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Expert Review of Respiratory Medicine

Lucía Ferreiro, José M Porcel, Silvia Bielsa, María Elena Toubes, José Manuel Álvarez-Dobaño, Luis Valdés
The management of infected pleural effusion is complex. Therapeutic resolution requires determining the following: appropriate antibiotic regimen, the need for pleural drainage, the optimal drainage tube size, and the need for intrapleural therapy or surgery. Areas covered: An updating of the latest advances in the management of parapneumonic pleural effusion based on the best evidence available is provided. Expert commentary: The correct management of parapneumonic pleural effusion is based on selecting an antibiotic regimen according to the origin of the pleural infection (community-acquired or nosocomial)...
May 20, 2018: Expert Review of Respiratory Medicine
Edward Kerwin, Gary T Ferguson
COPD is highly prevalent in the US and globally, requiring new treatment strategies due to the high disease burden and increase in the aging population. Here, we profile the newly FDA-approved LONHALA MAGNAIR (glycopyrrolate [GLY]/eFlow® Closed System [CS]; 25 mcg twice daily), a nebulized long-acting muscarinic antagonist (LAMA) for the long-term maintenance treatment of COPD, including chronic bronchitis and/or emphysema. Areas covered: An overview of COPD and the treatment landscape, focusing on GLY/eFlow CS, is reported by reviewing the published literature pertinent to the drug/device combination...
May 18, 2018: Expert Review of Respiratory Medicine
Flore Amat, André Labbé
Although symptom controls in asthmatic children can be achieved through compliant use of conventional medication, some children have uncontrolled severe persistent asthma, especially if they are allergic. For these children, omalizumab (approved by the EMA and FDA in children aged > 6 years) could be a therapeutic option. However, response to omalizumab varies from one child to another. Predictive biomarkers of omalizumab effectiveness could be useful to monitor response to treatment. Area covered: The authors searched in the PubMed database for publications related to the use of biomarkers in allergic asthma...
May 16, 2018: Expert Review of Respiratory Medicine
Elena Fernandez Fernandez, Chiara de Santi, Virginia De Rose, Catherine M Greene
Obstructive lung diseases such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are causes of high morbidity and mortality worldwide. CF is a multiorgan genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and is characterized by progressive chronic obstructive lung disease. Most cases of COPD are a result of noxious particles, mainly cigarette smoke but also other environmental pollutants. Areas covered: Although the pathogenesis and pathophysiology of CF and COPD differ, they do share key phenotypic features and because of these similarities there is great interest in exploring common mechanisms and/or factors affected by CFTR mutations and environmental insults involved in COPD...
May 11, 2018: Expert Review of Respiratory Medicine
Hitesh Batra, Lonny Yarmus
Rigid bronchoscopy is an invaluable tool for the management of airway disorders and an essential skill for an interventional pulmonologist. Since its introduction in the late 19th century, it has remained an important technique for the management of central airway obstruction, foreign body aspiration and massive hemoptysis. Areas covered: This article will review the history, indications, contraindication, technique and complications of rigid bronchoscopy. We will also briefly discuss the methods of anesthesia and ventilation and finally our perspective on the future of rigid bronchoscopy...
May 4, 2018: Expert Review of Respiratory Medicine
Thibaud Soumagne, Jean Charles Dalphin
Hypersensitivity pneumonitis (HP) is the result of an immunologically induced inflammation of the lung parenchyma in response to inhalation exposure to a large variety of antigens in genetically susceptible individuals. HP shares clinical and radiological features with other acute and chronic interstitial lung diseases and is sometimes difficult to diagnose if exposure to an antigenic agent is not detected. Several classifications and diagnostic criteria have been proposed but are not currently recommended by guidelines from any scientific society...
May 4, 2018: Expert Review of Respiratory Medicine
María Molina-Molina, Myriam Aburto, Orlando Acosta, Julio Ancochea, José Antonio Rodríguez-Portal, Jaume Sauleda, Carlos Lines, Antoni Xaubet
No abstract text is available yet for this article.
May 2, 2018: Expert Review of Respiratory Medicine
Charlotte Suppli Ulrik
No abstract text is available yet for this article.
April 30, 2018: Expert Review of Respiratory Medicine
(no author information available yet)
No abstract text is available yet for this article.
April 28, 2018: Expert Review of Respiratory Medicine
Victor J Thannickal, Veena B Antony
No abstract text is available yet for this article.
April 19, 2018: Expert Review of Respiratory Medicine
Anne Bergougnoux, Magali Taulan-Cadars, Mireille Claustres, Caroline Raynal
Cystic Fibrosis is among the first diseases to have general population genetic screening tests and one of the most common indications of prenatal and preimplantation genetic diagnosis for single gene disorders. During the past twenty years, thanks to the evolution of diagnostic techniques, our knowledge of CFTR genetics and pathophysiological mechanisms involved in cystic fibrosis has significantly improved. Areas covered: Sanger sequencing and quantitative methods greatly contributed to the identification of more than 2,000 sequence variations reported worldwide in the CFTR gene...
