Current Respiratory Medicine Reviews - Volume 19, Issue 1, 2023

Coronavirus diseases, from SARS to MERS and now COVID-19, have major implications for the aviation industry and international travels. Although many cities and countries are adopting ‘live with COVID’ strategies, various rules and regulations are still in place. Documents demonstrating COVID-19 vaccination or recovery from the disease have now become a basic requirement to enter many travel destinations, while some still require pre-entry and/or post-arrival testing of COVID-19. Recently, the author’s household became COVID-19 positive in late March 2022, as diagnosed by rapid antigen test (RAT), in Singapore whilst enroute to Hong Kong. This had an immediate knock-on impact on hotel quarantine and travel arrangements. Rapid antigen test (RAT) and Polymerase Chain Reaction (PCR) based tests have been used for quarantine, isolation and international travel purposes. The implications and issues of these tests are discussed. Ideally, a COVID-19 test that is fit for purpose should aim at identifying individuals who are infectious with risk of transmission only. Frequent surveillance with an effective RAT may be a more practical solution to normalize international travel without compromising public safety. Meanwhile, physicians have an important role in counselling anxious and often confused travelers before and during international travels. International travelers should be aware of the implications of these COVID-19 testing results, and plan, schedule and have travel insurance accordingly.

The current molecular advances in lung fibrosis pathogenesis distend beyond the cellular to involve subcellular and molecular levels. Lung fibrogenesis and autophagy impairment are tightly associated. Autophagy is involved in cell cycle control and regulation of the intracellular microenvironment. Degradation of impaired intracellular organelles and biproducts is crucial to maintaining a healthy cell and preventing its metaplasia / transdifferentiation to a pathological cell. Autophagy modifies the metabolism of alveolar epithelial cells, endothelial cells, and lung fibroblasts. Autophagy upregulation induces local lung fibroblast hyperactivity and fibrosis. Several molecular triggers were found to induce lung fibroblast autophagy including TGFβ by inhibition of the PI3K/AKT/mTOR. However, physiologically, a balance is retained between autophagy inducers and inhibitors. Each type of autophagy plays its role in the initiation and progression of lung fibrosis. The pathogenesis of pulmonary fibrosis is multifactorial and involves dysfunction / dysregulation of alveolar epithelial cells, fibroblasts, monocyte-derived macrophages, and endothelial cells. The deposition of extracellular matrix proteins, the remodeling of the lung architecture and the molecular changes include impaired glycolysis, mitochondrial oxidation, gene expression modification, altered phospholipid and sphingolipid metabolism, and dysregulated protein folding lead to reprogramming of lung fibroblast into myofibroblast and their activation. The paper thoroughly addresses the molecular triggers and inhibitors of lung fibroblast autophagy in lung fibrosis.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and also a leading cause of morbidity and mortality worldwide. The frequent readmissions of patients with COPD may reduce lung function, mental health, and quality of life; it also increases the cost of treatment and mortality rate. Some common factors that may increase the readmission frequency of COPD patients include delay of diagnosis, advanced lung function decline, lack of adherence for COPD treatment, ineffective management of comorbidities, acute exacerbation or stable COPD, and infections. However, these factors might be well controlled with appropriate approaches to minimize the readmission of patients with COPD. In this review, we propose a strategy with a seven-step approach to reduce the readmission in COPD patients, including early diagnosis of COPD, optimal treatment for stable COPD, targeted management of comorbidities, adequate therapy for acute exacerbations, individualized action plans for COPD patients, effective prevention of bacterial and viral infections, and adaptive program of pulmonary rehabilitation. Thus, implementing this approach may reduce the risk of readmission in patients with COPD.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV 2) has become a global threat that has led to tremendous societal instability. The SARS-CoV- 2 can exhibit a drastic variation in terms of the signs and symptoms in the patient’s body. This virus manifests its existence through cough, fever, sore throat, body aches, chest pain, headaches, and dyspnoea. These can lead to life-threatening respiratory insufficiency, thereby affecting several other organs such as the kidney, heart, lungs, liver, and nervous system. The lungs are the primary target site for SARS-CoV-2 and several diagnoses are being deployed in real time for treatment purposes. Although chest CT is the standard method for early diagnosis and management of Coronavirus Disease (COVID-19), lung ultrasound (US) has some merits over chest CT and may be used in addition to it in the workup of COVID-19. The goal of our review is to look at the observations of the reports on lung ultrasound in COVID-19 patients and the current advances.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality globally. It is associated with a low quality of life and socio-economic burden. Airway destruction in COPD pathogenesis is primarily due to the three mechanisms: protease-antiprotease imbalance, chronic airway inflammation, and oxidative stress, which is triggered by exposure to harmful particles, such as cigarette smoking. Neutrophil Elastase (NE), a serine protease stored in azurophilic granules of neutrophils, actively participates in airway remodeling and microbiocidal activity. It hydrolyzes elastin, collagen, and other vital Extracellular Matrix Proteins (EMP) in the respiratory tissue. In addition, neutrophil elastase activates other principal proteinases such as matrix metalloprotease (MMP)-2, MMP-9, Cathepsin B, Meprin α protease, and Calpain that amplify EMP degradation. Macrophage, the primary leukocyte, responsible for lung parenchymal inflammation in COPD, is also activated by NE. However, neutrophil elastase level is positively correlated with the degree of airway inflammation and disease severity. Neutrophil elastase activates reactive oxygengenerating systems such as Nicotinamide Adenine Dinucleotide Phosphate (NADPH) oxidase and myeloperoxidase and it also generates mitochondrial-derived-reactive oxygen species formation by inducing the secretion of Interleukin (IL)-1 and Tumour Necrosis Factor (TNF)- α. In addition, neutrophil elastase stimulates respiratory cell apoptosis by direct (e.g., activating the caspase-3 pathway) and indirect mechanisms (e.g., by secretion of Neutrophil Extracellular Traps). Surprisingly, neutrophil elastase may have small anti-inflammatory properties. In conclusion, neutrophil elastase is one of the main culprits responsible for COPD pathogenesis by mediating the activation of Triad COPD pathogenesis.

