Current Respiratory Medicine Reviews - Volume 17, Issue 1, 2021

Currently, there is a lot of clinical data on the basics of lung ultrasound (US) examination in patients with COVID-19. This article is focused on the principles of pneumonia diagnosis. It is established that the use of ultrasound can be informative at the prehospital stage and triage of patients and also detection of mild forms of the course of the disease.

Antifibrotic agents are known to treat idiopathic pulmonary fibrosis. The two antifibrotic agents approved and in usage are Pirfenidone and Nintedanib granted by the USFDA in 2014. They are both known to decrease inflammation in the lungs. The fact that COVID-19 has shown to cause inflammation and fibrosis in the lungs frames the theory of their usage in the treatment of the disease by reducing lung scaring and allowing faster discharge of patients with post-COVID complications. The need for them to change their status from orphans to blockbusters has not happened yet due to fewer data and less research available on them as well as various other economic and patient- related factors. Since COVID-19 is widespread and causes many complications of the lungs that are similar to what these two drugs treat. We believe that the status of these drugs could be changed due to an increase in demand for them.

Sleep-disordered breathing (SDB) is now a significant health problem in today's culture. It ranges from a spectrum of abnormal conditions during sleep from the primary snorer to mild, moderate, or severe obstructive sleep apnea (OSA). SDB also comprises other conditions, such as sleep-related hypoventilation, sleep-related hypoxemia, and central sleep apnea syndromes. One of the components of the pathophysiology of OSA that remain unclear is the association of allergic rhinitis (AR) in the evolution of OSA. Several studies relate the co-existence of OSA and AR in the common clinical practice, but its correlation was not clear. This review article aimed to review the pathophysiological relationship between OSA and AR in terms of the role of chemical mediators and the effect of AR treatment in support of OSA. The symptoms of AR further accelerate the clinical progression to OSA development. Inflammatory mediators such as histamine, cysteinyl leukotrienes, and interleukins are found at a high level in AR, which can aggravate AR symptoms such as nasal obstruction, rhinorrhea, and itchiness, which can then lead to sleep disruption in OSA patients. In addition, OSA patients also have increased chemical mediators such as tumor necrosis factor, interleukin 6, and 1, which would activate the T helper 2 phenotypes that can aggravate AR symptoms. This vicious cycle can potentiate each other and worsen the condition. Few studies have shown that treatment of AR can improve OSA, especially the use of intranasal steroid and leukotriene receptor antagonists. A detailed evaluation of rhinitis symptoms should be made for OSA patients so that they can benefit not only from the improvement of AR but also the good sleep quality.

Objective: This Scoping review was conducted to explore the impact of education programs on asthmatic children's knowledge of asthma, quality of life, school absenteeism, and selfmanagement. Data Sources: The Scoping review was restricted to randomized controlled trials and quasi-experimental designs. Studies published in the English language between 2000 and 2017 were retrieved from CINAHL, MEDLINE, OvidSP, Cochrane Library, ProQuest, and Google Scholar databases. Studies Selection: Along with specific inclusion and exclusion criteria for selecting studies, an evaluation for the quality of the experimental research based on the level of evidence was applied to categorize studies into poor to good quality. Results: Of the 1256 items initially identified references, 18 studies were included in the review to cover the impact of asthma education on four major areas: children's knowledge of asthma, quality of life, school absenteeism, and self-management. Conclusion: Despite some inconsistencies between the reviewed studies, asthma education programs demonstrated a positive effect on children's knowledge of asthma, quality of life, school absenteeism, and self-management. Further research on the effect of asthma education on children's activity level, symptoms, and emotional domains is warranted.

Background: Influenza virus and other respiratory viruses have been identified as an essential cause of acute respiratory infections (ARIs) in children worldwide. However, there are few data on its frequency and clinical presentation in Jordan. Objectives: We aimed to identify the viral etiology of acute respiratory infections and the various clinical presentations in hospitalized children, especially those with influenza viruses compared to other respiratory viruses. Methods: A retrospective study was conducted at the Jordan University Hospital. All the positive nasopharyngeal aspirates that were collected from hospitalized children aged 0-19 years from January 2017 to January 2019 were reviewed. Results: A total of 338 nasopharyngeal aspirates (NPAs) with positive viral serology results were reviewed. Among the patients younger than four years, the RSV virus was the most frequently detected. However, the Influenza B virus was the most commonly seen in patients older than 5 years, H1N1 was more frequent in autumn (29.5%), and RSV was the most frequent virus in winter. Bronchopneumonia was the most frequent diagnosis among all hospitalized patients, followed by bronchiolitis. Out of 338 patients, 50.3% had tachypnea, 70.7% of patients were admitted to the pediatric floor, while 18.6% presented with a severe illness and required admission to the pediatric intensive care unit (PICU). Infants under the age of one were more likely to have higher co-infection rates with other viruses compared to children over five years that had influenza. Conclusion: Presentations of influenza and other respiratory viruses vary between different age groups, such as sepsis in children younger than one year.

