Clinical Characteristics and Prognostic Predictors of Pneumocystis Jirovecii Pneumonia in Patients with and without Chronic Pulmonary Disease: A Retrospective Cohort Study.

Objective: Pneumocystis jirovecii pneumonia (PJP) is a severe respiratory infection caused by Pneumocystis jirovecii in immunocompromised hosts. The role of P. jirovecii colonization in the development or progression of various pulmonary diseases has been reported. Our aim was to explore serial change in serum biomarkers and the independent risk factors for mortality in patients with and without chronic pulmonary diseases who developed PJP. Methods: We performed a retrospective study to select patients with Pneumocystis jirovecii pneumonia between January 1, 2012, and December 31, 2021. Information regarding demographics, clinical characteristics, underlying diseases, laboratory tests, treatment, and outcomes was collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of in-hospital mortality. Results: A total of 167 patients diagnosed with PJP were included in the study: 53 in the CPD-PJP group and 114 in the NCPD-PJP group. The number of patients with PJP showed an increasing trend over the 10-year period. A similar trend was observed for in-hospital mortality. Independent risk factors associated with death in the NCPD-PJP group were procalcitonin level (adjusted OR 1.08, 95% CI 1.01-1.16, P=0.01), pneumothorax (adjusted OR 0.07, 95% CI 0.01-0.38, P=0.002), neutrophil count (adjusted OR 1.27, 95% CI 1.05-1.53, P=0.01) at 14 days, and hemoglobin level (adjusted OR 0.94, 95% CI 0.91-0.98; P=0.002) at 14 days after admission. The risk factor associated with death in the CPD-PJP group was neutrophil count (adjusted OR 1.19, 95% CI 0.99-1.43; P=0.05) at 14 days after admission. Conclusion: The risk factors for death were different between patients with PJP with and without chronic pulmonary disease. Early identification of these factors in patients with PJP and other underlying diseases may improve prognosis.

COVID-19 Vaccination Rates and Predictors of Vaccine Uptake Among Adults With Chronic Obstructive Pulmonary Disease: Insights From the 2022 National Health Interview Survey.

Background and objective The coronavirus disease 2019 (COVID-19) vaccination rates and predictors of vaccine uptake among patients with chronic obstructive pulmonary disease (COPD) in the United States are unknown. In light of this, we assessed COVID-19 vaccination rates in this population and evaluated predictors of vaccine uptake. Methods Using 2022 survey data from the National Health Interview Survey (NHIS), 1486 adults with COPD who responded with "yes/no" to whether they had received the COVID-19 vaccine were identified, including those who had received booster doses. A chi-square test was used to ascertain differences between those who had received the vaccine and those who had not, as well as between those who had received booster doses and those who had not. A logistic regression was used to evaluate predictors of COVID-19 vaccination uptake. Results A total of 1195 individuals among 1486 respondents with chronic pulmonary disease (78.4%) had been vaccinated against COVID-19, and 789/1195 (62.5%) had received booster shots. The majority of individuals were aged 65 years and above, exceeded the 1+ threshold for the ratio of family income to poverty (RFIP), and were covered by insurance. Positive predictors of COVID-19 vaccination were as follows: age 40 - 64 years (OR: 2.34, 95% CI: 1.31 - 4.19; p=0.004) and 65 years and above (OR: 1.93, 95% CI: 1.36 - 2.72; p<0.001), RFIP threshold of ≥1 (OR: 2.02, 95% CI: 1.42 - 2.88; p<0.001), having a college degree (OR: 1.92, 95% CI: 1.92 - 3.26, p=0.016), and being insured (OR: 3.12, 95% CI: 1.46 - 6.66, p=0.003). The current smoking habit negatively predicted the uptake (OR: 0.54, 95% CI: 0.33 - 0.87, p=0.012). The positive predictors of COVID-19 vaccination boosters were as follows: age 40 - 64 years (OR: 2.72, 95% CI: 1.39 - 5.30, p=0.003) and 65 years and above (OR: 4.85, 95% CI: 2.45 - 9.58, p<0.001). Being from the non-Hispanic (NH) black ethnicity negatively predicted receiving the COVID-19 booster (OR: 0.55, 95% CI: 0.36 - 0.85, p=0.007). Conclusions While COVID-19 vaccination rates are fairly satisfactory in COPD patients, the uptake of booster vaccines is relatively lower in this population. Socioeconomic and behavioral factors are associated with poor vaccine uptake, and targeted interventions should be implemented to address these factors.

