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Current Opinion in Pulmonary Medicine

David L Peloza, Daniel J Jackson
PURPOSE OF REVIEW: The goal of this review is to discuss strategies to prevent asthma exacerbations in children, focusing on recent advances in knowledge and understanding. RECENT FINDINGS: Asthma exacerbations are common, and their prevention is an important goal to avoid detrimental impacts such as loss of disease control and lung function and significant healthcare costs. A number of strategies have been studied as tools for prevention of asthma exacerbations...
November 12, 2018: Current Opinion in Pulmonary Medicine
Jonas S Erjefält
PURPOSE OF REVIEW: The clinical and inflammatory heterogeneity in asthma constitutes a major challenge for improved treatment. This review describes the nature of the inflammatory complexity and how it can be decoded to yield improved disease understanding and personalized treatment. The focus is on the difficult task of revealing the immunological complexity as it occurs inside diseased patient tissues. RECENT FINDINGS: The inflammatory heterogeneity in asthma stretches beyond the classical division into allergic Th2 eosinophilic versus Th1 and/or Th17 neutrophilic (or paucigranulocytic) phenotypes...
November 12, 2018: Current Opinion in Pulmonary Medicine
Sven F Seys, Ravi Lokwani, Jodie L Simpson, Dominique M A Bullens
PURPOSE OF REVIEW: Recent advances in both murine models and clinical research of neutrophilic asthma are improving our understanding on the etiology and pathophysiology of this enigmatic endotype of asthma. We here aim at providing an overview of our current and latest insights on the pathophysiology and treatment of neutrophilic asthma. RECENT FINDINGS: Activation of the NLRP3 inflammasome pathway with increased IL-1β has been demonstrated in various studies involving patients with asthma...
November 12, 2018: Current Opinion in Pulmonary Medicine
Zuzana Diamant, Wytze Aalders, Amit Parulekar, Leif Bjermer, Nicola A Hanania
PURPOSE OF REVIEW: In the past decades, cysteinyl leukotrienes (CysLTs) and prostaglandin D2 have been recognized as key mediators of asthma and comorbid conditions for their potent broncho-active and proinflammatory properties. However, both the development and initial positioning of small molecules targeting these lipid mediators [i.e., leukotriene-synthesis inhibitors, CysLT-antagonists, and chemoattractant receptor homologous molecule on T-helper2-cells (CRTH2) antagonists] experienced drawbacks by lacking adequate biomarkers to define potential responders...
November 12, 2018: Current Opinion in Pulmonary Medicine
Diana E Amariei, Robert M Reed
PURPOSE OF REVIEW: The pleiotropic anti-inflammatory effects of statins that have proven to improve outcomes in cardiovascular disease have also been of interest in the treatment of COPD, a disease with considerable morbidity and little available treatment that improves mortality. In-vitro and animal studies have supported biologic plausibility of statin therapy for lung health and function. Retrospective observational studies in humans have echoed this potential as well but confirmatory data from randomized studies are limited and somewhat disappointing...
November 9, 2018: Current Opinion in Pulmonary Medicine
Hiang Ping Chan, Tow Keang Lim
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPD) are major driver for healthcare utilization with each exacerbation begetting the next exacerbation. It is, therefore, important to treat each episode effectively to prevent the next. However, this can be challenging as AECOPD result from complex interactions between host, environment and infective agents. The benefits of starting antibiotics in AECOPD, which are not life-threatening (e...
November 9, 2018: Current Opinion in Pulmonary Medicine
Annelies L Robijn, Vanessa E Murphy, Peter G Gibson
PURPOSE OF REVIEW: Asthma affects up to 13% of pregnancies worldwide and has a varying and unpredictable clinical course during pregnancy. Pharmacological asthma treatment is recommended; however, studies show that some pregnant women with asthma cease their medication in early pregnancy. There is likely a large unmet disease burden arising from asthma in pregnancy. RECENT FINDINGS: Antenatal and asthma guidelines lack sufficient information on asthma management in pregnant women, and implementation of the current guidelines seems inadequate...
