Pub Date : 2022-12-01DOI: 10.2500/jprm.2022.5.220001
Kushinga M. Bvute, Feyikemi Ogunfuwa, M. DeDonno
Background: Tuberculosis (TB) was the worldwide leading cause of mortality from a single infectious agent before the coronavirus disease 2019 (COVID-19) pandemic. The incidence of TB infections has continually declined since 2000, but the COVID-19 pandemic has reversed this trend. In 2020, global health officials reported a 21% drop in documented cases relative to TB cases in 2019. Although previous studies evaluated the impact of the COVID-19 pandemic on global TB cases, we are not aware of reports that compared U.S. and global TB cases during the COVID-19 pandemic. Objective: To analyze prepandemic and pandemic volumes of TB cases within the United States and compare findings with global TB volumes. Methods: This descriptive study used data from the Centers for Disease Control and Prevention to compare reported TB cases in the United States in 2019 and 2020. TB cases from the United States were compared with data about global TB cases. Results: The COVID-19 pandemic was associated with decreased TB testing and cases in the United States. The five states with the highest number of TB cases remained the same in 2019 and 2020, and included California, Texas, New York, Florida, and New Jersey. In these states, TB predominantly occurred in non‐U.S.-born residents and most patients solely presented with pulmonary manifestations. In the United States, the most substantial risk factor for TB was diabetes mellitus. Conclusion: The COVID-19 pandemic decreased access to TB services and discouraged patients from seeking TB care, which inadvertently disrupted international and U.S. TB surveillance systems. Given the decline in documented TB cases, leaders may need to anticipate an increase in TB cases and begin to aggressively reallocate resources to improve TB detection and care to mitigate the recent changes.
{"title":"Tuberculosis infections during the COVID-19 pandemic: Comparing USA and global tuberculosis in 2019 and 2020","authors":"Kushinga M. Bvute, Feyikemi Ogunfuwa, M. DeDonno","doi":"10.2500/jprm.2022.5.220001","DOIUrl":"https://doi.org/10.2500/jprm.2022.5.220001","url":null,"abstract":"Background: Tuberculosis (TB) was the worldwide leading cause of mortality from a single infectious agent before the coronavirus disease 2019 (COVID-19) pandemic. The incidence of TB infections has continually declined since 2000, but the COVID-19 pandemic has reversed this\u0000 trend. In 2020, global health officials reported a 21% drop in documented cases relative to TB cases in 2019. Although previous studies evaluated the impact of the COVID-19 pandemic on global TB cases, we are not aware of reports that compared U.S. and global TB cases during the COVID-19 pandemic.\u0000 Objective: To analyze prepandemic and pandemic volumes of TB cases within the United States and compare findings with global TB volumes. Methods: This descriptive study used data from the Centers for Disease Control and Prevention to compare reported TB\u0000 cases in the United States in 2019 and 2020. TB cases from the United States were compared with data about global TB cases. Results: The COVID-19 pandemic was associated with decreased TB testing and cases in the United States. The five states with the highest number of\u0000 TB cases remained the same in 2019 and 2020, and included California, Texas, New York, Florida, and New Jersey. In these states, TB predominantly occurred in non‐U.S.-born residents and most patients solely presented with pulmonary manifestations. In the United States, the most substantial\u0000 risk factor for TB was diabetes mellitus. Conclusion: The COVID-19 pandemic decreased access to TB services and discouraged patients from seeking TB care, which inadvertently disrupted international and U.S. TB surveillance systems. Given the decline in documented TB cases,\u0000 leaders may need to anticipate an increase in TB cases and begin to aggressively reallocate resources to improve TB detection and care to mitigate the recent changes.","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89224819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.2500/jprm.2022.5.220003
S. Khurana
Fractional exhaled nitric oxide (FeNO) is a breath biomarker that is easy to perform at the point of care in individuals 5 years or older. Elevated FeNO levels indicate increased type 2 airway inflammation, specifically increased interleukin 4/13 activity. Recent guidelines have made recommendations on the utility of FeNO measurement in the diagnosis and management of asthma. Measurement of FeNO is recommended as an adjunct to the evaluation process in patients with suspected asthma in whom the diagnosis of asthma is uncertain based on clinical presentation, spirometry, and bronchodilator challenge testing. Elevated FeNO levels are associated with an increased risk of asthma exacerbation, and FeNO suppression test can help differentiate “difficult” from “severe” asthma. High FeNO levels can predict response to anti-inflammatory therapies, including corticosteroids and certain biologics. FeNO measurement also has value in evaluation of chronic cough with increased levels suggesting a corticosteroid responsive condition such as cough-variant asthma or eosinophilic bronchitis.