Cognitive Interventions in Individuals With Chronic Respiratory Diseases: Protocol for a Systematic Review.

BACKGROUND: Chronic respiratory diseases (CRDs) may cause reduced oxygen availability to organs and body tissues, leading to an increased risk for ischemic damage, which can result in brain tissue injury. This damage can lead to a myriad of neurological symptoms contributing to cognitive decline. Cognitive interventions may attenuate cognitive deficits in people with CRDs; however, the effects have not yet been systematically summarized in the literature. OBJECTIVE: The purpose of this systematic review is to assess the effects of cognitive interventions (including cognitive behavioral therapy and transcranial brain stimulation) on cognitive function (primary outcome), HRQL, self-management, symptoms, physical activity, physical function, ability to complete activities of daily living (ADLs), hospital admissions, functional capacity, functional performance, psychological and social outcomes, exacerbations, healthcare utilization, and survival in individuals with CRDs. METHODS: This review will be conducted in accordance with the Cochrane handbook for systematic reviews of interventions and reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be performed in MEDLINE, Embase, Emcare, PsycINFO, Scopus, and CINAHL. Articles will be included if they focus on the effects of cognitive interventions on adults with CRDs, are published in peer-reviewed journals, and are written in English, French, or Portuguese. Risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool for randomized controlled trials, and the Risk of Bias in Non-randomized Studies of Interventions tool for nonrandomized studies. Meta-analyses will be performed if at least 2 studies provided sufficient data for a specific outcome. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment will be used to evaluate the overall quality of the evidence. RESULTS: This systematic review was initiated in November 2022 and registered with PROSPERO in February 2023, prior to title and abstract screening. Full-text screening of articles will be completed in June 2023. Data extraction and drafting of the manuscript will occur from July 2023 to August 2023, with expected publication in February 2024. CONCLUSIONS: This systematic review will summarize the effects of cognitive interventions on cognitive function in people with CRDs. It will guide health care professionals in selecting evidence-based strategies to enhance cognitive well-being and overall health outcomes for individuals with CRDs. Additionally, it will identify research gaps and highlight areas for future exploration, supporting researchers in advancing knowledge in this field. TRIAL REGISTRATION: PROSPERO CRD42023396234; https://tinyurl.com/mwjrfbxv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48235.

Effect of Agrimonia eupatoria L. and Origanum vulgare L. Leaf, Flower, Stem, and Root Extracts on the Survival of Pseudomonas aeruginosa.

Pseudomonas aeruginosa is one of the most antibiotic multi-resistant bacteria, causing chronic pulmonary disease and leading to respiratory failure and even mortality. Thus, there has been an ever-increasing search for novel and preferably natural antimicrobial compounds. Agrimonia eupatoria L. and Origanum vulgare L. shoots are commonly used as teas or alcoholic tinctures for their human health-promoting and antibacterial properties. Here, we explored the antimicrobial effects of all plant parts, i.e., leaf, flower, stem, and root extracts, prepared in water or in 60% ethanol, against P. aeruginosa. The impact of these extracts on bacterial survival was determined using a luminescent strain of P. aeruginosa, which emits light when alive. In addition, the antimicrobial effects were compared with the antioxidant properties and content of phenolic compounds of plant extracts. Ethanolic extracts of O. vulgare roots and flowers showed the highest antimicrobial activity, followed by A. eupatoria roots. In particular, chlorogenic acid, the ethanolic extract of O. vulgare roots contained high levels of protocatechuic acid, hesperidin, shikimic acid, rutin, quercetin, and morin. The synergistic effects of these phenolic compounds and flavonoids may play a key role in the antibacterial activity of teas and tinctures.

The clinical spectrum of aspergillosis in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. In this review, we present the clinical spectrum and pathogenesis of syndromes caused by Aspergillus in COPD namely invasive aspergillosis (IA), community-acquired Aspergillus pneumonia, chronic pulmonary Aspergillosis and Aspergillus sensitisation. Some of these entities are clearly linked to COPD, while others may coexist, but are less clearly liked directly to COPD. We discuss current uncertainties as these pertain to IA in COPD cohorts and explore areas for future research in this field.

