Effects of soaked hay on lung function and airway inflammation in horses with severe asthma.

BACKGROUND: Reducing inhaled dust particles improves lung function in horses with severe asthma. Soaked hay is commonly used by owners, but its efficacy in improving lung function and inflammation has not been documented. OBJECTIVES: To measure the effects of soaked hay and alfalfa pellets in horses with severe asthma. ANIMALS: Ten adult horses with severe asthma from a research colony. METHODS: Prospective controlled trial. Horses in clinical exacerbation were housed indoors and allocated to be fed either soaked hay (n = 5) or alfalfa pellets (n = 5) for 6 weeks. Soaked hay was immersed for 45 minutes and dried out hay was discarded between meals. Pulmonary function and clinical scores were measured before and after 2, 4, and 6 weeks. Tracheal mucus scores and bronchoalveolar lavages were performed before and after 6 weeks. Lung function was analyzed with a linear mixed model using log-transformed data. RESULTS: Lung resistance decreased from (median (range)) 2.47 (1.54-3.95) to 1.59 (0.52-2.10) cmH2 O/L/s in the pellets group and from 1.89 (1.2-3.54) to 0.61 (0.42-2.08) cmH2 O/L/s in the soaked hay group over the 6-week period for an average difference of 1.06 cmH2 O/L/s for pellets (95% confidence interval [95% CI]: 0.09-2.04, P = .03, not significant after correction) and 1.31 cmH2 O/L/s for soaked hay (95% CI: -0.23 to 2.85, P < .001, significant). CONCLUSION AND CLINICAL IMPORTANCE: Soaked hay can control airway obstruction in horses with severe asthma. The strict protocol for soaking and discarding dried-out hay in this study could however be considered too great of an inconvenience by owners.

Impact of the new European respiratory (ERS)/American Thoracic Society (ATS) pulmonary function test interpretation guidelines 2021 on the interpretation of bronchodilator responsiveness in subjects with airway obstruction.

BACKGROUND: The impact of the new 2021 European Respiratory Society (ERS)/American Thoracic Society (ATS) pulmonary function test interpretation guidelines on the interpretation of bronchodilator responsiveness (BDR) in subjects with airway obstruction is still required. Therefore, the objective of this study was to explore the agreement between the 2005 and 2021 ERS/ATS criteria regarding the interpretation of the BDR. Moreover, we explore the factors that influenced the discordance of positive bronchodilator responsiveness (BDR+) between these two criteria. METHODS: The agreement regarding the interpretation of BDR + between the two criteria was assessed using kappa (κ). The percentage of agreement in the interpretation of BDR + between the two criteria was calculated. The factors that influenced the discordance of BDR + between these two criteria were also analyzed. RESULTS: A total of 500 subjects with a mean age of 60.5 ± 15.6 years, 62.2% male were included. The study observed a good level of agreement in the interpretation of BDR + between the two criteria with kappa values = 0.782. The percentages of agreement on the interpretation of BDR + between the two criteria were high, with values = 90.6%. Male sex was the only factor that influenced the discordance of BDR + between these two criteria. CONCLUSION: A good level of agreement was observed in the interpretation of BDR + between the 2005 and 2021 criteria. Therefore, the 2005 and 2021 ERS/ATS criteria for BDR can be used interchangeably. However, the discordance of BDR + between these two criteria could be affected by sex.

Bronchodilator-responsive bronchiolar obstruction in term neonates: a case series.

