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

Dear friends we are happy to present you new article by world known experts in Respiratory Medicine Maria Gabriella Matera, Clive Page, Paola Rogliani, Luigino Calzetta, Mario Cazzola: Therapeutic Monoclonal Antibodies for the Treatment of COPD (article from last issue of Drugs journal)!

Chronic obstructive pulmonary disease (COPD) is a disorder characterized by a complex chronic inflammatory response that is largely poorly responsive to treatment with corticosteroids. Consequently, there is a huge need to find effective anti-inflammatory agents for the treatment of patients with this disease. Inhibition of cytokines and chemokines or their receptors using monoclonal antibodies (mAbs) could be a potential strategy to treat the inflammatory component of COPD. In this article, we review the therapeutic potential of some of these mAbs; however, to date there has been little or no therapeutic effect of any mAb directed against cytokines or chemokines in patients with COPD. This may reflect the complexity of COPD in which there is no dominant role for any single cytokine or chemokine. It is also likely that since the umbrella term COPD covers many endotypes having different underlying mechanisms, mAbs directed towards specific cytokines or chemokines should be tested in restricted and focused populations.

Full text:

http://link.springer.com/article/10.1007/s40265-016-0625-9?wt_mc=socialmedia.f

acebook.1.SEM.ArticleAuthorAssignedToIssue

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

Mesothelioma is a type of cancer that affects the mesothelium, a tissue that lines most of the body’s organs. The most common type is pleural mesothelioma, cancer of the pleura or lining of the lungs. This cancer is aggressive, takes years to develop into recognizable symptoms, and is often diagnosed only after it is too late to expect treatment to cure it. For most people, this terrible illness is a death sentence.

 

Causes and Risk Factors

Doctors and researchers cannot pinpoint an exact cause of mesothelioma, which is not a common type of cancer. It is likely an interaction of several factors that leads to the development of malignant tumors. These include genetics, environmental factors, lifestyle, and health. While the cause cannot be made definite, there is one huge risk factor for mesothelioma that stands apart from all others: asbestos exposure.

Asbestos is a natural mineral that has been used for hundreds of years in a number of applications from insulation to shipbuilding to car brakes. It has been used for so long and in so many different ways because it is very strong and resistant to heat. Because asbestos is fibrous, when it is broken apart, particles get in the air and can be inhaled.

It is this inhalation that is the number one risk factor for mesothelioma. People who worked in conditions that included asbestos fibers and inadequate safety gear are at serious risk for the cancer. It can take 20 years and more for the cancer to develop and show symptoms and too many people are surprised later in life with this terrible diagnosis.

 

Treatment for Mesothelioma

It is unfortunate that this type of cancer is so aggressive and often gets diagnosed in later stages; many people don’t survive and treatments may only extend a patients’ life a little longer. Still, many opt for treatments to live longer and to be more comfortable.Treatment options for pleural mesothelioma include surgery to remove the cancerous tissue or even an entire lung, chemotherapy or radiation to kill cancer cells, and clinical trials with new medications and therapies, including gene therapy.

 

Mesothelioma and Legal Action

Many people diagnosed with mesothelioma were exposed to asbestos at work. This especially includes people who worked on ships or in construction with asbestos insulation. Most of these workers who end up with this terrible type of cancer had no idea that they were exposed to asbestos fibers or that they were at risk. They feel wronged and many want justice.

Mesothelioma lawsuits continue to rise because of these people suffering from cancer. They are working with lawyers to sue their employers, to file claims, and to seek compensation from asbestos trust funds. Their employers failed in a responsibility to provide them with a safe workplace, and now they are getting both compensation and justice for their suffering.

 

A Survivor’s Story

Katherine Keys is a woman who battled the odds and won. Diagnosed with pleural mesothelioma at age 49, she was given just two years to live, even though the cancer was rated as stage 1. Determined to fight and survive, Katherine underwent surgery to remove her right lung along with its pleura. She also had radiation treatment for several months.

Katherine is in remission and is now down to only annual follow ups to make sure that the cancer has not returned. Losing a lung has been difficult and she experiences pain and certain limitations, but is happy to be alive. Her story is one that brings hope to others battling this terrible type of cancer.