Efficacy of a Probiotic and Herbal Supplement in Models of Lung Inflammation.

BACKGROUND: Gut microbiome dysbiosis is associated with lung disease through the gut-lung axis. Abundant proteobacteria increase MMP-9 and contribute to tissue proteolysis followed by neutrophil recruitment, lung tissue injury, and perpetuation of chronic lung disease. We sought to determine if a scientifically formulated probiotic and herbal supplement could attenuate neutrophilic inflammation and improve lung structure and function in models of lung inflammation. METHODS: For in vitro experiments, epithelial cells exposed to proteobacteria were treated with resB-a blend of three probiotic Lactobacillus strains and turmeric, holy basil, and vasaka herbal extracts. For in vivo experimentation, mice exposed to pulmonary proteobacteria-derived lipopolysaccharide were treated by gavage with resB. RESULTS: In vitro, the bacterial and herbal components of resB decreased activity of the MMP-9 pathway. Mice exposed to LPS and pre- and post-treated with resB had decreased neutrophil recruitment and inflammatory biomarkers in bronchoalveolar lavage fluid, serum, and lung tissue compared to untreated mice. CONCLUSIONS: This study describes the mechanisms and efficacy of probiotic and herbal blend in pre-clinical models of lung injury and inflammation.

Cecropia pachystachya Trécul: identification, isolation of secondary metabolites, in silico study of toxicological evaluation and interaction with the enzymes 5-LOX and α-1-antitrypsin.

Cecropia pachystachya Tréc., popularly known as embaúba, belongs to the Cecropiaceae family and is used by the native population in the treatment of bronchitis, asthma, high blood pressure, fever, and as a diuretic. The pharmacological actions including anti-inflammatory, antioxidant, cardiotonic and sedative were previously reported. The objective of this study was to (1) isolate and identify bioactive compounds extracted from the ethanolic extract of C. pachystachya roots (ERCP), as well as (2) verify the affinity of these metabolites with the enzymes 5-lipoxygenase (5-LOX) and α-1-antitrypsin through in silico tests. Isolation and/or identification were performed using GC-MS, HPLC, Infrared (IR), and nuclear magnetic resonance (NMR) techniques. After isolation and identification of the active compounds, these substances were subjected to the in silico investigation that proceeded by performing PreADMET simulations and molecular docking calculations. The bioactive compounds identified were 1-(+)-ascorbic acid 2,6-dihexadecanoate, ethyl hexadecanoate, ethyl (9E,12E)-octadec-9,12-dienoate, ethyl (Z)-octadec-9-enoate and ethyl octadecanoate by GC-MS; chlorogenic acid, catechin, epicatechin, syringaldehyde by HPLC; ß-sitosterol, sitostenone, beccaridiol, tormentic acid, lupeol, α- and ß-amyrin by classical chromatography, IR, 1H and 13C NMR techniques. The ADMET (absorption, distribution, metabolism, excretion, and toxicity) properties were determined for each bioactive compound. Tormentic acid demonstrated a greater affinity for 5-LOX enzyme while sitostenone demonstrated a higher affinity for the α-1-antitrypsin enzyme. Our findings demonstrated a diverse range of secondary metabolites isolated from C. pachystachya that showed relevant interactions with the enzymes 5-LOX and α-1-antitrypsin. Thus, "embaúba" may be employed in in vivo experimental studies as a form of alternative treatment for chronic lung diseases.Abbreviations: ADT: Autodock Tools; BBB: Blood-brain barrier; CaCo2: Human colonic adenocarcinoma cells; CC: Classic/open Column; TLC: Thin Layer Chromatography; CD40: Differentiation Cluster 40; CENAUREMN: Centro Nordestino de Aplicação e Uso da Ressonância Magnética Nuclear; GC-MS: Gas Chromatography coupled to mass spectrometry; HPLC: High-Perfomance Liquid Chromatography; CYP2C9, CYP2C19, CYP2D6 and CYP3A4: Cytochrome P450 isoenzymes; COPD: Chronic Obstructive Pulmonary Disease; DRX-500: X-Ray Diffraction - 500; ERCP: Ethanolic extract of the roots of C. pachystachya; FAPEPI: Fundação de Amparo à Pesquisa do Piauí; HIA: Human Intestinal Absorption; IR: Infrared; Ki: Inhibition constant; 5-LOX: 5-Lipoxygenase; mM: miliMolar; nM: nanoMolar; OECD423: acute toxic class method; PDB: Protein Data Bank; P-gP: P-glycoprotein; PM2,5: Small inhalable particles 2,5; PPB: Plasm Protein Binding; PreADMET: Prediction Absorption, Distribution, Metabolization, Excretion and Toxicity; NMR: Nuclear Magnetic Resonance; +S9: with metabolic activation; -S9: no metabolic activation; SisGen: Sistema Nacional de Gestão de Patrimônio Genético e do Conhecimento Tradicional Associado; RT: Retention time; TA100: Ames test with TA100 cells line; TA1535: Ames test with cells of the TA1535 cell line; UESPI: State University of Piauí; V79: lung fibroblast cells; ΔG: Gibbs free energy (Kcal/mol); µM: microMolar.

