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European Respiratory Review : An... Apr 2024Neuroimmune recognition and regulation in the respiratory system is a complex and highly coordinated process involving interactions between the nervous and immune... (Review)
Review
Neuroimmune recognition and regulation in the respiratory system is a complex and highly coordinated process involving interactions between the nervous and immune systems to detect and respond to pathogens, pollutants and other potential hazards in the respiratory tract. This interaction helps maintain the health and integrity of the respiratory system. Therefore, understanding the complex interactions between the respiratory nervous system and immune system is critical to maintaining lung health and developing treatments for respiratory diseases. In this review, we summarise the projection distribution of different types of neurons (trigeminal nerve, glossopharyngeal nerve, vagus nerve, spinal dorsal root nerve, sympathetic nerve) in the respiratory tract. We also introduce several types of cells in the respiratory epithelium that closely interact with nerves (pulmonary neuroendocrine cells, brush cells, solitary chemosensory cells and tastebuds). These cells are primarily located at key positions in the respiratory tract, where nerves project to them, forming neuroepithelial recognition units, thus enhancing the ability of neural recognition. Furthermore, we summarise the roles played by these different neurons in sensing or responding to specific pathogens (influenza, severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus, human metapneumovirus, herpes viruses, Sendai parainfluenza virus, , , , amoebae), allergens, atmospheric pollutants (smoking, exhaust pollution), and their potential roles in regulating interactions among different pathogens. We also summarise the prospects of bioelectronic medicine as a third therapeutic approach following drugs and surgery, as well as the potential mechanisms of meditation breathing as an adjunct therapy.
Topics: Humans; Animals; Neuroimmunomodulation; Respiratory System; Host-Pathogen Interactions; Respiratory Tract Diseases; Signal Transduction
PubMed: 38925790
DOI: 10.1183/16000617.0008-2024 -
Annals of Palliative Medicine Nov 2023The coronavirus disease 2019, also known as COVID-19, has caused significant worldwide morbidity and mortality. Given the direct effect of severe acute respiratory... (Review)
Review
BACKGROUND AND OBJECTIVE
The coronavirus disease 2019, also known as COVID-19, has caused significant worldwide morbidity and mortality. Given the direct effect of severe acute respiratory syndrome virus-2 (SARS-CoV-2) on the respiratory system, it is important that clinicians who manage chronic respiratory conditions are familiar with the pathophysiology and impact of COVID-19 on pre-existing respiratory disease.
METHODS
Literature review relating to COVID-19 and respiratory disorders from PubMed and Google Scholar was conducted, with aim to encompass all publications relating to the most commonly encountered respiratory diseases in clinical practice, namely chronic obstructive lung disease (COPD), asthma, interstitial lung disease (ILD), obstructive sleep apnea (OSA), as well as obesity given it's known effect on both gas exchange and mechanistic aspects of respiration. The publications were analyzed for relevance to clinical implications and pathophysiologic mechanisms. Additional manual literature review was conducted based on citations from large review articles and society guidelines/statement papers.
KEY CONTENT AND FINDINGS
Certain respiratory disorders such as COPD, ILD, OSA, and obesity carry higher burden of morbidity and mortality associated with COVID-19. Surprisingly, and in contrast to previously studied viral epidemics, asthma does not carry increased associated risk of contracting the virus or worse clinical outcomes.
CONCLUSIONS
A thorough understanding of the mechanisms responsible for control of breathing and the effect of COVID-19 on pulmonary pathophysiology will allow clinicians who manage chronic respiratory disease to effectively predict associated clinical outcomes as well as improve management strategies.
Topics: Humans; COVID-19; SARS-CoV-2; Pulmonary Disease, Chronic Obstructive; Asthma; Lung Diseases, Interstitial; Sleep Apnea, Obstructive; Obesity
PubMed: 37164968
DOI: 10.21037/apm-22-1427 -
Methodist DeBakey Cardiovascular Journal 2023Heart and lung interaction within the thoracic cavity is well known during inhalation and exhalation, both spontaneously and during mechanical ventilation. Disease and... (Review)
Review
Heart and lung interaction within the thoracic cavity is well known during inhalation and exhalation, both spontaneously and during mechanical ventilation. Disease and dysfunction of one organ affect the function of the other. A review of the cause-and-effect relationship between cardiovascular disease and acute respiratory distress syndrome (ARDS) is of significance, as the disease burden of both conditions has both a national and global impact on health care. This literature review examines the relationship between cardiovascular disease and ARDS over the past 25 years.
Topics: Humans; Cardiovascular Diseases; Respiratory Distress Syndrome; Respiration, Artificial; Lung
PubMed: 37547902
DOI: 10.14797/mdcvj.1244 -
Military Psychology : the Official... 2023Since September 11, 2001, over 2.7 million United States service members have deployed to South-West Asia and the Middle East and have been exposed to environmental...