March 27, 2018: Expert Review of Respiratory Medicine
Amir A Zeki, Mona Elbadawi-Sidhu
Asthma manifests as chronic airflow obstruction with persistent inflammation and airway hyperresponsiveness. The immunomodulatory and anti-inflammatory properties of the HMG-CoA reductase (HMGCR) inhibitors (a.k.a. statins), suggest a therapeutic role in chronic inflammatory lung diseases. However, despite positive laboratory investigations and promising epidemiological data, clinical trials using statins for the treatment of asthma have yielded conflicting results. Inadequate statin levels in the airway compartment could explain these findings...
March 26, 2018: Expert Review of Respiratory Medicine
Anupam Kumar, Siddhartha G Kapnadak, Reda E Girgis, Ganesh Raghu
Idiopathic Pulmonary Fibrosis (IPF) is a unique type of interstitial pneumonia in which progressive fibrosis can ultimately result in respiratory failure and death. The median survival of IPF remains dismal despite newer anti-fibrotic therapies. Lung transplantation is the only modality currently known to enhance survival for patients with IPF. Areas covered: Since IPF is predominantly a disorder of the elderly, determination of the impact of co-morbidities is crucial for risk stratification of the individual patient...
May 2018: Expert Review of Respiratory Medicine
Rob Janssen, Ianthe Piscaer, Emiel Fm Wouters
Current pharmacologic therapy of chronic obstructive pulmonary disease (COPD) can reduce respiratory symptoms and exacerbation frequency. However, no single COPD intervention except for lung transplantation has proven effective in recovering lung function. Lung elasticity is reduced in COPD lungs, which is for a large part due to chronically enhanced elastin degradation. Elastin calcification and formation of advanced glycation end products (AGEs) may also contribute to this. Areas covered: We propose inhalation therapy to induce repair of damaged pulmonary elastin fibers by stimulating tropoelastin synthesis, assembly and crosslinking in order to improve lung function in patients with COPD...
May 2018: Expert Review of Respiratory Medicine
Fernanda Ferreira Cruz, Lorenzo Ball, Patricia Rieken Macedo Rocco, Paolo Pelosi
Mechanical ventilation is required to support respiratory function in the acute respiratory distress syndrome (ARDS), but it may promote lung damage, a phenomenon known as ventilator-induced lung injury (VILI). Areas covered: Several mechanisms of VILI have been described, such as: inspiratory and/or expiratory stress inducing overdistension (volutrauma); interfaces between collapsed or edema-filled alveoli with surrounding open alveoli, acting as stress raisers; alveoli that repetitively open and close during tidal breathing (atelectrauma); and peripheral airway dynamics...
May 2018: Expert Review of Respiratory Medicine
Job J M H van Bragt, Susanne J H Vijverberg, Els J M Weersink, Levi B Richards, Anne H Neerincx, Peter J Sterk, Elisabeth H D Bel, Anke H Maitland-van der Zee
The complexity and heterogeneous nature of asthma and chronic obstructive pulmonary disease (COPD) results in difficulties in diagnosing and treating patients. Biomarkers that can identify underlying mechanisms, identify patient phenotypes and to predict treatment response could be of great value for adequate treatment. Areas covered: Biomarkers play an important role for the development of novel targeted therapies in airways disease. Blood biomarkers are relatively non-invasive, easy to obtain and easy to apply in routine care...
May 2018: Expert Review of Respiratory Medicine
Octavio Ramos-Espinosa, León Islas-Weinstein, Marco Polo Peralta-Álvarez, Manuel Othoniel López-Torres, Rogelio Hernández-Pando
Tuberculosis (TB) is the first cause of mortality by a single infectious agent in the world, causing more than one million deaths worldwide as reported by the World Health Organization (WHO). For the optimal control of TB infection, a protective immune response that limits bacterial spread without causing damage to the host is essential. Although most healthy individuals are capable of generating protective responses, patients who suffer pulmonary TB commonly present a defective immune function. Areas covered: We intend to highlight the potential of novel immunotherapeutic strategies that enhance and promote effective immune responses...
May 2018: Expert Review of Respiratory Medicine
Luke S Howard
Acute pulmonary embolism (PE) is a relatively common cardiopulmonary emergency that is a major cause of hospitalization and morbidity and is the primary cause of mortality associated with venous thromboembolism (VTE). During the last decade, one of the biggest changes in the management of PE has been the approval of four non-vitamin K antagonist oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban and rivaroxaban) for the treatment of PE and deep vein thrombosis and secondary prevention of VTE. Areas covered: This article reviews the evolving management of PE in the NOAC era and addresses three fundamental questions: who should receive NOACs over conventional heparin/vitamin K antagonist regimens for the treatment of acute PE; should patients be treated as inpatients or outpatients; and how long should patients be treated to reduce the risk of recurrence? Expert commentary: The management of PE is changing...
May 2018: Expert Review of Respiratory Medicine
Jean-François Etter
No abstract text is available yet for this article.
May 2018: Expert Review of Respiratory Medicine
(no author information available yet)
No abstract text is available yet for this article.
May 2018: Expert Review of Respiratory Medicine
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