Management of ventilator-associated pneumonia (VAP) caused by resistant gram-negative bacteria: which is the best strategy to treat?
Authors: Sarda C, Fazal F, Rello J Abstract Introduction: Treatment of ventilator-associated pneumonia (VAP) is a major challenge. The increase in multi-drug resistant bacteria has not been accompanied by the validation of new drugs, or by any new antimicrobial strategies to exploit the available agents. VAP due to Gram-negative bacteria has increased mortality, both due to the resistant pathogens themselves and due to inappropriate treatment. Local epidemiology, patients' characteristics and clinical responses provide the most important information for therapeutic decision-making. Moreover, data on VAP therapy due...
Source: Expert Review of Respiratory Medicine - June 19, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications.
Conclusion: Challenges with using and changing inhalers has meant this market has not followed other high-volume drug classes following patent loss. This is starting to change, with the situation monitored to enhance efficient prescribing alongside continued good quality care. PMID: 31189394 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - June 15, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

A comprehensive and practical approach to the management of idiopathic pulmonary fibrosis.
Authors: Moran-Mendoza O, Colman R, Kalluri M, Cabalteja C, Harle I Abstract Introduction: Idiopathic pulmonary fibrosis (IPF) is a debilitating, progressive, and fatal fibrotic pulmonary disease with a prognosis comparable to that of lung cancer. IPF management is a complex process that involves pharmacological and nonpharmacological interventions, extensive patient education, and addressing patient needs that change through the course of the illness. Areas covered: This review summarizes the key aspects of a multifaceted, multidisciplinary, individualized approach to IPF care that incorporates available treatment...
Source: Expert Review of Respiratory Medicine - June 12, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

The use of indwelling pleural catheters for the treatment of malignant pleural effusions.
This article will provide an overview of IPCs in MPE; how they're inserted, their indications, continuing management, complications and possible future applications. Expert Opinion IPCs should be considered first-line management of MPEs, alongside standard talc pleurodesis. Recognition of the advantages and disadvantages of each approach allows a more informed patient choice. It is recognized that the use of IPCs can provoke pleurodesis, leading to removal of the catheter. For patients in whom prompt removal of the catheter is a priority, then a more aggressive drainage regime or instillation of talc via the IPC is a reaso...
Source: Expert Review of Respiratory Medicine - June 12, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Lung tissue bioengineering for chronic obstructive pulmonary disease: overcoming the need for lung transplantation from human donors.
Authors: Skolasinski SD, Panoskaltsis-Mortari A Abstract Introduction: Chronic obstructive pulmonary disease (COPD) affects more than 380 million people, causing more than 3 million deaths annually worldwide. Despite this enormous burden, currently available therapies are largely limited to symptom control. Lung transplant is considered for end-stage disease but is severely limited by the availability of human organs. Furthermore, the pre-transplant course is a complex orchestration of locating and harvesting suitable lungs, and the post-transplant course is complicated by rejection and infection. Lung tissue bioen...
Source: Expert Review of Respiratory Medicine - June 7, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Novel dietary risk factors for asthma.
Authors: Varraso R, Camargo CA PMID: 31159622 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - June 5, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Immunodiagnosis of active tuberculosis.
Authors: Halliday A, Masonou T, Tolosa-Wright M, Mandagere V, Lalvani A Abstract Introduction: There is an unmet clinical need for improved diagnostic tests for active tuberculosis (TB) to provide high sensitivity for all cases, accelerate time to diagnosis and ensure timely and appropriate treatment. Whilst the measurement of M.tb-specific immune responses is widely used for detecting infection in the absence of TB symptoms (i.e. latent TB infection), there is currently no role for immunodiagnostics in active TB disease. This is primarily due to insufficient sensitivity, and an inability to discriminate between ac...
Source: Expert Review of Respiratory Medicine - May 29, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Pulmonary fibrosis: a disease of alveolar collapse and collagen deposition.
