Current Respiratory Medicine Reviews - Volume 18, Issue 3, 2022

Pulmonary rehabilitation is a multidisciplinary intervention recommended by international guidelines in managing COVID-19 patients and/or post-COVID-19 conditions with mid-and long-term complications of the initial illness. Physiotherapy-based pulmonary rehabilitation has received considerable attention since the COVID-19 pandemic, with supervised exercise training probably the most important component. Current guidelines clearly encourage low- to moderateintensity exercises for COVID-19 recovered patients and discourage high-intensity/vigorous exercises. However, the ongoing interest in high-intensity interval training (HIIT) has extended to post- COVID-19 rehabilitation based on its efficacy and safety in other patient populations. In this perspective, several reasons behind the possibility of the inappropriateness of the HIIT in post-COVID- 19 conditions will be discussed and supported by evidence. In addition, the key points for safe exercise after COVID-19 illness will be listed.

The World Health Organization (WHO) considers tuberculosis to be the most dangerous chronic communicable disease in the world, infecting two billion people or one-third of the world’s population. Tuberculosis (TB) caused by Mycobacterium tuberculosis remains a leading cause of mortality worldwide into the 21st century. Tuberculosis is second only to AIDS among other infectious diseases causing deaths worldwide. The emergence of AIDS, multidrug-resistant TB (MDRTB), extensively drug-resistant tuberculosis (XDR-TB), the decline of socioeconomic standards, and a reduced emphasis on tuberculosis control programmers contribute to the disease’s resurgence in industrialized countries.

Exercise training is paramount in improving aerobic capacity, lung function, reducing the symptoms of dyspnea, and reconditioning the lean skeletal muscles. Many literature and guidelines have advocated the importance of exercise intervention in addressing the secondary impairment to post covid-19 infection, including home-based therapy and telerehabilitation. Pulmonary hypertension (PH) was previously thought to be contraindicated by exercise training; however, exercise was later found to be beneficial and relatively safe in chronic PH. However, there is a lack of highquality evidence on the safety and effectiveness of exercise training in post-COVID-19 infected individuals with PH. Pulmonary hypertension has been documented to be one of the post-COVID-19 complications. PH occurred due to COVID-19 infection should be carefully considered before subjecting them to exercise training, especially in home-based therapy. This article aims to discuss the differing etiological factor, pathophysiological backgrounds, and the possible disease long-term outcomes that may compromise the safety of exercise training in post-COVID-19 patients complicated with PH. By understanding the risk of developing PH, risk assessment and stratification can be explicitly outlined for a safe exercise prescription through proper patient selections. Any possible complications can be anticipated; hence, proper preventive strategies can be instituted.

Airway involvement results from long-standing rheumatoid arthritis leading to severe pulmonary complications, correlated with increased mortality and socioeconomic costs. Different types of pulmonary lesions, including pulmonary rheumatoid nodule, pulmonary arteritis, diffuse interstitial fibrosis, and rheumatoid pneumoconiosis or Caplan's syndrome, are believed to be related to rheumatoid arthritis (R.A.). The above changes may indicate the increased susceptibility to the infection, toxins from a disease, or chronic immunity activation. The symptoms vary from asymptomatic to severe life-treating conditions, and the prognosis varies depending on the genre and severity of involvement. Our study aims to assess the prevalence and characteristics of airways association in rheumatoid arthritis as these data provide a brief insight into early diagnosis and treatment, which could be applied to minimize complications of airways diseases in rheumatoid arthritis.

Tuberculosis is one of the most common and oldest human afflictions caused by the deadly pathogen, Mycobacterium tuberculosis. Its infection is drastically increasing worldwide with time despite the application of various antibiotics and live attenuated vaccines. The major risk factor associated with tuberculosis is the long-term malfunction of the respiratory system that increases deaths, whereas the continuous emergence of drug-resistant MTB strains (MDR/TDR/XDR) acts as a driving force to accelerate additional obstacles to humankind. Researchers are effortlessly in-volved in a systematic examination of tuberculosis and drug designing against it, but still, we could not find a permanent cure for tuberculosis. Therefore, it is extremely necessary to analyse patho-genesis, epidemiology, and associated risk factors to plan an overall strategy against this deadly dis-ease. In the present study, we have gone through a comprehensive literature survey to provide all related information that may assist us in understanding this disease and designing strategic plan-ning. This study would fill the gap created due to a lack of knowledge on MTB infection and mo-lecular mechanisms, which is the biggest hurdle in finding a therapeutic lead against tuberculosis.

