Open Respiratory Medicine Journal最新文献

Despite medical science advancements in recent years, pulmonary diseases are still hard to control and can be potentially life-threatening. These include asthma, COPD, lung cancer, cystic fibrosis, pneumonia, pleurisy, and sarcoidosis. These illnesses often cause severe breathing problems, which can be fatal if not treated properly. While some chemical drugs are used to treat these conditions, they can cause side effects and are not always effective. Herbal medicine offers an alternative treatment option with fewer side effects and has shown promise in treating respiratory issues. Certain medicinal plants, such as garlic (Allium sativum), hawthorn (Crataegus rhipidophylla), moringa (Moringa oleifera), and ashwagandha (Withania somnifera), may help manage lung diseases. Natural compounds found in plants, like apple polyphenol, ligustrazine, salidroside, resveratrol, and quercetin, can also help reduce symptoms. These plants and compounds work by reducing cell overgrowth, fighting oxidative stress, lowering inflammation, stopping tumor growth, improving blood flow, and relaxing the airways. This review outlines the types of plants and compounds that can be utilized in treating pulmonary conditions, along with their respective mechanisms of action.

Background: Dyspnea impacts daily activities; women tend to report a higher perception of dyspnea and experience greater emotional distress compared to men. Therefore, the study aims to assess the prevalence and severity of dyspnea among Saudi women aged 18 to 35 years and explore associated risk factors.

Method: A quantitative cross-sectional study was conducted in Saudi Arabia. The data were collected using an electronic online questionnaire survey. The questionnaire consisted of participants' demographic data, and the status of factors associated with dyspnea, such as body mass index, physical activity, and smoking status. Using the modified Medical Research Council (mMRC) dyspnea scale is another option. The modified Medical Research Council (mMRC) dyspnea scale was used in a descriptive analysis to characterize the prevalence and score of dyspnea.A Mann-Whitney U test and Chi-square tests were conducted to determine the differences and associations according to the dyspnea risk factors. A p-value of <0.05 determined the statistical significance.

Results: A total of 554 participants were recruited. The overall prevalence of dyspnea was reported by 115 (21%) participants, with a mean score of 1.42 (SD 1.38) on the MRC Dyspnea Scale. The majority of participants were from the central region (74%) and aged 18 to 24 years (65.5%). No statistically significant differences were found between participants with and without dyspnea in terms of body mass index (22.6 [19.6-25.6] vs 22.8 [20.1-26.2], p=0.68, respectively), passive smoking status (p=0.07), or physical activity level (p=0.37).

Conclusion: The study concludes that approximately one in five young females experienced dyspnea, suggesting that this symptom may be quite prevalent. However, no significant association was found between dyspnea and factors such as body mass index, passive smoking, or physical activity levels.

Pulmonary Arterial Hypertension (PAH) is an uncommon condition with high mortality. It is an underrecognized condition both in developing and developed countries, especially in developing countries, due to a lack of advanced healthcare facilities and resources for timely diagnosis. More than half of the individuals diagnosed with PAH live less than five years after diagnosis. In recent years, tremendous advancements have been made in diagnostic and therapeutic strategies for PAH patients. Phosphodiesterase 5 (PDE5) inhibitors, endothelin receptor antagonists, and prostacyclin inhibitors in various forms (oral, inhaled, intravenous, or subcutaneous) have been the cornerstone of medical treatment. Atrial septostomy, heart and lung transplant, balloon pulmonary angioplasty, and pulmonary thromboendarterectomy are existing therapeutic options currently available. There has been a continuous effort to introduce newer therapies to improve life expectancy and modify disease. Newer therapies have shown promising results but require future data to guarantee long-term safety and efficacy. We aim to discuss a few of these critical updates in the constantly evolving field of PAH.

Introduction: Evaluate asthma control and determine its influencing factors to ensure adequate management and improve the quality of life for asthmatic children.

Method: A prospective cross-sectional study was conducted over a two-month period, from 02/11/2022 to 01/01/2023, at the pneumo-pediatric consultation at the MCH. The target population was asthmatic children aged 4 to 11 and their parents. The Arabic version of the C-ACT and PMAQ-3W were used to assess asthma control and medication compliance, respectively.Statistical analysis was performed with SPSS, using descriptive and correlational analysis (bivariate and multivariate).

