Em uma amostra de 12 por cento da população urbana de Botucatu, São Paulo, constituída de 7.075 pessoas, foram identificados 525 indivíduos com sintomas sugestivos de doença respiratória crônica inespecífica (DRCI). Utilizando o questionário de sintomas respiratórios \"ATS-DLD-78\", aplicado por entrevistadores leigos, a autora determinou a prevalência de alguns sintomas e de associações sugestivas de asma brônquica, bronquite crônica e doença pulmonar obstrutiva crônica (DPOC). Os sintomas mais frequentes no sexo masculino, foram: tosse, expectoração e chiado, cuja prevalência foi de 6,2 por cento , 5,4 por cento e 5,3 por cento , respectivamente. No sexo feminino os sintomas mais frequentes foram: tosse, chiado, dispnéia e rinite alérgica cujas taxas de prevalência foram: 4,7 por cento , 4,7 por cento , 4,2 por cento e 4,0 por cento , respectivamente. Houve maior prevalência de sintomas respiratórios nos maiores de 50 anos de idade e nos menores de 15 anos. A prevalência média de sintomas sugestivos de asma brônquica foi de 5, 0 por cento , e de 1,9 por cento para bronquite crônica e de 0,1 por cento para DPOC. A influência do hábito de fumar, presente entre os sintomáticos respiratórios em 33,7 por cento dos homens e 23,4 por cento das mulheres, foi estudada em relação aos sintomas de tosse e expectoração pela manhã e aos sintomas sugestivos de bronquite crônica. Em vista dos resultados, a autora analisa e comenta a metodologia utilizada e a aplicabilidade do questionário \"ATS-DLD-78\" em nosso meio. Frente a escassez de dados relativos às DRCI, no Brasil, conclui sobre a necessidade de novos inquéritos epidemiológicos em regiões diferentes, realizados com metodologia adequada que possibilite a comparação dos resultados, complementados, quando possível, por estudos clínicos, tendo em vista o planejamento de medidas e programas de intervenção. / In a sample of 12 per cent of the urban population of Botucatu, São Paulo (7075 persons) submitted to a general health and life conditions survey, 525 people with symptoms of inespecific chronic respiratory diseases (ICRD) were detected. The \"ATS-DLD-78\" questionnaire for respiratory symptoms was applyed to these 525 people by non-medical interviewers, and from the collected data the prevalence of some symptoms and association of symptoms suggesting asthma, chronic bronchitis and chronic obstructive pulmonar disease (COPD) was determined. The most frequent symptoms in males were cough (6,2 per cent ), expectoration (5.4 per cent ) and wheezing (5.3 per cent ) and in females, cough (4.7 per cent ), wheezing (4.7 per cent ), dyspnea (4.2 per cent ) and allergic rhinitis (4.01). The prevalence os respiratory symptoms was greater before 15 after 50 years of age. The mean prevalence of symptoms suggesting asthma was 5.0 per cent , suggesting chronic bronchitis, 1.9 per cent and COPD 0,1 per cent . Tobacco smoking was presente in 33.7 per cent of symptomatic men and 23.4 per cent of the symptomatic women. There was a relation between smoking and the presence of morning cough and phlegm and symptoms of chronic bronchitis. The used metodology and the applicability of the \"ATS-DLD-78\" questionnaire to our population is analysed and commented. Taking into account the scarcity of data about ICRD in Brazil, the author concludes emphazising the need of another epidemiological surveys in different parts of the country, using tested and standardized methods that make possible a comparison of data, with the aim of planning intervention measures and programmes.

