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Expert Review of Respiratory Medicine

Rob Janssen, Ianthe Piscaer, Frits Me Franssen, Emiel Fm Wouters
Distinct pathologies can cause chronic obstructive pulmonary disease (COPD). Emphysema is a COPD-phenotype characterized by destruction of lung parenchyma. Alpha-1 antitrypsin deficiency (AATD) is a genetic cause of emphysema, whereas smoking is the most important risk factor of non-AATD emphysema. A general underappreciation of non-AATD emphysema has hampered progress in the field, and clinical guidelines have prohibited the use of emphysema as a diagnosis. Non-AATD emphysema, however, is far from irrelevant as it associates with dyspnea, reduced exercise capacity and relevant outcome measures...
February 14, 2019: Expert Review of Respiratory Medicine
Young Soon Yoon, Minhee Jin, Don D Sin
Introduction The prevalence of chronic obstructive pulmonary disease (COPD) increases exponentially with aging. Its pathogenesis, however, is not well known and aside from smoking cessation, there are no disease-modifying treatments for this disease. Areas covered COPD is associated with accelerating aging and aging-related diseases. In this review, we will discuss the hallmarks of aging including genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, mitochondrial dysfunction, deregulated nutrient sensing, cellular senescence, stem cell exhaustion, and altered intercellular communication, which may be involved in COPD pathogenesis...
February 8, 2019: Expert Review of Respiratory Medicine
Allan R Brasier
Activation of antigen-independent inflammation (a.k.a. the "innate" immune response (IIR)) plays a complex role in allergic asthma (AA). Although activation of the pulmonary IIR by aerosolized bacterial lipopolysaccharide early in life may be protective of AA, respiratory viral infections promote AA. The mechanisms how the mucosal IIR promotes allergic sensitization, remodeling, and altered epithelial signaling are not understood. Areas covered: This manuscript overviews: 1. Mechanistic studies identifying how allergens and viral patterns activate the mucosal IIR; 2...
February 4, 2019: Expert Review of Respiratory Medicine
Eihab O Bedawi, Maged Hassan, David McCracken, Najib M Rahman
INTRODUCTION: Pleural infection is a condition that continues to pose a significant challenge to respiratory physicians. We hypothesize that the main barriers to progress include limited understanding of the etiopathogenesis, microbiology and role of antibiotics in the pleural space. AREAS COVERED: PubMed was searched for articles related to adult pleural infection using the terms 'pleural infection', 'empyema' and 'parapneumonic'. The search focused on relevant literature within the last ten years, with any older citations used only to display context or lack of progress...
February 1, 2019: Expert Review of Respiratory Medicine
Hrishikesh Kulkarni, Sairam Parthasarathy
The role of noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) in the home-setting remains controversial. Despite studies suggesting potential benefits, there is an apparent under-utilization of such therapy in patients with stable COPD in a domiciliary setting. Areas covered: The reasons for under-utilization in the home-setting are multi-factorial, and we provide our perspective on the adequacy of scientific evidence and implementation barriers that may underlie the observed under-utilization...
February 1, 2019: Expert Review of Respiratory Medicine
Walter T McNicholas
Obstructive sleep apnoea (OSA) is highly prevalent and there is considerable evidence supporting an independent association with a wide range of co-morbidities including cardiovascular, endocrine and metabolic, neuropsychiatric, pulmonary, and renal. Areas covered: A PubMed search of all the recent literature relating to OSA and co-morbidities was undertaken to critically evaluate the potential relationships and possible benefit of continuous positive airway pressure (CPAP) therapy. Expert Commentary: The evidence supporting an independent association is stronger for some co-morbidities than others and in cardiovascular diseases is strongest for hypertension and atrial fibrillation...
