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Expert Review of Respiratory Medicine

Maria Paula Henao, Timothy J Craig
Alpha-1-antitrypsin Deficiency (AATD) is an orphan disease that predisposes individuals to COPD and liver disease. The following is a comprehensive review of AATD from epidemiology to treatment for physicians who treat COPD or asthma. Areas Covered: In this comprehensive review of alpha-1-antitrypsin deficiency, we describe the historical perspective, genetics, epidemiology, clinical presentation and symptoms, screening and diagnosis, and treatments of the condition. Expert Commentary: The two most important directions for advancing the understanding of AATD involve improving detection of the condition, especially in asymptomatic patients, and advancing knowledge of treatments directed specifically at AATD-related conditions...
October 24, 2016: Expert Review of Respiratory Medicine
Denis E O'Donnell, J Alberto Neder, Ingrid Harle, Onofre Moran-Mendoza
Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung disease, with a median survival time of two to five years. Most patients with IPF experience chronic breathlessness, which is closely linked to poor perceived quality of life and significant restriction of daily activities; therefore, effective management of this distressing symptom is a major goal of patient care. Areas covered: This report summarizes the physiology of IPF during rest and exercise, outlines current concepts of the mechanisms of breathlessness, and provides a physiological rationale for optimal management of individual patient...
October 21, 2016: Expert Review of Respiratory Medicine
Pedro L Silva, Paolo Pelosi, Patricia R M Rocco
No abstract text is available yet for this article.
October 21, 2016: Expert Review of Respiratory Medicine
Diego Viasus, Oscar Ramos, Leidy Ramos, Antonella F Simonetti, Jordi Carratalà
Community-acquired pneumonia is a major public health problem worldwide. In recent years, there has been an increase in the frequency of resistance to the antimicrobials such as β-lactams or macrolides which have habitually been used against the causative pathogens. Solithromycin, a next-generation macrolide, is the first fluoroketolide with activity against most of the frequently isolated bacteria in community-acquired pneumonia, including typical and atypical bacteria as well as macrolide-resistant Streptococcus pneumoniae...
October 18, 2016: Expert Review of Respiratory Medicine
Jun Fukihara, Yasuhiro Kondoh
Nintedanib is a new anti-fibrosis agent that is an intracellular tyrosine kinase inhibitor targeting platelet derived growth factor receptor, fibroblast growth factor receptor and vascular endothelial growth factor receptor. Although nintedanib is attracting much attention as a new treatment option for patients with idiopathic pulmonary fibrosis (IPF), the clinical evidence is limited mainly to the results from the dose-deciding phase II TOMORROW trial and phase III INPULSIS trials, which evaluated efficacy and safety of nintedanib for patients with IPF, prespecified subgroup analyses, pooled analyses and meta-analyses derived from those trials...
October 17, 2016: Expert Review of Respiratory Medicine
Ritesh Agarwal, Inderpaul S Sehgal, Sahajal Dhooria, Ashutosh N Aggarwal
Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. It is the most prevalent of the Aspergillus disorders with an estimated five million cases worldwide. Despite six decades of research, the pathogenesis, diagnosis and treatment of this condition remains controversial. The International Society for Human and Animal Mycology has formed a working group to resolve the controversies around this entity...
October 17, 2016: Expert Review of Respiratory Medicine
Ruth K Michl, Harold Tabori, Julia Hentschel, James F Beck, Jochen G Mainz
Cystic fibrosis (CF) is the most frequent life-shortening autosomal recessive disorder in Caucasians. Defects or absence of the CF-transmembrane conductance regulator impair ion transport in apical membranes of exocrine glands. Leading symptoms of typical CF are exocrine pancreatic insufficiency and progressive pulmonary destruction, causing premature death. Additionally, patients can suffer from chronic rhinosinusitis, hepatic and intestinal involvement, diabetes and predominantly male infertility. Areas covered: CFTR-related disorders affect only one or several different organ systems, often to a milder degree...
October 12, 2016: Expert Review of Respiratory Medicine
Valerie Waters, Sanja Stanojevic, Felix Ratjen
Introduction Cystic fibrosis (CF) is a disease characterized by recurrent flares of respiratory symptoms, known as pulmonary exacerbations (PExs), which have a cumulative, detrimental effect on lung function decline and overall mortality. Although much research has been done on the effects of PExs in adults with CF, considerably less is known about these events in young children with CF. Areas covered This review describes the typical presentation of PExs in children and their impact on long-term clinical outcomes...
October 8, 2016: Expert Review of Respiratory Medicine
Peter J Barry, Patrick A Flume
Cystic fibrosis airways disease is characterized by chronic inflammation and infection resulting in bronchiectasis. Published guidelines recommend medications for use by CF patients to maintain lung health. There are conflicting recommendations regarding inhaled bronchodilators. This is primarily because of the interpretation of the available evidence, which suffers from studies using small numbers of subjects, varying doses and durations of treatment, and modest effects on clinically relevant endpoints. Areas covered: Herein we review the available evidence demonstrating the challenge in determining whether bronchodilators have benefit for patients...
October 8, 2016: Expert Review of Respiratory Medicine
Jenna MacNeil, Robyn H Loves, Shawn D Aaron
Asthma is diagnosed based on patients' respiratory symptoms of wheeze, cough, chest tightness and/or dyspnea together with physiologic evidence of variable and reversible expiratory airflow limitation. A high prevalence of overdiagnosis, underdiagnosis and misdiagnosis of adult asthma has been reported in the literature. Areas covered: Misdiagnosis of asthma in adults can occur in the community due to physicians' failure to confirm airflow limitation using spirometry, the relatively poor sensitivity of spirometry to absolutely rule in asthma, the complexity of multiple asthma phenotypes and endotypes, and the inherent day to day variability of asthma symptoms and airflow limitation...