Impact of Obesity on Lung Function in Cats with Bronchoconstriction.

Obesity is a nutritional disorder commonly diagnosed in adult cats that has been associated with an increased risk of different chronic diseases including respiratory diseases. The main objective of this study is to define if there is a relation between lung function measured by barometric whole-body plethysmography and obesity in cats with bronchoconstriction. Fifty-three cats were included in the study. All animals presented a bronchoconstriction status diagnosed with an Enhanced Pause (Penh) value higher than the reference range. Based on a standardized 9-point body condition scale, 36 cats were normal-weight cats (with BCS < 6), and 17 cats were considered overweight or obese cats (with BCS ≥ 6). Overweight cats were mainly male cats and older, and presented lower tidal volume values, lower minute volume values, and lower peak inspiratory and expiratory flows than normal-weight cats. According to the results of the present study, overweight cats showed a more compromised lung function parameters related to restrictive pattern compared with normal-weight cats. However, overweight cats did not show a higher bronchoconstriction level compared with normal-weight cats.

Chronic Pulmonary Disease Caused by Tsukamurella toyonakaense.

Unidentified Mycobacterium species are sometimes detected in respiratory specimens. We identified a novel Tsukamurella species (Tsukamurella sp. TY48, RIMD 2001001, CIP 111916T), Tsukamurella toyonakaense, from a patient given a misdiagnosis of nontuberculous mycobacterial pulmonary disease caused by unidentified mycobacteria. Genomic identification of this Tsukamurella species helped clarify its clinical characteristics and epidemiology.

Anxiety and Comorbidities Differences in Adults with Chronic Pulmonary Diseases: Serbian Single Center Experience.

Background and objectives: The purpose of this study is to investigate the differences in the degree of the anxiety and comorbidity levels in patients with different chronic pulmonary diseases such as chronic obstructive bronchitis (COPD) without emphysema phenotype, pulmonary emphysema, bronchial asthma and lung cancer. Materials and Methods: The prospective clinical study included 272 patients that were diagnosed and treated of pulmonary pathology. COPD (without emphysema phenotype) (Group-1), pulmonary emphysema (Group-2), bronchial asthma (Group-3) and lung cancer (Group-4) were assessed. For the evaluation of the anxiety degree, we used Hamilton Anxiety Rating Scale (HAM-A). Results: The degree of cardiovascular symptoms was significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p = 0.001) and Group-4 (p = 0.013), and significantly higher in Group-4 versus Group-2 (p = 0.046). The degree of respiratory symptoms was significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p < 0.001) and Group-4 (p = 0.002), and significantly higher in Group-4 versus Group-2 (p = 0.013) and versus Group-3 (p = 0.023). For gastrointestinal symptoms, the degree of one was significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p < 0.001) and Group-4 (p = 0.017). Somatic subscale values were significantly higher in Group-1 versus Group-2 (p < 0.001), Group-3 (p < 0.001) and Group-4 (p = 0.015), and significantly higher in Group-4 versus Group-2 (p = 0.024). Total HAM-A score was significantly higher in Group-1 versus Group-2 (p = 0.002) and Group-3 (p = 0.007). Conclusions: Patients with COPD (without emphysema phenotype) followed by the lung cancer are at elevated risk of being more mentally challenged in terms of increased anxiety. Furthermore, patients with exacerbation of evaluated pulmonary pathologies have various levels of comorbidities degrees.

Home Respiratory Care: Design of a Prototype for Continuous Measurement at the Nasal Septum.

