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1.
PLoS One ; 16(11): e0260416, 2021.
Article in English | MEDLINE | ID: covidwho-1793553

ABSTRACT

This study determined the association between respiratory symptoms and death from respiratory causes over a period of 45 years. In four cohorts of random samples of Norwegian populations with 103,881 participants, 43,731 persons had died per 31 December 2016. In total, 5,949 (14%) had died from respiratory diseases; 2,442 (41%) from lung cancer, 1,717 (29%) chronic obstructive pulmonary disease (COPD), 1,348 (23%) pneumonia, 119 (2%) asthma, 147 (2%) interstitial lung disease and 176 (3%) other pulmonary diseases. Compared with persons without respiratory symptoms the multivariable adjusted hazard ratio (HR) for lung cancer deaths increased with score of breathlessness on effort and cough and phlegm, being 2.6 (95% CI 2.1-3.2) for breathlessness score 3 and 2.1 (95% CI 1.7-2.5) for cough and phlegm score 5. The HR of COPD death was 6.4 (95% CI 5.4-7.7) for breathlessness score 3 and 3.0 (2.4-3.6) for cough and phlegm score 5. Attacks of breathlessness and wheeze score 2 had a HR of 1.6 (1.4-1.9) for COPD death. The risk of pneumonia deaths increased also with higher breathlessness on effort score, but not with higher cough and phlegm score, except for score 2 with HR 1.5 (1.2-1.8). In this study with >2.4 million person-years at risk, a positive association was observed between scores of respiratory symptoms and deaths due to COPD and lung cancer. Respiratory symptoms are thus important risk factors, which should be followed thoroughly by health care practitioners for the benefit of public health.


Subject(s)
Lung Diseases/diagnosis , Respiration Disorders/diagnosis , Adolescent , Adult , Asthma/diagnosis , Asthma/epidemiology , Cohort Studies , Cough/diagnosis , Cough/epidemiology , Dyspnea/epidemiology , Female , Forced Expiratory Volume , Humans , Lung Diseases/epidemiology , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Male , Middle Aged , Norway/epidemiology , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiration Disorders/epidemiology , Respiratory Sounds , Risk Factors , Young Adult
2.
J Glob Health ; 12: 04023, 2022.
Article in English | MEDLINE | ID: covidwho-1776559

ABSTRACT

Background: Asthma was one of the top causes of hospitalization and unscheduled medical attendances due to acute exacerbations and its complications. In Malaysia, all pilgrims must undergo a mandatory health examination and certified fit to perform pilgrimage. We studied the current organisational and clinical routines of Hajj health examination in Malaysia with a focus on the delivery of care for pilgrims with asthma. Methods: We conducted non-participant observation to obtain ethnographic understanding of Hajj health examination activities for 2019. Observations were guided by a checklist and recorded as notes that were analysed thematically. The study was conducted at 11 public (from each region in Malaysia, namely, North, South, East, West of Peninsular Malaysia, and Sabah and Sarawak of East Malaysia) and two private primary care clinics. Results: We observed considerable variation in the implementation and practice of Hajj health examinations among the 11 public clinics but no marked variation among the private clinics. The short time span of between three to four months was inadequate for disease control measures and had put pressure on health care providers. They mostly viewed the Hajj health examination as merely a certification of fitness to perform the pilgrimage, though respiratory health assessment was often inadequate. The opportunity to optimise the health of pilgrims with asthma by providing the appropriate medications, asthma action plan and asthma education including the preventive measures was disregarded. The preliminary health screening, which aimed to optimise pilgrims' health before the actual Hajj health examination was not appreciated by either pilgrims or health care providers. Conclusions: There is great potential to reform the current system of Hajj health certification in order to optimise its potential benefits for pilgrims with asthma. A systematic approach to restructuring the delivery of Hajj health examination could address the time constraints, clinical competency of primary health care providers and resources limitations.