Em uma amostra de 12 por cento da população urbana de Botucatu, São Paulo, constituída de 7.075 pessoas, foram identificados 525 indivíduos com sintomas sugestivos de doença respiratória crônica inespecífica (DRCI). Utilizando o questionário de sintomas respiratórios \"ATS-DLD-78\", aplicado por entrevistadores leigos, a autora determinou a prevalência de alguns sintomas e de associações sugestivas de asma brônquica, bronquite crônica e doença pulmonar obstrutiva crônica (DPOC). Os sintomas mais frequentes no sexo masculino, foram: tosse, expectoração e chiado, cuja prevalência foi de 6,2 por cento , 5,4 por cento e 5,3 por cento , respectivamente. No sexo feminino os sintomas mais frequentes foram: tosse, chiado, dispnéia e rinite alérgica cujas taxas de prevalência foram: 4,7 por cento , 4,7 por cento , 4,2 por cento e 4,0 por cento , respectivamente. Houve maior prevalência de sintomas respiratórios nos maiores de 50 anos de idade e nos menores de 15 anos. A prevalência média de sintomas sugestivos de asma brônquica foi de 5, 0 por cento , e de 1,9 por cento para bronquite crônica e de 0,1 por cento para DPOC. A influência do hábito de fumar, presente entre os sintomáticos respiratórios em 33,7 por cento dos homens e 23,4 por cento das mulheres, foi estudada em relação aos sintomas de tosse e expectoração pela manhã e aos sintomas sugestivos de bronquite crônica. Em vista dos resultados, a autora analisa e comenta a metodologia utilizada e a aplicabilidade do questionário \"ATS-DLD-78\" em nosso meio. Frente a escassez de dados relativos às DRCI, no Brasil, conclui sobre a necessidade de novos inquéritos epidemiológicos em regiões diferentes, realizados com metodologia adequada que possibilite a comparação dos resultados, complementados, quando possível, por estudos clínicos, tendo em vista o planejamento de medidas e programas de intervenção. / In a sample of 12 per cent of the urban population of Botucatu, São Paulo (7075 persons) submitted to a general health and life conditions survey, 525 people with symptoms of inespecific chronic respiratory diseases (ICRD) were detected. The \"ATS-DLD-78\" questionnaire for respiratory symptoms was applyed to these 525 people by non-medical interviewers, and from the collected data the prevalence of some symptoms and association of symptoms suggesting asthma, chronic bronchitis and chronic obstructive pulmonar disease (COPD) was determined. The most frequent symptoms in males were cough (6,2 per cent ), expectoration (5.4 per cent ) and wheezing (5.3 per cent ) and in females, cough (4.7 per cent ), wheezing (4.7 per cent ), dyspnea (4.2 per cent ) and allergic rhinitis (4.01). The prevalence os respiratory symptoms was greater before 15 after 50 years of age. The mean prevalence of symptoms suggesting asthma was 5.0 per cent , suggesting chronic bronchitis, 1.9 per cent and COPD 0,1 per cent . Tobacco smoking was presente in 33.7 per cent of symptomatic men and 23.4 per cent of the symptomatic women. There was a relation between smoking and the presence of morning cough and phlegm and symptoms of chronic bronchitis. The used metodology and the applicability of the \"ATS-DLD-78\" questionnaire to our population is analysed and commented. Taking into account the scarcity of data about ICRD in Brazil, the author concludes emphazising the need of another epidemiological surveys in different parts of the country, using tested and standardized methods that make possible a comparison of data, with the aim of planning intervention measures and programmes.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation.

Chronic respiratory diseases such as asthma and chronic bronchitis have significantly increased in prevalence in Africa over the past 10 years. Recent studies have demonstrated that exposure to air pollution may be associated with an increased risk of chronic respiratory diseases. However, such studies have predominantly been conducted in western societies or often used urbanicity as a proxy for exposure to air pollution. Therefore, we evaluated the association between PM2.5 exposure and asthma/chronic bronchitis in Senegal. A cross-sectional study was conducted for the time period of 3 October 2010 to 28 April 2011 using annual concentrations of PM2.5 measured via multiple satellite instruments, and asthma/chronic bronchitis, which was self-reported at baseline via a health survey questionnaire. We used mixed model logistic regression to evaluate the relationship between PM2.5 exposure and asthma/chronic bronchitis risk while adjusting for lifestyle factors, location, and other air pollutants. Sex was evaluated as an effect modifier. The adjusted association between PM2.5 and asthma/chronic bronchitis was 1.03 (95%CI: 0.99 – 1.06). In males the adjusted odds ratio was 1.09 (95%CI: 1.03-1.15), compared to females (aOR 1.01 (95%CI: 0.97 – 1.05). Our results suggest that increasing levels of exposure to PM2.5 puts individuals at a higher risk for chronic respiratory diseases, especially men. These findings have significant policy implications and should be built upon in future research.