 

EXERCISE-INDUCED BRONCHOCONSTRICTION IN ATHLETES (full text article)

Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. It can occur in patients with asthma as well in patients who were previously not diagnosed with the disease. 

Many studies have been performed in elite-level athletes that have documented prevalence of EIB varying between 30 and 70%, depending on the population, sport type, studied and methods implemented but no relationship were currently found regarding height, weight, age and gender. The clinical symptoms of EIB include coughing, wheezing, chest pain and dyspnoea following an exercise but can often can be absent or not noticed by the athlete. Further examination often reveals some degree of atopy. But it should be noted that self-reported symptoms are not always present and asymptomatic forms are very common. 

Highly trained athletes tend to be frequently and for a long period of time exposed to cold air during winter training, to pollen allergens in spring and summer, different chemical substances used as disinfectants in swimming pools. These factors probably explain why elite athletes so often have EIB. This condition is most commonly found in endurance sports, such as cycling, swimming, or long-distance running. The occurrences of exercise-induced bronchospasm vary from 3% to 35% and depend on testing environment, type of exercise used, and athlete population tested. Still the highest risk for developing EIB in swimmers may be even higher, being 36%-79%. 

Full text article:

https://www.researchgate.net/publication/297733949_Exercise-Induced_Bronchoconstriction_in_Athletes

Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? (Chest 2016 free full text)

Background  Problems with the use of inhalers by patients were noted shortly after the launch of the metered-dose inhaler (MDI) and persist today. We aimed to assess the most common errors in inhaler use over the past 40 years in patients treated with MDIs or dry powder inhalers (DPIs).

Methods  A systematic search for articles reporting direct observation of inhaler technique by trained personnel covered the period from 1975 to 2014. Outcomes were the nature and frequencies of the three most common errors; the percentage of patients demonstrating correct, acceptable, or poor technique; and variations in these outcomes over these 40 years and when partitioned into years 1 to 20 and years 21 to 40. Analyses were conducted in accordance with recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Strengthening the Reporting of Observational Studies in Epidemiology.
Results  Data were extracted from 144 articles reporting on a total number of 54,354 subjects performing 59,584 observed tests of technique. The most frequent MDI errors were in coordination (45%; 95% CI, 41%-49%), speed and/or depth of inspiration (44%; 40%-47%), and no postinhalation breath-hold (46%; 42%-49%). Frequent DPI errors were incorrect preparation in 29% (26%-33%), no full expiration before inhalation in 46% (42%-50%), and no postinhalation breath-hold in 37% (33%-40%). The overall prevalence of correct technique was 31% (28%-35%); of acceptable, 41% (36%-47%); and of poor, 31% (27%-36%). There were no significant differences between the first and second 20-year periods of scrutiny.
Conclusions  Incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years, pointing to an urgent need for new approaches to education and drug delivery.
Read more:
http://journal.publications.chestnet.org/article.aspx?articleid=2514047&resultClick=3

@respiratorydec supporting the #SentinelsofScience with @Publons this Peer Review Week 2016!

Publons is rewarding the heroes on the front lines of peer review for Peer Review Week 2016. Are you in the running? 

Expert peer reviewers are the Sentinels of Science. They protect the world from false findings that could set back advances in human knowledge by decades.

When researchers are committed to peer review, we discover cures, develop innovative technologies and realise human potential faster.

That’s why we’re saluting the Sentinels of Science for Peer Review Week 2016. At the end of Peer Review Week 2016, Publons will announce the top contributors to peer review over the past year, including the:

• Top 10% of reviewers for each discipline
• Top 3 overall contributors to peer review
• Top 3 peer review contributors from the top five reviewing countries (by number)
• Top 3 contributing editors (most manuscripts handled, by number)
• Top 3 recognition advocates (top 3 editors that have invited reviewers to add a review record to Publons).

The top 10% of reviewers in each discipline will each receive a Sentinel Badge on their profile, signifying their commitment on the front lines of peer review over the past year.

Winners in all other categories will receive prizes from our biggest ever prize pool, thanks to contributions from our partners at: Wiley, Digital Science, ScholarOne and more.

So make sure your Publons profile is up to date with all your expert reviewing and editorial activity and get recognised as a true Sentinel of Science!

