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The International Journal of... Jun 2024Asthma is a disease characterized by chronic airway hyperresponsiveness and inflammation, with signs of variable airflow limitation and impaired lung function leading to...
Asthma is a disease characterized by chronic airway hyperresponsiveness and inflammation, with signs of variable airflow limitation and impaired lung function leading to respiratory symptoms such as shortness of breath, chest tightness and cough. Eosinophilic asthma is a distinct phenotype that affects more than half of patients diagnosed with severe asthma. It can be effectively treated with monoclonal antibodies targeting specific immunological signaling pathways that fuel the inflammation underlying the disease, particularly Interleukin-5 (IL-5), a cytokine that plays a crucial role in asthma. In this study, we propose a data analysis pipeline aimed at identifying subphenotypes of severe eosinophilic asthma in relation to response to therapy at follow-up, which could have great potential for use in routine clinical practice. Once an optimal partition of patients into subphenotypes has been determined, the labels indicating the group to which each patient has been assigned are used in a novel way. For each input variable in a specialized logistic regression model, a clusterwise effect on response to therapy is determined by an appropriate interaction term between the input variable under consideration and the cluster label. We show that the clusterwise odds ratios can be meaningfully interpreted conditional on the cluster label. In this way, we can define an effect measure for the response variable for each input variable in each of the groups identified by the clustering algorithm, which is not possible in standard logistic regression because the effect of the reference class is aliased with the overall intercept. The interpretability of the model is enforced by promoting sparsity, a goal achieved by learning interactions in a hierarchical manner using a special group-Lasso technique. In addition, valid expressions are provided for computing odds ratios in the unusual parameterization used by the sparsity-promoting algorithm. We show how to apply the proposed data analysis pipeline to the problem of sub-phenotyping asthma patients also in terms of quality of response to therapy with monoclonal antibodies.
PubMed: 38910330
DOI: 10.1515/ijb-2023-0061 -
Fitoterapia Jun 2024Daphne genkwa, as a traditional medicine, is widely distributed in China, Korea and Vietnam. In China, the dried flower buds of this plant are named "Yuanhua". It has... (Review)
Review
Daphne genkwa, as a traditional medicine, is widely distributed in China, Korea and Vietnam. In China, the dried flower buds of this plant are named "Yuanhua". It has the ability to effectively promote urination, eliminate phlegm and alleviate cough, eliminate parasites and cure of scabies, with a broad spectrum of pharmacological effects and considerable clinical efficacy. This paper provides a summary and classification of the main chemical constituents of D. genkwa based on a review of relevant domestic and foreign literature. It also outlines the current research status of traditional clinical usage, pharmacological effects, and toxicity of D. genkwa. The aim is to provide a theoretical basis for further study of D. genkwa and its potential new clinical applications.
PubMed: 38906384
DOI: 10.1016/j.fitote.2024.106089 -
Internal and Emergency Medicine Jun 2024Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well...
Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well studied. We aimed to evaluate the relationship between PPI use and asthma exacerbation using a large administrative claims database in Japan. We conducted a self-controlled case series using the JMDC Claims Database (JMDC, Inc., Tokyo, Japan). The cases included adult patients with asthma who were prescribed PPI and experienced at least one outcome event between January 2015 and December 2019. The primary outcome was the composite outcome of hospital admissions and unscheduled outpatient clinic visits due to asthma exacerbation. We also conducted stratified analyses based on PPI generation, the presence of gastroesophageal reflux disease (GERD), asthma severity, and the number of allergic comorbidities. A total of 7379 eligible patients were included in the study. PPI prescription was associated with a decrease in the composite outcomes (incidence rate ratio, 0.90; 95% confidence interval, 0.87-0.93). However, PPI prescriptions did not affect the outcomes of hospital admissions (incidence rate ratio, 1.34; 95% confidence interval, 0.86-2.10). Stratified analyses based on PPI generation, the presence of GERD, asthma severity (except for severe asthma), and the number of allergic comorbidities yielded consistent results. PPI use was associated with a moderate decrease in asthma exacerbation, regardless of the patient profile. However, this effect was not as strong as the prevention of hospital admissions, and outcome events were not prevented in patients with severe asthma.
PubMed: 38904742
DOI: 10.1007/s11739-024-03687-4 -
BMC Pulmonary Medicine Jun 2024Chronic cough has been associated with reduced health-related quality of life, negative impacts on sleep, work, and other daily activities, and increased use of health...
BACKGROUND
Chronic cough has been associated with reduced health-related quality of life, negative impacts on sleep, work, and other daily activities, and increased use of health care resources. Little is known about the prevalence of chronic cough in Italy. In the present study we sought to estimate the prevalence of chronic cough in Italy, describe sociodemographic and clinical characteristics associated with chronic cough, and characterize the impact of chronic cough on overall health and wellness, work and other daily activities, and health care resource use.
METHODS
We conducted a cross-sectional study to collect sociodemographic and health-related data from Italian residents who participated in the 2020 National Health and Wellness Survey (N = 10,026). To assess the characteristics and burden of chronic cough, adults who indicated that they had experienced chronic cough during the prior 12 months were compared with propensity score-matched controls without chronic cough.