Background: As the prevalence of allergic diseases is increasing all over the world, it is vital to identify the specific allergens, which contribute to the development and persistence of such conditions. Objectives: This study aims to assess the prevalence of aeroallergen sensitization and, to evaluate the profile of skin prick test among atopic Jordanian children who are visiting Jordan University Hospital (JUH). Methods: A retrospective analysis of all Skin Prick Test (SPT) and results of atopic children and adolescents aged (1.5-18 years) who visited the pediatrics clinics at JUH from January 2018 until December 2019. Results: Over two years, a total of 171 children (male: female ratio of 1.9) with a median age of 6.2 years (1.5-18) were subjected to SPT. One hundred and seven children (62.5%) were found to be sensitized to at least one of the ten aeroallergen extracts tested. The most common sensitizations were to olive pollen (45.6%), Mites Dermatophagoides Petronyssinus (42.0%), and Dog Dander (38.6%). The highest sensitization rate was among the age group 2-4 years (28.1%). The sensitization rates increased in conjunction with an increase in age in the first age groups (preschool and school-age groups). Conclusion: The study’s findings provide an understanding of the locally prevalent aeroallergens, yet a multi-center review would be more useful for creating an optimized SPT panel specific to the Jordanian pediatric population.

Background: Children are at higher risk of developing respiratory diseases when they expose to biomass smoke. Very few studies have compared the duration of exposure to pulmonary function tests in children. The purpose of the study was to observe the effect of biomass fuel smoke on respiratory functions in 40 school-going children aged between 7 to 14 years and to compare these parameters with 40 age and sex-matched healthy children of the same school, and correlate their duration of exposure through pulmonary function tests. Methods: This prospective cross-sectional study was carried out over six months (August 2018 to January 2019). The selection of the study population was carried out from one of the Government primary schools. Eighty students participated in the study. The study population was divided into two groups. Group-1 consisted of 40 school children exposed to biomass smoke aged between 7 to 14 years as cases. Group-2 consisted of the same number of sex and age-matched controls who had no exposure to biomass smoke. After the relevant history, questionnaire, and respiratory examinations, children were subjected to spirometry. Schiller’s Spirovit-SP1 was also used. Results: The prevalence of some of the respiratory symptoms in biomass smokers was significant compared to non-smokers. There was a significant 1.125 fold reduction in FVC (p=0.003*) and 1.195 fold reduction in FEV1 (p=0.000*) in smokers compared to non-smokers. A significant correlation existed between duration of exposure to FVC (r=-0.508 p=0.001) and FEV1 (r=-0.462 p=0.005). Conclusion: We concluded that biomass smoke significantly reduced FVC and FEV1 in children, and these parameters are negatively correlated with the number of hours of exposure.

Background: Why is bodyweight not a predictor of lung function, while height, sex, race, and age are predictors of lung capacity and function? In this study, we want to investigate the association between body composition and pulmonary function. And, as much as possible, answer the question of why bodyweight is not predictive of lung function. Methods: This cross-sectional study was performed among 2967 employees of Tehran University of Medical Sciences (TUMS) who participated in the TUMS Employees Cohort (TEC) study. The body composition of the participants was measured using the Bioelectrical Impedance Analysis (BIA) method. Anthropometric variables were also measured as a confounder. The pulmonary function of participants was assessed by a forced spirometry test. Results: The correlation of BIA values including fat-free mass and total body water with a pulmonary function such as FEV1, FVC, and FEF25-75 is higher than most anthropometric values such as weight, wrist circumference, and the waist to hip ratio. Also, in regression analysis, age and sex had an association with pulmonary function, but the weight did not show a significant relationship. On the other hand, fat-free mass and visceral fat were significantly associated with pulmonary function. One is direct and the other is inverse. Conclusion: We observed a negative association between visceral fat and pulmonary function tests and a direct association between Fat-free mass pulmonary function tests (FEV1 and FVC) adjusted for age, sex, and anthropometric indices.