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Impact of occupation on respiratory disease.

OBJECTIVES: This study identified occupations with a marked impact on sick leaves due to respiratory disease. METHODS: A national sick-leave register containing information on all sick leaves exceeding 14 days, physicians' diagnoses, and the occupational status of all manual and service employees in the private sector in Sweden was studied. Sick leaves during 1992-1994 (N=210,755) were analyzed with special attention to respiratory disease and occupation. RESULTS: Respiratory disease accounted for 4.4% of the total number of sick leaves. The incidence of long-term (> or = 90 days) sick leaves due to respiratory disease was 3 times higher in occupations with a high incidence than in those with a low incidence. There was a high correlation (r=0.80) between the incidence of long-term sick leave due to respiratory disease and sick leave due to all other conditions; this finding suggests that market and selection factors may play an important role in determining the overall risk for sick leave in various occupations. The proportion of sick leaves due to long-term respiratory disease out of all long-term disease was compared between occupations. Agricultural workers had a 46% higher proportion of long-term respiratory disease than metal workers. Industrial workers, food industry workers, and painters were also occupations with an increased risk. These findings could not be explained by differences in age or smoking habits. CONCLUSIONS: Major differences were found among manual and service occupations regarding long-term sick leave due to respiratory disease. Several occupations, in which exposure to respiratory sensitizers and irritants are known to occur, were among those in which workers had an increased risk for long-term respiratory disease.

Adult↗

Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease.

BACKGROUND: We compared the efficacy and safety of the low-molecular weight heparin enoxaparin with unfractionated heparin (UFH) for the prevention of venous thromboembolic disease in patients with heart failure or severe respiratory disease. METHODS: This was a multicenter, controlled, randomized, open study in which patients received either enoxaparin (40 mg once daily) or UFH (5000 IU 3 times daily) for 10 +/- 2 days in 64 medical departments in Germany. Patients were stratified and enrolled according to their underlying disease: severe respiratory disease or heart failure. The primary efficacy parameter was a thromboembolic event up to 1 day after the treatment period. RESULTS: Of the 665 patients enrolled, 451 patients were able to be evaluated in the primary efficacy analysis. The incidence of thromboembolic events was 8.4% with enoxaparin and 10.4% with UFH. Enoxaparin was at least as effective as UFH, with a 1-sided equivalence region of -4% (90% CI -2.5-6.5, P =.015). Enoxaparin was associated with fewer deaths, less bleeding, and significantly fewer adverse events (45.8% vs 53.8%, P =.044). CONCLUSIONS: Enoxaparin is at least as effective as UFH in the prevention of thromboembolic events in patients with heart failure or severe respiratory disease. Its beneficial safety profile and once-daily administration is advantageous for inpatient and outpatient use.

Aged↗

Natural history and clinical features of aspirin-exacerbated respiratory disease.

Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome characterized by chronic rhinosinusitis, nasal polyposis, asthma and precipitation of asthma, and rhinitis attacks after ingestion of aspirin (ASA) and most other nonsteroidal antiinflammatory drugs (NSAIDs). Although precipitation of asthma attacks by ingestion of ASA and other NSAIDs is considered a hallmark of the syndrome, the respiratory mucosal inflammatory disease process begins and continues in the absence of ongoing or even intermittent exposure to ASA or NSAIDs. The typical patient with AERD is an adult who develops refractory chronic rhinitis in the third or fourth decade of life. The chronic rhinitis evolves into chronic eosinophilic rhinosinusitis with associated nasal polyposis. Anosmia appears in most patients. CT of the sinuses most often demonstrates pansinusitis and patients often undergo multiple sinus operations resulting in only limited temporary benefit. During the evolution of the sinus disease persistent asthma develops. Finally, if patients are exposed to ASA or NSAIDs acute respiratory reactions begin to occur. Despite subsequent avoidance of ASA and other NSAIDs, the respiratory mucosal inflammatory disease persists, often requiring systemic corticosteroids for control of both upper- and lower-respiratory tract symptoms. Adequate control of asthma can often only be accomplished with the simultaneous control of the associated rhinosinusitis. With few exceptions, once AERD develops it remains for the remainder of the patient s life.

Anti-Inflammatory Agents, Non-Steroidal↗

Sternomastoid muscle function and fatigue in breathless patients with severe respiratory disease.

