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Current Opinion in Pulmonary Medicine

Elin T G Kersten, Gerard H Koppelman
PURPOSE OF REVIEW: Although currently available drugs to treat asthma are effective in most patients, a proportion of patients do not respond or experience side-effects; which is partly genetically determined. Pharmacogenetics is the study of how genetic variations influence drug response. In this review, we summarize prior results and recent studies in pharmacogenetics to determine if we can use genetic profiles for personalized treatment of asthma. RECENT FINDINGS: The field of pharmacogenetics has moved from candidate gene studies in single populations toward genome-wide association studies and meta-analysis of multiple studies...
October 18, 2016: Current Opinion in Pulmonary Medicine
Matteo Bonini
PURPOSE OF REVIEW: Asthma is the most prevalent chronic respiratory disease and represents a relevant socioeconomic burden. e-Health has the potential to improve disease control and adherence to treatment in asthmatic patients. Available data are, however, scarce and inconsistent limiting the use of e-health in clinical practice. This article aims to provide a systematic review of the literature published in the last year regarding the real place and impact of e-health in the management of asthma...
October 18, 2016: Current Opinion in Pulmonary Medicine
Aran Singanayagam, Andrew I Ritchie, Sebastian L Johnston
PURPOSE OF REVIEW: The emergence of next-generation 16S rRNA sequencing techniques has facilitated a more detailed study of the body's microbiota and led to renewed interest in the association between microbial exposure and asthma inception. In this review, we evaluate the evidence that the respiratory tract and intestinal microbiota contribute to asthma pathogenesis and progression. RECENT FINDINGS: Human studies have revealed associations between the presence of potentially pathogenic bacteria in the respiratory tract in early life and subsequent risk of allergic sensitization and asthma...
October 15, 2016: Current Opinion in Pulmonary Medicine
Kathryn V Blake
PURPOSE OF REVIEW: Poor adherence to asthma controller medications, particularly inhaled corticosteroids, has been well known for decades and is a major cause of uncontrolled asthma and increased healthcare utilization. This review presents recent evidence on factors leading to nonadherence in specific age groups, parents of young children, adolescents and young adults, adults, and the elderly. Novel management strategies including electronic sensors with associated smart phone applications for adherence improvement are discussed...
October 15, 2016: Current Opinion in Pulmonary Medicine
Duy Le Pham, Ji-Ho Lee, Hae-Sim Park
PURPOSE OF THE REVIEW: The pathophysiology of aspirin-exacerbated respiratory disease (AERD) is not fully understood and diagnostic methods and so far, treatments for AERD have not been standardized. We summarize recent research into the pathological mechanisms of AERD, diagnostic methods, and treatments for AERD patients. RECENT FINDINGS: In AERD pathophysiology, not only the reduced expression of E prostanoid 2 but also the dysfunction of its pathway could be involved...
September 20, 2016: Current Opinion in Pulmonary Medicine
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November 2016: Current Opinion in Pulmonary Medicine
Steven R Olmos
PURPOSE OF REVIEW: This article explains the high comorbidity of craniofacial pain (chronic face pain, temporomandibular disorders, and primary headaches) with obstructive sleep breathing disorders and obstructive sleep apnea (OSA). It is recommended that physicians treating OSA should be aware of the concurrent chronic pain that affects the quality of sleep, and also dentists treating chronic pain be aware of a sleep breathing origin so that proper reciprocal referrals be made for optimal patient treatment outcome...
November 2016: Current Opinion in Pulmonary Medicine
Jacquelien Noordhoek, Vincent Gulmans, Kors van der Ent, Jeffrey M Beekman
PURPOSE OF REVIEW: New therapeutics have been introduced for cystic fibrosis that modulate cystic fibrosis transmembrane conductance regulator (CFTR) function in a mutation-specific fashion. Despite CFTR genotype-based stratification of treatments, treatment efficacy is variable between study participants suggesting that individual factors further contribute to drug efficacy. Moreover, these treatments are licensed for a limited amount of CFTR mutations, and study participants with rare mutations that can potentially benefit from available treatments may be missed...
November 2016: Current Opinion in Pulmonary Medicine
Sophie D West, Chris Turnbull
PURPOSE OF REVIEW: Obstructive sleep apnoea (OSA) is increasing in prevalence due to rising obesity. Public awareness is also growing. Although OSA is a disorder primarily of the upper airway during sleep, its physiological impact on other parts of the body is now well recognized. There is increasing interest in the association of OSA with various eye disorders. Work in this field has been directed predominantly to OSA prevalence and association studies, but some authors have tried to elucidate the effect of OSA therapies on eye diseases, including continuous positive airway pressure, upper airway surgery or bariatric surgery...
November 2016: Current Opinion in Pulmonary Medicine
Rexford Muza, Madeleine Lawrence, Panagis Drakatos
PURPOSE OF REVIEW: The purpose of this review is to help further the understanding of the clinical profile of patients with sexsomnia and to better understand the spectrum of the clinical manifestations of sexsomnia. We will review the literature from the past decade on the subject and then compare it with our own clinical experience from patients who were retrospectively identified with sexsomnia at a tertiary sleep clinic over a 6-year period. RECENT FINDINGS: The prevalence of sexual behaviours in sleep remains unknown, but it seems to involve predominantly younger male adults who also frequently exhibit other non-rapid eye movement-related parasomnias...
November 2016: Current Opinion in Pulmonary Medicine
Christopher A Gerdung, Adetayo Adeleye, Valerie G Kirk
PURPOSE OF REVIEW: Sleep-related breathing disorders are complex conditions that require the integration of clinical and sleep laboratory findings to support a diagnosis. Analysis of carbon dioxide (CO2) levels during sleep provides important additional information to the clinician that is not obtained from other polysomnographic indices, and that may have a direct impact on both diagnosis and patient mortality. Although arterial blood gas (ABG) is considered the gold standard for assessing PaCO2 levels, there are numerous drawbacks...
