Showing papers in "Expert Review of Respiratory Medicine in 2018"
TL;DR: This article reviews the literature addressing the relationship between obesity and lung function, and studies addressing how the mechanical and inflammatory effects of obesity might lead to changes in lung mechanics and pulmonary function in obese adults and children.
Abstract: Introduction: There is a major epidemic of obesity, and many obese patients suffer with respiratory symptoms and disease. The overall impact of obesity on lung function is multifactorial, r...
382 citations
TL;DR: The potential effect of anti-fibrotic therapy in the pre and post-transplant period is reviewed; and the factors that need to be considered in deciding between single lung and bilateral lung transplantation are discussed.
Abstract: Introduction: Idiopathic Pulmonary Fibrosis (IPF) is a unique type of interstitial pneumonia in which progressive fibrosis can ultimately result in respiratory failure and death. The median surviva...
105 citations
TL;DR: This review focuses on surgical, respiratory and critical care settings discussing the most significant changes over the past decade with an increased focus on rehabilitation across the care continuum and a shift away from providing predominately airway clearance in established disease populations but also providing this in emerging groups.
Abstract: Introduction: Cardiorespiratory physiotherapy is an evidence-based practice that has evolved alongside changes in medical and surgical management, analgesia, the ageing society and increasing comor...
61 citations
TL;DR: This review summarizes physiological mechanisms linking respiratory muscle dysfunction to dyspnea and exercise limitation in patients with chronic obstructive pulmonary disease and provides an overview of available therapeutic approaches to better maintain load-capacity balance of respiratory muscles during exercise.
Abstract: Introduction: Respiratory muscle dysfunction is common and contributes to dyspnea and exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Improving dynamic function o...
48 citations
TL;DR: This article will review the history, indications, contraindication, technique and complications of rigid bronchoscopy, and suggest that interventional pulmonologists must have training and develop expertise in this technique.
Abstract: Introduction: Rigid bronchoscopy is an invaluable tool for the management of airway disorders and an essential skill for an interventional pulmonologist. Since its introduction in the late 19th cen...
46 citations
TL;DR: This review highlights the important aspects of the diagnosis, workup, and surgical treatment of pediatric laryngotracheal stenosis as well as the application and feasibility of tracheal transplantation and replacement.
Abstract: Introduction: Laryngotracheal stenosis comprises a broad spectrum of congenital and acquired conditions that commonly cause pediatric airway obstruction. Although the majority of these cond...
42 citations
TL;DR: In this review, recent studies involving automated analysis of oximetry by means of advanced signal processing and machine learning algorithms are analyzed and Oximetry is a cost-effective tool for OSAS screening in patients showing high pretest probability for the disease.
Abstract: Introduction: Overnight oximetry has been proposed as an accessible, simple, and reliable technique for obstructive sleep apnea syndrome (OSAS) diagnosis. From visual inspection to advanced signal ...
37 citations
TL;DR: Tezacaftor is a CFTR corrector that was recently approved by the FDA to be used in combination with the first approved CFTR potentiator, ivacaftor, and is approved for a large number of non-F508del, residual function mutations that are predicted to respond based on in vitro testing.
Abstract: INTRODUCTION Cystic fibrosis (CF) is the most common, life-limiting autosomal recessive disease in Caucasians, and is caused by defects in production of the CFTR ion channel. Until recently, there were no available treatments targeting the disease-causing defects in CFTR but newly developed CFTR modulators are changing the course of disease in CF. The newest modulator, tezacaftor, is a CFTR corrector that was recently approved by the FDA to be used in combination with the first approved CFTR potentiator, ivacaftor. Areas covered: A detailed review of the clinical trials and published literature, focusing on safety and efficacy, leading to the approval of tezacaftor in CF. Expert commentary: Recent trials have demonstrated that the combination of tezacaftor-ivacaftor is a slightly superior combination to its predecessor, lumacaftor-ivacaftor, with respect to an increase in FEV1, adverse event profile, and drug-drug interactions. It is also approved for a large number of non-F508del, residual function mutations that are predicted to respond based on in vitro testing. The horizon for continued improvements in CFTR-targeted treatments is promising, with three-drug combinations currently in Phase 3 clinical trials, and other drugs with novel mechanisms of action being studied. Within the next 5 years, the vast majority of patients with CF are expected to have a modulator approved for their genotype.