November 6, 2018: Current Opinion in Pulmonary Medicine
Maarten van den Berge, Hataitip Tasena
PURPOSE OF REVIEW: Numerous signaling pathways and inflammatory responses in cells and tissues are under microRNA (miRNA) control. In the present review, the role of miRNAs and exosomes in the pathogenesis of asthma will be discussed. RECENT FINDINGS: MiRNAs differentially expressed with asthma, for example, miRNA-34/449, let-7, miRNA-19, miRNA-21, and miRNA-455, were identified in various cell types and tissues including epithelial cells, T cells, type 2 innate lymphoid cells, lung tissues, and smooth muscles...
November 1, 2018: Current Opinion in Pulmonary Medicine
Jon Grace, Arjun Mohan, Njira Lucia Lugogo
PURPOSE OF REVIEW: Despite advances in our understanding of the obese asthma phenotype, heterogeneity and large gaps in knowledge have hindered significant advances in directed interventions. RECENT FINDINGS: Obesity is associated with poorer asthma-related outcomes and increased risk of progression to severe asthma. Obese asthma is associated with variability in the expression of inflammatory markers, lung function impairments, and response to conventional and biologic therapies...
November 1, 2018: Current Opinion in Pulmonary Medicine
Jason E Lang
PURPOSE OF REVIEW: Asthma is a common chronic disease of the airways characterized by recurrent respiratory symptoms, bronchoreactivity, and airway inflammation. The high toll on quality of life has led to sustained efforts to understand the factors leading to asthma inception and poor disease control. Obesity is another increasingly common pediatric disease, which appears to increase the risk for incident asthma and worsened disease severity. Currently, our understanding of how obesity affects asthma risk and affects its phenotypic characteristics remains incomplete...
October 16, 2018: Current Opinion in Pulmonary Medicine
Esther Herrera-Luis, Natalia Hernandez-Pacheco, Susanne J Vijverberg, Carlos Flores, Maria Pino-Yanes
PURPOSE OF REVIEW: Asthma exacerbations have been suggested to result from complex interactions between genetic and nongenetic components. In this review, we provide an overview of the genetic association studies of asthma exacerbations, their main results and limitations, as well as future directions of this field. RECENT FINDINGS: Most studies on asthma exacerbations have been performed using a candidate-gene approach. Although few genome-wide association studies of asthma exacerbations have been conducted up to date, they have revealed promising associations but with small effect sizes...
October 16, 2018: Current Opinion in Pulmonary Medicine
Paul Brinkman, Anke-Hilse Maitland-van der Zee, Ariane H Wagener
PURPOSE OF REVIEW: The long-term management goals of the inflammatory airway diseases asthma and chronic obstructive pulmonary disease (COPD) are similar and focus on symptom control and reduction of exacerbation frequency and severity. Treatable traits have recently been postulated as a management concept which complements the traditional diagnostic labels 'asthma' and 'COPD', thereby focusing on therapy targeted to a patients' individual disease-associated characteristics. Exhaled volatile organic compounds (VOCs) may be utilized as noninvasive biomarker for disease activity or manifestation in asthma and COPD...
October 15, 2018: Current Opinion in Pulmonary Medicine
Santiago Quirce, Joaquín Sastre
PURPOSE OF REVIEW: This review focuses on new findings in the clinical and inflammatory aspects that can help to better identify the different phenotypes of work-related asthma and the development of specific biomarkers useful in diagnosis and follow-up. RECENT FINDINGS: Studies on phenotyping of occupational asthma, a subtype of work-related asthma, have mainly compared the clinical, physiological, and inflammatory patterns associated with the type of agent causing occupational asthma, namely, high-molecular-weight and low-molecular-weight agents...
