Aim The burden of wheezing illnesses in Australian infants has not been documented since the success of initiatives to reduce maternal cigarette smoking. We aimed to determine the incidence of wheeze and related health‐care utilisation during the first year of life among a contemporary Australian birth cohort. Methods A birth cohort of 1074 infants was assembled between 2010 and 2013. Parents completed questionnaires periodically. Several non‐exclusive infant respiratory disease phenotypes were defined, including any wheeze, wheeze with shortness of breath and recurrent wheeze. Skin prick testing was performed to determine atopic wheeze. Health‐care utilisation for respiratory disease was determined from questionnaires and hospital medical records. Results Retention to 1 year was 840/1074 (83%). The incidence of any wheeze was 51.8% (95% confidence interval (CI) 48.3–55.2%), wheeze with shortness of breath 20.6% (95% CI 17.9–23.5), recurrent wheeze 19.4% (95% CI 16.8–22.2) and atopic wheeze 6% (95% CI 4.6–7.8). Respiratory illness resulted in primary health‐care utilisation in 82.2% (95% CI 79.3–84.8) of participants and hospital presentation in 8.8% (95% CI 7.2–10.6). Maternal smoking during pregnancy was uncommon (15.7%) and was not associated with wheeze or health resource utilisation. Male gender, familial atopy and asthma and smaller household size were associated with a higher incidence of wheeze. Conclusions The incidence of wheezing illness among Australian infants remains high despite relatively low rates of maternal smoking during pregnancy. The majority of the health‐care burden is borne by primary health‐care services. Further research is required to inform novel prevention strategies.

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We examined the pattern of adrenaline administration in patients presenting with anaphylaxis. Forty-four percent required repeated adrenaline administration, among whom there had been greater cardiorespiratory compromise. Repeated administration was more frequent in males and older patients, and those triggered by insect sting or unknown cause; no other patient factors were identified. This study supports the provision of two adrenaline auto-injectors to all anaphylaxis patients.

Background: The mechanisms involved in the amplification of the mast cell response during anaphylaxis are unclear. Mouse models of anaphylaxis demonstrate the critical involvement of neutrophils. These innate immune cells are highly abundant in peripheral blood and can be rapidly activated to trigger both local and systemic inflammation. The purpose of this study was to investigate neutrophil activation in the peripheral blood during acute human anaphylaxis.

BackgroundMultidisciplinary systematic assessment improves outcomes in difficult‐to‐treat asthma, but without clear response predictors. Using a treatable‐traits framework, we stratified patients by trait profile, examining clinical impact and treatment responsiveness to systematic assessment.MethodsWe performed latent class analysis using 12 traits on difficult‐to‐treat asthma patients undergoing systematic assessment at our institution. We examined Asthma Control Questionnaire (ACQ‐6) and Asthma Quality of Life Questionnaire (AQLQ) scores, FEV1, exacerbation frequency, and maintenance oral corticosteroid (mOCS) dose, at baseline and following systematic assessment.ResultsAmong 241 patients, two airway‐centric profiles were characterized by early‐onset with allergic rhinitis (n = 46) and adult onset with eosinophilia/chronic rhinosinusitis (n = 60), respectively, with minimal comorbid or psychosocial traits; three non‐airway‐centric profiles exhibited either comorbid (obesity, vocal cord dysfunction, dysfunctional breathing) dominance (n = 51), psychosocial (anxiety, depression, smoking, unemployment) dominance (n = 72), or multi‐domain impairment (n = 12). Compared to airway‐centric profiles, non‐airway‐centric profiles had worse baseline ACQ‐6 (2.7 vs. 2.2, p < .001) and AQLQ (3.8 vs. 4.5, p < .001) scores. Following systematic assessment, the cohort showed overall improvements across all outcomes. However, airway‐centric profiles had more FEV1 improvement (5.6% vs. 2.2% predicted, p < .05) while non‐airway‐centric profiles trended to greater exacerbation reduction (1.7 vs. 1.0, p = .07); mOCS dose reduction was similar (3.1 mg vs. 3.5 mg, p = .782).ConclusionDistinct trait profiles in difficult‐to‐treat asthma are associated with different clinical outcomes and treatment responsiveness to systematic assessment. These findings yield clinical and mechanistic insights into difficult‐to‐treat asthma, offer a conceptual framework to address disease heterogeneity, and highlight areas responsive to targeted intervention.