Since September 11, 2001, over 2.7 million United States service members have deployed to South-West Asia and the Middle East and have been exposed to environmental hazards and psychological trauma. Many of these service members have returned with medical and psychological illnesses, some of which have proved complex and resistant to treatment. One notable constellation of symptoms is post-deployment respiratory illness, which has become a focus of research and policy efforts. The present study sought to examine the impact of post-deployment psychological distress on respiratory symptom severity. Data were obtained from the Veterans Affairs Airborne Hazards and Open Burn Pit Registry (AHOBPR) health surveillance database (107,403). Psychological factors were compared against common organic and environmental predictors of post-deployment respiratory distress. Psychological distress following deployment was a stronger predictor of 12-month shortness of breath severity than general respiratory pathology or level of exposure to environmental hazards, controlling for gender, age, race, and tobacco use. Additionally, psychological distress was a better predictor of shortness of breath severity than documented respiratory illnesses including asthma, chronic obstructive pulmonary disease, and chronic bronchitis. Implications and directions for future research are discussed, as well as potential alterations to existing treatment and health surveillance paradigms.
Topics: Humans; United States; Veterans; Military Personnel; Dyspnea; Asthma; Respiratory Distress Syndrome
PubMed: 37903168
DOI: 10.1080/08995605.2022.2131189 -
American Journal of Physiology. Lung... May 2024Acute respiratory distress syndrome (ARDS) is a fatal pulmonary disorder characterized by severe hypoxia and inflammation. ARDS is commonly triggered by systemic and... (Review)
Review
Acute respiratory distress syndrome (ARDS) is a fatal pulmonary disorder characterized by severe hypoxia and inflammation. ARDS is commonly triggered by systemic and pulmonary infections, with bacteria and viruses. Notable pathogens include , , , coronaviruses, influenza viruses, and herpesviruses. COVID-19 ARDS represents the latest etiological phenotype of the disease. The pathogenesis of ARDS caused by bacteria and viruses exhibits variations in host immune responses and lung mesenchymal injury. We postulate that the systemic and pulmonary metabolomics profiles of ARDS induced by COVID-19 pathogens may exhibit distinctions compared with those induced by other infectious agents. This review aims to compare metabolic signatures in blood and lung specimens specifically within the context of ARDS. Both prevalent and phenotype-specific metabolomic signatures, including but not limited to glycolysis, ketone body production, lipid oxidation, and dysregulation of the kynurenine pathways, were thoroughly examined in this review. The distinctions in metabolic signatures between COVID-19 and non-COVID ARDS have the potential to reveal new biomarkers, elucidate pathogenic mechanisms, identify druggable targets, and facilitate differential diagnosis in the future.
Topics: Humans; COVID-19; Respiratory Distress Syndrome; SARS-CoV-2; Lung; Metabolome; Biomarkers; Metabolomics
PubMed: 38469648
DOI: 10.1152/ajplung.00266.2023 -
Paediatric Respiratory Reviews Sep 2023Long-term non-invasive ventilation (NIV) is an accepted therapy for sleep-related respiratory disorders and respiratory insufficiency or failure. Increase in the use of... (Review)
Review
Long-term non-invasive ventilation (NIV) is an accepted therapy for sleep-related respiratory disorders and respiratory insufficiency or failure. Increase in the use of long-term NIV may, in part, be driven by an increase in the number of children surviving critical illness with comorbidities. As a result, some children start on long-term NIV as part of transitioning from hospital to home. NIV may be used in acute illness to avoid intubation, facilitate extubation or support tracheostomy decannulation, and to avoid the need for a tracheostomy for long-term invasive ventilation. The decision about whether long-term NIV is appropriate for an individual child and their family needs to be made with care. Preparing for transition from the hospital to home involves understanding how NIV equipment is obtained and set-up, education and training for parents/caregivers, and arranging a plan for clinical follow-up. While planning for these transitions is challenging, the goals of a shorter time in hospital and a child living well at home with their family are important.
Topics: Child; Humans; Noninvasive Ventilation; Hospital to Home Transition; Respiration, Artificial; Respiratory Insufficiency; Hospitals
PubMed: 36806331
DOI: 10.1016/j.prrv.2023.01.002 -
Viruses Aug 2023RSV often leads to hospitalization, and accurate knowledge of risk factors is crucial.
BACKGROUND
RSV often leads to hospitalization, and accurate knowledge of risk factors is crucial.
METHODS
We retrospectively analyzed laboratory-confirmed RSV hospitalizations regarding pregnancy factors, birth status, cigarette smoke exposure, nutrition, social conditions, clinical presentation, and severe disease defined as a need for passive oxygen therapy (pO2Tx), the presence of pneumonia, respiratory failure, intensive care unit (ICU) transfer, and prolonged hospitalization.
RESULTS
A univariate analysis included 594 children (median age 4 months) and revealed a pO2Tx relationship with age ≤ 3 months (OR = 1.56), prematurity (OR = 1.71), being born during RSV season (OR = 1.72), smoke exposure during pregnancy (both parents (OR = 2.41, father (OR = 1.8)), dyspnea (OR = 5.09), and presence of apnea (OR = 5.81). Pneumonia was associated with maternal smoke exposure (OR = 5.01), fever (OR = 3.92), dyspnea (OR = 1.62), history of aspiration (OR = 4.63), and inversely with age ≤ 3 months (OR = 0.45). Respiratory failure was associated with prematurity (OR = 3.13) and apnea (OR = 18.78), while the lower odds were associated with older age (OR = 0.57 per month) and presence of fever (OR = 0.11). ICU transfer was associated with apnea (OR = 17.18), but an inverse association was observed with age (OR = 0.54) and fever (OR = 0.11). A prolonged hospital stay was associated with prematurity (OR = 1.76), low birth weight (OR = 2.89), aspiration (OR = 4.93), and presence of fever (OR = 1.51).
