The burden of chronic respiratory diseases in adults in Nepal: A systematic review

While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67–14.3%; asthma, 4.2–8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required.

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824 Case Series on the Use of Volume Assured Pressure Support in Patients with Chronic Pulmonary Disease and Progressive Hypercapnia

SLEEP ◽

10.1093/sleep/zsab072.821 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A321-A322

Author(s):

William LeMaster ◽

Dale Jun ◽

Sharon De Cruz ◽

Michelle Zeidler ◽

Rajan Saggar

Keyword(s):

Respiratory Failure ◽

Lung Disease ◽

Pulmonary Disease ◽

Lung Diseases ◽

Lung Transplant ◽

Pressure Support ◽

Case Series ◽

Chronic Obstructive ◽

Hypoxemic Respiratory Failure ◽

Chronic Lung Diseases

Abstract Introduction Chronic hypercapnia results from destruction of lung parenchyma which occurs in chronic lung diseases including interstitial lung disease (ILD), bronchiectasis, and chronic lung transplant rejection. Many patients with these diseases will experience progressive respiratory failure eventually requiring consideration of transplantation or re-transplantation. Due to physiologic changes in sleep including reduction in tidal volume, worsening air tapping, and REM atonia, hypoventilation can be exacerbated during the sleeping hours. We present four patients who were prescribed nocturnal Volume Assured Pressure Support VAPS for their progressive hypercapnia. Report of case(s) Subject 1 is a 72 year old female with severe bronchiectasis and restrictive lung disease due to TB pneumonia at a young age. Subject 2 is a 45 year old male with history of pulmonary cavitation due to extensive TB disease when he was younger. Subject 3 is a 45-year-old woman with rheumatoid arthritis related ILD with associated pulmonary arterial hypertension. Subject 4 is a 74 year old patient with a bilateral lung transplant for IPF complicated by bronchiolitis obliterans syndrome who presented with progressive dyspnea and hypercapnia. Despite optimal therapy, all of these patients were admitted for hypercapnic and hypoxemic respiratory failure requiring treatment with BPAP then transitioned to nocturnal VAPS on discharge. For all patients, dyspnea and pCO2 improved as outpatients although all patients did eventually experience an exacerbation of their lung disease requiring repeat admission. Conclusion Due to the physiologic changes that occur with sleep, patients with severe lung disease may experience worsening CO2 retention while sleeping. There is little data assessing the use of chronic nocturnal non-invasive ventilation (NIV) to treat the hypercapnia of chronic lung diseases other than chronic obstructive pulmonary disease, extra-thoracic restriction, and neuromuscular disease. In this case series, nocturnal VAPS stabilized and/or reduced pCO2 in patients with pulmonary parenchymal disease of various etiologies. Additional studies are needed to assess long term effects of VAPS in these patients, including exacerbations, symptoms, and overall mortality. Support (if any):

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Disease burden and associated risk factors for metabolic syndrome among adults in Ethiopia

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1201-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Samrawit Solomon ◽

Wudeneh Mulugeta

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Low Income ◽

Disease Burden ◽

Addis Ababa ◽

Treatment Strategies ◽

Density Lipoprotein ◽

World Health ◽

Low Income Countries ◽

Cross Sectional

Abstract Background Metabolic Syndrome (MetS) and Non-communicable diseases (NCDs) are alarmingly increasing in low-income countries. Yet, very limited is known about the prevalence and risk factors associated with MetS in Ethiopia. Methods A cross-sectional study was conducted among adult outpatients (N = 325) at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. The study was conducted in accordance with STEPwise approach of the World Health Organization. MetS was defined using modified National Cholesterol Education Program’s Adult Treatment Panel III criteria. Univariate and multivariate analyses were performed. Results The overall prevalence of MetS was 20.3%. Among the 325 participants, 76.9% had at least one MetS components. Reduced high-density lipoprotein cholesterol was the most common MetS component at 48.6%, followed by elevated blood pressure at 36.3%, and elevated fasting glucose at 32.6%. Older age (odds ratio [OR] = 4.15; 95% confidence interval [CI] = 1.43–12.04), Amhara ethnicity (OR = 2.36; 95%CI = 1.14–4.88), overweight status (OR = 2.21; 95%CI = 1.03–4.71), higher income (OR = 3.31; 95%CI = 1.11–9.84) and higher education levels (OR = 2.19; 95%CI = 1.05–4.59) were risk factors for MetS. Conclusion The disease burden of MetS among Ethiopians is high, and is associated with age, weight, income, education and ethnicity. Comprehensive screening and assessment of MetS is needed along with effective preventive and treatment strategies in low-income countries, such as Ethiopia.

