Clinical Respiratory Journal
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Clinical and etiological analysis of co‐infections and secondary infections in COVID‐19 patients: An observational studyAbstract Background Co‐infections, secondary bacterial or fungal infections, are important risk factors for poor outcomes in viral infections. The prevalence of co‐infection and secondary infection in patients infected with SARS‐CoV‐2 is not well understood. Aims To investigate the role of co‐infections and secondary infections in disease severity of hospitalized individuals with COVID‐19. Materials and Methods A retrospective study was carried out between 11 January 2020 and 1 March 2020 among 408 laboratory confirmed COVID‐19 patients in China. These patients were divided into three groups based on disease severity: mild or moderate, severe, or critically ill. Microbiological pathogens in blood, urine, and respiratory tract specimens were detected by the combination of culture, serology, polymerase chain reaction, and metagenomic next‐generation sequencing (mNGS). Results The median age of participants was 48 years (IQR 34–60 years). Fifty‐two patients (12.7%) had at least one additional pathogen, 8.1% were co‐infected, and 5.1% had a secondary infection. There were 13 Mycoplasma pneumoniae cases, 8 Haemophilus influenzae cases, 8 respiratory viruses, and 3 Streptococcus pneumoniae cases, primarily detected in mild and moderate COVID‐19 patients. Hospital‐acquired infection pathogens were more common in critically ill patients. Compared to those without additional pathogens, patients with co‐infections and/or secondary infections were more likely to receive antibiotics (p < 0.001) and have elevated levels of d‐dimer (p = 0.0012), interleukin‐6 (p = 0.0027), and procalcitonin (p = 0.0002). The performance of conventional culture was comparable with that of mNGS in diagnosis of secondary infections. Conclusion Co‐infections and secondary infections existed in hospitalized COVID‐19 patients and were relevant to the disease severity. Screening of common respiratory pathogens and hospital infection control should be strengthened.
Clinical Respiratory Journal - Tập 15 Số 7 - Trang 815-825 - 2021
Cardiorespiratory fitness of asthmatic children and validation of predicted aerobic capacityAbstract Introduction: Predicted aerobic capacity (PAC) was estimated by submaximal exercise test and compared with monitored aerobic capacity (MAC) measured by laboratory conditions [maximal oxygen uptake (VO2peak )] in 18 children and adolescents, 10 asthmatics and 8 matched controls.Objectives: To compare aerobic capacity between asthmatic children and controls, to estimate the agreement between PAC and MAC and observe for trend of PAC.Materials and Methods: The design was prospective, 4 years (PAC) and cross‐sectional (MAC and VO2peak ). Non‐parametric Wilcoxon rank sums were applied for statistical evaluation; the method of Bland and Altman estimated the agreement between PAC and MAC; P < 0.05.Results: PAC at baseline and follow‐up, and MAC at follow‐up, showed significant differences between groups (P < 0.05), and the mean difference between PAC and MAC at follow‐up was −1.0 mLO2 /min/kg [non‐significant (ns)], indicating that PAC had a bias towards underestimation as compared with MAC. Limits of agreement, mean difference [±2 standard deviations (SD)], ranged from −8.5 to 6.5 mLO2 /min/kg, indicating good agreement between the two measurements. No trend of PAC was observed (ns). Physical activity level and subjective health showed no differences between groups, or level and categories, respectively.Conclusion: The asthmatic participants presented with lower aerobic capacity than controls in both PAC and MAC; therefore, results confirmed the validity of the PAC method. Data warrant exploration by large‐scale paediatric asthma epidemiology.Please cite this paper as: Lochte L, Angermann M and Larsson B. Cardiorespiratory fitness of asthmatic children and validation of predicted aerobic capacity. The Clinical Respiratory Journal 2009; 3: 42–50.
