Current Respiratory Medicine Reviews - Volume 18, Issue 2, 2022

Despite the wide range of available therapies, asthma remains uncontrolled in 40-65% of patients for a number of different reasons. Treatment with an inhaled corticosteroid (ICS) is recommended in the Global Initiative for Asthma 2021 report for patients across all asthma severities, with treatment options combining an ICS with a long-acting β2-agonist (LABA) or a LABA and a long-acting muscarinic antagonist (LAMA), depending on disease severity. Based on this, the availability of a single inhaler fixed-dose ICS/LABA/LAMA combination is a major need in asthma management. Indacaterol acetate/glycopyrronium bromide/mometasone furoate has been developed as a once-daily inhaled asthma treatment that combines an ICS (mometasone furoate), a LABA (indacaterol acetate), and a LAMA (glycopyrronium bromide) in a formulation delivered using the dry powder inhaler Breezhaler®, for patients with uncontrolled asthma on medium- or high-dose ICS/LABA. This article provides an overview of the different and complementary mechanisms of action and the clinical effectiveness of the monocomponents of the indacaterol/glycopyrronium/ mometasone furoate fixed combination and highlights the benefits of using the three agents in combination in patients with moderate and severe asthma.

Rhinovirus is one of the two most common viral agents that cause bronchiolitis in young children. During the first 12 months, it is second to the respiratory syncytial virus, but after 12 months, it begins dominating the statistics. Wheezing and dry cough are typical clinical symptoms indicative of rhinovirus-induced bronchiolitis, although overlap of symptoms with other virus infections is common. Several studies have shown that atopic predisposition and reduced interferon responses increase susceptibility to rhinovirus-induced wheezing. More recent studies have found that certain genetic variations at strong asthma loci also increase susceptibility. Rhinovirus-induced wheezing in the early years of life is known to increase the risk of subsequent asthma development and may be associated with airway remodeling. This risk is increased by aeroallergen sensitization. Currently, there are no clinically approved preventive treatments for asthma. However, studies show promising results indicating that children with rhinovirus-affected first-time wheezing respond to bronchodilators in terms of less short-term symptoms and that controlling airway inflammatory responses with anti-inflammatory medication may markedly decrease asthma development. Also, enhancing resistance to respiratory viruses has been a topic of discussion. Primary and secondary prevention strategies are being developed with the aim of decreasing the incidence of asthma. Here, we review the current knowledge on rhinovirus-induced early wheezing as a risk factor for subsequent asthma development and related asthma-prevention strategies.

One of the important comorbidities that has a longstanding research history in COPD is diabetes. Although there are multiple studies on COPD and diabetes, the exact links between these two conditions are still controversial. The exact prevalence of diabetes in COPD varies between 2 and 37 %. The true nature of this relationship is complex and may be partially related to the traditional risk factors for diabetes such as smoking, cardiovascular disease and use of steroids. However, COPD is a disease that has multiple phenotypes and is no longer regarded as a homogeneous condition. It seems that some COPD patients who overlap with asthma or the obese phenotype are at a particular risk for T2DM. The aim of this review is to analyze the prevalence, risk factors and possible interactions between COPD and diabetes mellitus.

In 1891, German doctor E. Romberg was the first to report PAH. It is widespread throughout the world, but it is particularly problematic in India and other developing countries. Pulmonary arterial hypertension (PAH) is characterised by an increase in pulmonary arterial pressure as well as the emergence of progressive symptoms, such as a loss of functional ability, shortness of breath, and fatigue. Blood flows from the right side of the heart to the lungs through the pulmonary arteries. Pulmonary arterial pressure refers to the pressure in the arteries of the lungs (PAH). It necessitates immediate treatment because high blood pressure in the lungs causes the right side of the heart to work much harder, increasing the risk of heart failure. This article aimed to provide brief information about the prevalence, pathology, classification, and different therapies of PAH.

Background: Histopathological abnormalities of pulmonary tuberculosis (TB) include caseous granuloma formation, tissue damage, and cavity formation, all of which could lead to permanent changes in the pulmonary anatomy. In pulmonary TB, an increase in serum Matrix Metalloproteinase (MMP)-9 correlates with disease severity and worse prognosis. This study aims to analyze the association between serum MMP-9 levels and the values of FVC, FEV1, and FEV1/FVC. Methods: A cross-sectional study involving patients with pulmonary tuberculosis was conducted at the Tuberculosis Outpatient Clinic, Dr. Soetomo Academic Hospital, Surabaya, Indonesia. Spirometry and serum MMP-9 levels were examined in new pulmonary TB patients prior to antituberculosis therapy. The relationship between serum MMP-9 levels and results of spirometry examination was then analyzed. Results: There were 44 new pulmonary TB cases with a mean age of 37.90 ± 15.15 years. The patients who experienced symptoms in <1 month were 20.5%, ≥ 1 month were 59.1%, and ≥ 2 months were 20.4%. The mean MMP-9 serum level was 11.27 ± 5.47 ng/ml. Spirometry results were: FVC 1.83 ± 0.69 L, FVC predicted 56.24 ± 18.74%, FEV1 1.71 ± 0.72 L/sec, FEV1 predicted 60.85 ± 21.30%, and FEV1/FVC 104.16 ± 17.45%. In pulmonary TB patients with symptoms experienced in <1 month, a significant relationship between MMP-9 and FVC levels was found with r = -0.839 (p = 0.005). Conclusion: There is a correlation between serum MMP-9 level and restrictive pulmonary impairment in new pulmonary TB cases with symptoms experienced in <1 month.