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Vitamin D Deficiency and Chronic Lung Disease

Canadian Respiratory Journal ◽

10.1155/2009/829130 ◽

2009 ◽

Vol 16 (3) ◽

pp. 75-80 ◽

Cited By ~ 44

Author(s):

Christopher R Gilbert ◽

Seth M Arum ◽

Cecilia M Smith

Keyword(s):

Vitamin D ◽

Pulmonary Function ◽

Lung Disease ◽

Vitamin D Deficiency ◽

Chronic Lung Disease ◽

Obstructive Lung Disease ◽

Lung Diseases ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Chronic Lung Diseases

Vitamin D deficiency is increasingly being recognized as a prevalent problem in the general population. Patients with chronic lung diseases such as asthma, cystic fibrosis, chronic obstructive lung disease and interstitial pneumonia appear to be at increased risk for vitamin D deficiency for reasons that are not clear.Several studies indicate that vitamin D possesses a range of anti-inflammatory properties and may be involved in processes other than the previously believed functions of calcium and phosphate homeostasis. Various cytokines, cellular elements, oxidative stress and protease/antiprotease levels appear to affect lung fibroproliferation, remodelling and function, which may be influenced by vitamin D levels. Chronic lung diseases such as asthma and chronic obstructive lung disease have also been linked to vitamin D on a genetic basis. This immune and genetic influence of vitamin D may influence the pathogenesis of chronic lung diseases. A recent observational study notes a significant association between vitamin D deficiency and decreased pulmonary function tests in a large ambulatory population.The present review will examine the current literature regarding vitamin D deficiency, its prevalence in patients with chronic lung disease, vitamin D anti-inflammatory properties and the role of vitamin D in pulmonary function.

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COVID-19 and restrictive lung disease: A deadly combo to trip off the fine balance

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1346 ◽

2020 ◽

Vol 90 (2) ◽

Cited By ~ 2

Author(s):

Kamal Kant Sahu ◽

Ajay Kumar Mishra ◽

Kevin Martin ◽

Iryna Chastain

Keyword(s):

Risk Factors ◽

Chronic Obstructive Pulmonary Disease ◽

Risk Factor ◽

Lung Disease ◽

Lung Diseases ◽

Chronic Obstructive ◽

Immunocompromised Patients ◽

Obstructive Pulmonary Disease ◽

Restrictive Lung Disease ◽

Chronic Lung Diseases

Coronavirus Disease (COVID-19) pandemic has so far led to innumerable deaths worldwide. The risk factors so far that have been most studied as poor prognostic factors are old age, individuals with multiple comorbidities and immunocompromised patients. Amongst the chronic lung diseases, most patients with COVID-19 reported so far had asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease. Herein, we discuss the significance of restrictive lung disease during the COVID-19 pandemic as a potential risk factor via an example of a patient with kyphoscoliosis who succumbed to death due to COVID-19 pneumonia.

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Epidemiological Characteristics of COVID-19 Patients in Kütahya Province in Turkey

Eurasian Journal of Family Medicine ◽

10.33880/ejfm.2021100304 ◽

2021 ◽

Vol 10 (3) ◽

pp. 135-140

Author(s):

Cagla Ozdemir ◽

Adem Durmaz ◽

Nurcan Akbas Gunes

Keyword(s):

Risk Factors ◽

Low Income ◽

Lung Diseases ◽

Kidney Diseases ◽

Cross Sectional Study ◽

Adult Patients ◽

Advanced Age ◽

Cross Sectional ◽

Chronic Lung Diseases ◽

Epidemiological Characteristics

Aim: It is aimed to evaluate the epidemiological features of COVID-19 patients and risk factors affecting hospitalization. Methods: This cross-sectional study included 883 adult patients whose Polymerase Chain Reaction tests were positive for SARS-CoV-2 in Kütahya province until July 2020. The patients were questioned in terms of their socio-demographic characteristics, drugs, comorbidities, and symptoms. They were divided into two groups according to their hospitalization status and outpatient treatment status. Results: There were 473 female and 410 male participants in the study. 532 of 883 adult patients were hospitalized. The most common symptoms were fatigue (47.9%), myalgia (44.7%), and loss of smell and taste (32.4%). Hospitalization was associated with advanced age, low income, presence of additional disease, several symptoms, smoking, comorbidities including diabetes mellitus, chronic kidney diseases, cardiovascular and respiratory system. In multivariant analyses, advance age, low income, fever, dyspnea and chronic lung diseases were associated with increased odds of hospital admission. Conclusion: In our study, it was found that independent risk factors for hospitalization were advanced age, low income, fever, shortness of breath, and chronic lung diseases. We think that determining risk factors for hospitalization may be a guide for clinicians in predicting patient prognosis. Keywords: COVID-19, epidemiology, hospitalization, symptoms, comorbidity

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Proteases, Mucus, and Mucosal Immunity in Chronic Lung Disease

