- Emerging therapies in adult and paediatric bronchiectasis. [Review]
- RRespirology 2018 Sep 21
- Bronchiectasis is a chronic respiratory disorder characterized by persistent productive cough and recurrent chest infections secondary to permanent structural airway damage. The current treatment str...
Bronchiectasis is a chronic respiratory disorder characterized by persistent productive cough and recurrent chest infections secondary to permanent structural airway damage. The current treatment strategies for this debilitating disorder are limited to prompt antibiotic treatment of infective exacerbations and regular airway clearance techniques. Despite its high morbidity and associated mortality across all age groups, it has been a neglected area of research in respiratory medicine and there remain no licensed disease-modifying therapies. In this review, we have explored the numerous potential therapeutic targets to break the vicious cycle of infection and inflammation seen in these patients and the novel therapeutic agents that have been developed to target them. We have reviewed the role of novel anti-inflammatory agents designed to target the persistent neutrophilic inflammatory infiltrate seen in bronchiectatic airways, including neutrophil elastase inhibitors, CXCR2 (CXC chemokine receptor 2) antagonists, DPP-1 (dipeptidyl peptidase 1) inhibitors, PDE4 (phosphodiesterase 4) inhibitors and statins. Furthermore, we have explored novel targets to improve mucociliary clearance, namely ENaC (epithelial sodium channel) inhibitors, and discussed the potential of alternative antimicrobial strategies such as inhaled phages. Our review highlights the importance of a multi-faceted approach to bronchiectasis management, which aims not only to eradicate or suppress bronchial infection but also to break the cycle of persistent airway inflammation that results in progressive lung damage in these patients.
- Takotsubo cardiomyopathy triggered by influenza B. [Journal Article]
- PMPol Merkur Lekarski 2018 Aug 29; 45(266):67-70
- Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-ind...
Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-induced takotsubo cardiomyopathy (TC), all of them triggered by virus A influenza, have been reported so far. Another two TC cases after anti-influenza vaccination are also available in the literature. The authors describe a new case of TC, this time provoked by influenza B. An 89-year-old female with a history of hypertension and chronic obstructive pulmonary disease (COPD) was admitted due to a fever (39oC), muscle aches and cough. Pneumonia was excluded in chest X-ray while the test for influenza confirmed virus B infection, so she was given oseltamivir. On the second day of hospitalization, she developed severe HF. ECG showed new negative T waves in inferior and anterolateral leads coexisting with a moderate troponin I and marked brain natriuretic peptide release, while echocardiography revealed left ventricular (LV) apical ballooning with decreased ejection fraction (EF 24%) and global longitudinal strain (GLS -8.1%). Symptomatic treatment of HF was initiated. The symptoms of influenza resolved after 5 days. LV function began to improve after 4 days and became normal after 6 days (EF 58%, GLS -18.1%). Despite an advanced age and the coexisting disorders (COPD, mild cognitive impairment, possible neoplastic disease), the patient was discharged in stable clinical condition on day 10. The authors conclude that in the evaluation of cardiac complications of influenza, TC should be taken into account.
- Chronic respiratory symptoms and lung abnormalities among people with a history of tuberculosis in Uganda: a national survey. [Journal Article]
- CIClin Infect Dis 2018 Sep 18
- CONCLUSIONS: In Uganda, a history of TB was a strong predictor of respiratory symptoms and lung abnormalities, before older age and smoking. Eliminating TB disease could reduce the prevalence of chronic respiratory symptoms as much as eliminating smoking.
- Respiratory symptoms associated with eosinophilic esophagitis. [Review]
- PPPediatr Pulmonol 2018 Sep 20
- Eosinophilic esophagitis (EoE) is an atopic condition diagnosed based on eosinophilic infiltration in the esophagus and symptoms of esophageal dysfunction. Typical clinical manifestations of EoE incl...
Eosinophilic esophagitis (EoE) is an atopic condition diagnosed based on eosinophilic infiltration in the esophagus and symptoms of esophageal dysfunction. Typical clinical manifestations of EoE include feeding refusal, vomiting, and dysphagia however recent reports highlight an associations with extraesophageal symptoms. By definition the inflammatory response in EoE is restricted to the esophagus. However, accounts of symptoms such as chronic refractory cough, recurrent croup, hoarseness as well as subglottic stenosis, and an increase in otolaryngologic surgeries in patients with EoE raise the possibility of extraesophageal manifestations of the disease. These symptoms have been reported at times in the absence of typical gastrointestinal symptoms. While the condition is usually managed by gastroenterologist and/or allergist, the presence of extraesophageal symptoms and comorbid conditions may result in patients presenting initially to providers in other subspecialties such as pulmonology and otorhinolaryngology. The use of proton pump inhibitors and corticosteroids are part of the management of EoE. Awareness of the possibility of EoE before the empiric use of these therapies is important as there use can make identifying and diagnosing patients with EoE correctly challenging. We review the medical literature regarding extraesophageal manifestations of EoE and highlight the importance of awareness for subspecialist outside of gastroenterology and allergy for the condition.
