Introduction The evaluation of acute cough in primary care settings remains inconsistent, and cough sounds are seldom used for evaluation. This retrospective observational study examined how clinicians across different medical specialties utilize cough sounds and auscultations alongside different diagnostic approaches for the evaluation and categorization of acute cough and overall acute cough-related complications. Methods Electronic medical records from 2017 to 2023 for patients with acute cough were analyzed retrospectively across pediatric (<18 years), adult (18-65 years), and elderly (>65 years) age groups. Auscultation patterns, diagnostic investigations, and cough-related complications were analyzed. Results Unspecified cough predominated across all age groups - pediatric: 128,184 (88.22%); adult: 707,788 (78.29%); and elderly: 154,129 (76.48%). The most common auscultatory finding was wheezing reported by pulmonologists (376, 6.73%) in pediatric patients, 2,954 (5.53%) in adults, and 934 (6.45%) in the elderly. Chest X-ray was the primary diagnostic tool across specialties, whereas imaging use was conservative in pediatric populations (3,767, 15.7%), 33,850 (34.9%) in adults, and 7,869 (56.4%) in the elderly. Chest pain emerged as the most predominant complication in 1,631 (6.78%) pediatric patients, 22,906 (23.61%) adults, and 5,095 (36.58%) elderly. Most general practitioners demonstrated nominal use of cough sounds and auscultatory findings for the evaluation of cough, as it is not a regular practice. Conclusion The use of cough sounds and auscultations remains underutilized in practice, especially by general practitioners. Incorporating systematic acoustic analysis, including cough sounds and auscultatory patterns in primary care, could improve acute cough categorization, reduce or better plan diagnostic testing, and enable targeted and prompt treatment. Future research should focus on developing standardized tools and training programs to optimize acute cough management.

Bronchospasm is a condition commonly encountered in the perioperative setting and represents an airway emergency that requires immediate identification and management. While multiple factors increase the risk for bronchospasm, it can still appear in patients who are otherwise well. Of note, once treatment has been administered, it is important to continue monitoring the patient after the event to ensure full resolution. A 58-year-old medically well woman presented for an emergent laparoscopic cholecystectomy. Soon after intubation, she developed a sudden oxygen desaturation with hypotension and notable bilateral wheeze on auscultation. A rapid assessment was performed, considering issues with the endotracheal tube, airway obstruction, her depth of anaesthesia, bronchospasm, and anaphylaxis. Following this, she was treated for bronchospasm and supported briefly with metaraminol, with improvement in her vital signs and subsequent uneventful extubation. However, while in recovery, she had another episode of oxygen desaturation with a normal chest radiograph and a blood gas analysis suggesting a high A-a gradient, likely a further reactive airways event that required further treatment with bronchodilators and led to an overnight admission to the high-dependency unit for close monitoring and resolution of her hypoxia. A follow-up procedure in the next few days was pre-treated with nebulised bronchodilators, with an uneventful procedure and subsequent discharge home. A review of the literature shows the differential for bronchospasm remains broad, and multiple factors must be considered while ensuring patient safety. While treatment may be similar, it is paramount to ensure full resolution of symptoms prior to any consideration of discharge, as bronchospasm may recur in the short term with poor outcomes if not promptly addressed.

Bronchiolitis is a lower respiratory tract infection most frequently caused by viral infections and is usually managed with supportive care. The role of bronchodilators particularly intravenous (IV) β2-agonists remain uncertain. Emerging evidence suggests that bronchiolitis comprises heterogeneous phenotypes, with a subset demonstrating bronchodilator responsiveness. We report two infants (ten and three months old) with RSV confirmed severe bronchiolitis who exhibited respiratory distress and hypoxemia despite maximal supportive therapy, including oxygen, continuous positive airway pressure (CPAP), corticosteroids and inhaled salbutamol. IV terbutaline was initiated as rescue therapy after failure of supportive treatment and titrated up to 0.4 µg/kg/min resulting in progressive improvement in clinical respiratory scores, resolution of wheeze, and normalization of oxygen saturation within 24-48 hours. No adverse effects were observed. These case reports highlight the potential role of IV terbutaline as a rescue therapy in selected infants with bronchiolitis associated bronchospasm and warrant further well designed larger prospective studies.

Bee pollen has become an increasingly popular dietary supplement due to potential therapeutic effects. However, ingestion has been shown to trigger allergic responses as severe as anaphylaxis. This case highlights allergic asthma development in a 26-year-old female patient with subsequent anaphylaxis secondary to bee pollen ingestion. This patient presented to the emergency department with complaints of lip and tongue swelling, dyspnea, nausea, abdominal pain, and itching 4 h after bee pollen ingestion. Her medical history included seasonal allergic rhinitis and prior exercise-induced asthma that had not required treatment for 10 years. She was treated with a standard anaphylaxis pharmacological regimen and discharged. The patient then began to experience dyspnea and wheezing 1 month later during peak fall pollen levels. On allergy testing, the patient's total serum immunoglobulin E (IgE) was elevated at 189 kU/L. She also had elevated specific IgE to common ragweed, mugwort, and cocklebur, which are prominent allergens in the fall. Given the timing of onset of new symptoms, partial relief with an inhaled short-acting B2 agonist, and no pertinent findings for other causes, the patient was subsequently diagnosed with allergic asthma secondary to bee pollen ingestion. Although anaphylaxis to bee pollen is rare, it is becoming increasingly reported in literature and demonstrates an adverse effect that can occur when proper regulation and education are not performed. Dietary supplements like bee pollen need to have further testing and contain more thorough warnings on labels to decrease adverse events and protect people from undue harm.

A one-year-old boy was referred to our respiratory department for further evaluation of obstructing endobronchial lesions. The lesions were detected on chest computed tomography (CT) performed at another hospital after the patient presented with cough and worsening wheezing. Physical examination revealed tachypnea and diminished breath sounds bilaterally without rales. The patient was receiving supplemental oxygen. Notably, his medical history was significant for an admission at 21 days of age for persistent cough, right upper lung atelectasis, and sputum analysis that revealed Bordetella pertussis, Acinetobacter baumannii, and rhinovirus. Despite advanced testing, including bronchoalveolar lavage acid-fast staining, tuberculin skin testing, and metagenomic next-generation sequencing, the diagnosis was initially missed and was ultimately established only after multi-institutional pathology review with deeper histologic recuts identifying a rare acid-fast bacillus. This case demonstrates a rare but high-risk presentation of pediatric tuberculosis: near-complete tracheobronchial obstruction due to endobronchial tuberculosis (EBTB) in an infant.

Despite widespread use of polybrominated diphenyl ethers (PBDEs) and other brominated flame retardants (BFRs) in indoor environments, data on children's BFR exposure in Portuguese schools and associated health effects remain limited. We aimed to characterize indoor air BFR concentrations in 20 Portuguese primary schools, examine grade-specific exposure patterns, and investigate the associations between BFR concentrations and childhood asthma, wheezing, and eczema. Air BFRs were measured using passive sampling in 80 classrooms over 28 days. Health outcomes (lifetime asthma history, current asthma, wheezing, and eczema) were obtained from standardized parental questionnaires. Multilevel logistic regression models accounting for school-level clustering evaluated associations between log-transformed concentrations and health outcomes, adjusting for relevant confounders. The sum of BFR (∑BFR) concentrations ranged between 28.12 and 154.54 pg/m[3] . Replacement BFRs, particularly decabromodiphenyl ethane (DBDPE), were dominant contributors, while BDE-47 and BDE-209 remained prevalent among legacy compounds. Grade 1 students exhibited higher exposure to several BFRs than older students. Per log10-unit increase, BDE-209 was associated with higher odds of lifetime asthma history (OR=2.13; 1.09-5.11) and wheezing (OR=1.75; 1.17-3.18), while an increase in ∑BFRs (OR=1.93; 1.29-3.91) was associated with higher odds of current asthma. Furthermore, a log10-unit increase in ∑non-BDEs was associated with a significantly higher eczema odds (OR=2.88; 1.65-5.46). Children in schools are exposed to legacy and replacement BFRs, with patterns varying per grade. The prominence of replacement compounds underscores an ongoing transition in indoor BFR profiles, reinforcing the need for targeted mitigation strategies and continued evaluation of potential health risks to children.

Wheezing is a common respiratory symptom in infants and toddlers, and recurrent wheezing is a significant respiratory disorder affecting this age group. Given the multifactorial etiology of recurrent wheezing, clinical practice lacks standardized diagnostic and therapeutic protocols. Recent years have witnessed substantial progress in clinical research and therapeutic advancements, yielding robust evidence to inform clinical decision-making for recurrent wheezing in infants and toddlers. The guideline is developed by integrating the latest domestic and international clinical consensus statements, evidence-based guidelines, and relevant research findings. Meanwhile, this guideline comprehensively takes into account the actual situation in China and the opinions of Chinese experts. This guideline aims to provide clinicians with standardized protocols to enhance diagnostic accuracy and therapeutic efficacy in managing infants and toddlers with recurrent wheezing.

