Clinical characteristics of chronic obstructive pulmonary disease in never-smokers: A systematic review

Introduction Chronic Obstructive Pulmonary Disease (COPD) is the third cause of death worldwide. While tobacco smoking is a key risk factor, COPD also occurs in never-smokers (NS). However, available evidence on risk factors, clinical characteristics, and natural history of the disease in NS is scarce. Here, we perform a systematic review of the literature to better describe the characteristics of COPD in NS. Methods We searched different databases following the PRISMA guidelines with explicit inclusion and exclusion criteria. A purpose-designed quality scale was applied to the studies included in the analysis. It was not possible to pool the results due to the high heterogeneity of the studies included. Results A total of 17 studies that met the selection criteria were included, albeit only 2 of them studied NS exclusively. The total number of participants in these studies were 57,146 subjects, 25,047 of whom were NS and 2,655 of the latter had NS-COPD. Compared to COPD in smokers, COPD in NS is more frequent in women and older ages, and is associated with a slightly higher prevalence of comorbidities. There are not enough studies to understand if COPD progression and clinical symptoms in NS are different to that of ever-smokers. Conclusions There is a significant knowledge gap on COPD in NS. Given that COPD in NS account for about a third of all COPD patients in the world, particularly in low-middle income countries, and the decrease in tobacco consumption in high income countries, understanding COPD in NS constitutes a public-health priorityThis work was supported by the Instituto de Salud Carlos III (ISCIII)/PI20/00476/Cofinanciado Unión Europea (UE-FEDER) and Grupo de referencia competitiva Xunta de GaliciaS

Expansion of different subpopulations of CD26−/low T cells in allergic and non-allergic asthmatics

CD26 displays variable levels between effector (TH17 ≫ TH1 > TH2 > Treg) and naïve/memory (memory > naïve) CD4+ T lymphocytes. Besides, IL-6/IL−6R is associated with TH17-differentiation and asthma severity. Allergic/atopic asthma (AA) is dominated by TH2 responses, while TH17 immunity might either modulate the TH2-dependent inflammation in AA or be an important mechanism boosting non-allergic asthma (NAA). Therefore, in this work we have compared the expression of CD26 and CD126 (IL-6Rα) in lymphocytes from different groups of donors: allergic (AA) and non-allergic (NAA) asthma, rhinitis, and healthy subjects. For this purpose, flow cytometry, haematological/biochemical, and in vitro proliferation assays were performed. Our results show a strong CD26-CD126 correlation and an over-representation of CD26− subsets with a highly-differentiated effector phenotype in AA (CD4+CD26−/low T cells) and NAA (CD4−CD26− γδ-T cells). In addition, we found that circulating levels of CD26 (sCD26) were reduced in both AA and NAA, while loss of CD126 expression on different leukocytes correlated with higher disease severity. Finally, selective inhibition of CD26-mRNA translation led to enhanced T cell proliferation in vitro. These findings support that CD26 down-modulation could play a role in facilitating the expansion of highly-differentiated effector T cell subsets in asthma.This work was supported by grants from Sociedad Española de Neumología y Cirugía Torácica, (SEPAR) (121/2012) and Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (Fondo de Investigación Sanitaria, FIS; co-financed by European Union ERDF funds) (PI13/02046). JJN-F is a recipient of a Xunta de Galicia Fellowship (co-financed by European Social Fund (ESF))S

Trend di ospedalizzazione nell’asma dell’adulto: effetto di età e genere

Background: Hospital admissions due to asthma are a reliable source of information on the morbidity of the disease which, after the increase observed in the last quarter of the last century, shows a declining trend in the last few years. The aim of this study was to look at hospital admission trends due to asthma in our community and analyze some of its associated factors. Methods: Retrospective analysis of all hospital admissions involving adults aged 15 years and older with asthma as the primary or secondary diagnosis (if the first diagnosis was respiratory failure or respiratory infection) in Public Health Service hospitals in the Galician region of Spain between the years 1995-2009 (total 24,766 admissions). Results: The majority of patients admitted were female (71%), over 60 years of age (64%), and admission occurred predominantly in the winter months. The hospitalization rate due to asthma tripled over the period studied, this being mainly accounted for by women aged over 60 years. Mean hospital stay was 9.2 days, longer in older patients or those admitted over the weekend. Conclusions: A significant increase in hospital admissions due to asthma over the last few years has been observed in our community, mainly involving older women. The mean stay seems long, increasing with patients' age and admission over the weekend.Razionale: I ricoveri ospedalieri dovuti ad asma sono una fonte d’informazione attendibile sulla morbilità della patologia che, dopo un incremento osservato nell’ultimo quarto del secolo scorso, è in fase di declino negli ultimi anni. Scopo di questo studio era descrivere i trend di ospedalizzazione per asma nella nostra comunità ed analizzare alcuni dei fattori associati. Metodi: Analisi retrospettiva di tutte le ospedalizzazioni di adulti dai 15 anni in su per asma come diagnosi primaria, o come diagnosi secondaria in caso la prima diagnosi fosse insufficienza respiratoria o un’infezione respiratoria, in ospedali pubblici della regione Galizia della Spagna tra gli anni 1995 e 2009 (totale dei ricoveri: 24.766). Risultati: La maggioranza dei pazienti ricoverati erano femmine (71%), di età superiore a 60 anni (64%) e la maggior parte degli accessi avveniva nella stagione invernale. Il tasso di ospedalizzazione per asma è triplicato nel periodo studiato, soprattutto per le donne di età superiore a 60 anni. La durata media del ricovero era di 9,2 giorni, più prolungata nei pazienti più anziani ed in coloro che erano ricoverati nel fine settimana. Conclusioni: Un significativo incremento delle ospedalizzazioni per asma negli ultimi anni è stato osservato nella nostra comunità, soprattutto a carico delle donne più anziane. La durata media del ricovero appare lunga ed aumenta con l’età del paziente e nei ricoveri del fine settimana.S

Residential radon and characteristics of chronic obstructive pulmonary disease

It is not known whether residential radon exposure may be linked to the development of chronic obstructive pulmonary disease (COPD) and/or have an influence on the functional characteristics or exacerbations of COPD. The aim of this study was therefore to ascertain whether there might be an association between residential radon concentrations and certain characteristics of COPD. We analyzed COPD cases drawn from a case–control study conducted in an area of high radon exposure. Data were collected on spirometric pulmonary function variables, hospital admissions, and smoking. Radon measurements were taken using alpha-track-type CR-39 detectors individually placed in patients’ homes. All statistical analyses were performed using the IBM SPSS v22 computer software program. The study included 189 COPD cases (79.4% men; median age 64 years). The median radon concentration was 157 Bq/m3. No differences were found between radon concentration and sex, age or severity of breathing obstruction as measured by FEV1%. It should be noted, however, that 48.1% of patients with FEV1%  600 Bq/m3 exhibited no different characteristics in lung function. Exposure to radon does not appear to have an influence on the clinical characteristics of smokers and ex-smokers with COPD. As exposure to residential radon increases, there is no trend towards a worsening of FEV1%. Further studies are thus needed to analyze this possible association in never-smokers with COPDSpanish Society of Pneumology & Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica—SEPAR), competitive Project Number 439, call 2018S

The CD14 (−159 C/T) SNP is associated with sCD14 levels and allergic asthma, but not with CD14 expression on monocytes

LPS-ligation to CD14/TLR-4 on monocytes/macrophages triggers the production of IL-12-family cytokines. IL12/18 promote TH1-differentiation, counteracting the TH2-driven asthma. Therefore, CD14 modulation could alter the TH2-differentiation and should be taken into account when studying asthma. To analyse the alteration in CD14 levels and its association with CD14 (−159 C/T) SNP (rs2569190) in Caucasian adults with stable allergic asthma, we performed a cross-sectional study (277 healthy subjects vs. 277 patients) where clinical parameters, CD14 values and the CD14 (−159 C/T) SNP were studied. Apart from typical biomarkers, we found an increment of neuron-specific enolase (NSE) in allergic asthma, probably linked to monocyte activity. Indeed, we evidenced increased monocyte numbers, but lower CD14 expression and normalised sCD14 values in patients. Moreover, we noticed an association of the T allele (P = 0.0162) and TT genotype (P = 0.0196) of the CD14 SNP with a decreased risk of allergic asthma and augmented sCD14 levels. In conclusion, monocyte CD14 expression and normalized sCD14 values were reduced in stable state asthmatics, and this could be related to the presence of an expanded CD14low monocyte subset. This study also demonstrates that the CD14 (−159 C/T) polymorphism is a risk factor for moderate-severe allergic asthma in adult CaucasiansThis study was funded by grants from Sociedad Española de Neumología y Cirugía Torácica, (SEPAR) (121/2012) and Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (Fondo de Investigación Sanitaria, FIS; co-financed by European Union ERDF funds) (PI13/02046). JJNF is a recipient of a Xunta de Galicia Fellowship (Co-financed by European Social Fund (ESF))S

