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Chest Aug 2020Chronic cough due to chronic bronchitis (CB) causes significant impairment in quality of life, and effective treatment strategies are needed. We conducted a systematic...
BACKGROUND
Chronic cough due to chronic bronchitis (CB) causes significant impairment in quality of life, and effective treatment strategies are needed. We conducted a systematic review on the management of chronic cough due to CB to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic.
METHODS
This systematic review asked three questions: (1) What are the clinical features of the history that suggest a patient's cough-phlegm syndrome is due to CB? (2) Can treatment of stable CB improve or eliminate chronic cough? (3) Can therapy that targets chronic cough due to CB prevent or reduce the occurrence of acute CB exacerbations? Studies of adult patients with CB were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the CHEST organization methodology.
RESULTS
The search strategy used an assortment of descriptors and assessments to identify studies of chronic cough due to CB.
CONCLUSIONS
The evidence supporting the management of chronic cough due to CB is limited overall and of low quality. This article provides guidance on treatment by presenting suggestions based on the best currently available evidence and identifies gaps in our knowledge and areas for future research.
Topics: Adult; Bronchitis, Chronic; Cough; Humans; Quality of Life; Symptom Flare Up; United States
PubMed: 32105719
DOI: 10.1016/j.chest.2020.02.015 -
Recenti Progressi in Medicina Jan 2020In recent years there has been an enormous development in the use of electronic cigarettes (e-cig). In Italy, in the 2019, the users of e-cig are about 900.000. E-cig... (Comparative Study)
Comparative Study
BACKGROUND
In recent years there has been an enormous development in the use of electronic cigarettes (e-cig). In Italy, in the 2019, the users of e-cig are about 900.000. E-cig users tend to overlook the absolute risk of the e-cig product in favor of the relative risk compared to traditional ones. This is also due to the fact that at the moment there are large knowledge gaps on the health effects of using e-cig. Recently reports have emerged regarding serious health adverse effects (AE) related to their use. As of December 2019, the American Centers for Disease Control and Prevention (CDC) reported 2409 cases of lung disease associated with the use of e-cig, and 52 deaths.
AIM
To summarize the available evidence on the health effects of electronic cigarettes.
METHODS
We searched systematic reviews (SR) of the literature published up to September 2019.
RESULTS
The systematic searches led to the identification of 14 SRs (1037 studies included of which 77 provided useful information for this review) that met the inclusion criteria. Given the heterogeneity of the comparisons and of the outcome measures considered, the results are described narratively. Effects on the respiratory system: cough, phlegm, asthma and bronchitis symptoms, cases of chronic bronchitis and COPD have also been reported. Effects on the oropharyngeal system: lesions in the oral cavity, villous black tongue, allergic reactions, endogenous formation of carcinogens, development of oral cancer. Effects on the cardiovascular system: increased heart rate, increased systolic and diastolic pressure. Effects on skin and annexes: squamous and pruritic dermatitis. Any adverse effect: the most frequently reported AEs are cough, dry mouth, shortness of breath, irritation of the mouth and throat and headache. Effects of exposure to e-cig passive smoking: increase in cotinine levels in exposed environments.
CONCLUSIONS
These results, based on evidence from very low to moderate, show a series of possible risks linked to the use of e-cig. However, there is a need for further well-conducted studies with longer follow-up periods to confirm these results.
Topics: Electronic Nicotine Delivery Systems; Humans; Risk; Tobacco Smoke Pollution; Vaping
PubMed: 31992902
DOI: 10.1701/3294.32651 -
Thorax Nov 2018Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs).
DESIGN
Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation.
SETTING
LMICs PARTICIPANTS: Women and children INTERVENTIONS: Improved biomass cookstoves MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women.
RESULTS
We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women.
CONCLUSION
Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact.
REGISTRATION
PROSPERO: CRD42016033075.
Topics: Air Pollution, Indoor; Child Health; Cooking; Developing Countries; Environmental Exposure; Environmental Illness; Global Health; Humans; Morbidity; Women's Health
PubMed: 29925674
DOI: 10.1136/thoraxjnl-2017-210952 -
Chemistry Central Journal May 2018Dioscorea nipponica Makino is a perennial twining herbs belonging to the family Dioscoreaceae, which is mainly distributed in the northeastern, northern, eastern and... (Review)
Review
Dioscorea nipponica Makino is a perennial twining herbs belonging to the family Dioscoreaceae, which is mainly distributed in the northeastern, northern, eastern and central regions of China. Traditionally, the rhizome of this herb has been commonly used by Miao and Meng ethnic groups of China to treat rheumatoid arthritis, pain in the legs and lumbar area, Kashin Beck disease, bruises, sprains, chronic bronchitis, cough and asthma. Modern pharmacological studies have discovered that this herb possesses anti-tumor, anti-inflammatory, anti-diuretic, analgesic, anti-tussive, panting-calming and phlegm-dispelling activities, along with enhancing immune function and improving cardiovascular health. In recent years, both fat-soluble and water-soluble steroidal saponins were isolated from the rhizomes of D. nipponica using silica gel column chromatography, thin layer chromatography and high performance liquid chromatography methods. Saponin and sapogenins are mainly responsible for most of the pharmacological effects of this plant. Further, the chemical components of the aboveground parts contain more than 10 kinds of phenanthrene derivatives. The present review summarizes the knowledge concerning the geographical distribution, chemical composition, pharmacological effects, toxicology studies and clinical applications of D. nipponica.