Clinical Respiratory Journal - Tập 3 Số 1 - Trang 42-50 - 2009
Particulate matter‐induced epigenetic changes and lung cancerAbstract Background and Aims: Lung cancer is the leading cause of cancer death worldwide. Cigarette smoking is the well‐known risk factor for lung cancer. Epidemiological studies suggest that air pollution, especially particulate matter (PM) exposure, is associated with increased lung cancer risk and mortality independent of cigarette smoking.Methods: English‐language publications focusing on PM, epigenetic changes, and lung cancer were reviewed. The epigenome serves as an interface between the environment and the genome. PM is one of the environmental factors that can cause epigenetic changes. The epigenome serves as an interface between the environment and the genome. Some of the epigenetic changes lead to increased disease susceptibility and progression. In cardiovascular disease and asthma, the association between PM exposure and the disease specific epigenetic changes has been identified. In lung cancer, the epigenetic changes in DNA methylation, histone modification and microRNA expression are commonly found, but the specific link between PM exposure and lung cancer remains incompletely understood.Results: The results of epidemiological studies indicate the important effects of PM exposure on lung cancer. PM2.5 is consistently associated with the increased lung cancer risk and mortality. Based on the epidemiological associations between PM exposure and lung cancer, PM‐induced epigenetic changes may play important roles in the pathogenesis of lung cancer.Conclusion: In this review, we focus on the current knowledge of epigenetic changes associated with PM exposure and lung cancer. Better understanding of the link between PM exposure and lung cancer at the epigenomic level by comprehensive comparison approach may identify lung cancer early detection biomarkers and novel therapeutic targets.
Clinical Respiratory Journal - Tập 11 Số 5 - Trang 539-546 - 2017
Organizing pneumonia related to electronic cigarette use: A case report and review of literatureAbstract Background and Objective Electronic cigarettes (e cigarettes) are battery operated devices that produce aerosol by heating a solution typically made up of nicotine, propylene glycol, glycerin and flavouring agents. The use of e cigarettes has risen dramatically in recent years especially among adolescents and young adults. These devices have been marketed as safer alternatives to tobacco smoking by their manufactures despite lack of adequate safety data. Methods We present a case of 40‐year‐old female patient who developed significant pulmonary toxicity secondary to e cigarette use and searched existing literature relevant to the case. Results To our knowledge this is the second reported case of organizing pneumonia and tenth reported case of pulmonary toxicity related to e cigarette use. Our patient presented with symptoms of worsening dyspnoea and intermittent chest pain for past 1 month. She reported increased use of e cigarettes during this time period to help her quit smoking. Patient developed acute hypoxemic respiratory failure requiring intubation and mechanical ventilation. She was diagnosed with organizing pneumonia on open lung biopsy and was successfully treated with steroids along with abstinence from e cigarette use. Conclusions As the current data on health effects of e cigarettes is limited, case reports can serve important piece of information in this regard. The use of e cigarettes has increased exponentially in recent years and continue to rise; therefore, physicians should be aware of adverse effects and toxicity related to its use.
Clinical Respiratory Journal - Tập 12 Số 3 - Trang 1295-1299 - 2018
The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung diseaseAbstract Background and Aims It is not yet known if transbronchial cryobiopsy (TCB ) is a reliable and safe diagnostic tool in the investigation of interstitial lung disease (ILD ). To date, there have been no studies directly comparing the value of TCB with that of surgical lung biopsy (SLB ). The study was initiated to determine whether the samples taken by TCB lead to a reliable diagnosis and whether SLB can be avoided in a relevant percentage of cases. Methods We analyzed 32 subjects with suspected ILD who underwent a TCB . Subjects' baseline characteristics, pathological findings after TCB and SLB , and complication rates were analyzed. The pathological inter‐rater agreement was quantified statistically. Results The overall inter‐rater agreement concerning TCB sample evaluation was good with a kappa value of 0.80. In 23/32 cases (72%), the findings from the TCB showed a strong congruence with all other clinical data, thereby enabling a definitive diagnosis. Eight of the remaining nine subjects gave their consent for an SLB , which led to a definitive histological diagnosis in six cases (75%). Following TCB , pneumothorax occurred in 6/32 subjects (19%) and endobronchial bleeding was moderate in 8/32 (25%) and was severe in 17/32 cases (53%). Conclusion This is the first study to correlate histological results and complications following TCB and SLB in ILD subjects, some of whom underwent both procedures. TCB is a suitable diagnostic tool in ILD , potentially completely dispensing with the need for an SLB in some cases. In all cases, an interdisciplinary case evaluation is necessary as a final step.
