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Obstructive lung diseases

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Fulvio Braido, Henry Chrystyn, Ilaria Baiardini, Sinthia Bosnic-Anticevich, Thys van der Molen, Ronald J Dandurand, Alison Chisholm, Victoria Carter, David Price
Inhaled therapies are the backbone of asthma and chronic obstructive pulmonary disease management, helping to target therapy at the airways. Adherence to prescribed treatment is necessary to ensure achievement of the clinician's desired therapeutic effect. In the case of inhaled therapies, this requires patients' acceptance of their need for inhaled therapy together with successful mastery of the inhaler technique specific to their device(s). This article reviews a number of challenges and barriers that inhaled mode of delivery can pose to optimum adherence-to therapy initiation and, thereafter, to successful implementation and persistence...
September 2016: Journal of Allergy and Clinical Immunology in Practice
Pierre Le Cann, Hélène Paulus, Philippe Glorennec, Barbara Le Bot, Sophie Frain, Jean Pierre Gangneux
Home health care workers interventions have been implemented in western countries to improve health status of patients with respiratory diseases especially asthma and allergic illnesses. Twenty-six controlled studies dealing with prevention and control of these diseases through home environmental interventions were reviewed. After a comprehensive description of the characteristics of these studies, the effectiveness of each intervention was then evaluated in terms of participants' compliance with the intervention program, improvement of quality of the indoor environment, and finally improvement of health outcomes, in detailed tables...
September 21, 2016: Journal of Allergy and Clinical Immunology in Practice
Marina Pretolani, Anders Bergqvist, Gabriel Thabut, Marie-Christine Dombret, Dominique Knapp, Fatima Hamidi, Loubna Alavoine, Camille Taillé, Pascal Chanez, Jonas S Erjefält, Michel Aubier
BACKGROUND: The effectiveness of bronchial thermoplasty (BT) has been reported in severe asthma, yet its impact on the different bronchial structures remains unknown. OBJECTIVE: To examine the effect of BT on bronchial structures and to explore their association with clinical outcome in severe refractory asthmatics. METHODS: Bronchial biopsies (n = 300) were collected from 15 severe uncontrolled asthmatics before and 3 months after BT. Immunostained sections were assessed for airway smooth muscle (ASM) area, sub-epithelial basement membrane thickness, nerve fibers and epithelium neuroendocrine cells...
September 5, 2016: Journal of Allergy and Clinical Immunology
Kathryn V Blake
PURPOSE OF REVIEW: Poor adherence to asthma controller medications, particularly inhaled corticosteroids, has been well known for decades and is a major cause of uncontrolled asthma and increased healthcare utilization. This review presents recent evidence on factors leading to nonadherence in specific age groups, parents of young children, adolescents and young adults, adults, and the elderly. Novel management strategies including electronic sensors with associated smart phone applications for adherence improvement are discussed...
October 15, 2016: Current Opinion in Pulmonary Medicine
Aran Singanayagam, Andrew I Ritchie, Sebastian L Johnston
PURPOSE OF REVIEW: The emergence of next-generation 16S rRNA sequencing techniques has facilitated a more detailed study of the body's microbiota and led to renewed interest in the association between microbial exposure and asthma inception. In this review, we evaluate the evidence that the respiratory tract and intestinal microbiota contribute to asthma pathogenesis and progression. RECENT FINDINGS: Human studies have revealed associations between the presence of potentially pathogenic bacteria in the respiratory tract in early life and subsequent risk of allergic sensitization and asthma...
October 15, 2016: Current Opinion in Pulmonary Medicine
Matteo Bonini
PURPOSE OF REVIEW: Asthma is the most prevalent chronic respiratory disease and represents a relevant socioeconomic burden. e-Health has the potential to improve disease control and adherence to treatment in asthmatic patients. Available data are, however, scarce and inconsistent limiting the use of e-health in clinical practice. This article aims to provide a systematic review of the literature published in the last year regarding the real place and impact of e-health in the management of asthma...