BACKGROUND: Bronchiolar obstruction, which causes airway obstruction in hyperresponsive airways, often results from the contraction of the airway's smooth muscles, increased viscid mucous secretions, and mucosal oedema consequent upon a reduced cyclic 3,5-adenosine monophosphate (c-AMP). These processes respond to bronchodilators. The six cases presented to us, in Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia, in the newborn period with clinical features suggesting obstruction with airway reactivity with response to bronchodilator treatment are presented here. Our capacity-limited literature search did not show any such report in neonates. This report highlights the need for this condition to be sought in neonates, medically managed in resource-poor countries without resorting to high-cost equipment use, and for its possible future classification. CASE PRESENTATION: We report six cases of Gambian neonates consisting of four males and two females ages 2-27 days who presented to us with histories of fast breathing of a few hours duration and expiratory respiratory distress. All were term babies with rhonchi and demonstrable prolonged expiration with terminal effort. They all had a diagnosis of hyperreactive airway disease with bronchiolar obstruction. Five cases were first-time wheezers, while one was a recurrence. All were eventually treated with bronchodilators and steroids with good results. The median duration for resolution of most symptoms with treatment was two days, with a range of 1-5 days. CONCLUSION: Clinically determined bronchiolar obstructions in term neonates can be relieved with bronchodilators and steroids, and this treatment modality, if employed where the pathological process can be established, can reduce the demand on scarce resources in resource-poor countries.

Pediatric Laryngeal Coccidioidomycosis: A Case Series in an Endemic Region.

BACKGROUND: Laryngeal coccidioidomycosis is a rare but life-threatening manifestation of coccidioidomycosis. Data in children are sparse and limited to case reports. We conducted this study to review the characteristics of laryngeal coccidioidomycosis in children. METHODS: We performed a retrospective review of patients ≤21 years of age with laryngeal coccidioidomycosis who were treated from January 2010 to December 2017. We collected demographic data, clinical and laboratory studies and patient outcomes. RESULTS: Five cases of pediatric laryngeal coccidioidomycosis were reviewed. All children were Hispanic and 3 were female. The median age was 1.8 years and the median duration of symptoms before diagnosis was 24 days. The most common symptoms included fever (100%), stridor (60%), cough (100%) and vocal changes (40%). Airway obstruction requiring tracheostomy and/or intubation for airway management was present in 80%. The most frequent location of lesions was the subglottic area. Coccidioidomycosis complement fixation titers were frequently low and culture/histopathology of laryngeal tissue was necessary to make a definitive diagnosis. All patients required surgical debridement and were treated with antifungal agents. None of the patients had recurrence during the follow-up period. CONCLUSIONS: This study suggests that laryngeal coccidioidomycosis in children presents with refractory stridor or dysphonia and severe airway obstruction. Favorable outcomes can be achieved with a comprehensive diagnostic work-up and aggressive surgical and medical management. With the rise in cases of coccidioidomycosis, physicians should have a heightened awareness regarding the possibility of laryngeal coccidioidomycosis when encountering children who have visited or reside in endemic areas with stridor or dysphonia.

Application of topical pharyngeal anesthesia to reduce adverse reactions during painless gastroscopy: A prospective randomized study.

BACKGROUND: Studies have reported that certain adverse reactions can occur during painless gastroscopy examination. Knowing how to decrease the risks and incidence of adverse reactions is of great importance. OBJECTIVE: To investigate whether topical pharyngeal anesthesia combined with intravenous anesthesia is superior to intravenous anesthesia alone in patients undergoing painless gastroscopy and to determine whether this combined approach had any additional benefits. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to either the control group or the experimental group. In the control group, patients were anesthetized with propofol, while patients in the experimental group received propofol combined with 2% lidocaine spray for topical pharyngeal anesthesia. Hemodynamic parameters before and after the procedure, including the heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SPO2) were recorded. Any adverse reactions experienced by the patient, including choking and respiratory depression, and the total dosage of propofol required during each procedure were also documented. RESULTS: Compared with pre-anesthetic data, the HR, MAP, and SPO2 were reduced after the completion of the painless gastroscopy procedure in both groups. However, the HR, MAP, and SPO2 measurements taken after the gastroscopy were significantly lower in the control group than those of the experimental group (P< 0.05); thus, the hemodynamic parameters of the experimental group were more stable. Compared with the control group, there was significant reduction in the total amount of propofol administered in the experimental group (P< 0.05). The incidence of adverse reactions, including choking and respiratory depression, was significantly lower in the experimental group (P< 0.05). CONCLUSION: The results demonstrated that the application of topical pharyngeal anesthesia in painless gastroscopy can significantly reduce the incidence of adverse reactions. Thus, the combination of topical pharyngeal and intravenous anesthesia is worthy of clinical application and promotion.

