Predictors of Airway Hyperresponsiveness in Symptomatic Children with Normal Spirometry and Suspicious of Possible Asthma

<b><i>Background:</i></b> Asthma diagnosis may be challenging particularly in patients with mild symptoms without an obstructive pattern in spirometry. Detection of airway hyperresponsiveness (AHR) by a positive methacholine challenge (MCC) is still an important diagnostic tool to confirm the presence of asthma with reasonable certainty. However, it is time consuming and could be exhausting for patients. We aimed to identify the predictive factors for AHR in children with respiratory symptoms without obstructive pattern in spirometry. <b><i>Methods:</i></b> Data from children who had undergone MCC were analyzed retrospectively. The demographic features of patients along with laboratory results were collected. <b><i>Results:</i></b> A total of 123 children with a median age of 10.5 years were enrolled. AHR was detected in 81 children (65.8%). The age of the children with AHR was significantly younger. The prevalences of aeroallergen sensitization, nocturnal cough, wheezing, and a baseline forced expiratory flow at 75% of vital capacity (FEF₇₅) &#x3c;65% were significantly more frequent in children with AHR. Multivariate logistic regression analysis revealed age, ever wheezing, nocturnal cough, tree pollen allergy, and FEF₇₅ &#x3c;65% as independent predictors of AHR. A weighted clinical risk score was developed (range, 0–75 points). At a cutoff point of 35, the presence of AHR is predicted with a specificity of 90.5% and a positive predictive value of 91.5%. <b><i>Conclusion:</i></b> In children suspected of having asthma, but without an obstructive pattern in the spirometry, combining independent predictors, which can be easily obtained in clinical practice, might be used to identify children with AHR.

Risk Factors Associated With Health Care Utilization in Preschool Recurrent Wheezers in a Tropical Environment

Introduction: The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear.Objective: To evaluate the factors associated with health care utilization in preschool recurrent wheezers in Cartagena, Colombia.Methods: One hundred twenty-seven recurrent wheezers (age 2–6 years old) who were admitted to the emergency room (ER) due to wheezing in a Pediatric reference hospital in Cartagena were included. Children were evaluated by means of questionnaires and classified according to the number of ER visits, need for hospitalization and history of intensive care unit (ICU) admission due to wheezing within the last year. Total serum IgE and specific IgE to house dust mite allergens (HDM) were measured by ImmunoCAP® and allergen sensitization was evaluated by skin prick tests (SPT).Results: The maternal report of nocturnal cough without fever in their children increased the risk to have ≥5 ER visits in the last year due to wheezing. The use of montelukast was negatively associated with hospitalization, while a history of pneumonia and lack of tap water, increased the risk of hospitalization due to wheezing. A history of bronchiolitis, family history of asthma, cohabiting with two or more siblings, passive exposure to smoke and lack of sewage facilities increased the risk of ICU admission due to wheezing. The presence of atopy evaluated by SPT reactivity, total IgE levels or specific IgE to HDM were not associated with health care utilization. We also found that seroprevalence of positive IgE (≥0.35 kU/L) was 27% to B. tropicalis and 20.3% to D. pteronyssinus but the prevalence of positive IgE sensitization to these allergens was below 2% and 8% when evaluated by SPT, respectively.Conclusions: Poverty indicators are associated with ICU admission in a group of preschool recurrent wheezers and should be considered as aggravating factors for wheezing. These factors must be systematically assessed in the medical approach in underdeveloped regions in the tropics. Nocturnal cough without fever is a symptom associated with frequent ER visits while atopy was not associated with health care utilization in preschool recurrent wheezers.