CONCLUSIONS
Age (up to 3 months), prematurity, and presence of apnea are risk factors for a severe RSV course.
Topics: Child; Female; Pregnancy; Humans; Infant; Child, Hospitalized; Apnea; Respiratory Syncytial Virus Infections; Retrospective Studies; Dyspnea; Risk Factors; Fever; Respiratory Insufficiency
PubMed: 37632055
DOI: 10.3390/v15081713 -
CMAJ : Canadian Medical Association... Jun 2024
Topics: Humans; Sleep Apnea, Obstructive; Child; Continuous Positive Airway Pressure; Polysomnography; Child, Preschool
PubMed: 38857936
DOI: 10.1503/cmaj.230897-f -
BMC Pulmonary Medicine Sep 2023Sleep apnea is associated with chronic comorbidities and acute complications. Existing data suggest that sleep apnea may predispose to an increased risk and severity of...
BACKGROUND
Sleep apnea is associated with chronic comorbidities and acute complications. Existing data suggest that sleep apnea may predispose to an increased risk and severity of respiratory tract infections.
METHODS
We investigated the incidence of lower respiratory tract infections in the first and second year before and after diagnosis of sleep apnea in a Finnish nationwide, population-based, retrospective case-control study based on linking data from the national health care registers for primary and secondary care from 2015-2019. Controls were matched for age, sex, hospital district, and multimorbidity status. We furthermore analysed the independent effect of comorbidities and other patient characteristics on the risk of lower respiratory tract infections, and their recurrence.
RESULTS
Sleep apnea patients had a higher incidence of lower respiratory tract infections than their matched controls within one year before (hazard ratio 1.35, 95% confidence interval 1.16-1.57) and one year after (hazard ratio1.39, 95% confidence interval1.22-1.58) diagnosis of sleep apnea. However, we found no difference in the incidence of lower respiratory tract infections within the second year before or after diagnosis of sleep apnea in comparison with matched controls. In sleep apnea, history of lower respiratory tract infection prior to sleep apnea, multimorbidity, COPD, asthma, and age greater than 65 years increased the risk of incident and recurrent lower respiratory tract infections.
CONCLUSIONS
Sleep apnea patients are at increased risk of being diagnosed with a lower respiratory tract infection within but not beyond one year before and after diagnosis of sleep apnea. Among sleep apnea patients, chronic comorbidities had a significant impact on the risk of lower respiratory tract infections and their recurrence.
Topics: Humans; Aged; Case-Control Studies; Retrospective Studies; Sleep Apnea Syndromes; Respiratory Tract Infections; Asthma
PubMed: 37684580
DOI: 10.1186/s12890-023-02623-0 -
International Journal of Chronic... 2023GOLD 2023 defines an exacerbation of COPD (ECOPD) by a deterioration of breathlessness at rest (BaR), mucus and cough. The severity of an ECOPD is determined by the...
BACKGROUND
GOLD 2023 defines an exacerbation of COPD (ECOPD) by a deterioration of breathlessness at rest (BaR), mucus and cough. The severity of an ECOPD is determined by the degree of BaR, ranging from 0 to 10. However, it is not known which symptom is the most important one to detect early of an ECOPD, and which symptom that predicts future ECOPDs best. Thus, the purpose of the present study was to find out which symptom is the most important one to monitor.
METHODS
We analysed data on COPD symptoms from the telehealth study The eHealth Diary. Frequent exacerbators (n = 27) were asked to daily monitor BaR and breathlessness at physical activity (BaPA), mucus and cough, employing a digital pen and symptom scales (0-10). Twenty-seven patients with 105 ECOPDs were analysed. The association between symptom development and the occurrence of exacerbations was evaluated using the Andersen-Gill formulation of the Cox proportional hazards model for the analysis of recurrent time-to-event data with time-varying predictors.
RESULTS
According to the criteria proposed by GOLD 2023, 42% ECOPDs were mild, 48% were moderate and 5% were severe, while 6% were undefinable. Mucus and cough improved over study time, while BaR and BaPA deteriorated. Mucus appeared earliest, which was the most prominent feature of the average exacerbation, and worsening of mucus increased the risk for a future ECOPD. There was a 58% increase in the risk of exacerbation per unit increase in mucus score.
CONCLUSION
This study suggests that mucus worsening is the most important COPD symptom to monitor to detect ECOPDs early and to predict future risk för ECOPDs. In the present study, we also noticed a pronounced difference between GOLD 2022 and 2023. Hence, GOLD 2023 defined the ECOPD severity much lower than GOLD 2022 did.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Cough; Disease Progression; Telemedicine; Dyspnea
PubMed: 37492490
DOI: 10.2147/COPD.S417735