RESULTS
The estimated weighted lifetime and 12-month prevalence of chronic cough were estimated as 9.2% and 6.3%, respectively. Compared with matched controls, respondents with chronic cough had significantly lower measures of overall physical and mental health (P < .001 for both comparisons), and significantly higher rates of anxiety, depression, and sleep disorders (P < .001 for all comparisons). Chronic cough was significantly associated with higher rates of impairment of work and other activities (P < .001 for all comparisons) in the past 7 days, any-cause emergency department visits and hospitalizations in the prior 6 months (P < .001 for both comparisons), and more visits to general and specialist health care providers (P < .001 for both comparisons) in the prior 6 months.
CONCLUSIONS
In Italy, chronic cough affects an estimated 3.3 million adults annually and represents a significant burden to individuals and the health care system.
TAKE HOME MESSAGE
Little is known about the prevalence of chronic cough in Italy. We found that, in Italy chronic cough represents a significant burden to individuals and the health care system, affecting an estimated 3.3 million adults annually.
Topics: Humans; Cough; Italy; Cross-Sectional Studies; Male; Female; Chronic Disease; Prevalence; Middle Aged; Adult; Aged; Cost of Illness; Quality of Life; Young Adult; Adolescent; Health Surveys; Sleep Wake Disorders; Activities of Daily Living; Chronic Cough
PubMed: 38902654
DOI: 10.1186/s12890-024-03095-6 -
Cureus May 2024The long COVID phase is characterized by signs and symptoms persisting for at least three months after recovery from acute COVID-19 illness. There is limited data on...
BACKGROUND
The long COVID phase is characterized by signs and symptoms persisting for at least three months after recovery from acute COVID-19 illness. There is limited data on comprehensive long-term clinical follow-up of COVID-19 patients.
AIMS
This study aims to explore the burden and symptomatology of long COVID syndrome and its association with various health parameters.
SETTINGS AND DESIGN
This prospective observational study was conducted in Delhi from May 2022 to March 2023.
METHODS AND MATERIAL
A total of 553 adult patients who had recovered from COVID-19 were enrolled in the study. A sociodemographic and clinical profile was obtained using validated questionnaires, along with an evaluation of biochemical parameters to assess the associated factors.
STATISTICAL ANALYSIS USED
Chi-square test, unpaired t-test, and bivariate regression analysis were applied using Statistical Product and Service Solutions (SPSS, version 28; IBM SPSS Statistics for Windows, Armonk, NY). A p value of <0.05 was considered significant.
RESULTS
A total of 252 patients (45.6%) had long COVID syndrome, which was significantly associated with the presence of any pre-existing comorbidity (OR=1.46 (1.02-2.09); p=0.039), previous history of hypertension (OR=1.82 (1.07-3.09); p=0.027), and vaccination against COVID-19 (OR=1.392 (1.171-1.656); p=0.003). The most common symptoms reported were persistent fatigue (33.3%) and persistent dry cough (28.5%). Patients with long COVID syndrome are also reported to have poorer sleep quality. Biochemical findings showed abnormal T lymphocytes (9.3%) and raised HbA1c (11.9%).
CONCLUSIONS
Multiple risk factors and symptoms associated with long COVID syndrome were identified in this study. Research efforts and knowledge regarding the pattern of illness will aid in long-term monitoring and development of interventional strategies and guidelines for the care of recovered COVID-19 patients.
PubMed: 38899267
DOI: 10.7759/cureus.60652 -
International Journal of Language &... Jun 2024SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and...
BACKGROUND
SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD).
METHODS
This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire.
RESULTS
The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs.
CONCLUSION
These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed.
WHAT THIS PAPER ADDS
What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.
PubMed: 38895888
DOI: 10.1111/1460-6984.13077 -
Italian Journal of Pediatrics Jun 2024Mycoplasma pneumoniae pneumonia is a common respiratory infection among children. However, the occurrence of thromboembolism with plastic bronchitis in association with... (Review)
Review
BACKGROUND
Mycoplasma pneumoniae pneumonia is a common respiratory infection among children. However, the occurrence of thromboembolism with plastic bronchitis in association with Mycoplasma pneumoniae pneumonia is extremely rare. This case series presents five cases of children with Mycoplasma pneumoniae pneumonia who developed thromboembolism and plastic bronchitis. The clinical presentation, diagnostic approach, and management strategies are discussed.
METHODS
A retrospective analysis was conducted on medical records from a pediatric hospital. Patient demographics, clinical features, laboratory findings, imaging results, treatment modalities, and outcomes were collected.
RESULTS
The patients in our case series presented with varying degrees of respiratory distress, cough, and fever. Imaging studies revealed evidence of thromboembolism based on pulmonary artery occlusion. Bronchial casts were observed by bronchoscopy. Laboratory tests demonstrated elevated D-dimer levels and fibrinogen degradation products. All patients received a combination of low molecular weight heparin anticoagulation and supportive care.
