Background:Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is considered to be an important cause of morbidity, intensive care unit (ICU) admissionand mortality in COPD patients. Objectives:to identify the factors which could predict the outcome ofCOPDpatients. Patients and methods: A prospective study was conducted at Chest Department of Sohag University Hospital during the period from May 2016 to August 2017 and included 101 COPD patients with AECOPD. Patients were deemed to have AECOPD if this diagnosis appeared on their clinical histories. The studied variables included clinical parameters (symptoms & signs), spirometry and laboratory tests (complete blood count, serum creatinine, liver function tests-ALT, AST and serum albuminserum electrolytes, arterial blood gas test and sputum cultures), radiological data(plain chest x-ray, CT chest (if indicated) and echocardiographic data for every patient. The outcome in the studyincluded improvement or non-improvement (referral to ICU or death). Results:The study included 101 patients with AECOPD, the mean age of the patients was 60years, 66.34% of them were males and 33.66% females, according tothe outcome; 83 cases improved, 18 cases had poor outcome (i.e. need ICU admissionordied). Bacterial growth, in the sputum culture, was recorded in 65.35% of the cases. The most frequently recorded bacterial organism were: Streptococcus pneumonia, Haemophilus influenza and Pseudomonas aeruginosa (14.85%, 13.87% and 10.89% respectively). The factors, which had significant relation to poor outcome, were: male gender (P=0.04), frequent exacerbation (P=0.003), history of ≥2 hospital admission and previous ICU admission in the last year(P= 0.004 and 0.003 in order), history of prior LTOT(P=0.006),altered consciousness, tachycardia, tachypnea, fever, flapping tremor, pedal edema (P=0.009, 0.02, ˂0.0001, 0.03,˂0.0001and0.008 in order), associated comorbidities (bronchiectasis, corpulmonale and DM; P=0.047, 0.005 and 0.008respectively), lower mean values of pH, PaO 2 , SaO 2 and higher mean values of PaCO 2 on admission (P=0.007, 0.003, 0.001 and 0.01in order), leukocytosis, thrombocytopenia, elevated serum creatinine, elevated liver enzymes and hypoalbuminemia (P= 0.008, 0.001, 0.02, 0.001and0.007 in order), presence of cardiomegaly or bronchiectaic changes as radiological findings (P= 0.001 and 0.047 in order), severe pulmonary artery hypertension as an echocardiographic finding (P=0.03), lower mean values of FEV1and FVC(P=0.01 and 0.02 in order), Staph. aureusand P. aeruginosa isolation in sputum cultures (P˂0.0001 and 0.002 in order). Conclusion:The significant factors in predicting poor outcome of AECOPD were: male gender, frequent exacerbations, prior hospital (≥2 hospital admission/year) and ICU admission in the last year, history of prior LTOT, associated comorbidities (bronchiectasis,corpulmonale and DM), consciousness alteration, tachycardia, tachypnea, fever, flapping tremor, lower limb edema, arterial blood gas parameters on

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Background:adherence to medication is a growing issue and there aremany factors affecting adherence in bronchial asthma and COPD. Objectives:This study was designed to determine the factors affectingadherence to inhalation therapy in asthma and chronic obstructivepulmonary disease. Patients and Methods:The present study included 300 patients (164males and 136 females and 156 COPD and 144 asthma also 189 werealready on inhaler therapy and 111 were naive(no previous inhaler)whoattended Sohag university hospital (inpatient department and outpatientclinic of chest diseases)during the period from April 2016 to May 2017using morisky questionnaire to determine factors affecting adherence toinhaled therapy. Results: 300 patients 164cases (54.67%) were males and 136 cases(45.73)were female, Good adherence to inhaled therapy was observed in 124 (35.3%) patients and both intermediate and good adherence was observed in 227 ( 64.6% ) patients. Most of the naive patients were poor adherent to inhaled therapy.There was no relationship between demographic data and adherence in asthmatic patients. However, there was significant relation between adherence and socioeconomic status and residence in COPD patients. Patients with bronchial asthma had better adherence to inhaled therapy than patients with COPD, However good adherence was frequently encountered in patients with COPD who had 2-4 emergency visits in the last year. Good adherence was observed frequently in patients who had ENT diseases as comorbidity, while poor adherence was observed frequently in patients who had cardiac disease. Good adherence was frequently encountered among asthmatic patients whoused inhaler twice daily, who used drugs its onset of action 5-20 minutes, whoused aerolizer and turbohaler devices and who used budesonide and budesonide/formetrol. Good adherence was frequently encountered among patients with COPD who used inhaler twice daily, who used aerolizer and handihaler devices and who used formetrol and tiotropium Conclusion: This study confirmed that many factors affect adherence toinhaled therapy,so the interventions to maintain adherence contain fivecategories should be joint together(patient related factors, condition related factors, drug related factors, healthcare system related and socioeconomic status)to improve adherence and thus quality of life.

The purpose of this study was to identify the pattern of allergen-sensitivity in asthmatic patient in Sohag governorate, Egypt, and to provide data for therapeutic management of those patients by immunotherapy. The study included patients with bronchial asthma diagnosed clinically and by pulmonary function tests. Patients were subjected skin prick test to diagnose their sensitization to different allergens including aero-allergens, contact, and food allergens. Clinical and demographic data of the patients were collected for correlating it with the pattern of the sensitivity. The most frequent aero-allergen reported in asthmatic patients was birch (38.7%), followed by sunflower seeds and mixed grass (29.5% and 26.4% respectively), While the most frequent contact allergen reported was common wasp venom followed by honey bee venom (25.7% and 20.6% respectively). the most frequently reported food allergen was banana followed by milk and Sollanaceae (12.2%, 11.5%, and 11.0% respectively). In conclusion, our study provided useful information on the pattern of allergen sensitization in this part of the country; such information would be helpful in treating allergic patients.

The aim of this study is to find out the link between the involvement of complement activation in the inflammatory reactions in COVID-19 patients, the deterioration of the clinical status and development of sever COVID-19 in those patients. Methods: The study included 274 COVID-19 patients, divided into three groups; group1: severe COVID-19 patients (n=37), group 2; moderate COVID-19 severity patients (n=78), group 3; mild COVID-19 severity patients (n=159). Serum levels of C-reactive protein, D-dimer, and ferritin were measured in the three patient groups, and the patients were subjected to CT chest imaging. Serum levels of the tested biomarkers were measured by ELISA at diagnosis. Results: Sever COVID-19 patients had higher serum levels of ferritin and D-dimer in comparison to patients with moderate and mild severity COVID-19 with statistically significant difference (p value 0.01 and 0.02 respectively). There was a significant elevation in the serum levels IL-6 and TNFα in severe COVID-19 patients (488.5±112.2 and 159.6±38.3 respectively) versus moderate (206.07±53.3 and 93.5±39.5) and mild group (200.9± 52.27 and 52.9±23) respectively, (p value < 0.001). There was also a significant elevation of C5b and C5b-9 serum levels in severe ) compared to moderate (14.11±15.6 and 143.6±170) and mild COVID-19 groups (76± 11.32 and 3.9± 3.03) respectively. Conclusion: We conclude that the severity of inflammation presented in elevated neutrophil counts and serum levels of inflammatory cytokines IL-6 and TNF in association with sever complement activation are implicated in severity and bad prognosis of COVID-19.