Current Respiratory Medicine Reviews - Volume 18, Issue 4, 2022

Tuberculosis (TB) and Diabetes Mellitus (DM) association poses the re-emerging problem nowadays and challenge on the way towards a tuberculosis-free world. There are some peculiarities in the immune function of DM patients, which make them more susceptible to infections, including TB. This results in a higher prevalence of TB among DM patients (OR=1.15 according to the last meta-analysis). Clinical manifestations of DM/TB often differ from the classical course of the disease - these patients are more frequently symptomatic, more inclined to cavitary disease and, according to some data, to lower lobe involvement. Data on multi-drug resistance prevalence among DM/TB patients are controversial and need further research, especially in terms of primary resistance. Higher frequency of adverse reactions, slower sputum conversion and foci regression make treatment in this population more difficult and worsen outcomes. Potential measures to lower the burden of co-morbidity are: new treatment regimens, bi-directional screening, proper DM managing and controlling, testing for latent tuberculosis infection and its treatment, and new vaccines development. Feasibility and efficacy of these measures are to be investigated in the context of settings with different DM and TB prevalence and available resources.

Introduction: Diabetes mellitus and lung cancer are two highly prevalent diseases on a global scale. The association between these two diseases has been the subject of study of many cohorts in the past, some of which presenting inconclusive results. Aim: To present existing evidence regarding the association of diabetes with lung cancer risk and survival as well as the impact of metformin and insulin on lung cancer. Methods: A narrative review of all the relevant published literature known to the authors was conducted. The references were identified by searching the Pubmed online database using the keywords such as diabetes and lung cancer risk, diabetes and lung cancer survival rates, metformin and lung cancer, insulin and lung cancer. Results: Although previous epidemiologic studies have failed to report any significant causal effect of diabetes on lung cancer risk, recent evidence from 2 large scale meta-analyses of observational studies and other studies showed a statistically significant correlation between nonsmoker diabetics and lung cancer risk (RR, 1.11; 95% CI, 1.02-1.20; I2 = 46.1% and RR, 1.14; 95% CI, 1.09-1.20; I2 = 0%). Recent evidence has shown that metformin is related to a lower risk of lung cancer incidence among never-smokers diabetic patients (HR, 0.57;95% CI, 0.33-0.99) and improved overall survival rates (HR=0.77, 95%CI=0.66-0.9, P=0.001) regardless of the histological type of lung cancer. On the other hand, a recently published large population-based retrospective cohort study has concluded that human insulin is associated with an increased risk of lung cancer (HR 1.545, 95% CI: 1.478-1.614). Interestingly, metformin has been reported to have an anti-resistant effect on lung cancer patients who are on Epidermal Growth Factor Receptor- Tyrosine Kinase Inhibitors, offering some protection against resistance to therapy. Conclusion: Published evidence shows that diabetes mellitus is associated with an increased risk of lung cancer and worse survival rates. Metformin plays a protective role in lung cancer pathogenesis and is also associated with prolonged progression-free survival in lung cancer patients with diabetes. There is a significant association between human insulin use and lung cancer risk. More randomized controlled studies are required to establish the positive association of diabetes and anti-diabetic drugs with lung cancer, taking into further consideration gender and lung cancer pathology as well as possible confounders such as smoking habits that can influence the results of these studies.

In India, asthma is a prevalent respiratory condition marked by frequent blowouts and a distinctive spread pattern. Respiratory diseases are the main cause of death globally. In India, asthma is more common, particularly in the North Indian states of Delhi and Uttar Pradesh. Our primary objective in this review is to study asthma medication therapy and its associated complications. The epidemiology, etiology, pathophysiology, mechanism of airway inflammation, classification, and diagnosis of asthma are all illustrated in the current work. Additionally, we have gathered state-bystate information on asthma for the last five years in Northern India. Asthma diagnosis and management are also discussed in accordance with the guidelines of many agencies, including NICE, BTS, SIGN, and WHO.

Overactivation of the local pulmonary fibroblast induces hyperproduction of the extracellular matrix. A myriad of pathomorphological changes occur during lung fibrosis, including interalveolar space (interstitial) deposition due to proliferation and differentiation of resident fibroblasts, recruitment of circulating stem cells and epithelial-mesenchymal transition, highly reactive and hyperplastic alveolar epithelium. Currently, many endogenous and exogenous factors are believed to be associated with lung fibrosis development. However, pathogenetic treatment remains in the womb of development. Exploring the underlying pathophysiology is crucial for the successful development of pathogenetic treatment. Several molecules termed chemokines and cytokines have been found to induce lung fibrosis, such as IL-6, IL-1β, PDGFRα, TNF-α, GM-CSF, and IL-13. However, many others, such as IL-8, RANTES, IP-10, and MIG or lymphotactin, have an antifibrosis effect. However, the pathogenesis is multifactorial and involves dysregulation of the immune system, impaired cell-cell adhesion regulation mechanisms, and loss of DNA repair. The paper aimed to thoroughly address the potential risk factors and molecular triggers of lung fibrosis.