Background: COVID-19 has still been expressed as a mysterious viral infection with dramatic pulmonary consequences. Objectives: This article aims to study the radiological pulmonary consequences of respiratory covid-19 infection at 6 months and their relevance to the clinical stage, laboratory markers, and management modalities. Methods: This study was implemented on two hundred and fifty (250) confirmed positive cases for COVID-19 infections. One hundred and ninety-seven cases (197) who completed the study displayed residual radiological lung shadowing (RRLS) on follow-up computed tomography (CT) of the chest. They were categorized by Simple clinical classification of COVID-19 into groups A, B and C. Results: GGO, as well as reticulations, were statistically significantly higher in group A than the other two groups; however, bronchiectasis changes, parenchymal scarring, nodules as well as pleural tractions were statistically significantly higher in group C than the other two groups. Conclusion: Respiratory covid-19 infection might be linked to residual radiological lung shadowing. Ground glass opacities GGO, reticulations pervaded in mild involvement with lower inflammatory markers level, unlike, severe changes that expressed scarring, nodules and bronchiectasis changes accompanied by increased levels of inflammatory markers.

Background: COVID-19 is known as a global health issue, which can cause high morbidity and mortality in patients. It is necessary to identify biomarkers, clinical and laboratory findings and effects on patients' mortality. Objective: This study aimed to evaluate the prognostic effect of clinical and laboratory findings on in-hospital mortality in patients with confirmed COVID-19. Methods: This retrospective cross-sectional study (February-August 2020) was conducted on adult patients with COVID-19 who were hospitalized in one of the main reference hospitals affiliated with Shiraz University of Medical Sciences, southern Iran. Patients with uncompleted or missed medical files were excluded from the study. Clinical and laboratory findings were extracted from the patients' medical files and then analyzed. The patients were categorized and later compared as survivor and nonsurvivors groups. Results: 345 patients were enrolled and 205 (59.4%) were male. The mean±SD of age was 53.67±16.97 years, and 32 (9.3%) out of the total did not survive. Hypertension (28.4%) and diabetes (25.5%) were the most prevalent comorbidities. All clinical symptoms were similar in both groups, except fever, which was observed significantly more in nonsurvivors (P=0.027). The duration of hospitalization was 9.20±5.62 (range; 2-42) days, which was higher in nonsurvivors (P<0.001). The results of Multivariate Logistic Regression Model showed that CRP (OR=1.032, P=0.01) and INR (OR=48.88, P=0.049) were the predictor factors for in-hospital mortality in hospitalized patients with confirmed COVID-19. Conclusion: The current study showed that in-hospital mortality was 9.3%. It was found that CRP and INR were the predictor factors for in-hospital mortality in hospitalized patients with confirmed COVID-19.

Background: COVID-19, a type of coronavirus emerged in Wuhan, China in December 2019, causing an epidemic of pneumonia with unknown reasons. Objective: This study aimed to investigate the factors affecting in-hospital mortality of patients with COVID-19 hospitalized in one of the main hospitals in central Iran. Methods: This retrospective cross-sectional study (February-May 2020) was conducted on patients with a confirmed diagnosis of COVID-19 admitted to Yazd Shahid Sadoughi Hospital in Iran. The patients with uncompleted or missed medical files were excluded from the study. Data were extracted from the patients' medical files and then analyzed. The patients were categorized as survivors and non-survivors groups, and they were compared. Results: Total 573 patients were enrolled and 356 (62.2%) were male. The mean±SD of age was 56.29±17.53 years, and 93 (16.23%) died. All the complications were more in non-survivors. Intensive care unit (ICU) admission was in 20.5% of the patients, which was more in non-survivors (P<0.001). The results of multivariate logistic regression test showed that pleural effusion in lung computed tomography (CT) scan (OR=0.055, P=0.019), white blood cell (WBC) (OR=1.418, P=0.022), serum albumin (OR=0.009, P<0.001), non-invasive mechanical ventilation (OR=34.351, P<0.001), and acute respiratory distress syndrome (ARDS) (OR=66.039, P=0.003) were the predictive factors for in-hospital mortality. Conclusion: In-hospital mortality with COVID-19 was about 16%. Plural effusion in lung CT scan, increased WBC count, lower mount of serum albumin, non-invasive mechanical ventilation, and ARDS were obtained as the predictive factors for in-hospital mortality.

Background: The present study aimed to assess the prevalence of persistent/late complications after recovery from the acute phase of COVID-19 in emergency medical technicians (EMTs). Methods: This is a cross-sectional case-series study performed during the last quarter of 2020 in Tehran, Iran. All EMTs who had been diagnosed with COVID-19 were eligible. The researcher contacted the EMTs via telephone to determine any complications following their recovery. Those who suffered from any complication were referred to an internal specialist physician for a detailed history and physical examination. Based on the physician’s opinion, some paraclinical or clinical evaluations were requested to be performed. Results: Four hundred thirty-one confirmed cases and two deaths due to this disease were registered among the Tehran EMS center’s EMTs during the study period. Two hundred thirty-eight EMTs were contacted, and 22.7% of them had at least one persistent/late complication following recovery of the acute phase of COVID-19; of whom, 28 EMTs were visited by an internist and completed the tests. The final participants mentioned seventy-five persistent/late complications. Only one EMT had a residual lesion among those who underwent lung CT scans. There were also some pathological findings in the echocardiographic examination and spirometry. Conclusion: Our study showed that persistent/late-onset complications could likely accompany by COVID-19.