EMJ Respiratory最新文献

{"title":"Electronic Cigarette Use Among Emerging and Young West Indian Adults","authors":"Rayshell Dhandoolal, Shivanni De Gannes, Andrew Dhanoolal, Matthew Desaine, Dania Dukhoo, Stephen Duncombe, Dylan Dupraj, Tai Dorsett, I. Dialsingh, S. Sakhamuri, L. P. Pinto Pereira","doi":"10.33590/emjrespir/10310313","DOIUrl":"https://doi.org/10.33590/emjrespir/10310313","url":null,"abstract":"Currently, evidence concerning electronic cigarette (e-cigarette) use in the West Indies is unavailable. This study examines the prevalence and associated factors of e-cigarette use in young Trinidadian adults, 6 years after e-cigarettes were introduced in Trinidad. Young adults between the ages of 18 and 40 years were surveyed from May–June 2016. Based on the survey results, descriptive statistics and logistic regression models were used to identify correlations in e-cigarette use. The prevalence of those who had used e-cigarettes was 24.6%, and 41.9% of these people had used both e-cigarettes and tobacco cigarettes. A high proportion (16.95%) of those who had never used tobacco cigarettes had used e-cigarettes. Males were twice as likely as females to have used e-cigarettes (odds ratio [OR]: 2.60; 95% confidence interval [CI]: 1.85–3.68), and participants aged 18–25 years were more likely than those aged 36–40 years to use e-cigarettes (OR: 0.37; 95% CI: 0.14–0.81). The predictors of e-cigarette use as assessed by univariate analysis were current tobacco cigarette smoking (OR: 9.34; 95% CI: 6.14–14.39; p<0.001) and the belief that e-cigarettes are dangerous to health (OR: 0.61; 95% CI: 0.44–0.85; p=0.004). The predictors as assessed by multivariate logistic regression (adjusted OR) were ethnicity (p=0.043), education (p=0.012), and age group (p=0.007). Those who quit using tobacco cigarettes were 7.98 times more likely to use e-cigarettes (95% CI: 4.21–15.45), and those who knew that e-cigarettes contain nicotine were 2.70 times more likely to use them (95% CI: 1.53–4.86; p<0.001). Two summative scales were constructed that measured knowledge and perception. The perception scale, but not the knowledge scale (Cronbach’s alpha=0.736), was a significant predictor of e-cigarette use. The number of e-cigarette users is high (24.6%) in young adults in Trinidad and in those who have never smoked tobacco (16.95%). Current smokers, as well as those who have quit smoking, are at an increased risk of e-cigarette use. This study established that young adults have a low level of knowledge regarding e-cigarettes and shows that they should be educated on e-cigarette use. Further research to examine the reasons for, and susceptibility to, e-cigarette use is necessary.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117182420","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}

{"title":"Chronic Obstructive Pulmonary Disease and Arterial Stiffness","authors":"M. Sarkar","doi":"10.33590/emjrespir/10311249","DOIUrl":"https://doi.org/10.33590/emjrespir/10311249","url":null,"abstract":"Comorbidities are common in chronic obstructive pulmonary disease (COPD). Cardiovascular comorbidity is a leading cause of morbidity and mortality in COPD patients. Low lung function is a risk factor for increased arterial stiffness, a condition that is common in COPD patients, independent of conventional cardiovascular risk factors. Arterial stiffness is an independent risk factor both for all-cause and for cardiovascular mortality, and carotid–femoral pulse wave velocity is the gold standard for the assessment of arterial stiffness. Various mechanisms proposed in the development of arterial stiffness include systemic inflammation, ageing, advanced glycation end products, renin–angiotensin–aldosterone system, increased elastolysis, and vitamin D deficiency. Early detection of arterial stiffness in COPD patients is warranted to detect cardiovascular comorbidity at the subclinical stage, which would help to prevent overt vascular events in the future. We need well-designed studies to see the impact of therapy that targets increased arterial stiffness on future cardiovascular events in COPD. This review discusses the epidemiology, diagnosis, and therapy of increased arterial stiffness in COPD patients.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127168438","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}