Authors: Snijder J, Peraza J, Padilla M, Capaccione K, Salvatore MM Abstract Introduction: Idiopathic pulmonary fibrosis (IPF) is a relentless form of fibrotic lung disease with a median survival of approximately 3 years after diagnosis and a mortality rate that surpasses that of many types of cancer. The pathophysiology of IPF is complex as there are likely different stages of disease occurring simultaneously in the lung. Areas covered: Some scientists consider IPF as primarily an epithelial driven disease in which dysfunctional surfactant-producing cells take an etiological precedent. Others focus on the augmente...
Source: Expert Review of Respiratory Medicine - May 25, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

An overview on clinical, pathological and molecular features of lung metastases from colorectal cancer.
Authors: Procaccio L, Bergamo F, Manai C, Di Antonio V, Fassan M, Zagonel V, Lonardi S, Loupakis F Abstract Introduction: Lung metastases occur in 10-20% of patients with colorectal cancer (CRC). Most of them are treated with palliative intent and have a poor prognosis. Pulmonary metastasectomy may be a curative option for carefully selected patients with 5-year survival rates ranging from 25% to 60%. However, up to 70% of patients develop recurrence after pulmonary metastasectomy. Therefore, the identification of prognostic factors is essential in CRC patients with resectable lung metastases. Areas covered: This r...
Source: Expert Review of Respiratory Medicine - May 25, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Combining immunotherapies to treat non-small cell lung cancer.
Authors: Spagnuolo A, Gridelli C Abstract Introduction: In recent years, immunotherapy has become an integral part of the treatment of many cancers, including non-small cell lung cancer (NSCLC). Precious therapeutic weapons impacting survival are monoclonal antibodies directed against the programmed death protein-1 (PD-1)/programmed death ligand-1 (PD-L1) immune checkpoint. Areas covered: Unfortunately, not all patients treated with checkpoint inhibitors have durable clinical responses. However, a better understanding of the complexity of interactions between the immune system and cancer, the latter capable of adop...
Source: Expert Review of Respiratory Medicine - May 23, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Challenges with optimizing nutrition in cystic fibrosis.
Authors: Colombo C, Nobili RM, Alicandro G Abstract INTRODUCTION: Optimizing nutrition remains the cornerstone of therapy for patients with cystic fibrosis (CF) since it is associated with better pulmonary function and survival. However, a significant proportion of patients still fail to achieve normal growth and nutritional status. Areas covered. This review describes the current challenges in providing effective nutritional therapy in CF with a focus on the current issues related to energy imbalance, dietary composition, adherence to nutritional recommendations, pancreatic enzyme replacement therapy, and the effe...
Source: Expert Review of Respiratory Medicine - May 18, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Minimally invasive surgical approaches for lung cancer.
Authors: Ujiie H, Gregor A, Yasufuku K Abstract INTRODUCTION: Surgery is the standard of care for early-stage non-small cell lung cancer (NSCLC), but there remains on an ongoing discussion as to what is the best surgical approach. Despite only modest adoption of minimally invasive surgery (MIS), it is now the favored approach over traditional open surgery. MIS techniques like video-assisted (VATS) and robot-assisted thoracoscopic surgery (RATS) have been demonstrated to reduce postoperative complications and shorten the length of hospitalization. Furthermore, despite unresolved questions of the oncological equivale...
Source: Expert Review of Respiratory Medicine - May 6, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Impact of current versus former smoking status on the outcomes of non-metastatic non-small cell lung cancer treated with upfront surgery; findings from the National Lung Screening Trial.
Authors: Abdel-Rahman O Abstract OBJECTIVE: To evaluate the impact of current versus former smoking status on the outcomes of non-metastatic non-small cell lung cancer (NSCLC) treated with upfront surgery. METHODS: This is a post-hoc analysis of patients diagnosed with NSCLC, stage I-III within the National Lung Screening Trial (NLST). Kaplan-Meier analysis and log-rank testing were used to delineate the impact of smoking status on overall and progression-free survival. Moreover, univariate and multivariate Cox regression analyses were utilized to assess factors predicting overall, lung cancer-specific and prog...
