Tag: respiratory diseases

Categories : Paediatrics Respiratory DiseasesTags :

More Physical Activity Linked to Fewer Respiratory Infections in Children

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A study of 104 children wearing pedometers to monitor daily activity showed that higher levels of physical activity are associated with reduced susceptibility to upper respiratory tract infections such as the common cold. Reporting the findings in Pediatric Research, the researchers suggest reduced inflammatory cytokines and improved immune responses as a possible mechanism.

Wojciech Feleszko, Katarzyna Ostrzyżek-Przeździecka and colleagues measured the physical activity levels and symptoms of upper respiratory tract infections of children aged between four and seven years in the Warsaw city region between 2018 and 2019. Participants wore a pedometer armband 24 hours a day for 40 days to measure their activity levels and sleep duration. For 60 days, parents used daily questionnaires to report their children’s symptoms of upper respiratory tract infections, such as coughing or sneezing. On a second questionnaire, parents reported their children’s vaccinations, participation in sport, whether they had siblings, and their exposure to smoking and pet hair.

The authors found that as the average daily number of steps taken by children throughout the study period increased by 1000, the number of days that they experienced symptoms of upper respiratory tract infections decreased by an average of 4.1 days. Additionally, children participating in three or more hours of sport per week tended to experience fewer days with respiratory tract infection symptoms than those not regularly participating in sports.

Higher activity levels at the beginning of the study were associated with fewer days with respiratory tract infection symptoms during the following six weeks. Among 47 children, with 5668 average daily steps during the first two weeks of the study period, the combined number of days during the following six weeks that these children experienced upper respiratory tract infection symptoms was 947. However, among 47 children whose initial average daily steps numbered 9368, the combined number of days during the following six weeks that these children experienced respiratory symptoms for was 724. Upper respiratory tract infection symptoms were not associated with sleep duration, siblings, vaccinations, or exposure to pet hair or smoking.

The authors speculate that higher physical activity levels could help reduce infection risk in children by reducing levels of inflammatory cytokines and by promoting immune responses involving T-helper cells. They also suggest that skeletal muscles could release small extracellular vesicles that modulate immune responses following exercise. However, they caution that future research is needed to investigate these potential mechanisms in children. In addition, since this was an observational study, causality could not be established.

Source: EurekAlert!

Categories : VaccinesTags :

Mucosal Vaccines Could be the Next Step Against Respiratory Viruses

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Vaccines that provide long-lasting protection against influenza, coronaviruses and respiratory syncytial virus (RSV) have proved exceptionally difficult to develop. In a new review article in Cell Host & Microbe, NIH researchers explore the challenges and outline approaches to improved vaccines and describe a promising path forward: mucosal vaccines.

Unlike the respiratory viruses that cause measles, mumps and rubella — for which vaccination or recovery from illness provides decades-long protection against future infection – flu, RSV, SARS-CoV-2 and “common cold” coronaviruses share several characteristics that enable them to cause repeated re-infections. These include very short incubation periods, rapid host-to-host transmission and replication in the nasal mucosa rather than throughout the body. This last feature – non-systemic replication – means these viruses do not stimulate the full force of the adaptive immune response, which typically takes a week or more to mount.

A next generation of improved vaccines for mucosa-replicating viruses will require advances in understanding on several fronts, the authors say. For instance, more must be learned about interactions between flu viruses, coronaviruses and RSV and the components of the immune response that operate largely or exclusively in the upper respiratory system. Over time, these interactions have evolved and led to “immune tolerance,” wherein the human host tolerates transient, limited infections by viruses that are generally non-lethal to avoid the destructive consequences of an all-out immune system attack.

The authors note that mucosal immunisation appears to be an optimal route of vaccination for the viruses of interest, when feasible. However, to develop useful mucosal vaccines, significant knowledge gaps must be filled including finding ideal vaccine formulations; determining dosage size, frequency and timing; and developing techniques for overcoming immune tolerance.

Source: NIH/National Institute of Allergy and Infectious Diseases

Categories : Paediatrics Respiratory DiseasesTags :

Hospital Readmissions for Children with Asthma on The Increase

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Hospital readmissions for asthma are increasing among children, likely stemming from COVID lockdowns reducing immunity to common respiratory viruses. These are the findings of a new study published in the Journal of Asthma. The finding highlights the gaps in health care for this most common of chronic paediatric illnesses.

The Australian study, led by the Murdoch Children’s Research Institute, found about one in three children, mostly pre-schoolers, are readmitted to hospital for asthma compared to one in five a decade ago.

Most asthma hospital presentations were preventable, Murdoch Children’s Dr Katherine Chen said, which emphasises the need for a holistic evaluation of each child’s asthma management to prevent future readmissions.

The study involved 767 children, aged three to 18 years, who were admitted to three hospitals in Victoria state between 2017-2018 with a diagnosis of asthma. It found that 34.3% were readmitted to hospital for asthma, with those aged three to five years accounting for 69.2%. Of the 767 participants, 20.6% were readmitted once, and 13.7% had two or more readmissions in 12 months. 

“Our study highlighted gaps in the children’s asthma care,” Dr Chen said. Over a third of children hadn’t had a review of their inhaler technique, and only about a quarter were prescribed a preventer or asked to continue using it.

“Almost three quarters were discharged without a preventer medication, and over 80 per cent did not have a follow-up clinic booked at the hospital, often reserved for children with difficult-to-control asthma. Most families, therefore, need to navigate their child’s asthma follow-up with their GP.”

Recently, said Dr Chen, asthma admissions had spiked due to the rise in respiratory infections and children lacking immunity to common viruses as a result of COVID lockdowns.

Professor Harriet Hiscock at MCRI said that the findings confirmed the important role of GPs in paediatric asthma management and how targeted interventions at each hospital could reduce readmissions.

“Less than 10 per cent were readmitted within 30 days suggesting the importance of ongoing community care and longer-term asthma control,” she said. The need to regularly review overall asthma management, minimise risk factors, arrange follow-up, and support optimum care in the community are key.

“Interactive digital symptom monitoring with specialist nurse support, home-based education and a culturally tailored education program could also help.”

Prof Hiscock said linked datasets were important to objectively measure the burden of asthma cases on health services.

“Our current dataset cannot verify whether the follow-up appointment was attended, whether caregivers had arranged follow-up post-discharge and if the medications were used as prescribed,” she said. “Integrating datasets such as health services and medication use into clinical care will improve the clinician’s understanding of the child’s asthma control and medication adherence and would assist in providing targeted treatments.”

Asthma is the most common chronic paediatric illness in industrialised countries, affecting 8–10% of children.

Source: Murdoch Children’s Research Institute

Categories : COVIDTags :

COVID Patient Study Could Change Future Heart and Lung Treatment

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A ground-breaking study into the effects of COVID on ICU patients in has confirmed evidence that the virus is associated with impaired function of the right side of the heart.

According to the study investigations, these findings could play a vital role in not only saving the lives of COVID patients, but also help in treating potentially fatal heart and lung issues generally. The findings will also help preparations for any possible future pandemic.

The first of its kind, the COVID-RV study aimed to help improve future care and outcomes for those most at risk from COVID, by gaining a better understanding of the impact the virus has on the sickest patients who require invasive ventilation.

The study was carried out in 10 ICUs across Scotland, examining 121 critically ill patients who were receiving treatment on ventilators due to the impact of SARS-CoV-2 on their system.

The findings revealed that about a third of the patients in the study showed evidence of abnormalities in the right side of the heart – the area that pumps blood to the lungs.

The study’s lead author Dr Philip McCall said that “A combination of factors create the perfect storm for COVID” to damage the right side of the heart, with possibly fatal outcomes as the lungs are unwilling to receive blood due to the infection.