Overall Survival of Small-cell Lung Cancer Patients With Malignant Central Airway Obstruction Who Received Chemotherapy Without Undergoing Transbronchial Interventions: A Single-institution Retrospective Study.

BACKGROUND/AIM: This study aimed to determine whether the prognosis of small-cell lung cancer (SCLC) patients with malignant central airway obstruction (MCAO) who receive chemotherapy without undergoing transbronchial intervention (TBI) is not inferior to that of SCLC patients without MCAO. PATIENTS AND METHODS: We compared overall survival (OS) from the time of SCLC diagnosis between stage III or IV SCLC patients with MCAO (MCAO group, n=22) and those without MCAO (non-MCAO group, n=88). MCAO is generally defined as >50% obstruction of the trachea or mainstem bronchi. RESULTS: The median interval from the time of SCLC diagnosis until the initiation of anticancer therapy and the median number of chemotherapy regimens were 6 days and 2 regimens, respectively, in the MCAO group and 15 days and 2 regimens in the non-MCAO group. During the median follow-up period of 11.7 months after SCLC diagnosis, 95% of the patients in the MCAO group and 85% of the patients in the non-MCAO group died. No difference in the median OS (11.9 months vs. 12.4 months, p=0.455) was seen between the MCAO group and the non-MCAO group. A multivariate analysis showed that the presence of MCAO was not associated with an increased risk of death in SCLC patients who received chemotherapy (p=0.664). CONCLUSION: The prognosis of SCLC patients with MCAO who receive chemotherapy without undergoing TBI is not inferior to that of SCLC patients without MCAO.

Reduced bronchodilator reversibility correlates with non-type 2 high asthma and future exacerbations: A prospective cohort study.

BACKGROUND: Given that airway obstruction in asthma is not always fully reversible, reduced bronchodilator reversibility (BDR) may be a special asthma phenotype. OBJECTIVE: To explore the characteristics of BDRhigh/low phenotypes (defined using two BDR criteria) and their associations with asthma exacerbations (AEs). METHODS: After baseline assessments, all patients were classified into BDRhigh or BDRlow phenotypes. This study consisted of 2 parts. Part I was a 12-month prospective observational cohort study designed to identify the clinical characteristics and associations with future AEs in BDRhigh/low phenotypes (n = 456). Part II, designed as a post hoc analysis of the data obtained in Part I, was conducted to assess the association between BDRhigh/low phenotypes and treatment responsiveness (n = 360). RESULTS: Subjects with BDRlow phenotypes had better baseline asthma symptom control and was negatively associated with eosinophilic asthma and type 2 (T2) high asthma. During the 12-month follow-up, those with BDRlow phenotypes had a higher risk of severe AEs (SAEs) (guideline-based criterion: RRadj = 2.24, 95% CI = [1.25, 3.68]; Ward's criterion: RRadj = 2.46, 95% CI = [1.40, 4.00]) and moderate-to-severe AEs (MSAEs) (guideline-based criterion: RRadj = 1.83, 95% CI = [1.22, 2.56]; Ward's criterion: RRadj = 1.94, 95% CI = [1.32, 2.68]) in the following year according to logistic regression models. Similar findings were obtained with negative binominal regression models. BDRlow phenotype was a risk factor for an insensitive response to anti-asthma treatment (guideline-based criterion: ORadj = 1.96, 95% CI = [1.05, 3.65]; Ward's criterion: ORadj = 2.01, 95% CI = [1.12, 3.58]). CONCLUSION: We identified that BDRlow phenotype was associated with non-T2 high asthma and future AEs. These findings have clinically relevant implications for asthma management.

Suspected Obstructive Sleep Apnea Successfully Treated with Ondansetron in a Pug.

Obstructive sleep apnea (OSA) has been uncommonly reported in dogs and is often associated with brachycephalic obstructive airway syndrome (BOAS). OSA independent from BOAS has been rarely reported. Treatment of OSA with ondansetron has only been reported in one dog and has not been reported in a breed commonly affected by BOAS. Here, we report the case of a pug with episodes of OSA despite appropriate treatment of BOAS. Administration of ondansetron led to a rapid and near-complete resolution of the clinical signs, with a follow-up of 3 mo. OSA independent of BOAS should be considered as a differential diagnosis in dogs that present for sleep-disordered breathing without exercise intolerance after appropriate treatment for BOAS. Use of certain serotonin antagonists may be useful as a treatment option for these cases.

Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children.

To analyze the effectiveness of dexamethasone in preventing upper airway obstruction (UAO) symptoms after extubation and the need of reintubation in critically ill children. Multicenter, prospective, double-blind, randomized, phase IV clinical trial involving five pediatric intensive care units. Children between 1 month and 16 years-of-age intubated for more than 48 h were included. Patients were randomized to receive placebo or dexamethasone 0.25 mg/kg every 6 h, 6-to-12 h prior to extubation (four doses). 48 h follow-up was carried out after extubation. Severity of UAO symptoms (Taussig score, stridor) and reintubation requirement were compared. 147 patients were randomized (10 were excluded), 70 patients received dexamethasone and 67 placebo. No global differences were found in the presence of stridor or moderate-to-severe UAO symptoms (Taussig ≥ 5), but Taussig ≥ 5 was less frequent in patients less than 2 years-of-age treated with steroids (p = 0.014). Median Taussig score was lower in the dexamethasone group 1 h after extubation, p < 0.001. 27 patients required reintubation, 9 due to UAO: 3 (4.3%) in the dexamethasone group and 6 (8.9%) in the placebo group, p = 0.319. In those intubated > 5 days, reintubation due to UAO was higher in the placebo group (2.4% vs. 14.3, p = 0.052). Nebulized epinephrine and budesonide were required more frequently in the placebo group in the first 2 h (p = 0.041) and 1 h (p = 0.02) after extubation, respectively. No relevant side effects were observed. Dexamethasone prior to extubation did not significantly reduce moderate-severe UAO symptoms, except for patients under 2-years of age. Dexamethasone could decrease Taussig score and the need of rescue therapies, as well as reintubation rates in those intubated for more than 5 days.

An observational assessment of the safety of mass drug administration for trachoma in Ethiopian children.

BACKGROUND: The International Trachoma Initiative (ITI) provides azithromycin for mass drug administration (MDA) to eliminate trachoma as a public health problem. Azithromycin is given as tablets for adults and powder for oral suspension (POS) is recommended for children aged <7 y, children <120 cm in height (regardless of age) or anyone who reports difficulty in swallowing tablets. An observational assessment of MDA for trachoma was conducted to determine the frequency with which children aged 6 mo through 14 y received the recommended dose and form of azithromycin according to current dosing guidelines and to assess risk factors for choking and adverse swallowing events (ASEs). METHODS: MDA was observed in three regions of Ethiopia and data were collected on azithromycin administration and ASEs. RESULTS: A total of 6477 azithromycin administrations were observed; 97.9% of children received the exact recommended dose. Of children aged 6 mo to <7 y or <120 cm in height, 99.6% received POS. One child experienced choking and 132 (2%) experienced ≥1 ASEs. Factors significantly associated with ASEs included age 6-11 mo or 1-6 y, non-calm demeanor and requiring coaxing prior to drug administration. CONCLUSIONS: There is a high level of adherence to the revised azithromycin dosing guidelines and low incidence of choking and ASEs.

Assessment of bronchodilator response by forced oscillation technique in a preterm infant with evolving bronchopulmonary dysplasia: A case report.