Survival after Endobronchial Valve Placement for Emphysema: A 10-Year Follow-up Study (article from American Journal of Respiratory and Critical Care Medicine)

We are happy to present you A 10-Year Follow-up Study of Survival after Endobronchial Valve Placement for Emphysema recently published in American Journal of Respiratory and Critical Care Medicine! This is one of the first long term follow up studies of Endobronchial Valves in Emphysema.

There is no effective therapy for advanced emphysema at present. Hence, to find novel therapeutic methods is needed. In the past decade, the new technology of bronchoscopic lung volume reduction with endobronchial valves (EBV) has been applied to clinical. Concerns of the less invasive bronchoscopic techniques to treat emphysema to achieve the similar beneficial effects to LVRS have been developed. Bronchoscopic lung volume reduction with EBV are one-way blocking devices that stop entry of air into the most affected emphysematous zone during inspiration while allowing it to escape during expiration in order to induce lobar atelectasis.

There are published several randomized controlled trials suggesting the role of EBV in patients with severe emphysema. Some non-controlled studies also demonstrated clinical improvements in lung volumes, health status and exercise tolerance. 

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201604-0852LE?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.V7fkbaKbeUk

@respiratorydec believe Respiratory Research deserve a broader audience!!!! Join #mobilizeresearch by Kudos

Respiratory decade believe Respiratory Research deserve a broader audience!!!! Join #mobilizeresearch campaign by Kudos!

Kudos is a web-based service that helps researchers and their institutions and funders to maximize the visibility and impact of their published articles. Kudos provides a platform for assembling and creating information to help search filtering, for sharing information to drive discovery, and for measuring and monitoring the effect of these activities. 

more info: https://blog.growkudos.com/2016/08/16/join-our-campaign-to-mobilize-research/

Research can only reach its full potential if it is found, understood and applied – by those within the field, by researchers in other disciplines, by practitioners outside academia, even by the “curious public”. Taking a little time to increase the visibility of work is rising up the priority list for many researchers.

 

At Kudos, we’ve spent the last two years helping researchers explain and share their work to broaden its audience. A recent study has shown that usage of our tools is correlated to 23% higher usage of the publications being explained and shared.

Now, we’re putting our money where our mouth is and launching the “mobilization pledge” for researchers who share our belief that research deserves a broader audience. We’ll donate one penny to Open Knowledge International for everyone who signs up to the pledge by tweeting their commitment (#mobilizeresearch) or by disseminating their work via Kudos.

The campaign will run from now until the end of the year – but don’t wait! The sooner you join the campaign, the sooner you can help the word spread far and wide and ensure that we will be digging deep at the end of the year!

Sign up to “mobilize research” now – by doing one or both of the following:

• Disseminate your work via Kudos. We will count all shares from now to December towards the pledge. This way, you get to give the visibility of your work a boost in the process.
• Post a tweet with the hashtag #mobilizeresearch. Yes, if you do both, we will count it twice – and you will be helping to spread the word even more effectively.  

Prevalence and burden of comorbidities in COPD (article from Respiratory Investigation, 2016)

Dear Respiratory friends we are happy to present you our new article on Prevalence and burden of comorbidities in COPD which appeared today in Respiratory Investigation.

Abstract

The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. 

These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.

Full text:

http://www.respiratoryinvestigation.com/article/S2212-5345(16)30070-3/fulltext

on Researchgate:

https://www.researchgate.net/publication/305995597_Prevalence_and_burden_of_

comorbidities_in_Chronic_Obstructive_

Pulmonary_Disease

Fevipiprant, a prostaglandin D2 receptor 2 antagonist, in patients with persistent eosinophilic asthma (Lancet article)

The clinical trial of Fevipiprant, conducted by experts at Leicester University, found that it led to a big drop in the the symptoms of asthma, improved sufferers’ lung function, reduced inflammation of the lungs and also helped to repair the lining of patients’ airways.

Background

Eosinophilic airway inflammation is often present in asthma, and reduction of such inflammation results in improved clinical outcomes. We hypothesised that fevipiprant (QAW039), an antagonist of prostaglandin D₂ receptor 2, might reduce eosinophilic airway inflammation in patients with moderate-to-severe eosinophilic asthma.