Chronic respiratory diseases have been on the rise, especially due to COVID-19, extreme air pollution, and other external circumstances. Millions of people around the world suffer from progressive lung diseases and require supplemental oxygen therapy to maintain blood oxygen (SpO2) levels above 90% to prevent hypoxic episodes that can lead to further organ damage. Today, these chronic episodes are more prevalent in aging populations suffering from Chronic Obstructive Pulmonary Disorder (COPD). Existing SpO2 measurement equipment, designed to assist with treating COPD at home, are suboptimal as they cannot measure SpO2 levels continuously, meaning supplemental oxygen devices are unable to adjust oxygen flow rates to the patient's needs. These discrepancies can result in hypoxic episodes of blood oxygen levels below 90%. Following this need, our team demonstrates preliminary results of the novel placement of a SpO2 sensor in the nasal septum to allow for comfortable and sustained SpO2 measurement. This will improve the experience of home-respiratory care with continuously obtained data from a novel location.

Co-infection associated with SARS-CoV-2 and their management.

SARS-CoV-2 was discovered in Wuhan, China and quickly spread throughout the world. This deadly virus moved from person to person, resulting in severe pneumonia, fever, chills and hypoxia. Patients are still experiencing problems after recovering from COVID-19. This review covers COVID-19 and associated issues following recovery from COVID-19, as well as multiorgan damage risk factors and treatment techniques. Several unusual illnesses, including mucormycosis, white fungus infection, happy hypoxia and other systemic abnormalities, have been reported in recovered individuals. In children, multisystem inflammatory syndrome with COVID-19 (MIS-C) is identified. The reasons for this might include uncontrollable steroid usage, reduced immunity, uncontrollable diabetes mellitus and inadequate care following COVID-19 recovery.

COVID-19 infection has reported in the development several other infections and co-morbidity in patients. The present review discusses risk and management strategies in patients suffeting from co-infections caused by COVID-19 infection.

Ovine gammaherpesvirus-2 infection associated with chronic interstitial pneumonia in a sheep.

Sheep Associated-Malignant Catarrhal Fever (SA-MCF) is severe, frequently lethal, lymphoproliferative disease predominantly of ruminants, that is caused by ovine gammaherpesvirus-2 (OvHV-2), a member of the MCF virus (MCFV) complex. However, SA-MCF in sheep is a rare entity with few demonstrations of natural diseases worldwide. This report documents the clinical, radiographical, pathological, immunohistochemical, and molecular findings of SA-MCF in a sheep. A 4-year-old, female, mixed-breed sheep with progressive emaciation for at least one month was humanely euthanized due to poor prognosis. Clinically, the animal had tachypnea, ruminal hypomotility, productive coughing with bilateral muffling sounds during pulmonary auscultation. Radiographical evaluation revealed alveolar opacity of the cranioventral pulmonary region. Grossly, there were distinct rib impressions on the pleural surface of the lungs, suggestive of interstitial pneumonia. Histopathologic evaluation of the lungs revealed several disease patterns including 1) chronic interstitial pneumonia with vasculitis and proliferating vascular lesions, and thrombosis; 2) pulmonary abscesses associated with embolic dissemination of Corynebacterium pseudotuberculosis from superficial lymph node due to caseous lymphadenitis, CLA; 3) granulomatous pneumonia associated with pulmonary nematodes; and 4) chronic pleuritis, probably due to caseous lymphadenitis. Additional significant histologic findings included widespread lymphocytic vasculitis and proliferating vascular lesions in multiple tissues, atrophic enteritis, segmental degeneration of myocardial fibers with lymphocytic pericarditis, lymphocytic interstitial nephritis, and non-suppurative encephalitis. An immunohistochemistry (IHC) assay, based on the monoclonal antibody 15A (MAb-15A), that is specific to all MCFV known to cause MCF, revealed positive, intracytoplasmic, intralesional immunoreactivity, predominantly within bronchial and bronchiolar epithelial cells of the lungs and cryptal epithelial cells of the small intestine, followed by the renal tubular epithelium, cardiomyocytes, and with patchy immunolabelling within neurons of the cerebral cortex. Molecular testing done to detect a wide range of bacterial and viral agents of ruminant diseases, only amplified OvHV-2 DNA from fresh tissue fragments of the lungs, kidney, liver, spleen, and cerebrum. Direct sequencing confirmed that the PCR amplicon derived from the pulmonary fragments had 99.2-99.7% nucleotide sequence identity with OvHV-2 reference strains and strains of OvHV-2 from Brazil. The clinical, radiographical, gross, histopathologic, IHC, and molecular findings in the lungs are consistent with chronic interstitial pneumonia associated with infection by OvHV-2. Furthermore, the non-detection of other viral agents associated with pulmonary diseases in ruminants suggest that OvHV-2 was directly associated with the development of chronic pneumonia in this sheep. Additionally, the dental alterations, CLA, and the pulmonary nematode may have contributed towards the reduced immunological statue of the animal and facilitated the occurrence of SA-MCF. These findings may indicate that OvHV-2 may be a major participant in the pathogenesis of pulmonary disease of sheep under special conditions. Moreover, the proliferating vascular lesions identified in multiple tissues are additional evidence of chronic manifestations of OvHV-2 infections as described in chronic SA-MCF of cattle, while the widespread vasculitis is consistent with SA-MCF. Additionally, the IHC findings using the MAb-15A confirmed that this diagnostic approach is efficient to identify intralesional antigens of OvHV-2.