In patients with severe respiratory disease, the work of breathing is increased and the respiratory muscles, particularly those of inspiration, may become fatigued. Hitherto, there has been little information on the incidence of respiratory muscle fatigue in acutely breathless patients. We studied 34 patients with severe respiratory disease on admission to hospital when they were most breathless, and then, if possible, 7 to 14 days later after recovery for evidence of sternomastoid muscle fatigue or increased fatigability. Frequency/force curves, numerically expressed as the 20:50 ratio, were carried out in all patients on admission. Three of the 34 patients had evidence of low frequency fatigue (i.e., greater than 15% reduction in 20:50 ratio) in the sternomastoid muscle on admission when first studied (mean +/- SEM 20:50 ratio, 56.3 +/- 1.2%; n = 3). The mean 20:50 ratio in the remaining 31 patients on admission was 75.7 +/- 1.6% (n = 31) compared with 77.8 +/- 1.4% (n = 25) when symptomatically better (p less than 0.05). The mean 20:50 ratio on admission was also significantly lower than the mean 20:50 ratio in a group of age- and sex-matched normal control subjects (i.e., 78.5 +/- 1.4%, n = 25; p less than 0.05). Twenty-five patients were studied completely both on admission and recovery, including a fatigability test that involved the performance of 50 fatiguing head lifts with measurements of the 20:50 ratio 10 and 60 min later. Sternomastoid muscle fatigability was significantly increased on admission when the patients were most breathless, compared with recovery when they were less breathless (p less than 0.001 at both 10 and 60 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The relationship between infections and chronic respiratory diseases: an overview.

This paper's goal is to review the relationship between infections and chronic respiratory disease, with particular reference to periodontal disease. The link between oral diseases in general, periodontal disease, and respiratory disease remains somewhat controversial. However, with cooperation between dentistry and medicine, the nature of the connection between dental and medical pathology can be better defined. An overview of respiratory disease and some of the factors that can contribute to respiratory infection is presented below, with special reference to infections related to aspiration.

Bacteria↗

Evaluation and management of respiratory disease in the horse.

Respiratory disease is one of the commonest medical reasons for referring a horse to the Royal Veterinary College, with coughing the main presenting sign. Investigation requires the taking of a detailed history, clinical examination, the use of appropriate diagnostic aids and noting response to medication and management changes. On arrival the horse is stabled in a minimal dust environment, remaining there until discharge. The use of a dust-free box frequently produces a favourable response without the use of medication which in itself is diagnostic. The problem of a horse which is asymptomatic on discharge from the Royal Veterinary College and becomes symptomatic following the failure of its owner to implement advice given on changes in management is discussed.

Animals↗

Bacterial respiratory disease of poultry.

Bacterial pathogens play an important role in causing respiratory disease in domestic poultry species. In many cases, the bacterial component of a respiratory disease colonizes the respiratory system only after a primary viral or environmental insult. Colonization of the airsacs of a chicken by Escherichia coli following an infectious bronchitis virus infection is an example of secondary bacterial invasion. In other cases, the bacterial component of the respiratory disease is the primary initiating cause of the disease. Examples of primary bacterial respiratory disease are infectious coryza in chickens and fowl cholera in chickens and turkeys.

Animals↗

[Impact of influenza vaccination on mortality by respiratory diseases among Brazilian elderly persons].

OBJECTIVE: Respiratory diseases, especially infectious ones, are becoming increasingly representative in the morbidity and mortality patterns of elderly persons. The aim of the present study was to analyze trends in the mortality by respiratory diseases and to observe the impact of influenza vaccination on mortality rates. METHODS: The study was carried out between 1980 and 2000. Subjects were elderly persons living in the State of Sao Paulo, and mortality data were obtained from the Mortality Information System of the Brazilian Ministry of Health. This is an ecological time-series study. We analyzed the time trends of standardized mortality rates by infectious diseases, according to age group (60-64, 65-69, 70-74, 75-79, and 80+ years) and sex, using polynomial regression. We estimated confidence intervals for the mean expected response in the years following the intervention. RESULTS: Rates increased for both sexes among the elderly population. After the intervention, we observed a declining trend with respect to mortality indicators. For older males, the mean rate in the 1980-1998 period was 5.08 deaths per thousand men, with a nonlinear, non-constant increase of 0.13 per year; in 2000, the rate observed was 4.72 deaths per thousand men. The mean annual rate among women over 60 years was 3.18 deaths per thousand women, with a nonlinear, non-constant increase of 0.08 per year; in 2000, the rate observed was 2.99 deaths per thousand women. There was also a significant reduction in mortality rates in all age groups. CONCLUSIONS: Data indicate the importance of respiratory diseases among the elderly population and suggest that specific protection against influenza has a positive effect on the prevention of mortality due to these diseases.