“This is a very difficult condition to spot, unless you are specifically looking for it. That is why the results of this study are so important. We now know that COVID is a problem associated with not just ventilation, but can affect the heart.”

Chief Investigator of the study Dr Ben Shelley said: “The study has revealed that there is no doubt COVID affects the heart and has a major impact on outcomes for the patient.

“However, now that we know this actually happens, and have a better understanding of how it affects people, we can plan for the future and put in place new care plans and treatments to help combat this.

“For example, ultrasound scans can be used differently to focus in on early warning signs and areas we now know to be at risk.

“If we are able to see these warning signs early enough, clinicians can explore the causes of any complications and start new treatments as soon as possible, potentially improving outcomes for the sickest COVID patients.

“This kind of knowledge is invaluable, not only in combatting any future waves of COVID but in planning for future pandemics to allow people to be treated more effectively. These findings also have several fascinating areas which could be expanded on to help care for other lung conditions in general.”

Nearly half of ventilated patients in the study (47%) died because of COVID, a figure that is comparable to national and international death rates. Experts leading the COVID-RV study from NHS Golden Jubilee said that the overall condition of a person’s heart can have a significant impact on how seriously you will be affected by the potentially deadly virus.

Source: University of Glasgow

Categories : Respiratory DiseasesTags :

Nintedanib Slows Autoimmune-related Lung Disease

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Anatomical model of lungs
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Findings from a new clinical trial published in Arthritis & Rheumatology reveal that nintedanib,  an intracellular inhibitor of tyrosine kinases, may help patients with fibrosing from autoimmune disease-related interstitial lung diseases (ILDs).

ILDs are a common manifestation of systemic autoimmune diseases such as rheumatoid arthritis. Connective tissue diseases and vasculitides affect all areas of the lungs (bronchioles, parenchyma, alveoles) which is why ILD is a common feature of rheumatology diseases.

The trial enrolled 170 subjects with a fibrosing ILD other than idiopathic pulmonary fibrosis, with diffuse fibrosing lung disease of > 10% extent on high-resolution CT imagery, forced vital capacity (FVC) ≥ 45% predicted and diffusing capacity of the lungs for carbon monoxide ≥ 30% –< 80% predicted. FVC is a predictor of mortality in patients with autoimmune disease-associated ILDs.

Patients were randomised to receive nintedanib or placebo. Investigators assessed patients’ forced vital capacity (FVC). The trial found that the rate of decline in FVC over one year was -75.9 mL/year with nintedanib versus -178.6 mL/year with placebo.

“Until now, therapies that can significantly reduce the rate of decline in lung function in connective tissue disease–related ILDs characterised by progressive fibrosis have been lacking. We now have a therapeutic approach that offers a strategy for reducing the morbidity associated with these diseases,” said lead author Eric L. Matteson, MD, MPH, of the Mayo Clinic College of Medicine and Science.

Source: Wiley

Categories : UncategorizedTags :

Many Respiratory Diseases Are Borne by Aerosols

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As the COVID pandemic forced a close study of airborne transmission, new evidence has challenged the idea that many respiratory pathogens besides SARS-CoV-2 were only carried in the large respiratory droplets from coughs and sneezes of infected individuals. Rather, they also spread through virus-laden microscopic respiratory aerosols.

In a review published in Science, Chia Wang and colleagues discussed recent research regarding airborne transmission of respiratory viruses and how an improved understanding of aerosol transmission will enable better-informed controls to reduce and mitigate airborne transmission.

Most respiratory pathogens were until recently assumed to spread largely in large droplets expirated from an infectious person or transferred from contaminated surfaces. Public health recommendations in mitigating viral spread has, thus far, been guided by this understanding.

It is also known however, that a number of respiratory pathogens, such as influenza and the common cold, spread through infectious respiratory aerosols, which can remain suspended in the air, travelling further and for much longer, infecting those that inhale them.