{"title":"Use of fractional exhaled nitric oxide to guide the treatment of asthma and chronic cough","authors":"S. Khurana","doi":"10.2500/jprm.2022.5.220003","DOIUrl":"https://doi.org/10.2500/jprm.2022.5.220003","url":null,"abstract":"Fractional exhaled nitric oxide (FeNO) is a breath biomarker that is easy to perform at the point of care in individuals 5 years or older. Elevated FeNO levels indicate increased type 2 airway inflammation, specifically increased interleukin 4/13 activity. Recent guidelines have made\u0000 recommendations on the utility of FeNO measurement in the diagnosis and management of asthma. Measurement of FeNO is recommended as an adjunct to the evaluation process in patients with suspected asthma in whom the diagnosis of asthma is uncertain based on clinical presentation, spirometry,\u0000 and bronchodilator challenge testing. Elevated FeNO levels are associated with an increased risk of asthma exacerbation, and FeNO suppression test can help differentiate “difficult” from “severe” asthma. High FeNO levels can predict response to anti-inflammatory therapies,\u0000 including corticosteroids and certain biologics. FeNO measurement also has value in evaluation of chronic cough with increased levels suggesting a corticosteroid responsive condition such as cough-variant asthma or eosinophilic bronchitis.","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90273180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.2500/jprm.2023.5.220002
{"title":"Abstracts presented at the Eastern Pulmonary Conference, September 8‐11, 2022, Palm Beach, Florida","authors":"","doi":"10.2500/jprm.2023.5.220002","DOIUrl":"https://doi.org/10.2500/jprm.2023.5.220002","url":null,"abstract":"","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85194365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.2500/jprm.2022.4.210002
{"title":"Abstracts presented at the Eastern Pulmonary Conference September 30 - October 3, 2021, Palm Beach, Florida","authors":"","doi":"10.2500/jprm.2022.4.210002","DOIUrl":"https://doi.org/10.2500/jprm.2022.4.210002","url":null,"abstract":"","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78965109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.2500/jprm.2022.4.210001
{"title":"Abstracts presented at the Eastern Pulmonary Conference January 7‐10, 2021, Palm Beach, Florida","authors":"","doi":"10.2500/jprm.2022.4.210001","DOIUrl":"https://doi.org/10.2500/jprm.2022.4.210001","url":null,"abstract":"","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89277976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.2500/jprm.2020.3.200001
J. Bellanti
Background: Asthma is now recognized as a heterogeneous collection of disease entities associated with different clinical phenotypic presentations and diverse endotypic mechanisms. Recently, a new system of nomenclature of asthma has evolved by using a type 2 (T2) high and T2-low endotypic classification that has proven useful for diagnosis and for choosing the right biologic for patients with asthma. Aim: The purpose of this report was to provide an overview of molecular endotypes, asthma phenotypes, and existing biomarkers, with a focus on the new classification system of T2 and non-T2 pathways in the historical context of the contributions of Francis M. Rackemann, M.D., that set the stage both for our current understanding of the spectrum of disease entities of asthma and for the basis for the use of emerging biologics for the treatment of these disorders. Methods: This article was based on literature review of PubMed and the author’s own research and clinical experiences. Results: Currently, the therapy for asthma is being directed to a treatment strategy based on patient-specific phenotypic characteristics and underlying endotypic mechanisms of tissue injury that focus on a T2-high and T2-low airway inflammation classification. Based on this classification, the clinician is provided with a useful treatment stratagem for choosing the right biologic for personalized care of patients with asthma. Although not perfect in its total applicability, it affords a guide in helping to choose among the currently available biologics, the most appropriate one, as well as those that inevitably will become available. Conclusion: The phenotypic classification of asthma described in this report began with the clinical observations that were made by of an astute clinician long before the supernova emergence of information related to T2-high and T2-low immune function. Rackemann’s legacy to clinical allergy practice once again illustrates that science and technology can best progress through the energizing force of clinical observation.