{"title":"A Confounding Case: Pneumococcal Pneumonia Unmasking Systemic Lupus Erythematosus","authors":"A. Arbat, S. Tirpude, Mitesh K. Dave, S. Bagdia, S. Arbat","doi":"10.33590/emjrespir/10310050","DOIUrl":"https://doi.org/10.33590/emjrespir/10310050","url":null,"abstract":"We report a case of systemic lupus erythematosus in a 27-year-old female complicated with pneumonia and severe respiratory failure, requiring treatment in an intensive care unit and non-invasive ventilation. Symptoms developed in an otherwise healthy female with no comorbidities except recurrent oral ulcers. Despite evidence of pulmonary infection, response was noted only after early introduction of intensive immunosuppressive treatment. Differential diagnosis and treatment of this condition represent a real challenge but close co-operation between the intensive care unit, pulmonology, and rheumatology departments reduce the risk of a fatal outcome.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114336705","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}

{"title":"Respiratory Symptoms, Lung Function Impairment, and Chronic Respiratory Diseases Among Crop Farmers: Assessment by Job Exposure Matrices","authors":"S. Stoleski, J. Minov, J. Karadžinska-Bislimovska, D. Mijakoski","doi":"10.33590/emjrespir/10312773","DOIUrl":"https://doi.org/10.33590/emjrespir/10312773","url":null,"abstract":"Objective: To evaluate the prevalence of chronic respiratory symptoms, lung function impairment, and chronic obstructive respiratory diseases in crop farmers. Our objective is to then examine their relation to exposure duration, and to explore the usefulness of job exposure matrices as tools for exposure assessment, and predictors for respiratory health impairment.\u0000\u0000Methods: A cross-sectional study was performed, including 50 males (mean age: 45.4±10.7 years) employed as crop farmers (duration of exposure: 21.6±9.7 years) and 50 male office workers as a control group (mean age: 44.1±9.8 years) matched for age, smoking habits, and socioeconomic status. Methods of evaluating examined subjects included the completion of a questionnaire on respiratory symptoms in the last 12 months (cough, phlegm, dyspnoea, wheezing, chest tightness, and nasal symptoms), spirometry and histamine challenge (provocative concentration producing a 20% fall in forced expiratory volume in 1 second [FEV1]: ≤8 mg/mL), as well as use of job exposure matrices.\u0000\u0000Results: Crop farmers had a significantly higher prevalence of cough (29.4%), phlegm (16.7%), and wheezing (11.9%), than the control group (p<0.05). All spirometric parameters (forced vital capacity [FVC], FEV1, FEV1/FVC%, maximal expiratory flow (MEF) at 75%, 50%, and 25%) were lower in crop farmers compared to the control patients, but statistical significance was confirmed only for MEF at 25%, 50%, and 25–75% (p=0.021, p=0.011, and p=0.003, respectively). The prevalence of bronchial hyperresponsiveness, asthma, and chronic obstructive pulmonary disease was higher in crop farmers but without statistical significance. JEM were useful tools for exposure assessment and predictors of factors for asthma and COPD development.\u0000\u0000Conclusion: The results suggest that occupational exposure among crop farmers is associated with a higher prevalence of respiratory symptoms, lung function impairment, and a higher prevalence of chronic respiratory diseases.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131718744","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}