International Journal of Molecular Sciences ◽

10.3390/ijms22095018 ◽

2021 ◽

Vol 22 (9) ◽

pp. 5018

Author(s):

Michael C. McKelvey ◽

Ryan Brown ◽

Sinéad Ryan ◽

Marcus A. Mall ◽

Sinéad Weldon ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Disease ◽

Lung Diseases ◽

Lung Damage ◽

Chronic Obstructive ◽

Lung Function Decline ◽

Obstructive Pulmonary Disease ◽

Chronic Lung Diseases ◽

Multifunctional Enzymes ◽

Disease Experience

Dysregulated protease activity has long been implicated in the pathogenesis of chronic lung diseases and especially in conditions that display mucus obstruction, such as chronic obstructive pulmonary disease, cystic fibrosis, and non-cystic fibrosis bronchiectasis. However, our appreciation of the roles of proteases in various aspects of such diseases continues to grow. Patients with muco-obstructive lung disease experience progressive spirals of inflammation, mucostasis, airway infection and lung function decline. Some therapies exist for the treatment of these symptoms, but they are unable to halt disease progression and patients may benefit from novel adjunct therapies. In this review, we highlight how proteases act as multifunctional enzymes that are vital for normal airway homeostasis but, when their activity becomes immoderate, also directly contribute to airway dysfunction, and impair the processes that could resolve disease. We focus on how proteases regulate the state of mucus at the airway surface, impair mucociliary clearance and ultimately, promote mucostasis. We discuss how, in parallel, proteases are able to promote an inflammatory environment in the airways by mediating proinflammatory signalling, compromising host defence mechanisms and perpetuating their own proteolytic activity causing structural lung damage. Finally, we discuss some possible reasons for the clinical inefficacy of protease inhibitors to date and propose that, especially in a combination therapy approach, proteases represent attractive therapeutic targets for muco-obstructive lung diseases.

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Increasing burden of noninfectious lung disease in persons living with HIV: a 7-year study using the French nationwide hospital administrative database

European Respiratory Journal ◽

10.1183/13993003.00359-2018 ◽

2018 ◽

Vol 52 (3) ◽

pp. 1800359 ◽

Cited By ~ 3

Author(s):

Thomas Maitre ◽

Jonathan Cottenet ◽

Guillaume Beltramo ◽

Marjolaine Georges ◽

Mathieu Blot ◽

...

Keyword(s):

Lung Disease ◽

Lung Fibrosis ◽

Lung Diseases ◽

Medical Information ◽

Chronic Respiratory Disease ◽

Administrative Database ◽

Chronic Obstructive ◽

Old Patients ◽

Persons Living With Hiv ◽

Living With Hiv

An overall reduction in the incidence of AIDS and a change in the spectrum of lung disease have been noticed in persons living with HIV (PLHIV). Our aim was to provide an epidemiological update regarding the prevalence of lung diseases in PLHIV hospitalised in France.We analysed the prevalence of lung disease in PLHIV hospitalised in France from 2007 to 2013, from the French nationwide hospital medical information database, and assessed the association between HIV and incident noninfectious disease over 4 years of follow-up.A total of 52 091 PLHIV were hospitalised in France between 2007 and 2013. Among PLHIV hospitalised with lung disease, noninfectious lung diseases increased significantly from 45.6% to 54.7% between 2007 and 2013, whereas the proportion of patients with at least one infectious lung disease decreased significantly. In 2010, 10 067 prevalent hospitalised PLHIV were compared with 8 244 682 hospitalised non-PLHIV. In 30–49-year-old patients, HIV infection was associated with chronic obstructive pulmonary disease (COPD), chronic respiratory failure, emphysema, lung fibrosis and pulmonary arterial hypertension (PAH) even after adjustment for smoking.The emergence of noninfectious lung disease, in particular COPD, emphysema, lung fibrosis, PAH and chronic respiratory disease, in PLHIV would justify mass screening in this population.

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Pulmonary hypertensive vasculopathy in parenchymal lung diseases and/or hypoxia

European Respiratory Review ◽

10.1183/16000617.0003-2017 ◽

2017 ◽

Vol 26 (144) ◽

pp. 170003 ◽

Cited By ~ 4

Author(s):

Maria Rosa Ghigna ◽

Wolter J. Mooi ◽

Katrien Grünberg

Keyword(s):

Lung Disease ◽

Lung Diseases ◽

Chronic Obstructive Lung Disease ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Chronic Obstructive ◽

Diffuse Lung Disease ◽

Mean Pulmonary Arterial Pressure ◽

Chronic Lung Diseases ◽

Obstructive Sleep

Pulmonary hypertension (PH) with complicating chronic lung diseases and/or hypoxia falls into group 3 of the updated classification of PH. Patients with chronic obstructive lung disease (COPD), diffuse lung disease (such as idiopathic pulmonary fibrosis (IPF)) and with sleep disordered breathing are particularly exposed to the risk of developing PH. Although PH in such a context is usually mild, a minority of patients exhibit severe haemodynamic impairment, defined by a mean pulmonary arterial pressure (mPAP) of ≥35 mmHg or mPAP values ranging between 25 mmHg and 35 mmHg with a low cardiac index (<2 L·min−1·m−2). The overlap between lung parenchymal disease and PH heavily affects life expectancy in such a patient population and complicates their therapeutic management. In this review we illustrate the pathological features and the underlying pathophysiological mechanisms of pulmonary circulation in chronic lung diseases, with an emphasis on COPD, IPF and obstructive sleep apnoea syndrome.