Subject(s)
Asthma , Travel , Asthma/diagnosis , Humans , Islam , Malaysia
3.
BMC Infect Dis ; 22(1): 244, 2022 Mar 12.
Article in English | MEDLINE | ID: covidwho-1736352

ABSTRACT

BACKGROUNDS: Respiratory viruses are the main triggers of asthma. Coronavirus is shown to contribute to respiratory tract infections that can lead to prolonged cough and asthma. OBJECTIVES: Present study aimed to determine the risk of developing Persistent cough and asthma-like symptoms in hospitalized children due to COVID-19. METHODS: This prospective study was carried out in a tertiary referral center. During the COVID-19 pandemic, 69 hospitalized pediatric patients admitted with COVID-19 were observed from February 2020 to January 2021. Clinical and laboratory data were recorded, and after discharge, patients were followed and visited for cough and asthma evaluation one, 2 and 6 months later. Patients with asthma-like diagnoses in follow up defined as asthma-like groups, and patients without any sign of asthma were categorized as the non-asthma group. Asthma-like co-morbids and risk factors were evaluated and compared between the two groups. RESULTS: In follow-up, most of the COVID-19 hospitalized patients (N = 42) (58.5%) were not affected by asthma-like symptoms. 60.9% of the COVID-19 patients were male. The asthma-like group cases had a significantly familial history of asthma (63.0%), past medical history of asthma (33.3%), and Allergic rhinitis (85.2%). Rates of signs and symptoms during hospitalization were significantly higher in patients with COVID-19 and past medical history of asthma. CONCLUSIONS: We found an asthma-like prevalence of 41.5% in the cohort of COVID-19 hospitalized children. Family history of asthma and previous history of asthma and allergic rhinitis are risk factors for asthma-like after COVID-19 hospitalization. COVID-19 presentations are more severe in the asthma-like group.


Subject(s)
Asthma , COVID-19 , Asthma/complications , Asthma/diagnosis , Asthma/epidemiology , COVID-19/epidemiology , Child , Cough/epidemiology , Cough/etiology , Hospitalization , Humans , Male , Pandemics , Prospective Studies , SARS-CoV-2
4.
Clin Pediatr (Phila) ; 61(4): 313-319, 2022 May.
Article in English | MEDLINE | ID: covidwho-1685821

ABSTRACT

COVID-19 has adversely affected child wellness, but it is unclear whether the pandemic led to changes in home management of chronic diseases like asthma. We surveyed 93 caregivers of children with persistent asthma from 2 ongoing asthma trials to measure changes in home asthma management, stressors, access to health care, and caregivers' worry about COVID-19 affecting their child's health. We conducted descriptive analyses, and assessed whether caregiver worry about COVID-19 was associated with asthma management, stressors, health care access, or recent symptoms. Most (80%) caregivers worried that COVID-19 would affect their child's health, and >50% restricted their child's physical activity to avoid asthma symptoms. We observed a dose-dependent relationship between increasing worry about COVID-19 and activity restrictions, financial hardship, difficulty obtaining asthma medications, and nocturnal asthma symptoms. These findings raise concern that children with persistent asthma may be at particular risk for weight gain and obesity-associated asthma morbidity due to the pandemic.


Subject(s)
Asthma , COVID-19 , Asthma/diagnosis , Asthma/epidemiology , Asthma/therapy , Caregivers , Child , Humans , Pandemics , Surveys and Questionnaires
5.
Rev Alerg Mex ; 69 Suppl 1: s15-s23, 2022.
Article in Spanish | MEDLINE | ID: covidwho-1634851

ABSTRACT

The COVID-19 pandemic has collapsed the health systems of many countries in the world and comorbidities in adults have exponentially increased their mortality; in matters of asthma, it has not been possible to establish a defining relationship in mortality. The clinical manifestations of asthmatic patients with SARS COV 2 are presented in a wide range; from asymptomatic to those who experience acute respiratory failure. The most sensitive method for the diagnosis of SARS-CoV-2 infection is RT-PCR. Antigen and serologic tests are quicker than RT-PCR, but they are less sensitive. Radiologic studies and the computed tomography of the chest assist in the diagnosis and follow-up of SARS-CoV-2 infection. The use of spirometry for diagnosis and follow-up is restricted due to the elevated risk of contagion. It has been shown that eosinophilia and TH2 inflammation, due to their antiviral immune effect, are protective factors against severe SARS-CoV-2/COVID-19. Patients with mild asthma express less angiotensin converting enzyme receptors (ACE2), and those with neutrophilic asthma express it in greater proportion, which suggests more severe presentations of COVID-19. The conventional asthma treatment modulates the SARS-CoV-2/COVID-19 immune response, which is why patients with controlled asthma have non-severe manifestations of COVID 19, however, the mechanisms are not clear.


La pandemia de COVID-19 ha colapsado los sistemas de salud de muchos países del mundo y las comorbilidades en adultos han incrementado exponencialmente su mortalidad; respecto al asma, no se ha podido establecer una relación determinante en la mortalidad. Las manifestaciones clínicas del paciente con asma y SARS-CoV-2 se presentan con una amplia gama, desde asintomáticas hasta las que experimentan insuficiencia respiratoria aguda. El método más sensible para el diagnóstico de la infección por SARS-CoV-2 es la RT-PCR. Las pruebas de antígeno y serológicas son más rápidas que la RT-PCR, pero menos sensibles. Los estudios radiológicos y la tomografía computarizada de tórax auxilian en el diagnóstico y seguimiento de la infección por SARS-CoV-2. El uso de la espirometría se restringe para el diagnóstico y seguimiento debido al alto riesgo de contagio. Se ha demostrado que la eosinofilia y la inflamación TH2, debido a su efecto inmunológico antivírico, son factores protectores contra SARS-CoV-2/COVID-19 severo. Los pacientes con asma leve expresan menos receptores de la enzima convertidora de angiotensina (ECA2) y aquellos con asma neutrofílica expresan mayor proporción, lo que sugiere presentaciones más severas de COVID-19. El tratamiento convencional del asma modula la respuesta inmunitaria del SARS-CoV-2/COVID-19, por lo cual, los pacientes con asma controlados tienen manifestaciones no graves de COVID-19, aunque los mecanismos no están claros.


Subject(s)
Asthma , COVID-19 , Asthma/diagnosis , Asthma/epidemiology , Humans , Pandemics , RNA, Viral , SARS-CoV-2
6.
Asian Pac J Allergy Immunol ; 40(1): 1-21, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1594710

ABSTRACT

The multidisciplinary experts in Thailand developed an asthma management recommendation that was relevant to low-middle income countries (LMICS). Populations level consideration about asthma management is emphasized. The healthcare systems, access to and availability of treatments as well as the asthma populations vary from country to country in LMICS. The feasibility in clinical practice for implementation is also a major issue. For these reasons, the practice guidelines that are relevant to local contexts are essential to improve better asthma control. Furthermore, integrative and collaboration between asthma experts and the public health sector to implement and discriminate such guidelines will help to achieve these challenging goals. The topics covered include the current asthma situation in Thailand and the Asia-Pacific region, the definition of asthma, asthma diagnosis, assessment of asthma patients, asthma treatment - both pharmacological and non-pharmacological, management of asthma exacerbation, management of asthma comorbidities, treatment of asthma in special conditions, severe and uncontrolled asthma, Thai alternative medicine and asthma, and asthma and coronavirus disease-19 (COVID-19).


Subject(s)
Asthma , COVID-19 , Adult , Asthma/diagnosis , Asthma/epidemiology , Asthma/therapy , Humans , Thailand
8.
An Bras Dermatol ; 97(2): 173-178, 2022.
Article in English | MEDLINE | ID: covidwho-1578973

ABSTRACT

BACKGROUND: The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases. OBJECTIVE: To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact. METHODS: Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. RESULTS: Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions "Recurrent pruritic lesions" and "Lesions in typical locations" (Kappa between 0.81-0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively). STUDY LIMITATIONS: Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic. CONCLUSIONS: Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.