Clinical characteristics of patients with chronic cough in Guangdong, China: a multicenter descriptive study

Background The clinical characteristics of patients with chronic cough are reported only in single-center survey in China, being significantly different from that in western countries. Here, we performed a multicenter study to describe the clinical characteristics of chronic cough patients. Methods A cross-sectional observational survey was conducted in thirteen tertiary hospitals of Guangdong, South China. Relevant data were recorded using a standardized questionnaire and analyzed, including demographics, educational attainment, cough features, and concomitant symptoms. Results Of 933 patients in this study, the median age was 40.0 (IQR 31.0–52.0) years with a peaked age of 30–39 years. The proportion of females (487, 52.2 %) was comparable to that of males (446, 47.8 %). Up to 81.9 % of the patients were non-smokers. More than two-thirds of the subjects with chronic cough had a low educational level. The median cough duration was 6.0 (IQR 3.0–24.0) months, and 73.0 % of chronic cough patients presented with dry cough. Laryngeal paresthesia was the most common concomitant symptom (704, 75.5 %), followed by rhinitis/sinusitis-related (350, 37.5 %) and respiratory symptoms (322, 34.5 %). Rhinitis/sinusitis-related symptoms more frequently occurred in patients with productive cough than in those with dry cough (49.0 % vs. 33.0 %, P < 0.001). Moreover, female patients displayed an older age and a higher prevalence of nocturnal cough compared to male patients (both P < 0.05). Conclusions Our results show an equal gender, young profile and laryngeal paresthesia in patients with chronic cough, and different clinical features between females and males.

Mycobacterium Kansasii infection in a psoriasis patient treated with adalimumab and switch to apremilast: first report and literature review

Patient under anti-TNF-alpha treatment have an increased risk of mycobacterial infections, particularly tuberculosis. Only four case reports of Mycobacterium kansasii infection under anti-TNF-α treatment (two with etanercept, two with infliximab) have been reported, but none under adalimumab. A 72-year-old man treated with adalimumab for psoriasis vulgaris and arthropathic psoriasis, complained on nocturnal cough, occasional hemoptysis and the new onset of ill-defined, reddish, asymptomatic persistent plaquesnodules covered by serum crusts on his back, on the dorsum of the right hand and right middle finger. Routine laboratory investigations, HIV and TB screening (QuantiFERONTB- Gold test) were all within normal limits. A skin biopsy was inconclusive and special stainings resulted negative for microorganisms. Only PCR identified M. kansasii. The patient stopped adalimumab and started anti-TB treatment with gradual improvement of the skin lesions. At 26 months follow-up visit no signs or symptoms of relapse of M. kansasii disease occurred.

Multisensory home-monitoring in individuals with stable COPD and Asthma: a usability study of the CAir-Desk (Preprint)

BACKGROUND Research integrating multisensory home-monitoring in respiratory disease is scarce. Therefore, we created a novel multisensory home-monitoring device tailored for long-term respiratory disease management (named the CAir-Desk). We hypothesize that recent technological accomplishments can be integrated into a multisensory participant-driven platform. We also believe that this platform could improve chronic disease management, and be accessible to large groups at an acceptable cost. OBJECTIVE To report on user-adherence and acceptance, as well as system functionality of the CAir-Desk in a sample of participants with stable COPD or Asthma. METHODS We conducted an observational usability study. Participants participated in 4 weeks of home-monitoring with the CAir-Desk. The CAir-Desk recorded data from all participants on symptom burden, physical activity, spirometry, and environmental air-quality; data on sputum production, and nocturnal cough was only recorded in participants experiencing the symptoms. After the study period, participants reported on their perceptions of the monitoring device usability through a purpose-designed questionnaire. We used descriptive statistics and visualizations to display results. RESULTS Ten participants, 5 with COPD and 5 with Asthma took part in this study. They completed symptom burden questionnaires on 96 (14, 96)%, spirometry recordings on 55 (20, 94)%, wrist-worn physical activity recordings on 100 (97, 100)%, arm-worn physical activity recordings on 45 (13, 63)%, nocturnal cough recordings on 34 (9, 54)%, sputum recordings on 5 (3, 12)%, and environmental air-quality recordings on 100 (99, 100)% of the study days. The participants indicated that the measurements consumed 13 (10, 15) min daily, and that they preferred the wrist-worn over the arm-worn physical activity monitor. CONCLUSIONS The CAir-Desk showed good technical performance and was well-accepted by our sample of stable COPD and Asthma participants. The obtained insights were used in a redesign of the CAir-Desk, which is currently applied in a RCT including an interventional program. CLINICALTRIAL NA

