Sunday, December 11, 2016

Elsevier’s CiteScore metrics provide comprehensive, transparent, current insights into journal impact

Impact plays an important part in understanding the performance of a journal over time and making decisions about its future. It is impossible to get a true picture of impact using a single metric alone, so a basket of metrics is needed to support informed decisions.
Today Elsevier is launching CiteScore metrics: a new standard that gives a more comprehensive, transparent and current view of a journal’s impact that will help you guide your journal more effectively in the future.
CiteScore metrics are part of the Scopus basket of journal metrics that includes SNIP (Source Normalized Impact per Paper), SJR (SCImago Journal Rank), citation- and document- counts and percentage cited. The integration of these metrics into Scopus provides insights into the citation impact of more than 22,220 titles.
CiteScore metrics from Scopus is a comprehensive, current and free metrics for serial titles in Scopus.

Search or filter below to find the sources of interest and see the new metrics. Report using these annual metrics and track the 2016 metrics via the links to each title’s Scopus source details page.

Be sure to use qualitative as well as the below quantitative inputs when presenting your research impact, and always use more than one metric for the quantitative part.
Use from now CiteScore metrics online:

Wednesday, December 7, 2016

New issue of Current Respiratory Medicine Reviews (Volume 12 - Number 3) online

Dear Friends was published new issue of Current Respiratory Medicine Reviews (Volume 12 - Number 3)!
Table of Contents  (For viewing abstracts please visit this link)

Meet Our Editorial Board Member Pp. 183-184
Russell W. Steele
[Download PDF]
Editorial: "COPD: More than a Moving Target!" Pp. 185-185
Alexandru Corlateanu and Joseph Varon
[Download PDF]
Review Article
Molecular Based Drug Targets for Idiopathic Pulmonary Fibrosis Pp. 186-207
Beatriz Ballester, Javier Milara, Esteban Morcillo and Julio Cortijo
[Abstract] [Purchase Article]
Review Article
Investigations of Malignant Mesothelioma Pp. 208-214
Jack A. Kastelik, Mahmoud Loubani, Gerard Avery, Anthony G. Arnold and Jaymin Morjaria
[Abstract] [Purchase Article]
Review Article
Understanding the Immune and Inflammatory Response to Rhinoviruses: Recent Advances with Relevance to Asthma Pp. 215-224
Kuhan Kunarajah, Olga Pena and John W. Upham
[Abstract] [Open Access Plus]
Research Article
Exercise-Induced Pulmonary Edema in Athletes Pp. 225-231
Serghei Covantev, Alexandru Corlateanu, Victor Botnaru and Joseph Varon
[Abstract] [Purchase Article]
Review Article
The Role of Systemic Treatment and Radiotherapy in Malignant Mesothelioma Pp. 232-240
Michael Lind, Rachael Barton, Andrzej Wieczorek, Mahmoud Loubani and Jack A. Kastelik
[Abstract] [Purchase Article]
Case Studies
Pleural Involvement Due to Metastatic Melanoma: A Rare Complication and Literature Review Pp. 241-245
Misael Avalos, Salim Surani and Joseph Varon
[Abstract] [Purchase Article]

Saturday, December 3, 2016

Start a clean air revolution!

On December 2nd, Paris, Madrid, Mexico City and Athens pledged to remove diesel vehicles from their roads by 2025. This unprecedented action will have a lasting impact on improving air quality and protecting the health of residents. 
The mayors of Paris, Mexico City, Madrid and Athens say they are implementing the ban to improve air quality.
They say they will give incentives for alternative vehicle use and promote walking and cycling.
The commitments were made in Mexico at a biennial meeting of city leaders.
The use of diesel in transport has come under increasing scrutiny in recent years, as concerns about its impact on air quality have grown. The World Health Organization (WHO) says that around three million deaths every year are linked to exposure to outdoor air pollution.
The respiratory tract is the portal of entry of air pollutants, and thus the lung is the first organ affected. The range of respiratory diseases that can be caused by air pollution exposure is large. Studies on the health impacts of air pollution differentiate between acute and chronic effects. The acute effects of pollution may be apparent within hours or days of exposure, but other health effects of air pollution result from long-term exposure, leading to chronic disease.

Wednesday, November 23, 2016

Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease (FREE FULL TEXT ARTICLE from RESPIRATORY INVESTIGATION 2016)

We are happy to present you article Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease from RESPIRATORY INVESTIGATION 2016 which was published today!
The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research.
This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.
Free full text:

Saturday, November 19, 2016

#BreatheBoldly for World COPD Day 2016!