Inhaled bronchodilators are often given in preterm infants with evolving or established bronchopulmonary dysplasia. However, it is unclear which patients may benefit from it and when it is the best time to start treatment. The forced oscillation technique (FOT) is a noninvasive method for assessing lung mechanics that proved sensitive to airway obstruction reversibility in children and adults. FOT does not need patient cooperation, which is ideal for infants. Bedside tools for applying FOT in infants during spontaneous breathing and different respiratory support modes are becoming available. This case report illustrates for the first time that FOT has potential value in assessing airway obstruction reversibility in preterm infants, informing which infants may manifest a clinical benefit from the treatment with bronchodilators.

Omalizumab in Asthma with Fixed Airway Obstruction: Post Hoc Analysis of EXTRA.

BACKGROUND: Although asthma is typically characterized by bronchodilator responsiveness (BDR), fixed airflow obstruction (FAO) occurs in ∼50% of patients with severe asthma. OBJECTIVE: Do FAO/BDR associate with efficacy of omalizumab, a monoclonal antibody that targets IgE? METHODS: In EXTRA, patients aged 12-75 years with inadequately controlled severe allergic asthma despite high-dose inhaled corticosteroids plus long-acting ß2-agonists were randomized to omalizumab (n = 427) or placebo (n = 423) for 48 weeks of treatment. In this post hoc analysis, high/low BDR were defined as ≥12%/<12% increases in baseline forced expiratory volume in 1 second (FEV1) after bronchodilator administration, respectively. FAO presence (+)/absence (-) were defined as baseline postbronchodilator FEV1/forced vital capacity <70%/≥70%, respectively. Poisson regression/analysis of covariance models were used to estimate exacerbation relative rate reductions (RRRs)/least-squares mean changes in FEV1, respectively. RESULTS: In patients with high BDR, omalizumab reduced exacerbations more than placebo over the 48-week treatment period regardless of FAO status (RRR [95% confidence interval (CI)]: FAO+, 59.8% [17.7-80.4%]; FAO-, 44.3% [16.6-62.8%]). Omalizumab improved FEV1 compared with placebo in the FAO-, high BDR subgroup (FEV1 change from baseline [95% CI] for omalizumab vs placebo, 0.065 L [-0.071 to 0.201 L] to 0.236 L [0.112-0.359 L]) across 48 weeks. This was not observed in patients with low BDR, irrespective of FAO. CONCLUSION: Omalizumab was more efficacious than placebo at reducing exacerbations in patients with high, but not low, BDR, regardless of the presence of FAO. Lung function improvement primarily occurred in FAO-, high BDR patients, suggesting that asthma with low BDR may represent a difficult-to-treat phenotype.

Bronchoscopic intratumoral injections of cisplatin and endostar as concomitants of standard chemotherapy to treat malignant central airway obstruction.

STUDY PURPOSE: Malignant central airway obstruction (CAO) in non-small cell lung cancer (NSCLC) is associated with high morbidity and requires endobronchial palliative treatment to re-establish a free air passage. We investigate intratumoral therapy combining anti-angiogenic and cytotoxic as a feasible therapeutic modality to treat malignant CAO. STUDY DESIGN: Ten NSCLC subjects with symptomatic malignant CAO underwent endobronchial intratumoral cisplatin and Endostar co-injection after tumour debulking next to systemic cisplatin-based chemotherapy. Injection was performed immediately after debulking surgery and was then carried out on day 2, day 6 and day 10 past systemic chemotherapy. Nine subjects of control group constantly received traditional cisplatin-based chemotherapy. Bronchoscopy, CT scanning, histology, FEV1/FVC ratio, Karnofsky performance (KPS) and shortness of breath scores were analysed to assess therapeutic efficacy. RESULTS: All 10 subjects benefited from the intratumoral cisplatin and endostar co-injection and systemic chemotherapy combination therapy. Bronchoscopy and CT scanning analyses showed a massive airway widening after treatment. Increased KPS and reduced shortness of breath score were also observed. A substantial improvement of lung function was further confirmed by increased FEV1/FVC ratio. For subjects of control group, the improvement was moderate and obviously not as optimal as the 10 subjects with intratumoral injection. CONCLUSIONS: We have shown that the intratumoral injection of cytotoxic cisplatin plus anti-angiogenic Endostar is an effective and safe adjuvant therapeutic option to treat malignant CAO in clinical practice. This time-staggered local and systemic treatment combination improves quality of life and clinical parameters, thus may provide a feasible therapeutic option for symptomatic CAO.

