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Therapeutic Advances in Respiratory Disease

Mario Malerba, Matteo Nardin, Giuseppe Santini, Nadia Mores, Alessandro Radaeli, Paolo Montuschi
Maintenance pharmacological treatment for stable chronic obstructive pulmonary disease (COPD) is based on inhaled drugs, including long-acting muscarinic receptor antagonists (LAMA), long-acting β2 -adrenoceptor agonists (LABA) and inhaled corticosteroids (ICS). Inhaled pharmacological treatment can improve patients' daily symptoms and reduce decline of pulmonary function and acute exacerbation rate. Treatment with all three inhaled drug classes is reserved for selected, more severe, patients with COPD when symptoms are not sufficiently controlled by dual LABA/LAMA therapy and exacerbations are frequent...
January 2018: Therapeutic Advances in Respiratory Disease
Phunsup Wongsurakiat, Sirapat Tulatamakit
Background We wanted to determine the impact of combined Clinical Pulmonary Infection Score (CPIS) and a spot serum procalcitonin (PCT)-guided protocol to shorten the duration of antibiotic treatment in patients with ventilator-associated pneumonia (VAP), mainly caused by nonfermentative gram-negative bacilli (NF-GNB). Methods Patients with VAP who received appropriate antibiotics for 7 days, temperature ⩽ 37.8°C, without shock, and CPIS ⩽ 6 were allocated to the PCT group or conventional group according to the treating physicians' decisions...
January 2018: Therapeutic Advances in Respiratory Disease
Cedric Van Holsbeke, Jan De Backer, Wim Vos, Jonathan Marshall
BACKGROUND: Functional respiratory imaging (FRI) uses three-dimensional models of human lungs and computational fluid dynamics to simulate functional changes within airways and predict the deposition of inhaled drugs. This study used FRI to model the effects of different patient inhalation and drug formulation factors on lung deposition of an inhaled corticosteroid/long-acting β2 -agonist (ICS/LABA) combination, administered by a pressurized metered-dose inhaler. METHODS: Three-dimensional models of the lungs of six patients with asthma (mean forced expiratory volume in 1 s, 83%), treated with an ICS/LABA, were included...
January 2018: Therapeutic Advances in Respiratory Disease
Yi-Ming Zeng, Yun-Feng Chen, Hui-Huang Lin, Xiao-Bin Zhang
BACKGROUND: Location of the affected bronchus of pleural air leaks is the most important step of trans-bronchoscopic bronchial occlusion for the treatment of intractable pneumothorax. The balloon occlusion test is the most commonly used technique, but has failed in some cases. The aim of the present study was: (1) to determine if endo-bronchial end-tidal CO2 (EtCO2 ) measurement can identify the affected bronchus that is the source of a persistent pleural air leak; and (2) to establish a methodology for endo-bronchial EtCO2 testing in locating affected bronchus in intractable pneumothorax...
January 2018: Therapeutic Advances in Respiratory Disease
Marcel Simon, Lars Harbaum, Tim Oqueka, Stefan Kluge, Hans Klose
BACKGROUND: Endoscopic lung volume reduction coil (LVRC) treatment is a therapeutic option for selected patients with advanced emphysema. The effects and the safety of endoscopic lung volume reduction in patients with very low forced expired volume in one second (FEV1 ) remain to be determined. This study was conducted to assess the effects and the safety of LVRC treatment in patients with very low FEV1 . METHODS: The study was performed as a retrospective observational study in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf on patients with very low FEV1 , defined as an FEV1 ⩽ 20% of predicted at baseline in whom LVRC treatment was performed between 1 April 2012 and 28 February 2017...
January 2018: Therapeutic Advances in Respiratory Disease
François Maltais, Denis O'Donnell, Juan Bautista Gáldiz Iturri, Anne-Marie Kirsten, Dave Singh, Alan Hamilton, Kay Tetzlaff, Yihua Zhao, Richard Casaburi
BACKGROUND: The TORRACTO® study evaluated the effects of tiotropium/olodaterol versus placebo on endurance time during constant work-rate cycling and constant speed shuttle walking in patients with chronic obstructive pulmonary disease (COPD) after 12 weeks of treatment. METHODS: The effects of once-daily tiotropium/olodaterol (2.5/5 and 5/5 μg) on endurance time during constant work-rate cycle ergometry (CWRCE) after 6 and 12 weeks of treatment were compared with placebo in patients with COPD in a randomized, double-blind, placebo-controlled, parallel-group clinical trial...
