Tuesday, May 3, 2016

Asthma 2016 Guidelines on World Asthma Day 2016: The 2016 update of the Global Strategy for Asthma Management and Prevention

World Asthma Day is a big event celebrated all over the world by the people to increase the awareness among public worldwide about the precautions and preventions of the asthma. This event is annually organized on international level by the GINA (Global Initiative for Asthma) in order to increase the asthma awareness all around the world. It is celebrated on annual basis at 1st Tuesday of the May month. World Asthma Day celebration was first started celebrating in the year 1998 by the GINA in more than 35 countries after its first “World Asthma Meeting” in the Barcelona, Spain.
The 2016 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.
Link for free download of the 2016 update of the Global Strategy for Asthma Management and Prevention:

Sunday, May 1, 2016

2016 Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults

Background: Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults; however, whether mild OSA has significant neurocognitive and cardiovascular complications is uncertain.
Objectives: The specific goals of this Research Statement are to appraise the evidence regarding whether long-term adverse neurocognitive and cardiovascular outcomes are attributable to mild OSA in adults, evaluate whether or not treatment of mild OSA is effective at preventing or reducing these adverse neurocognitive and cardiovascular outcomes, delineate the key research gaps, and provide direction for future research agendas.
Methods: Literature searches from multiple reference databases were performed using medical subject headings and text words for OSA in adults as well as by hand searches. Pragmatic systematic reviews of the relevant body of evidence were performed.
Results: Studies were incongruent in their definitions of “mild” OSA. Data were inconsistent regarding the relationship between mild OSA and daytime sleepiness. However, treatment of mild OSA may improve sleepiness in patients who are sleepy at baseline and improve quality of life. There is limited or inconsistent evidence pertaining to the impact of therapy of mild OSA on neurocognition, mood, vehicle accidents, cardiovascular events, stroke, and arrhythmias.
Conclusions: There is evidence that treatment of mild OSA in individuals who demonstrate subjective sleepiness may be beneficial. Treatment may also improve quality of life. Future research agendas should focus on clarifying the effect of mild OSA and impact of effective treatment on other neurocognitive and cardiovascular endpoints as detailed in the document.
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Saturday, April 30, 2016

Roflumilast combined with montelukast in asthma (free full text)

Roflumilast, a selective phosphodiesterase 4 inhibitor, has been shown to provide modest improvements in lung function in patients with mild-to-moderate asthma, but its efficacy in patients with moderate-to-severe asthma has not been assessed. Authors hypothesized that this drug might provide benefit if combined with montelukast, a leukotriene receptor antagonist, in patients whose symptoms are uncontrolled by inhaled corticosteroids and long-acting β-agonists.

The combination of roflumilast with montelukast compared with montelukast alone improved lung function and asthma control in patients with moderate-to-severe asthma and deserves further study for this indication.
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Saturday, April 23, 2016

Link between cigarette smoking and COPD: whats new in 2016

Our new article was published in ‪#‎Pneumologia‬: from ‪#‎smoking‬ to ‪#‎COPD‬: current approaches
Chronic obstructive pulmonary disease (COPD) remains a leading cause of death all over the world. Even though it is the most intensely studied disease induced by cigarette smoking there are still incomplete researches concerning its pathophysiology and treatment. So far it has been determined the deleterious effects of the secreted molecules diversity and some feasible therapies for their diminution. 
Discouraged by the fact that autoimmunity represents a black box full of surprises, identifying an autoimmune origin in COPD induced by smoking might serve not only as a starting point for new research but also strengthens the relevance of smoking cessation in such patients. By establishing tighter connections among smoking and the autoimmune origin of COPD similar to well defined autoimmune diseases there will be achievable to direct COPD’s therapy toward different classes of medicine.
In what concerns the available approaches toward smokers with COPD, the vital step in defeating the disease and preventing other noxious effects of cigarette smoking, remains smoking cessation.
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Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor) (full text from BMJ)

Authors of this interesting study have developed a theoretically informed internet-delivered intervention to manage respiratory tract infections among adults (‘The Internet Doctor’) that they have shown in a small exploratory trial results in higher levels of satisfaction, enablement and understanding of illness.