Source: Expert Review of Respiratory Medicine - May 6, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Lung cancer breath tests.
Authors: Haick H, Hashoul D PMID: 31043092 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - May 3, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Diagnosis and management of central sleep apnea syndrome.
Authors: Baillieul S, Revol B, Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Pépin JL Abstract INTRODUCTION: Central sleep apnea (CSA) syndrome has gained a considerable interest in the sleep field within the last 10 years. It is overrepresented in particular subpopulations such as patients with stroke or heart failure. Early detection and diagnosis, as well as appropriate treatment of central breathing disturbances during sleep remain challenging. Areas covered: Based on a systematic review of CSA in adults the clinical evidence and polysomnographic patterns useful for discerning central from obstruct...
Source: Expert Review of Respiratory Medicine - April 26, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Tobacco control - protecting future generations' lungs.
Authors: González-Marrón A, Martín-Sánchez JC, Martínez-Sánchez JM PMID: 31020876 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - April 26, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

The timing of chemotherapy in the management plan for medically operable early-stage malignant pleural mesothelioma.
Authors: Shohdy K, Abdel-Rahman O Abstract INTRODUCTION: Trimodality therapy (including surgery, chemotherapy and radiation therapy) represents an important management approach of early-stage malignant pleural mesothelioma (MPM). The oncological value, as well as the proper sequence of the three modalities, is still under investigations. Areas Covered: The article covers the timing of chemotherapy in the management plan either "neoadjuvant approach" or in the adjuvant setting. It evaluates also how to select patients for induction chemotherapy and how to assess the response to treatment. Expert Opinion: M...
Source: Expert Review of Respiratory Medicine - April 13, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Advances in spirometry testing for lung function analysis.
Authors: Lopes AJ Abstract INTRODUCTION: Spirometry, the most common lung function test, is used to evaluate individuals with respiratory complaints or known respiratory disease. However, its underutilization and the misinterpretation of its parameters are causes for concern. Areas covered: This review describes new spirometry-derived metrics, new reference equations, recent recommendations for presentation of results, recent spirometry-based prevalence studies, and technological advances in spirometry equipment. Expert Opinion: The underutilization of spirometry can be overcome by increasing access to portable, ha...
Source: Expert Review of Respiratory Medicine - April 13, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

What are the effects of rhinitis on patients with asthma?
Authors: Licari A, Manti S, Ciprandi G PMID: 30947587 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - April 6, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Spirometry reference equations for an adult middle eastern population.
CONCLUSION: Spirometric reference values were developed for a Middle Eastern adult population. PMID: 30942108 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - April 5, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Safety and efficacy of treatment with lumacaftor in combination with ivacaftor in younger patients with cystic fibrosis.
Authors: Cheng PC, Alexiou S, Rubenstein RC Abstract INTRODUCTION: Cystic fibrosis (CF) is the most common autosomal recessive disorder affecting approximately 70,000 people worldwide. The lack of functional cystic fibrosis transmembrane conductance regulator (CFTR) causes dysregulation of epithelial fluid transport in the lungs, gastrointestinal tract, and sweat glands. Areas covered: The most common disease-causing CFTR mutation, F508del, is present in nearly 75% of those affected and results in a defective protein. Therapies to improve the function of this mutant protein have the promise to reduce morbidity and ...
Source: Expert Review of Respiratory Medicine - April 2, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Pharmacogenomics of chronic obstructive pulmonary disease.
Authors: Hersh CP Abstract INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, which presents the opportunity for precision therapy based on genetics or other biomarkers. Areas covered: Alpha-1 antitrypsin deficiency, a genetic form of emphysema, provides an example of this precision approach to diagnosis and therapy. To date, research in COPD pharmacogenomics has been limited by small sample sizes, lack of accessible target tissue, failure to consider COPD subtypes, and different outcomes relevant for various medications. There have been several published genome-wide associatio...
Source: Expert Review of Respiratory Medicine - April 1, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Controversies when using mechanical ventilation in obese patients with and without acute distress respiratory syndrome.