{"title":"Modifying Alpha-1 Antitrypsin Deficiency-Related Emphysema: From Evidence to Practice","authors":"Mia Cahill","doi":"10.33590/emjrespir/10310897","DOIUrl":"https://doi.org/10.33590/emjrespir/10310897","url":null,"abstract":"The symposium discussed the role of disease modification in alpha-1 antitrypsin deficiency (AATD)-related emphysema. Evidence from the recent RAPID trial and its extension trial showed that treating AATD patients with intravenous alpha-1 antitrypsin (alpha-1 proteinase inhibitor; [A1-PI]) therapy slowed the rate of lung density decline and had a disease-modifying effect. By modifying the course of disease, survival can be extended by several years. Dr Ferrarotti opened the symposium by introducing the topic of AATD-related emphysema, highlighting the latest epidemiological data, and providing an overview of the treatment landscape. Prof Chorostowska-Wynimko then addressed how to determine the disease modification that occurs in AATD, focussing on the clinical trial design (classical parallel-group, placebo-controlled trial design versus a ‘late-start’ study design) and clinical outcomes (forced expiratory volume in 1 second [FEV1] versus computed tomography [CT] lung density). Prof Chapman explained the results and the post hoc analyses of the RAPID trials; a sustained reduction in lung density decline rate that proves to have a disease-modifying effect. Prof Koczulla closed the symposium by relating current evidence to the real-life management of patients, notably how patients should be monitored and the prospect of home-based care.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121348537","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}

{"title":"Therapeutic Effect of Whole Lung Lavage on Pneumoconiosis","authors":"Hongmei Zhang, Pei Liu, Hongmei Zheng, Deng Chunyan, Yanjun Zeng","doi":"10.33590/emjrespir/10311749","DOIUrl":"https://doi.org/10.33590/emjrespir/10311749","url":null,"abstract":"Pneumoconiosis as an occupational disease is a serious threat to the health of workers. Patients with pneumoconiosis are mainly engaged in dust-related work such as gold, coal, or iron mining, electric welding, or road work, and present with miliary nodules, fuse mass-like opacities, and cavity lesions on chest imaging. Clinical manifestations of pneumoconiosis include progressive chest tightness, dyspnoea, chest pain, coughing, expectoration, fever, and hypodynamia. Pneumoconiosis patients are prone to respiratory tract infections (including bacterial pneumonia and tuberculosis) because of poor disease resistance and will eventually lose the ability to work and fully function in daily life completely. Patients can lose their life because of complications such as pulmonary heart disease and respiratory failure. Disease prevention is the main method to control pneumoconiosis.\u0000\u0000We retrospectively analysed 516 cases of pneumoconiosis patients receiving whole lung lavage (WLL) procedure from May 2009–January 2015. The symptoms, pulmonary function, chest computed tomography manifestations, and living status were reviewed carefully. The improvement rate of chest tightness, chest pain, and dyspnoea was 99%, 90%, and 98%, respectively, 7 days after WLL procedure. The symptoms had improved in 235 patients at 3–6 months postoperatively. The therapeutic effect remained stable in 56 cases after 4–5 years. Chest tightness, chest pain, and dyspnoea were improved significantly, and pulmonary diffusion function and small airway resistance also improved. There was no progress in 62 patients 4–5 years postoperatively, as indicated by the chest computed tomography examination. Overall, WLL treatment is an effective method for treating pneumoconiosis.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116119269","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}