Results: 203 asthmatic children were included in the study, out of which 60.6% were male, with a mean age of 6 years. Asthma was uncontrolled in 53% of children. Factors associated with uncontrolled asthma were rural residence, low parental education, low monthly family income, lack of awareness of triggers, presence of conjunctivitis or allergic rhinitis, occurrence of respiratory infections, parental history of asthma, exposure to smoking, and non-compliance with treatment.

Conclusion: 53% of children had uncontrolled asthma. A range of predictive factors were significantly associated with suboptimal asthma control. Recommended actions to improve childhood asthma control include education on trigger prevention and medication compliance, treatment of comorbidities, and accessibility of care for all socio-economic classes.

Background: Pleural effusion, the pathological accumulation of fluid in the pleural space, is widespread. This study investigates pleural effusion in terms of malignancy among patients referred to tertiary health care centers and evaluates the response rates to different pleurodesis techniques.

Methods: This cross-sectional study enrolled all patients with pleural effusion referred to a tertiary health care center. Laboratory data, including White Blood Cell count and differentiation (WBC), Hemoglobin levels (HB), Erythrocyte Sedimentation Rate (ESR), and biochemical analysis results of the pleural fluid (protein, glucose, and lactate dehydrogenase) were recorded. Data from pleural fluid cytopathological examination, including cell count, cell types, gram staining, and pleural fluid culture, were also documented. Patients undergoing pleurodesis were assessed for response rates, which were categorized as complete, partial, or no response based on clinical and radiological criteria. Collected data were subjected to statistical analysis.

Results: The study investigated 144 patients with chronic pleural effusion, with an average age of 47.59 years. Of these, 97 patients (66%) were male and 47 patients (34%) were female. The most common cause of chronic pleural effusion was malignancy, with a prevalence of 65.9%. Among patients treated with pleurodesis, the overall response rate was 78.4%, with chemical pleurodesis achieving a higher complete response rate (65%) compared to mechanical pleurodesis (55%). Other prevalent causes of chronic pleural effusion, in descending order, included heart failure, liver cirrhosis, chronic kidney failure, and unknown factors.

Conclusion: This study highlights malignancy and chronic heart failure as the predominant etiologies of chronic pleural effusion in a tertiary healthcare setting. Furthermore, it emphasizes the efficacy of pleurodesis techniques, with chemical pleurodesis demonstrating superior outcomes. These findings offer valuable insights into the pathogenesis and management of chronic pleural effusion.

Traditional testing methods in the Middle East Region, including the United Arab Emirates (UAE), particularly the testing of Respiratory Syncytial Virus (RSV), influenza, group A streptococcus (GAS), and COVID-19 have the potential to be upgraded to new and advanced diagnostics methods that improve lead time to diagnosis, consumption of healthcare resources and patient experience. In addition, based on the research, it was reported that there is an underreporting of respiratory cases, overuse of antibiotics, and prolonged hospitalizations which is posing pressure on UAE healthcare stakeholders. A literature review was done exploring UAE's current diagnostic practices, recommended guidelines, diagnostic gaps, and challenges in RSV, GAS, Influenza, and COVID-19. This was followed by stakeholder discussions focusing on assessing current diagnostic practices, usage of rapid molecular point-of-care (POC) diagnostic tests, current gaps in diagnosis, targeted profiles for POC testing, and potential impact on patient management for targeted respiratory infections. A round table discussion with healthcare experts, insurance experts, key opinion leaders, and pulmonologists discussed challenges and opportunities in treating respiratory diseases. UAE healthcare stakeholders suggest that introducing alternative and up-to-date diagnostic methods such as POC molecular testing is expected to improve healthcare outcomes, optimize resources, and develop a robust case management of respiratory tract infections. It is essential to emphasize that by introducing POC testing, precision medicine is reinforced, efficiency is achieved, and the overall management of population health is enhanced.

Background: Extremely preterm infants (EPIs) often require advanced respiratory support to survive, and one such intervention is the heated, humidified, high-flow nasal cannula (HHHFNC). While the use of this cannula in EPIs has been studied, the relationship between its use and the length of hospital stay is an important yet unexplored research area that we aim to investigate in this study.