37 citations
TL;DR: This review outlines the clinical evidence of the utility and safety of flexible bronchoscopy in the intensive care unit, as well as specific considerations, including practical points and potential complications, in critically ill patients.
Abstract: Introduction: Flexible bronchoscopy has been well established for diagnostic and therapeutic purposes in critically ill patients.Areas covered: This review outlines the clinical evidence of the utility and safety of flexible bronchoscopy in the intensive care unit, as well as specific considerations, including practical points and potential complications, in critically ill patients.Expert commentary: Its ease to learn and perform and its capacity for bedside application with relatively few complications make flexible bronchoscopy an indispensable tool in the intensive care unit setting. The main indications for flexible bronchoscopy in the intensive care unit are the visualization of the airways, sampling for diagnostic purposes and management of the artificial airways. The decision to perform flexible bronchoscopy can only be made by trade-offs between potential risks and benefits because of the fragile nature of the critically ill. Flexible bronchoscopy-associated serious adverse events are inev...
36 citations
TL;DR: This review article describes the different forms of patient–ventilator asynchrony and how they are classified and quantified, and describes the actions that can be undertaken in order to limit the rate of asynchronies during both invasive ventilation and NIV mechanical ventilation.
Abstract: Introduction: Patient–ventilator asynchrony may occur with modes of partial ventilatory support. Because this problem is associated with worsened outcomes, identifying and managing asynchronies has...
36 citations
TL;DR: To prevent VILI, mechanical ventilation strategies should minimize inspiratory/expiratory stress, dynamic/static strain, energy, mechanical power, and intensity, as well as mitigate the hemodynamic consequences of positive-pressure ventilation.
Abstract: Introduction: Mechanical ventilation is required to support respiratory function in the acute respiratory distress syndrome (ARDS), but it may promote lung damage, a phenomenon known as ventilator-...
TL;DR: Comprehensive scores incorporating clinical, lung function, imaging and laboratory data will become essential in the future for predicting disease progression and for use in clinical trials.
Abstract: Introduction: Progressive lung disease is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Methods of correctly predicting the future progression of lung disease in...
TL;DR: Evidence relevant to potential respiratory health effects that may result from inhalation of e-cigarette aerosols is synthesized using results from laboratory, observational, and clinical studies, to better understand respiratory health risks tied to use of these products.
Abstract: Introduction: Use of electronic cigarettes (e-cigarettes) is frequently promoted as a less harmful alternative to cigarette smoking. The impact of repeated inhalation of e-cigarette aerosols on res...
TL;DR: This review provides an update of the understanding of the role of dysfunctional CFTR in both respiratory diseases and suggests drugs developed for people with CF to improve mutant CFTR function and enhance CFTR ion channel activity might also be beneficial in patients with COPD.
Abstract: Introduction: Obstructive lung diseases such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are causes of high morbidity and mortality worldwide. CF is a multiorgan geneti...
TL;DR: Recent advances in the understanding of the relationships between respiratory microbiota and CF lung disease are reviewed and measures of airway bacterial community diversity and estimates of the relative abundance of anaerobic species are focused on.
Abstract: Introduction: Cystic fibrosis (CF) lung disease is characterized by chronic cycles of pulmonary infection, inflammation, and mucus obstruction, beginning early in life, and eventually leading to progressive lung damage and early mortality. During the past ~15 years, culture-independent analyses of CF respiratory samples have identified diverse bacterial communities in CF airways, and relationships between respiratory microbiota and clinical outcomes.Areas covered: This paper reviews recent advances in our understanding of the relationships between respiratory microbiota and CF lung disease. The paper focuses on measures of airway bacterial community diversity and estimates of the relative abundance of anaerobic species. Finally, this paper will review the opportunities for advancing patient care suggested by these studies and highlight some of the ongoing challenges and unmet needs in translating this knowledge into clinical practice.Expert commentary: Culture-independent analyses of respiratory m...
TL;DR: How evaluation of the disease-defining PHOX2B gene aids diagnosis and helps prognosticate disease severity, review disease physiology, describe clinical presentation and various aspects of autonomic nervous system dysregulation, review ventilatory strategies, and highlight current challenges in the care of these complex patients are discussed.