November 2016: Current Opinion in Pulmonary Medicine
Rafaela Garcia Santos Andrade, Fernanda Madeiro, Pedro Rodrigues Genta, Geraldo Lorenzi-Filho
PURPOSE OF REVIEW: Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment. RECENT FINDINGS: One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy...
November 2016: Current Opinion in Pulmonary Medicine
George C Brainard, Laura K Barger, Robert R Soler, John P Hanifin
PURPOSE OF REVIEW: The review addresses the development of a new solid-state lighting system for the International Space Station (ISS) that is intended to enhance the illumination of the working and living environment of astronauts and to improve sleep, circadian entrainment, and daytime alertness. RECENT FINDINGS: Spaceflight missions often expose astronauts and mission support ground crews to atypical sleep-wake cycles and work schedules. A recent, extensive study describes the sleep characteristics and use of sleep-promoting pharmaceuticals in astronauts before, during, and after spaceflight...
November 2016: Current Opinion in Pulmonary Medicine
Uta Griesenbach, Jane C Davies, Eric Alton
PURPOSE OF REVIEW: Since cloning of the disease-causing gene 27 years ago, the development of cystic fibrosis (CF) gene therapy has been pursued. Here, we will summarize key findings with a particular focus on recent developments. RECENT FINDINGS: Almost 3 decades of research have highlighted the complexity of lung gene transfer and have generated a body of data that has recently led to the completion of a large phase IIB study. This trial has, for the first time, shown that nonviral gene transfer can, albeit modestly, stabilize lung function in CF and provides the impetus for further development of more potent gene transfer agents...
November 2016: Current Opinion in Pulmonary Medicine
Jerry A Nick, Kerstin Pohl, Stacey L Martiniano
PURPOSE OF REVIEW: The diagnosis of nontuberculous mycobacteria-pulmonary disease (NTM-PD) in cystic fibrosis (CF) is challenging, as it requires both microbiological and clinical evidence in the setting of coexisting airway infections and progressive lung disease. Although in some individuals NTM can accelerate the progression of CF lung disease, in others NTM may remain indolent for years, or appear transiently in sputum cultures. The dilemma faced by clinicians is to accurately identify those patients who are likely to benefit from therapy, while avoiding unnecessary treatment in those with indolent infection...
November 2016: Current Opinion in Pulmonary Medicine
Shanna V Diaz, Lee K Brown
PURPOSE OF REVIEW: To summarize recent research investigating the interaction between obstructive sleep apnea (OSA) and anxiety, and contextualize their bidirectional relationship. RECENT FINDINGS: Recent investigations corroborate the bidirectional relationship between sleep-disordered breathing (SDB) and anxiety, evaluate the etiological and clinical manifestations through different mechanisms, and provide insight into clinical implications of this interaction...
November 2016: Current Opinion in Pulmonary Medicine
Jürg Barben, Kevin W Southern
PURPOSE OF REVIEW: A challenging sequelae of newborn bloodspot screening (NBS) for cystic fibrosis (CF) has been the identification of infants with an unclear diagnosis after a positive NBS result, which leads to uncertainty for healthcare professionals and families. This review describes the classification, frequency, clinical outcome and early management of these infants. RECENT FINDINGS: In the US, infants with an inconclusive diagnosis after NBS are labelled 'CF transmembrane conductance regulator (CFTR)-related metabolic syndrome' (CRMS), and in Europe 'CF screen positive, inconclusive diagnosis' (CFSPID)...
November 2016: Current Opinion in Pulmonary Medicine
Claudia C Aguirre
PURPOSE OF REVIEW: The purpose of this review is to summarize recent advances in our understanding of the impact sleep disturbances have on our health, with particular focus on the brain. The present review considers the influence of sleep disturbance on the neurovascular unit; the role of sleep disturbance in neurodegenerative diseases; and relevant strategies of neuro-immuno-endocrine interactions that likely contribute to the restorative power of sleep. Given the latest discoveries about the brain's waste clearance system and its relationship to neurodegenerative diseases like Alzheimer's disease, this review gives a brief overview on the molecular mechanisms behind sleep loss-related impairments...
November 2016: Current Opinion in Pulmonary Medicine
Emma M de Koff, Karin M de Winter – de Groot, Debby Bogaert
PURPOSE OF REVIEW: Progression of lung disease in cystic fibrosis (CF) is punctuated by Pseudomonas aeruginosa infection and recurrent pulmonary exacerbations, and is the major determinant of a patient's life expectancy. With the advent of novel deep-sequencing techniques, polymicrobial bacterial assemblages rather than single pathogens seem to be responsible for the deterioration of pulmonary function. This review summarizes recent insights into the development of the CF respiratory tract microbiome, with its determinants and its relations to clinical parameters...
November 2016: Current Opinion in Pulmonary Medicine
Eptehal M Dongol, Adrian J Williams
PURPOSE OF REVIEW: One of the most common causes of excessive daytime sleepiness in clinical practice is obstructive sleep apnea syndrome (OSAS). So far, continuous positive airway pressure (CPAP) is the most effective treatment for OSA. Some of the patients do not improve on CPAP and remain sleepy despite using CPAP.This review provides updated information about the possible causes of residual sleepiness whilst using the CPAP in patients with OSAS. RECENT FINDINGS: Prevalence of OSAS has increased recently to 23...
November 2016: Current Opinion in Pulmonary Medicine
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