Role Of Particulate Matter On Emergency Department Visits For Asthma Exacerbation

Purpose To assess the correlation between progressive PM levels and Asthma Exacerbation events, we investigated the role of short-term PM exposure in the increase of Emergency Department (ED) admissions in Brescia. Methods We conducted an analysis of clinical records of ED admissions for Asthma Exacerbation, starting from January 2014 to December 2017. Daily PM levels were collected from the Environmental Protection Regional Agency (ARPA). We performed a time-series analysis using a Poisson regression model with single and multiple day-lag. Results were expressed as Relative Risk (RR) and Excess of Relative Risk (ER) of Asthma Exacerbation-related ED admissions, over a 10μg/m3 increase in PM10 and PM2.5 concentration. Results We included 543 admissions. The time-series study revealed an increase of the RR (CI95%) for Asthma Exacerbation-related ED admissions of 1.24 with an ER of 24.15% for PM2.5 at lag0-1 (p<0.05). We also documented a RR (CI95%) of 1.12 with an ER of 12.53% at lag0-5 (p≤0.05). We then studied the population living exclusively in the city, obtaining a RR (CI95%) for PM10 and PM2.5 respectively of 1.21 and 1.34 with ERs of 20.82% and 33.75% at lag01 (p<0.05). Lastly we evaluated the increase of hospitalizations after ED admission. For this event we documented a RR (CI95%) of 1.31 with an ER of 30.67% for PM2.5 at Lag01 (p<0.05). Conclusions Short-term PM exposure acts a critical role in inducing Asthma exacerbation events, especially PM2.5. Clinical Implications Rising pollution plays a crucial role in developing several respiratory diseases. Particulate Matter (PM)-induced Asthma Exacerbation is one of the most life-threating events

Evaluating the Emergency Department admission and hospitalization trend for COPD Exacerbation and time-dependent Particulate Matter exposure

Purpose We evaluated the relationship between short-term exposure to PM10 – PM2.5 and COPD Exacerbation, in terms of Emergency Department (ED) admissions and their outcomes in Brescia, one of the most polluted European cities. Methods ED admission data from 431 patients with diagnosis of COPD Exacerbation were collected, starting from January 2014 to January 2016. Daily PM levels were collected from the Environmental Protection Regional Agency (ARPA). A time-series study, using the Poisson regression model with single and multiple day-lag, has been performed. Results were expressed as Relative Risk (RR) and Excess of Relative Risk (ER) for COPD Exacerbation-related ED admissions and hospitalizations, over a 10µg/m3 increase in PM concentration. Results Both PM10 and PM2.5 were significantly associated with the risk of COPD exacerbation-related ED admission and hospitalization. Each increase of 10µg/m3 of PM10 and PM2.5 corresponded respectively to a RR(CI95%) for ED admissions of 1.06 and 1.08 in lag0-1; 1.06 and 1.09 in lag0-5 (p<0.05). Similar results for COPD Exacerbation-related hospitalizations have been found, with a RR of 1.07 and 1.10 in lag0-1; 1.07 and 1.11 in lag0-5. Conclusions Our findings show that an increasing exposure to PM10-PM2.5 is associated to higher ED admission and increasing hospitalizations due to COPD exacerbation. Clinical Implications Short-term exposure to elevated Particulate Matter (PM) concentrations can cause a worsening of several respiratory conditions

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors