Is the mesenchymal stem cell a new hope for the management of COPD?
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and inflicts substantial public health challenge for all human beings. It is characterized by destructive emphysematous changes and thickened bronchiolar walls with inflammation infiltration and luminal mucus occlusion. Current therapies can partly alleviate respiratory symptoms, but not prevent disease progression or reduce mortality. Therefore, novel approaches with less adverse reactions and more therapeutic effects are desperately needed for COPD. Stem cells with rigorous differentiation and r...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
Tailoring of corticosteroids in COPD management
Abstract
This literature review updates the reader on the new studies regarding steroid therapy over the last year in stable COPD and in exacerbations. In stable COPD, we critique the 2011 update and 2013 revision of the GOLD guidelines, discuss why combining inhaled corticosteroids (ICS) with long-acting beta-agonists (LABA) (ICS/LABA) is preferable over LABA alone and review the literature for intraclass differences, finding that the evidence does not clearly support superiority of any particular ICS/LABA. We also address other comparisons against ICS/LABA, including triple therapy. We briefly review ...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
Lung transplantation for interstitial lung disease
Abstract
There have been over 120 diffuse parenchymal lung diseases (DPLD) identified, and these diseases have similar clinical and pathological findings. These diseases are associated with autoimmune disorders, environmental or drug exposures, or are idiopathic in nature. Unfortunately, many of these diseases have limited effective therapies and may require lung transplantation for ongoing survival. Because of changes that have been made in lung allocation, lung transplantation in patients with DPLD is becoming more common. For successful lung transplantation, the DPLD patient requires optimized global...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
Lung transplantation for scleroderma-related lung disease
Abstract
Lung transplantation for scleroderma-related lung disease is considered a controversial procedure due to extrapulmonary organ involvement that may threaten allograft and patient survival after transplant surgery. Despite concerns, however, several lung transplant programs do offer this option for patients with scleroderma-related lung disease. In this review, we evaluate the scleroderma-related extrapulmonary organ involvement that may result in poorer outcomes as well as the existing evidence on survival, freedom from bronchiolitis obliterans syndrome (BOS), and other important clinical outcom...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
Personalized medicine in COPD treatment
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease, and not all patients respond to all currently available drugs. The importance of personalized treatment of COPD is increasingly recognized. The new GOLD guidelines have moved the principles of treatment of stable COPD forward by including concepts of symptoms and risks into the decision for therapy. COPD phenotypes are the basis of personalized treatment in clinical practice. Consensus has been reached concerning several phenotypes: phenotypes according to the evaluation of image; the frequent exacerbator and infrequent ex...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
Immunosuppression for lung transplant recipients
Abstract
The choices and extent of immunosuppression critically affect subsequent infection and rejection profiles after lung transplantation (LTx). Evidence does not support a particular induction strategy. Typically, a three drug regimen of a calcineurin inhibitor, cell cycle inhibitor, and corticosteroids provide LTx maintenance immunosuppression. Other agents (including mTOR inhibitors), and other routes of administration (sublingual or inhaled) tend to be held back for specific clinical problems. Treatment of acute cellular rejection with high dose corticosteroids is usually successful. By contrast...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
Chronic lung allograft dysfunction
Abstract
The recognition that chronic graft dysfunction after lung transplantation is a heterogeneous phenomenon has led to the introduction of a new term: chronic lung allograft dysfunction (CLAD). An International Society for Heart and Lung Transplantation working group will determine a definition of CLAD in 2014. It is thought that CLAD should not totally replace bronchiolitis obliterans syndrome (BOS), the conventional phenotype of chronic graft dysfunction, but that it should be a more comprehensive category that includes BOS as a purely obstructive disorder. Another phenotype to be included is res...
Source: Current Respiratory Care Reports - September 1, 2014 Category: Respiratory Medicine Source Type: research
The role of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal processes other than lung cancer
Abstract
The role of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration has expanded to include diseases other than lung cancer. In isolated mediastinal adenopathy with a low likelihood of lung cancer, EBUS has sensitivity of 92 %, and can prevent unnecessary mediastinoscopies. The procedure has an established use in sarcoidosis (overall diagnostic yield of 79 %) and in TB lymphadenitis with negative routine cultures. While the evidence in support of EBUS in lymphoma is not as robust, the technique may be used as a minimally invasive first-line diagnostic test. Novel roles for EBUS,...