Authors: Bonatti G, Robba C, Ball L, Silva PL, Rocco PRM, Pelosi P Abstract INTRODUCTION: As the prevalence of obesity increases, so does the number of obese patients undergoing surgical procedures and being admitted into intensive care units. Obesity per se is associated with reduced lung volume. The combination of general anaesthesia and supine positioning involved in most surgeries causes further reductions in lung volumes, thus resulting in alveolar collapse, decreased lung compliance, increased airway resistance, and hypoxemia. These complications can be amplified by common obesity-related comorbidities. In ot...
Source: Expert Review of Respiratory Medicine - March 30, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

First-line treatment of advanced non-small cell lung cancer with ALK rearrangement: State of the art and future development.
Authors: Rocco D, Della Gravara L, Battiloro C, Gridelli C Abstract Introduction Approximately 5% of all diagnosed non-small cell lung cancer (NSCLC) patients harbor a genetic rearrangement between the ALK and EML4 genes, representing a specific molecular, histological and clinical subgroup (ALK+ NSCLC). To date, upfront treatment with ALK-tyrosine-kinase inhibitors (ALK-TKIs) has replaced chemotherapy in the first line setting for this subset of patients with excellent results. However, all treated patients eventually develop acquired resistance mechanisms to these agents (mainly resistance mutations) and experien...
Source: Expert Review of Respiratory Medicine - March 30, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Exercise as a therapeutic intervention for people with cystic fibrosis.
This article summarises the most recent evidence regarding the use of exercise as a therapeutic intervention in CF and discusses some of the practical considerations for exercise prescription in this setting. Clinical trials in progress and future research priorities are outlined. Expert opinion: On the balance of available evidence, exercise is likely to assist in improving physical fitness and health-related quality of life (HRQOL) and may be associated with a slower rate of decline in respiratory function in CF. Limitations to current studies include small sample sizes, study durations insufficient to achieve a training...
Source: Expert Review of Respiratory Medicine - March 26, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Infection prevention and control in cystic fibrosis: a systematic review of interventions.
Authors: Rowbotham NJ, Palser SC, Smith SJ, Smyth AR Abstract INTRODUCTION: Cystic fibrosis is a life-limiting genetic condition characterized by recurrent pulmonary infection. Acquisition of infection can occur from environmental reservoirs, person-to-person transmission and from the healthcare environment. Primary prevention of infections through infection prevention and control measures is an important strategy in cystic fibrosis care. Areas covered: Here we present a systematic review of the evidence base around infection prevention and control in cystic fibrosis. We found 36 studies and 7 guidelines that met o...
Source: Expert Review of Respiratory Medicine - March 22, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Is long-term survival possible for patients with stage IV ALK+ non-small cell lung cancer?
Authors: Pacheco JM, Camidge DR PMID: 30892100 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - March 22, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

The role of immune checkpoint inhibitors in advanced non-small cell lung cancer.
Authors: Pistamaltzian NF, Georgoulias V, Kotsakis A Abstract INTRODUCTION: Cancer immunotherapy represents a major therapeutic breakthrough. Immune checkpoint inhibitors alone or in the context of a combination are considered the new standard of care in advanced non-small cell lung cancer (NSCLC). Areas covered: This review explains the biologic rationale behind the implementation of immune checkpoint inhibitors for the therapy of advanced NSCLC. It provides a detailed description of the clinical trials that have studied the various agents now in use and the results that lead to the currently approved indications....
Source: Expert Review of Respiratory Medicine - March 16, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Drowning is never dry.
Authors: Schmidt A, Hawkins S, Quan L PMID: 30817221 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - March 5, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Advances in synthetic lung surfactant protein technology.
Authors: Walther FJ, Gordon LM, Waring AJ PMID: 30817233 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - March 5, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

E-cigarette use and subsequent smoking in adolescents and young adults: a perspective.
Authors: Siddiqui F, Mishu M, Marshall AM, Siddiqi K PMID: 30822173 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - March 5, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Diagnosing and managing bronchiolitis obliterans in children.
