Current Respiratory Medicine Reviews - Volume 21, Issue 2, 2025

Clinical decision support systems (CDSS) are systems which analyse and present data so that users can make decisions more easily and are suggested as part of the solution to poor adoption of guidelines.

The aim of this review was to describe the literature on CDSS in chronic respiratory disease management, their function and the features that may impact their effectiveness.

The electronic databases PubMed, MEDLINE, EMBASE, Web of Science, the trial registries Cochrane Central Register of Controlled Trials, EU Clinical Trial Register, ClinicalTrials.gov and World Health Organisation (WHO) trial registry were searched with the aid of a medical librarian. All searches began from September 2019 to March 2021.

Data from relevant studies were extracted independently by 2 review authors using Covidence software and Microsoft Excel. Study quality was assessed. CDSS description and indication, function and the theory underpinning the CDSS (e.g., guidelines, expert opinion, etc.) were themed and summarised. The presence or absence of the important CDSS features were recorded i.e., (i) computer-based decision support, (ii) automatic provision of decision support as part of clinician workflow, (iiii) provision of decision support at the time and location of decision-making and (iv) provision of recommendations rather than just assessments.

Of the 2647 articles screened, 27 papers or abstracts (n = 22 full text and n = 5 abstracts) describing 26 studies met all inclusion and exclusion criteria.

The 26 studies evaluated asthma care (n = 16), COPD care (n = 9) and both asthma and COPD care (n = 1). The highest level of evidence was generated by RCTs (n = 7).

The 26 studies described 24 different CDSS. Most were based solely or in part on clinical and best practice guidelines. Whilst most CDSS had multiple functions, which were wide ranging, medicines management was the most prevalent function. Most systems had 3 out of 4 of the specific system features that have been correlated with improvements in clinical practice.

Generally, in both controlled studies and in other study designs, patient and process outcome measures were commonly reported with performance outcomes measures less commonly reported. Fewer positive effects were reported in the higher quality studies (i.e., controlled studies). The success rate of the CDSS was higher in those studies that had 3 out of the 4 important CDSS features.

This review demonstrates that CDSS can improve chronic respiratory disease management processes, performance and clinical outcomes in adult patients with asthma and COPD. Results from non-controlled study designs provided valuable information on important process and performance outcomes, including healthcare utility.

Chronic Obstructive Pulmonary Disease (COPD) poses a growing health challenge globally, contributing to declining lung function and increased mortality rates. Therefore, we have investigated the level of eosinophilia in sputum and the blood in patients with COPD.

In this cross-sectional study, ninety-four patients were selected from the Afzalipur Hospital's pulmonary department. Eosinophil levels were measured in both blood and lung sputum samples. Demographic data, acute attack frequency in the last year, smoking history, and residence details were also recorded.

The study revealed a significant elevation in eosinophils in lung sputum, particularly in male smokers, indicating associations with inflammatory reactions and structural lung changes. Additionally, residing in urban areas correlated with increased eosinophil counts in lung sputum.

This study highlights eosinophils' key role in COPD exacerbations, influenced by factors like smoking and urban living. Assessing eosinophil levels in lung sputum helps evaluate inflammation and allergies in COPD patients, managing personalized treatment.

Long-term impacts of inhaled corticosteroids (ICSs) on metabolic parameters of asthmatic children are still uncertain.

This study aimed to evaluate the effects of long-term use of ICSs on metabolic and anthropometric measures among children with asthma in Iran.

This case-control study was conducted among 200 pediatric asthmatic patients who were referred to Abuzar Hospital (Ahvaz, Iran) during nine months. Demographic and clinical data of the patients were recorded. The participants were categorized into two groups: Group 1 (n = 100) comprising children with moderate to severe asthma, and Group 2 (n = 100) consisting of those with mild asthma.

The average age of 200 patients was 8.1 ± 2.9 years. The majority of them were male. The prevalence of wasting, stunting, obesity, and overweight was higher among Group 1 compared to Group 2 (p < 0.05). Patients in Group 1 had significantly higher levels of calcium, vitamin D, lipids, and glycemic parameters than those in Group 2 (p < 0.05). In addition, the duration of ICS use was notably longer in Group 1 (p < 0.05).

