Roflumilast combined with montelukast in asthma (free full text)

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

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

Free full text:

http://www.jacionline.org/action/showFullTextImages?pii=S0091-6749%2816%2900107-X

Link between cigarette smoking and COPD: whats new in 2016

Our new article was published in ‪#‎Pneumologia‬: from ‪#‎smoking‬ to ‪#‎COPD‬: current approaches

Chronic obstructive pulmonary disease (COPD) remains a leading cause of death all over the world. Even though it is the most intensely studied disease induced by cigarette smoking there are still incomplete researches concerning its pathophysiology and treatment. So far it has been determined the deleterious effects of the secreted molecules diversity and some feasible therapies for their diminution. 

Discouraged by the fact that autoimmunity represents a black box full of surprises, identifying an autoimmune origin in COPD induced by smoking might serve not only as a starting point for new research but also strengthens the relevance of smoking cessation in such patients. By establishing tighter connections among smoking and the autoimmune origin of COPD similar to well defined autoimmune diseases there will be achievable to direct COPD’s therapy toward different classes of medicine.
In what concerns the available approaches toward smokers with COPD, the vital step in defeating the disease and preventing other noxious effects of cigarette smoking, remains smoking cessation.

Full text:

https://www.researchgate.net/publication/299775809_From_smoking_to_COPD_-_current_approaches

Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor) (full text from BMJ)

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

Objective To assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs).

Design Open pragmatic parallel group randomised controlled trial.

Setting Primary care in UK.

Participants Adults (aged ≥18) registered with general practitioners, recruited by postal invitation.

Intervention Patients were randomised with computer-generated random numbers to access the intervention website (intervention) or not (control). The intervention tailored advice about the diagnosis, natural history, symptom management (particularly paracetamol/ibuprofen use) and when to seek further help.

Outcomes Primary: National Health Service (NHS) contacts for those reporting RTIs from monthly online questionnaires for 20 weeks. Secondary: hospitalisations; symptom duration/severity.

Results 3044 participants were recruited. 852 in the intervention group and 920 in the control group reported 1 or more RTIs, among whom there was a modest increase in NHS direct contacts in the intervention group (intervention 37/1574 (2.4%) versus control 20/1661 (1.2%); multivariate risk ratio (RR) 2.25 (95% CI 1.00 to 5.07, p=0.048)). Conversely, reduced contact with doctors occurred (239/1574 (15.2%) vs 304/1664 (18.3%); RR 0.71, 0.52 to 0.98, p=0.037). Reduction in contacts occurred despite slightly longer illness duration (11.3 days vs 10.7 days, respectively; multivariate estimate 0.60 days longer (−0.15 to 1.36, p=0.118) and more days of illness rated moderately bad or worse illness (0.52 days; 0.06 to 0.97, p=0.026). The estimate of slower symptom resolution in the intervention group was attenuated when controlling for whether individuals had used web pages which advocated ibuprofen use (length of illness 0.22 days, −0.51 to 0.95, p=0.551; moderately bad or worse symptoms 0.36 days, −0.08 to 0.80, p=0.105). There was no evidence of increased hospitalisations (risk ratio 0.25; 0.05 to 1.12; p=0.069).

Conclusions An internet-delivered intervention for the self-management of RTIs modifies help-seeking behaviour, and does not result in more hospital admissions due to delayed help seeking. Advising the use of ibuprofen may not be helpful. 

fulltext:

http://bmjopen.bmj.com/content/6/4/e009769.full?utm_content=buffer612f3&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

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

Acute hypercapnic respiratory failure in adults (AHRF) results from an inability of the respiratory pump, in concert with the lungs, to provide sufficient alveolar ventilation to maintain a normal arterial PCO₂. Co-existent hypoxaemia is usually mild and easily corrected. Conventionally, a pH <7.35 and a PCO₂ >6.5 kPa define acute respiratory acidosis and, when persisting after initial medical therapy, have been used as threshold values for considering the use of non-invasive ventilation. More severe degrees of acidosis, such as pH<7.25, have been used as a threshold for considering provision of IMV.

AHRF complicates around 20% of acute exacerbations of COPD. It signals advanced disease, a high risk of future hospitalisations and limited long-term prognosis. The median survival following recovery from AHRF was 1 year in a large case series. Around 12% of patients with hypercapnic COPD died during the index admission and this increased to 33% if the respiratory acidosis developed after hospitalisation. In asthma, acute hypercapnia also signals an increased risk of death and an increased likelihood of future life-threatening attacks. The same risks apply to AHRF complicating CF and bronchiectasis, although this has not been formally reported. In the neuromuscular and CWDs, including morbid obesity, respiratory pump failure is often insidious in its onset, but AHRF may be acute and unexpected. Acute on chronic ‘decompensated’ episodes of AHRF are more common and normally indicate the future need for domiciliary NIV. 

Full text:

http://thorax.bmj.com/content/71/Suppl_2/ii1.full.pdf+html

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

Our new article was published in ‪#‎Pneumologia‬: from ‪#‎smoking‬ to ‪#‎COPD‬: current approaches

Chronic obstructive pulmonary disease (COPD) remains a leading cause of death all over the world. Even though it is the most intensely studied disease induced by cigarette smoking there are still incomplete researches concerning its pathophysiology and treatment. So far it has been determined the deleterious effects of the secreted molecules diversity and some feasible therapies for their diminution. 

According to current studies more relevance gains the possible autoimmune origin of COPD and the epigenetic modifications. The idea of autoimmunity in smoking induced COPD began to be speculated with the discovery of autoantibodies in patient's serum, but there are some studies who consider antibody complexes that reside in the lung tissue as more relevant for future research. By developing the autoimmune aspect of COPD it will become possible to select more precise treatment strategies. The importance of epigenetic changes in this field might be appreciated starting with the fact of an existing connection between epigenetic modifications induced by maternal smoking and latter COPD development. This explains the tendency toward different drugs capable of restoring these transformations such as deacetylation agents expected also to prevent steroid resistance. Nevertheless smoking cessation remains as the indispensable approach for COPD treatment and prevention.
Keywords: COPD, smoking, epigenetic changes 

Full text:

https://www.researchgate.net/publication/299775809_From_smoking_to_COPD_-_current_approaches

World Allergy Week 2016

The World Allergy Organization invites you to participate in the sixth annual World Allergy Week from 4 to 10 April, 2016 on the theme of: Pollen Allergies – Adapting to a Changing Climate: climate change worsens allergies globally.

Warmer weather brings joy to most people but misery for hay fever (pollen allergy) sufferers. For 50 million people in the United States alone, spring means sneezing spasms, very itchy and watery eyes, itchy nose, inside of ears and roof of the mouth, and runny and congested nose.

The lengthening of pollen allergy seasons is introducing an increased intensity of aeroallergen exposure. Plants are producing more pollen which results in more pollen in the air and therefore increased exposure. Pollen allergy and other allergies, including allergy to molds, are increasing in prevalence and severity around the world and will continue to be a concern as temperatures rise and exposures increase.

During World Allergy Week 2016 you can learn more about this aspect of allergic disease and also help to increase awareness of the concerns.

The WAO website contains resources that can be useful in your activities and communications, and it will be continuously updated at www.worldallergyweek.org.