Abstract: Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare disorder defined by a failure in autonomic control of breathing secondary to mutations of the PHOX2B gene. Affected individuals demonstrate absent or diminished physiologic response to hypercapnia and hypoxia that is most severe during sleep as well as multi-system dysregulation of autonomic functions.Areas covered: In this review, we will discuss how evaluation of the disease-defining PHOX2B gene aids diagnosis and helps prognosticate disease severity, review disease physiology, describe clinical presentation and various aspects of autonomic nervous system dysregulation, review ventilatory strategies, and highlight current challenges in the care of these complex patients.Expert commentary: CCHS is a rare disorder that requires a high degree of vigilance. PHOX2B mutation is essential for diagnosis and also helps direct disease management. There is currently no pharmacologic treatment proven effective in improving disease-re...
TL;DR: The evolution of the currently used definition, established pathophysiological mechanism, highlights the current best clinical practice to treat ARDS, gives a brief outlook on cutting edge trends in ARDS research and closes with an expert opinion on the subject.
Abstract: Introduction: More than fifty years after the first description of acute respiratory distress syndrome (ARDS) by Ashbaugh and colleagues, no specific treatment of the underlying pathophysiological ...
TL;DR: Therapeutics targeting the NFkB-BRD4 may be efficacious in reducing pathological effects of acute exacerbations in chronic lung disease and the approaches to development and characterization of selective inhibitors of epigenetic reprogramming on innate inflammation and structural remodeling in preclinical models are detailed.
Abstract: Introduction: Acute exacerbations of chronic lung disease account for substantial morbidity and health costs. Repeated inflammatory episodes and attendant bronchoconstriction cause structural remod...
TL;DR: The definition of asthma phenotypes and possible endotypes, advances in allergy-immunology field and contemporary personalized therapy options for asthma are reviewed, indicating a new era termed as ‘precision medicine’.
Abstract: Asthma, a common, non-communicable chronic disease affects over 300 million individuals worldwide. The Western world lifestyle is claimed to be responsible for this high and increasing prevalence. Asthma has been defined as a syndrome with various phenotypes and endotypes, allergic asthma and type 2 asthma being the most frequent. A great increase in prevalence of allergic diseases has necessitated intensive investigations both for understanding the underlying mechanisms and for the development of novel therapy options with long-term efficacy and limited side-effects. Allergic patients demonstrate unique presentations with variable visible characteristics and disease outcomes depending on different molecular mechanisms, related to influence of genes and epigenetic control by micro- and macro-environment. Areas covered: This article reviews the definition of asthma phenotypes and possible endotypes, advances in allergy-immunology field and contemporary personalized therapy options for asthma. Expert commentary: Better understanding of the complex immune network of allergic inflammation and key players of immunity is continuously being provided for clarification of asthma sub-types. Successful therapy of asthma requires better definition of underlying pathogenesis, which sequentially could end up with 'custom-tailored' individualized, evidence-based and more precise therapy options; a new era termed as 'precision medicine'. Endotype, phenotype, theratype and biomarker terms arise as major keywords in precision/personalized medicine.
TL;DR: PII EPID SEPAR, Mallorca, Spain; President of the European Federation of Idiopathic Pulmonary Fibrosis and related Disorders (EU-IPFF) and the Spanish Association of Patients and Relatives with IPF (AFEFPI).
Abstract: Idiopathic pulmonary fibrosis (IPF) is a rare disease characterized by chronic, progressive, and irreversible interstitial lung fibrosis of unknown cause [1,2]. Main symptoms and signs include dysp...
TL;DR: Cognitive impairment is an important but an under-recognized extra-pulmonary feature of chronic obstructive pulmonary disease (COPD) and is related to the burden of disability, worse health outcomes, and impaired self-management.
Abstract: Introduction: Cognitive impairment (CI) is an important but an under-recognized extra-pulmonary feature of chronic obstructive pulmonary disease (COPD). It is related to the burden of disability, w...
TL;DR: Adjunctive corticosteroids are of benefit in the treatment and prevention of paradoxical HIV-tuberculosis immune reconstitution inflammatory syndrome and evidence of harm in the form of opportunist malignancy in those not prescribed antiretroviral therapy is found.
Abstract: Introduction: Inflammation, or the prolonged resolution of inflammation, contributes to death from tuberculosis. Interest in inflammatory mechanisms and the prospect of beneficial immune modulation...
