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Therapeutic Advances in Respiratory Disease

Dany Gaspard, Thaddeus Bartter, Ziad Boujaoude, Haroon Raja, Rohan Arya, Nikhil Meena, Wissam Abouzgheib
BACKGROUND: Placement of endobronchial valves for bronchopleural fistula (BPF) is not always straightforward. A simple guide to the steps for an uncomplicated procedure does not encompass pitfalls that need to be understood and overcome to maximize the efficacy of this modality. OBJECTIVES: The objective of this study was to discuss examples of difficult cases for which the placement of endobronchial valves was not straightforward and required alterations in the usual basic steps...
October 14, 2016: Therapeutic Advances in Respiratory Disease
Andrea Picchianti Diamanti, Milica Markovic, Giuseppe Argento, Simonetta Giovagnoli, Alberto Ricci, Bruno Laganà, Raffaele D'Amelio
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can present different extrarticular manifestations involving heart, lungs and kidneys. In recent years there has been a growing awareness of the central role played by the lungs in the onset and progression of RA. In particular interstitial lung disease (ILD) is a common pulmonary manifestation that may be related to the inflammatory process itself, infectious complications and to the treatments used. Management of patients with ILD/RA is still a challenge for clinicians, both synthetic [mainly methotrexate (MTX), leflunomide] and biologic immunosuppressors [mainly anti-tumor necrosis factor (TNF)α] have in fact been related to the onset or worsening of lung diseases with conflicting data...
October 12, 2016: Therapeutic Advances in Respiratory Disease
Jasper H Kappen, Stephen R Durham, Hans In 't Veen, Mohamed H Shamji
Clinical and immunologic tolerance are hallmarks of successful allergen immunotherapy (AIT). Clinical benefits such as reduced symptoms, pharmacotherapy intake and improvement of quality of life persist following cessation of treatment. Successful AIT is associated with suppression of allergic inflammatory cells such as mast cells, eosinophils and basophils in target organs. Furthermore, AIT down-regulates type 2 innate lymphoid cells and allergen-specific type 2 T-helper (Th2) cells. The immunologic tolerant state following AIT is associated with the induction of distinct phenotypes of regulatory T-cells (T-regs) including interleukin (IL)-10-, IL-35- and transforming growth factor (TGF)-β- producing T-regs and FoxP3(+) T-regs...
September 27, 2016: Therapeutic Advances in Respiratory Disease
Michel Chalhoub, Zulfiqar Ali, Louis Sasso, Michael Castellano
Recurrent pleural effusions are frequently encountered in clinical practice. Whether malignant or nonmalignant, they often pose a challenge to the practicing clinician. When they recur, despite optimum medical therapy of the underlying condition and repeated thoracenteses, more invasive definitive approaches are usually required. Since its introduction in 1997, the PleurX catheter became the preferred method to treat recurrent malignant pleural effusions. Since then, a number of publications have documented its utility in managing recurrent nonmalignant pleural effusions...
September 21, 2016: Therapeutic Advances in Respiratory Disease
Francesco Menzella, Mirco Lusuardi, Carla Galeone, Nicola Facciolongo, Luigi Zucchi
Despite several therapeutic choices, 10-20% of patients with severe uncontrolled asthma do not respond to maximal best standard treatments, leading to a healthcare expenditure of up to 80% of overall costs for asthma. Today, there are new important therapeutic strategies, both pharmacological and interventional, that can result in improvement of severe asthma management, such as omalizumab, bronchial thermoplasty and other biological drugs, for example, mepolizumab, reslizumab and benralizumab. The availability of these new treatments and the increasing knowledge of the different asthmatic phenotypes and endotypes makes correct patient selection increasingly complex and important...
September 9, 2016: Therapeutic Advances in Respiratory Disease
Christian Vogelberg
Asthma is a chronic inflammatory airway disease, and its treatment is frequently challenging despite detailed national and international guidelines. While basic anti-inflammatory therapy usually consists of inhaled corticosteroids in doses adapted to the asthma severity, add-on treatment with bronchodilators is essential in more severe asthma. Only recently, the long-acting anticholinergic tiotropium was introduced into the GINA guidelines. This review reports on the studies that have been performed with tiotropium in adult asthmatic patients...