Respiratory Decade is supporting #BreatheBoldly campaign for increasing awareness for COPD!
We challenge you to post a straw selfie on social media to raise awareness and show empathy for the 300 million people with #COPD, because sadly, COPD can feel like breathing through a straw. So, #BreatheBoldly, because even with COPD, there’s always a way to make life better. For more information visit:

Thursday, November 17, 2016

New Global Strategy for Diagnosis, Management, and Prevention of COPD - 2017 Update (free full text link)

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease. the development of evidence-based strategy documents for COPD management, and events such as the annual celebration of World COPD Day, GOLD is working to improve the lives of people with COPD in every corner of the globe.
The GOLD report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems.  GOLD has been fortunate to have a network of international distinguished health professionals from multiple disciplines. Many of these experts have initiated investigations of the causes and prevalence of COPD in their countries, and have developed innovative approaches for the dissemination and implementation of the GOLD management strategy. The GOLD initiative will continue to work with National Leaders and other interested health care professionals to bring COPD to the attention of governments, public health officials, health care workers, and the general public to raise awareness of the burden of COPD and to develop programs for early detection, prevention and approaches to management. 
Full text:

Wednesday, November 16, 2016

World COPD Day 2016: COPD on the rise, but still underrated from BioMed Central’s blog network

To mark World COPD Day 2016 we invited Dr. Alexandru Corlateanu to give us a background on chronic obstructive pulmonary disease and how it can be managed. He also tells us about World COPD Day and what its aims are. It also has been highlighted on COPD Research and Practice website!

Read full text blog post:

Monday, November 14, 2016

World COPD Day 2016 in Italy

Dear Respiratory Friends!
We are happy to present you Great event dedicated to World COPD Day 2016 organized by World known Italian experts of COPD in Modena at 16 November 2016!
Read more:

Sunday, November 13, 2016

Severe asthma: anti-IgE or anti-IL-5? (full text article from European Clinical Respiratory Journal 2016)

Dear friends please read interesting article: Severe asthma: anti-IgE or anti-IL-5? from European Clinical Respiratory Journal 2016!
Severe asthma is a discrete clinical entity characterised by recurrent exacerbations, reduced quality of life and poor asthma control as ordinary treatment regimens remain inadequate. Difficulty in managing severe asthma derives partly from the multiple existing phenotypes and our inability to recognise them. Though the exact pathogenetic pathway of severe allergic asthma remains unclear, it is known that numerous inflammatory cells and cytokines are involved, and eosinophils represent a key inflammatory cell mediator. Anti-IgE (omalizumab) and anti-IL-5 (mepolizumab) antibodies are biological agents that interfere in different steps of the Th2 inflammatory cascade and are licensed in severe asthma.
Both exhibit a favourable clinical outcome as they reduce exacerbation rate and improve asthma control and quality of life, while mepolizumab also induces an oral steroid sparing effect. Nevertheless, it is still questionable which agent is more suitable in the management of severe allergic asthma since no comparable studies have been conducted. Omalizumab’s established effectiveness in clinical practice over a long period is complemented by a beneficial effect on airway remodelling process mediated mainly through its impact on eosinophils and other parameters strongly related to eosinophilic inflammation. However, it is possible that mepolizumab through nearly depleting eosinophils could have a similar effect on airway remodelling. Moreover, to date, markers indicative of the patient population responding to each treatment are unavailable although baseline eosinophils and exacerbation rate in the previous year demonstrate a predictive value regarding anti-IL-5 therapy effectiveness. On the other hand, a better therapeutic response for omalizumab has been observed when low forced expiratory volume in 1 sec, high-dose inhaled corticosteroids and increased IgE concentrations are present. Consequently, conclusions are not yet safe to be drawn based on existing knowledge, and additional research is necessary to unravel the remaining issues for the severe asthmatic population.
Read more:

Thursday, October 27, 2016

Tuberculosis in 2016 (free full text review from Nature Reviews Disease Primers)

New disease Primer provides a comprehensive overview of TB epidemiology, prevention, diagnosis and treatment – just published and open access for 30 days. This comprehensive Primer puts into context the current clinical and translational challenges in tackling TB globally and reviews the latest advances in the science of TB, which may lead to better tools and help us meet End TB targets.
Tuberculosis (TB) is an airborne infectious disease caused by organisms of the Mycobacterium tuberculosis complex. Although primarily a pulmonary pathogen, M. tuberculosis can cause disease in almost any part of the body. Infection with M. tuberculosis can evolve from containment in the host, in which the bacteria are isolated within granulomas (latent TB infection), to a contagious state, in which the patient will show symptoms that can include cough, fever, night sweats and weight loss. Only active pulmonary TB is contagious. In many low-income and middle-income countries, TB continues to be a major cause of morbidity and mortality, and drug-resistant TB is a major concern in many settings. Although several new TB diagnostics have been developed, including rapid molecular tests, there is a need for simpler point-of-care tests. Treatment usually requires a prolonged course of multiple antimicrobials, stimulating efforts to develop shorter drug regimens. Although the Bacillus Calmette–Guérin (BCG) vaccine is used worldwide, mainly to prevent life-threatening TB in infants and young children, it has been ineffective in controlling the global TB epidemic. Thus, efforts are underway to develop newer vaccines with improved efficacy. New tools as well as improved programme implementation and financing are necessary to end the global TB epidemic by 2035.
Read more:

Sunday, October 23, 2016

The Health Effects of Electronic Cigarettes (2016 free full text article from NEJM)

Electronic cigarettes (e-cigarettes), also known as electronic nicotine-delivery systems, are devices that produce an aerosol by heating a liquid that contains a solvent (vegetable glycerin, propylene glycol, or a mixture of these), one or more flavorings, and nicotine, although the nicotine may be omitted. The evaporation of the liquid at the heating element is followed by rapid cooling to form an aerosol. This process is fundamentally different from the combustion of tobacco, and consequently the composition of the aerosol from e-cigarettes and the smoke from tobacco is quite different. E-cigarette aerosol is directly inhaled (or “vaped”) by the user through a mouthpiece. Each device includes a battery, a reservoir that contains the liquid, and a vaporization chamber with heating element . The design of the e-cigarette was originally based on the design of conventional cigarettes but has since evolved, with later-generation devices permitting users to refill a single device with different liquids and to customize the heating element.
It is clear that the use of e-cigarettes has biologic effects and possibly health-related effects on persons who do not smoke conventional tobacco products. Although some studies suggest that smoking e-cigarettes may be less dangerous than smoking conventional cigarettes, more needs to be learned. A particular challenge in this regard is the striking diversity of the flavorings in e-cigarette liquids, since the effects on health of the aerosol constituents produced by these flavorings are unknown. At present, it is impossible to reach a consensus on the safety of e-cigarettes except perhaps to say that they may be safer than conventional cigarettes but are also likely to pose risks to health that are not present when neither product is used. Epidemiologic data indicate that e-cigarette use is growing among minors and young adults and may promote nicotine addiction in these age groups among those who would otherwise have been nonsmokers. More research is needed to understand the effectiveness of e-cigarettes as a smoking-cessation tool, to identify the health risks of e-cigarette use, and to make these products as safe as possible. Even as this research is under way, regulations that make e-cigarettes unavailable to children is warranted, as are public health initiatives that discourage nonsmokers from smoking conventional cigarettes or using e-cigarettes.
Read more:

Saturday, October 22, 2016

Current Controversies in the Pharmacological Treatment of Chronic Obstructive Pulmonary Disease (article from Blue Journal 2016)

Clinical phenotyping is currently used to guide pharmacological treatment decisions in chronic obstructive pulmonary disease (COPD), a personalized approach to care. Precision medicine integrates biological (endotype) and clinical (phenotype) information for a more individualized approach to pharmacotherapy, to maximize the benefit versus risk ratio. Biomarkers can be used to identify endotypes. To evolve toward precision medicine in COPD, the most appropriate biomarkers and clinical characteristics that reliably predict treatment responses need to be identified.
FEV1 is a marker of COPD severity and has historically been used to guide pharmacotherapy choices. However, we now understand that the trajectory of FEV1 change, as an indicator of disease activity, is more important than a single FEV1 measurement. There is a need to develop biomarkers of disease activity to enable a more targeted and individualized approach to pharmacotherapy. Recent clinical trials testing commonly used COPD treatments have provided new information that is likely to influence pharmacological treatment decisions both at initial presentation and at follow up. In this Perspective, we consider the impact of recent clinical trials on current COPD treatment recommendations. We also focus on the movement toward precision medicine and propose how this field needs to evolve in terms of using clinical characteristics and biomarkers to identify the most appropriate patients for a given pharmacological treatment.
Read More: 