Residual Volume Responsiveness Testing May Improve the Detection of Reversible Airway Obstruction in Asthma.

BACKGROUND: Residual volume responsiveness to bronchodilator administration has been observed in subjects with chronic obstructive pulmonary disease. However, the prevalence of residual volume (RV) responsiveness has not been formally studied in asthma. OBJECTIVE: To identify the prevalence and magnitude of RV responsiveness in asthma. METHODS: Physician-diagnosed adult subjects with asthma on treatment for >12 months were prospectively recruited to perform spirometry and measurement of lung volumes using body plethysmography before and after administration of 360 µg of albuterol. RESULTS: Among 120 subjects, 76% were women. The ethnic composition was 64% Caucasian, 32% Hispanic, and 13% African American. The mean age was 52 ± 15 years. The mean duration of asthma was 16 ± 15 years. The mean RV% responsiveness was -7.74 ± 14. Whereas patients with the lowest baseline forced expiratory volume in 1 second (FEV1) value showed the highest mean responsiveness (P = .001), the baseline RV value had minimal influence on RV responsiveness. Using -7.74% to define significant RV responsiveness, and ≥12% and ≥200 mL to define significant FEV1 responsiveness, more subjects showed isolated RV responsiveness (37%) compared with 6% with isolated FEV1 responsiveness and 14% with both FEV1 and RV responsiveness (P = .04). There was a minimal correlation between FEV1 responsiveness and RV responsiveness (r = 0.17, P = .06). The RV responsiveness was significantly associated with the wheeze score (P = .006) and dyspnea score (P = .029). CONCLUSION: The addition of RV responsiveness testing to spirometry based responsiveness testing can improve the identification of reversible airway obstruction in asthma. RV responsiveness may be useful in monitoring symptoms associated with air trapping in asthma.

Evaluation of Glucocorticoid Therapy in Asthma Children with Small Airway Obstruction Based on CT Features of Deep Learning.

This study was aimed at exploring the treatment of asthma children with small airway obstruction in CT imaging features of deep learning and glucocorticoid. A total of 145 patients meeting the requirements in hospital were included in this study, and they were randomly assigned to receive aerosolized glucocorticoid (n = 45), aerosolized glucocorticoid combined with bronchodilator (n = 50), or oral steroids (n = 50) for 4 weeks after discharge. The lung function and fractional exhaled nitric oxide (FENO) indexes of the three groups were measured, respectively, and then the effective rates were compared to evaluate the clinical efficacy of glucocorticoids with different administration methods and combined medications in the short-term maintenance treatment after acute exacerbation of asthma. Deep learning algorithm was used for CT image segmentation. The CT image is sent to the workbench for processing on the workbench, and then the convolution operation is performed on each input pixel point during the image processing. After 4 weeks of maintenance treatment, FEF50 %, FEF75 %, and MMEF75/25 increased significantly, and FENO decreased significantly (P < 0.01). The improvement results of FEF50 %, FEF75 %, MMEF75/25, and FENO after maintenance treatment were as follows: the oral hormone group was the most effective, followed by the combined atomization inhalation group, and the hormone atomization inhalation group was the least effective. The differences among them were statistically significant (P < 0.05). The accuracy of artificial intelligence segmentation algorithm was 81%. All the hormones were more effective than local medication in the treatment of small airway function and airway inflammation. In the treatment of aerosol inhalation, the hormone combined with bronchiectasis drug was the most effective in improving small airway obstruction and reducing airway inflammation compared with single drug inhalation. Deep learning CT images are simple, noninvasive, and intuitively observe lung changes in asthma with small airway functional obstruction. Asthma with small airway functional obstruction has high clinical diagnosis and evaluation value.

Deep Learning Algorithms-Based CT Images in Glucocorticoid Therapy in Asthma Children with Small Airway Obstruction.

CT image information data under deep learning algorithms was adopted to evaluate small airway function and analyze the clinical efficacy of different glucocorticoid administration ways in asthmatic children with small airway obstruction. The Res-NET in the deep learning algorithm was used to perform feature extraction, summary classification, and other reconstruction of CT images. A deep learning network model Mask-R-CNN was constructed to enhance the ability of image reconstruction. A total of 118 children hospitalized with acute exacerbation of asthma in the hospital were recruited. After acute exacerbation treatment, 96 children with asthma were screened out for small airway obstruction, which were divided into glucocorticoid aerosol inhalation group (group A, 32 cases), glucocorticoid combined with bronchodilator aerosol inhalation group (group B, 32 cases), and oral hormone therapy group (group C, 32 cases). Asthmatic children with small airway obstruction were screened after acute exacerbation treatment and were rolled into glucocorticoid aerosol inhalation group (group A), glucocorticoid combined with bronchodilators aerosol inhalation group (group B), and oral hormone therapy group (group C). Lung function indicators (maximal mid-expiratory flow (MMEF75 and 25), 50% forced expiratory flow (FEF50), and 75% forced expiratory flow (FEF75)), FeNO level, and airway inflammation indicators (IL-6, IL-35, and eosinophilic (EOS)) were compared before and one month after treatment. The ratio of airway wall thickness to outer diameter (T/D) and the percentage of airway wall area to total airway area (WA%) were measured by e-Health high-resolution CT (HRCT). The constructed network model was used to measure the patient's coronary artery plaque and blood vessel volume, and the image was reconstructed on the Res-Net network. It was found that the MSE value of the Res-Net network was the lowest, and the efficiency was very high during the training process. T/D and WA (%) of asthmatic children with small airway obstruction after treatment were significantly lower than those before treatment (P < 0.01). After treatment, MMEF75/25 and FEF75 were significantly higher than those before treatment (P < 0.05). Lung function-related indicator FEF50 was significantly higher than that before treatment (P < 0.01). FeNO level after treatment was remarkably lower than that before treatment (P < 0.01). In addition, lung function-related indicators, airway inflammation indicators, and FeNO level improved the most in group C, followed by group B, and those improvements in group A were the least obvious, with great differences among groups (P < 0.05). In summary, the Res-Net model proposed was of certain feasibility and effectiveness for CT image segmentation and can effectively improve the clinical evaluation of patient CT image information. Glucocorticoids could improve small airway function and airway inflammation in asthmatic children with small airway obstruction, and oral corticosteroids were more effective than aerosol inhalation therapy.

Assisting PNA transport through cystic fibrosis human airway epithelia with biodegradable hybrid lipid-polymer nanoparticles.

Cystic fibrosis (CF) is characterized by an airway obstruction caused by a thick mucus due to a malfunctioning Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein. The sticky mucus restricts drugs in reaching target cells limiting the efficiency of treatments. The development of new approaches to enhance drug delivery to the lungs represents CF treatment's main challenge. In this work, we report the production and characterization of hybrid core-shell nanoparticles (hNPs) comprising a PLGA core and a dipalmitoylphosphatidylcholine (DPPC) shell engineered for inhalation. We loaded hNPs with a 7-mer peptide nucleic acid (PNA) previously considered for its ability to modulate the post-transcriptional regulation of the CFTR gene. We also investigated the in vitro release kinetics of hNPs and their efficacy in PNA delivery across the human epithelial airway barrier using an ex vivo model based on human primary nasal epithelial cells (HNEC) from CF patients. Confocal analyses and hNPs transport assay demonstrated the ability of hNPs to overcome the mucus barrier and release their PNA cargo within the cytoplasm, where it can exert its biological function.

Persistence of both reversible airway obstruction and higher blood eosinophils may predict lung function decline in severe asthma.

OBJECTIVE: This study analysed whether the persistence of both reversible airway obstruction (RAO) and elevated BE counts was associated to reduced asthma control and accelerated lung function decline in treated severe asthmatics. METHODS: About 202 severe asthmatics were studied after 12-120 months of step-5 treatment associated to anti-IgE therapy. Following treatments, reversibility tests, after inhaling 400 mcg of Salbutamol, were performed. FEV1  > 12% or ≤12% changes differentiated RAO+ from RAO- subjects. Blood eosinophil (BE) counts after treatment were considered. RESULTS: Pre-/post-treatment bronchodilator FEV1 % and ACT were lower (61% [50-71], 74.4% [62.5-83.7] and 20[18-22]), whereas BE were higher (380 cells/µl [170-590]) in RAO+ compared to RAO- subjects (77% [64-88], p = 0.0001, 81.8% [66.1-94.3], p = 0.0001, 21[18-23], p = 0.045 and 230 cells/µl [80-360], p = 0.003). A negative relationship between SABA-induced FEV1 % changes and pre-bronchodilator FEV1 % (ß = -0.551%; p = 0.0001) and ACT (ß = -0.059; p = 0.038) was found. Conversely, post-treatment BE levels were positively related (ß = 145.565 cells/µl; p = 0.003) to FEV1  > 12% increases. A rising trend of pre-/post-bronchodilator FEV1 % in time was observed in RAO- subjects with BE < 300 cells/µl. Conversely, we highlighted significant declining tendencies of pre/post-bronchodilator FEV1 % in RAO+ patients with BE > 300 cells/µl reaching lower values after more than 36 months of step-5 treatment (59.6% [39.9-72.1] vs 74[66.5-89.2] of RAO+ individuals with BE < 300 cells/µl [p = 0.026] and 81.6% [66.1-91.8] of RAO-subjects with BE > 300 cells/µl [p = 0.009]). CONCLUSION: Persistent SABA-induced FEV1  > 12%, especially when associated to BE > 300 cells/ml, may be a marker of accelerated lung function decline in severe asthmatics despite maximal step-5 treatment. The highest bronchodilation associated to the lowest BE levels should be the main goal of asthma treatment to prevent such decline.

Nebulization of epinephrine to reduce the severity of brachycephalic obstructive airway syndrome in dogs.

OBJECTIVE: To determine the preoperative and postoperative effect of nebulized epinephrine on brachycephalic obstructive airway syndrome (BOAS) severity in dogs. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Thirty-one client-owned pugs, French bulldogs, and English bulldogs with moderate to severe BOAS. METHODS: Whole body barometric plethysmography was used to determine BOAS severity (BOAS index; 0%-100%) prior to and after nebulization with 0.05 mg/kg epinephrine diluted in 0.9% saline preoperatively. The same protocol was repeated postoperatively (within 24 hours of surgery). RESULTS: Five dogs were excluded because they did not tolerate nebulization, and postoperative data were available for 13 dogs. Epinephrine nebulization resulted in a decreased BOAS index across all breeds of dog both before (9.6% [3.1% to -30.2%], n = 26) and after surgery (14.3% [0.9% to -24.3%], n = 13). The preoperative reduction in BOAS index was greater (17.3% [1.8% to -27.4%]) in dogs with a baseline BOAS index >70% (P = .006) and in pugs (16.9% [0.8% to -27.4%]) compared with French bulldogs (5.2% [3.1% to -30.2%], P = .03). Simple linear regression was used to identify a positive relationship between baseline BOAS index and reduction in BOAS index for pugs (n = 10, P = .001). Nausea was noted as a side effect in four dogs. CONCLUSION: Nebulized epinephrine reduced the BOAS index of dogs in this study. This effect was clinically significant in preoperative dogs with a BOAS index >70% and in dogs recovering from surgery. CLINICAL SIGNIFICANCE: This study provides evidence to support the use of nebulized epinephrine in the perioperative management of BOAS-affected dogs.