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Expert Review of Respiratory Medicine

Allan R Brasier
Acute exacerbations of chronic lung disease account for substantial morbidity and health costs. Repeated inflammatory episodes and attendant bronchoconstriction cause structural remodeling of the airway. Remodeling is a multicellular response to mucosal injury that results in epithelial cell state changes, enhanced extracellular deposition and expansion of pro-fibrotic myofibroblast populations. Areas covered: This manuscript overviews mechanistic studies identifying key sentinel cell populations in the airway and how pattern recognition signaling induces maladaptive mucosal changes and airway remodeling...
September 21, 2018: Expert Review of Respiratory Medicine
Oliver J McElvaney, Cedric Gunaratnam, Oisin Fiachra McElvaney, Isha Bagwe, Emer P Reeves, Noel G McElvaney
Cystic fibrosis (CF) is an autosomal dominant chloride channelopathy caused by mutations in the CF transmembrane conductance regulator (CFTR) gene that results clinically in a multisystem disorder. The major source of morbidity and mortality in CF is lung disease, which is characterized by recurrent cycles of inflammation and infection and progressive respiratory decline. Therapeutics have traditionally focused on the downstream effects of the primary genetic defect. However, recent advances have shifted attention to modulation of upstream pathways and the defective CFTR protein itself...
September 19, 2018: Expert Review of Respiratory Medicine
Amlan Chakraborty, Jennifer C Boer, Cordelia Selomulya, Magdalena Plebanski, Simon G Royce
Airway inflammatory disorders are prevalent diseases in need of better management and new therapeutics. Immunotherapies offer a solution to the problem of corticosteroid resistance. Areas covered: The current review focuses on lipopolysaccharide (Gram-negative bacterial endotoxin)- mediated inflammation in the lung and the animal models used to study related diseases. Endotoxin-induced lung pathology is usually initiated by antigen presenting cells (APC). We will discuss different subsets of APC including lung dendritic cells (DC) and macrophages, and their role in responding to endotoxin and environmental challenges...
September 15, 2018: Expert Review of Respiratory Medicine
Oded Breuer, Daan Caudri, Stephen Stick, Lidija Turkovic
Progressive lung disease is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Methods of correctly predicting the future progression of lung disease in patients with CF are essential for directing aggressive treatment to prevent loss of lung function and end stage respiratory failure. Areas covered: This review addresses predictors of respiratory disease progression in patients with CF. We searched Web of Science and Medline, with no restriction on publication date, with the search terms 'cystic fibrosis' and 'disease progression', 'lung function decline', 'prognosis', 'prediction/predictive', 'prediction/prognostic scores', 'risk factors', 'outcome measures/endpoints/disease surrogate', 'longitudinal/long term', 'statistical model', and 'survival'...
September 13, 2018: Expert Review of Respiratory Medicine
Macario Camacho, Edward T Chang, Cindy Lee P Neighbors, Michael W Noller, Douglas Mack, Robson Capasso, Clete A Kushida
Positive airway pressure (PAP) devices are generally considered to be the first-line treatment of choice for most adults with obstructive sleep apnea (OSA). However, there are several alternatives. It is important for patients and their sleep providers to be aware of the most-up to date information regarding the current international literature. Areas Covered: The objective is to provide an overview of the meta-analyses evaluating Non-PAP treatments for OSA. Four authors searched four databases, including PubMed/MEDLINE through November 30, 2017, for meta-analyses evaluating non-PAP therapies as treatment for OSA...
September 11, 2018: Expert Review of Respiratory Medicine
Antoine Parrot, Sebastian Tavolaro, Guillaume Voiriot, Antony Canellas, Jalal Assouad, Jacques Cadranel, Muriel Fartoukh
Though rare, severe hemoptysis (SH) is associated with a mortality rate exceeding 50% when not managed properly. Areas covered: This paper reviews the recent epidemiological data regarding SH, the role of multidetector computed tomography angiography (MDCTA), and fiberoptic bronchoscopy (FOB) in its management, as well as the value of current treatments. Expert commentary: MDCTA is becoming an essential modality, since it allows determining the location, etiology, and mechanism of the bleeding. FOB can be delayed, except when local control of bleeding is required...
