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Infant respiratory infections and later respiratory hospitalisation in childhood.

Acute respiratory infections (ARI) cause significant morbidity in infancy. We sought to quantify the relationship between ARI and development of respiratory morbidity in early childhood.

Population-based longitudinal hospitalisation data were linked to perinatal, birth and death records for 145 580 Western Australian children from 1997 to 2002. We conducted Cox regression with sensitivity analyses to quantify the risk of recurrent ARI in infancy for respiratory hospitalisation after the age of 3 years.ARI in infancy was significantly related to respiratory hospitalisation before (hazard ratio (HR) 3.5, 95% CI 3.1-3.8) and after (HR 3.0, 95% CI 2.6-3.4) adjusting for known risk factors including maternal smoking during pregnancy, season of birth, delivery mode and gestational age.

We noted a dose response with the number and length of infant ARI hospitalisations and increasing risk with no effect modification by gestational age. Results were similar when later respiratory hospitalisations were restricted to asthma hospitalisations only.Recurrent hospitalisations for ARI in infancy significantly increase the risk of respiratory morbidity and asthma requiring hospitalisation after the age of 3 years in a dose-response fashion.

The increase in relative risk is not modified by gestational age. Efforts to reduce the occurrence of infant ARI are likely to have significant public health benefits.

Effectiveness and cost of influenza vaccine reminders for adults with asthma or chronic obstructive pulmonary disease.

OBJECTIVES: To assess the effectiveness and cost of interactive voice response (IVR) reminders for influenza vaccination compared with postcards, among adults with asthma or chronic obstructive pulmonary disease (COPD).

STUDY DESIGN: Pragmatic, 3-arm, randomized control trial.

METHODS: The trial was conducted in an integrated healthcare organization during 2012 and 2013, using an existing IVR system. All adults aged 19 through 64 years with asthma or COPD (n = 12,285) were randomized to receive 1 of the following vaccination reminders: 1) postcard reminder only, 2) IVR reminder only, or 3) postcard plus IVR reminder. The primary outcome was influenza vaccination by October 31, 2012; the secondary outcomes were influenza vaccination by December 31, 2012, and by March 31, 2013.

RESULTS: For subjects receiving an IVR call, 57% received a message on their answering machine; 27% answered the call; and 16% were not reached. Influenza vaccination rates were 29.5%, 31.1%, and 30.6% in the postcard-only, IVR-only, and postcard-plus-IVR study arms, respectively. After controlling for relevant covariates, IVR reminders were not significantly more or less effective than postcard reminders. Program costs were $0.78, $1.23, and $1.93 per subject for postcard-only, IVR-only, and postcard-plus-IVR reminders, respectively. Extrapolating costs to the entire population at the study site that typically receives influenza vaccination reminders (approximately 100,000 individuals), reminder costs would have been $0.55, $0.05, and $0.60 per subject for postcard-only, IVR-only, and postcard-plus-IVR reminders, respectively.

CONCLUSIONS: IVR reminders are not more effective at promoting influenza vaccination than postcard reminders, but IVR reminders may be less expensive for large patient populations.

CLCA1 and TMEM16A: the link towards a potential cure for airway diseases.

The hallmark traits of chronic obstructive airway diseases are inflammation, airway constriction due to hyperreactivity and mucus overproduction. The current common treatments for asthma and chronic obstructive pulmonary disease target the first two traits with none currently targeting mucus overproduction.

The main source of obstructive mucus production is mucus cell metaplasia (MCM), the transdifferentiation of airway epithelial cells into mucus-producing goblet cells, in the small airways. Our current understanding of MCM is profusely incomplete. Few of the molecular players involved in driving MCM in humans have been identified and for many of those that have, their functions and mechanisms are unknown. This fact has limited the development of therapeutics that target mucus overproduction by inhibiting MCM. Current work in the field is aiming to change that.

Microbiome and Asthma: What Have Experimental Models Already Taught Us?

Authors: Bonamichi-Santos R, Aun MV, Agondi RC, Kalil J, Giavina-Bianchi P Abstract Asthma is a chronic inflammatory disease that imposes a substantial burden on patients, their families, and the community. Although many aspects of the pathogenesis of classical allergic asthma are well known by the scientific community, other points are not yet understood. Experimental asthma models, particularly murine models, have been used for over 100 years in order to better understand the immunopathology of asthma. It has been shown that human microbiome is an important component in the development of the immune system. Furthermore, the occurrence of many inflammatory diseases is influenced by the presence of microbes. Again, experimental models of asthma have helped researchers to understand...

The Middle East respiratory syndrome puzzle: A familiar virus, a familiar disease, but some assembly still required

Research and observations to date have provided some of the pieces for the Middle East respiratory syndrome (MERS) puzzle, but more are needed. MERS-coronavirus (CoV) appears to be an enzootic, seasonal cause of upper and lower respiratory tract infections in African and Arabian Peninsula camels [1]. Camel trading may have a role in distributing the virus [2,3]. Transmission of MERS-CoV from camels to humans occurs rarely and transmission between humans is sporadic and inefficient. MERS-CoV does not currently pose a pandemic threat despite detection in two dozen countries. (Source: Journal of Infection and Public Health)

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