Thursday, July 21, 2016

Clinical Practice Guidelines 2016: The Diagnosis and Management of Alpha-1 Antitrypsin Deficiency in the Adult (free full text)

Dear Respiratory friends we are happy to present you Clinical Practice Guidelines 2016: The Diagnosis and Management of Alpha-1 Antitrypsin Deficiency in the Adult published today in Journal of the COPD Foundation!
http://journal.copdfoundation.org/jcopdf/id/1115/The-Diagnosis-and-Management-of-Alpha-1-Antitrypsin-Deficiency-in-the-Adult

Summary of Recommendations

Testing for Alpha-1 Antitrypsin Deficiency (AATD):

· All individuals with COPD regardless of age or ethnicity should be tested for AATD.

· All individuals with unexplained chronic liver disease should be tested for AATD.

· All individuals with necrotizing panniculitis, granulomatosis with polyangiitis, or unexplained bronchiectasis should be tested for AATD.

· Parents, siblings, and children, as well as extended family of individuals identified with an abnormal gene for AAT, should be provided genetic counseling and offered testing for AATD (see guideline document for special considerations about testing minors).

· For family testing after a proband is identified, AAT level testing alone is not recommended because it does not fully characterize disease risk from AATD.

· For diagnostic testing of symptomatic individuals, we recommend genotyping for at least the S and Z alleles. Advanced or confirmatory testing should include Pi-typing, AAT level testing, and/or expanded genotyping.

Pulmonary function testing in those with AATD:

· Initial evaluation with complete lung function testing is recommended.

· Annual follow-up of adults with at least a spirometry test is recommended.

Computed Tomography (CT) scan of the chest in the evaluation in those with AATD:

· In newly diagnosed patients who are symptomatic and/or have abnormal pulmonary function testing, a baseline CT scan of the chest is recommended.

· Serial chest CT scanning to monitor progression of disease is not recommended.

Monitoring for liver disease in those with AATD:

· Monitoring for liver disease at annual intervals (or more frequently as indicated by clinical circumstances), with physical examination including focused exam for signs of liver disease, liver ultrasound, and laboratory monitoring of AST, ALT, GGT, albumin, bilirubin, INR, and platelets is recommended.

Management of lung disease in those with AATD:

· Every effort should be made to prevent exposure to tobacco smoke and facilitate cessation in those who are smoking.

· Lung volume reduction surgery is not recommended for individuals with COPD related to AATD.

Intravenous augmentation therapy in those with AATD is recommended for:

· Individuals with an FEV1 less than or equal to 65% predicted.

o    For those with lung disease related to AATD and an FEV1 greater than 65%, we recommend discussion with each individual regarding the potential benefits of reducing lung function decline with consideration of the cost of therapy and lack of evidence for such benefit.

·         Individuals with necrotizing panniculitis.

Intravenous augmentation therapy is not recommended for:

· Individuals with the MZ genotype of AATD.

· Individuals with lung disease due to AATD who continue to smoke.

· Individuals with AATD and emphysema or bronchiectasis who do not have airflow obstruction.

· The treatment of liver disease due to AATD.

· Individuals who have undergone liver transplantation.

Additional recommendations regarding dosing of intravenous augmentation therapy:

· Weekly doses higher than the current FDA-approved dose are not recommended.

· Monitoring of trough AAT blood levels to evaluate the adequacy of AAT augmentation dosing is not recommended.

Friday, July 8, 2016

Pneumonology Quiz – Case 3 (article from Archives of Hellenic Medicine)

A 67-year-old male patient, lifelong smoker, with a background of asthma since childhood and recurrent ethmoid polyps attended for a routine clinical review. He was only prescribed a salbutamol inhaler, to be used when required. He reported intermittent episodes of shortness of breath with wheezing at night and a progressive deterioration of his symptoms over the previous two years. He was also complaining of cough productive of yellow phlegm, almost every morning. On examination, he was tachypneic at rest, with an oxygen saturation of 92% on room air. He was severely hyperinflated and a bit wheezy on auscultation.
https://www.researchgate.net/publication/304996769_Pneumonology_Quiz_-_Case_3
Read full text:

Sunday, July 3, 2016

Pocket Guide to COPD Diagnosis, Management, and Prevention – 2016 (Link for free download)

Pocket Guide has been developed from the Global Strategy for the Diagnosis, Management, and Prevention of COPD (2016 Update). Technical discussions of COPD and COPD management, evidence levels, and specific citations from the scientific literature are included in that source document.
https://www.facebook.com/worldcopdday/photos/a.431789760263749.1073741826.116682571774471/914253928683994/?type=3&theater

Thursday, June 30, 2016

Do we really need asthma–chronic obstructive pulmonary disease overlap syndrome?

Dear Respiratory friends we are happy to present you exciting article from The Journal of Allergy and Clinical Immunology by our Italian friends Mario Cazzola and Paola Rogliani on Hot Topic: Do we really need asthma–chronic obstructive pulmonary disease overlap syndrome? 