October 18, 2016: Current Opinion in Pulmonary Medicine
Elin T G Kersten, Gerard H Koppelman
PURPOSE OF REVIEW: Although currently available drugs to treat asthma are effective in most patients, a proportion of patients do not respond or experience side-effects; which is partly genetically determined. Pharmacogenetics is the study of how genetic variations influence drug response. In this review, we summarize prior results and recent studies in pharmacogenetics to determine if we can use genetic profiles for personalized treatment of asthma. RECENT FINDINGS: The field of pharmacogenetics has moved from candidate gene studies in single populations toward genome-wide association studies and meta-analysis of multiple studies...
October 18, 2016: Current Opinion in Pulmonary Medicine
Jillian M Cavallari, Tara S Jawaro, Nadia I Awad, Patrick J Bridgeman
Glucagon, a hormone secreted by pancreatic alpha cells, causes bronchial smooth muscle relaxation by activating the synthesis of cyclic adenosine monophosphate. It was studied in the 1980s and 1990s as a treatment option for the management of asthma but has since not been evaluated. Data to support its use are limited, but it may serve as a last-line agent for refractory asthma exacerbation. Here we describe 4 cases in which intravenous glucagon was used to manage severe, refractory asthma exacerbation in the emergency department...
September 30, 2016: American Journal of Emergency Medicine
Gennaro D'Amato, Carolina Vitale, Antonio Molino, Anna Stanziola, Alessandro Sanduzzi, Alessandro Vatrella, Mauro Mormile, Maurizia Lanza, Giovanna Calabrese, Leonardo Antonicelli, Maria D'Amato
Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma...
2016: Multidisciplinary 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
Steven Maltby, Peter G Gibson, Heather Powell, Vanessa M McDonald
BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are common airway diseases. Individuals with overlapping asthma and COPD experience increased health impairment and severe disease exacerbations. Efficacious treatment options are required for this population. Omalizumab (anti-IgE) therapy is effective in patients with severe, persistent asthma, but limited data are available on efficacy in populations with overlapping asthma and COPD. METHODS: Data from the Australian Xolair Registry (AXR) was used to compare treatment responses in individuals with asthma-COPD overlap to severe asthma alone...
October 11, 2016: Chest
Simon Couillard, Pierre Larivée, Josiane Courteau, Alain Vanasse
RATIONALE: A subset of patients with chronic obstructive pulmonary disease (COPD) demonstrates eosinophilic inflammation either in their sputum or blood. Previous studies regarding the association between increased blood eosinophils and poor readmission outcomes are conflicting. OBJECTIVE: Investigate outcomes following severe COPD exacerbations in patients with higher blood eosinophils. METHODS: With an observational study design, hospitalizations for severe COPD exacerbation were retrospectively gathered...
October 13, 2016: Chest
Philippe Jolliet, Lamia Ouanes-Besbes, Fekri Abroug, Jalila Ben Khelil, Mohamed Besbes, Aude Garnero, Jean-Michel Arnal, Fabrice Daviaud, Jean-Daniel Chiche, Benoît Lortat-Jacob, Jean-Luc Diehl, Nicolas Lerolle, Alain Mercat, Keyvan Razazi, Christian Brun-Buisson, Isabelle Durand-Zaleski, Joëlle Texereau, Laurent Brochard
RATIONALE: During non-invasive ventilation (NIV) for COPD exacerbations, Helium/Oxygen (He/O2) reduces work of breathing and hypercapnia more than Air/O2 but impact on clinical outcome remains unknown. OBJECTIVE: To determine whether continuous administration of He/O2 for 72 hours, during and in-between NIV sessions, is superior to Air/O2 in reducing NIV failure (25% to 15%) in severe hypercapnic COPD exacerbations. METHODS: Prospective, randomized, open-label trial (16 intensive care units, 6 countries)...