Background: Early mobilization of patients with critical illness reduces the consequences of extended periods of bed rest and improves self-care functions and quality of life. Early mobilization for mechanically ventilated patients in any ICU prevents patients from a spiral of progressive complications, leading to either nursing home placement or persistent critical illness. Early mobilization of ICU patients has been associated with improved muscle strength and functional independence, a shorter duration of delirium, mechanical ventilation, and ICU length of stay. Objective: This study was undertaken to assess the impact of physiotherapy management and early mobilization on Functional Status and Length of Stay in patients admitted to the Intensive Care Unit. Methods: An observational study was conducted at a tertiary care university teaching hospital in Mysore, South India, among patients admitted to medical and surgical intensive care units. The patients were assessed, and the patient’s baseline characteristics were recorded. The study subjects were divided into two groups, the intervention and the control groups. There were 71 patients in the intervention group and 67 patients control group. Subjects in the intervention group underwent physiotherapy management and early mobilization. Subjects in the control group did not undergo physiotherapy management and early mobilization. Physiotherapy intervention was given 2-3 times/day, and the outcome measures were the length of stay in ICU and assessment of physical morbidity using the Chelsea Critical Care Physical Assessment Tool (CPAx). Results: The results showed that subjects in the intervention group were weaned from the ventilator support (3.86±3.4 and 5.59±4.3, p = 0.005) and oxygen support (5.23±0.99 and 7.48±2.0, p = 0.000) much earlier than the subjects in the control group. The length of ICU stay was significantly less in the intervention group than in the control group (7.71±3.70 days and 11.64±4.8 days with a p-value, p = 0.000). respectively Conclusion: This study demonstrated that implementation of physiotherapy intervention and early mobilization in critically ill patients undergoing treatment in intensive care unit resulted in early weaning from ventilator support and supplemental oxygen therapy, with improvement in functional status leading to reduced length of ICU stays compared to the patients who were not given physiotherapy intervention and early mobilization.

Background: RDW has been proposed as a routine test and is available as a prognosis for many diseases and disorders, especially respiratory disorders. In this study, we intend to see if the association between pulmonary function and RDW also applies to non-patients. Methods: This study was performed on 800 people including 466 women and 344 men. Participants in the study were staff enrolled in the Tehran University of Medical Sciences cohort [TEC] study. In this study, RDW levels and pulmonary function were assessed. Elderly populations were not included in this study. Results: The results of the univariate analysis showed that normal values versus abnormal values of RDW were significantly associated with pulmonary function index FEV1, FVC, FEV1/FVC in nonpatient individuals. On the other hand, a significant correlation was observed between RDW values and FEV1 index and FEV1/FVC ratio. Based on linear regression, there was an association between RDW and FVC [R2=0.721]. Conclusion: In this study, we found an association between RDW and FVC so we suggest that abnormal RDW may be considered as a sign of pulmonary dysfunction.

Background: Asthma and rhinosinusitis share the same pathophysiological mechanism and often occur together. The root cause of chronic rhinosinusitis is still a challenge to cure, but its clinical symptoms can be improved by symptomatic treatment, also considered asthma symptom relievers. Objective: The primary objective of this study was to measure the prevalence of asthma with rhinosinusitis among adult patients in Saudi Arabia, as there have been limited studies that assessed this objective. Methods: This study is a retrospective cross-sectional study. The data was collected from a selected hospital from 2016 to 2019. The inclusion criteria were patients with a confirmed diagnosis of asthma and rhinosinusitis aged 18 years and older. Results: The prevalence of rhinosinusitis among asthma patients was 0.30% in a total of 1,688 asthmatic patients, and 1683 patients had asthma without rhinosinusitis (99.7%). Females accounted for 67.7% of the patients, while males accounted for 32.3%. Most of the asthma patients (56%) were 60 or older, and 44% were between 18 and 59 years old. Asthma patients with a past medical history of chronic obstructive pulmonary disease (COPD) accounted for 2.3% of the patients. Moreover, 1.9% of the asthma patients had bronchiectasis. The majority of the asthma patients (79%) had an unknown allergic status, while 21% had allergies. The smoking status variable revealed that 3.1% of the asthma patients were smokers. Conclusion: The prevalence of rhinosinusitis among asthma patients was considered low.