Background: Among First Nations adults living in OECD nations bronchiectasis appears at a particularly heightened rate, due to high childhood incidence, and high prevalence of associated risk factors. To date, however, the extent of the bronchiectasis disease burden among adult First Nations people has not been formally assessed. Methods: Two databases (Pubmed and Scopus) were reviewed for English literature published from January 2000 to March 2022 pertaining to bronchiectasis among adult First Nations indigenous people residing in OECD nations. All studies that reported on prevalence, incidence, or outcomes (i.e., hospitalisations, mortality) directly associated with bronchiectasis were included. Studies that did not provide indigenous specific, bronchiectasis specific data, or were paediatric studies were excluded. Participant numbers and demographics, bronchiectasis prevalence or incidence, respiratory comorbidities and outcomes including mortality, hospitalisations or univariate or multivariate modelling to describe the risk of bronchiectasis and outcomes were tabulated. Results: Twenty-five studies were included, drawn from Australia (n=16), New Zealand (n=7) and North America (n=1), with most studies (n=21) reporting on referred populations. A median number of participants was 241 (range 31 to 1765) (excluding nationwide hospitalisation datasets (n=3)) with a mean age of 48.4 years, and 55% females. The hospital admission rate for bronchiectasis was 3.5x to 5x higher among Māori compared to non-Māori New Zealanders, and 5x higher in indigenous compared to non-indigenous Australians. Mortality ranged from 10 to 56% on follow-up. Conclusion: Bronchiectasis disease burden is higher among adult First Nations indigenous populations, presenting earlier with high mortality and hospitalisation rate. Further studies are required to address this inequality.

Background: Lung cancer patients have a higher chance of getting infected and showing severe outcomes from coronavirus disease 2019 (COVID-19). This infection influences the respiratory system, albeit other organs are also involved with high risk related to health. The blend of COVID-19 disease and lung cancer predicts a higher mortality rate and more serious clinical results. Objective: This research reports the Systematic Review and Meta-analysis correlation between COVID-19 patients with lung cancer and comprehensive proof with regards to the mortality of these patients. Methods: A systematic review and meta-analysis were planned to evaluate the data from a PubMed systematic search on Lung Cancer Patients reported by COVID-19, as well as an efficient literature review and information research from 2019 to 2021. Results: 22 out of 3639 review and research literature assessments were gathered, and 10951 patients were COVID +ve and suffering from cancer, with 21% of the patients suffering from SCLC and NSCLC, and lung cancer accounting for 6% of the mortality. Conclusion: Lung cancer patients who are suffering from COVID-19 additionally reflected the seriousness of the illness and higher rates of intensive care unit confirmations and mechanical ventilation. COVID-19 in patients with lung cancer is related to extreme disease and expanded mortality compared with patients with different tumours. There is conflicting proof of explicit lung cancer therapies' results. Until more conclusive data is available, lung cancer-coordinated therapy should be restarted as soon as possible in mild to moderate cases to avoid decline and cancer-related mortality.