Clinical Respiratory Journal - Tập 10 Số 5 - Trang 589-595 - 2016
The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseasesAbstract Introduction Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC. Objective To report the diagnostic yield and safety of TBLC with different procedural techniques. Materials and Methods Retrospective multicenter study of subjects who underwent TBLC for the diagnosis of diffuse parenchymal lung diseases (DPLDs). The procedure was performed using various methods: flexible or rigid bronchoscopy, with or without the use of fluoroscopy or occlusion balloon. Results In total, 128 subjects (59% women) with a mean age of 48.9 years were included. The overall diagnostic yield of TBLC was 78.1%, with a definite diagnosis on multidisciplinary discussion made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with the number of biopsies taken {ajdusted odds ratio [AOR] [95% confidence interval (CI)], 2.17 [1.29‐3.67]}. The incidence of pneumothorax was lower in subjects who underwent TBLC with fluoroscopic guidance (5.9% vs 20.9%), [AOR (95% CI), 0.26 (0.07‐0.94)]. Moderate‐to‐severe bleeding occurred less frequently when an occlusion balloon was used [1.8% vs 35.7%; AOR (95% CI), 0.02 (0.001‐0.18)], after adjusting for age, use of fluoroscopy, number of biopsies obtained and number of lobes sampled. Four deaths occurred; 2 because of acute exacerbation of idiopathic pulmonary fibrosis. Conclusions Transbronchial lung cryobiopsy was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate‐to‐severe bleeding was lower with the use of fluoroscopy and an occlusion balloon, respectively.
Clinical Respiratory Journal - Tập 12 Số 4 - Trang 1711-1720 - 2018
Salivary C‐reactive protein and mean platelet volume in diagnosis of late‐onset neonatal pneumoniaAbstract Background Neonatal pneumonia is an important and major cause of neonatal morbidity and mortality worldwide therefore; its early detection plays a crucial role in successful therapy. Analysis of saliva as a non‐invasive method for detection of neonatal diseases holds great promise for improving health care. Till now, salivary C‐reactive protein (CRP), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR) and platelets/lymphocytes ratio (PLR) have not been studied as markers of diagnosis in neonatal pneumonia. Objective To assess the applicability of salivary CRP, MPV, NLR and PLR as diagnostic markers in late‐onset neonatal pneumonia. Methods A prospective case control study of 70 full‐term neonates, 35 with late‐onset neonatal pneumonia and 35 healthy controls, was enrolled. Serum and salivary CRP concentrations were measured by ELISA, while MPV, NLR and PLR were measured by automated blood cell counter. Results This study showed a statistically significant difference between salivary CRP means in neonates with late‐onset neonatal pneumonia vs control neonates (6.2 ± 4.6 and 2.8 ± 1.9 ng/L) respectively. At the cutoff point of 3.8 ng/L, salivary CRP showed 91.4% sensitivity and 80.9% specificity. Salivary CRP also showed accuracy in predicting elevated serum CRP in neonates with pneumonia. MPV showed a significant difference between pneumonia and controls (mean = 10.2 ± 0.7, 8 ± 0.5) respectively. At cutoff point 9.0, it has 80% sensitivity and specificity. Conclusions The present study showed for the first time that both salivary CRP and MPV are suitable as diagnostic markers in late‐onset neonatal pneumonia.
