Sunday, February 7, 2016

Aspirin-Exacerbated Respiratory Disease (full text from NEJM)

Aspirin-exacerbated respiratory disease (AERD) is characterized by asthma, chronic rhinosinusitis with nasal polyposis, and pathognomonic respiratory reactions to aspirin (Samter’s triad). It has been estimated that this syndrome affects 7% of adults with asthma and 14% of those who have severe asthma. Pathologically, AERD is characterized by marked eosinophilic inflammation and ongoing mast-cell activation in the respiratory mucosa. The frequent recurrence of nasal polyps after surgery, as well as the requirement for high-dose glucocorticoids to manage the asthma, reflect the aggressive, persistent nature of the disease. The typical onset is in adulthood, with or without preexisting asthma, rhinitis, or atopy. An absence of familial clustering argues against a strong genetic basis, and the identification of variants of candidate genes in small studies has not been replicated.

All nonsteroidal antiinflammatory drugs (NSAIDs) that inhibit both cyclooxygenase (COX)-1 and COX-2 may provoke the pathognomonic reactions in AERD; these reactions are accompanied by idiosyncratic activation of respiratory tract mast cells. In contrast, patients with AERD can usually be treated with COX-2–selective drugs without having these reactions. The fact that structurally diverse NSAIDs that block COX-1 all provoke reactions reflects an enigmatic requirement for COX-1–derived prostaglandins to maintain a tenuous homeostasis. Curiously, the reactions also induce a refractory state in which NSAIDs can be used with diminished or no sequelae (desensitization); in fact, after desensitization, high-dose aspirin has therapeutic benefits. Insights into the mechanisms responsible for the pathogenesis of AERD or its treatment have been limited.
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Thursday, February 4, 2016

Pathways connecting inflammation and Lung Cancer (2016 American Journal of Respiratory and Critical Care Medicine)
Lung cancer is the leading cause of cancer mortality worldwide, and at only 18%, it has one of the lowest 5-year survival rates of all malignancies. With its highly complex mutational landscape, treatment strategies against lung cancer have proved largely ineffective. However with the recent success of immunotherapy trials in lung cancer, there is renewed enthusiasm in targeting the immune component of tumors. Macrophages make up the majority of the immune infiltrate in tumors and are a key cell type linking inflammation and cancer. Although the mechanisms through which inflammation promotes cancer are not fully understood, two connected hypotheses have emerged: an intrinsic pathway, driven by genetic alterations that lead to neoplasia and inflammation, and an extrinsic pathway, driven by inflammatory conditions that increase cancer risk. Here, we discuss the contribution of macrophages to these pathways and subsequently their roles in established tumors. We highlight studies investigating the association of macrophages with lung cancer prognosis and discuss emerging therapeutic strategies for targeting macrophages in the tumor microenvironment.

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World Cancer Day - 4 February 2016

In recognition of World Cancer Day on February 4, we are supporting the World Cancer Day 2016: ‘We Can. I Can.’ campaign. The global campaign highlights how everyone, as a collective or as individuals, can do their part to reduce the global burden of cancer. 
Next year alone, nearly 9 million people are likely to die of cancer, and left unchecked, the number of deaths will increase to 13 million per year by 2030. World Cancer Day is a chance to reflect on what you can do: make a pledge and take action. Whatever you choose to do ‘We Can. I Can.’ will make a difference to the fight against cancer. The initiative outlines nine targets to be achieved by 2025 with the overarching goal to reduce cancer deaths by 25% by 2025. The targets include strengthening health systems, measuring cancer burden and impact of cancer plans in all countries, reducing exposure to cancer risk factors, universal coverage of HPV and HBV vaccination, reduction of stigma and dispelling myths about cancer, universal access to screening and early detection for cancer, improvement in access to services across the cancer care spectrum, universal availability of pain control and distress management, and improvement in education and training of healthcare professionals.
According to the World Health Organization, lung cancer is the most common cancer worldwide, accounting for 1.8 million new cases in 2012, and is responsible for nearly one in five deaths. While most understand that smoking is the single greatest risk factor for lung cancer, regular exposure to secondhand smoke also increases the risk. In addition, environmental exposure to radon, asbestos, arsenic, beryllium, and uranium have all been linked to lung cancer. The risk of lung cancer also increases with a history of cancer in another part of the body, age, family history, radiation to the chest area, and lung diseases like COPD and tuberculosis.

Monday, February 1, 2016

Treatable traits: toward precision medicine of chronic airway diseases (ERJ paper)

Dear friends, this is new article on new approaches in asthma and COPD from todays European Respiratory Journal! 
Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airway diseases that have a high personal and social impact. They likely represent a continuum of different diseases that may share biological mechanisms (i.e. endotypes), and present similar clinical, functional, imaging and/or biological features that can be observed (i.e. phenotypes) which require individualised treatment. Precision medicine is defined as “treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations”. In this Perspective, we propose a precision medicine strategy for chronic airway diseases in general, and asthma and COPD in particular.

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Sunday, January 31, 2016

Online survey: Impact of social media on promotion of lung health

Dear Respiratory Friends,
We are happy to invite you to participate in our Survey: Impact of social media on promotion of lung health!
Your input will help us to review role of social media in respiratory healthcare and guide the development of it in near future

Please fill out our questionnaire

Saturday, January 30, 2016

Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort (Chest article)

Asthma-COPD overlap syndrome is very contradictory topic in Respiratory medicine!
Background  Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult.

Methods  To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS.
Results  Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05).
Conclusions  The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria.
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Monday, January 25, 2016

An essential journal on Respiratory Medicine

Current Respiratory Medicine Reviews publishes original research papers, frontier reviews, drug clinical trial studies and guest edited issues dedicated to clinical research on all the latest advances on respiratory diseases and its related areas e.g. pharmacology, pathogenesis, clinical care, therapy. The journal is essential reading for all researchers and clinicians in respiratory medicine.