背景:哮喘现在被认为是一种异质性的疾病实体集合，与不同的临床表型表现和不同的内型机制相关。最近，一种新的哮喘命名系统通过使用2型(T2)高和T2低的内型分类而发展起来，这种分类已被证明有助于诊断和为哮喘患者选择正确的生物制剂。目的:本报告的目的是提供分子内型、哮喘表型和现有生物标志物的概述，重点关注在Francis M. Rackemann医学博士贡献的历史背景下T2和非T2途径的新分类系统，这为我们目前对哮喘疾病实体谱的理解奠定了基础，并为使用新兴生物制剂治疗这些疾病奠定了基础。方法:根据PubMed的文献综述，结合作者本人的研究和临床经验。结果:目前，哮喘的治疗是基于患者特异性表型特征和潜在的组织损伤内源性机制的治疗策略，重点是t2 -高和t2 -低气道炎症分类。基于这一分类，临床医生可以为哮喘患者的个性化护理选择合适的生物制剂提供有用的治疗策略。虽然它的整体适用性并不完美，但它提供了一个指南，帮助在当前可用的生物制剂中选择最合适的生物制剂，以及那些不可避免地会成为可用的生物制剂。结论:本报告中描述的哮喘表型分类始于一位精明的临床医生的临床观察，这些观察早在与t2 -高和t2 -低免疫功能相关的信息超新星出现之前就开始了。拉克曼对临床过敏实践的贡献再次说明，科学和技术可以通过临床观察的激励力量得到最好的进步。
{"title":"Phenotypic classification of asthma based on a new Type 2‐high and Type 2‐low endotypic classification: It all began with Rackemann","authors":"J. Bellanti","doi":"10.2500/jprm.2020.3.200001","DOIUrl":"https://doi.org/10.2500/jprm.2020.3.200001","url":null,"abstract":"Background: Asthma is now recognized as a heterogeneous collection of disease entities associated with different clinical phenotypic presentations and diverse endotypic mechanisms. Recently, a new system of nomenclature of asthma has evolved by using a type 2 (T2) high and\u0000 T2-low endotypic classification that has proven useful for diagnosis and for choosing the right biologic for patients with asthma. Aim: The purpose of this report was to provide an overview of molecular endotypes, asthma phenotypes, and existing biomarkers, with a focus\u0000 on the new classification system of T2 and non-T2 pathways in the historical context of the contributions of Francis M. Rackemann, M.D., that set the stage both for our current understanding of the spectrum of disease entities of asthma and for the basis for the use of emerging biologics for\u0000 the treatment of these disorders. Methods: This article was based on literature review of PubMed and the author’s own research and clinical experiences. Results: Currently, the therapy for asthma is being directed to a treatment strategy based\u0000 on patient-specific phenotypic characteristics and underlying endotypic mechanisms of tissue injury that focus on a T2-high and T2-low airway inflammation classification. Based on this classification, the clinician is provided with a useful treatment stratagem for choosing the right biologic\u0000 for personalized care of patients with asthma. Although not perfect in its total applicability, it affords a guide in helping to choose among the currently available biologics, the most appropriate one, as well as those that inevitably will become available. Conclusion: The\u0000 phenotypic classification of asthma described in this report began with the clinical observations that were made by of an astute clinician long before the supernova emergence of information related to T2-high and T2-low immune function. Rackemann’s legacy to clinical allergy practice\u0000 once again illustrates that science and technology can best progress through the energizing force of clinical observation.","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83421495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.2500/jprm.2019.190006
Gayatri B Patel, Anju T Peters
Background: Severe asthma can be a challenging disease to manage by the provider and by the patient, supported by evidence of increased health-care utilization by this population. Patients with severe asthma should be screened for comorbidities because these often contribute to poorly controlled asthma. The impact of comorbidities, however, are not completely understood. Objective: To review common comorbidities and their impact on severe asthma. Methods: A review of relevant clinical research studies that examined comorbidities in severe or difficult-to-treat asthma. Results: A number of comorbid diseases, including rhinitis, rhinosinusitis, gastroesophageal reflux, and obstructive sleep apnea, are associated with severe or difficult-to-treat asthma. If present and untreated, these conditions may adversely affect asthma control, quality of life, and/or lung function, despite adequate treatment with step-up asthma controller therapy. Conclusion: Treatable comorbidities are associated with severe and difficult-to-control asthma. Failure to recognize these comorbidities may divert appropriate care and increase disease burden. Assessment and management of these risk factors may contribute to improved asthma outcome; however, more investigation is needed to understand the relationship of comorbidities and asthma due to inconsistency in the findings.