Methods: In a quantitative retrospective cohort study, data were extracted from an electronic database. The study included all EPIs younger than 28 weeks of gestational age admitted to the neonatal intensive care unit of a tertiary hospital from January 1, 2020, to December 31, 2022. The descriptive analysis was conducted to describe each infant's demographic, maternal, and neonatal characteristics. A chi-squared test was also conducted, and a p-value of < 0.05 was considered statistically significant.

Results: The findings suggest that infants who receive an HHHFNC have a longer hospital stay than those who do not. Specifically, infants who did not receive a cannula spent 42.5 days on average in the hospital, compared with 99 days among those who received it, with a significant p-value (p=0.0001).

Conclusion: Infants receiving a cannula stay in hospital on average for twice as long as those who do not. However, to reduce the possibility of bias and produce more reliable results, we advise conducting clinical trials or prospective studies in future research.

Background: The role of the ratio between the arterial partial pressure of oxygen and the inspired fraction of oxygen (PaO₂/FiO₂ ratio) during the change in position is not fully established.

Methods: This retrospective, single-center cohort study included 98 patients with severe COVID-19 pneumonia.

Objective: This study aimed to evaluate the predictive value of the PaO₂/FiO₂ ratio for survival in patients with severe COVID-19 pneumonia between changing from supine to prone positions and vice versa. The PaO₂/FiO₂ ratio was measured preproning (T0), 30 min to 1 hour (T1), and 48 h after prone positioning (T2), and 30 min to 1 h after re-supination (T3).

Results: The PaO₂/FiO₂ ratio at T2 and T3 was higher in the survivors than in the non-survivors (T2= 251.5 vs. 208.5, p= 0.032; T3= 182 vs. 108.5, p<0.001). The PaO₂/FiO₂ ratio at T3 was an independent protective factor (Hazard Ratio (HR)= 0.993; 95% Confidence Interval (CI)= 0.989-0.998; p= 0.006) for survival. A threshold of ≤129 for the PaO₂/FiO₂ ratio at T3 predicted non-survival with a sensitivity and specificity of 67.86 and 80.95, respectively (Area Under the Curve (AUC)= 0.782; 95% CI 0.687-0.859).

Conclusion: The PaO₂/FiO₂ ratio is a significant protective factor of survival in severe COVID-19 pneumonia within 30 min-1 hour after returning to the supine position (re-supination).

Chronic Obstructive Pulmonary Disease (COPD) is associated with cough, sputum production, and a reduction in lung function, quality of life, and life expectancy. Currently, bronchodilator combinations (β2-agonists and muscarinic receptor antagonists, dual therapy) and bronchodilators combined with inhaled corticosteroids (ICS), triple therapy, are the mainstays for the management of COPD. However, the use of ICS in triple therapy has been shown to increase the risk of pneumonia in some patients. These findings have laid the foundation for developing new therapies that possess both anti-inflammatory and/or bronchodilation properties. Phosphodiesterase-4 (PDE4) inhibitors have been reported as an effective therapeutic strategy for inflammatory conditions, such as asthma and COPD, but their use is limited because of class-related side effects. Efforts have been made to mitigate these side effects by targeting the PDE4B subtype of PDE4, which plays a pivotal role in the anti-inflammatory effects. Unfortunately, no selective oral PDE4B inhibitors have progressed to clinical trials. This has led to the development of inhaled PDE4 inhibitors to minimize systemic exposure and maximize the therapeutic effect. Another approach, the bronchodilation property of PDE3 inhibitors, is combined with anti-inflammatory PDE4 inhibitors to develop dual inhaled PDE4/PDE3 inhibitors. A few of these dual inhibitors have shown positive effects and are in phase 3 studies. The current review provides an overview of various PDE4 inhibitors in the treatment of COPD. The possibility of studying different selective PDE4 inhibitors and dual PDE3/4 inhibitors in combination with currently available treatments as a way forward to increase their therapeutic effectiveness is also emphasized.

Background: The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes.

Objective: This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE.

Methods: Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis.

Results: The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs. 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs. 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs. 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge.

Conclusion: Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation.