tag:blogger.com,1999:blog-29217515461422614912024-03-12T15:03:46.600-07:00Respiratory DecadeAlexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.comBlogger512125tag:blogger.com,1999:blog-2921751546142261491.post-67135136901750927762018-11-19T08:38:00.000-08:002018-11-19T08:38:31.913-08:002018 GINA Severe Asthma Pocket Guide: Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients<div class="col span_12 dark left">
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<span style="font-size: x-large;">GINA has added an important addition to the resources that we
offer to assist practitioners treating patients with asthma. A new
Pocket Guide, “Diagnosis and Management of Difficult-to-treat and Severe
Asthma in adolescent and adult patients” is now available on the GINA
website, <a href="http://www.ginasthma.org/">www.ginasthma.org</a>. Embracing the issue of severe asthma was a
critical goal for the GINA Board of Directors and Science Committee, as
their mission remains focused on maximizing benefit for patients with
asthma whilst minimizing healthcare provider burden.</span></div>
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<a href="https://ginasthma.org/wp-content/uploads/2018/11/GINA-SA-FINAL-wms.pdf" target="_blank"><img alt="https://ginasthma.org/wp-content/uploads/2018/11/GINA-SA-FINAL-wms.pdf" border="0" data-original-height="740" data-original-width="470" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwj1N5rxJUZqigcuLLyYS6CwPPjVNxdQ-q-JryID856ZhA-Yq0_7RlyIA7wx8oNDRLHMreJ8XKq1pV6Y6nNGmN_cAsGmuOmKZB56yjULMpeRUgW2_a-auhlR-nrme3Fk817vWB8L-bigY/s1600/gina.jpg" /></a></div>
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<span style="font-size: x-large;">Prof. Helen Reddel, Chair of the GINA Science Committee and a
research leader at the Woolcock Institute of Medical Research in Sydney,
Australia, stated “Difficult-to-treat and severe asthma are high
priority issues because of the physical, emotional and financial burden
for patients and their families, and the impact on primary and
specialist healthcare systems. Clinicians in both low and high income
countries need practical advice about how to assess and treat patients
for whom conventional asthma therapies don’t seem to be working, and
about how treatment strategies, including biologic therapies if
available, can be implemented into patient care.”</span><br />
<span style="font-size: x-large;">The need for a practical resource addressing severe asthma was made
apparent to the GINA Science Committee and Board of Directors from
responses to a survey of members of the GINA Assembly, which is a group
of physician volunteers around the world who actively disseminate GINA
strategy in their respective countries. Two particular needs identified
were (1) at what point should a patient be referred to a specialist, and
(2) guidance for biologic therapies.</span><br />
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<span style="font-size: x-large;">THE GOALS OF THE POCKET GUIDE ARE STATED ON PAGE 4:</span></div>
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<span style="font-size: x-large;">The goal of this Pocket Guide is to provide a practical summary
for health professionals about how to identify, assess and manage
difficult-to-treat and severe asthma in adolescents and adults. It is
intended for use by general practitioners (GPs, primary care
physicians), pulmonary specialists and other health professionals
involved in the management of people with asthma.</span></div>
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<span style="font-size: x-large;">The recommendations in this Pocket Guide were based on evidence
where good quality systematic reviews or randomized controlled trials
or, lacking these, robust observational data, were available, and on
consensus by expert clinicians and researchers, where not. Development
of the Pocket Guide and decision tree included extensive collaboration
with experts in human-centered design to enhance the utility of these
resources for end-users. This means translating existing high level
lowcharts and text-based information to a more detailed visual format,
and applying information architecture and diagramming principles.</span></div>
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Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com52tag:blogger.com,1999:blog-2921751546142261491.post-52007984793350751762018-11-17T10:33:00.000-08:002018-11-17T10:33:01.211-08:002019 COPD GOLD Guidelines launched on World COPD Day<div class="separator" style="clear: both; text-align: center;">
<a href="https://goldcopd.org/gold-reports/" target="_blank"><img alt="https://goldcopd.org/gold-reports/" border="0" data-original-height="960" data-original-width="960" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFu6cI4GbhDSjxwLZGxeN4RhelRyadUjYoSDiqKm10KWIGvuYO2d7fCesi_y5PkBqjg_q8QSU-qW0zqPipTZyUQ4_uZr-PJRGROhHy_d9GK2X0moni-z-EqlhLA-6cD6eOJtx4FGaZ0G4/s640/45467649_1778612962248082_1012374871713251328_n.jpg" width="640" /></a></div>
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<i><span style="font-size: x-large;"><span>World COPD Day is organized by the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) in collaboration with health care
professionals and COPD patient groups throughout the world. <br />Its aim is to raise awareness about chronic obstructive pulmonary disease (COPD) and improve COPD care throughout the world.<br />Please join us in showing your support online using <a href="https://www.facebook.com/hashtag/worldcopdday" target="_blank">#WorldCOPDDay</a> and <a href="https://www.facebook.com/hashtag/copdday" target="_blank">#COPDDay</a> to shed light on critical issues surrounding COPD and lung health.</span></span></i> </div>
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<b><span style="font-size: x-large;">2019 GOLD Reports are available now on official website: </span></b></div>
<div style="text-align: justify;">
<b><span style="font-size: x-large;"><a data-ft="{"tn":"-U"}" data-lynx-mode="async" data-lynx-uri="https://l.facebook.com/l.php?u=https%3A%2F%2Fgoldcopd.org%2Fgold-reports%2F%3Ffbclid%3DIwAR2WetXL_6uF31HK4THVQogRd9koGlQM1aOEvMsd5P5jY6sI1zm0br2_fzQ&h=AT19HG4lBhuH15L1EDZ_J1ii9i300G___uWPmvxiC5ZzeXg3qswuE75yPkzSnla-_uCko6ldAXeKSBBB1HwKGqrFYKSxIp7b2kAGZ21CDWJWZ6Qr8A3Ig28UP0x3IVv3PbTC0ZbmMvUg_kgejvmtKaGZpmepK60ddSYUd4WYRnmGXoTWU530i-jMPN4C9g6Oiy70PJ_H6fBwTfy9ehVSuBdSby9WujUXi5N5H0hCVs0UKXLsjQw76U6wUpTUVJw9xHLHwJgHGvoGVMt_DkYzav-8ldHFEKS81cpMPeAjfORgRujot4yIanvONVu6_1qPi5nxkVZtQwEr6yPLSJ064rcoWTrs3Ck2_KnlJprKeEYX66b3T3693451uFEliSr6xX4kxVenAG-Us7oeMi9v1zNnLef2y27YcOc4awRS4c2wdvn5QzCb0Ta39ruOfGQP4qvjhZGZGtXRt6OSbEGVXThkTzArM1F_7PB2PF2o2hqikbMM8zMO2kbzS9y91NIhWlYoXKUKwCh-iPwnIcsueByKs2c5RYG7tH1h_4tmZAPAz2l450rZc1t9TRfuITf5ejYuaHhg4cEF5bUxFVTlOb97FIz4Fu1iSTvTyJi7RzhXP2tBS66Y06cDZD0sP1m-" href="https://goldcopd.org/gold-reports/?fbclid=IwAR2WetXL_6uF31HK4THVQogRd9koGlQM1aOEvMsd5P5jY6sI1zm0br2_fzQ" rel="noopener nofollow" target="_blank">https://goldcopd.org/gold-reports/</a></span></b></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com359tag:blogger.com,1999:blog-2921751546142261491.post-42912800683188859052018-05-11T23:23:00.001-07:002018-05-11T23:23:31.012-07:00Chronic Obstructive Pulmonary Disease and Stroke (Free full text from Journal of COPD 2018)<div style="text-align: justify;">
<span style="font-size: x-large;">Chronic obstructive pulmonary disease (COPD) is currently the fourth
leading cause of death in the world and its incidence and prevalence is
on the rise. It is evident that COPD is linked to cardiovascular
disease. In the last years, several studies demonstrated that COPD may
also be a risk factor for stroke, another major cause of death
worldwide. </span></div>
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<a href="https://www.tandfonline.com/eprint/pRdiFwmv3BetmbMjk7zQ/full" target="_blank"><img alt="https://www.tandfonline.com/eprint/pRdiFwmv3BetmbMjk7zQ/full" border="0" data-original-height="622" data-original-width="1455" height="272" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiyVY0Jp7HLl5YhHP1eZPD61pJqSBkLLMvTOLcSCzk8mJDZCRUOpEKn1cfGQnl8wUG_-Z9z3Y66gCfn1BdeWfkVDrSktwkJzz1lwQC4tAmRFcilZpOqzz-v1d23QsimFn6irX5oy7WK-M/s640/sostroke.jpg" width="640" /></a></div>
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<span style="font-size: x-large;">Taking in consideration that COPD has multiple comorbidities
it is hard to say whether COPD is an independent risk factor for stroke
or it is due to confounding effect. This review is aimed to discuss
current data on COPD and stroke, potential links, therapy, and
prevention. Current data suggest that COPD may increase the risk of
hemorrhagic stroke. The incidence of other stroke subtypes may also be
increased in COPD or may be due to confounding effect. However, COPD
patients who have stroke are at risk for pulmonary and extrapulmonary
complications. We conclude that more studies are needed to further
clarify the links between COPD and stroke. The management of COPD as
well as the use of prevention therapy is essential to decrease the risk
for stroke and should be at special attention in pulmonary medicine and
neurology.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">First </span><span style="font-size: x-large;">50 free online copies: </span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="https://www.tandfonline.com/eprint/pRdiFwmv3BetmbMjk7zQ/full">https://www.tandfonline.com/eprint/pRdiFwmv3BetmbMjk7zQ/full</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com14tag:blogger.com,1999:blog-2921751546142261491.post-81356057170752294052018-05-01T02:02:00.000-07:002018-05-01T02:02:16.507-07:002018 Update of Asthma Guidelines launched on World Asthma Day 2018<div style="text-align: justify;">