Subject(s)
Asthma , Dermatitis, Atopic , Eczema , Hypersensitivity , Asthma/diagnosis , Asthma/epidemiology , Child , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/epidemiology , Eczema/diagnosis , Eczema/epidemiology , Humans , Prevalence , Reproducibility of Results , Surveys and Questionnaires , Telephone
9.
Eur Respir Rev ; 30(162)2021 Dec 31.
Article in English | MEDLINE | ID: covidwho-1573627

ABSTRACT

As the world faces the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, concerns have been raised that asthma patients could be at increased risk of SARS-CoV-2 infection and disease severity. However, it appears that asthma is not an independent risk factor for both. Furthermore, asthma is not over-represented in hospitalised patients with severe pneumonia due to SARS-CoV-2 infection and there was no increased risk of asthma exacerbations triggered by SARS-CoV-2. There is accumulating evidence that asthma phenotypes and comorbidities are important factors in evaluating the risk for SARS-CoV-2 infection and disease severity, as findings suggest that Th2-high inflammation may reduce the risk of SARS-Cov-2 infection and disease severity in contrast to increased risk in patients with Th2-low asthma. The use of inhaled corticosteroids (ICS) is safe in asthma patients with SARS-CoV-2 infection. Furthermore, it has been proposed that ICS may confer some degree of protection against SARS-CoV-2 infection and the development of severe disease by reducing the expression of angiotensin converting enzyme-2 and transmembrane protease serine in the lung. In contrast, chronic or recurrent use of systemic corticosteroids before SARS-CoV-2 infection is a major risk factor of poor outcomes and worst survival in asthma patients. Conversely, biological therapy for severe allergic and eosinophilic asthma does not increase the risk of being infected with SARS-CoV-2 or having worse COVID-19 severity. In the present review we will summarise the current literature regarding asthma and COVID-19.


Subject(s)
Asthma , COVID-19 , Adrenal Cortex Hormones/adverse effects , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Humans , Pandemics , SARS-CoV-2
11.
Allergy Asthma Proc ; 42(6): 522-529, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1533596

ABSTRACT

Background: There are conflicting data with regard to the impact of respiratory and allergic comorbidities on the course of novel coronavirus disease 2019 (COVID-19) in children. Objective: This study aimed to investigate the relationship between allergic diseases and COVID-19 severity in pediatric patients. Methods: Seventy-five pediatric patients with COVID-19 were classified according to clinical severity and evaluated in the allergy/immunology and pulmonology departments 1 to 3 months after the infection resolved. Blood was collected from the patients for a complete blood cell count and assessment of immunoglobulin and total immunoglobulin E (IgE) levels, and skin-prick tests and spirometry tests were performed. Results: A total of 75 patients ages 5-18 years were evaluated. COVID-19 was asymptomatic/mild in 44 patients and moderate/severe/critical in 31 patients. Based on allergy evaluation, allergic rhinitis was diagnosed in 19 patients (25.3%), asthma in 10 patients (13%), and atopic dermatitis in 3 patients (4%). Aeroallergen sensitivity was detected in 26 patients (34.7%). COVID-19 infection was asymptomatic/mild in 15 patients with allergic rhinitis (78.9%) and in 21 with aeroallergen sensitivity (80.8%) (p = 0.038 and p = 0.005, respectively). There was no difference in severity between the patients with and without asthma (p = 0.550). The median (interquartile range) total IgE level was significantly higher in the asymptomatic/mild group (71.8 [30.7-211.2]) (p = 0.015). There were no differences in terms of spirometry parameters. Conclusion: Aeroallergen sensitization and allergic rhinitis in children may be associated with a milder course of COVID-19. The knowledge that atopy is associated with less-severe COVID-19 outcomes in children may guide clinical risk classification.