Inhaled Beta2-Agonists Increase In-Hospital Mortality in ICU Patients with Heart Failure.

The impact of beta2-agonists (B2As) on heart failure (HF) remains controversial. This study aimed to investigate whether inhaled B2As increased in-hospital mortality in ICU patients with HF.The Multiparameter Intelligent Monitoring in Intensive Care III database was initially searched to identify adult patients (≥ 18 years old) with HF in ICU. Then, patients using or not using inhaled B2As were matched using propensity score matching on a 1:1 basis to control for baseline confounders. In-hospital mortality was compared between the two groups, and logistic regression analysis was performed to assess the association between B2As and in-hospital mortality.The initial search retrieved 2345 eligible patients with HF from the database. After propensity score matching, 705 pairs of patients were included in the final analysis. Patients using B2As had markedly higher in-hospital mortality than those not using B2As (4.68% versus 2.27%; P = 0.013). In the multivariate logistic regression analysis, B2A use (odd ratios (OR), 2.471; 95% confidence interval (CI), 1.289-4.734; P = 0.006), stroke (OR, 4.581; 95% CI, 1.621-12.948; P = 0.004), and simplified acute physiology score II (SAPS-II) scores (OR, 1.090; 95% CI, 1.064-1.116; P < 0.001) were significantly associated with increased risk of in-hospital mortality, whereas renin angiotensin system inhibitor use (OR, 0.396; 95% CI, 0.202-0.778; P = 0.007) was significantly associated with decreased risk of in-hospital mortality. Subgroup analysis further indicated that the association between B2A use and mortality was significant only in patients with HF without chronic pulmonary disease (OR, 2.427; 95% CI, 1.351-4.362; P = 0.003), but not in those with chronic pulmonary disease (OR, 2.094; 95% CI, 0.582-7.537; P = 0.258).In ICU patients with HF but without chronic pulmonary disease, the use of inhaled B2As is associated with increased in-hospital mortality.

Trends in rotator cuff repair rates and comorbidity burden among commercially insured patients younger than the age of 65 years, United States 2007-2016.