- The prevalence of the defining features of primary ciliary dyskinesia within a cri du chat syndrome cohort. [Journal Article]
- PPPediatr Pulmonol 2018 Sep 20
- CONCLUSIONS: Clinicians should be aware of the genetic connection between CdCS and PCD. Non-informative genetic testing does not rule out PCD. CdCS patients with chronic respiratory symptoms may benefit from referral to specialized PCD diagnostic centers.
- WHAT IS A COPD EXACERBATION? CURRENT DEFINITIONS, PITFALLS, CHALLENGES AND OPPORTUNITIES FOR IMPROVEMENT. [Journal Article]
- EREur Respir J 2018 Sep 20
- Chronic Obstructive Pulmonary Disease (COPD) is a chronic illness that may be periodically punctuated by exacerbations, characterised by acute worsening of dyspnea, and/or cough and sputum production...
Chronic Obstructive Pulmonary Disease (COPD) is a chronic illness that may be periodically punctuated by exacerbations, characterised by acute worsening of dyspnea, and/or cough and sputum production, and/or increased sputum purulence. COPD exacerbations are common and carry with them important clinical and economic consequences including lost work productivity, increased utilisation of health care resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their goals of treatment of COPD to extend beyond improving lung function and symptoms and have also begun to address the importance of prevention and reduction of exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of exacerbations of COPD are imperfect and fraught with problems. The cardinal symptoms of an exacerbation of COPD are nonspecific and can result from acute cardio-respiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or sub-acute worsening of dyspnoea (≥5 using a 0-10 scale) sometimes but not necessarily accompanied by increased cough and/or sputum volume or sputum purulence. Necessary laboratory criteria for an exacerbation include: oxygen desaturation ≤4% below that of stable state, elevated circulating blood neutrophils or eosinophils (≥9000 neutrophils per mm3 or ≥2% blood eosinophils), and elevated CRP (≥3 mg·L-1), without evidence of pneumonia or pulmonary edema on the chest radiograph, and negative laboratory tests supportive of other etiologies. Herein, we will discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.
- Small Airway Obstruction, Dynamic Hyperinflation and Gas Trapping despite Normal Airway Sensitivity to Methacholine in Adults with Chronic Cough. [Journal Article]
- JAJ Appl Physiol (1985) 2018 09 20
- CONCLUSIONS: Individuals with COUGH develop dynamic hyperinflation and gas trapping comparable to individuals with ASTHMA despite less bronchoconstriction and smaller reductions in mid-to-late expiratory flows, which leads us to believe that COUGH is a distinct phenotype on the airway disease continuum.
- Current Indications for Transnasal Esophagoscopy: An American Broncho-Esophagological Association Survey. [Journal Article]
- AOAnn Otol Rhinol Laryngol 2018 Sep 21; :3489418800840
- CONCLUSIONS: TNE indications have not been well established. According to respondents from the American Broncho-Esophagological Association, TNE is most commonly used for dysphagia and laryngopharyngeal reflux and slightly less so for GER and head and neck cancer screening and surveillance. Several clinical indicators were identified that influence the decision to perform TNE.
- Prevalence of smoking in a psychiatric hospital and its relationship with respiratory symptoms and the prevalence of COPD. [Journal Article]
- IJInt J Chron Obstruct Pulmon Dis 2018; 13:2797-2804
- CONCLUSIONS: Smokers presented many more respiratory symptoms and chronic bronchitis but did not present a worse quality of life or physical activity due to their younger age and milder psychiatric involvement.
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- Prevalence of undiagnosed COPD in male patients with coronary artery disease: a cross-sectional study in Jordan. [Journal Article]
- IJInt J Chron Obstruct Pulmon Dis 2018; 13:2759-2766
- CONCLUSIONS: There was a high prevalence of COPD among male patients with CAD and most were underdiagnosed despite having respiratory symptoms. Male smokers with CAD and respiratory symptoms should be evaluated for airflow limitation and the presence of COPD.