According to a growing body of evidence, much of which gained from studying the spread of COVID, airborne transmission may be a more dominant mode of respiratory virus transmission than previously thought. Here, Wang et al. highlight how infectious aerosols are generated, travel throughout an environment and deliver their viral payloads to hosts. Before COVID, the maximum size for droplets to be classified as aerosols was 5 micrometres, but this has now been updated to 100 micrometres, because up to this size, droplets can remain suspended in the air for up to 5 seconds from a height of 1.5m and travel one metre to be inhaled by another.

The deal with this under-appreciated threat, the authors described ways to mitigate aerosol transmission at long and short ranges, including improvements to ventilation and airflows, air filtration, UV disinfection and personal face mask fit and design.

Source: News-Medical.Net

Categories : COVID Diseases, Syndromes and ConditionsTags :

Nearly a Third of COVID Patients Are Readmitted to Hospital

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According to a study reported by The Telegraph, almost a third of COVID patients are readmitted to hospital later. The new study, still on the MedRxiv preprint server and not yet peer reviewed, was conducted by Leicester University and the Office for National Statistics (ONS).

Approximately 1 in 10 people who are infected with COVID go on to develop long COVID symptoms, which include breathlessness, excessive fatigue and muscle aches. This appears to be causing hospital readmissions – and deaths.

The study looked at 47 780 individuals with a primary diagnosis of COVID who had a hospital visit between 1 January 2020 and 31 August 2020, and a COVID-negative control group admitted over the same period. The mean follow-up time was 140 days for those with a COVID diagnosis, and during this team 29.4% were readmitted and 12.3% died. The study also found a higher risk in those under 70 and of ethnic minority groups in the UK, most notably in respiratory diseases.

Study author Kamlesh Khunti, professor of primary care diabetes and vascular medicine at Leicester University, said: “This is the largest study of people discharged from hospital after being admitted with Covid.

“People seem to be going home, getting long-term effects, coming back in and dying. We see nearly 30 per cent have been readmitted, and that’s a lot of people. The numbers are so large.”The message here is we really need to prepare for long Covid. It’s a mammoth task to follow up with these patients and the NHS is really pushed at the moment, but some sort of monitoring needs to be arranged.”

One finding which surprised the team was that many patients went back in and had a new diagnosis, such as liver, heart or kidney conditions, as well as diabetes. This means, according to Prof Khunti, that it is important for patients to receive follow-up and protective therapies such as statins or aspirin, adding: “We don’t know if it’s because Covid destroyed the beta cells which make insulin and you get Type 1 diabetes, or whether it causes insulin resistance, and you develop Type 2, but we are seeing these surprising new diagnoses of diabetes.”

Source: Yahoo News

Categories : UncategorizedTags :

UV Key to Seasonality of Airborne Respiratory Diseases

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It has long been observed that flu seasons in the northern hemisphere tend to last over autumn and winter, while in regions closer to the equator, they tend to have a year-round prevalence.

A group of Italian researchers believe that the sun – specifically its UV rays, which are known to inactivate various pathogens – holds the key. This periodic change in UV radiation over the seasons resonates with another cyclical event – the loss of resistance in the host over half a year of antigenic drift. The researchers incorporated these effects into a series of models, which reflect the seasonality of airborne respiratory diseases.

“From an epidemiologic point of view, these models clarify an important and long-standing mystery: why do influenza epidemics disappear every year when the number of susceptible individuals is still very far from that needed to trigger the herd immunity mechanism?” said Mario Clerici, Immunologist at the University of Milan and the Don Gnocchi Foundation.
“The Italian data of the SARS-CoV-2 pandemics can also be described accurately by our model,” said Fabrizio Nicastro, INAF researcher and PI of the work, “but the predictive power of the model depends critically (other than on the implementation of new restriction measures) on the exact UV-B/A lethal doses for the COVID-19 virus, which our collaboration is about to measure.”

Source: Medical Xpress