Friday, October 21, 2016

Exercise-Induced Pulmonary Edema in Athletes (article from 2016 Current Respiratory Medicine Reviews)

Dear Respiratory friends we are happy to present you our fresh article from Current Respiratory Medicine Reviews on Exercise-Induced Pulmonary Edema in Athletes!
Several pulmonary conditions were proven to be fatal in athletes. One of these conditions is pulmonary edema in athletes which requires differential diagnosis and often management in the ICU.
Pulmonary edema in athletes can develop due to different sport activities including swimming, diving, running, cycling, mountain biking and the etiology and pathophysiology of these conditions may be different. This underlines the importance of pulmonary medicine specialist in the management of acute disease in athletes. The review focuses on pulmonary edema in athletes who participate in aquatic activities, running, cycling and mountain biking.

Friday, September 23, 2016

Chronic Respiratory Symptoms with Normal Spirometry: A Reliable Clinical Entity? (Blue journal 2016)

Dear friends we are happy to present you new interesting review on new clinical entity: chronic respiratory symptoms in persons with normal spirometry!
The 2001 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report defined five stages of spirometric severity (post-bronchodilator FEV1/FVC≥0.7): 0, and 1 (mild) to 4 (very severe). GOLD Stage 0 was defined by chronic cough and sputum production or chronic mucus hypersecretion (CMH) alone with preserved FEV1/FVC. Subsequently, GOLD 0 was discarded as further evidence of COPD development in subjects with GOLD 0 was not more likely to develop.
When expanding symptomatic burden in GOLD 0 to include other chronic respiratory symptoms, such as dyspnea, wheeze, poor quality of life, limited physical activity, and ‘COPD exacerbations-like’ events needing health resources, symptomatic smokers with normal FEV1 resulted in larger risk of death. We review the evidence supporting a relationship between an increased symptom burden, long-term FEV1 decline and development of COPD. We also address the evidence for the presence of respiratory symptoms with normal FEV1 in smokers as a potential clinical entity. This subset of symptomatic patients encompasses a compelling category of smokers with normal spirometry but increased risk for poor outcomes. What exactly these symptomatic patients with intact FEV1 represent remains unclear. Whether they exemplify smoking-induced just a broadening of respiratory abnormalities or a distinct clinical entity that precedes the development of COPD or both remains unknown. Other aims, such as providing information on pathogenesis and future areas of research, are just as vital. What ultimately prevails however is the importance of the public health message to the frightening presence of chronic respiratory symptoms in the whole population.
Read More: 

Wednesday, September 21, 2016

Asthma 2016 Guidelines: The 2016 update by the British Thoracic Society (free full text)

Today was published an important update to British Thoracic Society guidance on the management of asthma!
Diagnosing asthma
The guideline, produced jointly by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) emphasises that there is still no single test that can definitively diagnose asthma and an individual’s asthma status can change over time.
It recommends that if a health professional suspects asthma, they should undertake a ‘structured clinical assessment’ using a combination of patient history, examination and tests to assess the probability of asthma. 
The history should include a review of the following:
  • Symptoms of cough, breathlessness, wheeze and chest tightness that have varied over time
  • Any history of recurrent attacks of symptoms
  • Any wheeze previously recorded by a health professional
  • A personal or family history of allergic conditions such as eczema and allergic rhinitis
  • Objective evidence of variability over time in obstruction to a patient’s airflow (using the results of lung function tests)
  • The absence of any pointers to an alternative diagnosis to asthma.
Quality assured spirometry is spotlighted as the key frontline breathing test to be performed in most situations with adults and children over 5 years of age.  It is important that spirometry is quality assured i.e. professionals are trained and experienced in preparing and delivering the test as well as analysing the results.
If the test shows obstruction to the patient’s airflow which reverses with treatment, this strongly supports a diagnosis of asthma.
But a normal spirometry result does not always exclude an asthma diagnosis – especially if a patient has no symptoms at the time. It may be necessary for healthcare professionals to repeat spirometry when a patient has symptoms, and/or use different breathing tests - and observe over time.
One, often secondary, breathing test that can be carried out, involves measuring an individual’s fractional exhaled nitric oxide (FeNO) - a gas found in slightly higher levels in people with asthma. An increase suggests inflammation of the airways, and supports, but doesn’t prove, a diagnosis of asthma.
The guideline helps health professionals to assign patients into 3 groups based on the probability they have asthma; either high, intermediate or low.  It then summarises the key treatment and management actions to be taken for each group.
If the probability of asthma is high, health professionals should start a carefully monitored trial of treatment. If patients respond well, according to lung function tests or symptom questionnaires, this will confirm the diagnosis.   Health professionals should code their records as ‘suspected asthma’ until a diagnosis is confirmed and should make a clear record on what basis the diagnosis was confirmed. If the probability is low, further tests or immediate referral to a lung specialist may be appropriate.
Treating asthma
The updated guideline also includes new or revised content in the following areas: asthma drug treatment (replacing the previous stepwise approach), non-drug treatments, supported self-management, and the role of telehealthcare.
Key highlights include: 
  • Short acting beta2 agonists - a group of drugs that can provide quick relief of asthma symptoms - are the key ‘rescue therapy’ from symptoms or asthma attacks and can form part of all treatment plans, but should rarely be used on their own
  • A key emphasis on medication to prevent future asthma attacks - inhaled corticosteroids remain the most effective ‘preventer’ drug for all adults and children
  • Asthma inhalers should not be prescribed generically to avoid patients being given an unfamiliar device that they may not know how to use properly
  • If a patient has poor control of their asthma, it is essential to check whether they are using their current drug treatment correctly and regularly, before stepping up treatment
  • Weight loss initiatives – including dietary and exercise programmes – can be offered for overweight or obese adults and children with asthma and may improve their asthma control 
  • Each patient should be offered a written asthma action plan as it is key to the effective management of their asthma
  • The use of new electronic technologies can help in the delivery of asthma care, and evidence shows they can be at least as good as traditional methods, although outcomes do vary
Approaches include; games to encourage children to take their medication, remote consultations, automated treatment reminders, and computerised decision-support systems for health professionals. The guideline says they can be considered according to local need
  • Women with asthma who are pregnant should be informed of the importance of continuing their asthma medication during pregnancy for the health of both mother and baby
Dr John White, British Thoracic Society member and Consultant Respiratory Physician, York NHS Foundation Trust, who co-chaired the group that delivered the updated BTS/SIGN Guideline, said:
‘Asthma is a complex disease and symptoms can vary over time.  In addition, evidence shows there’s still no single ‘magic bullet test’ for asthma. This all means that diagnosis isn’t always easy.
This update should be really valuable as it gives healthcare professionals an evidence-based but highly practical approach to suspecting and confirming a diagnosis of asthma, as well as giving the latest guidance on the most appropriate treatments and interventions to combat the disease.  
The guideline also reinforces previous messages that remain vital in the battle against asthma. It is critical, for example, that everyone with the condition is offered a written personalised action plan and review, and that inhalers are only prescribed after patients have received training in using them and demonstrate adequate technique.
We do hope that health, social care and education professionals can work together with people with asthma in using these guidelines to provide the best care possible.’   
SIGN is part of Healthcare Improvement Scotland.
Sara Twaddle, Director of Evidence for Healthcare Improvement Scotland, said:
“Over 5 million people are currently being treated for asthma in the UK and 1,468 people died from asthma attacks in the UK in 2015 – the highest level for 10 years. It’s important that we diagnose and treat people to the best of our ability, hence the reason we update this guideline for clinicians every two years using the most up-to-date evidence. This new updated guideline underlines that there is still no single diagnostic test for asthma, and emphasises the importance of preventive therapy. We urge clinicians across the UK to refer to this guideline for diagnosis and treatment. By doing so, they will help to improve the care that people with asthma receive.”
The BTS/SIGN asthma guideline is a ‘living guideline’ updated biennially.  Following a scoping exercise, key sections are selected for updating based on availability of new evidence. 
Free full text:

Monday, September 19, 2016

Effects of omalizumab in severe asthmatics across ages: A real life Italian experience (article from Respiratory Medicine 2016)

Dear friends, read new article from last issue of Respiratory Medicine on effects of Omalizumab in asthmatics!


This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting.


105 consecutive severe asthmatics (GINA step 4–5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18–39, 40–64 and ≥ 65 years.


Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049).
After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40–64 (OR = 0.284 [CI95% = 0.098–0.826], p = 0.021) and 18–39 (OR = 0.133 [CI95% = 0.026–0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (β = −1.070; p = 0.046) passing from each age class was observed.


Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.

Friday, September 16, 2016

Predicting Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease: The Impact of Age (article from Respiration)

Dear Friends, we are happy to present you our new article published online yesterday in Respiration!
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity in the elderly population. COPD leads to a reduced health-related quality of life (HRQL), but the factors which contribute to this are not well understood. A better understanding of the factors which determine HRQL should lead to an improved care for such patients. Objectives: The purpose of this study was to investigate possible age-related differences in HRQL in a population of patients with a similar severity of obstruction.
Methods: A total of 180 consecutive COPD patients were enrolled into the study. We analyzed spirometric data, BODE index and its components, and comorbidities were assessed by the Charlson index. HRQL was assessed by the Clinical COPD Questionnaire (CCQ) and St. George's Respiratory Questionnaire (SGRQ). Results: The cohort consisted of 93 ‘younger' patients (mean age 54.8 ± 3.1 years) and 87 older patients (mean age 73.1 ± 5.5 years). Patients in both groups had a similar severity of obstruction: FEV1 (% from predicted) was 39.9 ± 13.2% in the elderly group compared to 41.7 ± 11.7% in the younger group (p > 0.05). The forward stepwise regression analysis shows that the BODE index, the Charlson index, and the rate of exacerbations are important predictors of deterioration of HRQL in elderly COPD patients, which explains 29% of the total SGRQ score. In the younger COPD patients, the coefficient of determination R2 was 0.27, but the predictors were the BODE index and the rate of exacerbations. Conclusions: The BODE index, the Charlson index, and the rate of exacerbations were found to be the major determinants of HRQL in elderly COPD patients, while in younger COPD patients, the BODE index and the rate of exacerbations were influential factors.
Full text:

Sunday, September 11, 2016

Tiotropium formulations and safety: a network meta-analysis (paper from Therapeutic Advances in Drug Safety)

Dear friends, its new paper on safety of tiotropium from Therapeutic Advances in Drug Safety by great Italian team!
Tiotropium is now delivered via two different inhaler devices: the original Handihaler 18 μg once daily, which uses a powder formulation; and the newer Respimat Soft Mist Inhaler (SMI) 5 μg once daily. It has been questioned whether the two devices can be assumed to have the same safety profile, although the TIOSPIR trial showed that tiotropium when administered via Respimat SMI 5 μg is not less safe than Handihaler 18 μg. Therefore, we have carried out a safety evaluation of tiotropium Handihaler 18 µg versus tiotropium Respimat SMI 5 µg and 2.5 µg, via systematic review and network meta-analysis of the currently available clinical evidence. The results of our meta-analysis with an extremely large number of patients analysed demonstrate that the safety profile of tiotropium HandiHaler is generally superior to that of tiotropium Respimat SMI, although no statistical difference was detected between these two devices. However, the SUCRA analysis favoured tiotropium Respimat SMI with regards to serious adverse events (AEs). We do not believe that using Respimat SMI rather that HandiHaler exposes patients to higher risks of real AEs.
Rather, we believe that there may be a different cardiovascular (CV) response to muscarinic receptors blockage in individual patients. Therefore, it will be essential to make all possible efforts to proactively identify patients at increased risk of CV AEs when treated with tiotropium or another antimuscarinic drug. 
Full text:

Friday, August 26, 2016

Therapeutic Monoclonal Antibodies for the Treatment of COPD (article from Drugs)

Dear friends we are happy to present you new article by world known experts in Respiratory Medicine Maria Gabriella Matera, Clive Page, Paola Rogliani, Luigino Calzetta, : Therapeutic Monoclonal Antibodies for the Treatment of COPD (article from last issue of Drugs journal)!  acebook.1.SEM.ArticleAuthorAssignedToIssue
Chronic obstructive pulmonary disease (COPD) is a disorder characterized by a complex chronic inflammatory response that is largely poorly responsive to treatment with corticosteroids. Consequently, there is a huge need to find effective anti-inflammatory agents for the treatment of patients with this disease. Inhibition of cytokines and chemokines or their receptors using monoclonal antibodies (mAbs) could be a potential strategy to treat the inflammatory component of COPD. In this article, we review the therapeutic potential of some of these mAbs; however, to date there has been little or no therapeutic effect of any mAb directed against cytokines or chemokines in patients with COPD. This may reflect the complexity of COPD in which there is no dominant role for any single cytokine or chemokine. It is also likely that since the umbrella term COPD covers many endotypes having different underlying mechanisms, mAbs directed towards specific cytokines or chemokines should be tested in restricted and focused populations.
Full text:

Pleural Mesothelioma: Cancer of the Lining of the Lungs (Guest post by Katherine Keys)

Mesothelioma is a type of cancer that affects the mesothelium, a tissue that lines most of the body’s organs. The most common type is pleural mesothelioma, cancer of the pleura or lining of the lungs. This cancer is aggressive, takes years to develop into recognizable symptoms, and is often diagnosed only after it is too late to expect treatment to cure it. For most people, this terrible illness is a death sentence.
Causes and Risk Factors
Doctors and researchers cannot pinpoint an exact cause of mesothelioma, which is not a common type of cancer. It is likely an interaction of several factors that leads to the development of malignant tumors. These include genetics, environmental factors, lifestyle, and health. While the cause cannot be made definite, there is one huge risk factor for mesothelioma that stands apart from all others: asbestos exposure.
Asbestos is a natural mineral that has been used for hundreds of years in a number of applications from insulation to shipbuilding to car brakes. It has been used for so long and in so many different ways because it is very strong and resistant to heat. Because asbestos is fibrous, when it is broken apart, particles get in the air and can be inhaled.
It is this inhalation that is the number one risk factor for mesothelioma. People who worked in conditions that included asbestos fibers and inadequate safety gear are at serious risk for the cancer. It can take 20 years and more for the cancer to develop and show symptoms and too many people are surprised later in life with this terrible diagnosis.
Treatment for Mesothelioma
It is unfortunate that this type of cancer is so aggressive and often gets diagnosed in later stages; many people don’t survive and treatments may only extend a patients’ life a little longer. Still, many opt for treatments to live longer and to be more comfortable.Treatment options for pleural mesothelioma include surgery to remove the cancerous tissue or even an entire lung, chemotherapy or radiation to kill cancer cells, and clinical trials with new medications and therapies, including gene therapy.
Mesothelioma and Legal Action
Many people diagnosed with mesothelioma were exposed to asbestos at work. This especially includes people who worked on ships or in construction with asbestos insulation. Most of these workers who end up with this terrible type of cancer had no idea that they were exposed to asbestos fibers or that they were at risk. They feel wronged and many want justice.
Mesothelioma lawsuits continue to rise because of these people suffering from cancer. They are working with lawyers to sue their employers, to file claims, and to seek compensation from asbestos trust funds. Their employers failed in a responsibility to provide them with a safe workplace, and now they are getting both compensation and justice for their suffering.
A Survivor’s Story
Katherine Keys is a woman who battled the odds and won. Diagnosed with pleural mesothelioma at age 49, she was given just two years to live, even though the cancer was rated as stage 1. Determined to fight and survive, Katherine underwent surgery to remove her right lung along with its pleura. She also had radiation treatment for several months.
Katherine is in remission and is now down to only annual follow ups to make sure that the cancer has not returned. Losing a lung has been difficult and she experiences pain and certain limitations, but is happy to be alive. Her story is one that brings hope to others battling this terrible type of cancer.

Sunday, August 21, 2016


Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. It can occur in patients with asthma as well in patients who were previously not diagnosed with the disease
Many studies have been performed in elite-level athletes that have documented prevalence of EIB varying between 30 and 70%, depending on the population, sport type, studied and methods implemented but no relationship were currently found regarding height, weight, age and gender. The clinical symptoms of EIB include coughing, wheezing, chest pain and dyspnoea following an exercise but can often can be absent or not noticed by the athlete. Further examination often reveals some degree of atopy. But it should be noted that self-reported symptoms are not always present and asymptomatic forms are very common. 
Highly trained athletes tend to be frequently and for a long period of time exposed to cold air during winter training, to pollen allergens in spring and summer, different chemical substances used as disinfectants in swimming pools. These factors probably explain why elite athletes so often have EIB. This condition is most commonly found in endurance sports, such as cycling, swimming, or long-distance running. The occurrences of exercise-induced bronchospasm vary from 3% to 35% and depend on testing environment, type of exercise used, and athlete population tested. Still the highest risk for developing EIB in swimmers may be even higher, being 36%-79%
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