<b><span style="font-size: x-large;">Today marks the 20th annual <a class="twitter-hashtag pretty-link js-nav" data-query-source="hashtag_click" dir="ltr" href="https://twitter.com/hashtag/WorldAsthmaDay?src=hash"><s>#</s><b>WorldAsthmaDay</b></a>! </span></b></div>
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<b><span style="font-size: x-large;">The 2018 update of the <em><a href="http://ginasthma.org/" target="_blank">Global Strategy for Asthma Management and Prevention</a> </em>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.</span></b></div>
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<a href="http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/" target="_blank"><img alt="http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/" border="0" data-original-height="572" data-original-width="762" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEPbu84u3gaj8L21tHtywIRaLUmrIPr2eg4ey_61VV-CKNhr2O8HSEgAchRvDRoRRaJr6ZnRYfbBARSqLBqOcDAgetDF1mhGTs4S3Xl2zEexl0sffjiEjL9_s02Zw5-sLEd32Dbw1aBxw/s640/DcGTtaNW0AAyz55.jpg+large.jpg" width="640" /></a></div>
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Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com16tag:blogger.com,1999:blog-2921751546142261491.post-45672220184145220022018-04-28T08:46:00.000-07:002018-04-28T08:46:43.029-07:00Evidence-Based Inhaler Therapy for COPD in 2018<div style="text-align: left;">
<b><span style="font-size: x-large;">See the winner of the 2018 Best of ATS Video Lecture Series: Penn PET Project: Evidence-Based Inhaler Therapy for #COPD
</span></b><iframe allowfullscreen="true" allowtransparency="true" frameborder="0" height="315" scrolling="no" src="https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FRespiratoryDecade%2Fvideos%2F1667615623304030%2F&show_text=0&width=660" style="border: none; overflow: hidden;" width="660"></iframe></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com3tag:blogger.com,1999:blog-2921751546142261491.post-74682764408733050262018-04-21T11:08:00.001-07:002018-04-21T11:08:22.570-07:00Triple versus Dual Inhaler Therapy in Patients with COPD - IMPACT Trial can change COPD Guidelines in 2019<div style="text-align: justify;">
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<i><b><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">The Informing the Pathway of COPD Treatment (IMPACT) trial, now reported in the <a href="http://www.nejm.org/" target="_blank">The New England Journal of Medicine</a>,
aims to fill this gap with a report on the effectiveness of
LAMA–LABA–inhaled glucocorticoid treatment, contained in a single
inhaler, in COPD. </span></b></i></div>
<b><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"></span></b></div>
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<b><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">Background</span></b></div>
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<span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">The benefits
of triple therapy for chronic obstructive pulmonary disease (COPD) with an
inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a
long-acting </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">β</span><sub><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">2</span></sub><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">-agonist
(LABA), as compared with dual therapy (either inhaled glucocorticoid–LABA or
LAMA–LABA), are uncertain.</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"></span></div>
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<b><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">Methods</span></b></div>
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<span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">In this
randomized trial involving 10,355 patients with COPD, we compared 52 weeks of a
once-daily combination of fluticasone furoate (an inhaled glucocorticoid) at a
dose of 100 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g, umeclidinium (a LAMA) at a dose of 62.5 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g, and vilanterol (a LABA) at
a dose of 25 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g (triple therapy) with fluticasone furoate–vilanterol (at doses of 100 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g and 25 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g,
respectively) and umeclidinium–vilanterol (at doses of 62.5 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g and 25 </span><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">μ</span><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">g,
respectively). Each regimen was administered in a single Ellipta inhaler. The
primary outcome was the annual rate of moderate or severe COPD exacerbations
during treatment.</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"></span></div>
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<a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1713901" target="_blank"><img alt="http://www.nejm.org/doi/full/10.1056/NEJMoa1713901" border="0" data-original-height="500" data-original-width="759" height="419" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpcD-YmSEtszH3di4P-bIzvlq38EedQXnB_e7p0J8LGsaX8kDydU3asxKg4O7sYT97PTEkzOu4VdyHirnrFGUyfue0q3aTATE9Wx6d1zE-wGYtTvXT3T6fW7DwyILRXq_QOAnuWu5Xw44/s640/iStock_37954576_LARGE-759x500.jpg" width="640" /></a></div>
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<b><span style="font-size: 18.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">Results</span></b></div>
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<span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">The rate of
moderate or severe exacerbations in the triple-therapy group was 0.91 per year,
as compared with 1.07 per year in the fluticasone furoate–vilanterol group
(rate ratio with triple therapy, 0.85; 95% confidence interval [CI], 0.80 to
0.90; 15% difference; P<0.001) and 1.21 per year in the
umeclidinium–vilanterol group (rate ratio with triple therapy, 0.75; 95% CI,
0.70 to 0.81; 25% difference; P<0.001). The annual rate of severe
exacerbations resulting in hospitalization in the triple-therapy group was
0.13, as compared with 0.19 in the umeclidinium–vilanterol group (rate ratio,
0.66; 95% CI, 0.56 to 0.78; 34% difference; P<0.001). There was a higher
incidence of pneumonia in the inhaled-glucocorticoid groups than in the
umeclidinium–vilanterol group, and the risk of clinician-diagnosed pneumonia
was significantly higher with triple therapy than with umeclidinium–vilanterol,
as assessed in a time-to-first-event analysis (hazard ratio, 1.53; 95% CI, 1.22
to 1.92; P<0.001).</span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"></span></div>
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<b><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">Conclusions</span></b></div>
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<span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">Triple
therapy with fluticasone furoate, umeclidinium, and vilanterol resulted in a
lower rate of moderate or severe COPD exacerbations than fluticasone
furoate–vilanterol or umeclidinium–vilanterol in this population. Triple
therapy also resulted in a lower rate of hospitalization due to COPD than
umeclidinium–vilanterol.</span></div>
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<b><span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;">full text:</span></b></div>
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<span lang="EN-US" style="font-size: 18.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"><a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1713901">http://www.nejm.org/doi/full/10.1056/NEJMoa1713901</a> </span><span lang="EN-US" style="mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: RU;"></span></div>
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<![endif]-->Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com9tag:blogger.com,1999:blog-2921751546142261491.post-55773854077197043622018-04-15T02:01:00.000-07:002018-04-15T02:01:35.835-07:00Higher cigarette prices would help millions avoid poor health and extreme poverty<div class="subsection" id="sec-1" style="text-align: justify;">
<div id="p-2">
<span style="font-size: x-large;"><b><span style="font-size: medium;">According to a study published in the these days in BMJ, a significant increase
in </span><span style="font-size: medium;">prices of </span></b><span style="font-size: medium;"><b>cigarette would aid millions of people at the global level to avoid
poor health and extreme poverty.</b></span></span><br />
<span style="font-size: x-large;"><b>Objective</b> To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection.</span></div>
</div>
<div class="subsection" id="sec-2" style="text-align: justify;">
<div id="p-3">
<span style="font-size: x-large;"><b>Design</b> Compartmental model study.</span></div>
</div>
<div class="subsection" id="sec-3" style="text-align: justify;">
<div id="p-4">
<span style="font-size: x-large;"><b>Setting</b> 13 middle income countries, totalling two billion men.</span></div>
</div>
<div class="subsection" id="sec-4" style="text-align: justify;">
<div id="p-5">
<span style="font-size: x-large;"><b>Participants</b> 500 million male smokers.</span></div>
</div>
<div class="subsection" id="sec-5" style="text-align: justify;">
<div id="p-6">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.bmj.com/content/361/bmj.k1162?hootPostID=51c0bc6fd1849b19ae564a28dc77dea8" target="_blank"><img alt="https://www.bmj.com/content/361/bmj.k1162?hootPostID=51c0bc6fd1849b19ae564a28dc77dea8" border="0" data-original-height="760" data-original-width="1140" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSbcHsKtJ6GrpfZT_v0uIx2ajRbbYjkltJmAoZvc-Mdk4hQSP_8mB5DN9Vsnc1GW8VxdMphuN4rDi5SHBKYJrw5ltvI1uP4RenRmF62iwOS-bwqrva6tDQwcPr4RS2Cb81JekEpbESLWQ/s640/2018-04-12-cigarette.jpg" width="640" /></a></div>
</div>
<div id="p-6">
<span style="font-size: x-large;"><b>Main outcome measures</b>
Life years gained, averted treatment costs, number of men avoiding
catastrophic healthcare expenditures and poverty, and additional tax
revenue by income group.</span></div>
</div>
<div class="subsection" id="sec-6" style="text-align: justify;">
<div id="p-7">
<span style="font-size: x-large;"><b>Results</b>
A 50% increase in cigarette prices would lead to about 450 million
years of life gained across the 13 countries from smoking cessation,
with half of these in China. Across all countries, men in the bottom
income group (poorest 20% of the population) would gain 6.7 times more
life years than men in the top income group (richest 20% of the
population; 155 <i>v</i> 23 million). The average life years gained
from cessation for each smoker in the bottom income group was 5.1 times
that of the top group (1.46 <i>v</i> 0.23 years). Of the $157bn
(£113bn; €127bn) in averted treatment costs, the bottom income group
would avert 4.6 times more costs than the top income group ($46bn <i>v</i>
$10bn). About 15.5 million men would avoid catastrophic health
expenditures in a subset of seven countries without universal health
coverage. As result, 8.8 million men, half of them in the bottom income
group, would avoid falling below the World Bank definition of extreme
poverty. These 8.8 million men constitute 2.4% of people living in
extreme poverty in these countries. In contrast, the top income group
would pay twice as much as the bottom income group of the $122bn
additional tax collected. Overall, the bottom income group would get 31%
of the life years saved and 29% each of the averted disease costs and
averted catastrophic health expenditures, while paying only 10% of the
additional taxes.</span></div>
</div>
<div class="subsection" id="sec-7" style="text-align: justify;">
<div id="p-8">
<span style="font-size: x-large;"><b>Conclusions</b>
Higher prices of cigarettes provide more health and financial gains to
the poorest 20% than to the richest 20% of the population. Higher excise
taxes support the targets of the sustainable development goals on
non-communicable diseases and poverty, and provides financial protection
against illness.</span></div>
<div class="4" id="boxed-text-2">
<div class="subsection" id="sec-20">
<h4>
<span style="font-size: x-large;">
What is already known on this topic</span></h4>
<ul class="list-simple " id="list-9">
<li id="list-item-15"><div id="p-63">
<span style="font-size: x-large;">Higher
excise taxes on tobacco are essential to reach the sustainable
development goals to reduce mortality from non-communicable diseases by
one third by 2030</span></div>
</li>
<li id="list-item-16"><div id="p-64">
<span style="font-size: x-large;">Low income groups are more responsive to price increases than high income groups</span></div>
</li>
<li id="list-item-17"><div id="p-65">
<span style="font-size: x-large;">There are few published studies of the distributional impact of higher tobacco taxes on health and financial outcomes</span></div>
</li>
</ul>
</div>
<div class="subsection" id="sec-21">
<h4>
<span style="font-size: x-large;">
What this study adds</span></h4>
<ul class="list-simple " id="list-10">
<li id="list-item-18"><div id="p-66">
<span style="font-size: x-large;">Despite
differences in socioeconomic class and health finance arrangements a
50% increase in tobacco prices strongly favours those in the bottom
income group for life years saved, out-of-pocket expenses from tobacco
attributable treatment costs averted, and avoidance of catastrophic
health expenditures or poverty</span></div>
</li>
<li id="list-item-19"><div id="p-67">
<span style="font-size: x-large;">Higher
tobacco excise taxes are a powerful but generally underused tool by
most governments to reduce expenditures on treatment of diseases that
are a major cause of income poverty</span></div>
</li>
<li id="list-item-20"><div id="p-68">
<span style="font-size: x-large;">In
13 middle income countries studied, around 450 million life years would
be saved from higher excise taxes, contributing substantially to the
target of the sustainable development goals of a one third reduction in
mortality from non-communicable diseases at ages 30-69 by 2030</span></div>
</li>
</ul>
</div>
</div>
<div id="p-8">
<a href="https://www.bmj.com/content/361/bmj.k1162?hootPostID=51c0bc6fd1849b19ae564a28dc77dea8" target="_blank"><span style="font-size: x-large;">Full text</span></a></div>
</div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com12tag:blogger.com,1999:blog-2921751546142261491.post-38271218322806253842018-04-07T11:50:00.000-07:002018-04-07T11:50:09.676-07:00Emerging biological therapies for treating eosinophilic COPD<div id="abspara0010" style="text-align: justify;">
<i><span style="font-size: x-large;"><span>In <a href="https://www.sciencedirect.com/journal/pulmonary-pharmacology-and-therapeutics" target="_blank">Pulmonary Pharmacology & Therapeutics</a> was published</span> meta-analysis by great Italian team on hot topic Emerging biological therapies for treating chronic obstructive pulmonary disease: A pairwise and network meta-analysis.</span></i></div>
<div id="abspara0010" style="text-align: justify;">
<span style="font-size: x-large;"><span></span></span></div>
<div id="abspara0010" style="text-align: justify;">
<span style="font-size: x-large;">Inflammation in COPD is often corticosteroid resistant and, thus, alternative
anti-inflammatory approaches are needed. Since it is still not clear
whether blocking specific pro-inflammatory factors may provide clinical
benefit in COPD, we have performed a meta-analysis to quantify the
impact of monoclonal antibodies (mABs) targeting the
cytokine/chemokine-mediated inflammation in COPD.</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://www.sciencedirect.com/science/article/pii/S1094553918300579" target="_blank"><img alt="https://www.sciencedirect.com/science/article/pii/S1094553918300579" border="0" data-original-height="525" data-original-width="900" height="371" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlQBx3VzhkgGatTPCNP-j2Da-hTzrRZz8g0xx3_BH-KmZzcANqVzvOk1rRp97jY5cDGZESIWsCkGAW0syFTJL6HWLcz0TzCmE0G13l-LqhE2bB5x7kXDqqCkqWyDr69ppSY-ljRpcf0vg/s640/upfront-intro.jpg" width="640" /></a></div>
<div id="abspara0010" style="text-align: justify;">
</div>
<div id="abspara0015" style="text-align: justify;">
<span style="font-size: x-large;">A
pairwise and network meta-analyses were performed by extracting data
from randomized clinical trials on COPD concerning the impact of mABs
vs. placebo on the risk of exacerbation, forced expiratory volume in 1 s
(FEV<sub>1</sub>), and St. George's Respiratory Questionnaire (SGRQ).</span></div>
<div id="abspara0020" style="text-align: justify;">
<span style="font-size: x-large;">Data
on the interleukin (IL)-1β antagonist canakinumab, IL-1R1 antagonist
MEDI8986, IL-5 antagonist mepolizumab, IL-5R antagonist benralizumab,
IL-8 antagonist ABX-IL8, and TNF-α antagonist infliximab were found.
Overall, mAB therapy had a moderate impact on the risk exacerbation, but
not on FEV<sub>1</sub> and SGRQ. The pairwise meta-analysis performed
in eosinophilic patients, and the network approach, indicated that
mepolizumab elicited a beneficial effect against the risk of
exacerbation, whereas benralizumab was more effective in improving both
FEV<sub>1</sub> and SGRQ.</span></div>
<div id="abspara0025" style="text-align: justify;">
<span style="font-size: x-large;">This study demonstrates that targeting the pathway activated by IL-5 may have a beneficial impact in eosinophilic COPD patients.</span></div>
<div id="abspara0025" style="text-align: justify;">
<span style="font-size: x-large;">Full text:</span></div>
<div id="abspara0025" style="text-align: justify;">
<span style="font-size: x-large;"><a href="https://www.sciencedirect.com/science/article/pii/S1094553918300579">https://www.sciencedirect.com/science/article/pii/S1094553918300579</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com8tag:blogger.com,1999:blog-2921751546142261491.post-28639006404944823252018-03-31T07:01:00.000-07:002018-03-31T07:01:27.734-07:00Its time to revise Asthma Guidelines? Single maintenance and reliever therapy (SMART) decrease asthma exacerbations<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Importance</strong>
<span>Combined use of inhaled corticosteroids and long-acting
β-agonists (LABAs) as the controller and the quick relief therapy termed
<i>single maintenance and reliever therapy</i> (SMART) is a potential therapeutic regimen for the management of persistent asthma.</span></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://jamanetwork.com/journals/jama/fullarticle/2675737" target="_blank"><img alt="https://jamanetwork.com/journals/jama/fullarticle/2675737" border="0" data-original-height="368" data-original-width="1600" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSORlOvnqeRG5V1gcMNMxDPYEg3W8aHwJ43iL_oPBmvH23kNY2UJL4urtSbZVHFp2Du172Bi_B0S2TMDRliVdzIILsfKuLBkKrXwUeEjha-eWzyMp68ds6c6CQfsvxHPdyHbigJI08CmI/s640/joi180028f3.png" width="640" /></a></div>
<div style="text-align: justify;">
<span style="font-size: large;"><strong></strong></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Objective</strong>
<span>To conduct a systematic review and meta-analysis of the effects of SMART in patients with persistent asthma.</span></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Data Sources and Study Selection</strong>
<span>The databases of MEDLINE via OVID, EMBASE, the Cochrane
Central Register of Controlled Trials, and the Cochrane Database of
Systematic Reviews were searched from database inception through August
2016 and updated through November 28, 2017. Two reviewers selected
randomized clinical trials or observational studies evaluating SMART vs
inhaled corticosteroids with or without a LABA used as the controller
therapy and short-acting β-agonists as the relief therapy for patients
aged 5 years or older with persistent asthma and reporting on an outcome
of interest.</span></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Data Extraction and Synthesis</strong>
<span>Meta-analyses were conducted using a random-effects model to
calculate risk ratios (RRs), risk differences (RDs), and mean
differences with corresponding 95% CIs. Citation screening, data
abstraction, risk assessment, and strength of evidence grading were
completed by 2 independent reviewers.</span></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Main Outcomes and Measures</strong>
<span>Asthma exacerbations.</span></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Results</strong>
<span>The analyses included 16 randomized clinical trials
(N = 22 748 patients), 15 of which evaluated SMART as a combination
therapy with budesonide and formoterol in a dry-powder inhaler. Among
patients aged 12 years or older (n = 22 524; mean age, 42 years; 14 634
[65%] were female), SMART was associated with a reduced risk of asthma
exacerbations compared with the same dose of inhaled corticosteroids and
LABA as the controller therapy (RR, 0.68 [95% CI, 0.58 to 0.80]; RD,
−6.4% [95% CI, −10.2% to −2.6%]) and a higher dose of inhaled
corticosteroids and LABA as the controller therapy (RR, 0.77 [95% CI,
0.60 to 0.98]; RD, −2.8% [95% CI, −5.2% to −0.3%]). Similar results were
seen when SMART was compared with inhaled corticosteroids alone as the
controller therapy. Among patients aged 4 to 11 years (n = 341; median
age, 8 [range, 4-11] years; 69 [31%] were female), SMART was associated
with a reduced risk of asthma exacerbations compared with a higher dose
of inhaled corticosteroids as the controller therapy (RR, 0.55 [95% CI,
0.32 to 0.94]; RD, −12.0% [95% CI, −22.5% to −1.5%]) or the same dose of
inhaled corticosteroids and LABA as the controller therapy (RR, 0.38
[95% CI, 0.23 to 0.63]; RD, −23.2% [95% CI, −33.6% to −12.1%]).</span></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><strong>Conclusions and Relevance</strong>
<span>In this meta-analysis of patients with persistent asthma, the
use of single maintenance and reliever therapy compared with inhaled
corticosteroids as the controller therapy (with or without a long-acting
β-agonist) and short-acting β-agonists as the relief therapy was
associated with a lower risk of asthma exacerbations. Evidence for
patients aged 4 to 11 years was limited.</span></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><span>Full text:</span></span></div>
<div style="text-align: justify;">
<span><span style="font-size: x-large;"><a href="https://jamanetwork.com/journals/jama/fullarticle/2675737" target="_blank">https://jamanetwork.com/journals/jama/fullarticle/2675737 </a></span></span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-75866149051710781952018-03-17T11:58:00.000-07:002018-03-17T11:58:06.757-07:00Exacerbations of COPD: prevention is still actual in 2018!!<div style="text-align: justify;">
<span style="font-size: x-large;">Chronic obstructive pulmonary disease (COPD) is the third leading cause
of death worldwide. While COPD is a mainly chronic disease, a
substantial number of patients suffer from exacerbations. Severe
exacerbations are related to a significantly worse survival outcome.
This review summarises the current knowledge on the different aspects of
COPD exacerbations. The impact of risk factors and triggers such as
smoking, severe airflow limitation, bronchiectasis, bacterial and viral
infections and comorbidities is discussed. More severe exacerbations
should be treated with β-agonists and anticholinergics as well as
systemic corticosteroids. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://err.ersjournals.com/content/27/147/170103" target="_blank"><img alt="http://err.ersjournals.com/content/27/147/170103" border="0" data-original-height="1071" data-original-width="1600" height="428" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlYjuROCGJd4z4i1WnJi2W8nWm56IrZbT2U72fQWjAJRQZRa4o0KT7uOKpML-kDQAj9PNF_3hpSxkFUs8Vrsn5_H7dc9KvlqG9MStJzSMKqPbaZyGQO7VFlhJOg74X6RjLyhyphenhyphen5GQGcjGg/s640/ex+F1.large.jpg" width="640" /></a></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Antibiotic therapy should only be given to
patients with presumed bacterial infection. Noninvasive ventilation is
indicated in patients with respiratory failure. Smoking cessation is key
to prevent further COPD exacerbations. Other aspects include choice of
pharmacotherapy, including bronchodilators, inhaled corticosteroids,
phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics.
Better education and self-management as well as increased physical
activity are important. Influenza and pneumococcal vaccination is
recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of
COPD exacerbations, while most interventional bronchoscopic therapies
increase exacerbation risk within the first months after the procedure.</span></div>
<div style="text-align: justify;">
<i><b><span style="font-size: x-large;">The prevention of exacerbations is one of the most important treatment
goals. To achieve that goal, patient education and smoking cessation
programmes as well as patient-tailored pharmacological and
nonpharmacological treatments are mandatory.</span></b></i></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Full text:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://err.ersjournals.com/content/27/147/170103">http://err.ersjournals.com/content/27/147/170103</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-25685869892541011782018-03-09T08:49:00.001-08:002018-03-09T08:49:26.247-08:002018 New approach for the treatment of severe uncontrolled asthma<div style="text-align: justify;">
<span style="font-size: x-large;">New updated approach to severe uncontrolled asthma was presented by Greek team in ERJ Open research!!! </span><br />
<span style="font-size: x-large;">Asthma is a common, chronic and heterogeneous disease, affecting people
of all ages. It may be mild, barely noticed by the patient, or it may
range all the way to very severe disease, causing constant symptoms
greatly affecting the life of the patient, and may result in poor
quality of life and severe, life-threatening attacks. </span><br />
<span style="font-size: x-large;">A small subgroup of patients with asthma suffers from severe disease
that is either partially controlled or uncontrolled despite intensive,
guideline-based treatment. These patients have significantly impaired
quality of life and although they constitute <5% of all asthma
patients, they are responsible for more than half of asthma-related
healthcare costs. Here, we review a definition for severe asthma and
present all therapeutic options currently available for these severe
asthma patients. Moreover, we suggest a specific algorithmic treatment
approach for the management of severe, difficult-to-treat asthma based
on specific phenotype characteristics and biomarkers. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://openres.ersjournals.com/content/4/1/00125-2017" target="_blank"><img alt="http://openres.ersjournals.com/content/4/1/00125-2017" border="0" data-original-height="715" data-original-width="1280" height="355" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghx98wLgHxYbxl6Iw3xmdR-3sFfxXLbclWlWogV-m4vypKZazRcofQKiVXc0-qXKUDAtgHc4G4L6gBx3msRsRXlbeZmxW_dIZ6oLRpR9oPxYMK54NUqpPSDZR8VHTl0D0BolzWXcsJK0c/s640/asthmaF1.large.jpg" width="640" /></a></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-size: x-large;">The diagnosis and
management of severe asthma requires specialised experience, time and
effort to comprehend the needs and expectations of each individual
patient and incorporate those as well as his/her specific phenotype
characteristics into the management planning. Although some new
treatment options are currently available for these patients, there is
still a need for further research into severe asthma and yet more
treatment options.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Full text:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://openres.ersjournals.com/content/4/1/00125-2017">http://openres.ersjournals.com/content/4/1/00125-2017</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-58639064928962836302018-03-08T00:01:00.003-08:002018-03-08T00:01:25.193-08:00New study contradicts Asthma Guidelines: How efficient is escalating inhaled glucocorticoids for prevention of asthma exacerbations?<div style="text-align: justify;">
<span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: x-large;"><i><b>Evidence indicates
that substantial escalation of regularly used inhaled glucocorticoids,
fails to prevent most asthma exacerbations.</b></i> A
small subgroup of adults and adolescents with asthma may have a
response to an escalation strategy; however, their baseline and
exacerbation characteristics remain to be defined.</span></span><br />
<span style="font-family: Times, "Times New Roman", serif;"><span style="font-size: x-large;">New study was published in NEJM on</span><span class="title_default"><span style="font-size: x-large;"> Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations.</span></span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1710988?query=recirc_curatedRelated_article" target="_blank"><img alt="http://www.nejm.org/doi/full/10.1056/NEJMoa1710988?query=recirc_curatedRelated_article" border="0" data-original-height="476" data-original-width="1375" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfxHRoTP-Ch0bv7bLRstOOff31_RzFXO6w59xpCpGsjzC9E_Rue5E59GPIk1ML2oIvsUyQRyKz0LIX25c-E81dcwKKJeYrUsPavXjJ8CAzU_qCRmqnQrZqYwX9Ix_Evg0cukvilpx7uxY/s640/nejm.jpg" width="640" /></a></div>
<span style="font-family: Times, "Times New Roman", serif;"><span class="title_default"></span></span><br />
<span style="font-size: x-large;"><span style="font-family: Times, "Times New Roman", serif;">In children with mild-to-moderate persistent asthma treated with daily
inhaled glucocorticoids, <b><i>quintupling the dose at the early signs of loss
of asthma control did not reduce the rate of severe asthma
exacerbations or improve other asthma outcomes and may be associated
with diminished linear growth</i></b>.</span></span><br />
<span style="font-size: x-large;"><a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1710988?query=recirc_curatedRelated_article" target="_blank"><b><span style="font-family: Times, "Times New Roman", serif;">Full text</span></b></a></span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-20867624861650846612018-03-03T04:06:00.000-08:002018-03-03T04:06:58.124-08:00More evidences for ban of e-cigarettes: prolonged exposure might result in asthma, COPD and inflammation<div style="text-align: justify;">
<span style="font-size: x-large;">A critical review outlining the toxicological profile and immunological consequences of e-cigarette use was published these days in <a href="http://err.ersjournals.com/content/27/147/170119" target="_blank">European Respiratory Review</a>! </span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Knowledge of the long-term toxicological and immunological effects of
e-cigarette (e-cig) aerosols remains elusive due to the relatively short
existence of vaping. Therefore, we performed a systematic search of
articles published in public databases and analysed the research
evidence in order to provide critical information regarding e-cig
safety. Electronic nicotine delivery systems (or e-cigs) are an
alternative to traditional cigarettes for the delivery of nicotine and
are typically filled with glycerol or propylene glycol-based solutions
known as e-liquids. Though present in lower quantities, e-cig aerosols
are known to contain many of the harmful chemicals found in tobacco
smoke. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://err.ersjournals.com/content/27/147/170119" target="_blank"><img alt="http://err.ersjournals.com/content/27/147/170119" border="0" data-original-height="1049" data-original-width="1280" height="524" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUuVpvlHZ3BJjf5Jh37Zek8UVC5alTULFAqTO-uwNF4kkOAr3HYsk_krv3m7FuALsEbf24Zj18o6_TMsHWij1pjxAr4B-ORZAiCZkLdiXzmIkhoudYafzYnQD6wXgFJwMbJVbA_xVQDVY/s640/e+cig+F2.large.jpg" width="640" /></a></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-size: x-large;">However, due to the paucity of experimental data and
contradictory evidence, it is difficult to draw conclusive outcomes
regarding toxicological, immunological and clinical impacts of e-cig
aerosols. Excessive vaping has been reported to induce inflammatory
responses including mitogen-activated protein kinase, Janus tyrosine
kinase/signal transducer and activator of transcription and nuclear
factor-κB signalling, similar to that induced by tobacco smoke. <b> </b></span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><b>Based on
recent evidence, prolonged exposure to some constituents of e-cig
aerosols might result in respiratory complications such as asthma,
chronic obstructive pulmonary disease and inflammation.</b> </span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Future studies
are warranted that focus on establishing correlations between e-cig
types, generations and e-liquid flavours and immunological and
toxicological profiles to broaden our understanding about the effects of
vaping.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Full text:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://err.ersjournals.com/content/27/147/170119">http://err.ersjournals.com/content/27/147/170119</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com4tag:blogger.com,1999:blog-2921751546142261491.post-63355346467737776292018-02-24T10:19:00.000-08:002018-02-24T10:19:32.992-08:002018 Update: Acute Respiratory Distress Syndrome Advances in Diagnosis and Treatment<div style="text-align: justify;">
<span style="font-size: large;"><b>Importance</b>
Acute respiratory distress syndrome (ARDS) is a
life-threatening form of respiratory failure that affects approximately
200 000 patients each year in the United States, resulting in nearly
75 000 deaths annually. Globally, ARDS accounts for 10% of intensive
care unit admissions, representing more than 3 million patients with
ARDS annually.</span></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b>Objective</b>
To review advances in diagnosis and treatment of ARDS over the last 5 years.</span></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b>Evidence Review</b>
We searched MEDLINE, EMBASE, and the Cochrane Database of
Systematic Reviews from 2012 to 2017 focusing on randomized clinical
trials, meta-analyses, systematic reviews, and clinical practice
guidelines. Articles were identified for full text review with manual
review of bibliographies generating additional references.</span></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b>Findings</b>
After screening 1662 citations, 31 articles detailing major
advances in the diagnosis or treatment of ARDS were selected. The Berlin
definition proposed 3 categories of ARDS based on the severity of
hypoxemia: mild (200 mm Hg<Pa<span style="font-variant: small-caps;">o</span><sub>2</sub>/F<span style="font-variant: small-caps;">io</span><sub>2</sub>≤300 mm Hg), moderate (100 mm Hg<Pa<span style="font-variant: small-caps;">o</span><sub>2</sub>/F<span style="font-variant: small-caps;">io</span><sub>2</sub>≤200 mm Hg), and severe (Pa<span style="font-variant: small-caps;">o</span><sub>2</sub>/F<span style="font-variant: small-caps;">io</span><sub>2</sub>
≤100 mm Hg), along with explicit criteria related to timing of the
syndrome’s onset, origin of edema, and the chest radiograph findings.
The Berlin definition has significantly greater predictive validity for
mortality than the prior American-European Consensus Conference
definition. Clinician interpretation of the origin of edema and chest
radiograph criteria may be less reliable in making a diagnosis of ARDS.
The cornerstone of management remains mechanical ventilation, with a
goal to minimize ventilator-induced lung injury (VILI). Aspirin was not
effective in preventing ARDS in patients at high-risk for the syndrome.
Adjunctive interventions to further minimize VILI, such as prone
positioning in patients with a Pa<span style="font-variant: small-caps;">o</span><sub>2</sub>/F<span style="font-variant: small-caps;">io</span><sub>2</sub>
ratio less than 150 mm Hg, were associated with a significant mortality
benefit whereas others (eg, extracorporeal carbon dioxide removal)
remain experimental. Pharmacologic therapies such as β<sub>2</sub>
agonists, statins, and keratinocyte growth factor, which targeted
pathophysiologic alterations in ARDS, were not beneficial and
demonstrated possible harm. Recent guidelines on mechanical ventilation
in ARDS provide evidence-based recommendations related to 6
interventions, including low tidal volume and inspiratory pressure
ventilation, prone positioning, high-frequency oscillatory ventilation,
higher vs lower positive end-expiratory pressure, lung recruitment
maneuvers, and extracorporeal membrane oxygenation.</span></div>
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<a href="https://jamanetwork.com/journals/jama/fullarticle/2673154?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=022418#.WpF1Eg3QKDs.twitter" target="_blank"><img alt="https://jamanetwork.com/journals/jama/fullarticle/2673154?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=022418#.WpF1Eg3QKDs.twitter" border="0" data-original-height="1600" data-original-width="970" height="740" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMNP882JRZBQPYJq85S47sJmIq3XqoaM6ZyWdPSGJ1KxaD5sRHm7ovxMjyHW3lTMRMztchTETmM9mJTjByRyDeYmhu-fdcwq2d7V6QUi2Tvkt0QvVFIYkKMxJFqrB982r9L9OV4V1eyeM/s640/jrv170010f2.png" width="348" /></a></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b>Conclusions and Relevance</b>
The Berlin definition of acute respiratory distress syndrome
addressed limitations of the American-European Consensus Conference
definition, but poor reliability of some criteria may contribute to
underrecognition by clinicians. No pharmacologic treatments aimed at the
underlying pathology have been shown to be effective, and management
remains supportive with lung-protective mechanical ventilation.
Guidelines on mechanical ventilation in patients with acute respiratory
distress syndrome can assist clinicians in delivering evidence-based
interventions that may lead to improved outcomes.</span></div>
<div style="text-align: justify;">
<span style="font-size: large;"><a href="https://jamanetwork.com/journals/jama/fullarticle/2673154?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=022418#.WpF1Eg3QKDs.twitter" target="_blank">Full text</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com1tag:blogger.com,1999:blog-2921751546142261491.post-49417166139277583192018-02-23T09:44:00.000-08:002018-02-23T09:44:06.904-08:00Impact of obstructive sleep apnea on chronic obstructive pulmonary disease: prospective, consecutive study<div style="text-align: justify;">
<span style="font-size: x-large;"><b><i>What is not known yet, about the topic</i></b><br />Coexistent chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are insufficiently studied in terms of prevalence, frequency and spectrum of complications, health risks and impact on quality of life.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><i><b> </b></i></span><a href="https://www.researchgate.net/publication/323289116_Impact_of_obstructive_sleep_apnea_on_chronic_obstructive_pulmonary_disease_prospective_consecutive_study" target="_blank"><img alt="https://www.researchgate.net/publication/323289116_Impact_of_obstructive_sleep_apnea_on_chronic_obstructive_pulmonary_disease_prospective_consecutive_study" border="0" data-original-height="744" data-original-width="1418" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNOXVzOEWAjGGWJrqWjFO-aKjoOn-j3b9IMH4zXjr3hcvw6RF6KK9Xh91u8Bk-dtF-vKy_tCGkNfAyAjDrXIzCC-e8QJyE8ARSJfkOEysqS4XNXm547aAetHTlLzcf4kAsIgWNyEWwz58/s640/1+mjhs.jpg" width="640" /></a><span style="font-size: x-large;"><i><b> </b></i></span></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><i><b>Research hypothesis</b></i><br />Certain clinical and demographic parameters or data obtained from nocturnal polysomnography can have significant predictive value for overlap syndrome, induced by coexistent obstructive sleep apnea and chronic obstructive pulmonary<br />disease.<br /><i><b>Article’s added novelty on this scientific topic</b></i><br />It was established that increased body mass index and high Epworth sleepiness score have significant predictive value for coexistent OSA and COPD.</span></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="https://www.researchgate.net/publication/323289116_Impact_of_obstructive_sleep_apnea_on_chronic_obstructive_pulmonary_disease_prospective_consecutive_study" target="_blank">Full text</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com4tag:blogger.com,1999:blog-2921751546142261491.post-81522877379167892302018-02-18T09:10:00.000-08:002018-02-18T09:10:39.817-08:00Dual LABA/LAMA bronchodilators in COPD: why? when? and how?<div style="text-align: justify;">
<span style="font-size: x-large;">Dual LABA/LAMA bronchodilators in COPD: why? when? and how?</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Still many questions in our real everyday practice!</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Read Editorial in</span> <span style="font-size: x-large;"><a href="http://www.tandfonline.com/loi/IERX" target="_blank">Expert Review of Respiratory Medicine</a> by great Italian team conducted by professor Mario Cazzola. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<img border="0" data-original-height="624" data-original-width="1454" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSZJtFlWHtIqR7MHpWho_oWiRW-ZfeFxOytQ8-WEhMoEHhI19zLXq_ExWQVBBv7qHx8ID3Z63iSqHlcNMPVmY5ByXy-NSYY0Y_QTktNxSbeK6sEtTd0dTEOksI4skElnBK1eNRvSsopMs/s640/1+article.jpg" width="640" /><a href="http://www.tandfonline.com/doi/abs/10.1080/17476348.2018.1442216" target="_blank">http://www.tandfonline.com/doi/abs/10.1080/17476348.2018.1442216</a></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">LABA/LAMA combinations induce bronchorelaxant synergistic interaction when the drugs mixture is well-balanced and administered at low isoeffective concentrations.<br />The overall approach of Drug Companies has been to combine in a FDC a LABA and a LAMA at the same doses for which the monocomponents were previously approved. Indeed, this practice does not permit to optimize the synergy in the final<br />LABA/LAMA FDCs. Conversely, dose-finding studies are required to identify the correct dose-ratio and establish the minimal doses for each monocomponent in the FDC leading to the greater synergism with regard to the improvement in lung<br />function, symptoms, and exacerbations.<br />Furthermore, although LABA/LAMA FDCs are characterized by an acceptable safety profile, the cardiovascular toxicity of LABAs and LAMAs may overlap. Thus, postmarketing surveillance and observational studies are needed to assess the real risk of rare, but potentially serious, cardiovascular adverse events associated with the dual bronchodilation therapy in COPD patients.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Full text:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://www.tandfonline.com/doi/abs/10.1080/17476348.2018.1442216" target="_blank">http://www.tandfonline.com/doi/abs/10.1080/17476348.2018.1442216</a></span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-59230163721283685812018-02-17T04:45:00.002-08:002018-02-17T04:45:43.148-08:00COPD in 2018: syndrome or disease - first steps to new classification <div style="text-align: justify;">
<span style="font-size: x-large;">New article from <a href="http://openres.ersjournals.com/" target="_blank">ERJ Open Research</a> by Celli and Agusti is dedicated to hot topic in COPD: new classification with absolutely fresh approach! </span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Due to well-conducted epidemiological studies and advances in genetics,
molecular biology, translational research, the advent of computed
tomography of the lungs and bioinformatics, the diagnosis of chronic
obstructive pulmonary disease (COPD) as a single entity caused by
susceptibility to cigarette smoke is no longer tenable. Furthermore, the
once-accepted concept that COPD results from a rapid and progressive
loss of lung function over time is not true for a sizeable proportion of
adults with the disease. Now we know that some genetic predisposition
and/or different environmental interactions (nutritional, infectious,
pollution and immunological) may negatively modulate post-natal lung
development and lead to poorly reversible airflow limitation later in
life, consistent with COPD. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: x-large;"> </span><a href="http://openres.ersjournals.com/content/4/1/00132-2017" target="_blank"><img alt="http://openres.ersjournals.com/content/4/1/00132-2017" border="0" data-original-height="465" data-original-width="1280" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP03T7Aj50HfUub62N08F4D3Xr8wtPhOs9GrEiIb-Z_PZAZjOVhwJdDOrErZspBAYXFCg5H904tOAkK7iPo33SI4QLnB6mcq_D1svkwesWJ82A47v_Qqzaw-0sFLTzaN-mtkBHRUFNzo4/s640/F1.large.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">We believe it is time to rethink the
taxonomy of this disease based on the evidence at hand. To do so, we
have followed the principles outlined in the 1980s by J.D. Scadding who
proposed that diseases can be defined by four key characteristics: 1)
clinical description (syndrome), 2) disorder of structure (morbid
anatomy), 3) disorder of function (pathophysiology) and 4) causation
(aetiology). </span></div>
<div style="text-align: justify;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://openres.ersjournals.com/content/4/1/00132-2017" target="_blank"><img alt="http://openres.ersjournals.com/content/4/1/00132-2017" border="0" data-original-height="640" data-original-width="1280" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPp4WHK27xCIgM3NnP6BIrn8jTZ-10odh6NvoIJesTZfA66_PEpNbWEg5o9SMfSeN4PuQ85L-YLMcj-YZ4Pdn_Tu1-vMzHd5_68kLo9xAoOm37TG7tvGabOqKW5hNZoj_JfX0cFB0ykAs/s640/F2.large.jpg" width="640" /></a></div>
<br /><div style="text-align: justify;">
<span style="font-size: x-large;">Here, we propose a pragmatic approach to the taxonomy of
COPD based on different processes that result in a similar syndromic
presentation. It can accommodate changes over time, as the pathobiology
that may lead to COPD expands. We hope that stakeholders in the field
may find it useful to better define the patients now boxed into one
single entity, so that specific studies can be designed and conducted
for each type of COPDs.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Free full text:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://openres.ersjournals.com/content/4/1/00132-2017">http://openres.ersjournals.com/content/4/1/00132-2017</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com3tag:blogger.com,1999:blog-2921751546142261491.post-73743554119494864412017-07-28T10:06:00.000-07:002017-07-28T10:06:05.607-07:00Assessment of Health-related Quality of Life in Different Phenotypes of COPD (article from 2017 Current Respiratory Medicine Reviews)<div style="box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 10px; text-align: justify;">
<span style="font-size: x-large;">Introduction: Phenotypic characterization of COPD subjects may rely on clinical and physiological manifestations, imaging, assessment of patient-related outcomes (health related quality of life), COPD comorbidities, COPD exacerbations and systemic inflammation. The aim of the study was to evaluate and to analyze the health-related quality of life (HRQL) in COPD patients classified into different phenotypes.</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.eurekaselect.com/154321" target="_blank"><span style="font-size: x-large;"><img border="0" data-original-height="303" data-original-width="1010" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0Rct_iQGGxEpsig60mvgNzMDiAKUXXXvhTxrGBJ6ael7lwRSS33hd7oiRGEzTo3GHhrvA0Gaur477S_zViPaqSB3LVbe36vyxaXjVLojZDn5UAoLFDYn19h-QB5cp7hmcmkNmkTmxqPU/s640/crmr_05.jpg" width="640" /></span></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div style="box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 10px; text-align: justify;">
<span style="font-size: x-large;">Methods: 395 consecutive COPD patients were enrolled into the study. Spirometric data were analyzed (FEV1, FVC, FEV1/FVC). HRQL was assessed by the St. George Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ).</span></div>
<div style="box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 10px; text-align: justify;">
<span style="font-size: x-large;">Results: The cohort consisted of 395 COPD patients with mean age 62.7 ± 9.4 years, 79 % were males. Patients were divided in 4 groups according to phenotypes: 44% of the patients were nonexacerbators, 35% frequent exacerbators with chronic bronchitis (CB), 12% frequent exacerbators without CB, and 8% were patients with asthma-COPD overlap syndrome (ACOS). There were statistically significant differences in HRQL and lung function between COPD phenotypes. Frequent exacerbators with chronic CB and without CB had the similar total SGRQ scores, CCQ scores and CAT, and these scores were worse in comparison with HRQL of non-exacerbators and patients with ACOS.</span></div>
<div style="box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 10px; text-align: justify;">
<span style="font-size: x-large;">Conclusion: Frequent exacerbators with chronic CB and without CB have a more severe deterioration of the HRQL and worse lung function then non-exacerbators and patients with ACOS.</span></div>
<div style="box-sizing: border-box; font-family: "Helvetica Neue", Helvetica, Arial, sans-serif; margin-bottom: 10px; text-align: justify;">
<span style="font-size: x-large;">full text:</span></div>
<div style="box-sizing: border-box; margin-bottom: 10px; text-align: justify;">
<span style="font-family: Helvetica Neue, Helvetica, Arial, sans-serif; font-size: x-large;"><a href="http://www.eurekaselect.com/154321">http://www.eurekaselect.com/154321</a></span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-75729127433622444802017-07-08T12:05:00.000-07:002017-07-08T12:05:28.313-07:00Pulmonary rehabilitation and cardiovascular risk in COPD: a systematic review (Free Full text from 2017 COPD Research and Practice)<div class="AbstractSection" id="ASec1" style="background-color: white; box-sizing: border-box; color: #333333; font-family: "Open Sans";" xmlns:func="http://oscar.fig.bmc.com" xmlns="http://www.w3.org/1999/xhtml">
<h3 class="Heading" style="-webkit-font-smoothing: antialiased; box-sizing: border-box; line-height: 1.4; margin-bottom: 8px; margin-top: 0px; text-align: justify;" xmlns="">
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<b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">Introduction</span></b><b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">Pulmonary Rehabilitation (PR) is an effective
intervention in COPD however the value of PR in reducing cardiovascular risk in
COPD (measured by aortic pulse wave velocity, PWV) is unclear and there is no
existing systematic review.</span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0026-9" target="_blank"><img border="0" data-original-height="235" data-original-width="490" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEZY1IB8vOS22ovFNCRBhpN5FUcCpV72TbaWxAZ075gEYnrCgfWfIny1mQ_XfLt6QoGWVZ7E7hcBPTX-2CsbJ7wdsqv2g-BM7Kq2GVOZHrKfnNQUDeN0zNRkj6YQblBuVPiGqYvtd3nvw/s640/pulm-rehab.jpg" width="640" /></a><a href="https://www.blogger.com/blogger.g?blogID=2921751546142261491" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div>
<span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;"><br /></span></div>
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<b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;">Objectives</span></b><br />
<span style="font-family: "open sans", serif; font-size: 24pt;">To conduct a systematic review examining whether PR
results in alteration of CV risk in COPD (as measured by aPWV).</span></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">Methods</span></b><b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">An electronic systematic search concordant with PRISMA
guidelines was conducted. The search was complete to the 27th of May 2017. Six
databases were examined: Embase, Medline, AMED, Web of Science, Cochrane
clinical trials, and CINAHL.</span><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">Results</span></b><b><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">This study generated 767 initial matches, which were
filtered using inclusion/exclusion criteria. Three studies (201 COPD
participants) were included. Our analysis does not confirm that PR affects aPWV
but studies were heterogeneous.</span><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<b><span style="font-family: "open sans" , serif; font-size: 24pt;">Conclusion</span></b><b><span style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; line-height: normal; margin-bottom: 0.0001pt;">
<span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">There is currently insufficient information on the
effect of PR on reducing CV risk in COPD. Therefore controversy remains, with
the possibility that there might be some subjects who benefit and others who
might experience an increase in CV risk in response to PR. These results will
be of value to those interested in gaining a better understanding of the
benefits of PR on CV risk in COPD. </span><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "open sans" , serif; font-size: 24pt;">Free full text:</span><span lang="EN-US" style="font-family: "open sans" , serif; font-size: 13.5pt;"><o:p></o:p></span></div>
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<span style="font-family: "open sans" , serif; font-size: 24pt;"><a href="https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0026-9"><span lang="EN-US" style="color: blue; mso-ansi-language: EN-US; mso-bidi-font-size: 11.0pt;">https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0026-9</span></a></span><span lang="EN-US" style="color: black; font-family: "times new roman" , "serif"; font-size: 13.5pt;"><o:p></o:p></span></div>
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Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com1tag:blogger.com,1999:blog-2921751546142261491.post-44557163246771019202017-06-24T07:51:00.001-07:002017-06-24T07:51:13.257-07:00Adherence to COPD treatment: Myth and reality (article from 2017 Respiratory Medicine)<div class="abstract svAbstract
abstractHighlights
" data-etype="ab" style="text-align: justify;">
<h2 class="secHeading" id="author-highlightsabs00151">
<span style="font-size: x-large;"><span style="font-weight: normal;">Great Respiratory article from our Italian Friends!!!</span> </span></h2>
<h2 class="secHeading" id="author-highlightsabs00151">
<span style="font-size: x-large;">Highlights</span><span style="font-size: x-large;"> </span></h2>
<ul>
<li><h2 class="secHeading" id="author-highlightsabs00151">
<i><span style="font-weight: normal;"><span style="font-size: x-large;">The level of medication adherence in COPD patients is very low</span></span></i></h2>
</li>
<li><h2 class="secHeading" id="author-highlightsabs00151">
<i><span style="font-weight: normal;"><span style="font-size: x-large;">Approaches to assess adherence of COPD are burdened with important limitations.</span><span style="font-size: x-large;"> </span></span></i></h2>
</li>
<li><h2 class="secHeading" id="author-highlightsabs00151">
<i><span style="font-weight: normal;"><span style="font-size: x-large;">Patient views on therapy effectiveness are powerful predictors of reported adherence.</span><span style="font-size: x-large;"> </span></span></i></h2>
</li>
<li><h2 class="secHeading" id="author-highlightsabs00151">
<i><span style="font-weight: normal;"><span style="font-size: x-large;">The physician can affect adherence in COPD with his/her prescription.</span><span style="font-size: x-large;"> </span></span></i></h2>
</li>
<li><h2 class="secHeading" id="author-highlightsabs00151">
<i><span style="font-weight: normal;"><span style="font-size: x-large;">In COPD, adherence to inhalation medication is device-related.</span></span></i></h2>
</li>
</ul>
</div>
<div class="abstract svAbstract " data-etype="ab" style="text-align: justify;">
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.sciencedirect.com/science/article/pii/S0954611117301737" target="_blank"><img alt="http://www.sciencedirect.com/science/article/pii/S0954611117301737" border="0" data-original-height="338" data-original-width="507" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSFZbYrJoRrKjmVQ7QMuGeeL4IGJS1-zNfh4xJ6yW47ADjWnE9_8UxsrW9VbPsPFN_MKMFkCEt6HSQSzyFTd1K2Hma4sesXqUMW4qeZjDzmlZ0dF8DUkscLkyT94QcguLRm0g438l8tV8/s640/ThinkstockPhotos-516280293.jpg" width="640" /></a></div>
<h2 class="secHeading" id="authorabs00101">
</h2>
<div id="abspara0010">
<span style="font-size: x-large;">COPD
is a chronic disease in which effective management requires long-term
adherence to pharmacotherapies but the level of adhesion to the
prescribed medications is very low and this has a negative influence on
outcomes. There are several approaches to detect non-adherence, such as
pharmacy refill methods, electronic monitoring, and self-report
measures, but they are all burdened with important limitations.
Medication adherence in COPD is multifactorial and is affected by
patients (health beliefs, cognitive abilities, self-efficacy,
comorbidities, psychological profile, conscientiousness), physicians
(method of administration, dosing regimen, polypharmacy, side effects),
and society (patient-prescriber relationship, social support, access to
medication, device training, follow-up). Patient-health care
professional communication, especially that between patient and
physician or pharmacist, is central to optimizing patient adherence.
However, the most realistic approach is to keep in mind that
non-adherence is always possible, indeed, probable.</span></div>
<div id="abspara0010">
<span style="font-size: x-large;">Article is <a href="http://www.sciencedirect.com/science/article/pii/S0954611117301737" target="_blank">HERE</a>!!! </span></div>
</div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com3tag:blogger.com,1999:blog-2921751546142261491.post-61522886979748584332017-06-08T12:36:00.000-07:002017-06-08T12:36:14.948-07:00To sleep, or not to sleep – that is the question, for polysomnography (Free full text from Breathe)<div id="p-4" style="text-align: justify;">
<span style="font-size: x-large;">As the English dramatist Thomas Dekker wrote, “Sleep is that
golden chain that ties health and our bodies together”. One of the most
frequently sleep-related disorders (SRD) is obstructive sleep apnoea
syndrome (OSAS). OSAS is a relatively “young” disease and at the same
time, one of the most important respiratory conditions discovered in the
last 50 years due to its incidence, prevalence, health-related impact
on the patient’s life and economic burden.</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://breathe.ersjournals.com/content/13/2/137" target="_blank"><img alt="http://breathe.ersjournals.com/content/13/2/137" border="0" data-original-height="581" data-original-width="1430" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgm4hH8-5cqeEPEa9ZJZFoG6MlMmZuMd69wvz4FopzvHOdj-4kWAannL9CHk5qJKN3gQB_EM73LkeMuu_Ne6HCSWHk3sapqQJ28HfSE0jaBSfQY2S32zaVNItz_XQi5av9pm1l0VzcuNQU/s640/brea.jpg" width="640" /></a></div>
<div id="p-4" style="text-align: justify;">
<br /></div>
<div id="p-5" style="text-align: justify;">
<span style="font-size: x-large;">Nevertheless,
50 years is still a large amount of time and our understanding of OSAS
has grown significantly over these years. The first reports discussed
how to diagnose this rare condition. Later, it was demonstrated that the disease itself is not that rare and is extremely underdiagnosed.