{"title":"Non-Intubated Video-Assisted Thoracic Surgery from Multi to Uniport Approaches: Single-Centre Experience","authors":"T. Mineo, V. Ambrogi, F. Sellitri","doi":"10.33590/emjrespir/10312090","DOIUrl":"https://doi.org/10.33590/emjrespir/10312090","url":null,"abstract":"The success and evolution of video-assisted thoracic surgery (VATS) renewed the interest for thoracoscopic operations in awake patients. Non-intubated, or tubeless, procedures found progressive credit and uptake. In particular, non-intubated uniportal VATS represents the latest stage in its evolution. An increasing number of more complicated procedures have been successfully carried out with this combined modality.\u0000\u0000In the early 2000s, the Awake Thoracic Surgery Research Group at the University of Rome Tor Vergata started an investigational programme of thoracic operations performed without general anaesthesia and one-lung ventilation. Since that date >1,000 operations have been successfully carried out. Initially, non-intubated anaesthesia was successfully employed in non-oncologic conditions such as pneumothorax, emphysema, pleural infection, and interstitial lung disease. Oncologic conditions such as malignant pleural effusion, peripheral lung nodules, and mediastinal tumours were successively approached. Major operations are now being performed in this way. Uniportal access was progressively adopted with significant positive outcomes in postoperative recovery, patient acceptance, and economical costs. Operations of this kind overcome many anatomical and technical challenges satisfying the patient, surgeon, physician, nurse, and economical administrator. The hindrance caused by operating with a breathing lung is that it requires a particular set of skills but experience demonstrates that the learning curve is no longer than that required for any other new endoscopic procedure.\u0000\u0000Other investigations have involved the biological impact of the procedure, demonstrating lower concentrations of inflammatory and stress mediators with a lower degree of immune-depression. Psychological preselection of the most suitable patients for non-intubated surgery is one of our fields of investigation. Non-intubated thoracic surgery is projected towards the future and still represents a nearly unexplored and potentially fruitful field.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115398918","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}

{"title":"Device Matters: Looking Beyond the Drug","authors":"Blair R. Hesp","doi":"10.33590/emjrespir/10313970","DOIUrl":"https://doi.org/10.33590/emjrespir/10313970","url":null,"abstract":"Prof Helen Reddel opened the symposium by discussing the need to examine the modifiable nonpharmacological factors in the treatment of asthma and chronic obstructive pulmonary disease (COPD) that can be addressed to improve clinical outcomes. Dr Kai-Michael Beeh set the scene and discussed the need to review patient behaviour and drug delivery mechanisms to improve outcomes for patients with asthma and COPD. Dr John Haughney then discussed how patient preferences for inhalers can impact real-world outcomes. Prof Sinthia Bosnic-Anticevich outlined the challenges in learning and maintaining correct inhaler technique, while Prof Henry Chrystyn highlighted how inhaler design can help minimise the impact of inhaler errors on clinical outcomes. Prof Helen Reddel closed the session by bridging the gap between guidelines and clinical care, describing ways to incorporate regular checking and training of inhaler skills into a range of settings.\u0000The meeting objectives were to look beyond drugs to the role of devices in optimising asthma and COPD management, to understand the impact of inhaler technique on treatment efficacy, to review how patient perspectives about their inhaler can impact on clinical outcomes, and to discuss how to implement current clinical guidelines on inhaler technique in day-to-day clinical care.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131328373","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}

{"title":"Why, When, and How? Optimising the Management of Patients with Severe Eosinophilic Asthma","authors":"Mia Cahill","doi":"10.33590/emjrespir/10311829","DOIUrl":"https://doi.org/10.33590/emjrespir/10311829","url":null,"abstract":"The main objectives of this symposium were to explore the challenges faced when treating patients with severe eosinophilic asthma, to evaluate the key clinical assessments that are available for early disease recognition, and to discuss the latest personalised treatment options that could shape future management strategies. Prof Ian Pavord opened the symposium by introducing uncontrolled severe asthma, focussing on the challenges and unmet needs of patients. Prof Buhl then delved into the basics of eosinophilic asthma from a molecular and physiological point of view, discussing the clinical relevance and characterisation of eosinophilic patients. Prof Costello focussed on the key clinical assessments (diagnosis, adherence, and phenotyping) and management of patients. Prof Castro summarised the latest evidence from studies of mepolizumab, benralizumab, reslizumab, anti-interleukin (IL)-4, and anti-IL-13 therapies, and how this relates to clinical practice.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124864011","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}

{"title":"Smoking Cessation with Lung Cancer: Not Too Little, Never Too Late!","authors":"R. Gemine, K. Lewis","doi":"10.33590/emjrespir/10311510","DOIUrl":"https://doi.org/10.33590/emjrespir/10311510","url":null,"abstract":"","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122784107","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}