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Clinics in Chest Medicine

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https://read.qxmd.com/read/30691721/asthma
#1
EDITORIAL
Sumita B Khatri, Serpil C Erzurum
No abstract text is available yet for this article.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691720/diet-and-metabolism-in-the-evolution-of-asthma-and-obesity
#2
REVIEW
Anne E Dixon, Fernando Holguin
Obesity is a major risk factor for asthma. This association appears related to altered dietary composition and metabolic factors that can directly affect airway reactivity and airway inflammation. This article discusses how specific changes in the western diet and metabolic changes associated with the obese state affect inflammation and airway reactivity and reviews evidence that interventions targeting weight, dietary components, lifestyle, and metabolism might improve outcomes in asthma.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691719/microbiome-in-mechanisms-of-asthma
#3
REVIEW
Tara F Carr, Rhonda Alkatib, Monica Kraft
The lung and gut microbiome are factors in asthma risk or protection. Relevant elements of the microbiome within both niches include the importance of the early life window for microbiome establishment, the diversity of bacteria, richness of bacteria, and effect of those bacteria on the local epithelium and immune system. Mechanisms of protection include direct anti-inflammatory action or induction of non-type 2 inflammation by certain bacterial colonies. The gut microbiome further impacts asthma risk through the contribution of metabolic products...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691718/nonallergic-triggers-and-comorbidities-in-asthma-exacerbations-and-disease-severity
#4
REVIEW
Octavian C Ioachimescu, Nikita S Desai
Asthma triggers are exogenous or endogenous factors that could worsen asthma acutely to cause an exacerbation, or perpetuate chronic symptoms and airflow limitation. Because it is well known that recent asthma exacerbations and poor symptom control are strong predictors of future disease activity, it is not surprising that the number of (allergic or nonallergic) asthma triggers in the environment correlates with the disease-related quality of life. There is a need to identify and avoid specific triggers as the centerpiece of disease management, especially in those with heightened sensitivity to certain factors...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691717/systematic-approach-to-asthma-of-varying-severity
#5
REVIEW
Sandhya Khurana, Nizar N Jarjour
Asthma is a serious global health issue and asthma guidelines recommend a stepwise approach to management with goals to achieve control and minimize future risk. Prior to escalation of pharmacotherapy, steps to confirm accurate diagnosis as well as address comorbidities and triggers are critical to effective asthma management. This article provides readers with a structured approach to evaluation and management of asthma of varying severity.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691716/modulation-of-bronchomotor-tone-pathways-in-airway-smooth-muscle-function-and-bronchomotor-tone-in-asthma
#6
REVIEW
Cynthia J Koziol-White, Reynold A Panettieri
Airway smooth muscle is the primary cell mediating bronchomotor tone. The milieu created in the asthmatic lung modulates airway smooth muscle contractility and relaxation. Experimental findings suggest intrinsic abnormalities in airway smooth muscle derived from patients with asthma in comparison with airway smooth muscle from those without asthma. These changes to excitation-contraction pathways may underlie airway hyperresponsiveness and increased airway resistance associated with asthma.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691715/proinflammatory-pathways-in-the-pathogenesis-of-asthma
#7
REVIEW
R Stokes Peebles, Mark A Aronica
There are multiple proinflammatory pathways in the pathogenesis of asthma. These include both innate and adaptive inflammation, in addition to inflammatory and physiologic responses mediated by eicosanoids. An important component of the innate allergic immune response is ILC2 activated by interleukin (IL)-33, thymic stromal lymphopoietin, and IL-25 to produce IL-5 and IL-13. In terms of the adaptive T-lymphocyte immunity, CD4+ Th2 and IL-17-producing cells are critical in the inflammatory responses in asthma...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691714/the-future-of-asthma-care-personalized-asthma-treatment
#8
REVIEW
Stephen T Holgate, Samantha Walker, Brigitte West, Kay Boycott
Although once considered a single disease entity, asthma is now known to be a complex inflammatory disease engaging a range of causal pathways. The most frequent forms of asthma are identified by sputum/blood eosinophilia and activation of type 2 inflammatory pathways involving interleukins-3, -4, -5, and granulocyte-macrophage colony-stimulating factor. The use of diagnostics that identify T2 engagement linked to the selective use of highly targeted biologics has opened up a new way of managing severe disease...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691713/the-use-of-geographic-data-to-improve-asthma-care-delivery-and-population-health
#9
REVIEW
Margaret E Samuels-Kalow, Carlos A Camargo
The authors examine uses of geographic data to improve asthma care delivery and population health and describe potential practice changes and areas for future research.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691712/bronchial-thermoplasty
#10
REVIEW
Anne S Mainardi, Mario Castro, Geoffrey Chupp
Bronchial thermoplasty is an advanced therapy for severe asthma. It is a bronchoscopic procedure in which radiofrequency energy is applied to the airway wall, resulting in decreased airway smooth muscle burden. Human trials have shown that bronchial thermoplasty may reduce asthma exacerbations and improve quality of life in patients with severe uncontrolled asthma. It has been demonstrated to be a safe procedure, with most adverse events being early and mild. More studies are required to understand the precise effects of bronchial thermoplasty on the asthmatic airway and optimal parameters to appropriately select patients for this novel procedure...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691711/immunomodulators-and-biologics-beyond-stepped-care-therapy
#11
REVIEW
Mauli Desai, John Oppenheimer, David M Lang