This was only the tip of the iceberg, since it was furthermore
discovered that OSAS is linked to multiple comorbidities and is a major
healthcare problem. Now, we are moving further forward, and discussing more efficient ways to diagnose and manage this condition.</span></div>
<div id="p-5" style="text-align: justify;">
<span style="font-size: x-large;">Free full text:</span></div>
<div id="p-5" style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://breathe.ersjournals.com/content/13/2/137">http://breathe.ersjournals.com/content/13/2/137</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com1tag:blogger.com,1999:blog-2921751546142261491.post-7184967126630475722017-05-31T07:14:00.000-07:002017-05-31T07:14:42.589-07:00Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions (Free Full text from 2017 COPD Research and Practice)<div style="text-align: justify;">
<span style="font-size: x-large;">Chronic obstructive pulmonary disease and asthma are the most frequent
chronic respiratory diseases that affect the general population. For a
long period of time these two conditions were considered to be separate
diseases. However, it became evident that some patients share symptoms
and clinical findings from both diseases. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0025-x" target="_blank"><img alt="https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0025-x" border="0" data-original-height="412" data-original-width="1091" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgT1whTWKBWW202OcDxXVfXQkjK0H63MBF9n06ENoGYdyA4FwwyP8FvZ6K3MWZZR86zYauNcDAQoFjtitTNoUmdp7isDI1m61qUQ6wb7X3KFSooawSd8lT_3n0lynY0mFu-MRTf7pNg8ag/s640/ACOS.jpg" width="640" /></a></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-size: x-large;">These patients are considered
to represent a distinct phenotype, called asthma-COPD overlap syndrome
(ACOS). However, since approximately the one third of the asthmatics
smoke the ACOS may primarily define those patients. This is a relatively
newly defined clinical syndrome whose underlying mechanisms and most
appropriate management remain to be confirmed. In this review, we
summarize current knowledge on this syndrome, aiming to update
clinicians and help their daily practice.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Free full text:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0025-x" target="_blank">https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0025-x </a></span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-31741830046525494322017-05-27T22:36:00.000-07:002017-05-27T22:36:57.337-07:00Oral Glucocorticoid–Sparing Effect of Benralizumab in Severe Asthma (free full text from 2017 NEJM)<div style="text-align: justify;">
<span style="font-size: x-large;">Many patients with severe asthma rely on oral
glucocorticoids to manage their disease. We investigated whether
benralizumab, a monoclonal antibody directed against the alpha subunit
of the interleukin-5 receptor that significantly reduces the incidence
of asthma exacerbations, was also effective as an oral
glucocorticoid–sparing therapy in patients relying on oral
glucocorticoids to manage severe asthma associated with eosinophilia.</span></div>
<span style="font-size: x-large;"> </span><div class="section" style="text-align: justify;">
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1703501#Top" target="_blank"><img alt="http://www.nejm.org/doi/full/10.1056/NEJMoa1703501#Top" border="0" data-original-height="712" data-original-width="1500" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKkEHavxetRX-Rs_vtAtpcAC2UlnSVMcF5_Gb0c-7-juKuGTr-wNlK2ufXGcvcxuvu97alrVfugI5_VUhQnBqi-Cd4T9eDS6sPvt6iMSDv7V_in_4jCsZPmq3BZAcQSsoI_V_erc7RDfU/s640/nejmoa1703501_f1.jpeg" width="640" /></a></div>
<h3 id="articleMethods">
</h3>
<span style="font-size: x-large;">In
a 28-week randomized, controlled trial, we assessed the effects of
benralizumab (at a dose of 30 mg administered subcutaneously either
every 4 weeks or every 8 weeks [with the first three doses administered
every 4 weeks]) versus placebo on the reduction in the oral
glucocorticoid dose while asthma control was maintained in adult
patients with severe asthma. The primary end point was the percentage
change in the oral glucocorticoid dose from baseline to week 28. Annual
asthma exacerbation rates, lung function, symptoms, and safety were
assessed.</span><br />
</div>
<div class="section" style="text-align: justify;">
<h3 id="articleResults">
<span style="font-size: x-large;">Results</span></h3>
<span style="font-size: x-large;">Of
369 patients enrolled, 220 underwent randomization and started
receiving benralizumab or placebo. The two benralizumab dosing regimens
significantly reduced the median final oral glucocorticoid doses from
baseline by 75%, as compared with a reduction of 25% in the oral
glucocorticoid doses in the placebo group (P<0.001 for both
comparisons). The odds of a reduction in the oral glucocorticoid dose
were more than 4 times as high with benralizumab as with placebo. Among
the secondary outcomes, benralizumab administered every 4 weeks resulted
in an annual exacerbation rate that was 55% lower than the rate with
placebo (marginal rate, 0.83 vs. 1.83, P=0.003), and benralizumab
administered every 8 weeks resulted in an annual exacerbation rate that
was 70% lower than the rate with placebo (marginal rate, 0.54 vs. 1.83,
P<0.001). At 28 weeks, there was no significant effect of either
benralizumab regimen on the forced expiratory volume in 1 second (FEV<sub>1</sub>),
as compared with placebo. The effects on various measures of asthma
symptoms were mixed, with some showing significant changes in favor of
benralizumab and others not showing significant changes. Frequencies of
adverse events were similar between each benralizumab group and the
placebo group.</span><br />
</div>
<span style="font-size: x-large;"></span><b><span style="font-size: x-large;">Conclusions</span></b><div style="text-align: justify;">
<span style="font-size: x-large;">Benralizumab
showed significant, clinically relevant benefits, as compared with
placebo, on oral glucocorticoid use and exacerbation rates. These
effects occurred without a sustained effect on the FEV<sub>1</sub>.</span></div>
<span style="font-size: x-large;">Free full text:</span><br />
<span style="font-size: x-large;"><a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1703501#Top">http://www.nejm.org/doi/full/10.1056/NEJMoa1703501#Top</a></span>Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2tag:blogger.com,1999:blog-2921751546142261491.post-83520070674055079932017-05-20T10:55:00.000-07:002017-05-20T10:55:44.884-07:00Imprecision in the Era of Precision Medicine in Non-Small Cell Lung Cancer (2017 Frontiers of Medicine free full text)<div style="text-align: justify;">
<span style="font-size: x-large;">Over the past decade, major advances have been made in the management of
advanced non-small cell lung cancer (NSCLC). There has been a
particular focus on the identification and targeting of putative driver
aberrations, which has propelled NSCLC to the forefront of precision
medicine. Several novel molecularly targeted agents have now achieved
regulatory approval, while many others are currently in late-phase
clinical trial testing. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://journal.frontiersin.org/article/10.3389/fmed.2017.00039/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_275249_39_Medici_20170518_arts_A" target="_blank"><img alt="http://journal.frontiersin.org/article/10.3389/fmed.2017.00039/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_275249_39_Medici_20170518_arts_A" border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvrDnnRDg6xIDTiSFN-gUp89o5Q83eUsz0mqN1pNpXuPk5U5-kzO9tQ0GcDjvN2ZcUCacNX4b6u4IYoK2JFUzCU3CqFTpbloq_9zZmtQeG-8K2AdL2jyN39wv8U0Q35EqbIv19sPoAS-s/s640/fmed-04-00039-g001.jpg" width="640" /></a></div>
<div style="text-align: justify;">
</div>
<div style="text-align: justify;">
<span style="font-size: x-large;">These antitumor therapies have significantly
impacted the clinical outcomes of advanced NSCLC and provided patients
with much hope for the future. Despite this, multiple deficiencies still
exist in our knowledge of this complex disease, and further research is
urgently required to overcome these critical issues. This review traces
the path undertaken by the different therapeutics assessed in NSCLC and
the impact of precision medicine in this disease. We also discuss the
areas of “imprecision” that still exist in NSCLC and the modern
hypothesis-testing studies being conducted to address these key
challenges.</span></div>
<div style="text-align: justify;">
<a href="http://journal.frontiersin.org/article/10.3389/fmed.2017.00039/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_275249_39_Medici_20170518_arts_A" target="_blank"><span style="font-size: x-large;">Free full text</span></a></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com3tag:blogger.com,1999:blog-2921751546142261491.post-51378806931562168282017-05-17T10:42:00.000-07:002017-05-17T10:42:02.017-07:00Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations (Hot topic article from Journal of COPD 2017)<div style="text-align: justify;">
<span style="font-size: x-large;">Chronic respiratory failure due to chronic obstructive pulmonary disease
(COPD) is an increasing problem worldwide. Many patients with severe
COPD develop hypoxemic respiratory failure during the natural
progression of disease. Long-term oxygen therapy (LTOT) is a
well-established supportive treatment for COPD and has been shown to
improve survival in patients who develop chronic hypoxemic respiratory
failure. The degree of hypoxemia is severe when partial pressure of
oxygen in arterial blood (PaO<sub>2</sub>) is ≤55 mmHg and moderate if PaO<sub>2</sub>
is between 56 and 69 mmHg. </span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1319918"><img alt="http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1319918" border="0" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg-CbkE4dZdGxl5p1F-2qyoCVeDHeLYIOdXSyjUy8y107OBDGHQjUjE5948KvKOCeKnPIQwHTPbPVVglJa1phEgXMethhWCLvZdBlIDOBo44hIBQ3aOB8mhzPym7ZpT6ZOfa3fSuzzGxY/s640/COPDpatient.jpg" width="640" /></a></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Although current guidelines consider LTOT
only in patients with severe resting hypoxemia, many COPD patients with
moderate to severe disease experience moderate hypoxemia at rest or
during special circumstances, such as while sleeping or exercising. The
efficacy of LTOT in these patients who do not meet the actual
recommendations is still a matter of debate, and extensive research is
still ongoing to understand the possible benefits of LTOT for survival
and/or functional outcomes such as the sensation of dyspnea,
exacerbation frequency, hospitalizations, exercise capacity, and quality
of life. Despite its frequent use, the administration of “palliative”
oxygen does not seem to improve dyspnea except for delivery with
high-flow humidified oxygen. This narrative review will focus on current
evidence for the effects of LTOT in the presence of moderate hypoxemia
at rest, during sleep, or during exercise in COPD.</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;">Full text link:</span></div>
<div style="text-align: justify;">
<span style="font-size: x-large;"><a href="http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1319918">http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1319918</a> </span></div>
Alexandru Corlateanuhttp://www.blogger.com/profile/13384977175688591045noreply@blogger.com2