PubMed: 29748731
DOI: 10.1186/s13065-018-0423-4 -
Respiratory Research Feb 2018A significant proportion of patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed. Characterizing these patients can increase our understanding... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A significant proportion of patients with chronic obstructive pulmonary disease (COPD) remain undiagnosed. Characterizing these patients can increase our understanding of the 'hidden' burden of COPD and the effectiveness of case detection interventions.
METHODS
We conducted a systematic review and meta-analysis to compare patient and disease factors between patients with undiagnosed persistent airflow limitation and those with diagnosed COPD. We searched MEDLINE and EMBASE for observational studies of adult patients meeting accepted spirometric definitions of COPD. We extracted and pooled summary data on the proportion or mean of each risk factor among diagnosed and undiagnosed patients (unadjusted analysis), and coefficients for the adjusted association between risk factors and diagnosis status (adjusted analysis).
RESULTS
Two thousand eighty-three records were identified through database searching and 16 articles were used in the meta-analyses. Diagnosed patients were less likely to have mild (v. moderate to very severe) COPD (odds ratio [OR] 0.30, 95%CI 0.24-0.37, 6 studies) in unadjusted analysis. This association remained significant but its strength was attenuated in the adjusted analysis (OR 0.72, 95%CI 0.58-0.89, 2 studies). Diagnosed patients were more likely to report respiratory symptoms such as wheezing (OR 3.51, 95%CI 2.19-5.63, 3 studies) and phlegm (OR 2.16, 95% CI 1.38-3.38, 3 studies), had more severe dyspnea (mean difference in modified Medical Research Council scale 0.52, 95%CI 0.40-0.64, 3 studies), and slightly greater smoking history than undiagnosed patients. Patient age, sex, current smoking status, and the presence of coughing were not associated with a previous diagnosis.
CONCLUSIONS
Undiagnosed patients had less severe airflow obstruction and fewer respiratory symptoms than diagnosed patients. The lower disease burden in undiagnosed patients may significantly delay the diagnosis of COPD.
Topics: Cost of Illness; Cross-Sectional Studies; Humans; Observational Studies as Topic; Pulmonary Disease, Chronic Obstructive; Risk Factors; Spirometry
PubMed: 29415723
DOI: 10.1186/s12931-018-0731-1 -
Evidence-based Complementary and... 2017To study the correlation between Traditional Chinese Medicine (TCM) constitution and dyslipidemia. (Review)
Review
OBJECTIVE
To study the correlation between Traditional Chinese Medicine (TCM) constitution and dyslipidemia.
METHODS
CNKI, VIP, Wanfang database, CBMdisc, PubMed, and Embase were searched, and meta-analysis was performed by Review Manager 5.2 software.
RESULTS
Altogether 11 studies were included with 12890 individuals. The results showed that balanced constitution was a protective factor of dyslipidemia (OR = 0.62, 95% CI 0.47~0.82) while phlegm-dampness constitution was a risk factor of it (OR = 2.50, 95% CI 2.22~2.80), and the effect of phlegm-dampness constitution in South China (OR = 3.31, 95% CI 1.71~6.43) was more obvious than that in East (OR = 2.40, 95% CI 2.06~2.80) and North China (OR = 2.24, 95% CI 1.81~2.78).
CONCLUSION
This study provides evidence for the prevention and treatment of dyslipidemia in TCM. However, most of the studies included are of moderate quality; more high quality, multicenter, large-sample studies are expected to provide higher level evidence.
PubMed: 29234371
DOI: 10.1155/2017/1896746 -
PloS One 2017The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases... (Meta-Analysis)
Meta-Analysis Review
AIMS
The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations.
MATERIALS AND METHODS
Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment.
RESULTS
A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1-36%) than for asthma (5-31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies.
CONCLUSIONS
Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma.