January 2018: Therapeutic Advances in Respiratory Disease
Michele Vitacca, Alessandra Montini, Laura Comini
Within telehealth there are a number of domains relevant to pulmonary care: telemonitoring, teleassistance, telerehabilitation, teleconsultation and second opinion calls. In the last decade, several studies focusing on the effects of various telemanagement programs for patients with chronic obstructive pulmonary disease (COPD) have been published but with contradictory findings. From the literature, the best telemonitoring outcomes come from programs dedicated to aged and very sick patients, frequent exacerbators with multimorbidity and limited community support; programs using third-generation telemonitoring systems providing constant analytical and decisionmaking support (24 h/day, 7 days/week); countries where strong community links are not available; and zones where telemonitoring and rehabilitation can be delivered directly to the patient's location...
January 2018: Therapeutic Advances in Respiratory Disease
Prantesh Jain, Chhavi Jain, Vamsidhar Velcheti
Immune checkpoint inhibitors, mainly drugs targeting the programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA4) pathways, represent a remarkable advance in lung cancer treatment. Immune checkpoint inhibitors targeting PD-1 and PD-L1 are approved for the treatment of patients with non-small-cell lung cancer, with impressive clinical activity and durable responses in some patients. This review will summarize the mechanism of action of these drugs, the clinical development of these agents and the current role of these agents in the management of patients with lung cancer...
January 2018: Therapeutic Advances in Respiratory Disease
Sanjeeva Dissanayake, Jason Suggett
Valved holding chambers (VHCs) reduce the need for inhalation-actuation coordination with pressurized metered dose inhalers (pMDIs), reduce oropharyngeal drug deposition and may improve lung deposition and clinical outcomes compared to pMDIs used alone. While VHCs are thus widely advocated for use in vulnerable patient groups within clinical and regulatory guidelines, there is less consensus as to whether the performance differences between different VHCs have clinical implications. This review evaluates the VHC literature, in particular the data pertaining to large- versus small-volume chambers, aerosol performance with a VHC adjunct versus a pMDI alone, charge dissipative/conducting versus non-conducting VHCs, and facemasks, to ascertain whether potentially meaningful differences between VHCs exist...
January 2018: Therapeutic Advances in Respiratory Disease
Ann D Morgan, Rosita Zakeri, Jennifer K Quint
Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this population is considerable and the cumulative cost of treating comorbidities may even exceed that of treating COPD itself. Our understanding of the biological mechanisms that link COPD and various forms of CVD has improved significantly over the past decade...
January 2018: Therapeutic Advances in Respiratory Disease
Konstantinos Farsalinos
The issue of electronic cigarettes is one of the most controversial topics in public health. There is intense debate and dividing opinions about their use patterns, health effects and association with smoking. This is expected since they were only recently introduced to the market and they refer to a harm-reduction approach and strategy that is not universally accepted for smoking and tobacco use in the public health community. Three main factors determine the public health impact of electronic cigarettes: (1) their safety/risk profile, both relative to smoking and in absolute terms; (2) their effectiveness for smoking reduction and cessation; (3) the patterns of use by different population subgroups, especially never-smokers, and adoption of use by youth...
January 2018: Therapeutic Advances in Respiratory Disease
Akiko Yawata, Atsuhiro Tsubaki, Haruka Yawata, Haruna Takai, Kayomi Matsumoto, Nana Takehara, Ryosaku Kobayashi
BACKGROUND: Cough peak flow (CPF) is widely used for measuring voluntary cough intensity. However, the respective factors that affect CPF are not known. The aim of this study was to determine the factors affecting CPF by sex in community-dwelling adults. METHOD: We recruited participants using posters exhibited at a public gymnasium. Participation was voluntary, and all participants provided informed consent. Nonsmoking community residents (102 males, 49.6 ± 20...
December 2017: Therapeutic Advances in Respiratory Disease
Chao Liu, Jia-Jia Wang, Ye-Han Zhu, Cheng Chen
We present a rare case of giant endobronchial hamartoma coexisting with lung atelectasis for more than 3 years. The small specimen initially biopsied via bronchoscope did not reveal tissue features, but some features were suspicious for squamous cell carcinoma. The lesion was removed completely using snare electrocautery combined with argon plasma coagulation via flexible fiberoptic bronchoscopy. The patient made a satisfactory recovery, and a pathological diagnosis was made. This could be a useful option in selected endobronchial tumors...