CONCLUSION
Thromboembolism with plastic bronchitis associated with Mycoplasma pneumoniae pneumonia is a rare but potentially serious complication in children. Prompt recognition and management are crucial for improving patient outcomes. This case series highlights the diverse clinical presentations, diagnostic challenges, and treatment strategies for this unique clinical entity. Further research is needed to better understand the pathogenesis and optimal management of this condition.
Topics: Humans; Pneumonia, Mycoplasma; Male; Bronchitis; Female; Child; Child, Preschool; Retrospective Studies; Thromboembolism; Bronchoscopy; Anticoagulants
PubMed: 38886770
DOI: 10.1186/s13052-024-01690-1 -
IEEE Journal of Biomedical and Health... Jun 2024Cough is an important symptom in children with acute and chronic respiratory disease. Daily cough is common in Cystic Fibrosis (CF) and increased cough is a symptom of...
Development of a miniaturized mechanoacoustic sensor for continuous, objective cough detection, characterization and physiologic monitoring in children with cystic fibrosis.
Cough is an important symptom in children with acute and chronic respiratory disease. Daily cough is common in Cystic Fibrosis (CF) and increased cough is a symptom of pulmonary exacerbation. To date, cough assessment is primarily subjective in clinical practice and research. Attempts to develop objective, automatic cough counting tools have faced reliability issues in noisy environments and practical barriers limiting long-term use. This single-center pilot study evaluated usability, acceptability and performance of a mechanoacoustic sensor (MAS), previously used for cough classification in adults, in 36 children with CF over brief and multi-day periods in four cohorts. Children whose health was at baseline and who had symptoms of pulmonary exacerbation were included. We trained, validated, and deployed custom deep learning algorithms for accurate cough detection and classification from other vocalization or artifacts with an overall area under the receiver-operator characteristic curve (AUROC) of 0.96 and average precision (AP) of 0.93. Child and parent feedback led to a redesign of the MAS towards a smaller, more discreet device acceptable for daily use in children. Additional improvements optimized power efficiency and data management. The MAS's ability to objectively measure cough and other physiologic signals across clinic, hospital, and home settings is demonstrated, particularly aided by an AUROC of 0.97 and AP of 0.96 for motion artifact rejection. Examples of cough frequency and physiologic parameter correlations with participant-reported outcomes and clinical measurements for individual patients are presented. The MAS is a promising tool in objective longitudinal evaluation of cough in children with CF.
PubMed: 38885105
DOI: 10.1109/JBHI.2024.3415479 -
Journal of Thoracic Disease May 2024() is a species of nontuberculous mycobacteria (NTM) that rarely causes infection. It has previously been labeled the most common NTM contaminant. Bronchiectasis is a...
() is a species of nontuberculous mycobacteria (NTM) that rarely causes infection. It has previously been labeled the most common NTM contaminant. Bronchiectasis is a disease characterized by abnormal airway dilation leading to chronic cough, sputum production and pulmonary infections. Patients with bronchiectasis are at higher risk of NTM-lung disease with more pathogenic NTM species including complex (MAC) and (). The relationship between bronchiectasis and less-pathogenic NTM species such as is less well understood. We performed a retrospective study on patients who had isolated from respiratory specimens at UConn Health between May 2, 2010 and October 18, 2022. was isolated 74 times from 56 patients. It was isolated 35 (47.3%) times from 31 patients with bronchiectasis and 39 (52.7%) times from 26 patients without bronchiectasis. Data was available on all mycobacterial cultures sent from May 2 2018 to October 18 2022. Mycobacterial cultures sent from patients with bronchiectasis were significantly more likely to grow than patients without bronchiectasis (4.3% . 1.6%, P=0.007). Furthermore, when considered at the patient level, there remained a significant increased rate of isolation among patients with bronchiectasis (7.1% . 2.2%, P<0.001). We then looked at past and future isolation of more pathogenic NTM species and found a non-statistically increased rate of isolation of more pathogenic NTM species including MAC and in patients with bronchiectasis (45.2% . 29%, P=0.09). Based on our results, isolation of should raise suspicion of chronic airway disease and defects in host immune response, such as those seen in bronchiectasis. Furthermore, isolation of may suggest increased risk of infection with more pathogenic NTM species such as MAC and .
PubMed: 38883635
DOI: 10.21037/jtd-23-1648 -
Therapeutic Advances in Respiratory... 2024Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.
BACKGROUND
Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.
OBJECTIVES
To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.
DESIGN
Retrospective cohort study.
METHODS
Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's -test, Pearson's chi-square, and zero-inflated Poisson models were used.
RESULTS
About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance.
CONCLUSION
Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.
Topics: Humans; Retrospective Studies; Analgesics, Opioid; Male; Cough; Female; Middle Aged; Adult; Chronic Disease; Electronic Health Records; Cohort Studies; Aged; Antitussive Agents; United States; Drug Prescriptions; Medicaid; Midwestern United States; Practice Patterns, Physicians'; Young Adult; Adolescent; Chronic Cough
PubMed: 38877686
DOI: 10.1177/17534666241259373