Topics: Asthma; Cough; Exhalation; Health Promotion; Hospitalization; Humans; Patient Admission; Pulmonary Disease, Chronic Obstructive; Respiration Disorders; Sensation Disorders; Smoking; Spirometry
PubMed: 28759596
DOI: 10.1371/journal.pone.0181035 -
Complementary Therapies in Medicine Apr 2017Niuhuang Jiangya Preparation (NHJYP) is one of the most commonly used traditional Chinese patent medicines for essential hypertension (EH) in China. Our meta-analysis... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Niuhuang Jiangya Preparation (NHJYP) is one of the most commonly used traditional Chinese patent medicines for essential hypertension (EH) in China. Our meta-analysis performed a systematic evaluation on the therapeutic efficacy and safety of NHJYP for EH.
DESIGN
Systematic review and meta-analysis.
METHODS
PubMed, Embase, the Cochrane library, CNKI,VIP, Sinomed, and Wanfang Database were searched up to June 2015. Randomized controlled trials (RCTs) comparing NHJYP or combined with western antihypertensive drugs (WAD) versus WAD were included. Quality of each trial was assessed according to the Cochrane Reviewers' Handbook 5. 1.0. Statistical software (RevMan 5.3) was used for data analysis. The primary outcome was categorical or continuous blood pressure, and the secondary outcome was Traditional Chinese Medicine (TCM) syndrome.
RESULTS
12 RCTs including 1651 cases were identified. The methodological quality of trials was low. Meta-analysis showed that, firstly, NHJYP used alone compared with WAD had no significant effect on BP reduction; however, subgroup analysis was used based on whether apply TCM diagnostic criteria in recruitment. It was suggested that, for population that applied TCM diagnostic criteria, RR=1.35,95% CI:1.17-1.56,P<0.0001; for population that didn't apply TCM diagnostic criteria, RR=0.96,95% CI:0.70-1.33,P=0.81.Reduction in systolic blood pressure (SBP) levels showed similar results. But there was no significant difference in improving diastolic blood pressure (DBP). Secondly, we found that NHJYP plus WAD probably lower BP (RR=1.13,95% CI:1.03-1.24,P=0.01)and improve TCM symptoms than WAD only. And subgroup analysis suggested significant BP reduction effect for population that applied TCM diagnostic. No serious adverse events were reported.
CONCLUSIONS
Our review indicated that NHJYP has some beneficial effects in EH patients with liver-yang hyperactivity and abundant phlegm-heat syndrome. However, the evidence is not reliable enough. To produce definite evidence, more rigorously designed trials are needed.
Topics: Biological Products; Blood Pressure; Drugs, Chinese Herbal; Essential Hypertension; Humans; Hypertension; Medicine, Chinese Traditional; Treatment Outcome
PubMed: 28434477
DOI: 10.1016/j.ctim.2017.02.005 -
Respiratory Care Nov 2016This systematic review focuses on respiratory effects of inhalational marijuana. The systematic review of the literature was conducted using a comparative method between... (Review)
Review
This systematic review focuses on respiratory effects of inhalational marijuana. The systematic review of the literature was conducted using a comparative method between 2 researchers. Abstracts were reviewed for inclusion of respiratory effects related to inhalational marijuana. Relevant abstracts were collected, and full text articles were retrieved for review. Articles were removed if they did not contain burning marijuana; were animal studies; or were editorials, systematic reviews, commentaries, non-English language, or non-respiratory-related articles. Forty-eight articles were collected and categorized by respiratory effects. In particular, lung cancer, bullous emphysema/COPD, and other respiratory symptoms were the primary categories. Articles were noted by study population country, sample size, age distribution, and findings that were pertinent to respiratory health. The research indicates that there is a risk of lung cancer from inhalational marijuana as well as an association between inhalational marijuana and spontaneous pneumothorax, bullous emphysema, or COPD. A variety of symptoms have been reported by inhalational marijuana smokers, including wheezing, shortness of breath, altered pulmonary function tests, cough, phlegm production, bronchodilation, and other symptoms. It is important to stay current with research findings to educate patients on this smoking behavior.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cough; Dyspnea; Female; Humans; Lung; Lung Neoplasms; Male; Marijuana Smoking; Middle Aged; Pneumothorax; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Respiratory Function Tests; Respiratory Sounds; Young Adult
PubMed: 27507173
DOI: 10.4187/respcare.04846 -
Allergy, Asthma & Immunology Research Mar 2016Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been...
PURPOSE
Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics.
METHODS
A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions.
RESULTS
A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95% confidence interval 0.92-1.73) with significant heterogeneity (I²=96%, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity.
CONCLUSIONS
This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.
PubMed: 26739408
DOI: 10.4168/aair.2016.8.2.146