September 10, 2018: Expert Review of Respiratory Medicine
Susan S Li, Dmitry Tumin, Katie A Krone, Debra Boyer, Stephen E Kirkby, Heidi M Mansour, Don Hayes
Survival after lung transplantation lags behind outcomes of other solid organ transplants, and complications from lung transplant are the second most common cause of death in cystic fibrosis. Evolving surgical techniques, therapeutics, and perioperative management have improved short-term survival after lung transplantation, yet have not translated into significant improvement in long-term mortality. Areas covered: We review risk factors for poor long-term outcomes among patients with cystic fibrosis undergoing lung transplantation to highlight areas for improvement...
September 9, 2018: Expert Review of Respiratory Medicine
Dan Kibuule, Roger K Verbeeck, Ruswa Nunurai, Farai Mavungha, Albertina Thomas, Rosalia Amutenya, Guna Gunther, Ette Ene, Brian Godman, Timonthy Rennie
OBJECTIVES: Optimal treatment success rates are critical to end tuberculosis in Namibia. Despite the scale-up of high quality directly observed therapy short-course strategy (DOTS) in Namibia, treatment success falls short of the global target of 90%. The objective of this study was to ascertain the predictors of treatment success rates under DOTS in Namibia to provide future direction. METHODS: A nation-wide comparative analysis of predictors of treatment success was undertaken...
September 8, 2018: Expert Review of Respiratory Medicine
Garry M Walsh
Severe or refractory asthma is seen in approximately 5% of asthmatic subjects who have unsatisfactory symptom control despite adherence to high-dose inhaled glucocorticoid therapies resulting in significant morbidity, reduced quality of life and health-care cost implications. Asthma exhibits marked heterogeneity both clinically and at the molecular phenotypic level requiring specifically targeted treatments to block the key pathways of the disease. Monoclonal antibody-based biologics targeted at inhibition of the type 2 cytokines IL-4, IL-5 and IL-13 have considerable potential as effective treatments for severe asthma...
September 7, 2018: Expert Review of Respiratory Medicine
Roberto Badagliacca, Silvia Papa, Roberto Poscia, Beatrice Pezzuto, Giovanna Manzi, Roberto Torre, Francesco Fedele, Carmine Dario Vizza
Pulmonary arterial hypertension (PAH) is a progressive, life-threatening, and incurable disease. Its prognosis is based on right ventricular (RV) function. Therefore, adequate assessment of RV function is mandatory. Areas covered: This article presents the case of a patient with PAH in which the traditional diagnostic approach did not provide a complete assessment of RV function. The authors show how the analysis of other parameters yielded additional information that improved the management of this patient...
September 6, 2018: Expert Review of Respiratory Medicine
Charlotte Schutz, Angharad G Davis, Bianca Sossen, Rachel P-J Lai, Mpiko Ntsekhe, Yolande Xr Harley, Robert J Wilkinson
Inflammation, or the prolonged resolution of inflammation, contributes to death from tuberculosis. Interest in inflammatory mechanisms and the prospect of beneficial immune modulation as an adjunct to antibacterial therapy has revived and the concept of host directed therapies has been advanced. Such renewed attention has however, overlooked the experience of such therapy with corticosteroids. Areas covered: The authors conducted literature searches and evaluated randomized clinical trials, systematic reviews and current guidelines and summarize these findings...
September 6, 2018: Expert Review of Respiratory Medicine
Lindsay J Caverly, John J LiPuma
Cystic fibrosis (CF) lung disease is characterized by chronic cycles of pulmonary infection, inflammation, and mucus obstruction, beginning early in life, and eventually leading to progressive lung damage and early mortality. During the past ~15 years, culture-independent analyses of CF respiratory samples have identified diverse bacterial communities in CF airways, and relationships between respiratory microbiota and clinical outcomes. Areas covered: This paper reviews recent advances in our understanding of the relationships between respiratory microbiota and CF lung disease...
September 3, 2018: Expert Review of Respiratory Medicine
Jamie S Y Ho, Edwin R Chilvers, Muhunthan Thillai
Sarcoidosis is a multisystem granulomatous disease predominantly affecting the lungs, with increased risk of cardiovascular disease, pulmonary hypertension and cardiac sarcoidosis (CS), the latter due to direct granuloma infiltration. Sarcoidosis is often managed by chest physicians who need to understand the diagnostic pathways and initial management plans for patients with cardiac involvement. Areas covered: The most serious consequence of CS is sudden cardiac death due to ventricular tachyarrhythmias or complete atrioventricular block...