Chronic respiratory diseases (CRDs) include chronic diseases involving the airways and other structures of the lung. In the current circumstance of Vietnam, people are exposed to numerous risk factors of CRD, such as heavy smoking, high frequency of pulmonary tuberculosis, chronic helminthiasis, allergic factors, migration and urbanization (the last associated with traffic-related pollution). The phenotype diagnoses should take into account the risk factors of each individual besides the clinical features, while the differential diagnoses mostly depend on the available techniques in each healthcare center. Our aim was to improve the differential diagnoses of the 3 most frequent CRDs: chronic obstructive pulmonary disease (COPD), asthma and COPD – asthma overlap syndrome (ACOS), in Vietnam. In the first part, we evaluated the prevalence of the allergen sensitization among patients with CRD, in regard to the urban and rural area in the South of Vietnam. House dust mites and cockroach droppings were the most frequent sensitizer. Compared with participants born in the urban setting, those born in the rural environment were less frequently sensitized and this protective effect disappeared in the case of migration from rural to urban areas. In the second part, we evaluated skin prick test as a method to screen dust mite sensitization in CRD in southern Vietnam. The data suggested that, in the present circumstance, skin prick test can be used to screen mite sensitization. In the third part, we evaluated the risk of mite sensitization in the native and migrant population, in regard to several environmental factors. Consistently with the hygiene hypothesis, compared to urban, exposure to high endotoxin concentration in rural was a protective factor against allergic sensitization. We reported for the first time that this effect was reversible among the migrants from rural to urban setting in association with lower endotoxin exposure. In the fourth part, we have defined asthma, COPD and ACOS based on clinical symptoms, cumulative smoking and airway expiratory flow with reversibility, on one side, and the age-related of the different phenotypes, on the other side. We hypothesized that the cumulative exposure to noxious particles should increase the age-related prevalence of COPD, while due to the immunosenescence process, the prevalence of IgE-mediated asthma should decrease with age, and ACOS prevalence being not related to age due to the combined mechanisms.  In conclusion, we showed in the South of Vietnam that:1) mites and cockroach allergens were the most frequent sensitizer in chronic respiratory diseases;2) the skin prick test to mite has been validated to screen mite sensitization;3) associated with a reduced level of endotoxin level, migration from rural to the urban setting was a risk factor of mite sensitization in chronic respiratory diseases;4) based on the clinical symptoms, spirometric values, and cumulative smoking, the diagnosis of asthma, COPD and ACOS have been made and their prevalence were 25, 42 and 33%, respectively. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Chaque année, les maladies respiratoires figurent parmi les dix premières causes de décès dans le monde. L'exposition continue de l'épithélium pulmonaire aux particules et microorganismes aériens explique en partie cette vulnérabilité. Cette situation génère un dilemme immunologique pour l'organisme : il doit produire une réponse immunitaire adéquate pour protéger l’épithélium respiratoire tout en limitant l’inflammation qui pourrait nuire à son intégrité. Les lymphocytes T-CD8+ jouent un rôle essentiel dans l’immunosurveillance des cellules infectées ou tumorales. Leur activation rapide repose sur l’expression généralisée du Complexe Majeur d’Histocompatibilité de type I (CMH I) par toutes les cellules nucléées. Notre laboratoire a découvert en 2020 que les Cellules Épithéliales Pulmonaires (CEP) expriment peu de CMH I. Cette observation soulève des questions sur l'efficacité de la surveillance immunitaire dans les poumons, souvent cibles de maladies graves comme les infections, les cancers et les maladies chroniques. Cette thèse vise à explorer les mécanismes régulant l'expression du CMH I dans les CEP, en conditions normales et pathologiques, afin de comprendre les implications des variations de son expression sur la santé respiratoire. La première étude présentée dans cette thèse aborde la régulation du CMH I dans les CEP de souris en réponse à un contexte inflammatoire. Ces travaux ont révélé la capacité des CEP à augmenter significativement leur expression de CMH I en cas d'inflammation. À l'aide de modèles de souris transgéniques, les molécules impliquées dans cette régulation ont été identifiées, en particulier les Interférons (IFN) via les facteurs STAT1, STAT2 et NLRC5. De plus, ces analyses ont mis en évidence une association entre l'augmentation du CMH I et une diminution significative de gènes essentiels à l'intégrité de l'épithélium pulmonaire, soulignant ainsi un équilibre délicat entre défense immunitaire et maintien de l'intégrité tissulaire. Une seconde étude, basée sur des analyses de séquençage ARN de cellules uniques, a confirmé la faible expression du CMH I dans les CEP humaines. Ces résultats ont mis en lumière une augmentation significative de son expression chez des patients atteints de trois types de maladies respiratoires chroniques : la Maladie Pulmonaire Obstructive Chronique (MPOC), la Fibrose