Background: Prior US studies have shown increasing rotator cuff repair rates through 2009. We hypothesize that rotator cuff repair rates are continuing to increase and the comorbidity profiles of patients are becoming more complex over time. Methods: We identified rotator cuff repairs in a large US cohort of people 18-64 years of age with ≥1 year of commercial insurance coverage. Repair rate trends across time were standardized by age, sex, and geographic region. Procedures were categorized as inpatient vs. outpatient and as arthroscopic vs. open. Prevalent comorbidities were defined as 1 inpatient diagnosis claim or 2 outpatient diagnosis claims during the year before rotator cuff repair. General population comorbidity prevalence was determined based on a random 5% sample of the commercially insured population and compared with patients with rotator cuff repair using standardized morbidity ratios. Results: From 2007 to 2016, 314,239 rotator cuff repairs were identified (165 repairs per 100,000 person-years). Rotator cuff repairs were performed more frequently in men, older people, and in the Midwest. Across time, cuff repair rates increased by 1.6% per year (95% confidence interval [CI] = +1.4%-1.7%) adjusting for demographics. The highest increases in repair rates were observed among patients aged 50-64 years (+2.0%, 95% CI = +1.8%-2.2%). Rotator cuff repairs were more frequently performed using an arthroscopic approach and in an outpatient setting in later calendar years. In 2016, 83% of rotator cuff repairs were arthroscopic procedures and 99% were performed as outpatient procedures. Comorbidity prevalence in rotator cuff repair patients increased across calendar time by 4.5% per year for hypertension (95% CI = +4.2%-4.7%), 2.3% per year for diabetes (+1.9%-2.7%), 0.9% per year for hypercholesterolemia (+0.3%-1.5%), 2.9% for congestive heart failure (+0.8%-4.9%), 4.2% for peripheral vascular disease (+2.4%-6.0%), and 4.2% for chronic pulmonary disease (+3.6%-4.8%). Comorbidity prevalence in repair patients was higher than prevalence in the general population, and prevalence relative to the general population was most heightened during later calendar years. For example, hypertension prevalence was 1.58 times higher in repair patients than the general population in 2007 (95% CI = 1.53-1.62), and 2.06 times higher in 2016 (95% CI = 2.02-2.11). Conclusion: Rotator cuff repair is becoming more frequent in the US commercially insured population, particularly in those 50-64 years of age. More rotator cuff repairs are being performed using an arthroscopic approach and in an outpatient setting. Over time, the comorbidity profile of patients undergoing rotator cuff repair is becoming more complex with greater prevalence of numerous conditions, including hypertension, peripheral vascular disease, and chronic pulmonary disease.

Use of Pneumococcal and influenza vaccine in patients with COPD, asthma bronchiale and interstitial lung diseases in south east Germany.

INTRODUCTION: The aim of this study was to analyse use of and adherence to influenza and pneumococcal vaccination in high-risk patients with chronic pulmonary disease. METHODS: The study was initiated at the Centre of Pneumology in Donaustauf, Germany. All patients with asthma bronchiale (AB), chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) that were treated in a pneumological Non-ICU ward, in the sleep laboratory or in the outpatient's clinic between October 1st, 2019 and March 26th, 2020 and provided informed consent were included. Vaccination certificates and a vaccination-centred questionnaire were analysed in relation to vaccination status, risk factors, patient characteristics. RESULTS: 133 patients with COPD, 68 patients with AB and 104 patients with ILD were included. PCV13/PPSV23 vaccination only (no sequential vaccination) was performed in less than 10%/33% of all patients. Sequential vaccination of PCV13 and PPSV23 was performed in 12.8% of COPD, 7.4% of AB patients and 13.5% of ILD patients. Influenza vaccination was performed in less than 30% of all patients. Vaccinations were mainly performed by general practitioners (GPs) and rarely by specialists of pulmonary care (<6%). 67% of all patients were seen by a specialist in pulmonary care in the last 36 months, but in less than 15% the vaccination status was evaluated. DISCUSSION: Use of and adherence for PPSV23 and influenza vaccinations is low in patients with COPD, AB and ILD in south east Germany.

Comorbid Chronic Diseases are Strongly Correlated with Disease Severity among COVID-19 Patients: A Systematic Review and Meta-Analysis.

Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. In order to explore the effects of comorbid chronic diseases on clinical outcomes of COVID-19, a search was conducted in PubMed, Ovid MEDLINE, EMBASE, CDC, and NIH databases to April 25, 2020. A total of 24 peer-reviewed articles, including 10948 COVID-19 cases were selected. We found diabetes was present in 10.0%, coronary artery disease/cardiovascular disease (CAD/CVD) was in 8.0%, and hypertension was in 20.0%, which were much higher than that of chronic pulmonary disease (3.0%). Specifically, preexisting chronic conditions are strongly correlated with disease severity [Odds ratio (OR) 3.50, 95% CI 1.78 to 6.90], and being admitted to intensive care unit (ICU) (OR 3.36, 95% CI 1.67 to 6.76); in addition, compared to COVID-19 patients with no preexisting chronic diseases, COVID-19 patients who present with either diabetes, hypertension, CAD/CVD, or chronic pulmonary disease have a higher risk of developing severe disease, with an OR of 2.61 (95% CI 1.93 to 3.52), 2.84 (95% CI 2.22 to 3.63), 4.18 (95% CI 2.87 to 6.09) and 3.83 (95% CI 2.15 to 6.80), respectively. Surprisingly, we found no correlation between chronic conditions and increased risk of mortality (OR 2.09, 95% CI 0.26 to16.67). Taken together, cardio-metabolic diseases, such as diabetes, hypertension and CAD/CVD were more common than chronic pulmonary disease in COVID-19 patients, however, each comorbid disease was correlated with increased disease severity. After active treatment, increased risk of mortality in patients with preexisting chronic diseases may reduce.

