Long-term Improvement of Air Quality Associated with Lung Function Benefits in Chinese Young Adults: A Quasi-experiment Cohort Study

Background: Long-term exposure to air pollution is associated with lung function impairment. However, whether long-term improvements in air quality could improve lung function is unclear.<br />Methods: We conducted a prospective quasi-experiment cohort study with 1731 college students in Shandong, China from September 2019 to September 2020, covering COVID-19 lockdown period. Data on PM2.5, PM10, NO2 and SO2 concentrations were obtained from China Environmental Monitoring Station. The concentration of O3 was obtained from Tracking Air Pollution in China. Lung function indicators included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and forced expiratory flow at 50% of FVC (FEF50%). Linear mixed-effects model was used to examine the associations between the change of air pollutants’ concentrations and the change of lung functions. We also conducted stratified analysis by sex.<br />Results: Compared with 2019, the mean FVC, FEV1 and FEF50% were elevated by 414.4ml, 321.5ml, and 28.4ml respectively in 2020. Every 5μg/m3 decrease in annual average PM2.5 concentrations was associated with 36.0ml [95% confidence interval (CI):6.0, 66.0ml], 46.1ml (95% CI:16.7, 75.5ml), and 124.2ml/s (95% CI:69.5, 178.9ml/s) increment in the FVC, FEV1, and FEF50%, respectively. Similar associations were found for PM10. There was no significant effect difference between male and female.<br />Conclusions: Long-term improvement of air quality can improve lung function among young adults. Stricter policies on improving air quality are needed to protect human health.<br />Funding: Taishan Scholar Program

Tiotropium bromide as adjunct therapy in children with asthma: a clinical experience

Background The Global Initiative for Asthma has only recently added tiotropium bromide as adjunct controller therapy in severe asthma (Step 4 or 5) in adults (2015) and children (2019). Although not yet approved for pediatric use by Health Canada, it has been occasionally offered by asthma specialists as a therapeutic trial in children with troublesome asthma or treatment for adverse effects. The objective of this study was to describe the indications and real-life clinical experience in initiating tiotropium in children with asthma. Methods We designed a retrospective mixed-method case series study of children aged 1–17 years who initiated tiotropium in our tertiary-care centre between 2013 and 2020. Clinical information was extracted from electronic medical records and tiotropium dispensing, from drug claims. Parents/children and physicians independently completed a questionnaire about treatment goals, perceived efficacy, safety, satisfaction, and lessons learned. Results The 34 (11 females; 23 males) children had a median (range) age of 9.1 (1.4–17.8) years. Children were primarily on Step 4 (85%) or 5 (6%) prior to tiotropium initiation, yet most (84%) did not increase their treatment step after tiotropium initiation. The physicians’ treatment goals were to improve asthma control, alleviate adverse effects of current therapy, and/or improve lung function. The most improved symptoms were coughing/moist cough, difficulty breathing, whistling breath, and bronchial secretions/mucus. Although most parents and physicians reported a significant benefit with tiotropium bromide, physicians particularly remarked, as their “lesson learned’, on the improvement in chronic symptoms in asthmatic children, particularly those with prominent moist cough and in lung function, in those with seemingly none (or incompletely) reversible obstruction as well as the ability to decrease the ICS and/or LABA dose to lessen adverse effects. A few physicians raised caution on the risk of lower adherence with an additional inhaler. Conclusion In children with severe asthma on Step 4 or 5, tiotropium bromide was primarily used as substitute, rather than additional, adjunct therapy to improve asthma control, alleviate adverse effects, and/or to improve lung function. The latter two indications, combined with its perceived effectiveness in children with prominent moist cough, also suggest additional indications of tiotropium to be formally explored.

Effectiveness of a Motivational Nutritional Intervention through Social Networks 2.0 to Increase Adherence to the Mediterranean Diet and Improve Lung Function in Active Smokers: The DIET Study, a Randomized, Controlled and Parallel Clinical Trial in Primary Care

Background: Diet can help preserve lung function in smokers, as well as aid individuals who avoid smoking. This study aimed to evaluate the effectiveness of a nutritional intervention, using the Social Networks 2.0 tool, to increase adherence to the Mediterranean diet (MD) and improve lung function in smokers without prior respiratory disease. Methods: A randomized controlled parallel design was used. The participants were assigned to either the intervention or control group. Data from representative smokers without respiratory disease (n = 77) aged 18–70 years were analyzed. The participants completed a validated semi-quantitative food-frequency questionnaire, and their adherence to the diet was evaluated by using the questionnaire called the Mediterranean Diet Adherence Score (MEDAS, with 14 items), which considers ≥9 points to indicate high adherence. The lung function was assessed by spirometry. Associations among variables were determined by logistic regression. Results: A comparison of the variables at the end of the study between the control and intervention groups showed that the intervention significantly increased adherence to the MD based on the MEDAS questionnaire (0.69 (2.1) vs. 2.05 (2.03); p = 0.009). Specifically, the consumption of fruits was increased after two years in both groups; however, a more significant increase was detected in the intervention group (121 (178) vs. 12.7 (167) in the control group; p-value = 0.008). In the unadjusted analysis, the intervention only showed a statistical significant increase in the score of adherence to the MD (β: 1.36; 95% CI 0.35; 2.3; p = 0.009), and this increase was maintained after adjusting for age and sex (β: 1.15; 95% CI 0.05; 2.2; p = 0.040) and after adjusting for various sociodemographic, lifestyle and anthropometric variables (β: 1.17; 95% CI 0.02; 2.31; p = 0.046). The pulmonary function parameters improved more in the intervention group; however, no significant differences were observed between the two groups. Conclusions: A nutritional intervention based on a dietetic-nutritional education program resulted in a significant increase in adherence to the MD. However, some evidence suggests that an MD dietary intervention can improve lung function, but in our study, we were not able to demonstrate this. Further research is needed to obtain more robust data and confirm a possible benefit of the program before it can be extended to general practice.

