Chronic cough due to occupational factors

Within the large variety of subtypes of chronic cough, either defined by their clinical or pathogenetic causes, occupational chronic cough may be regarded as one of the most preventable forms of the disease. Next to obstructive airway diseases such as asthma or chronic obstructive pulmonary disease, which are sometimes concomitant with chronic cough, this chronic airway disease gains importance in the field of occupational medicine since classic fiber-related occupational airway diseases will decrease in the future. Apart from acute accidents and incidental exposures which may lead to an acute form of cough, there are numerous sources for the development of chronic cough within the workplace. Over the last years, a large number of studies has focused on occupational causes of respiratory diseases and it has emerged that chronic cough is one of the most prevalent work-related airway diseases. Best-known examples of occupations related to the development of cough are coal miners, hard-rock miners, tunnel workers, or concrete manufacturing workers. As chronic cough is often based on a variety of non-occupational factors such as tobacco smoke, a distinct separation into either occupational or personally -evoked can be difficult. However, revealing the occupational contribution to chronic cough and to the symptom cough in general, which is the commonest cause for the consultation of a physician, can significantly lead to a reduction of the socioeconomic burden of the disease

Respiratory parameters at varied altitudes in intermittent mining work

Objectives: Workers in the mining industry in altitude are subjected to several risk factors, e.g., airborne silica and low barometric pressure. The aim of this study has been to assess the risks for this work category, evaluating single risk factors as airborne silica, altitude and work shift, and relating them with cardiovascular and ventilatory parameters. Material and Methods: Healthy miners employed in a mining company, Chile, working at varied altitudes, and subjected to unusual work shifts, were evaluated. Cardiovascular and respiratory parameters were investigated. Exposure to airborne silica was evaluated and compared to currently binding exposure limits. Results: At varied altitudes and work shifts, alterations emerged in haemoglobin, ventilation and respiratory parameters, related to employment duration, due to compensatory mechanisms for hypoxia. Haemoglobin increased with altitude, saturation fell down under 90% in the highest mines. The multiple linear regression analysis showed a direct relationship, in the higher mine, between years of exposure to altitude and increased forced vital capacity percent (FVC%), and forced expiratory volume in 1 s (FEV1). An inverse relationship emerged between forced vital capacity (FVC) and years of exposure to airborne silica. In the workplace Mina Subterrànea (MT-3600), statistically significant inverse relationship emerged between the Tiffeneau index and body weight. Conclusions: The working conditions in the mining industry in altitude appeared to be potentially pathogenic; further investigations should be realized integrating risk assessment protocols even in consideration of their undeniable unconventionality

Developing a service for patients with very severe chronic obstructive pulmonary disease (COPD) within resources

Chronic obstructive pulmonary disease (COPD) is a common life-limiting illness with significant burden for patient and carer. Despite this, access to supportive and specialist palliative care is inconsistent and implementation of published good practice recommendations may be challenging within current resources. The aim of this service development was to improve local service provision in Barnsley, within the currently available resources, for patients with very severe COPD, to improve patient identification and symptom management, increase advance care planning and the numbers of patients dying in their preferred place, and increase patient and carer support and satisfaction. To do this a working group was formed, the service problems identified and baseline data collected to identify the needs of people with very severe COPD. A multidisciplinary team meeting was piloted and assessed by community matron feedback, patient case studies and an after death analysis. These indicated a high level of satisfaction, with improvements in advance care planning, co-ordination of management and support for patients' preferred place of care at the end of life. In conclusion this is the first reported very severe COPD service development established in this way and within current resources. Preliminary data indicates the development of the multidisciplinary team meeting has been positive. The appointment of a coordinator will aid this development. Further evaluations particularly seeking patient views and estimations of cost savings will be performed

Blood and sputum biomarkers in COPD and asthma: a review

Chronic obstructive pulmonary disease (COPD) and asthma are lung inflammatory diseases that represent major public health problems. The primary, and often unique, method to evaluate lung function is spirometry, which reflects disease severity rather than disease activity. Moreover, its measurements strictly depend on patient's compliance, physician's expertise and data interpretation. The limitations of clinical history and pulmonary function tests have encouraged focusing on new possible tracers of diseases. The increase of the inflammatory response in the lungs represents an early pathological event, so biological markers related to inflammation may play key roles in earlier diagnosis, evaluation of functional impairment and prognosis. Biomarkers are measurable indicators associated with the presence and/or severity of a biological or pathogenic process, which may predict functional impairment, prognosis and response to therapy. The traditional approach based on invasive techniques (bronchoalveolar lavage and biopsies) may be replaced, at least in part, by using less invasive methods to collect specimens (sputum and blood), in which biomarkers could be measured. Proteomics, by the association between different protein profiles and pathogenic processes, is gaining an important role in pulmonary medicine allowing a more precise discrimination between patients with different outcomes and response to therapy. The aim of this review was to evaluate the use of biomarkers of airway inflammation in the context of both research and clinical practice

