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Editorial: Timely topical reviews on climate change, indoor air pollution, coalworkers’ pneumoconiosis, and chronic obstructive pulmonary disease
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil Varkey Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - January 30, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Exercise and lifestyle changes in pediatric asthma
Purpose of review The purpose of this review is to discuss the most recent studies on lifestyle interventions in pediatric asthma. We include studies on physical activity and exercise, sedentary time, nutrition, behavioral therapy and the role of schools. Recent findings Several small studies in children with asthma suggest that exercise interventions can improve aerobic fitness, asthma symptoms or control and quality of life. Existing evidence supports recommending higher intake of fruits and vegetables for asthma risk and control. In contrast, the ‘Western diet’ – high in refined grains, highly processed foods...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

How harmless are E-cigarettes? Effects in the pulmonary system
Purpose of review Electronic cigarettes have quickly risen to be the leading alternative nicotine source to tobacco. E-cigarette use is hard to research and regulate because of the novelty and rapid evolution of the devices and E-liquids. Epidemiological data on long-term usage is currently lacking, but in smaller cohort studies we are starting to understand the usage patterns and demographics of users, which differ depending on where the study takes place and the regulatory environment. The present review describes the current knowledge of the effects of E-cigarettes on the pulmonary system and knowledge of their usage ...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The burden of corticosteroid overload in severe and difficult to treat asthma: how to reduce this?
Purpose of review Severe asthma is a serious condition that requires an individualized approach combining several treatment agents administered simultaneously in order to reach adequate control. Glucocorticosteroid treatment, as the cornerstone of asthma pharmacotherapy, has great disease-controlling capability, although it may induce a vast amount of severe adverse effects. This review describes our current knowledge of the monitoring and managing options of these adverse effects and possibilities to prevent them, including new therapeutic options. Recent findings A large amount of new drugs is emerging, which may of...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The role of genomic profiling in identifying molecular phenotypes in obstructive lung diseases
Purpose of review The biology underlying asthma and chronic obstructive pulmonary disease (COPD) is heterogeneous. Targeting therapies to patient subgroups, or ‘molecular phenotypes’, based on their underlying biology is emerging as an efficacious treatment strategy. This review summarizes the role of airway sample gene expression profiling in understanding molecular phenotypes in obstructive lung disease. Recent findings Recent gene expression studies have reinforced the importance of Type two (T2) inflammation in asthma and COPD subgroups. Studies in asthma also suggest that the molecular phenotype with enhanced...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Precision medicine in severe pediatric asthma: opportunities and challenges
Purpose of review Severe pediatric asthma exerts a substantial burden on patients, their families and society. This review provides an update on the latest insights and needs regarding the implementation of precision medicine in severe pediatric asthma. Recent findings Biologicals targeting underlying inflammatory pathways are increasingly available to treat children with severe asthma, holding the promise to enable precision medicine in this heterogeneous patient population with high unmet clinical needs. However, the current understanding of which child would benefit from which type or combination of biologicals is ...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Anti-alarmin approaches entering clinical trials
Purpose of review The alarmins, thymic stromal lymphopoietin (TSLP), interleukin (IL)-25 and IL-33, are upstream regulators of T2 (type 2) inflammation and found to be expressed at high levels in airway epithelium of patients with T2 asthma. This review will summarize how alarmins regulate the inflamed asthmatic airways through previously described and newly identified mechanisms. Recent findings Alarmins drive allergic and nonallergic asthma through activation of innate lymphoid cell 2 (ILC2), which are a rich source of cytokines such as IL-5 and IL-13, with resulting effects on eosinophilopoeisis and remodelling, re...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The different faces of the macrophage in asthma
Purpose of review Asthma is a chronic inflammatory disease in which changes in macrophage polarization have been shown to contribute to the pathogenesis. The present review discusses the contribution of changes in macrophage function to asthma related to polarization changes and elaborates on possible therapeutic strategies targeting macrophage function and polarization. Recent findings Macrophage function alterations were shown to contribute to asthma pathology in several ways. One is by impaired phagocytosis and efferocytosis. Another is by changing inflammation, by altered (anti)inflammatory cytokine production and...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Can training induce inflammatory control in asthma, or is it symptom control only?
Purpose of review Exercise has shown to reduce asthma symptoms; however, the underlying mechanism for this improvement remains unclear. Improvement in inflammatory control could be the reason for this reduction in symptoms. This review discusses recent studies evaluating the effect of exercise on inflammatory control in patients with asthma. Recent findings New studies support that exercise is well tolerated and feasible regardless of intensity. Exercise seems to improve systemic low-grade inflammation, but consistency lacks when it comes to reduction in airway inflammation. Summary Physical exercise as an adjuvant...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

The impact of comorbidities on severe asthma
Purpose of review Severe asthma is often associated with numerous comorbidities that complicate disease management and affect patient's outcomes. They contribute to poor disease control and mimic asthma symptoms. Although some comorbidities such as obstructive sleep apnea, bronchiectasis, and chronic obstructive pulmonary disease are generally well recognized, many other may remain undiagnosed but may be detected in an expert specialist setting. The management of comorbidities seems to improve asthma outcomes, and optimizes therapy by avoiding overtreatment. The present review provides recent knowledge regarding the most...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Lost in transition: biomarkers of remodeling in patients with asthma
Purpose of review ‘Biomarkers of remodeling’ represent a loose collection of features referring to several biological adaptations of the lung to cope with stressing factors. In addition, remodel-’ing’ infers a dynamic process that would require a spatiotemporal resolution. This review focuses on different aspects of remodeling in pediatric and adult care. Recent findings This review will cover aspects of pediatric remodeling, adult remodeling and techniques and procedures to adequately assess remodeling across different age spectra. In pediatrics, the onset and first features of remodeling are discussed and th...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Precision medicine and treatable traits in chronic airway diseases - where do we stand?
Purpose of review To provide an update on the implementation of precision medicine, based on treatable traits and mechanisms, in the daily clinical management of chronic airways diseases. Recent findings Recent insights into the complex and heterogeneous nature of chronic airway diseases including chronic obstructive pulmonary disease (COPD) and asthma identified several clinical and inflammatory phenotypes. This shifted the management focus of these diseases away from the prototypic disease labels and paved the way for developing novel targeted therapies. The concept of precision medicine aims to link the right pati...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Ecological interactions in asthma: from environment to microbiota and immune responses
Purpose of review Asthma is a heterogeneous condition shaped not only by genetics but also host conditioning by environmental factors. Recognizing the ecological context of microbe-immune interactions across environments and body sites is a necessary step toward better understanding how human microbiota influence or drive the pathogenesis and pathophysiology of asthma in its various presentations. Recent findings There is increasing evidence of a critical role for microbiota in asthma pathogenesis and outcomes across various body compartments, including the upper and lower airways, and gut. We discuss recent studies f...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research

Epithelial dysfunction in chronic respiratory diseases, a shared endotype?
Purpose of review Epithelial barrier defects are being appreciated in various inflammatory disorders; however, causal underlying mechanisms are lacking. In this review, we describe the disruption of the airway epithelium with regard to upper and lower airway diseases, the role of epigenetic alterations underlying this process, and potential novel ways of interfering with dysfunctional epithelial barriers as a novel therapeutic approach. Recent findings A defective epithelial barrier, impaired innate defence mechanisms or hampered epithelial cell renewal are found in upper and lower airway diseases. Barrier dysfunction...
Source: Current Opinion in Pulmonary Medicine - November 28, 2019 Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research