Background The major published clinical guidelines for the management of hypothyroidism and osteoporosis are not uniformly consistent and may be a significant contributor to variability of clinical care delivered by endocrinologists, in addition to other factors, such as physician experience, physician and patient perceptions, and patient comorbidities. The purpose of this study was to assess practice patterns of hypothyroidism and osteoporosis within an academic endocrine clinic. Methods A retrospective medical record review of the first 200 adult patients ( n = 100 with primary hypothyroidism and n = 100 with osteoporosis or osteopenia) seen by an endocrinologist beginning January 2, 2017at a large U.S. urban tertiary academic medical center was performed. Data were collected regarding patient demographics, clinic visit type, patterns of ordering laboratory tests and imaging, and choice of pharmacologic treatment. Results Most patients with hypothyroidism (99%) had a serum thyroid stimulating hormone concentration measured. Other thyroid indices measured included serum total thyroxine (10%), serum free thyroxine [T4] (82%), serum free T4 index (6%), serum total triiodothyronine [T3] (9%), and serum free T3 (12%). Forty-eight percent also had serum thyroid antibodies checked. A variety of thyroid hormone supplements were used to treat hypothyroidism, including levothyroxine (83%), levothyroxine and liothyronine combination (8%), and desiccated thyroid extract (6%). In regards to patients with osteoporosis, mean duration of all pharmacologic therapy combined was 73.4 ± 81.9 months. For those with more than one bone density (DXA) scans (64%), the mean time interval between two consecutive DXA scans was variable (mean 32.0 ± 24.7 [SD] months). Sixty eight percent of the patients had bone turnover markers assessed within 7 months of the visit. Conclusions This study reports a real-world experience of endocrinology practice patterns at a large U.S. academic healthcare system. For the common diagnoses of hypothyroidism and osteoporosis, there are opportunities for increased standardization of care, particularly regarding the ordering of laboratory testing and radiologic studies. Identifying areas with significant practice variability may improve the quality and health outcomes and reduce the cost of care for patients with these conditions. Increased understanding regarding the reasons behind ordering various studies may help physician and patients further align their goals.

Air pollution can lead to the elevated incidence of various respiratory diseases, seriously endangering the health of urban residents. To better comprehend the association between urban air pollution and respiratory disease incidence, this study focused on Xinxiang City, a typical industrial city in the North China Plain, as the research object. By analyzing monthly air pollution index concentrations from 2018 to 2021 and confirmed cases of respiratory diseases, and incorporating meteorological factors as reference points, we conducted a correlation analysis between disease data and pollutant concentrations. We then constructed a Poisson regression model to obtain maximum likelihood estimates, which were used to predict the quantitative relationship between the incidence of respiratory diseases and air pollution indicators. The results showed that an increase of 1 μg/m³ in the average mass concentration of PM2.5, PM10, NO2, and SO2 in ambient air was associated with an elevated incidence of respiratory diseases by 0.2–1.4%, 0.7–1.6%, 3.7–8.2%, and 0.5–2.3%, respectively; meanwhile, a monthly mean mass concentration of CO increased by 1 mg/m³ led to a rise in pulmonary tuberculosis incidence by 2.9%. Additionally, based on health risk data following exposure to air pollution in Xinxiang City, it was confirmed that the impact of respiratory diseases as measured by the air quality composite index was more applicable than the single pollution index. Furthermore, there was a significant association between air pollution and the incidence of respiratory diseases.