Background. Women with asthma using antiasthmatics during the later part of the pregnancy have an increased risk for obstetric complications and their infants of neonatal complications. Material and Methods. The study is based on a linkage between the Swedish Medical Birth Register and a register of prescribed drugs in Sweden for the years 2009&#x2013;2011, identifying women who had filled prescriptions for antiasthmatics after the first trimester. Their characteristics, their obstetric history, and the neonatal conditions of their infants were compared with all other women who gave birth. Adjusted Mantel-Haenszel odds ratios were determined. Results. We found an increased risk for a number of maternal conditions but no risk increase for gestational diabetes (after adjustment for body mass index) or for premature rupture of membranes. There was an increase in preterm births for some drugs used at severe asthma and of low birth weight and small for gestational age for most drug combinations. An increased risk was seen for neonatal hypoglycemia, respiratory problems, and low Apgar score. Conclusions. There are many hazards associated with maternal asthma and use of antiasthmatic drugs. Most evidence suggests a disease effect. A careful control of the asthma during pregnancy is important.

Bengt K&#xe4;ll&#xe9;n

Birgitta Norstedt Wikner

Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes

The purpose of this study was to assess the efficacy of using rapid on-site evaluation (ROSE) for samples taken during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) at Austin Health, Victoria. This was compared to data collected for cases performed without ROSE. A retrospective analysis was conducted on 188 consecutive patients who underwent EBUS-TBNA from May 2012 to July 2014 whose data was collected prospectively at the time of the procedure. The presence of a cytologist during ROSE resulted in a significant reduction in the number of lesions sampled [mean: 1.5 &#xb1; 0.7 (1, 4) versus 1.9 &#xb1; 0.8 (1, 4), P = 0.0020] and the number of TBNAs required per case [mean: 3.6 &#xb1; 1.4 (1, 8) versus 4.2 &#xb1; 1.5 (1, 8), P = 0.0017]. This could potentially result in a shorter procedure time and, ultimately, a reduction in complication rate. The quality of the samples obtained during EBUS-TBNA with ROSE was higher. A larger proportion of samples yielded a satisfactory cell block allowing the potential benefit of additional pathology testing including immunohistochemistry and molecular pathology. In summary, the use of ROSE during EBUS-TBNA was superior to off-site cytological assessment of bronchoscopy specimens.

Raymond W. M. Wong

Alesha Thai

Yet H. Khor

Kerryn Ireland-Jenkin

Celia J. Lanteri

Barton R. Jennings

The Utility of Rapid On-Site Evaluation on Endobronchial Ultrasound Guided Transbronchial Needle Aspiration: Does It Make a Difference?

Background and Objectives. Low counts are more difficult to find in microscopic sputum examination and thus are more likely to be missed. In this study, we aimed to estimate the proportion of low-count grading and assessing any age and gender differences in sputum smear grading in a low HIV prevalence setting. Materials and Methods. From the tuberculosis laboratory register information on sputum positivity including the grading of smears, age and gender were extracted for January 2011&#x2013;December 2011. Smears were examined using Ziehl-Neelsen technique and graded as per the Program Guidelines. Positive smears were classified into low grade positive smears (scanty and 1+) and high grade positive smears (2+ and 3+). Differences in grading of smear based on gender and age were analysed using chi square test. Results. Of 9000 smears examined, 8210 (91.2&#x25;) were collected as diagnostic smears from tuberculosis suspects. Low grade positivity was 37.5&#x25; among diagnostic smears and 69.6&#x25; among follow-up smears. Sputum smears from female examinees had higher proportions of low grade positive smears <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.3616pt" id="M1" height="12.0395pt" version="1.1" viewBox="-0.0498162 -9.6779 62.6639 12.0395" width="62.6639pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-41" d="M300 -147C201 -63 143 98 143 270S200 602 300 686L282 710C136 610 70 450 70 271V270C70 89 136 -72 282 -170L300 -147Z"/></g><g transform="matrix(.0135,0,0,-0.0135,4.688,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,16.837,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,28.575,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,35.078,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,38.167,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,44.67,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,51.173,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.0135,0,0,-0.0135,57.677,0)"><path id="g113-42" d="M275 270C275 450 212 609 64 710L45 686C145 604 203 442 203 270S147 -63 45 -147L64 -170C213 -68 275 89 275 270Z"/></g></svg>. Stratification of age and sex within TB suspects had clearly demonstrated the observance of higher low grade positivity among female TB suspects at extremes of age.

Palanivel Chinnakali

Kalaiselvi Selvaraj

Pruthu Thekkur

Gomathi Ramasamy

Mahalakshmy Thulasingam

Kavita Vasudevan

Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

Introduction. Obstructive sleep apnea (OSA) is a growing public health problem in developing countries. However the burden among commercial drivers is not well described. Methods. The Epworth Sleepiness Scale (ESS) and Berlin questionnaire were administered to interstate commercial road transport drivers to assess the tendency to sleep in daytime and the risk of OSA, respectively. Body mass index (BMI), neck, and waist-hip circumferences were measured. Results. Out of 138 commercial drivers, 124 (90&#x25;) responded and provided complete data. The mean (SD) age, BMI, neck, and waist circumferences were 40.4 (9.3) years, 28.0 (4.6)&#x2009;kg/m2, 40.0 (3.0)&#x2009;cm, and 92.8 (11.1)&#x2009;cm, respectively. Twenty-two percent had ESS score above 11 and 36&#x25; of the respondents had a high risk for obstructive sleep apnea. Adjusting for age, BMI, and waist and neck circumferences, the key predictors of road accidents were ESS score above 11 (OR 3.77, 95&#x25; CI 1.18&#x2013;12.06), self-reported diagnosis of hypertension (OR 4.63, 95&#x25; CI 1.46&#x2013;14.69), and increasing hip circumference (OR 1.12, 95&#x25; CI 1.01&#x2013;1.23). Conclusion. Obstructive sleep apnea is common among commercial interstate road drivers in Nigeria and ESS may be a simple tool for assessing accident risk.

Daniel O. Obaseki

Gregory E. Erhabor

Josephine E. Obaseki

Ibukun Abidoye

Akinjide Adebisi

Babatunde Olaiya

Obstructive Sleep Apnea, Excessive Daytime Sleepiness, and Road Traffic Accidents among Interstate Commercial Vehicle Drivers in Nigeria

Improved multiplex PCR detection methods are facilitating the correlation of the etiology of respiratory tract infections with specific symptoms or clinical manifestations. We conducted a retrospective analysis of the incidence of respiratory pathogens and initial symptoms in 1,286 patients at a tertiary care center tested by multiplex respiratory pathogen PCR from July 1, 2012, to June 30, 2013. Rhinovirus/enterovirus (Rhino/Entero) infections were the most prevalent (25.4&#x25;) followed by respiratory syncytial virus (RSV) (13.6&#x25;) and influenza A (6.2&#x25;). Eleven percent of patients were positive for multiple analytes with Rhino/Entero and RSV being the most common combination. Asthma or asthma exacerbation was the most common presenting symptom in patients positive for Rhino/Entero (38.4&#x25;) or positive for Rhino/Entero along with RSV or hMPV (34.8&#x25;). Of the patients positive for Rhino/Entero and presenting with asthma, 97&#x25; were &#x2264;17 years of age. RSV positive patients most commonly presented with respiratory distress (40.3&#x25;) followed by asthma (18&#x25;) or pneumonia (18&#x25;). The most prevalent initial clinical manifestation for influenza was fever (27.4&#x25;) followed by respiratory distress (13&#x25;) or pneumonia (11.9&#x25;). The significant percentage of patients positive for Rhino/Entero virus presenting with asthma supports the role of rhinovirus as an important trigger for asthma exacerbation.

Christy S. Stover

Christine M. Litwin

The Epidemiology of Upper Respiratory Infections at a Tertiary Care Center:  Prevalence, Seasonality, and Clinical Symptoms

Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, <svg style="vertical-align:-0.3003pt;width:50.299999px;" id="M1" height="11.2875" version="1.1" viewBox="0 0 50.299999 11.2875" width="50.299999" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g><g transform="matrix(.017,-0,0,-.017,8.222,10.862)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" /></g><g transform="matrix(.017,-0,0,-.017,20.155,10.862)"><path id="xB1" d="M535 290h-212v-206h-58v206h-213v50h213v193h58v-193h212v-50zM535 -22h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,33.907,10.862)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g><g transform="matrix(.017,-0,0,-.017,42.066,10.862)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g>

		
	
</svg> years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87&#x25; and a specificity of 71&#x25;. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction.

Alexandre Quesnel

Fran&#xe7;oise Beuret Blanquart

Jean Paul Marie

Eric Verin

Explorations of Unilateral Diaphragmatic Paralysis

Asthma care imposes economic burden on affected patients. Patient costs for asthma care have not been documented in Africa. We aimed to determine the out-of-pocket cost of asthma follow-up care incurred by patients in Nigeria. We conducted a cross-sectional study in three tertiary hospitals in southeastern and northwestern Nigeria. Poorly controlled asthma patients attending a follow-up visit in the respiratory clinic of the hospitals were surveyed. Sociodemographic, health-seeking behavior, and cost data were collected using a structured questionnaire. Of the 110 patients who completed the study, 56 (51&#x25;) were females. Also, 72 (65&#x25;) of the patients had known about their asthma illness for more than four years. Mean annual direct cost of asthma care was US&#x24;368.4 (&#xb1;228) per patient. Medication cost accounted for the majority (87&#x25;) of this cost. Patient costs of care incurred did not differ significantly across age (P = 0.15), education (P = 0.23), marital status (0.49), residence (P = 0.47), or gender (P = 0.65) categories. We conclude that direct cost of care was found to be substantial among poorly controlled asthma patients. Further studies to estimate the costs incurred by patients with exacerbation and differing severity of the disease should be conducted.

Cajetan Chigozie Onyedum

Olufemi Olumuyiwa Desalu

Kingsley Nnanna Ukwaja

Chinwe Chukwuka

Nnamdi Ikechukwu Nwosu

Chijioke Ezeudo

Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African Country

Congenital central hypoventilation syndrome is a disorder predisposed by a paired-like homebox PHOX2B gene. A mutation in the PHOX2B gene is a requisite when diagnosing congenital central hypoventilation syndrome. This mutation is identified in 93&#x2013;100&#x25; of diagnosed patients. The mutation regarding this disorder affects the sensors, the central controller, and the integration of the signals within the central nervous system. This, inter alia, leads to insufficient ventilation and a decrease in PaO2, as well as an increase in PaCO2. Affected children are at risk during and after the neonatal period. They suffer from hypoventilation periods which may be present whilst sleeping only or in more severe cases when both asleep and awake. It is important for clinicians to perform an early diagnosis of congenital central hypoventilation in order to prevent the deleterious effects of hypoxaemia, hypercapnia, and acidosis on the neurocognitive and cardiovascular functions. Patients need long-term management and appropriate ventilatory support for improving the qualities of their lives. This paper provides a detailed review of congenital central hypoventilation syndrome, a congenital disorder that is genetic in origin. We describe the genetic basis, the wider clinical picture, and those challenges during the diagnosis and management of patients with this condition.

Karin Ljubi&#x10D;

Iztok Fister

Congenital Central Hypoventilation Syndrome: A Comprehensive Review and Future Challenges

Diesel particulate matter (DPM) has adverse health effects. Examining the underlying pathophysiological mechanisms would be facilitated by the introduction of an exposure method that is safe, portable, and cost-effective. The purpose of this study was to establish a novel method to study DPM exposure via nebulization and an inhalation dose that was safe, yet capable of eliciting an inflammatory response. Ten participants enrolled in this nonblinded, nonrandomized study. Subjects inhaled nebulized 0.9&#x25; saline and increasing doses of DPM suspended in 0.9&#x25; saline (75, 150, and 300&#x2009;&#x3bc;g) in a sequential manner. FEV1 was measured repeatedly during the first 2&#x2009;h after exposure and blood, oximetry, sputum, and heart rate were taken before, 2&#x2009;h, and 24&#x2009;h after inhalation challenge. DPM inhalation was well-tolerated at all doses. A decrease in FEV1 was observed after each inhalation challenge (including saline). Inhalation of 300&#x2009;&#x3bc;g DPM produced a significantly different FEV1 response curve. An increase in particle inclusion-positive sputum macrophages for all DPM doses confirmed that the nebulized particles were reaching the lower airways. Serum GM-CSF was elevated after exposures to 150 and 300&#x2009;&#x3bc;g DPM. No other inflammatory changes were detected. DPM inhalation via nebulizer is a safe method of delivering low doses of DPMs in healthy people.

Sandra C. Dorman

Kaylyn M. Sutcliffe

Jacques Abourbih

Stacey A. Ritz

Inhalation of Nebulized Diesel Particulate Matter: A Safety Trial in Healthy Humans

Respiratory exposure to air pollutants is associated with cardiovascular morbidity and mortality and firefighters have been shown to be at an increased risk of work-related cardiovascular events. Wildland firefighters experience intermittent, intense exposure to biomass smoke. The aim of this study was to characterize the respiratory and systemic effects of smoke exposure in wildland firefighters. Seventeen seasonal firefighters from a northeastern Ontario community were recruited at the beginning of the fire season and baseline measurements obtained; postexposure measurements were made at various times within 16&#x2009;d of firefighting. Spirometric measurements showed a transient decline in forced vital capacity within 7&#x2009;d of fire exposure, not evident by 8&#x2013;16&#x2009;d. Induced sputum showed a significant increase in macrophages and epithelial cells within 7&#x2009;d, with evidence that macrophages had internalized particles; such changes were not evident in the second week following exposure. Likewise, peripheral blood analysis revealed significant increases in erythrocytes, hemoglobin, monocytes, and platelets within the first week after fire exposure, which were diminished 8&#x2013;16&#x2009;d in postexposure group. We conclude that acute exposure to forest-fire smoke elicits transient inflammatory responses, both in the airways and systemically. Whether these changes contribute to the observed increased risk of cardiovascular events requires further study.

Smoke Exposure Has Transient Pulmonary and  Systemic Effects in Wildland Firefighters

About this journal

Journal profile

Meet the editorial board

Editor spotlight

Find out more

This journal's articles appear in a wide range of abstracting and indexing databases, and are covered by numerous other services that aid discovery and access. Find out more about where and how the content of this journal is available.

Journal of Respiratory Medicine