September 9, 2016: Therapeutic Advances in Respiratory Disease
Sayako Morikawa, Takuya Okamura, Tomoyuki Minezawa, Yasuhiro Goto, Masamichi Hayashi, Teppei Yamaguchi, Sumito Isogai, Yuki Mieno, Naoki Yamamoto, Sakurako Uozu, Toru Nakanishi, Mitsushi Okazawa, Kazuyoshi Imaizumi
BACKGROUND: Bronchial occlusion with an Endobronchial Watanabe Spigot (EWS) has been shown to be useful in managing prolonged bronchopleural fistulas and intractable hemoptysis. EWS bronchial occlusion using a curette is less technically demanding. This retrospective study evaluated the clinical utility and simplicity of this method. METHODS: A total of 18 consecutive patients (15 men, 3 women, aged 47-85 years) who underwent bronchial occlusion using an EWS from April 2012 to August 2014 were evaluated...
September 5, 2016: Therapeutic Advances in Respiratory Disease
Nanshan Zhong, Jiangtao Lin, Jinping Zheng, Kefang Lai, Canmao Xie, Ke-Jing Tang, Mao Huang, Ping Chen, Changzheng Wang
BACKGROUND: Asthma affects a large number of patients in China, but relatively little is known about asthma management among Chinese patients. This study aims to estimate asthma control rate among adult Chinese patients and to identify predictors associated with uncontrolled asthma. METHODS: A total of 4125 asthma patients aged ⩾17 years and representing all regions of mainland China except Tibet were surveyed. Asthma control status was assessed using the Asthma Control Test (ACT) and classified as controlled (ACT score ⩾ 20) and uncontrolled (ACT score ⩿ 19)...
September 5, 2016: Therapeutic Advances in Respiratory Disease
Stella S Hahn, Mina Makaryus, Arunabh Talwar, Mangala Narasimhan, Gulrukh Zaidi
Pulmonary arterial hypertension (PAH) is an uncommon, progressive and life threatening disease characterized by a proliferative vasculopathy of the small muscular pulmonary arterioles resulting in elevated pulmonary vascular resistance and eventually right ventricular failure. An increasing understanding of the pathobiology of PAH and its natural history has led to the development of numerous targeted therapies. Despite these advances there is significant progression of disease and the survival rate remains low...
September 5, 2016: Therapeutic Advances in Respiratory Disease
Magnus Kentson, Kristina Tödt, Elisabeth Skargren, Per Jakobsson, Jan Ernerudh, Mitra Unosson, Kersti Theander
BACKGROUND: The aim of this study was to determine the influence of selected physiological, psychological and situational factors on experience of fatigue, and functional limitations due to fatigue in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: In total 101 patients with COPD and 34 control patients were assessed for experience of fatigue, functional limitation due to fatigue (Fatigue Impact Scale), physiological [lung function, 6-minute walk distance (6MWD), body mass index (BMI), dyspnoea, interleukin (IL)-6, IL-8, high sensitivity C-reactive protein (hs-CRP), surfactant protein D], psychological (anxiety, depression, insomnia), situational variables (age, sex, smoking, living alone, education), and quality of life...
October 2016: Therapeutic Advances in Respiratory Disease
Bing Hou, Xu-Feng Deng, Dong Zhou, Quan-Xing Liu, Ji-Gang Dai
BACKGROUND: Although lobectomy is still the preferred treatment for patients with stage I non-small cell lung cancer (NSCLC), segmentectomy or wedge resection is frequently performed on patients who cannot withstand the physiological rigors of lobectomy. The objective of this study was to compare the overall survival (OS), cancer-specific survival (CSS), and disease-free survival outcomes among patients with stage I NSCLC who have undergone these procedures. METHODS: A systematic electronic search in three online databases was conducted from their earliest publication dates to June 2015...
October 2016: Therapeutic Advances in Respiratory Disease
Miguel Tortajada-Girbés, Miriam Moreno-Prat, David Ainsa-Laguna, Silvia Mas
BACKGROUND: Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually benign and self-limiting, with only supportive therapy being needed, but severe cases may require invasive measures. Asthma exacerbations have classically been described as a cause of SPM. However, detailed descriptions in asthmatic children are scarce. We aimed at improving the current understanding of the features of SPM and subcutaneous emphysema, and outcomes, by means of a case report and a systematic review...
October 2016: Therapeutic Advances in Respiratory Disease
Richard B L Lim
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline...
October 2016: Therapeutic Advances in Respiratory Disease
Ricardo Henao-Villada, Monica P Sossa-Briceño, Carlos E Rodríguez-Martínez
BACKGROUND: Although bronchiolitis poses a significant health problem in low- and middle-income countries (LMICs), to the best of our knowledge, to date it has not been determined whether evidence-based bronchiolitis clinical practice guidelines (CPGs) complemented by standardized educational strategies reduce the use of unnecessary diagnostic tests and medications and improve clinically important outcomes in LMICs. METHODS: In an uncontrolled before and after study, we assessed the impact of the implementation of an evidence-based bronchiolitis CPG on physician behavior and the care of infants with bronchiolitis by comparing pre-guideline (March to August 2014) and post-guideline (March to August 2015) use of diagnostic tests and medications through an electronic medical record review in a children's hospital in Bogota, Colombia...