Methods

We performed a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial at Glenfield Hospital (Leicester, UK). We recruited patients with persistent, moderate-to-severe asthma and an elevated sputum eosinophil count (≥2%). After a 2-week single-blind placebo run-in period, patients were randomly assigned (1:1) by the trial pharmacist, using previously generated treatment allocation cards, to receive fevipiprant (225 mg twice per day orally) or placebo, stratified by the use of oral corticosteroid treatment and bronchoscopy. The 12-week treatment period was followed by a 6-week single-blind placebo washout period. The primary outcome was the change in sputum eosinophil percentage from baseline to 12 weeks after treatment, analysed in the intention-to-treat population. All patients who received at least one dose of study drug were included in the safety analyses. This trial is registered with ClinicalTrials.gov, number NCT01545726, and with EudraCT, number 2011-004966-13.

Findings

Between Feb 10, 2012, and Jan 30, 2013, 61 patients were randomly assigned to receive fevipiprant (n=30) or placebo (n=31). Three patients in the fevipiprant group and four patients in the placebo group withdrew because of asthma exacerbations. Two patients in the fevipiprant group were incorrectly given placebo (one at the mid-treatment visit and one throughout the course of the study). They were both included in the fevipiprant group for the primary analysis, but the patient who was incorrectly given placebo throughout was included in the placebo group for the safety analyses. Between baseline and 12 weeks after treatment, sputum eosinophil percentage decreased from a geometric mean of 5·4% (95% CI 3·1–9·6) to 1·1% (0·7–1·9) in the fevipiprant group and from 4·6% (2·5–8·7) to 3·9% (CI 2·3–6·7) in the placebo group. Compared with baseline, mean sputum eosinophil percentage was reduced by 4·5 times in the fevipiprant group and by 1·3 times in the placebo group (difference between groups 3·5 times, 95% CI 1·7–7·0; p=0·0014). Fevipiprant had a favourable safety profile, with no deaths or serious adverse events reported. No patient withdrawals were judged by the investigator to be related to the study drug.

Interpretation

Fevipiprant reduces eosinophilic airway inflammation and is well tolerated in patients with persistent moderate-to-severe asthma and raised sputum eosinophil counts despite inhaled corticosteroid treatment.

Full text:

http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(16)30179-5/abstract

2016 Clinical Practice Guideline From the American College of Physicians - Management of Chronic Insomnia Disorder in Adults (free full text)

Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of chronic insomnia disorder in adults.

Methods: This guideline is based on a systematic review of randomized, controlled trials published in English from 2004 through September 2015. Evaluated outcomes included global outcomes assessed by questionnaires, patient-reported sleep outcomes, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with chronic insomnia disorder. This guideline grades the evidence and recommendations by using the ACP grading system, which is based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Recommendation 1: ACP recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder. (Grade: strong recommendation, moderate-quality evidence)
Recommendation 2: ACP recommends that clinicians use a shared decision-making approach, including a discussion of the benefits, harms, and costs of short-term use of medications, to decide whether to add pharmacological therapy in adults with chronic insomnia disorder in whom cognitive behavioral therapy for insomnia (CBT-I) alone was unsuccessful. (Grade: weak recommendation, low-quality evidence)
Free full text:
http://annals.org/article.aspx?articleid=2518955
 

2016 Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea (free full text)

The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients’ conditions, extent of interventions and available resources. 

This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

Free full text:

http://journals.lww.com/anesthesia-analgesia/Fulltext/2016/08000/Society_of_Anesthesia_and_Sleep_Medicine.22.aspx

Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study (video abstract and full free text from Journal of COPD)

Dear Respiratory Friends, we are happy to present you fresh article Impact of anemia on short-term survival in severe COPD exacerbations: a cohort study from Journal of COPD by our Turkish friends Begum Ergan and Recai Ergün!!!

Purpose: Anemia is reported to be an independent predictor of hospitalizations and survival in COPD. However, little is known of its impact on short-term survival during severe COPD exacerbations. The primary objective of this study was to determine whether the presence of anemia increases the risk of death in acute respiratory failure due to severe COPD exacerbations.

Patients and methods: Consecutive patients with COPD exacerbation who were admitted to the intensive care unit with the diagnosis of acute respiratory failure and required either invasive or noninvasive ventilation (NIV) were analyzed.