Background: Machine learning algorithms, such as artificial neural networks (ANN), provide more accurate predictions by discovering complex patterns within data. Since COVID-19 disease is prevalent, using advanced statistical tools can upgrade clinical decision making by identifying high risk patients at the time of admission. Objective: This study aims to predict in-hospital mortality in COVID-19 patients with underlying cardiovascular disease (CVD) using the ANN model. Methods: In the current retrospective cohort study, 880 COVID-19 patients with underlying CVD were enrolled from 26 health centers affiliated with Shiraz University of Medical Sciences and followed up from 10 June to 26 December 2020. The five-fold cross-validation method was utilized to build the optimal ANN model for predicting in-hospital death. Moreover, the predictive power of the ANN model was assessed with concordance indices and the area under the ROC curve (AUC). Results: The median (95% CI) survival time of hospitalization was 16.7 (15.2-18.2) days and the empirical death rate was calculated to be 17.5%. About 81.5% of intubated COVID-19 patients were dead and the majority of the patients were admitted to the hospital with triage level two (54%). According to the ANN model, intubation, blood urea nitrogen, C-reactive protein, lactate dehydrogenase, and serum calcium were the most important prognostic indicators associated with patients’ in-hospital mortality. In addition, the accuracy of the ANN model was obtained to be 83.4%, with a sensitivity and specificity of 72.7% and 85.6%, respectively (AUC=0.861). Conclusion: In this study, the ANN model demonstrated a good performance in the prediction of in-hospital mortality in COVID-19 patients with a history of CVD.

Background: The impact of COVID-19 on asthmatic patients is still uncertain. Objective: This study intended to examine the associations between the severity of coronavirus disease 2019 (COVID-19), asthma, and some inflammatory markers among pediatric patients. Methods: A retrospective study enrolled pediatric COVID-19 patients who were admitted to Abuzar Hospital (Ahvaz, Iran) during eight months. The diagnosis of COVID-19 was according to the real-time reverse transcription-polymerase chain reaction (RT-PCR) method. Asthma diagnosis was confirmed by specialists through functional and clinical evaluations (positive bronchodilator reversibility test or positive methacholine challenge test). Demographic and clinical characteristics of the patients were documented. Asthmatic patients with COVID-19 were considered as Group 1 (n= 52) and non-asthmatic COVID-19 patients were assigned as Group 2 (n= 54). Results: The mean age of 106 patients was 71.28 ± 50.09 months (range: 1-16 years). Children with severe and moderate COVID-19 had significantly lower levels of neutrophils and lymphocytes, higher inflammatory markers, and longer hospital length of stay (LOS) than patients with a mild course of COVID-19 (p < 0.001). Patients in Group 1 had significantly longer LOS, higher dry cough, chest radiographic findings, fever, levels of D-dimer, fibrinogen, and C-reactive protein (CRP), as well as lower neutrophil and lymphocyte counts, compared with those in Group 2 (p < 0.001). Conclusion: The presence of asthma in COVID-19 patients was associated with severe COVID-19 in comparison with their non-asthmatic counterparts. Additional studies with large sample sizes are deemed necessary to determine the impact of asthma on the management and incidence of COVID- 19 disease.

Introduction: Heart rate recovery (HRR) delay is a marker of cardiac autonomic dysfunction. In people with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation programs, assessing HRR could have prognostic utility, yielding valuable information for setting treatment goals and targets in therapeutic interventions. Therefore, this study aimed to establish the sociodemographic, pulmonary function, and functional aerobic capacity differences in people with COPD with normal and abnormal HRR during the 6-minute walk test (6MWT) and explore factors associated with abnormal HRR. Methods: Analytical cross-sectional study. Sociodemographic, anthropometric characteristics, pulmonary function, aerobic capacity, BODE index, and Hospital Anxiety and Depression Scale (HADS) were assessed in COPD patients. An HRR cut-off point of 14 beats or more was used to define HRR delay. Results: Of 128 patients included, 89 (69.5%) showed abnormal HRR. Patients with abnormal HRR were classified with higher overweight/obesity, lower resting SpO2 and lower distance walked, predicted percentage, and estimated VO2 in the 6MWT, with more significant symptoms at one minute after the end of the test (dyspnea and fatigue). In the multivariate regression model adjusted for age, sex, resting heart rate, and FEV1, findings showed that distance walked in the 6MWT (OR 0.994, pvalue= 0.010), fatigue at 1 minute (OR 2.12, p-value=0.000), and HADS depression domain (OR 0.87, p-value=0.018) are factors associated with HRR. Conclusion: In outpatients with COPD, HRR relates to the distance walked in the 6MWT, fatigue, and depression measured with the HADS.