Effects of high intensity interval training on exercise capacity in people with chronic pulmonary conditions: a narrative review.

BACKGROUND: Exercise training is important in the management of adults with chronic pulmonary conditions. However, achieving high intensity exercise may be challenging for this clinical population. There has been clinical interest in applying interval-based training as a strategy to optimise the load that can be tolerated during exercise training. Evidence for such an approach is limited in most chronic pulmonary populations. MAIN BODY: In this narrative review, we provide an appraisal of studies investigating whole-body high intensity interval training (HIIT) in adults with chronic obstructive pulmonary disease (COPD). This is the first review to also include studies investigating HIIT in people with conditions other than COPD. Studies undertaken in adults with a chronic pulmonary condition were reviewed when participants were randomised to receive; (i) HIIT or no exercise or, (ii) HIIT or moderate intensity continuous exercise. Data were extracted on peak rate of oxygen uptake (VO2peak; 'cardiorespiratory fitness') and maximal work rate (Wmax; 'exercise capacity').In people with COPD, two studies demonstrated between-group differences favouring HIIT compared with no exercise. There appears to be no advantage for HIIT compared to continuous exercise on these outcomes. In people with cystic fibrosis (CF), no studies have compared HIIT to no exercise and the two studies that compared HIIT to continuous exercise reported similar benefits. In people prior to resection for non-small cell lung cancer, one study demonstrated a between-group difference in favour of HIIT compared with no exercise on VO2peak. In people with asthma, one study demonstrated a between-group difference in favour of HIIT compared with no exercise on VO2peak and one that compared HIIT to continuous exercise reported similar benefits. No studies were identified non-CF bronchiectasis or interstitial lung diseases. CONCLUSIONS: High intensity interval training increases cardiorespiratory fitness and exercise capacity when compared with no exercise and produces a similar magnitude of change as continuous exercise in people with COPD. There is a paucity of studies exploring the effects of HIIT in other chronic pulmonary conditions.

Real-Time Analysis of the Respiratory Flow Through a Valved Holding Chamber.

Background: The ability of patients to take, correctly and regularly, aerosol treatments is a key for good control of asthma and chronic obstructive pulmonary disease. Devices that help to improve inhalation technique could train the patient to take their medication properly, reducing risk of exacerbations. In this study we evaluate a new device that by recording real-time respiratory flow into the valved holding chamber (VHC) mouthpiece, could be used to improve patient technique. Methods and Results: Using computational fluid dynamics analysis we demonstrated that compared to a mouthpiece with no flow probe, the presence of a probe modifies the flow profile and velocity regardless of the probe shape or position. During flow measurement using a SDP610 pressure sensor (Sensirion, Switzerland), all probes can accurately record adult and child respiratory patterns. Resistance was determined from the back pressure generated by the VHC with or without probes; and resistance was not impacted by the probes. Aerodynamic particle size distribution and drug delivery measurement were assessed using the United States Pharmacopeia throat model (Copley Scientific, UK), next generation impactor (NGI; Copley Scientific), and a breath simulator (BRS200; Copley Scientific). To test different formulations, these experiments were performed with fluticasone propionate (Flixotide®; GSK, UK), salbutamol (Ventolin®; GSK), and beclomethasone dipropionate (BDP) (QvarSpray®; GSK). Depending on the molecule or the probe configuration, we noticed a decrease of the emitted doses, fine particle deposition, mass median aerodynamic diameter, but no significant change in the mass of drug delivered. A decrease in the fine particle fraction (FPF) was observed in most testing conditions. However, a slight increase was noticed for two conformations with BDP (round and close [Rc] and diamond and far [Df]) and salbutamol (Rc and round and far [Rf]). Conclusion: By inserting a flow probe directly into the mouthpiece of a VHC we could perform real-time analysis of respiratory flow during the VHC use without disturbing drug delivery, or increasing resistance.