October 8, 2016: Expert Review of Respiratory Medicine
Raphaëlle Varraso, Carlos A Camargo
No abstract text is available yet for this article.
October 5, 2016: Expert Review of Respiratory Medicine
M L Brouwer, L S van den Wijngaart, C A C Hugen, G P J M Gerrits, J Roukema, P J F M Merkus
The goal of monitoring pediatric asthma is to obtain and maintain asthma control, which is defined as minimizing asthma symptoms, restrictions to daily activities and the use of rescue medication. Long term goals include reducing the risk of fixed airflow limitation, and preventing asthma exacerbations and side effects of treatment. Several monitoring tools are available but no consensus exists on how to monitor patients in the most optimal way. Areas covered: In this review, we provide an overview of different tools and address general considerations on monitoring childhood asthma...
October 5, 2016: Expert Review of Respiratory Medicine
Catia Cilloniz, Adrian Ceccato, Alicia San Jose, Antoni Torres
Community acquired pneumonia (CAP) is a major health problem in elderly persons and is associated with high morbidity and mortality. Areas covered: This article reviews the most recent publications relative to CAP in the elderly population, with a focus on epidemiology, prognostic factors, microbial etiology, therapy and prevention. The data discussed in this review were mainly obtained from a non-systematic review using Medline, and references from relevant articles. Expert Commentary: CAP can occur at any age, but its incidence and risk of death are linked to increasing age...
October 3, 2016: Expert Review of Respiratory Medicine
A Matikas, V Georgoulias, A Kotsakis
Non-small cell lung cancer lung cancer (NSCLC) is a devastating disease, with poor prognosis for patients with metastatic disease. The management of these patients has evolved during the past decade, challenging the role of cytotoxic chemotherapy as the only available treatment option. Nevertheless, chemotherapy still retains a dominant position for the majority of both treatment naïve and pretreated patients. Among the chemotherapeutic agents, docetaxel is one of the most commonly used in 1st and subsequent treatment lines, even in the current era of precision medicine...
October 3, 2016: Expert Review of Respiratory Medicine
Kovi Levin, Sakhee Kotecha, Glen Westall, Gregory Snell
Optimization of lungs for organ donation is becoming increasingly important as donation rates stagnate despite growing waiting lists. Improving procurement and utilization of donated lungs has the ability to reduce mortality and time on the lung transplantation (LTx) waiting list. Additionally, assessment and optimization of donor lungs can reduce both early and late post-LTx morbidity and mortality, as well as reduce overall costs and resource utility. Areas covered: Strategies that we will discuss in detail include intensive care management practices, such as targeted ventilation protocols and therapeutic bronchoscopy, as well as the ever expanding possibilities within the arena of ex vivo lung perfusion (EVLP)...
October 3, 2016: Expert Review of Respiratory Medicine
Andrew D Lerner, Lonny Yarmus, Jed A Gorden, Christopher R Gilbert
No abstract text is available yet for this article.
October 3, 2016: Expert Review of Respiratory Medicine
Eleonora Dehlink, Claire Hogg, Siobhan B Carr, Andrew Bush
INTRODUCTION: Primary ciliary dyskinesia (PCD) is a rare, mostly autosomal-recessive disorder of motile cilia, characterized by chronic lung disease, rhinosinusitis, hearing impairment, and subfertility. PCD is still often missed or diagnosed late since symptoms overlap with common respiratory complaints, but should be considered if one or more of the cardinal clues are present. AREAS COVERED: We provide an overview on clinical presentations of PCD and clues for when to consider PCD, these include unexplained neonatal respiratory distress, persistent rhinitis from the first days of life, situs anomalies, or otorrhoea following tympanostomy tube insertion...
September 28, 2016: Expert Review of Respiratory Medicine
Carlos A Hartmann, Wint T Aye, Janis E Blair
INTRODUCTION: Coccidioidomycosis is an endemic fungal infection caused by the soil-dwelling fungi, Coccidioides species. Coccidioidal infections may be asymptomatic in up to two-thirds of infected persons. Pulmonary coccidioidomycosis is the most common form of symptomatic infection. Fluconazole is the antifungal agent typically used to treat pulmonary coccidioidomycosis. Other azoles and amphotericin B products may be prescribed to treat nuanced aspects of coccidioidomycosis. AREAS COVERED: This review discusses current literature regarding medical treatment options, including the various triazoles and amphotericin B products...
October 2016: Expert Review of Respiratory Medicine
Beatrice Borsellino, Marcus J Schultz, Marcelo Gama de Abreu, Chiara Robba, Federico Bilotta
INTRODUCTION: Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers...
October 2016: Expert Review of Respiratory Medicine
Hanneke Coumou, Elisabeth H Bel
INTRODUCTION: Diagnosing eosinophilic asthma is important, because uncontrolled eosinophilic airway inflammation is associated with reduced response to glucocorticoids and increased risk of severe exacerbations. AREAS COVERED: Currently, the diagnosis of eosinophilic asthma is based on measurements of sputum eosinophils, which is time consuming and requires specific technical expertise. Therefore, biomarkers such as blood eosinophils, FeNO, serum IgE and periostin are being used as surrogates...
October 2016: Expert Review of Respiratory Medicine
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