Age Distribution↗

Viruses associated with outbreaks of equine respiratory disease in New Zealand.

AIM: To identify viruses associated with respiratory disease in young horses in New Zealand. METHODS: Nasal swabs and blood samples were collected from 45 foals or horses from five separate outbreaks of respiratory disease that occurred in New Zealand in 1996, and from 37 yearlings at the time of the annual yearling sales in January that same year. Virus isolation from nasal swabs and peripheral blood leukocytes (PBL) was undertaken and serum samples were tested for antibodies against equine herpesviruses (EHV-1, EHV-2, EHV-4 and EHV-5), equine rhinitis-A virus (ERAV), equine rhinitis-B virus (ERBV), equine adenovirus 1 (EAdV-1), equine arteritis virus (EAV), reovirus 3 and parainfluenza virus type 3 (PIV3). RESULTS: Viruses were isolated from 24/94 (26%) nasal swab samples and from 77/80 (96%) PBL samples collected from both healthy horses and horses showing clinical signs of respiratory disease. All isolates were identified as EHV-2, EHV-4, EHV-5 or untyped EHV. Of the horses and foals tested, 59/82 (72%) were positive for EHV-1 and/or EHV-4 serum neutralising (SN) antibody on at least one sampling occasion, 52/82 (63%) for EHV-1-specific antibody tested by enzyme-linked immunosorbent assay (ELISA), 10/80 (13%) for ERAV SN antibody, 60/80 (75%) for ERBV SN antibody, and 42/80 (53%) for haemagglutination inhibition (HI) antibody to EAdV-1. None of the 64 serum samples tested were positive for antibodies to EAV, reovirus 3 or PIV3. Evidence of infection with all viruses tested was detected in both healthy horses and in horses showing clinical signs of respiratory disease. Recent EHV-2 infection was associated with the development of signs of respiratory disease among yearlings [relative risk (RR)=2.67, 95% CI=1.59-4.47, p=0.017]. CONCLUSIONS: Of the equine respiratory viruses detected in horses in New Zealand during this study, EHV-2 was most likely to be associated with respiratory disease. However, factors other than viral infection are probably important in the development of clinical signs of disease.

Journal Article↗

Respiratory disease in a colony of rats. I. The natural disease.

An epidemic of acute respiratory disease in a colony of CFE rats is described, the main laboratory findings are recorded and its aetiology discussed.The epidemic showed that severe respiratory disease varying from peracute to chronic was associated with infection of the lungs with a mycoplasma but that mycoplasmas could be present in rats, even in the lungs, without signs of disease, thus suggesting that one or more other factors were involved. It is also evident that there are strain differences in the susceptibility of rats to this disease.

Acute Disease↗

Delirium in inpatients with respiratory diseases.

The features of delirium in patients being hospitalized due to respiratory diseases were investigated. From the inpatients in the respiratory medical ward of Tokyo Metropolitan Hiroo General Hospital over the course of 1 year, the patients who had delirium were diagnosed by a semistructured interview. The total number of subjects was 454, and patients with delirium were 43. Various clinical factors were compared between the delirium group and non-delirium group. In the delirium group, there were many elderly patients of 70 years or older. Moreover, there were many patients who had a chronic respiratory disease, patients in which the respiratory diseases were mutually complicated, and patients in whom other diseases combined with the respiratory disease in the delirium group. There were also many patients in the Intensive Care Unit (ICU), and patients with an endotracheal intubation or extubation. Based on the results of a multiple logistic regression analysis, for age, ICU accommodation, and endotracheal intubation, the value of the delirium group was more significant than that of the non-delirium group. In half of the patients from the delirium group, delirium developed within 1 week after hospitalization. In the patients who died in the hospital, however, delirium often developed days after they had been hospitalized. It was suggested that the later developed delirium had a relation to the prognosis.

Adolescent↗

Serological evidence of Mycoplasma cynos infection in canine infectious respiratory disease.

A high proportion of dogs suffer from respiratory disease when they are placed in kennels for vacation or re-homing. The role of Mycoplasma cynos as an initiating agent in canine infectious respiratory disease was investigated by examining the serological response of dogs to this organism at the time of entry into a large re-homing kennel. Forty-two paired serum samples from dogs (21-day interval) were examined for antibody to M. cynos using Western blotting. The development of antibody in the serum was related to clinical disease recorded over the same period. Sixty seven per cent of the dogs showed a two-fold or greater rise in antibody to M. cynos during the first 3 weeks in the kennel. Reactivity with a 45kDa antigen was dominant. Of those showing a positive serological reaction, 80% had recorded clinical respiratory disease while 20% remained healthy. The findings of this study show that an antibody response to M. cynos is common in dogs entering the re-homing kennel and is positively related to the development of clinical respiratory disease.