December 2017: Therapeutic Advances in Respiratory Disease
Mark S Ferguson, Jennifer Claire Magill, Bhik T Kotecha
Snoring and obstructive sleep apnoea (OSA) are increasingly common conditions, and confer a significant health and socioeconomic burden. Furthermore, untreated OSA represents a significant mortality risk. Patients require careful assessment, including detailed clinical history and examination, sleep study and drug-induced sleep endoscopy (DISE). Although nasal continuous positive airway pressure (nCPAP) is the gold standard treatment for moderate and severe OSA, multidisciplinary team assessment is often required to develop the best treatment plan for an individual, especially when nasal CPAP is poorly tolerated...
November 2017: Therapeutic Advances in Respiratory Disease
Marco Mantero, Stefano Aliberti, Chiara Azzari, Maria Moriondo, Francesco Nieddu, Francesco Blasi, Marta Di Pasquale
BACKGROUND: The aim of this study was to determine the incidence of exacerbations due to Streptococcus pneumoniae in chronic obstructive pulmonary disease (COPD) patients during stable state. METHODS: We conducted a prospective, observational, cohort study including stable COPD patients, who were evaluated at least every 4 months over a 24-month period at the Respiratory Unit of the IRCCS Policlinico Hospital in Milan, Italy, from 2012 to 2015. Sputum samples were collected at enrollment during stable state to evaluate the frequency of S...
October 2017: Therapeutic Advances in Respiratory Disease
Roberto Bernabeu-Mora, Gloria García-Guillamón, Elisa Valera-Novella, Luz M Giménez-Giménez, Pilar Escolar-Reina, Francesc Medina-Mirapeix
BACKGROUND: Readmission after hospital discharge is common in patients with acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD). Although frailty predicts hospital readmission in patients with chronic nonpulmonary diseases, no multidimensional frailty measures have been validated to stratify the risk for patients with COPD. AIM: The aim of this study was to explore multidimensional frailty as a potential risk factor for readmission due to a new exacerbation episode during the 90 days after hospitalization for AE-COPD and to test whether frailty could improve the identification of patients at high risk of readmission...
October 2017: Therapeutic Advances in Respiratory Disease
Raffaella Nenna, Renato Cutrera, Antonella Frassanito, Claudia Alessandroni, Ambra Nicolai, Giulia Cangiano, Laura Petrarca, Serena Arima, Serena Caggiano, Nicola Ullman, Paola Papoff, Enea Bonci, Corrado Moretti, Fabio Midulla
BACKGROUND: We sought to clarify possibly modifiable risk factors related to pollution responsible for acute bronchiolitis in hospitalized infants. METHODS: For this observational study, we recruited 213 consecutive infants with bronchiolitis (cases: median age: 2 months; age range: 0.5-12 months; boys: 55.4%) and 213 children aged <3 years (controls: median age: 12 months; age range: 0.5-36 months; boys: 54.5%) with a negative medical history for lower respiratory tract diseases hospitalized at 'Sapienza' University Rome and IRCCS Bambino Gesù Hospital...
October 2017: Therapeutic Advances in Respiratory Disease
Karim Rihawi, Francesco Gelsomino, Francesca Sperandi, Barbara Melotti, Michelangelo Fiorentino, Laura Casolari, Andrea Ardizzoni
Immune checkpoint inhibitors (ICPIs) are considered one of the most important breakthroughs in cancer treatment of the past decade; notably, different studies of programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors have reported impressive clinical activity and durable responses in patients with advanced non-small cell lung cancer (NSCLC). These findings have led to the changing of the current therapeutic algorithm of advanced NSCLC, adding a new standard first-line treatment option for patients with PD-L1-positive tumors...
September 2017: Therapeutic Advances in Respiratory Disease
Tuhina Raman, Nikhil Meena
BACKGROUND: Indwelling tunneled pleural catheters (TPCs) are increasingly being used to treat recurrent pleural effusions. There is also an increased interest in early pleurodesis in order to prevent infectious complications. We studied the time to removal and other outcomes for all the TPCs placed at our institution. METHODS: After institutional review board approval, records of patients who had had a TPC placed between July 2009 and June 2016 were reviewed; the catheters were placed in an endoscopy suite or during pleuroscopy with or without a sclerosant...
September 2017: Therapeutic Advances in Respiratory Disease
Yanling Xu, Peng Gao, Xuejiao Lv, Lin Zhang, Jie Zhang
Lung cancer is the leading cause of death due to cancer worldwide. It is estimated that approximately 1.2 million new cases of lung cancer are diagnosed each year. Early detection and treatment are crucial for improvements in both prognosis and quality of life of lung cancer patients. The ataxia telangiectasia mutated (ATM) gene is a cancer-susceptibility gene that encodes a key apical kinase in the DNA damage response pathway. It has recently been shown to play an important role in the development of lung cancer...
August 1, 2017: Therapeutic Advances in Respiratory Disease
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