October 13, 2016: American Journal of Respiratory and Critical Care Medicine
Won-Young Kim, Soonyoung Park, Hwa Jung Kim, Eun Jin Chae, Kyung-Hyun Do, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
BACKGROUND AND OBJECTIVE: Inhalation exposure to household chemicals can result in serious health problems, although the long-term outcomes are unclear. We evaluated the changes in lung function after home humidifier disinfectant (HD) exposure. METHODS: This post hoc analysis of a prospective nationwide cohort involved patients with inhalation lung injury due to HD. Patients underwent spirometric measurements at onset and annually thereafter. RESULTS: Forty subjects met the eligibility criteria...
October 12, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Pallav L Shah, Felix J Herth, Wouter H van Geffen, Gaetan Deslee, Dirk-Jan Slebos
Advanced emphysema is a lung disease in which alveolar capillary units are destroyed and supporting tissue is lost. The combined effect of reduced gas exchange and changes in airway dynamics impairs expiratory airflow and leads to progressive air trapping. Pharmacological therapies have limited effects. Surgical resection of the most destroyed sections of the lung can improve pulmonary function and exercise capacity but its benefit is tempered by significant morbidity. This issue stimulated a search for novel approaches to lung volume reduction...
September 29, 2016: Lancet 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
Diego Jose Maselli, Maria Ines Velez, Linda Rogers
Interleukin-5, an important cytokine in the pathophysiology of asthma, participates in terminal maturation and increases chemotaxis, endothelial adhesion, and activation of eosinophils. Blockade of interleukin-5 activity with monoclonal antibodies have been successful in decreasing eosinophil counts. Reslizumab, a monoclonal antibody that targets interleukin-5, has been studied for the treatment of severe asthma. Several studies have shown that reslizumab can effectively treat severe asthma with an eosinophilic phenotype...
2016: Journal of Asthma and Allergy
Kanchan Pyasi, Ellen Tufvesson, Subhabrata Moitra
Leukotrienes (LTs) initiate a cascade of reactions that cause bronchoconstriction and inflammation in asthma. LT-modifying drugs have been proved very effective to reduce inflammation and associated exacerbation however despite some illustrious clinical trials the usage of these drugs remains overlooked because the evidence to support their utility in asthma management has been mixed and varied between studies. Although, there are plenty of evidences which suggest that the leukotriene-modifying drugs provide consistent improvement even after just the first oral dose and reduce asthma exacerbations, the beneficial effect of these drugs has remained sparse and widely debated...
September 17, 2016: Pulmonary Pharmacology & Therapeutics
Feisal A Al-Kassimi, Esam H Al-Hamad, Mohammed S Al-Hajjaj, Emad Raddaoui, Abdulaziz H Alzeer, Ahmad A Alboukai, Ali M Somily, Joseph G Cal, Abdalla F Ibrahim, Shaffi A Shaik
BACKGROUND AND OBJECTIVE: Post-mortem and computed tomography (CT) studies indicated that emphysema is a feature of COPD even in the 'blue bloater/chronic bronchitis' type. We aim to test the hypothesis that the non-emphysematous patients are distinct from the main body of COPD and are more akin to asthmatic patients. METHODS: We studied 54 patients with COPD. Emphysema was measured by Goddard's visual scoring of CT scan and the carbon monoxide transfer coefficient (KCO)...
September 13, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Asger Bjerregaard, Ingrid A Laing, Vibeke Backer, Markus Fally, Siew-Kim Khoo, Glenys Chidlow, Chisha Sikazwe, David W Smith, Peter Le Souëf, Celeste Porsbjerg
BACKGROUND AND OBJECTIVE: Airway eosinophilia is associated with an increased risk of asthma exacerbations; however, the impact on the severity of exacerbations is largely unknown. We describe the sputum inflammatory phenotype during asthma exacerbation and correlate it with severity and treatment response. METHODS: Patients presenting to hospital with an asthma exacerbation were recruited during a 12-month period and followed up after 4 weeks. Induced sputum was collected at both visits...
September 21, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
2016-10-01 21:28:42
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