This review highlights recent data concerning efficacy and safety of biological agents that are currently approved by Food and Drug Administration (FDA), as well as several agents that will likely soon be FDA approved, for management of properly selected patients with severe persistent asthma that is poorly or not well controlled despite "stepped care" management according to best evidence.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691710/asthma-and-corticosteroid-responses-in-childhood-and-adult-asthma
#12
REVIEW
Amira Ali Ramadan, Jonathan M Gaffin, Elliot Israel, Wanda Phipatanakul
Corticosteroids are the most effective treatment for asthma; inhaled corticosteroids (ICSs) are the first-line treatment for children and adults with persistent symptoms. ICSs are associated with significant improvements in lung function. The anti-inflammatory effects of corticosteroids are mediated by both genomic and nongenomic factors. Variation in the response to corticosteroids has been observed. Patient characteristics, biomarkers, and genetic features may be used to predict response to ICSs. The existence of multiple mechanisms underlying glucocorticoid insensitivity raises the possibility that this might indeed reflect different diseases with a common phenotype...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691709/asthma-over-the-adult-life-course-gender-and-hormonal-influences
#13
REVIEW
Joe G Zein, Joshua L Denson, Michael E Wechsler
Asthma is a common disorder that affects genders differently across the life span. Earlier in life, it is more common in boys. At puberty, asthma becomes more common and often more severe in girls and women. The effect of sex hormones on asthma incidence and its severity is difficult to differentiate from other asthma severity risk factors, such as racial background, socioeconomic factors, obesity, atopy, environmental exposure, and, in particular, lung aging. Recognizing gender-associated and age-associated differences is important to understanding the pathobiology of asthma and to providing effective education and personalized care for patients with asthma across the life course...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691708/three-major-efforts-to-phenotype-asthma-severe-asthma-research-program-asthma-disease-endotyping-for-personalized-therapeutics-and-unbiased-biomarkers-for-the-prediction-of-respiratory-disease-outcome
#14
REVIEW
Philip E Silkoff, Wendy C Moore, Peter J Sterk
The SARP, ADEPT, and U-BIOPRED programs are all significant efforts in characterizing asthma and reporting clusters that will assist in designing personalized therapies for asthma, and especially severe asthma. Key aspects of the design of these programs are summarized and major findings are reported in this review.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691707/life-cycle-of-childhood-asthma-prenatal-infancy-and-preschool-childhood-and-adolescence
#15
REVIEW
Kristie R Ross, W Gerald Teague, Benjamin M Gaston
Asthma is a heterogeneous developmental disorder influenced by complex interactions between genetic susceptibility and exposures. Wheezing in infancy and early childhood is highly prevalent, with a substantial minority of children progressing to established asthma by school age, most of whom are atopic. Adolescence is a time of remission of symptoms with persistent lung function deficits. The transition to asthma in adulthood is not well understood.
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691706/the-exposome-and-asthma
#16
REVIEW
Ahila Subramanian, Sumita B Khatri
This article on exposome and asthma focuses on the interaction of patients and their environments in various parts of their growth, development, and stages of life. Indoor and outdoor environments play a role in pathogenesis via levels and duration of exposure, with genetic susceptibility as a crucial factor that alters the initiation and trajectory of common conditions such as asthma. Knowledge of environmental exposures globally and changes that are occurring is necessary to function effectively as medical professionals and health advocates...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30691705/practical-and-conceptual-considerations-for-the-primary-prevention-of-asthma
#17
REVIEW
Steven M Brunwasser, Tina V Hartert
Asthma is among the most common chronic diseases worldwide and is a significant contributor to the global health burden, highlighting the urgent need for primary prevention. This article outlines several practical and conceptual challenges that accompany primary prevention efforts. It advocates for improved predictive modeling to identify those at high-risk of developing asthma using automated algorithms within electronic medical records systems and explanatory modeling to refine understanding of causal pathways...
March 2019: Clinics in Chest Medicine
https://read.qxmd.com/read/30390756/respiratory-infections-an-ongoing-challenge-with-a-promising-future
#18
EDITORIAL
Michael S Niederman
No abstract text is available yet for this article.
December 2018: Clinics in Chest Medicine
https://read.qxmd.com/read/30390755/personalizing-the-management-of-pneumonia
#19
REVIEW
Samir Gautam, Lokesh Sharma, Charles S Dela Cruz
Pneumonia is a highly prevalent disease with considerable morbidity and mortality. However, diagnosis and therapy still rely on antiquated methods, leading to the vast overuse of antimicrobials, which carries risks for both society and the individual. Furthermore, outcomes in severe pneumonia remain poor. Genomic techniques have the potential to transform the management of pneumonia through deep characterization of pathogens as well as the host response to infection. This characterization will enable the delivery of selective antimicrobials and immunomodulatory therapy that will help to offset the disorder associated with overexuberant immune responses...
December 2018: Clinics in Chest Medicine
https://read.qxmd.com/read/30390754/new-antibiotics-for-pneumonia
#20
REVIEW
Matteo Bassetti, Elda Righi, Alessandro Russo, Alessia Carnelutti
Delayed antimicrobial prescriptions and inappropriate treatment can lead to poor outcomes in pneumonia. In nosocomial infections, especially in countries reporting high rates of antimicrobial resistance, the presence of multidrug-resistant gram-negative and gam-positive bacteria can limit options for adequate antimicrobial treatment. New antibiotics, belonging to known classes of antimicrobials or characterized by novel mechanisms of actions, have recently been approved or are under development. Advantages of the new compounds include enhanced spectrum of activity against resistant bacteria, high lung penetration, good tolerability, and possibility for intravenous to oral sequential therapy...
December 2018: Clinics in Chest Medicine
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