January 28, 2019: Expert Review of Respiratory Medicine
William C Arnold, Christian Guilleminault
Upper airway resistance syndrome (UARS) as obstructive sleep apnea syndrome (OSAS) has been described as abnormal breathing during sleep, based on the recording technologies and knowledge of the time. These terms have advanced the field, but the question raised is are they still useful? Area Covered: Historically, the definition of UARS syndrome was aimed at recognizing pathology not covered by 'OSAS' and to prompt specialists to go further than the obvious. It was aimed also at pushing specialists to recognize pathologies earlier and to elicit research in the developmental features of sleep-disordered-breathing (SDB)...
January 28, 2019: Expert Review of Respiratory Medicine
Sarah A Wicher, Y S Prakash, Christina M Pabelick
Flask-shaped plasma membrane (PM) invaginations called caveolae and their constitutive caveolin and cavin proteins regulate cellular function via plasma membrane and intracellular signal transduction pathways. Caveolae are present in a variety of cells in the lung including airway smooth muscle (ASM) where they interact with other proteins, receptors, and ion channels and thereby have the potential to affect both normal and disease processes such as inflammation, contractility, and fibrosis. Given their involvement in cell signaling, caveolae may play important roles in mediating and modulating aging processes, and contribute to lung diseases of aging...
January 28, 2019: Expert Review of Respiratory Medicine
Aparna Das, Anupam Kumar, Andrea Valeria Arrossi, Subha Ghosh, Kristin B Highland
Interstitial lung disease (ILD) is the most common cause of mortality in systemic sclerosis; accounting for approximately 35% of deaths. Although immunosuppression is currently opted as first line therapy for scleroderma-related ILD (SSc-ILD), the benefits from it remain modest with concerns for systemic toxicity from long term use. Areas covered: We review the important facets in monitoring a patient with SSc-ILD, including recognizing various patterns of ILD, identifying those at risk for disease progression and discuss the strength of evidence for immunosuppressant drugs and lung transplantation...
January 28, 2019: Expert Review of Respiratory Medicine
Jennifer Furin
Pediatric tuberculosis (TB) is a significant global health threat and is one of the top ten causes of death in children. There are a number of diagnostic, treatment, and preventive innovations that have been developed in the last decade for TB, however, these are out of reach for many children in the world. Areas covered: A comprehensive review of the literature on TB in children was done using PubMed and Ovid databases from January 1, 1996 up to October 31, 2018. Topic areas covered included diagnosis of TB, treatment of TB (including novel medications and regimens), prevention of DR-TB, and support to achieve the best possible outcomes...
January 16, 2019: Expert Review of Respiratory Medicine
Filippo De Marinis, Massimo Barberis, Vito Barbieri, Alfonso Marchianò, Stefano Gasparini, Maria Rita Migliorino, Giampiero Romano, Francesca Spinnato, Fabiana Vitiello, Cesare Gridelli
In the era of personalized cancer therapy, the sampling of adequate tumor tissue for histologic diagnosis and genomic profiling is crucial, not only at the initial diagnosis but also in the event of resistant and recurrent disease when sequential biopsies may be required to evaluate somatic mutations and histologic changes. Areas covered: The identification of genetic driver alterations led to the selection of patients who are most likely to benefit from epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) and rat osteosarcoma (ROS-1) tyrosine kinase inhibitors; on the other hand, in the absence of oncogenic alterations, platinum-based doublet chemotherapy regimens were the cornerstone of treatment...
January 14, 2019: Expert Review of Respiratory Medicine
Donald W Cockcroft, Beth E Davis, Christianne M Blais
INTRODUCTION: Bronchoprovocation inhalation challenge tests with direct acting stimuli (e.g. methacholine) are widely used clinically to aid in the diagnosis of asthma. Areas covered: The history of direct challenges with histamine and muscarinic agonists is reviewed. This began with parenteral administration of stimuli with responses monitored clinically and by VC, progressing to inhalation dose-response challenges monitored by FEV1 and FEV1 /VC ratio, both (the challenge method and the technology to measure FEV1 ) developed by Robert Tiffeneau in the mid-1940s...