The association of asthma and chronic obstructive pulmonary disease (COPD) in the same patient, which is designated as mixed asthma-COPD phenotype or overlap syndrome (ACOS), remains a controversial issue. This is primarily because many conflicting aspects in the definition of ACOS remain, and it is extremely difficult to summarize the distinctive features of this syndrome. Furthermore, we are realizing that asthma, COPD, and ACOS are not single diseases but rather syndromes consisting of several endotypes and phenotypes and, consequently, comprising a spectrum of diseases. The umbrella term ACOS blurs the lines between asthma and COPD and allows an approach that simplifies therapy. However, this approach contradicts the modern concept according to which we must move toward more targeted and personalized therapies to treat patients with these diseases.  

http://www.jacionline.org/article/S0091-6749(16)30368-2/fulltext
Therefore we argue that the term ACOS must be abandoned and ultimately replaced when new phenotypes and underlying endotypes are identified and a new taxonomy of airway diseases is generated.

Full text:

Wednesday, June 29, 2016

GOLD 2016 update on Asthma-COPD Overlap Syndrome (Link for free download)



Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by similar mechanisms: airway inflammation, airway obstruction and airway hyperresponsiveness. However, the distinction between the two obstructive disease is not always clear. Multiple epidemiological studies demonstrate that in elderly people with obstructive airway disease, as many as half or more may have overlapping diagnoses of asthma and COPD. A COPD-Asthma overlap syndrome is defined as an airflow obstruction that is not completely reversible, accompanied by symptoms and signs of increased obstruction reversibility. For the clinical identification of  overlap syndrome COPD-Asthma Spanish guidelines proposed six diagnostic criteria The major criteria include very positive bronchodilator test (increase in FEV1 ≥15% and ≥400 ml),  eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥12% and ≥200 ml) on two or more occasions. The overlap syndrome COPD-Asthma is associated with enhanced response to inhaled corticosteroids due to the predominance of eosinophilic bronchial inflammation.
https://www.facebook.com/worldcopdday/photos/a.431789760263749.1073741826.116682571774471/911633245612729/?type=3&theater
 The furture clinical studies and multicenter clinical trials should lead to the investigation of disease mechanisms and simultaneous development of the novel treatment.

Monday, June 27, 2016

5th International Congress of Georgian Respiratory Association - Great success!

Dear Respiratory friends we are happy to share with you Great Respiratory event - 5th International Congress of Georgian Respiratory Association organized by our friends in Georgia, which take place last week in Batumi!!!
Georgian Respiratory Association with about 1000 members representing various disciplines of respiratory medicine together with world-renowned experts from Europe, America and Asia made this meeting a unique scientific event not only in Georgia but at the global level.
  • The European Board for Accreditation in Pneumology (EBAP) accredited Congress with 12 credits of Continuing Medical Education (CME)!
  • 1000 of participants from more than 25 countries!
  • 38 International speakers from all over the world on Hot Topics in Respiratory Medicine!
  • 25 scientific sessions covered all fields related to respiratory medicine including Asthma and Allergy, Respiratory Critical Care Medicine, Lung Cancer, Pulmonary Infections, Thoracic Imaging, Thoracic Surgery, Thoracic Oncology, Rare Lung Diseases, COPD, Interventional Bronchoscopy, and Pediatric Pulmonology!
  •  All sessions were live in internet and you can view sessions at Official Facebook page of Georgian Respiratory Association: https://www.facebook.com/Georgian-Respiratory-Association-208587155871083/?fref=ts 

The event was of great success because it was organized by young and inspired team conducted by President of the Congress Ivane Chkhaidze, and Congress co-chairs:  Vakhtang Katsarava, Tamaz Maglakelidze and Kakha Vacharadze! 
Batumi, it is perfect place for Congress and great place to be!

Sunday, June 19, 2016

Speakers of 5th International Congress of Georgian Respiratory Association

Dear Respiratory friends we are happy to invite you on Great Respiratory event - 5th International Congress of Georgian Respiratory Association organized by our friends in Georgia!!!
http://congress.georanet.org.ge/uploads/files/foreign_speakers.pdf
Georgian Respiratory Association with about 1000 members representing various disciplines of respiratory medicine together with world-renowned experts from Europe, America and Asia make this gathering a unique scientific event not only in Georgia but also in the region.
38 International speakers on Hot Topics in Respiratory Medicine!
http://congress.georanet.org.ge/uploads/files/foreign_speakers.pdf
The Scientific Committee is planning a very comprehensive program catering for all specialties of respiratory medicine that will deliver state of the art lectures, update presentations, postgraduate courses, and abstract presentations. The program covers all fields related to respiratory medicine including Asthma and Allergy, RespiratoryCritical Care Medicine, Lung Cancer, Pulmonary Infections, Thoracic Imaging, Thoracic Surgery, Thoracic Oncology, Rare Lung Diseases, COPD, Interventional Bronchoscopy, and Pediatric Pulmonology.

Final Program of 5th International Congress of Georgian Respiratory Asso

5th International Congress of Georgian Respiratory Association, Batumi, 23-25 june 2016

ciation, Batumi, 23-25 june 2016