Occupational lung diseases remain a significant public health concern in mining populations, particularly in high-exposure environments. This study examined occupational exposure profiles and respiratory health outcomes among surface and underground miners in Mpumalanga Province. A cross-sectional analytical design was employed among 239 mine workers. Data on socio-demographic characteristics, occupational exposures, behavioural factors, and respiratory outcomes were analysed using descriptive statistics, chi-square tests, and logistic regression models. Underground miners were significantly more likely to report high dust exposure (44.9% vs. 24.1%), poor ventilation (60.6% vs. 39.3%), and longer working hours (>8 h: 68.5% vs. 50.0%) compared to surface miners. They also reported a higher prevalence of respiratory symptoms, including chronic cough (45.7% vs. 25.9%), shortness of breath (41.7% vs. 23.2%), wheezing (34.6% vs. 18.8%), and diagnosed lung disease (23.6% vs. 9.8%). Multivariable analysis showed that underground mining (AOR = 1.92; 95% CI: 1.08-3.41), smoking (AOR = 1.78; 95% CI: 1.02-3.11), and high dust exposure (AOR = 2.89; 95% CI: 1.45-5.76) were independent predictors of chronic cough. A significant interaction between smoking and underground mining (AOR = 2.74; 95% CI: 1.32-5.68) further amplified respiratory risk. Additionally, underground miners demonstrated lower levels of knowledge (48.8% vs. 66.1%) and poorer preventive practices (44.1% vs. 64.3%). These findings highlight the combined influence of occupational and behavioural factors on respiratory health and highlight the need for integrated interventions to reduce the burden of occupational lung diseases.

Background: Acute bronchiolitis is one of the most common lower respiratory tract infections in early childhood and is frequently associated with recurrent wheezing and later development of asthma. Identifying biomarkers related to airway epithelial injury and disease severity may improve risk stratification. Materials and Methods: A total of 155 children aged 1-36 months who presented with their first episode of wheezing were enrolled. Clinical data and bronchiolitis symptom scores were recorded at admission. Serum levels of CC16, surfactant protein-D (SP-D), YKL-40, and isoprostane were measured. Patients were followed for one year to assess recurrence of wheezing. Results: According to symptom scores, 81 patients had mild and 74 had moderate bronchiolitis; no severe cases were observed. The distribution of bronchiolitis severity differed significantly between recurrent and non-recurrent wheezing groups. Serum YKL-40 levels were significantly correlated with disease severity (p < 0.05), and the effect size analysis indicated a moderate effect. SP-D levels showed a non-significant trend with severity (p = 0.17). No significant associations were observed for CC16 or isoprostane. Conclusions: Serum YKL-40 may be a potential biomarker reflecting disease severity in children with acute bronchiolitis. Further longitudinal studies are needed to evaluate the prognostic value of epithelial injury markers for recurrent wheezing and asthma development.

Background: Preschool wheezing is common, but distinguishing transient wheezing from early persistent asthma remains difficult. Oscillometric techniques, including impulse oscillometry (IOS), may provide objective prognostic information. Objective: To systematically review longitudinal studies assessing whether oscillometric measurements obtained at preschool age are associated with later asthma-related outcomes or lung function impairment. Methods: PubMed, Scopus, and MEDLINE (via EBSCOhost) were searched from inception to 28 February 2026. Eligible studies included preschool-aged children or closely related early-childhood populations assessed with IOS or forced oscillation technique (FOT), longitudinal follow-up, and later asthma-related or spirometric outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias with QUIPS. Owing to substantial heterogeneity, findings were synthesized qualitatively. Results: Seven longitudinal cohort studies, encompassing 1077 children, met the eligibility criteria; baseline oscillometry was performed between ages 2 and 7 years, and follow-up ranged from 1 to 10 years. Short-term classification and longer-term prognostic studies were interpreted separately. Resistance-based indices, particularly R5, showed the most consistent associations with later asthma-related outcomes and lower subsequent spirometric indices, including FEV1 and FEV1/FVC. Most studies were at moderate risk of bias, and some reports came from related cohorts. Conclusions: Preschool oscillometry may provide complementary physiological information to assess asthma risk in symptomatic or high-risk preschool-aged children, particularly through resistance-based measures. However, evidence remains limited, heterogeneous, and insufficient to support a single validated cutoff, routine screening of apparently healthy children, or routine stand-alone prognostic use.