Air pollution and multiple acute respiratory outcomes.

Eur Respir J. 2013 Jan 11;

Authors: Faustini A, Stafoggia M, Colais P, Berti G, Bisanti L, Cadum E, Cernigliaro A, Mallone S, Scarnato C, Forastiere F, on behalf of the EPIAIR collaborative Group

Abstract
Short-term effects of air pollutants on respiratory mortality and morbidity have been consistently reported but usually studied separately.To more completely assess air pollution effects, we studied hospitalisations for respiratory diseases together with out-of hospital respiratory deaths.A "time-stratified" case-crossover study was carried out in six Italian cities from 2001-2005. Associations between daily particulate matter (PM10) and nitrogen dioxide (NO2) and hospitalisations for respiratory diseases (n. 100,690), chronic obstructive pulmonary disease (COPD) (n. 38,577), lower respiratory tract infections (LRTI) among COPD patients (n. 9,886) and out-of-hospital respiratory deaths (n 5,490) were estimated for 35+year-old residents.For 10 μg·m(-3) PM10, we found an immediate 0.59% (lag 0-1) increase in hospitalisations for respiratory diseases and a 0.67% increase for COPD; the 1.91% increase in LRTI hospitalisations lasted longer (lag 0-3) and the 3.95% increase in respiratory mortality lasted six days. Effects of NO2 were stronger and lasted longer (lag 0-5). Age, gender, and previous ischemic heart disease acted as effect modifiers for different outcomes.Analysing multiple more than single respiratory events shows stronger air pollution effects. The temporal relationship between the pollutants' increases and hospitalizations or mortality for respiratory diseases differs.

PMID: 23314899 [PubMed - as supplied by publisher]

Related Articles

Year in review 2012: Lung cancer, respiratory infections, tuberculosis, pleural diseases, bronchoscopic intervention and imaging.

Respirology. 2013 Jan 15;

Authors: Porcel JM, Leung CC, Restrepo MI, Takahashi K, Lee P

Abstract
This Year in Review series addresses the most relevant articles published in Respirology and other respiratory medicine journals during 2012 concerning five specific areas that we consider to be of importance to practicing pulmonologists, namely lung cancer, respiratory infections, tuberculosis (TB), pleural diseases, and interventional pulmonology and imaging. Some important findings that will be commented on more in depth are that: 1) screening for lung cancer using low-dose computed tomography (CT) in high risk populations is promising, although not firmly established, 2) an enhanced CURB (which stands for confusion, urea, respiratory rate, blood pressure) score as well as the Japanese A-DROP (age, dehydration, respiratory failure, orientation disturbance, and pressure) prognostic scale are as accurate as the pneumonia severity index (PSI) scoring system to predict mortality in patients with community-acquired pneumonia (CAP), 3) randomized trials are urgently needed to optimize multidrug-resistant (MDR)-TB treatment, 4) the use of video-assisted thoracoscopic surgery (VATS) to quantify pleural tumor burden and, if feasible, perform an intrathoracic cytoreduction in patients with malignant effusions secondary to ovarian cancer (OC) may have a significant impact on further patient management plans, and 5) respiratory endoscopy and its different diagnostic and therapeutic modalities, is a safe procedure with overall complication rates less than 1%.

PMID: 23317457 [PubMed - as supplied by publisher]

Related Articles

Viral and bacterial interactions in the upper respiratory tract.

PLoS Pathog. 2013 Jan;9(1):e1003057

Authors: Bosch AA, Biesbroek G, Trzcinski K, Sanders EA, Bogaert D

Abstract
Respiratory infectious diseases are mainly caused by viruses or bacteria that often interact with one another. Although their presence is a prerequisite for subsequent infections, viruses and bacteria may be present in the nasopharynx without causing any respiratory symptoms. The upper respiratory tract hosts a vast range of commensals and potential pathogenic bacteria, which form a complex microbial community. This community is assumed to be constantly subject to synergistic and competitive interspecies interactions. Disturbances in the equilibrium, for instance due to the acquisition of new bacteria or viruses, may lead to overgrowth and invasion. A better understanding of the dynamics between commensals and pathogens in the upper respiratory tract may provide better insight into the pathogenesis of respiratory diseases. Here we review the current knowledge regarding specific bacterial-bacterial and viral-bacterial interactions that occur in the upper respiratory niche, and discuss mechanisms by which these interactions might be mediated. Finally, we propose a theoretical model to summarize and illustrate these mechanisms.

PMID: 23326226 [PubMed - in process]

Infectious complications in patients with lung cancer.

Eur Rev Med Pharmacol Sci. 2013 Jan;17(1):8-18

Authors: Akinosoglou KS, Karkoulias K, Marangos M

Abstract
Infections remain a part of the natural course of cancer. During the course of their disease, patients with lung cancer frequently present with an infection that can ultimately be fatal. Pathogenesis of infectious syndromes is usually determined by the underlying disease, as well as, the iatrogenic manipulations that occur during its management. Hence, lung cancer infections include lower respiratory tract infections in the context of COPD, aspiration, obstruction and opportunistic infections due to immunosuppression. Moreover, treatment-related infectious syndromes including post operative pneumonia, febrile neutropenia and superimposed infection following radiation/chemotherapy toxicity is common. Importantly, diagnosis of infection in the febrile lung cancer patient is challenging and requires a high index of suspicion in order to distinguish from other causes of fever, including malignant disease and pulmonary embolism. Prompt initiation of treatment is pivotal to avoid increased mortality. Careful consideration of infection pathogenesis can predict most likely pathogens and guide antibiotic management, thus, ensuring most favourable outcome.

PMID: 23329518 [PubMed - in process]