September 3, 2018: Expert Review of Respiratory Medicine
Audrey De Jong, Laure Calvet, Virginie Lemiale, Alexandre Demoule, Djamel Mokart, Michael Darmon, Samir Jaber, Elie Azoulay
A growing number of immunocompromised (IC) patients with acute hypoxemic respiratory failure (ARF) is admitted to the intensive care unit (ICU) worldwide. Areas covered: This review provides an overview of the current knowledge of the ways to prevent intubation in IC patients with ARF. Expert commentary: Striking differences oppose ARF incidence, characteristics, etiologies and management between IC and non-IC patients. Survival benefits have been reported with early admission to ICU in IC patients. Then, while managing hypoxemia and associated organ dysfunction, the identification of the cause of ARF will be guided by a rigorous clinical assessment at the bedside, further assisted by an invasive or noninvasive diagnostic strategy based on clinical probability for each etiology...
August 28, 2018: Expert Review of Respiratory Medicine
Kareem Ahmad, Steven D Nathan
Idiopathic pulmonary fibrosis (IPF) treatment was revolutionized by the advent of two novel antifibrotics, nintedanib and pirfenidone. However, neither is a panacea and other agents are still sorely needed. This review presents ongoing efforts to improve outcomes for patients with IPF by targeting novel pharmacologic pathways, improving comorbidity management, and aiming for improved quality of life. Areas covered: We provide an overview of ongoing basic and clinical science efforts focused on development of additional drug therapies for patients with IPF...
August 23, 2018: Expert Review of Respiratory Medicine
Holly Seale
No abstract text is available yet for this article.
August 23, 2018: Expert Review of Respiratory Medicine
Miguel Tortajada-Girbés, Rosa Bousquet, Montserrat Bosque, Jesús Joaquín Carrera Martínez, María Dolores Ibáñez, Ana Moreira, Antonio Nieto, Ana María Plaza, Cristina Rivas, Gloria Requena, Manuel Sánchez-Solis, Ana Tabar, Javier Torres-Borrego, Lydia Zapatero
Omalizumab is a monoclonal antibody that binds and inhibits free serum immunoglobulin E, a mediator involved in the clinical manifestations of allergic asthma. Evidence for its efficacy and safety in the treatment of moderate-to-severe allergic asthma is based primarily on studies in adolescents and adults. However, there is increasing evidence of its utility in children with allergic asthma aged 6-12 years. Areas covered: This article reviews efficacy, safety, and effectiveness of omalizumab in the treatment of moderate-to-severe allergic asthma in children aged 6-12 years in clinical trials and in studies in clinical practice...
September 2018: Expert Review of Respiratory Medicine
Paola C Sacco, Paolo Maione, Giovanni Palazzolo, Cesare Gridelli
Lung cancer is predominantly a disease that affects the elderly; about 30-40% of lung cancers are diagnosed in patients aged 70 or more. The increasing number of elderly patients over the next decades is generating a new social and health problem; despite that, these patients are underrepresented in clinical trials and undertreated in clinical practice. Areas covered: The main difficulty in treating elderly patients is to maximize the therapy benefits while minimizing the treatment risk. Elderly patients show a vulnerable clinical profile due to the higher prevalence of comorbid disease, higher polypharmacy interactions and aged organ dysfunction that increase the risk of mortality and toxicity with cancer treatments compared to younger patients...
September 2018: Expert Review of Respiratory Medicine
Nikki Bozinoff, Bernard Le Foll
Tobacco use remains the leading cause of preventable death in the United States. There are efficacious behavioral and pharmacological options for smoking cessation including three FDA approved therapies - nicotine replacement therapy, varenicline and bupropion. Nevertheless, uptake of smoking cessation treatments continues to be poor and there is a need for novel smoking cessation treatments. Areas covered: This article reviews the biobehavioral basis of nicotine addiction, its implications for smoking cessation treatments, the various neurotransmitter systems involved in nicotine addictive effects, and their potential therapeutic value...
September 2018: Expert Review of Respiratory Medicine
Cevdet Ozdemir, Umut Can Kucuksezer, Mubeccel Akdis, Cezmi A Akdis
Asthma, a common, non-communicable chronic disease affects over 300 million individuals worldwide. The Western world lifestyle is claimed to be responsible for this high and increasing prevalence. Asthma has been defined as a syndrome with various phenotypes and endotypes, allergic asthma and type 2 asthma being the most frequent. A great increase in prevalence of allergic diseases has necessitated intensive investigations both for understanding the underlying mechanisms and for the development of novel therapy options with long-term efficacy and limited side-effects...
September 2018: Expert Review of Respiratory Medicine
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