Asthma is a noncommunicable, chronic respiratory disease affecting 339 million individuals globally. The SNAPSHOT study suggests a prevalence rate of 6.4% in the Middle East region and 7.6% in the Gulf region alone, causing a significant healthcare burden. The management of severe asthma poses a significant challenge, thus accounting for suboptimal disease control. Diagnosis of severe asthma is quite difficult, considering the multiple factors playing a pivotal role in disease progression and management. Primary care physicians (PCPs) are predominantly involved in decision- making in asthma diagnosis and control. Therefore, educating the PCPs regarding diagnostic strategies and guiding them for a timely referral to specialists can reduce fatal episodes and disease exacerbations. In this way, PCPs may ensure effective treatment and achieve optimal disease control. To develop an algorithm and decision tree that may aid PCPs in the timely referral of severe asthma patients to specialists, an expert committee meeting was convened in December 2020 with leading experts from the United Arab Emirates. A three-step algorithm “CAR” was established to guide PCPs: “confirm” and check diagnosis, “assess” factors contributing to exacerbations and poor quality of life, and “refer” to a specialist. The “Severe Asthma Referral approach” conceptualized herein for the PCPs may help overcome the pragmatic challenges of early diagnosis, establish simple referral criteria for specialists, and attain severe asthma treatment goals.

Objective: Electrical Impedance Tomography (EIT) has emerged as a non-invasive, radiation- free imaging modality that allows monitoring at the patient's bedside, providing real-time information on the regional distribution of pulmonary ventilation. Although there has been increasing research on EIT in Intensive Care Units (ICUs), few studies use this tool in patients with spontaneous breathing. The objective is to describe the current evidence regarding the outpatient use of EIT in patients with chronic obstructive pulmonary disease (COPD). Methods: A scoping review was performed. An extensive search was conducted in seven healthbased databases, Scopus, Medline, OVID, Scielo, PEDro, EBSCO, and VHL search portal. In this scoping review, the checklist recommended by PRISMA was used. To assess the quality of the studies, the BEME protocol of "questions to ask about the evidence of an investigation or evaluation" was used. Results: In this scoping review, 7 studies published between 2009 and 2019 related to the outpatient use of EIT in COPD patients were identified. The evidence reviewed allowed us to identify that the frequent use is related to the evaluation of the distribution of ventilation, the evaluation of regional respiratory mechanics, and the degree of pre- and post-bronchodilator obstruction. Conclusion: EIT is used on an outpatient basis in patients with COPD as an evaluation tool that complements the information regarding the clinical results of pulmonary function tests, improving the monitoring of the course of the disease in real-time, non-invasively, and without ionizing radiation.

Background: Inhaled corticosteroids (ICS) have an essential and established role in the treatment of asthma. Both systemic and local adverse effects may accompany the long-term use of ICS. Systemic adverse drug reactions (ADRs) of ICS are well established. However, there is a paucity of information on local ADRs, especially in the Indian population. Objectives: This study aimed to determine the prevalence, severity, predictability, and preventability of local ADRs to ICS and their associated risk factors. Methods: Patients with asthma who need ICS were enrolled. Study patients were interviewed with open-ended questions to assess local ADRs to ICS at baseline and each follow-up visit, once a month for three months. Causality (Naranjo’s algorithm and WHO scale), severity (Hartwig SC scale), predictability (based on the frequency of occurrence of ADR and history of drug exposure), and preventability (Schumock and Thornton criteria) of local ADRs were assessed. Bivariate analysis and subsequently multivariate logistic regression were used to identify the risk factors for local ADRs to ICS. Results: A total of 243 patients (134 female) were included in the study. A total of 74 local ADRs were observed in 59 patients (a prevalence of 24.3%). The most common local ADRs included the feeling of thirst (14.8%), followed by cough during inhalation (8.6%) and taste disturbance (4.5%). All ADRs were predictable and mild in severity. Preventability assessment found 85.1% of local ADRs as ‘probably preventable’. Two out of five patients who had ADRs reduced or skipped doses because of the discomfort, despite their physician’s recommendation to continue their regular dose of ICS. Age >41 years, use of MDI without spacer, and use of budesonide were identified as the risk factors for developing ADRs to ICS. Conclusion: Local ADRs to ICS were observed in approximately one in four patients with asthma. Two out of five patients who had ADRs reduced or skipped doses. Strategies to prevent local ADRs to ICS should focus on patients aged >41 years, receiving budesonide, and using MDI without a spacer. We need to establish standards on the best practices for preventing ADRs, such as identifying the most suited device or ICS that is best tolerated by the individual patient and identifying the least ICS dose that maintains ideal asthma control.

Background: The coronavirus disease 2019 (COVID128;19) was first reported in December 2019 in Wuhan, China. Skin manifestations of COVID-19 have been reported sporadically. Staphylococcus aureus occurs after viral infection due to unregulated IFN-α. We designed this reported case to pay more attention to the rare skin manifestations following COVID-19. Case Report: The patient was a 12-month-old girl who presented with fever and skin rashes. Two days before admission, erythematous rashes spread around the mouth, nose, eyes, and trunk. Erythematous lesions begin to peel the next day. RT-PCR of the nasopharynx was positive for COVID- 19. Treatment with vancomycin and clindamycin was started. The patient was discharged with complete recovery of skin lesions. Conclusion: One of the early manifestations of COVID-19 in children can be fever and rash. Clinical suspicion led to more attention to complications of bacterial superinfection such as staphylococcal scalded skin syndrome.