapy, negative inspiratory pressure, nasal expiratory pressure valves, nasal congestion treatments, upper airway surgeries including hypoglossal nerve stimulation, and medications.
ESSENTIAL POINTS
OSA is a common disorder that causes sleep and daytime symptoms and increases the risk of neurologic and medical complications. Neurologists should be aware of atypical presentations and understand the diagnostic and treatment options.
Topics: Humans; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Sleep; Hot Temperature
PubMed: 37590823
DOI: 10.1212/CON.0000000000001264