October 12, 2018: Current Opinion in Pulmonary Medicine
Sophie Corriveau, Jenna Sykes, Anne L Stephenson
PURPOSE OF REVIEW: Tracking patient outcomes using cystic fibrosis (CF) national data registries, we have seen a dramatic improvement in patient survival. As there are multiple ways to measure survival, it is important for readers to understand these different metrics in order to clearly translate this information to patients and their families. The aims of this review were to describe measures of survival and to review the recent literature pertaining to survival in CF to capture the changing epidemiology...
November 2018: Current Opinion in Pulmonary Medicine
Neeraj M Shah, Patrick B Murphy
PURPOSE OF REVIEW: Despite the importance of sleep in patients with COPD, this is frequently left unassessed in clinical practice. This review is intended to highlight the inter-relationship between COPD and sleep with an overview of the underlying pathophysiology and symptom burden followed by a review of the current management. RECENT FINDINGS: Recent data has indicated that specific respiratory support provided to patients with COPD and sleep disordered breathing improves clinical outcomes...
November 2018: Current Opinion in Pulmonary Medicine
Chou-Han Lin, Elisa Perger, Owen D Lyons
PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) is highly prevalent in patients with chronic kidney disease (CKD). The relationship between OSA and CKD is likely to be bi-directional. On one hand, the presence of OSA leads to intermittent hypoxia, sympathetic nervous system activity, and hypertension, all of which may have deleterious effects on kidney function. On the other hand, in patients with end-stage renal disease (ESRD), intensification of renal replacement therapy has been shown to attenuate sleep apnea severity, suggesting that the renal disease itself contributes to the pathogenesis of OSA...
November 2018: Current Opinion in Pulmonary Medicine
Joanne Kavanagh, David J Jackson, Brian D Kent
PURPOSE OF REVIEW: There is a longstanding recognition of the detrimental effect of poorly controlled asthma on sleep, but recent years have seen a growing interest in how asthma and sleep may interact. This review examines the current evidence of relationships between asthma, sleep and sleep disorders. RECENT FINDINGS: Poor quality sleep and sleep disturbance is highly prevalent in asthmatic patients, and particularly in those with severe asthma. Impaired sleep quality correlates with worse asthma control and quality of life...
November 2018: Current Opinion in Pulmonary Medicine
Renata L Riha
PURPOSE OF REVIEW: To explore the evidence for using exogenous melatonin in the treatment of sleep disorders, both primary and secondary, in children and adults. RECENT FINDINGS: A number of recently published meta-analyses have shown that there is evidence for the efficacy of exogenously administered melatonin in a number of sleep disorders. However, melatonin is likely to be prescribed largely for reasons of perceived minimal side-effect profile and very low cost in situations in which high-quality evidence for its usefulness is not forthcoming...
November 2018: Current Opinion in Pulmonary Medicine
Silke Ryan
PURPOSE OF REVIEW: Abnormal sleep duration, including short and long sleep, and sleep disorders, in particular obstructive sleep apnea (OSA), have evolved as major public health concerns attributed to their high prevalence and significant links with mortality and comorbid conditions. There is compelling evidence of an independent association of such sleep disturbances with the development, control, and progression of disorders affecting glucose metabolism such as type 2 diabetes (T2D)...
November 2018: Current Opinion in Pulmonary Medicine
Luciano F Drager, Chi-Hang Lee
PURPOSE OF REVIEW: The aim of this study was to provide an update of the primary and secondary prevention of obstructive sleep apnoea (OSA) treatment on cardiovascular disease. RECENT FINDINGS: Consistent evidence suggest that OSA can contribute to cardiovascular diseases, including hypertension, atrial fibrillation, coronary artery disease and stroke. In patients with no previous history of cardiovascular events (primary prevention scenario), observational studies suggest that continuous positive airway pressure (CPAP), the main treatment for OSA, is able to prevent hypertension incidence and to decrease nonfatal cardiovascular events in men and fatal cardiovascular events in men, women and elderly...
November 2018: Current Opinion in Pulmonary Medicine
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