Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.CONTEXTE : L’objectif de ces normes cliniques est de fournir des conseils sur les « meilleures pratiques » en matière de diagnostic, de traitement et de prévention des maladies pulmonaires post-COVID-19. MÉTHODES : Un groupe d’experts internationaux représentant des sociétés scientifiques, des associations et des groupes actifs dans le domaine des maladies pulmonaires post-COVID-19 a été constitué ; 45 d’entre eux ont participé à un processus Delphi. Une échelle de Likert en 5 points a permis d’indiquer le niveau d’accord avec les projets de normes. La version finale a été approuvée par consensus (100% d’accord). RÉSULTATS : Quatre normes cliniques ont été approuvées pour les patients ayant des antécédents de COVID-19 : Norme 1, les patients présentant des séquelles non expliquées par un autre diagnostic doivent être évalués en vue d’une éventuelle maladie pulmonaire post-COVID-19 ; Norme 2, les patients présentant une altération de la fonction pulmonaire, une diminution de la tolérance à l’effort, une réduction de la qualité de vie (QoL) ou d’autres signes pertinents ou des symptômes persistants, quatre semaines ou plus après l’apparition des premiers symptômes, doivent être évalués en vue d’un traitement et d’une réadaptation pulmonaire (PR, de l’anglais ‘pulmonaire rehabilitation’) ; Norme 3, le programme de PR doit être basé sur des critères de faisabilité, d’efficacité et de rentabilité, organisé en fonction des services de santé locaux et adapté aux besoins individuels des patients ; et Norme 4, chaque patient qui suit et termine un programme de PR doit être évalué pour déterminer son efficacité et avoir accès à une session de conseil/éducation à la santé. CONCLUSION : Il s’agit du premier ensemble consensuel de normes cliniques pour le diagnostic, le traitement et la prévention des maladies pulmonaires post-COVID-19. Notre objectif est d’améliorer les soins et la qualité de vie des patients en guidant les cliniciens, les responsables de programmes et les responsables de la santé publique dans la planification et la mise en œuvre d’un programme de relations publiques pour la prise en charge des maladies pulmonaires post-COVID-19

919 Thunderstorm asthma in the mediterranean area: seasonal weather and effect on health for outdoor workers

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The Effect of Fire Smoke Exposure on Firefighters' Lung Function: A Meta-Analysis

Firefighters are exposed to a range of harmful substances during firefighting. Exposure to fire smoke has been associated with a decrease in their lung function. However, the cause-effect relationship between those two factors is not yet demonstrated. This meta-analysis aimed to evaluate the potential associations between firefighters' occupational exposure and their lung function deterioration. Studies were identified from PubMed, Web of Science, Scopus and Science Direct databases (August 1990-March 2021). The studies were included when reporting the lung function values of Forced Expiratory Volume in 1 s (FEV1) or Forced Vital Capacity (FVC). The meta-analyses were performed using the generic inverse variance in R software with a random-effects model. Subgroup analysis was used to determine if the lung function was influenced by a potential study effect or by the participants' characteristics. A total of 5562 participants from 24 studies were included. No significant difference was found between firefighters' predicted FEV1 from wildland, 97.64% (95% CI: 91.45-103.82%; I-2 = 99%), and urban fires, 99.71% (95% CI: 96.75-102.67%; I-2 = 98%). Similar results were found for the predicted FVC. Nevertheless, the mean values of firefighters' predicted lung function varied significantly among studies, suggesting many confounders, such as trials' design, statistical methods, methodologies applied, firefighters' daily exposure and career length, hindering an appropriate comparison between the studies

Sex and gender differences in tobacco smoking among adolescents in French secondary schools

Aim. We investigated the relationship between sex (genetic/biological) and gender (environmental/ cultural) factors in relation to adolescent tobacco smoking. Methods. A representative sample of 11,582 students from French secondary public schools participated in the study by completing a self-administered, standardised questionnaire. Results. Using the WHO classification for smoking in the youth, 15.6% of the adolescents were regular smokers, 7.7% occasional smokers, 17.9% experimental smokers and 4.8% ex-smokers, with no statistically significant gender difference. Taking non-smoking as a reference, puberty had a much greater effect on the likelihood of being a regular smoker [OR=18.0 (95% Confidence Interval: 9.6- 32)] than of being an experimental/occasional smoker [OR=3.7 (2.9-4.6)] among girls. For boys, the effect of puberty was not as great [OR=4.7 (3.5-6.5)] for regular vs. [OR=2.1 (1.8-2.5)] for experimental/occasional smokers). Similarly, illicit drug use had a larger effect on the likelihood of being regular smoker vs. non-smoker [OR=15.0 (12.0-20.0) in boys and 12 (8.8-16.0) in girls] than of being experimental/occasional smoker vs. a non-smoker [OR=4.8 (3.7-6.1) and 2.9 (2.1-3.9) respectively]. Other factors related to regular smoking were exposure to passive smoking and regular alcohol consumption. Living with both parents was a protective factor for life and regular smoking in both genders. Conclusions. Our results show that influential factors of sex-related (puberty), gender-specific (environmental tobacco smoking, alcohol consumption, drug abuse) or sex/gender (regular sexual intercourse) are related to the smoking behaviour in French adolescents

Issue 2 - “Update on adverse respiratory effects of indoor air pollution” Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective

Objective To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. Results Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. Conclusions Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity

Distribution and Etiology of Chronic Respiratory Diseases in Primary Healthcare Departments in Cape Verde

Data on chronic respiratory diseases (CRD) are scarce or unavailable in most African countries. We aimed to determine the prevalence of CRD and associated risk factors in Cape Verde, at the primary healthcare level

Third-hand smoking: indoor measurements of concentration and sizes of cigarette smoke particles after resuspension

International audienc

Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective

Objective: To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. Results: Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. Conclusions: Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.proofepub_ahead_of_prin