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The Impact of the Synergistic Effect of Temperature and Air Pollutants on Chronic Lung Diseases in Subtropical Taiwan

Journal of Personalized Medicine ◽

10.3390/jpm11080819 ◽

2021 ◽

Vol 11 (8) ◽

pp. 819

Author(s):

Da-Wei Wu ◽

Szu-Chia Chen ◽

Hung-Pin Tu ◽

Chih-Wen Wang ◽

Chih-Hsing Hung ◽

...

Keyword(s):

Air Pollution ◽

Lung Disease ◽

Air Pollutants ◽

Lung Diseases ◽

Environmental Parameters ◽

Effect Of Temperature ◽

Cross Sectional ◽

Chronic Lung Diseases ◽

The Impact ◽

The Relationship

Previous studies have suggested an association between air pollution and lung disease. However, few studies have explored the relationship between chronic lung diseases classified by lung function and environmental parameters. This study aimed to comprehensively investigate the relationship between chronic lung diseases, air pollution, meteorological factors, and anthropometric indices. We conducted a cross-sectional study using the Taiwan Biobank and the Taiwan Air Quality Monitoring Database. A total of 2889 participants were included. We found a V/U-shaped relationship between temperature and air pollutants, with significant effects at both high and low temperatures. In addition, at lower temperatures (<24.6 °C), air pollutants including carbon monoxide (CO) (adjusted OR (aOR):1.78/Log 1 ppb, 95% CI 0.98–3.25; aOR:5.35/Log 1 ppb, 95% CI 2.88–9.94), nitrogen monoxide (NO) (aOR:1.05/ppm, 95% CI 1.01–1.09; aOR:1.11/ppm, 95% CI 1.07–1.15), nitrogen oxides (NOx) (aOR:1.02/ppm, 95% CI 1.00–1.05; aOR:1.06/ppm, 95% CI 1.04–1.08), and sulfur dioxide (SO2) (aOR:1.29/ppm, 95% CI 1.01–1.65; aOR:1.77/ppm, 95% CI 1.36–2.30) were associated with restrictive and mixed lung diseases, respectively. Exposure to CO, NO, NO2, NOx and SO2 significantly affected obstructive and mixed lung disease in southern Taiwan. In conclusion, temperature and air pollution should be considered together when evaluating the impact on chronic lung diseases.

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Role of extracellular vesicles in chronic lung disease

Thorax ◽

10.1136/thoraxjnl-2020-216370 ◽

2021 ◽

pp. thoraxjnl-2020-216370

Author(s):

Anne Trappe ◽

Seamas C Donnelly ◽

Paul McNally ◽

Judith A Coppinger

Keyword(s):

Lung Disease ◽

Extracellular Vesicles ◽

Chronic Lung Disease ◽

Lung Diseases ◽

Drug Carriers ◽

Chronic Obstructive ◽

Sources Of Information ◽

Chronic Obstructive Pulmonary Disorder ◽

Chronic Lung Diseases

To explore the role of extracellular vesicles (EVs) in chronic lung diseases.EVs are emerging as mediators of intercellular communication and possible diagnostic markers of disease. EVs harbour cargo molecules including RNA, lipids and proteins that they transfer to recipient cells. EVs are intercellular communicators within the lung microenvironment. Due to their disease-specific cargoes, EVs have the promise to be all-in-one complex multimodal biomarkers. EVs also have potential as drug carriers in chronic lung disease.Descriptive discussion of key studies of EVs as contributors to disease pathology, as biomarkers and as potential therapies with a focus on chronic obstructive pulmonary disorder (COPD), cystic fibrosis (CF), asthma, idiopathic pulmonary fibrosis and lung cancer.We provide a broad overview of the roles of EV in chronic respiratory disease. Recent advances in profiling EVs have shown their potential as biomarker candidates. Further studies have provided insight into their disease pathology, particularly in inflammatory processes across a spectrum of lung diseases. EVs are on the horizon as new modes of drug delivery and as therapies themselves in cell-based therapeutics.EVs are relatively untapped sources of information in the clinic that can help further detail the full translational nature of chronic lung disorders.

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