TL;DR: This review addresses the wide variability in defining and reporting adherence to palivizumab prophylaxis across different studies and assesses whether a relationship exists in the outcomes reported in studies relative to the monthly adherence protocol as defined in published randomized controlled trials of the efficacy and safety of palivizer.
Abstract: Introduction: Palivizumab is a humanized monoclonal antibody used for respiratory syncytial virus (RSV) prophylaxis. RSV is the primary cause of lower respiratory tract infection in children aged <2 years, and can give rise to high-burden hospitalization and respiratory complications in later life. Adherence to a monthly dosing regimen, both in timing and injection number, is essential to sustain therapeutic levels of palivizumab and maintain protective status. Deviation from the approved dosing schedule may reduce the efficacy of palivizumab and increase the risk of breakthrough RSV infection and hospitalization.Areas covered: There is no standardized definition of adherence to palivizumab treatment. This review addresses the wide variability in defining and reporting adherence to palivizumab prophylaxis across different studies. The review assesses whether a relationship exists in the outcomes reported in studies relative to the monthly adherence protocol as defined in published randomized contr...
TL;DR: The protective effect of NAC against AECOPD seems to be related not only to its well-documented mucolytic activity but also to activation of antioxidant pathways, inhibition of pro-oxidant and inflammatory pathways, and modulation of human bronchial tone.
Abstract: Introduction: N-acetyl-l-cysteine (NAC), a derivative of the naturally occurring amino acid l-cysteine, is a mucolytic agent that may also act as an antioxidant by providing cysteine intracellularl...
TL;DR: This review shows that various genetic variants have been identified, but none are currently used to guide asthma treatment, and one of the most promising genetic variants is the Arg16 variant in the ADRB2 gene to guide LABA treatment in asthmatic children.
Abstract: Introduction: Asthmatic patients show a large heterogeneity in response to asthma medication. Rapidly evolving genotyping technologies have led to the identification of various genetic variants ass...
TL;DR: The results indicate that long-term follow-up of COPD patients using daily SpO2 spot checks is practically feasible and standardization of the measurements, data science techniques and advancing technology can still boost performance of telemonitoring applications.
Abstract: Introduction: Telemonitoring applications are expected to become a key component in future healthcare. Despite the frequent use of SpO2 measurements in telemonitoring of patients with chron...
TL;DR: Clinical trials of oral statins in asthma, lab investigations relevant to the systemic versus inhaled administration of statins, address the advantages and disadvantages of inhaled statin treatment, and answer the question: is there a role for inhaledstatins in the treatment of asthma.
Abstract: Introduction: Asthma manifests as chronic airflow obstruction with persistent inflammation and airway hyperresponsiveness. The immunomodulatory and anti-inflammatory properties of the HMG-CoA reduc...
TL;DR: Although the administration of fibrinolytics is not required in all cases, when necessary, recombinant t-PA in combination with deoxyribonuclease is the preferred therapy.
Abstract: Introduction: The management of infected pleural effusion is complex. Therapeutic resolution requires determining the following: appropriate antibiotic regimen, the need for pleural drainage, the o...
TL;DR: This review summarizes current prediction strategies as applied to OSA, covering diagnosis, consequences and treatment outcomes, as well as potential emergent areas of focus.
Abstract: Introduction: Obstructive sleep apnoea (OSA) is common disorder, under-diagnosed, and can be difficult to treat adequately across the lifespan. OSA is a heterogeneous disorder with different risk f...
TL;DR: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management and suggests individualized management for different subgroups of MPE patients should be a long-term research goal.
Abstract: Introduction: Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic surgery (VATS)) and non-surgical strategies are available. Clinicians should be aware of the evidence supporting the use of different modalities to guide treatment choice.Areas covered: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management.Expert commentary: Randomized clinical trials (RCTs) are needed to define the roles and benefits of VATS as existing literature is often flawed by selection bias. Three RCTs have failed to show benefits of VATS talc poudrage over bedside talc pleurodesis. VATS-pleurectomy offered no survival advantage in a RCT of mesothelioma patients. Modification of VATS techniques has reduced the invasiveness and associated risks. Future trials should compare VATS with contemporary, non-surgical approaches (especially combine...