Pulmonaire Idiopathique (FPI) et la Fibrose Kystique (FK), principalement médiée par la voie NF-B. De plus, cette étude a révélé un dimorphisme sexuel dans l’expression du CMH I chez des donneurs sains ainsi que chez les patients atteints de MPOC et de FPI, avec des tendances opposées dans les deux maladies. Les analyses d’expression différentielle de gènes suggèrent une implication du stress oxydatif dans la régulation différenciée du CMH I entre hommes et femmes. Ces travaux représentent une avancée significative dans la compréhension des mécanismes régulant le CMH I dans les CEP, ainsi que des facteurs influençant la diversité de son expression. Les variations d’expression du CMH I dans les CEP pourraient jouer un rôle majeur dans la pathogenèse des maladies respiratoires et dans la susceptibilité individuelle à différentes affections. Ces découvertes ouvrent la voie à une meilleure compréhension de la physiologie pulmonaire, des maladies respiratoires, et à des approches thérapeutiques plus ciblées et personnalisées. / Respiratory diseases consistently rank among the top ten causes of global mortality every year. The continuous exposure of the pulmonary epithelium to airborne particles and microorganisms partly explains this vulnerability. This situation creates an immunological dilemma for the organism: it must produce an adequate immune response to protect the respiratory epithelium while limiting inflammation that threatens its integrity. CD8+ T lymphocytes play an essential role in immunosurveillance against infected or tumor cells. Their swift activation hinges on the widespread expression of the major histocompatibility complex class I across all nucleated cells. Our laboratory discovered in 2020 that Lung Epithelial Cells (LECs) exhibit shallow levels of MHC I expression. This discovery prompted critical inquiries into the efficacy of pulmonary immune surveillance, crucial given the lungs' heightened susceptibility to various ailments such as infections, cancers, and chronic illnesses. This thesis aims to explore the mechanisms regulating MHC I expression in LECs under normal and pathological conditions to understand the implications of its expression variations on respiratory health. The first study that will be presented examines MHC I regulation in mice's LECs during inflammation. These works highlighted the ability of LECs to significantly increase their expression of MHC I in response to an inflammatory challenge. The molecules involved in this regulation were identified using transgenic mouse models, including IFN through STAT1, STAT2, and NLRC5 factors. Additionally, these analyses revealed an association between increased MHC I expression and a significant decrease in genes essential for the integrity of the pulmonary epithelium, emphasizing a delicate balance between defense and integrity maintenance. In a second study, analyses of single-cell RNA sequencing confirmed the low expression of MHC I in human LECs. These results also demonstrated a significant increase in its expression in LECs from patients with three types of chronic respiratory diseases: Chronic Obstructive Pulmonary Disease (COPD), Idiopathic Pulmonary Fibrosis (IPF), and Cystic Fibrosis (CF), principally mediated by the NF-B pathway. Furthermore, this study highlighted a sexual dimorphism in MHC I expression in healthy donors as well as in patients with COPD and IPF, with opposite directions in the two diseases. Differential gene expression analysis suggests an involvement of oxidative stress in the differentiated regulation of MHC I between men and women. Our comprehensive analyses offer profound insights into the intricate regulatory mechanisms governing MHC I expression in LECs and shed light on the factors contributing to its heterogeneous expression. These variations in MHC I expression levels could significantly influence the pathogenesis of respiratory disorders and individual susceptibilities to diverse respiratory ailments. These works pave the way for a better understanding of pulmonary physiology and respiratory diseases and toward more personalized therapeutic management of chronic respiratory alignments.

Detection of early pathophysiological changes of breathing in children with chronic respiratory disease MD. Vaclav Koucky - Ph.D. thesis Abstract Introduction: Currently, there are different methods for infant pulmonary function testing (iPFT) and morphological assessment of microscopic changes in endobronchial biopsy samples (EBB). In research setting, they allow detection of early pathophysiological changes of breathing in small children with chronic respiratory disease, respectively in risk of its development. Their clinical significance, however, is not fully acknowledged. The aim of this thesis is to evaluate the safety, feasibility and clinical significance of iPFT and EBB in infants younger than 2 years of age. In addition, the relationship between functional and morphological changes of respiratory tract and the function of peripheral chemoreceptors was studied in selected patients' subgroups. Methods: Fifty-five infants with cystic fibrosis (CF), 35 physician-confirmed recurrent wheezers (AB), 9 infants with congenital diaphragmatic hernia, 7 with interstitial lung disease (chILD) and 3 with primary ciliary dyskinesia (PCD) were enrolled. All infants underwent iPFT and relevant clinical history data were recorded. Based on patients' age, CF group was divided into CFmalí (< 6 months) and CFvelcí (>...