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Exhaled nitric oxide as a better diagnostic indicator for evaluating wheeze and airway hyperresponsiveness in preschool children

Objective: Fractional concentration of exhaled nitric oxide (FeNO) is a known marker of airway inflammation. The aims of this study were to evaluate FeNO, impulse oscillometry (IOS), and spirometry in preschool children and to investigate their relationship with wheeze and airway hyperresponsiveness (AHR).

Methods: We performed a population-based, cross-sectional study with 561 children aged 5–6 years. A total of 544 children completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and eligible for the study. We measured FeNO, spirometry, methacholine bronchial provocation, and IOS. AHR was defined as the induction of a 20% decrease in FEV1(PC20) by a methacholine concentration ≤8.0 mg/dL.

Results: Children who had wheeze or AHR had higher FeNO levels than children without these symptoms. However, neither IOS nor spirometry parameters showed significant differences between children with wheeze or AHR and those without. FeNO was associated with AHR, whereas IOS or spirometry parameters showed no association. Mean FeNO levels were positively correlated with a dose–response slope for methacholine, but neither IOS nor spirometry parameters showed significant correlations.

Conclusions: FeNO is a more sensitive measurement of AHR and wheeze than spirometry or IOS in preschool children.

Respiratory Syncytial Virus (RSV): Symptoms, Transmission & Prevention

Respiratory syncytial virus (RSV) is a form of respiratory virus that infects a person's lungs and their breathing passages. Healthy people commonly experience mild, cold-like symptoms and recover within a week or two. Yet RSV may be serious – especially for infants and seniors. In fact, RSV is the most common cause of, 'bronchiolitis,' or inflammation of the small airways in the lung and pneumonia in children who are younger than one year of age in America. RSV is also being recognized more often as a significant cause of respiratory illness in seniors. (Source: Disabled World)

No Evidence to Support Widespread Screening for COPD

Chronic obstructive pulmonary disease (COPD) -- a serious disease that impairs breathing -- is the third leading cause of death in the United States. But an influential government panel says there's as yet no evidence to support screening for COPD in adults with no symptoms.

In a draft recommendation released Monday, the U.S. Preventive Services Task Force said the panel had reviewed the latest evidence and saw no reason to change its earlier recommendation on COPD screening, issued in 2008.

"The task force found that there is no evidence that screening for COPD in adults without symptoms results in improved health outcomes," member Dr. William Phillips said in a news release from the independent panel of experts. ...

Quantitative analysis of pathogens in the lower respiratory tract of patients with chronic obstructive pulmonary disease

Bacterial infection of the lower respiratory tract is believed to play a major role in the pathogenesis of chronic obstructive pulmonary disease (COPD) and acute exacerbations of COPD (AECOPD). This study investigates the potential relationship between AECOPD and the load of six common bacterial pathogens in the lower respiratory tract using real-time quantitative PCR (RT-qPCR) in COPD patients.

Methods : Protected specimen brush (PSB) and bronchoalveolar lavage fluid (BALF) samples from the lower respiratory tract of 66 COPD patients and 33 healthy subjects were collected by bronchoscopy. The load of Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonos aeruginosa, Haemophilus influenzeae, and Moraxella catarrhalis were detected by RT-qPCR.

Results : High Klebsiella pneumoniae, Pseudomonos aeruginosa, Haemophilus influenzeae and Moraxella catarrhalis burden were detected by RT-qPCR in both PSB and BALF samples obtained from stable COPD and AECOPD patients compared with healthy subjects. The load of the above four pathogenic strains in PSB and BALF samples obtained from AECOPD patients were significantly higher compared with stable COPD patients. Finally, positive correlations between bacterial loads and inflammatory mediators such as neutrophil count and cytokine levels of IL-1β, IL-6 and IL-8, as well as negative correlations between bacterial loads and the forced expiratory volume in one second (FEV1) % predicted, forced vital capacity (FVC) % predicted, and FEV1/FVC ratio, were detected.

Conclusions : These findings suggest that increased bacterial loads mediated inflammatory response in the lower respiratory tract and were associated with AECOPD. In addition, these results provide guidance for antibiotic therapy of AECOPD patients.

Peak oxygen uptake and breathing pattern in COPD patients ; a four-year longitudinal study

Background: Activities of daily living in patients with chronic obstructive pulmonary disease (COPD) are limited by exertional dyspnea and reduced exercise capacity. The aims of the study were to examine longitudinal changes in peak oxygen uptake (V̇O 2peak ), peak minute ventilation (V̇ Epeak ) and breathing pattern over four years in a group of COPD patients, and to examine potential explanatory variables of change.

Methods: This longitudinal study included 63 COPD patients, aged 44-75 years, with a mean forced expiratory volume in one second (FEV 1 ) at baseline of 51 % of predicted (SD = 14). The patients performed two cardiopulmonary exercise tests (CPETs) on treadmill 4.5 years apart. The relationship between chan...

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