Subject(s)
Allergens/adverse effects , Asthma/diagnosis , COVID-19/complications , Dermatitis, Atopic/diagnosis , Hypersensitivity/diagnosis , Rhinitis, Allergic/diagnosis , Skin Tests/statistics & numerical data , Adolescent , Asthma/epidemiology , Asthma/immunology , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , Dermatitis, Atopic/epidemiology , Dermatitis, Atopic/immunology , Female , Humans , Hypersensitivity/epidemiology , Hypersensitivity/immunology , Immunoglobulin E/blood , Male , Respiratory Function Tests , Rhinitis, Allergic/epidemiology , Rhinitis, Allergic/immunology , SARS-CoV-2 , Severity of Illness Index , Turkey/epidemiology
12.
Eur Respir Rev ; 30(162)2021 Dec 31.
Article in English | MEDLINE | ID: covidwho-1523278

ABSTRACT

Asthma is a heterogenous disease, and its prevalence and severity are different in males versus females through various ages. As children, boys have an increased prevalence of asthma. As adults, women have an increased prevalence and severity of asthma. Sex hormones, genetic and epigenetic variations, social and environmental factors, and responses to asthma therapeutics are important factors in the sex differences observed in asthma incidence, prevalence and severity. For women, fluctuations in sex hormone levels during puberty, the menstrual cycle and pregnancy are associated with asthma pathogenesis. Further, sex differences in gene expression and epigenetic modifications and responses to environmental factors, including SARS-CoV-2 infections, are associated with differences in asthma incidence, prevalence and symptoms. We review the role of sex hormones, genetics and epigenetics, and their interactions with the environment in the clinical manifestations and therapeutic response of asthma.


Subject(s)
Asthma , COVID-19 , Adult , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Child , Female , Gonadal Steroid Hormones , Humans , Male , Pregnancy , Prevalence , SARS-CoV-2 , Sex Factors
14.
Respir Res ; 22(1): 200, 2021 Jul 07.
Article in English | MEDLINE | ID: covidwho-1450712

ABSTRACT

BACKGROUND: The first step in SARS-CoV-2 infection is binding of the virus to angiotensin converting enzyme 2 (ACE2) on the airway epithelium. Asthma affects over 300 million people world-wide, many of whom may encounter SARS-CoV-2. Epidemiologic data suggests that asthmatics who get infected may be at increased risk of more severe disease. Our objective was to assess whether maintenance inhaled corticosteroids (ICS), a major treatment for asthma, is associated with airway ACE2 expression in asthmatics. METHODS: Large airway epithelium (LAE) of asthmatics treated with maintenance ICS (ICS+), asthmatics not treated with ICS (ICS-), and healthy controls (controls) was analyzed for expression of ACE2 and other coronavirus infection-related genes using microarrays. RESULTS: As a group, there was no difference in LAE ACE2 expression in all asthmatics vs controls. In contrast, subgroup analysis demonstrated that LAE ACE2 expression was higher in asthmatics ICS+ compared to ICS‾ and ACE2 expression was higher in male ICS+ compared to female ICS+ and ICS‾ of either sex. ACE2 expression did not correlate with serum IgE, absolute eosinophil level, or change in FEV1 in response to bronchodilators in either ICS- or ICS+. CONCLUSION: Airway ACE2 expression is increased in asthmatics on long-term treatment with ICS, an observation that should be taken into consideration when assessing the use of inhaled corticosteroids during the pandemic.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Angiotensin-Converting Enzyme 2/metabolism , Asthma/drug therapy , Receptors, Virus/metabolism , Respiratory Mucosa/drug effects , Administration, Inhalation , Adrenal Cortex Hormones/adverse effects , Adult , Angiotensin-Converting Enzyme 2/genetics , Asthma/diagnosis , Asthma/enzymology , Asthma/genetics , COVID-19/enzymology , COVID-19/virology , Case-Control Studies , Female , Host-Pathogen Interactions , Humans , Male , Middle Aged , Receptors, Virus/genetics , Respiratory Mucosa/enzymology , SARS-CoV-2/pathogenicity , Time Factors , Up-Regulation , Virus Internalization , Young Adult
15.
Expert Rev Respir Med ; 15(11): 1377-1386, 2021 11.
Article in English | MEDLINE | ID: covidwho-1437786