Novel predictors of airway hyperresponsiveness in children with respiratory symptoms without obstructive pattern

Background: Methacholine challenge (MCC) is the most common method to detect airway hyperresponsiveness (AHR). Although MCC is accepted as safe diagnostic tool, it is time consuming and could be exhausting for patients. Thus, it might be helpful to identify predictive factors for AHR. We aimed to develop a diagnostic tool for predicting AHR in children with respiratory symptoms without obstructive pattern. Methods: Data from children who had undergone MCC were analyzed retrospectively. The demographic features of patients along with laboratory results were collected. Results: A total of 123 children with a median age of 10.5 years were enrolled. AHR was detected in 81 children (65.8%). The age of the children with AHR was significantly younger. The prevalences of aeroallergen sensitization, nocturnal cough, wheezing and a baseline forced expiratory flow at 75% of vital capacity (FEF75) <65% were significantly more frequent in children with AHR. Multivariate logistic regression analysis revealed age, ever wheezing, nocturnal cough, tree pollen allergy and FEF75<65% as independent predictors of the AHR. A weighted clinical risk score was developed (range, 0-75 points). At a cutoff point of 35 the presence of AHR is predicted with a specificity of 90.5% and a positive predictive value (PPV) of 91.5%. Conclusion: In children suspected of having asthma, but without an obstructive pattern, combining independent predictors, which can be easily obtained in clinical practice, in a novel prediction rule might be used to identify children with AHR.

Non-Contact Measurements of Electrocardiogram and Cough-Associated Electromyogram from the Neck Using In-Pillow Common Cloth Electrodes: A Proof-of-Concept Study

Asthma and chronic obstructive pulmonary disease are associated with nocturnal cough and changes in heart rate. In this work, the authors propose a proof-of-concept non-contact system for performing capacitive electrocardiogram (cECG) and cough-associated capacitive electromyogram (cEMG) measurements using cloth electrodes under a pillowcase. Two electrodes were located along with the approximate vector of lead II ECG and were used for both cECG and cEMG measurements. A signature voltage follower was introduced after each electrode to detect biopotentials with amplitudes of approximately 100 µV. A bootstrapping technique and nonlinear electrical component were combined and implemented in the voltage follower to attain a high input impedance and rapid static discharge. The measurement system was evaluated in a laboratory experiment for seven adult males and one female (average age: 22.5 ± 1.3 yr). The accuracy of R-wave detection for 2-min resting periods was 100% in six subjects, with an overall average of 87.5% ± 30.0%. Clearly visible cEMGs were obtained for each cough motion for all subjects, synchronized with reference EMGs from submental muscle. Although there remains room for improvement in practical use, the proposed system is promising for unobtrusive detection of heart rate and cough over a prolonged period of time.

Prevalence of Asthma Symptoms in 13-14-year-old Adolescents in Karaj

Asthma is the most common chronic inflammatory respiratory disorder in children. This study was designed to assess the prevalence of asthma in 13-14-year-old adolescents in Karaj, Alborz province in Iran, using the international study of asthma and allergies in childhood (ISAAC) questionnaire. Totally 950 adolescents attending 40 schools located in 4 regions of Karaj city were enrolled in the survey. The Persian version of the ISAAC questionnaire was filled by 13-14-year-old students. Multi-stage clustered random sampling was used to divide the city of Karaj into four educational districts. Ever wheezing was reported in 22% of the individuals; 10.52% claimed to have wheeze in the last 12 months and 22.73% had during or after exercise. The experience of wheezing in the last 12 months was more prevalent among males (11.73% vs. 9.38%; p<0.05). However, having a history of asthma was higher among males (7.55% vs. 3.47%; p<0.05). History of hospitalization (60.8%), family history of asthma (49.4%), and history of food allergy (42.3%) were found to be the most frequent characteristics significantly associated with" ever wheezing" (p<0.05). The prevalence of wheezing in the last 12 months, as a major index of current asthma, was 10% which was close to the national average. However, nocturnal cough and exercise-induced wheezing were higher in Karaj compared to other cities of Iran; which could be related to the high level of air pollution in this industrial area.