Source: Current Respiratory Care Reports - August 15, 2014 Category: Respiratory Medicine Source Type: research
Indwelling pleural catheters for benign pleural effusions
Abstract
Indwelling pleural catheters (IPCs) have an established role in the management of recurrent pleural effusions due to malignancy. They are typically used in patients with trapped lung, those who have previously failed an attempted talc pleurodesis, or as first-line therapy. Experience of, and evidence for, IPC use in this setting is well established. In contrast, IPC use in patients with recurrent pleural effusions due to benign disease is limited, and there are no randomized studies evaluating their efficacy and safety in this patient group. Retrospective data suggest that IPCs may be effective...
Source: Current Respiratory Care Reports - June 1, 2014 Category: Respiratory Medicine Source Type: research
Parapneumonic effusions: epidemiology and predictors of pleural infection
Abstract
The development of a pleural effusion represents a common complication of pneumonia. Clinically there is a recognised spectrum of effusions from simple parapneumonic, which typically resolve without requiring intervention other than antibiotic treatment, to complicated parapneumonic effusions associated with bacterial infection and inflammatory cell infiltration, through to empyema, with the presence of frank pus in the pleural space. It was previously believed that no clinical features could identify patients at risk of pleural infection, but recent research suggests this is not the case. Pati...
Source: Current Respiratory Care Reports - June 1, 2014 Category: Respiratory Medicine Source Type: research
Imaging of pleural effusions: a pictorial review
Abstract
In the majority of pleural effusions, chest radiograph and transthoracic ultrasonography (TUS) are sufficient for clinical management. TUS is able to identify very small volumes of fluid, suggest a malignant etiology, and guide pleural procedures. Computed tomography is of particular value in pleural effusions of uncertain etiology, whereas positron emission tomography and, specifically, magnetic resonance imaging are solely indicated for very select cases. This pictorial review addresses the main radiological signs of frequently encountered causes of pleural effusions. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - June 1, 2014 Category: Respiratory Medicine Source Type: research
Pleural ultrasound-guided interventions: advances and future potentials
Abstract
Transthoracic ultrasonography is an essential tool for the diagnosis and investigation of pleural disease. It can identify and characterise pleural effusions, pleural thickening and pleurally based masses, and ultrasound guidance has become standard of care for transthoracic procedures such as pleurocentesis and thoracostomy tube insertion. Ultrasound-assisted fine needle aspiration and closed pleural biopsy (Abrams or cutting needle) of lesions arising from the pleura are safe procedures with high diagnostic yield. Transthoracic ultrasound performed by clinicians confidently excludes pneumotho...
Source: Current Respiratory Care Reports - June 1, 2014 Category: Respiratory Medicine Source Type: research
Sleep in intensive care units
Abstract
Patients admitted to intensive care units (ICU) have significantly disrupted sleep with circadian displacement. In this article we briefly discuss factors related to sleep disruption in ICU and the tasks of individual members of ICU multidisciplinary teams in promoting consolidated nocturnal sleep of critically ill patients. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - June 1, 2014 Category: Respiratory Medicine Source Type: research
Immunotherapy for non-small-cell lung cancer: current approaches
Abstract
Lung cancer has long been regarded as a poor candidate for immunotherapy, because it has a relatively low content of tumor-infiltrating lymphocytes compared with, for example, melanoma. However, new developments in immunotherapy are about to change this situation. Therapeutic vaccines are different from the well-known prophylactic vaccines, in that they are designed to treat patients already suffering from a disease instead of preventing the disease in healthy individuals. Several therapeutic vaccines are in late-stage clinical development for non-small-cell lung cancer (NSCLC). These vaccines ...
Source: Current Respiratory Care Reports - March 1, 2014 Category: Respiratory Medicine Source Type: research
Transbronchial cryobiopsy in diffuse lung disease
Abstract
Transbronchial biopsy is required for evaluation of some patients with interstitial lung disease (ILD). The diagnostic success of histopathologic assessment is variable, and affected by such factors as specimen size and the presence of crush artifact attributable to the use of conventional biopsy forceps. Use of cryoprobes to perform transbronchial biopsy enables larger and better quality samples to be obtained compared with conventional methods. The safety profile of transbronchial cryobiopsy is similar to that of transbronchial biopsy with forceps. Diagnostic success of histopathology seems h...
Source: Current Respiratory Care Reports - March 1, 2014 Category: Respiratory Medicine Source Type: research