Effectiveness of Pulmonary Rehabilitation in Patients with COPD

Background: Pulmonary rehabilitation (PR) is beneficial for patients with COPD, with improvement in exercise capacity and health-related quality of life. Despite these overall benefits, the responses to PR vary significantly among different individuals. It is not clear if PR is beneficial for patients with COPD and normal exercise capacity. Although it is believed that longer pulmonary rehabilitation programs can provide better results, most of the evidence comes from short-term programs. Objective: The objective of this analysis was to determine the effectiveness of respiratory services provided in the hospital or community by respiratory therapists (RTs) in reducing health care utilization and improving patient outcomes. The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease. Methodology: All 65 Pakistani patients who met the inclusion criteria with ages between 40 to 65 years, including both male and female, with mild to severe COPD were enrolled in the study on the basis of convenient sampling. Informed consent was taken from each patient starting about the study and their rights to withdraw from study. A demographics detail (name, age, sex) was noted along with the necessary medical history. A questionnaire was made to see the effects of pulmonary rehabilitation in patients with COPD. All necessary tests were performed to evaluate the patient betterment completely. Results: The mean FEV1 in the subjects was 1.29 ± 0.47 L/min, 64.8 ± 23.0% of predicted. Clinically there is a little effect on CXR pattern, FEV1 and FEV1/FVC after pulmonary rehabilitation. But overall quality of life improved after pulmonary rehabilitation. Mainly improvement occurs in peak expiratory flow rate, BORG dyspnea scale, 6 mint walk test distance (meters) and Oxygen saturation after rehabilitation. Conclusion: These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Exercise training can result in significant improvement in health-related quality of life, exercise capacity, respiratory muscle strength, and exertional dyspnea in subjects with COPD and normal exercise capacity

Bronchiolitis obliterans.

Bronchiolitis obliterans in the adult patient is a relatively uncommon and vexing clinical entity. This confusion results because this pathologic finding occurs in a variety of diverse clinical settings. Bronchiolitis obliterans is a fibrotic process that primarily affects the small conducting airways. The lesion results from damage to the bronchiolar epithelium and the repair process leads to excessive proliferation of granulation tissue. The alveoli adjacent to the small airway are almost always involved; however, a considerable portion of the interstitium is usually spared. The findings in these patients may physiologically and radiographically mimic chronic obstructive pulmonary disease (COPD). On the other hand, some of the processes associated with bronchiolitis obliterans result in restrictive or mixed restrictive and obstructive ventilatory defects; consequently, they may be confused with other diffuse infiltrative lung disorders. This review will focus principally on bronchiolitis obliterans in adults, which, until recently, was considered rare. There has been heightened interest in this process in adults because of its association with the connective tissue diseases, its development following toxic fume exposure, its occurrence as a result of chronic graft versus host reactions, and the increasing recognition of patients with idiopathic forms of the disease that have an insidious onset often confused with more common problems such as COPD or idiopathic pulmonary fibrosis

PHT-bot: Deep-Learning based system for automatic risk stratification of COPD patients based upon signs of Pulmonary Hypertension

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. Identifying those at highest risk of deterioration would allow more effective distribution of preventative and surveillance resources. Secondary pulmonary hypertension is a manifestation of advanced COPD, which can be reliably diagnosed by the main Pulmonary Artery (PA) to Ascending Aorta (Ao) ratio. In effect, a PA diameter to Ao diameter ratio of greater than 1 has been demonstrated to be a reliable marker of increased pulmonary arterial pressure. Although clinically valuable and readily visualized, the manual assessment of the PA and the Ao diameters is time consuming and under-reported. The present study describes a non invasive method to measure the diameters of both the Ao and the PA from contrast-enhanced chest Computed Tomography (CT). The solution applies deep learning techniques in order to select the correct axial slice to measure, and to segment both arteries. The system achieves test Pearson correlation coefficient scores of 93% for the Ao and 92% for the PA. To the best of our knowledge, it is the first such fully automated solution

Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

Background Chronic Obstructive Pulmonary Disease (COPD) is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT) to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a) Tele-health supported Community COPD Service; or (b) Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist) then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a complex service delivered through a collaboration between local authority and health care partners. The implementation of this service demanded significant changes to established working patterns and has been a challenging process requiring considerable planning - a challenge that many providers are likely to face in the future. Trial registration Current Controlled Trials ISRCTN6885601