Clinical Respiratory Journal - Tập 12 Số 4 - Trang 1644-1650 - 2018
Regulatory T cells in inflammation and resolution of acute lung injuryAbstract Introduction Acute respiratory distress syndrome (ARDS) is characterized by hypoxemia and increased lung permeability and would result in acute respiratory failure and with high mortality. In patients who survive from acute lung injury (ALI)/ARDS, it is an active process of the transition from injury to resolution depending on the coordinated immune system. The roles of regulatory CD4+ T cells (Tregs) are now gradually being clarified during inflammation and resolution of ARDS. However, clear conclusions about roles of Tregs in ALI/ARDS are only a few. Objective This review provides an overview of phenotype, differentiation, and suppressive mechanisms of Tregs and focuses on keys of biology of Tregs in alveolar space during the inflammatory response and resolution of ALI/ARDS. Data Source Literature search of Web of Science, PubMed, and EMBASE was made to find relative articles about Tregs in ALI/ARDS. We used the following search terms: Tregs, ALI, ARDS, inflammation, and resolution. Conclusion More and more studies have indicated Tregs involved in the processes of inflammation and resolution of ALI/ARDS. A deep understanding of the roles of Tregs may indicate new treatments for patients of ARDS. Therapies aimed at expansion or adaptive transfer of Tregs could be an effective therapy to ARDS patients.
Clinical Respiratory Journal - Tập 16 Số 9 - Trang 587-595 - 2022
Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis – a randomized controlled trialAbstract Introduction Breathing exercises with positive expiratory pressure are often recommended to patients with advanced neurological deficits, but the potential benefit in multiple sclerosis (MS ) patients with mild and moderate symptoms has not yet been investigated in randomized controlled trials. Objectives To study the effects of 2 months of home‐based breathing exercises for patients with mild to moderate MS on respiratory muscle strength, lung function, and subjective breathing and health status outcomes. Methods Forty‐eight patients with MS according to the revised McDonald criteria were enrolled in a randomized controlled trial. Patients performing breathing exercises (n = 23) were compared with a control group (n = 25) performing no breathing exercises. The breathing exercises were performed with a positive expiratory pressure device (10–15 cmH2 O Results Following the intervention, there was a significant difference between the breathing group and the control group regarding the relative change in lung function, favoring the breathing group (vital capacity: P < 0.043; forced vital capacity: P < 0.025). There were no other significant differences between the groups. Conclusion Breathing exercises may be beneficial in patients with mild to moderate stages of MS . However, the clinical significance needs to be clarified, and it remains to be seen whether a sustainable effect in delaying the development of respiratory dysfunction in MS can be obtained.
Clinical Respiratory Journal - Tập 10 Số 6 - Trang 698-706 - 2016
Early non‐invasive ventilation treatment for respiratory failure due to severe community‐acquired pneumoniaAbstract Background and Aims Severe community‐acquired pneumonia (sCAP ) have been as defined pneumonia requiring admission to the intensive care unit or carrying a high risk of death. Currently, the treatment of sCAP consists of antibiotic therapy and ventilator support. The use of invasive ventilation causes several complications as does admission to ICU . For this reason, non‐invasive ventilation (NIV ) has been used for acute respiratory failure to avoid endotracheal intubation. However, few studies have currently assessed the usefulness of NIV in sCAP . Methods We prospectively assessed 127 patients with sCAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio (P aO 2 /F iO 2 ) <250]. We defined successful NIV as avoidance of intubation and the achievement of P aO 2 /F iO 2 >250 with spontaneous breathing. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses. Results NIV failed in 32 patients (25.1%). Higher chest X ‐ray score at admission, chest X ‐ray worsening, and a lower P aO 2 /F iO 2 and higher alveolar‐arteriolar gradient (A ‐aDO 2 ) after 1 h of NIV all independently predicted NIV failure. Higher lactate dehydrogenase and confusion, elevated blood urea, respiratory rate, blood pressure plus age ≥65 years at admission, higher A ‐aDO 2 , respiratory rate and lower P aO 2 /FiO 2 after 1 h of NIV and intubation rate were directly related to hospital mortality.Conclusions Successful treatment is strongly related to less severe illness as well as to a good initial and sustained response to medical therapy and NIV treatment. Constant monitoring of these patients is mandatory.
Clinical Respiratory Journal - Tập 10 Số 1 - Trang 98-103 - 2016
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