January 11, 2019: Expert Review of Respiratory Medicine
Lykourgos Kolilekas, Spyridon Papiris, Demosthenes Bouros
Idiopathic pulmonary fibrosis (IPF) is a progressive and invariable fatal interstitial lung disease. Current antifibrotic treatment halts disease progression but do not cure the disease itself. In the last decade, a substantial understanding in disease pathobiological mechanisms led to the development of numerous clinical trials testing promising pharmacologic agents. Areas covered: In this review, we summarize and discuss current and emerging pharmacological therapies for IPF and highlight the potential of different promising investigational compounds in phase II-IV trials with positive or pending results...
January 11, 2019: Expert Review of Respiratory Medicine
Antonio Valero, Paula Ribó, Luis Maíz, Esther Barbero, Myriam Calle, Carlos Campo, Paula Rytilä, Jordi Giner, Vicente Plaza
BACKGROUND: The preferences and opinions of patients are important when choosing the optimal inhaler device for asthma management. We compared patient satisfaction of three dry powder inhalers in patients with moderate to severe asthma. METHODS: We selected a group of patients treated with EasyhalerTM (n = 164) and a second group of patients treated with TurbuhalerTM (n = 100) or DiskusTM (AccuhalerTM ) (n = 64) from the register of an observational, multicenter study...
January 9, 2019: Expert Review of Respiratory Medicine
Julie Wacker, Robert Weintraub, Maurice Beghetti
Pulmonary hypertension is a severe condition that can develop during childhood due to several different etiologies. During the last two decades, based on a better understanding of the underlying pathobiology leading to pulmonary arterial hypertension, targeted therapies have been developed and have improved the dreadful prognosis of the condition. However, curative therapy remains elusive. Areas covered: In this article, we will review the current available drugs in paediatric pulmonary arterial hypertension and discuss the recommended management strategies...
January 5, 2019: Expert Review of Respiratory Medicine
Susanna Esposito, Nicola Principi
Pediatric community-acquired pneumonia (CAP) remains a significant health problem worldwide. Although knowledge in the etiology of CAP is not satisfactory, in most cases, therapy is decided following probability-based criteria that are derived from studies that report the frequency of detection of pathogens in children with CAP. Areas covered: This narrative review discusses the present knowledge on pediatric CAP etiology, the limits of the aetiological studies and the tests for differentiation of viral from bacterial infections...
January 2, 2019: Expert Review of Respiratory Medicine
Paula Peyrani, Lionel Mandell, Antoni Torres, Glenn S Tillotson
Community-acquired pneumonia (CAP) is a significant global health problem and leading cause of death and hospitalization in both the US and abroad. Increasing macrolide resistance among Streptococcus pneumoniae and other pathogens results in a greater disease burden, along with changing demographics and a higher preponderance of comorbid conditions. Areas covered: This review summarizes current data on the clinical and economic burden of CAP, with particular focus on community-acquired bacterial pneumonia (CABP)...
December 30, 2018: Expert Review of Respiratory Medicine
N Lovell, A Wilcock, S Bajwah, S N Etkind, C J Jolley, M Maddocks, I J Higginson
Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain may have a role. Antidepressants have been proposed; however, current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost, and wide availability, along with additional potential benefits...
December 30, 2018: Expert Review of Respiratory Medicine
Linda Ye, Shaokang Ma, Bruce W Robinson, Jenette Creaney
Immunotherapy has long been considered a potential therapy for malignant mesothelioma and is currently being pursued as such. Some of the early phase clinical trials involving immunomodulators have demonstrated encouraging results and numerous clinical trials are underway to further investigate this treatment approach in various treatment settings and larger patient cohorts. Areas covered: This review summarizes the current and emerging clinical evidence for checkpoint blockade and other immunotherapeutic strategies in mesothelioma...
December 30, 2018: Expert Review of Respiratory Medicine
John S Tregoning, Patrick Mallia
No abstract text is available yet for this article.
December 22, 2018: Expert Review of Respiratory Medicine
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