Authors: Kavaliunaite E, Aurora P Abstract INTRODUCTION: Bronchiolitis obliterans (BO) is a chronic and irreversible obstructive lung disease leading to the obstruction and/or obliteration of the small airways. Three main BO entities are distinguished: post infectious BO (PIBO); BO post lung transplantation; and BO after bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT). All three entities are separate, however, there are similarities in histopathological characteristics and possibly in aspects of the development pathway. Areas covered: We review current evidence of bronchiolitis o...
Source: Expert Review of Respiratory Medicine - February 27, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Emerging approaches in pediatric mechanical ventilation.
Authors: Williams DC, Cheifetz IM Abstract INTRODUCTION: The use of mechanical ventilation is an invaluable tool in caring for critically ill patients. Enhancing our capabilities in mechanical ventilation has been instrumental in the ability to support clinical conditions and diseases which were once associated with a high mortality. Areas covered: Within this manuscript, we will look to discuss emerging approaches to improving the care of pediatric patients who require mechanical ventilation. After an extensive literature search we will provide a brief review of the history and pathophysiology of acute respiratory...
Source: Expert Review of Respiratory Medicine - February 27, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Emphysema: looking beyond alpha-1 antitrypsin deficiency.
Authors: Janssen R, Piscaer I, Franssen FM, Wouters EF Abstract INTRODUCTION: Distinct pathologies can cause chronic obstructive pulmonary disease (COPD). Emphysema is a COPD-phenotype characterized by destruction of lung parenchyma. Alpha-1 antitrypsin deficiency (AATD) is a genetic cause of emphysema, whereas smoking is the most important risk factor of non-AATD emphysema. A general underappreciation of non-AATD emphysema has hampered progress in the field, and clinical guidelines have prohibited the use of emphysema as a diagnosis. Non-AATD emphysema, however, is far from irrelevant as it associates with dyspnea...
Source: Expert Review of Respiratory Medicine - February 16, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Mechanisms how mucosal innate immunity affects progression of allergic airway disease.
Authors: Brasier AR Abstract INTRODUCTION: Activation of antigen-independent inflammation (a.k.a. the "innate" immune response (IIR)) plays a complex role in allergic asthma (AA). Although activation of the pulmonary IIR by aerosolized bacterial lipopolysaccharide early in life may be protective of AA, respiratory viral infections promote AA. The mechanisms how the mucosal IIR promotes allergic sensitization, remodeling, and altered epithelial signaling are not understood. Areas covered: This manuscript overviews: 1. Mechanistic studies identifying how allergens and viral patterns activate the mucosal IIR...
Source: Expert Review of Respiratory Medicine - February 6, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Is positive airway pressure therapy underutilized in chronic obstructive pulmonary disease patients?
Authors: Kulkarni H, Parthasarathy S Abstract INTRODUCTION: The role of noninvasive positive pressure ventilation (NIPPV) in patients with stable chronic obstructive pulmonary disease (COPD) in the home-setting remains controversial. Despite studies suggesting potential benefits, there is an apparent under-utilization of such therapy in patients with stable COPD in a domiciliary setting. Areas covered: The reasons for under-utilization in the home-setting are multi-factorial, and we provide our perspective on the adequacy of scientific evidence and implementation barriers that may underlie the observed under-utiliz...
Source: Expert Review of Respiratory Medicine - February 3, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Pleural infection: a closer look at the etiopathogenesis, microbiology and role of antibiotics.
Authors: Bedawi EO, Hassan M, McCracken D, Rahman NM Abstract INTRODUCTION: Pleural infection is a condition that continues to pose a significant challenge to respiratory physicians. We hypothesize that the main barriers to progress include limited understanding of the etiopathogenesis, microbiology and role of antibiotics in the pleural space. AREAS COVERED: PubMed was searched for articles related to adult pleural infection using the terms 'pleural infection', 'empyema' and 'parapneumonic'. The search focused on relevant literature within the last ten years, with any older citations used only to display conte...