October 2016: Therapeutic Advances in Respiratory Disease
Joline S J Lim, Ross A Soo
Progress in the treatment of patients with advanced stage squamous cell non-small cell lung cancer (NSCLC) has been limited. An improvement in the understanding of tumor immunosurveillance has resulted in the development of the immune checkpoint inhibitors such as nivolumab. Nivolumab (Opdivo(®)), a human immunoglobulin (Ig)G4 anti-programmed death (PD)-1 monoclonal antibody, was the first PD-1 inhibitor approved in the treatment of patients with advanced stage squamous cell NSCLC following platinum-based chemotherapy...
October 2016: Therapeutic Advances in Respiratory Disease
Carl Selya-Hammer, Nuria Gonzalez-Rojas Guix, Michael Baldwin, Andrew Ternouth, Marc Miravitlles, Maureen Rutten-van Mölken, Lucas M A Goosens, Nasuh Buyukkaramikli, Valentina Acciai
BACKGROUND: The objective of this study was to compare the cost-effectiveness of the fixed-dose combination (FDC) of tiotropium + olodaterol Respimat(®) FDC with tiotropium alone for patients with chronic obstructive pulmonary disease (COPD) in the Italian health care setting using a newly developed patient-level Markov model that reflects the current understanding of the disease. METHODS: While previously published models have largely been based around a cohort approach using a Markov structure and GOLD stage stratification, an individual-level Markov approach was selected for the new model...
October 2016: Therapeutic Advances in Respiratory Disease
Dandan Zong, Ruoyun Ouyang, Jinhua Li, Yan Chen, Ping Chen
Notch signaling is an evolutionarily conserved cell-cell communication mechanism that plays a key role in lung homeostasis, injury and repair. The loss of regulation of Notch signaling, especially Notch1 and Notch3, has recently been linked to the pathogenesis of important lung diseases, in particular, chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis, pulmonary arterial hypertension (PAH), lung cancer and lung lesions in some congenital diseases. This review focuses on recent advances related to the mechanisms and the consequences of aberrant or absent Notch1/3 activity in the initiation and progression of lung diseases...
October 2016: Therapeutic Advances in Respiratory Disease
Raúl H Sansores, Alejandra Ramírez-Venegas, Rosario Arellano-Rocha, Valeri Noé-Díaz, Leonor García-Gómez, Oliver Pérez Bautista, Mónica Velázquez Uncal
INTRODUCTION: Use of varenicline for as long as necessary to achieve abstinence has not been studied. The aim of this study was to test whether smokers with mild-to-moderate chronic obstructive pulmonary disease (COPD) are able to quit if they use varenicline for a sufficient length of time. METHODS: A total of 30 heavy smokers with COPD took varenicline for sufficiently long enough for smoking cessation. Smokers were allowed to smoke without a fixed quit date. The main endpoints were the time of voluntary abstinence (VA) and the continuous abstinence rate (CAR) at 12 and 18 months...
October 2016: Therapeutic Advances in Respiratory Disease
Massimo Corradi, Monica Spinola, Stefano Petruzzelli, Piotr Kuna
The high-strength formulation of extrafine beclometasone dipropionate/formoterol fumarate (BDP/Form) 200/6 µg has been developed to step up inhaled corticosteroid treatment, without increasing the dose of the bronchodilator, in patients who are not controlled with previous therapies. Two clinical studies have evaluated efficacy of high-strength BDP/Form as compared with another high-dose fixed combination and BDP monotherapy. Overall, data show that BDP/Form 200/6 μg improves lung function and has beneficial effects on symptoms, use of rescue medication and asthma control, with an acceptable safety profile comparable with that of high-dose fluticasone propionate/salmeterol...
October 2016: Therapeutic Advances in Respiratory Disease
Laurent Greillier, Pascale Tomasini, Fabrice Barlesi
Angiogenesis is one of the hallmarks of cancer. Antivascular endothelial growth factor therapy, including bevacizumab, is therefore a major option in targeting angiogenesis, especially for the management of stage IV nonsquamous non-small cell lung cancer patients. This review focuses first on the data from clinical trials available to date regarding efficacy and safety of chemotherapy plus bevacizumab. This review then highlights the current remaining questions related to the use of this drug in daily practice and how the patients might be clinically and radiologically selected...
October 2016: Therapeutic Advances in Respiratory Disease
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