{"title":"Comorbidities associated with severe asthma.","authors":"Gayatri B Patel, Anju T Peters","doi":"10.2500/jprm.2019.190006","DOIUrl":"https://doi.org/10.2500/jprm.2019.190006","url":null,"abstract":"Background: Severe asthma can be a challenging disease to manage by the provider and by the patient, supported by evidence of increased health-care utilization by this population. Patients with severe asthma should be screened for comorbidities because these often contribute to poorly controlled asthma. The impact of comorbidities, however, are not completely understood. Objective: To review common comorbidities and their impact on severe asthma. Methods: A review of relevant clinical research studies that examined comorbidities in severe or difficult-to-treat asthma. Results: A number of comorbid diseases, including rhinitis, rhinosinusitis, gastroesophageal reflux, and obstructive sleep apnea, are associated with severe or difficult-to-treat asthma. If present and untreated, these conditions may adversely affect asthma control, quality of life, and/or lung function, despite adequate treatment with step-up asthma controller therapy. Conclusion: Treatable comorbidities are associated with severe and difficult-to-control asthma. Failure to recognize these comorbidities may divert appropriate care and increase disease burden. Assessment and management of these risk factors may contribute to improved asthma outcome; however, more investigation is needed to understand the relationship of comorbidities and asthma due to inconsistency in the findings.","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2500/jprm.2019.190006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25391479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.2500/jprm.2019.40.190010
{"title":"Eastern Pulmonary Conference, September 12‐15, 2019, Palm Beach, Florida","authors":"","doi":"10.2500/jprm.2019.40.190010","DOIUrl":"https://doi.org/10.2500/jprm.2019.40.190010","url":null,"abstract":"","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82513288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.2500/jprm.2019.190008
D. Mahler
Background: Controversy exists about the use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). Although ICS are not approved as monotherapy for COPD, four ICS molecules, beclomethasone, budesonide, fluticasone furoate, and fluticasone propionate, are used widely in combination with long-acting bronchodilators to treat patients with this disease. Objectives: (1) To review the mechanisms of action of ICS therapy that contribute to the clinical benefits in COPD; and (2) to describe improvements in lung function, relief of dyspnea, increase in exercise tolerance, and the reduction in exacerbations with ICS use in COPD. Methods: A critical review of phase III and IV randomized clinical trials that evaluated ICS therapy in patients with COPD. Results: ICS have two major mechanisms of action in human airways: a reduction in edema and inflammation, and a decrease in airway hyperresponsiveness. ICS monotherapy significantly increases the morning peak expiratory flow rate and forced expiratory volume in 1 second (peak and trough) as early as the first day of treatment. Discontinuation of ICS therapy leads to deterioration in lung function. Treatment with ICS, alone and in combination with a long-acting bronchodilator, reduces dyspnea related to daily activities, whereas withdrawal increases breathing difficulty. Patients with COPD exhibit a significant increase in exercise duration with ICS therapy. The combination of ICS with one or more bronchodilators significantly reduces the exacerbation rate compared with bronchodilator therapy alone. The major serious adverse effect is an increased risk of pneumonia. Conclusion: Randomized controlled trials demonstrate that ICS therapy improves both physiologic and clinical outcomes in patients with COPD. These benefits are enhanced when ICS molecules are combined with one or more long-acting bronchodilators.
{"title":"Pro: Inhaled corticosteroids for chronic obstructive pulmonary disease","authors":"D. Mahler","doi":"10.2500/jprm.2019.190008","DOIUrl":"https://doi.org/10.2500/jprm.2019.190008","url":null,"abstract":"Background: Controversy exists about the use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). Although ICS are not approved as monotherapy for COPD, four ICS molecules, beclomethasone, budesonide, fluticasone furoate, and fluticasone\u0000 propionate, are used widely in combination with long-acting bronchodilators to treat patients with this disease. Objectives: (1) To review the mechanisms of action of ICS therapy that contribute to the clinical benefits in COPD; and (2) to describe improvements in lung\u0000 function, relief of dyspnea, increase in exercise tolerance, and the reduction in exacerbations with ICS use in COPD. Methods: A critical review of phase III and IV randomized clinical trials that evaluated ICS therapy in patients with COPD. Results: ICS\u0000 have two major mechanisms of action in human airways: a reduction in edema and inflammation, and a decrease in airway hyperresponsiveness. ICS monotherapy significantly increases the morning peak expiratory flow rate and forced expiratory volume in 1 second (peak and trough) as early as the\u0000 first day of treatment. Discontinuation of ICS therapy leads to deterioration in lung function. Treatment with ICS, alone and in combination with a long-acting bronchodilator, reduces dyspnea related to daily activities, whereas withdrawal increases breathing difficulty. Patients with COPD\u0000 exhibit a significant increase in exercise duration with ICS therapy. The combination of ICS with one or more bronchodilators significantly reduces the exacerbation rate compared with bronchodilator therapy alone. The major serious adverse effect is an increased risk of pneumonia. \u0000 Conclusion: Randomized controlled trials demonstrate that ICS therapy improves both physiologic and clinical outcomes in patients with COPD. These benefits are enhanced when ICS molecules are combined with one or more long-acting bronchodilators.","PeriodicalId":87312,"journal":{"name":"Journal of precision respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84301746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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