ABSTRACT

INTRODUCTION: Asthma is one of the most common chronic diseases worldwide. As a disease of the respiratory tract, the site of entry for the SARS-CoV-2 virus, there may be an important interplay between asthma and COVID-19 disease. AREAS COVERED: We report asthma prevalence among hospitalized cohorts with COVID-19. Those with non-allergic and severe asthma may be at increased risk of a worsened clinical outcome from COVID-19 infection. We explore the epidemiology of asthma as a risk factor for the severity of COVID-19 infection. We then consider the role COVID-19 may play in leading to exacerbations of asthma. The impact of asthma endotype on outcome is discussed. Lastly, we address the safety of common asthma therapeutics. A literature search was performed with relevant terms for each of the sections of the review using PubMed, Google Scholar, and Medline. EXPERT OPINION: Asthma diagnosis may be a risk factor for severe COVID-19 especially for those with severe disease or nonallergic phenotypes. COVID-19 does not appear to provoke asthma exacerbations and asthma therapeutics should be continued for patients with exposure to COVID-19. Clearly much regarding this topic remains unknown and we identify some key questions that may be of interest for future researchers.[Figure: see text].


Subject(s)
Asthma , COVID-19 , Asthma/diagnosis , Asthma/epidemiology , Humans , Prevalence , Risk Factors , SARS-CoV-2
16.
Expert Rev Respir Med ; 15(12): 1605-1612, 2021 12.
Article in English | MEDLINE | ID: covidwho-1434304

ABSTRACT

BACKGROUND: During the pandemic, there have been disruptions to how patients seek care. RESEARCH DESIGN AND METHODS: To investigate monthly prescription claims for asthma and chronic obstructive pulmonary disease (COPD) medicines during the first UK wave, interrupted time series (ITS) analysis was used. A national cohort of community patients' data were examined. RESULTS: Descriptive statistics show salbutamol, aminophylline, ipratropium, and theophylline remain below pre-pandemic levels.Montelukast showed pre-pandemic monthly increase (Est. 67,151 doses, P = 0.05, 95% CI: 1011, 133,291), followed by a jump of 1.6 million doses at March , followed by monthly declines (Est. -112,098 doses, P = 0.216, 95% CI: -293,499, 69,303).Before the pandemic, tiotropium, salbutamol, aminophylline, and ipratropium (P = 0.003) show monthly declines but theophylline and beclometasone showed increases. In March , salbutamol (P = 0.033) and ipratropium (P = 0.001) show a significant jump. After March , ipratropium continues with a downward trajectory (P = 0.001), with a generalized negative trend for all other agents. Salbutamol confidence bounds become negative after March 2020. Some brands were unavailable. CONCLUSIONS: An 'unmet' medical gap is identified. While it is essential to understand the underlying reasons, urgent action needs to be taken to reassess patients and ensure continuity of care.PLAIN LANGUAGE SUMMARIES (PLS)Asthma and chronic obstructive pulmonary disease (COPD) are long-term lung conditions, affecting 6 million & 1.2 million people respectively and causing breathing difficulties. Sufferers are at a higher risk of chest infections including the coronavirus. Regular use of prescribed medication stabilizes these conditions and prevents them from getting worse. It is common to be prescribed a combination of five to eight oral and inhaled medications.We investigated the impact of the pandemic on the dispensing of these specific medicines across England during the first wave. The English Prescribing Dataset was checked from January 2019 to February 2020 (14 months before the pandemic) and March to October 2020 (8 months after its onset).We find that since March 2020, salbutamol, aminophylline, ipratropium, and theophylline have not returned to their pre-pandemic levels. However, for all agents, there is great variability. Further analysis suggests these trends are not reversing, suggesting that people have not been using their medication as anticipated for 8 months, which is concerning.As a consequence of this work, we recommend that doctors specifically call these patients and discuss their health as a matter of urgency, we encourage patients to continue to take their medication. We advise policy changes to waive the NHS prescription levy for asthma and COPD medication and we seek more granular data for further harm quantification. There are several strengths and weaknesses to our analysis, and we need to conduct more studies to ask patients about their experiences.