Children with moderate and severe asthma had significantly elevated lipid and glycemic parameters, as well as a higher prevalence of wasting, stunting, obesity, and overweight compared to patients with mild asthma. Further studies involving larger sample sizes and longer durations are necessary to confirm these findings.

Pulmonary sequestration is a rare birth defect. It is a nonfunctioning dysplastic lung tissue without connection to the tracheobronchial tree, and its blood supply is from one or more aberrant systemic arteries. The aim of this study is to review the current literature regarding the role of video-assisted thoracic surgery (VATS) in the management of pulmonary sequestration.

This review aims to assess the safety, efficacy, and outcomes of Video-Assisted Thoracoscopic Surgery (VATS) in managing pulmonary sequestration while considering patient characteristics, symptoms, arterial sources, surgical techniques, and postoperative advantages.

The Web of Science, PubMed, MEDLINE, and Google Scholar were searched for articles published in English. Article titles containing the words “Video-Assisted Thoracoscopic Surgery for Pulmonary Sequestration and/or VATS” were filtered out of the search to exclude a large portion of irrelevant studies. The extracted data were analyzed. The data extracted were presented as frequencies and percentages.

After excluding the unrelated articles, 27 studies were identified for analysis; most of the studies (18) were case reports, with nine being case series, and the total number of patients who underwent pulmonary sequestration by VATS was 240. Both genders were equally affected (125, 52% were male and 115, 48% were female), the most common presenting symptom was coughing,and the descending thoracic aorta was the most common artery from which the feeders originated. About 149 patients (62.08%) underwent a lobectomy.

Pulmonary sequestration can safely be treated by VATS at single or multiple ports with a shorter hospital stay, less postoperative pain, and fewer analgesic requirements.

Bronchiectases are structural alterations characterized by the dilation of bronchial walls due to inflammation, resulting in a loss of elasticity and muscle function. They are more common in adults than children and have various etiologies (such as chronic infections, particularly in developing countries, or immunodeficiencies in industrialized nations), with up to 40% being idiopathic.

We reported the case of a nine-year-old child who, following two lower respiratory tract infections (a severe H1N1 influenza pneumonia and a milder episode caused by M. pneumoniae), developed bronchiectasis without underlying predisposing conditions.

Bronchiectasis is a morphological alteration of the bronchi, which can develop subsequently to lung infections and may remain clinically silent even for a long time. The most common associated symptoms include productive cough, persistent rales, therapy-resistant “asthma,” and recurrent lung infections. High-Resolution CT (HRCT) scans are the gold standard for their diagnosis, while their management requires a comprehensive approach, including pharmacological and psychosocial measures. It is always advisable to investigate the underlying etiology to eventually establish a causal treatment.

This study aims to emphasize that not only bacteria but also viral infections and their associated inflammatory impact on lung tissue can contribute to the development of bronchiectasis. This study aims to implement current knowledge regarding non-cystic fibrosis-related bronchiectasis and to underscore the significance of post-acute instrumental reassessment in lower respiratory tract infections, especially when severe.

Spirulina algae are widely used in food, cosmetic, and dietary applications, and laboratory and clinical studies have reported their antiviral and immune-enhancing properties.

We aimed to evaluate the prescription of spirulina, a safe food supplement with antiviral properties, and N-acetylcysteine in the treatment of hospitalized patients with Coronavirus Disease 2019 (COVID-19).

This study was conducted as a multicenter, randomized, single-masked, open-label phase II clinical trial on 66 patients with COVID-19. Patients were randomly assigned to two intervention groups and one control group. The intervention groups were defined as follows: one group received spirulina algae (23 people), and the other group received N-acetylcysteine plus spirulina algae (21 people). In the control group (22 people), the patients only received the national standard treatment for COVID-19. The intervention groups were prescribed 80 mg/kg of spirulina green algae daily.

The duration of hospitalization (P = 0.874), Intensive Care Unit (ICU) admission (P = 0.320), and mortality (P = 0.320) of patients between the three groups did not show any significant difference. Side effects, including headache (P = 0.022) and nausea (P = 0.039), were significantly less common in the control group. No statistically significant difference was observed regarding the frequency of symptoms after discharge in the three-month follow-up (P = 0.420).

Our study showed that administering spirulina with or without N-acetylcysteine did not affect the length of hospitalization, ICU admission, mortality, and the frequency of symptoms or long COVID.

IRCT20220509054793N1.