Objective To assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs).
Design Open pragmatic parallel group randomised controlled trial.
Setting Primary care in UK.
Participants Adults (aged ≥18) registered with general practitioners, recruited by postal invitation.
Intervention Patients were randomised with computer-generated random numbers to access the intervention website (intervention) or not (control). The intervention tailored advice about the diagnosis, natural history, symptom management (particularly paracetamol/ibuprofen use) and when to seek further help.
Outcomes Primary: National Health Service (NHS) contacts for those reporting RTIs from monthly online questionnaires for 20 weeks. Secondary: hospitalisations; symptom duration/severity.
Results 3044 participants were recruited. 852 in the intervention group and 920 in the control group reported 1 or more RTIs, among whom there was a modest increase in NHS direct contacts in the intervention group (intervention 37/1574 (2.4%) versus control 20/1661 (1.2%); multivariate risk ratio (RR) 2.25 (95% CI 1.00 to 5.07, p=0.048)). Conversely, reduced contact with doctors occurred (239/1574 (15.2%) vs 304/1664 (18.3%); RR 0.71, 0.52 to 0.98, p=0.037). Reduction in contacts occurred despite slightly longer illness duration (11.3 days vs 10.7 days, respectively; multivariate estimate 0.60 days longer (−0.15 to 1.36, p=0.118) and more days of illness rated moderately bad or worse illness (0.52 days; 0.06 to 0.97, p=0.026). The estimate of slower symptom resolution in the intervention group was attenuated when controlling for whether individuals had used web pages which advocated ibuprofen use (length of illness 0.22 days, −0.51 to 0.95, p=0.551; moderately bad or worse symptoms 0.36 days, −0.08 to 0.80, p=0.105). There was no evidence of increased hospitalisations (risk ratio 0.25; 0.05 to 1.12; p=0.069).
Conclusions An internet-delivered intervention for the self-management of RTIs modifies help-seeking behaviour, and does not result in more hospital admissions due to delayed help seeking. Advising the use of ibuprofen may not be helpful. 

Wednesday, April 13, 2016

2016 BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults (full text)

Acute hypercapnic respiratory failure in adults (AHRF) results from an inability of the respiratory pump, in concert with the lungs, to provide sufficient alveolar ventilation to maintain a normal arterial PCO2. Co-existent hypoxaemia is usually mild and easily corrected. Conventionally, a pH <7.35 and a PCO2 >6.5 kPa define acute respiratory acidosis and, when persisting after initial medical therapy, have been used as threshold values for considering the use of non-invasive ventilation. More severe degrees of acidosis, such as pH<7.25, have been used as a threshold for considering provision of IMV.
AHRF complicates around 20% of acute exacerbations of COPD. It signals advanced disease, a high risk of future hospitalisations and limited long-term prognosis. The median survival following recovery from AHRF was 1 year in a large case series. Around 12% of patients with hypercapnic COPD died during the index admission and this increased to 33% if the respiratory acidosis developed after hospitalisation. In asthma, acute hypercapnia also signals an increased risk of death and an increased likelihood of future life-threatening attacks. The same risks apply to AHRF complicating CF and bronchiectasis, although this has not been formally reported. In the neuromuscular and CWDs, including morbid obesity, respiratory pump failure is often insidious in its onset, but AHRF may be acute and unexpected. Acute on chronic ‘decompensated’ episodes of AHRF are more common and normally indicate the future need for domiciliary NIV. 
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Friday, April 8, 2016

From smoking to COPD – current approaches in 2016 (full text from Pneumologia)

Our new article was published in ‪#‎Pneumologia‬: from ‪#‎smoking‬ to ‪#‎COPD‬: current approaches
Chronic obstructive pulmonary disease (COPD) remains a leading cause of death all over the world. Even though it is the most intensely studied disease induced by cigarette smoking there are still incomplete researches concerning its pathophysiology and treatment. So far it has been determined the deleterious effects of the secreted molecules diversity and some feasible therapies for their diminution. 
According to current studies more relevance gains the possible autoimmune origin of COPD and the epigenetic modifications. The idea of autoimmunity in smoking induced COPD began to be speculated with the discovery of autoantibodies in patient's serum, but there are some studies who consider antibody complexes that reside in the lung tissue as more relevant for future research. By developing the autoimmune aspect of COPD it will become possible to select more precise treatment strategies. The importance of epigenetic changes in this field might be appreciated starting with the fact of an existing connection between epigenetic modifications induced by maternal smoking and latter COPD development. This explains the tendency toward different drugs capable of restoring these transformations such as deacetylation agents expected also to prevent steroid resistance. Nevertheless smoking cessation remains as the indispensable approach for COPD treatment and prevention.
Keywords: COPD, smoking, epigenetic changes 
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