Background: Obstructive Sleep Apnea (OSA) is a disorder caused by the repetitive collapse of the upper airway during sleep. The pathophysiology of health problems related to OSA is most strongly linked to irregular hypoxia, which results in cell function damage. In our investigation, no determinants of the OSA were found. Objective: The aim of this study was to assess obstructive sleep apnea among adult hypertensive patients on follow-up at Jimma Medical Center (JMC) in 2020. Methods: An institution-based descriptive cross-sectional study was carried out at the JMC clinic during follow-up care. All hypertensive patients who attended the JMC's chronic follow-up clinic were our baseline populations, while those who gave their consent and met our inclusion criteria during the study period were enrolled as study participants. The data were sorted and entered into the computer using Epi-data version 3.1 and exported to the Statistical Package for Social Sciences (SPSS) version 20.0 for analysis. Descriptive statistics were shown in frequency, percentage, and mean. Results: A total of 291 adult hypertension patients on follow-up care at the JMC were included in the study, comprising 155 (53.3%) men and 136 (46.7%) women. The age of the participants ranged from 28 to 74 years, and the mean age was 51 years. Of the 291 hypertensive patients screened for OSA using the STOP-Bang questionnaire, 187 (64.3%) were classified as high risk for OSA. Conclusion: The present study showed that the prevalence of OSA is considerably high, with remarkable fluctuations and increases with age. It is also associated with gender. Moreover, men are reported to be the most affected by OSA compared to women.

Background: Fractional Exhaled Nitric Oxide (FENO) is currently used as a biomarker of airway inflammation in patients with asthma. However, the role of alveolar nitric oxide (CANO) in asthmatic children has not been clearly demonstrated. Methods: It was a prospective and descriptive study. The measurement of FENO and CANO, spirometry, blood eosinophil counts (BEC), and total IgE levels were performed for each study subject. Results: This study included 109 uncontrolled asthmatic children without inhaled corticosteroid (ICS) treatment. The exhaled NO level in asthmatic patients was significantly higher than in control subjects: FENO: 22.5 vs. 8.4 ppb; CANO: 5.9 vs. 2.8 ppb; J’awNO (maximum airway nitric oxide flux): 56.9 vs. 18.7 ppb; respectively. The sensitivities and specificities for asthma diagnosis with the cut-off of CANO at 3.5 ppb and 5.0 ppb were 74.3% and 73.3%, and 46.0% and 83.3%, respectively. There were the moderate and the weak correlations between CANO with FENO and CANO with IgE in asthmatic patients (r = 0.465, 95%CI (0.133-0.659), P=0.001; r=0.133, 95%CI (0.068- 0.497), P=0.184; respectively). The percentage of controlled asthma in patients with CANO ≥5 ppb at inclusion was higher than that in CANO <5 ppb group. Conclusion: Exhaled NO is a relevant biomarker of allergic asthma. The level of FENO and CANO might be used to predict asthma control in children.

Introduction: The SARS-CoV-2 made the world stop its activities, and the only chance of returning to normal life is the vaccine. But like any vaccination, some complications have been reported. We report the case of a patient who presented a myositis following the administration of the Covishield* (AZD1222, ChAdOx1 nCoV-19, AstraZeneca) COVID-19 vaccine. Case Report: 12 hours after his first dose, an 84-year-old patient presented to us reporting a decreased muscle strength: the patient can move against gravity but not against resistance. The biological assessment showed that CK was at 4,250 IU/L, myoglobin was at 144 microgram/L and aldolases at 16.9 U/L. The patient received high doses of corticosteroids. Discussion: The development of vaccines and immunization programs reduced the morbidity and mortality of several diseases. Other case reports suggested the possible association between myopathies and the administration of the hepatitis B vaccine and H1N1 plus the seasonal trivalent influenza and other vaccines. The exact mechanism is still unknown, but a presumable autoimmune phenomenon is incriminated. Conclusion: The main purpose of this case report is to raise awareness about the possible link between the COVID-19 vaccination and polymyositis and the urge to take charge to avoid further complications.

Background: Intrathoracic teratoma is a form of germ cell tumors and is mostly found in the anterior mediastinum. Isolated intrapulmonary teratoma (IPT) is by far a rarity. The clinical presentation is often non-specific and radiological images - in most cases-are not sufficient to establish a final diagnosis. Surgical resection is the gold standard curative treatment after proper preoperative assessment. Case Presentation: In this case report, we describe a case of an IPT in a 33-year-old female patient who presented with hemoptysis, and was successfully treated with right upper lobe resection. The diagnosis was histologically proven as a mature IPT. Conclusion: IPT is extremely rare. Surgical resection is the standard gold method for diagnostic and curative purposes. Strict preoperative assessment should be performed to exclude other cases of lung masses.