Genetic evidence supports the development of SLC26A9 targeting therapies for the treatment of lung disease

Background: Over 400 variants in the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) are CF-causing. CFTR modulators target different variants to improve lung function, but large variability in response exists and current therapies do not address all CF-causing variants highlighting an unmet need. Alternative epithelial ion channels such as SLC26A9 could compensate for CFTR dysfunction, providing a therapeutic target that benefits all individuals with CF. Method: We investigate the relationship between SLC26A9 and lung function pre- and post-treatment with CFTR modulators in Canadian and US CF cohorts, in the general population, and in those with chronic obstructive pulmonary disease (COPD). Results: SLC26A9 rs7512462 CC genotype is associated with greater lung function in individuals with minimal function variants (for which there are currently no approved therapies; p=0.002); and gating (p=0.03) and p.Phe508del/ p.Phe508del (p=0.009) genotypes upon treatment with CFTR modulators. Analogously, p.Phe508del/p.Phe508del human nasal epithelia with CC after triple combination modulator treatment show greatest CFTR function (p=8x10-4). Beyond CF, rs7512462 is associated with lung function in the UK Biobank (meta-p=2.74x10-44) and in COPD (min p=0.007). Conclusion: These findings support SLC26A9 as a therapeutic target to improve lung function for all people with CF and in individuals with other obstructive lung diseases such as COPD.

Tiotropium Bromide As Adjunct Therapy In Children With Asthma: A Clinical Experience

Background: The Global Initiative for Asthma has only recently been added tiotropium bromide as adjunct controller therapy in severe asthma (Step 4 or 5) in adults (2015) and children (2019). Although not yet approved for pediatric use by Health Canada, it has been occasionally offered by asthma specialists as a therapeutic trial in children with troublesome asthma or treatment adverse effects. The objective of this study was to describe the indications and real-life clinical experience in initiating tiotropium in children with asthma.Methods: We designed a retrospective mixed-method case series study of children aged 1-17 years who initiated tiotropium in our tertiary-care centre between 2013-2020. Clinical information was extracted from electronic medical records and tiotropium dispensing, from drug claims. Parents/children and physicians independently completed a questionnaire about treatment goals, perceived efficacy, safety, satisfaction, and lessons learned. Results: The 34 (11 females; 23 males) children had a median (range) age of 9.1 (1.4-17.8) years. Children were primarily on Step 4 (85%) or 5 (6%) prior to, yet most (84%) did not increase their treatment step after, tiotropium initiation. The physicians’ treatment goals were to improve asthma control, alleviate adverse effects of current therapy, and/or improve lung function. The most improved symptoms were coughing/moist cough, difficulty breathing, whistling breath, and bronchial secretions/mucus. Although most parents and physicans reported a significant benefit with tiotropium bromide, physicians particularly remarked, as their “lesson learned’, on the improvement in chronic symptoms in asthmatic children, particularly those with prominent moist cough and in lung function, in those with apparent fixed obstruction as well as the ability to decrease the ICS and/or LABA dose to lessen adverse effects. A few physicians raised caution on the risk of lower adherence with an additional inhaler. Conclusion: In children with severe asthma on Step 4 or 5, tiotropium bromide was primarily used as substitute, rather than additional, adjunct therapy to improve asthma control, alleviate adverse effects and/or to improve lung function. The latter two indications, combined with its perceived effectiveness in children with prominent moist cough, also suggest additional indications of tiotropium to be formally explored.

New Perspectives in COPD Management

LEARNING OBJECTIVES • Collaborate with patients to inform treatment decision-making that addresses their symptoms, goals, and concerns • Individualize guideline-recommended therapy to reduce chronic obstructive pulmonary disease (COPD) exacerbations, improve lung function, manage daily symptoms such as breathlessness, and help achieve the patient’s goals • Select an inhaler and an optimal dose of medication to best meet a patient’s needs and capabilities

A Comparison of Effect of Semi Fowler’s and Side Lying Position on Pulmonary Functions and Oxygen Saturation in Bedridden Patients

Background: Body positioning is prescribed to optimize cardiopulmonary functions. Positioning helps to improve lung function and oxygen saturation in patients who are bedridden for longer duration. The aim of the present study is comparing semi fowler’s position to side lying position (right and left side lying). Method: Thirty bedridden subjects who were haemodynamically stable were included in the study. Out of them three groups were made in which first group was given semi fowler’s position, second group was given left side lying and third group was given right side lying position. Patients have to maintain this position for 30 minutes. Outcome measure: FVC, FEV1, RR and SPO2 were taken before and after positioning which are objective measure of lung function and oxygen saturation respectively. Parameters were compared before and after positioning and between groups by non-parametric tests. Result: shows significant difference between before and after within groups. When each of these sides lying position were compared to semi fowler’s positions, semi fowler’s position was found to be more effective in improving pulmonary functions and oxygen saturation. Key words: Semi Fowler’s, Side Lying, Positioning, Pulmonary Functions, Oxygen Saturation.