Subject(s)
Asthma , COVID-19 , Pulmonary Disease, Chronic Obstructive , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Bronchodilator Agents/adverse effects , Drug Prescriptions , England/epidemiology , Humans , Ipratropium/therapeutic use , Pandemics , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , SARS-CoV-2
17.
Curr Opin Allergy Clin Immunol ; 21(6): 597-601, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1429314

ABSTRACT

PURPOSE OF REVIEW: As of June 2021, coronavirus disease 2019 (COVID-19) exceeded 180 million reported cases and was responsible for almost 4 million deaths globally. Asthma affects approximately 262 million people worldwide and is an important cause of morbidity and mortality. Presently, it appears asthma is neither associated with an increased risk of contracting COVID-19 nor with a risk of severe COVID-19 or COVID-19 related death. Regarding the severe asthma patients on biologics, questions remain. The purpose of this review is to discuss the evidence regarding the relationship between asthma, biologics and COVID-19. RECENT FINDINGS: The available evidence does not suggest that severe asthmatics on treatment with biologics have a higher risk of severe acute respiratory syndrome coronavirus 2 infection compared to the general population. It does not appear that they have a higher risk of severe disease or COVID-19 related death either. SUMMARY: This review suggests that treatment with biologics for severe asthma is safe and should be maintained during the COVID-19 pandemic. However, more studies are needed to address this question and the role of biological therapy on different asthma phenotypes.


Subject(s)
Asthma/drug therapy , Biological Products/adverse effects , COVID-19/immunology , Immunologic Factors/adverse effects , SARS-CoV-2/immunology , Asthma/diagnosis , Asthma/immunology , Biological Products/administration & dosage , COVID-19/diagnosis , COVID-19/mortality , Humans , Immunologic Factors/administration & dosage , Risk Assessment/statistics & numerical data , Risk Factors , Severity of Illness Index
18.
Clin Exp Allergy ; 51(9): 1100-1102, 2021 09.
Article in English | MEDLINE | ID: covidwho-1388227
19.
Sensors (Basel) ; 21(16)2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1376960

ABSTRACT

Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician's diagnosis. The chosen model is a bidirectional long-short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs-healthy or pathology (in general or belonging to a specific respiratory pathology)-reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians' diagnosis. To classify the subject's respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.


Subject(s)
Asthma , Cough , Asthma/diagnosis , Child , Cough/diagnosis , Humans , Longitudinal Studies , Neural Networks, Computer , Respiratory Sounds/diagnosis , Sound
20.
Respir Investig ; 59(6): 871-875, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1364443

ABSTRACT

Spirometry is a crucial test used in the diagnosis and monitoring of patients with chronic obstructive pulmonary disease (COPD). Severe acute respiratory syndrome coronavirus 2 pandemic has posed numerous challenges in performing spirometry. Dynamic-ventilatory digital radiography (DR) provides sequential chest radiography images during respiration with lower doses of radiation than conventional X-ray fluoroscopy and computed tomography. Recent studies revealed that parameters obtained from dynamic DR are promising for evaluating pulmonary function of COPD patients. We report two cases of COPD evaluated by dynamic-ventilatory DR for pulmonary function and treatment efficacy and discuss the potential of dynamic DR for evaluating COPD therapy.


Subject(s)
Lung/diagnostic imaging , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Radiographic Image Enhancement/methods , Radiography, Thoracic/methods , Aged , Asthma/diagnosis , Asthma/drug therapy , Bronchodilator Agents/therapeutic use , Drug Combinations , Fluticasone/therapeutic use , Formoterol Fumarate/therapeutic use , Glycopyrrolate/analogs & derivatives , Glycopyrrolate/therapeutic use , Humans , Indans/therapeutic use , Lung/physiology , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/drug therapy , Quinolones/therapeutic use , Spirometry , Tiotropium Bromide/therapeutic use , Treatment Outcome
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