Source: Expert Review of Respiratory Medicine - February 3, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Obstructive sleep apnoea and comorbidity - an overview of the association and impact of continuous positive airway pressure therapy.
Authors: McNicholas WT Abstract INTRODUCTION: Obstructive sleep apnoea (OSA) is highly prevalent and there is considerable evidence supporting an independent association with a wide range of co-morbidities including cardiovascular, endocrine and metabolic, neuropsychiatric, pulmonary, and renal. Areas covered: A PubMed search of all the recent literature relating to OSA and co-morbidities was undertaken to critically evaluate the potential relationships and possible benefit of continuous positive airway pressure (CPAP) therapy. Expert Commentary: The evidence supporting an independent association is stronger for so...
Source: Expert Review of Respiratory Medicine - January 31, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Scleroderma-related interstitial lung disease: principles of management.
Authors: Das A, Kumar A, Arrossi AV, Ghosh S, Highland KB Abstract INTRODUCTION: Interstitial lung disease (ILD) is the most common cause of mortality in systemic sclerosis; accounting for approximately 35% of deaths. Although immunosuppression is currently opted as first line therapy for scleroderma-related ILD (SSc-ILD), the benefits from it remain modest with concerns for systemic toxicity from long term use. Areas covered: We review the important facets in monitoring a patient with SSc-ILD, including recognizing various patterns of ILD, identifying those at risk for disease progression and discuss the strength ...
Source: Expert Review of Respiratory Medicine - January 30, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Caveolae, Caveolin-1 and Lung Diseases of Aging.
Authors: Wicher SA, Prakash YS, Pabelick CM Abstract INTRODUCTION: Flask-shaped plasma membrane (PM) invaginations called caveolae and their constitutive caveolin and cavin proteins regulate cellular function via plasma membrane and intracellular signal transduction pathways. Caveolae are present in a variety of cells in the lung including airway smooth muscle (ASM) where they interact with other proteins, receptors, and ion channels and thereby have the potential to affect both normal and disease processes such as inflammation, contractility, and fibrosis. Given their involvement in cell signaling, caveolae may pl...
Source: Expert Review of Respiratory Medicine - January 30, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Upper airway resistance syndrome 2018: non-hypoxic sleep disordered breathing.
Authors: Arnold WC, Guilleminault C Abstract INTRODUCTION: Upper airway resistance syndrome (UARS) as obstructive sleep apnea syndrome (OSAS) has been described as abnormal breathing during sleep, based on the recording technologies and knowledge of the time. These terms have advanced the field, but the question raised is are they still useful? Area Covered: Historically, the definition of UARS syndrome was aimed at recognizing pathology not covered by 'OSAS' and to prompt specialists to go further than the obvious. It was aimed also at pushing specialists to recognize pathologies earlier and to elicit research in ...
Source: Expert Review of Respiratory Medicine - January 30, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging.
Authors: Di Mango AL, Zanetti G, Penha D, Menna Barreto M, Marchiori E Abstract INTRODUCTION: Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrycosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in...
Source: Expert Review of Respiratory Medicine - January 24, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Diagnosis of asbestos-related lung diseases.
Discussion of quantitative asbestos exposure estimation and risk assessment, selection of the most appropriate imaging modality and frequency of imaging. Expert Commentary: Consideration of the future for asbestos-related lung disease includes screening those at highest risk particularly in relation to ongoing mining operations and the management of in-situ asbestos. In the future, screening programs designed with estimation of risk of malignancy, based on quantitative estimates of asbestos exposure, and smoking history are indicated. PMID: 30648431 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - January 18, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Advances in the diagnosis, treatment, and prevention of tuberculosis in children.
Authors: Furin J Abstract INTRODUCTION: Pediatric tuberculosis (TB) is a significant global health threat and is one of the top ten causes of death in children. There are a number of diagnostic, treatment, and preventive innovations that have been developed in the last decade for TB, however, these are out of reach for many children in the world. Areas covered: A comprehensive review of the literature on TB in children was done using PubMed and Ovid databases from January 1, 1996 up to October 31, 2018. Topic areas covered included diagnosis of TB, treatment of TB (including novel medications and regimens), prevent...