Influenza A H1N1 Community-Acquired Pneumonia: Characteristics and Risk Factors—A Case-Control Study

Introduction. Influenza A H1N1 community-acquired pneumonia (CAP) is a quite frequent respiratory disease. Despite being considered more serious than other CAPs, there are very few studies comparing its characteristics with noninfluenza CAP. We aim to establish the differences between pneumonia due to H1N1 virus and pneumonia not caused by H1N1 influenza virus and to determine the probability that a pneumonia is due to an H1N1 virus infection based on the most relevant variables. Methods. We used a case-control study where cases were H1N1 CAP patients with confirmed microbiological diagnosis and controls were patients with CAP admitted to hospital. H1N1 and other influenza types were discarded among controls. We calculated the probability of being a case or control using multivariate logistic regression. Results. We included 99 cases and 270 controls. Cases were younger than controls (53 vs 71 years, respectively). Mortality was much higher for H1N1 patients (13% vs 0.3%), and admission to intensive care unit was more frequent for H1N1 cases. The variables most associated with presenting H1N1 CAP were bilateral affectation on chest X-rays (OR: 5.70; 95% CI 2.69–10.40), followed by presence of arthromyalgias, with cases presenting close to three times more arthromyalgias compared to controls. Low leukocytes count and high AST values were also significantly associated with H1N1 CAP. H1N1 CAPs are characterized by bilateral affectation, low leukocyte count, presence of arthromyalgias, and high AST. Conclusions. A few and easy to obtain clinical parameters might be extremely useful to distinguish H1N1 CAP from CAPs of other origin.S

100 años investigando el mar. El IEO en su centenario (1914-2014).

Se trata de un libro que pretende divulgar a la sociedad las principales investigaciones multidisciplinares llevadas a cabo por el Instituto Español de Oceanografía durante su primer siglo de vida, y dar a conocer la historia del organismo, de su Sede Central y de los nueve centros oceanográficos repartidos por los litorales mediterráneo y atlántico, en la península y archipiélagos.Kongsberg 20

La obesidad no aumenta el riesgo de reingresos de asma

The relationship between obesity and asthma exacerbations is still under debate. The aim of our work is to analyse the relationship between obesity and hospital re-admissions in asthmatics. A review was retrospectively performed on all hospital admissions of adult patients due to asthma exacerbation occurring in our hospital for 11 years. All those cases with asthma as the first diagnosis in the discharge report were included, or those with asthma as the second diagnosis provided when the first diagnosis was respiratory infection or respiratory failure. Only the first hospital admission of each patient was included in this study. The Odds Ratios of a higher incidence of early/late readmissions due to asthma exacerbation were calculated using a binary logistic regression, using the body mass index (BMI) as independent variable, adjusted for all the variables included in the study. The study included 809 patients with a mean age of 55.6 years, and 65.2% were female. The majority (71.4%) were obese or overweight. No significant relationship was observed in the univariate or multivariate analyses between overweight or obesity and the early or late hospital readmissions due to asthma. Therefore, obesity does not seem to be a determining factor in the risk of asthma exacerbations.S

100 años investigando el mar. El IEO en su centenario (1914-2014).

Se trata de un libro que pretende divulgar a la sociedad las principales investigaciones multidisciplinares llevadas a cabo por el Instituto Español de Oceanografía durante su primer siglo de vida, y dar a conocer la historia del organismo, de su Sede Central y de los nueve centros oceanográficos repartidos por los litorales mediterráneo y atlántico, en la península y archipiélagos.Kongsberg 200Postprin