Animals↗

Guidelines for improving care in respiratory disease in the UK.

More than eight million people in the UK have respiratory conditions and one in four people die from them. We appear to be facing a major paradox with regard to the management of respiratory disease in the UK. Although we have a wide range of diagnostic tests and effective treatments at our disposal, we do not appear to be making any impact on the morbidity and mortality of respiratory disease. Respiratory disease needs to be moved onto the 'must do' agenda.

Age Distribution↗

The importance of picornavirus infections in respiratory disease of man and other mammals.

Picornaviruses may be divided, by physicochemical properties, into enteroviruses, cardioviruses, caliciviruses, rhinoviruses and foot-and-mouth diseases viruses. Although the respiratory tract may be the primary site of entry and multiplication for enteroviruses, cardioviruses and FMD viruses, few agents in these groups cause respiratory disease. A notable exception is coxsackievirus A21 which is an important cause of upper respiratory tract diseases in military recruits. The picornaviruses which most frequently cause respiratory illness are rhinoviruses and caliciviruses. There are over one hundred rhinovirus serotypes which infect man and they have been isolated from up to 50 percent of cases of mild respiratory illness, from 1-2 percent of healthy adults and from 5-10 percent of healthy children. About 10 percent of rhinovirus infections in adults are symptomless. The two bovine serotypes of rhinovirus and the two equine serotypes frequently infect cattle and horses respectively but seldom cause disease. Numerous calicivirus serotypes have been found in 17 percent of cats with respiratory disease and in 19 percent of clinically normal cats. However, experimental inoculation with caliciviruses has confirmed their causative role in respiratory disease of cats. The high rate of virus isolation from normal cats is probably due to their ability to carry virus in an infectious form for up to two years after initial infection and illness.

Adult↗

Risk of depression in patients with chronic respiratory diseases: results from two large cohort studies in Chinese elderly from Hong Kong.

OBJECTIVE: Although it has been suggested that depression is common in patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), few studies on the association between chronic respiratory diseases and depression have been conducted in the community. METHOD: Data from the baseline examination of two cohort studies, Mr and Ms Os, Hong Kong were used. Three thousand nine hundred and ninety-eight Hong Kong men and women aged 65 to 92 were recruited. Depression was assessed by face-to-face interview, using the short-form of a validated Chinese version of the Geriatric Depression Scale (GDS). Chronic respiratory disease was assessed by subjects' self reports of chronic respiratory disease (chronic bronchitis, emphysema and asthma) diagnosed by medical doctors. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CI) for depression among subjects with chronic respiratory diseases relative to those without (controls) were calculated, after adjustments were made for potential confounders. RESULTS: Chronic respiratory disease was associated with a higher prevalence of depressive disorders with an odds ratio of 1.58 (95% CI = 1.12-2.13) after adjustment was made for age, sex, cigarette smoking, alcohol drinking and history of cardiovascular diseases when compared with controls. For those subjects with self report of chronic respiratory disease and who screened positive for depression (n = 44), none were on antidepressants. Among subjects who screened positive for depression without self-report of chronic respiratory disease (n = 328), only 2.74% (n = 9) were on antidepressants. CONCLUSIONS: We conclude that chronic respiratory disease is independently associated with depression in Chinese elderly. Moreover, depression in the elderly is under-treated in those with and without chronic respiratory disease. Clinicians, especially primary care physicians in the community, should be more aware of increased prevalence of depression in patients with chronic respiratory disease.

Aged↗

Negative findings concerning Alcaligenes faecalis as an etiologic agent in acute respiratory disease of turkeys.

An acute respiratory disease of turkeys in Israel was first reported in November 1978. Alcaligenes faecalis was isolated from sick turkeys and from chickens not affected by the disease. Plate agglutination tests with A. faecalis antigen of 1,067 turkey and 494 chicken serum samples gave variable results: healthy turkeys gave positive reactions and sick turkeys sometimes gave negative ones. All isolated strains were highly sensitive in vitro drug sensitivity tests, but chemotherapy failed in the field. Pathogenicity trials with A. faecalis, given alone or in combination with Yucaipa virus to 8-day-old turkey poults, failed to reproduce the disease.

Alcaligenes↗