Source: Expert Review of Respiratory Medicine - January 18, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Diagnosis and first-line treatment of non-small cell lung cancer in the era of novel immunotherapy: recommendations for clinical practice.
Authors: De Marinis F, Barberis M, Barbieri V, Marchianò A, Gasparini S, Migliorino MR, Romano G, Spinnato F, Vitiello F, Gridelli C Abstract INTRODUCTION: In the era of personalized cancer therapy, the sampling of adequate tumor tissue for histologic diagnosis and genomic profiling is crucial, not only at the initial diagnosis but also in the event of resistant and recurrent disease when sequential biopsies may be required to evaluate somatic mutations and histologic changes. Areas covered: The identification of genetic driver alterations led to the selection of patients who are most likely to benefit from ...
Source: Expert Review of Respiratory Medicine - January 15, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Existing and emerging treatments for idiopathic pulmonary fibrosis.
Authors: Kolilekas L, Papiris S, Bouros D Abstract INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a progressive and invariable fatal interstitial lung disease. Current antifibrotic treatment halts disease progression but do not cure the disease itself. In the last decade, a substantial understanding in disease pathobiological mechanisms led to the development of numerous clinical trials testing promising pharmacologic agents. Areas covered: In this review, we summarize and discuss current and emerging pharmacological therapies for IPF and highlight the potential of different promising investigational compound...
Source: Expert Review of Respiratory Medicine - January 13, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Direct bronchoprovocation test methods: history 1945-2018.
CONCLUSIONS: The methacholine inhalation test is highly sensitive for a diagnosis of current asthma when symptoms under evaluation are clinically current and when methacholine is inhaled without deep inhalations. Under these circumstances, a methacholine PD20> 400 μg excludes current asthma with reasonable certainty. PD20 values>25 μg and ≤ 400 μg will have a variable specificity and positive predictive value for asthma which increases the lower the PD20 and the higher the pre-test probability for a diagnosis of asthma. A PD20 ≤ 25 μg has high specificity and low sensitivity for asthma. PMID: 30...
Source: Expert Review of Respiratory Medicine - January 13, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

Asthma patient satisfaction with different dry powder inhalers.
CONCLUSIONS: Specific satisfaction with inhaler was higher with EasyhalerTM in a homogeneous population of patients with moderate to severe asthma. However, the relationship between satisfaction with the inhaler and adherence and asthma control deserves more investigation. PMID: 30625015 [PubMed - as supplied by publisher] (Source: Expert Review of Respiratory Medicine)
Source: Expert Review of Respiratory Medicine - January 11, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

The role of ultrasound lung artefacts in the diagnosis of respiratory diseases.
Authors: Soldati G, Demi M, Smargiassi A, Inchingolo R, Demi L Abstract INTRODUCTION: Thoracic ultrasound is employed for the diagnosis of many thoracic diseases and is an accepted detection tool of pleural effusions, atelectasis, pneumothorax and pneumonia. However, the use of ultrasound for the evaluation of parenchymal lung disease, when the organ is still aerated, is a relatively new application. Areas covered: The diagnosis of a normal lung and the differentiation between a normally aerated lung and a lung with interstitial pathology is based on the interpretation of ultrasound artifacts universally known as A...
Source: Expert Review of Respiratory Medicine - January 10, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

An update on current and emerging treatments for pulmonary arterial hypertension in childhood and adolescence.
Authors: Wacker J, Weintraub R, Beghetti M Abstract INTRODUCTION: Pulmonary hypertension is a severe condition that can develop during childhood due to several different etiologies. During the last two decades, based on a better understanding of the underlying pathobiology leading to pulmonary arterial hypertension, targeted therapies have been developed and have improved the dreadful prognosis of the condition. However, curative therapy remains elusive. Areas covered: In this article, we will review the current available drugs in paediatric pulmonary arterial hypertension and discuss the recommended management str...
Source: Expert Review of Respiratory Medicine - January 8, 2019 Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research