Results: A total of 106 patients (78.3% male; median age 71 years) were included in the study; of them 22 (20.8%) needed invasive ventilation immediately and 84 (79.2%) were treated with NIV. NIV failure was observed in 38 patients. Anemia was present in 50% of patients, and 39 patients (36.8%) died during hospital stay. When compared to nonanemic patients, hospital mortality was significantly higher in the anemic group (20.8% vs 52.8%, respectively; P=0.001). Stepwise multivariate logistic regression analysis showed that presence of anemia and NIV failure were independent predictors of hospital mortality with odds ratios (95% confidence interval) of 3.99 ([1.39–11.40]; P=0.010) and 2.56 ([1.60–4.09]; P<0.001), respectively. Anemia was not associated with long-term survival in this cohort.
Conclusion: Anemia may be a risk factor for hospital death in severe COPD exacerbations requiring mechanical ventilatory support. 

Full text:

https://www.dovepress.com/impact-of-anemia-on--short-term-survival-in-severe-copd-exacerbations--peer-reviewed-fulltext-article-COPD

Are you attending the most important European Respiratory Society meeting?

Welcome from ERS President Jørgen Vestbo 

It is a true pleasure to be hosting the 26th International Congress of the European Respiratory Society in London.

The ERS International Congress has grown to be the largest meeting in the world in the respiratory field and this year's event will not disappoint. The Chairs of the Scientific and Educational Councils, together with all ERS Officers, are busy preparing a programme that will challenge our thinking minds, encourage debate and offer new insights across the spectrum of respiratory health and disease.The ERS International Congress has grown to be the largest meeting in the world in the respiratory field and this year's true pleasure to be hosting the 26th International Congress of the European Respiratory Society in London.

We extend a special welcome to our existing and new members as we have seen our numbers rise this year with more partnerships developed with national and international societies. The Congress is the pinnacle of the year for our growing respiratory community, and others who attend our Congress, and represents a key opportunity to share knowledge across borders and professional disciplines as we work towards a common goal of improving respiratory health.

This year will see the most interactive Congress experience available. Alongside our official Congress app, we will partner with SpotMe, a highly effective networking app available for free for all delegates. The app will allow you to navigate the programme, network, access session materials, use the interactive floor plan and exhibition map, interact with faculty, access CME points, collect Congress materials, watch missed sessions and much more. More information on this will be shared on the website and in our newsletter.

Also, the venue is spectacular. It offers lots of space, also for sitting down with colleagues and collaborators for networking – one of the main attractions for coming to an ERS International Congress.

I look forward to welcoming you to London for the most exciting event in the respiratory calendar.

Professor Jørgen Vestbo

AACE/ACE CLINICAL PRACTICE GUIDELINES 2016 FOR COMPREHENSIVE MEDICAL CARE OF PATIENTS WITH OBESITY (full text)

American association of clinical endocrinologists and American college of endocrinology published recently clinical practice guidelines for comprehensive medical care of patients with obesity! Take a look sleep apnea and asthma are included for obligatory screening!

Obstructive sleep apnea
• R21. All patients with overweight or obesity should be evaluated for obstructive sleep apnea during medical history and physical examination; this is based on the strong association of these disorders with each other (Grade B; BEL 2).
Polysomnography and other sleep studies, at home or in a sleep lab, should be considered for patients at high risk for sleep apnea based on clinical presentation, severity of excess adiposity, and symptomatology (Grade D). All patients with
obstructive sleep apnea should be evaluated for the presence of overweight or obesity (Grade B; BEL 2).

Asthma/reactive airway disease
• R22. All patients with overweight or obesity should be evaluated for asthma and reactive airway disease based on the strong association of these disorders with each other (Grade B; BEL 2). Based on medical history, symptomatology, and
physical examination, spirometry and other pulmonary function tests should be considered for patients at high risk for asthma and reactive airway disease (Grade D). All patients with asthma should be evaluated for the presence of
overweight or obesity (Grade D).

full text links:

Executive summary:

https://www.aace.com/files/guidelines/ObesityExecutiveSummary.pdf 

Algorithm

https://www.aace.com/files/guidelines/ObesityAlgorithm.pdf