Respiratory Decade

2018 GINA Severe Asthma Pocket Guide: Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients

2018-11-19T08:38:00.000-08:00

GINA has added an important addition to the resources that we offer to assist practitioners treating patients with asthma. A new Pocket Guide, “Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients” is now available on the GINA website, www.ginasthma.org. Embracing the issue of severe asthma was a critical goal for the GINA Board of Directors and Science Committee, as their mission remains focused on maximizing benefit for patients with asthma whilst minimizing healthcare provider burden.

Prof. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, stated “Difficult-to-treat and severe asthma are high priority issues because of the physical, emotional and financial burden for patients and their families, and the impact on primary and specialist healthcare systems. Clinicians in both low and high income countries need practical advice about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care.”
The need for a practical resource addressing severe asthma was made apparent to the GINA Science Committee and Board of Directors from responses to a survey of members of the GINA Assembly, which is a group of physician volunteers around the world who actively disseminate GINA strategy in their respective countries. Two particular needs identified were (1) at what point should a patient be referred to a specialist, and (2) guidance for biologic therapies.

THE GOALS OF THE POCKET GUIDE ARE STATED ON PAGE 4:

The goal of this Pocket Guide is to provide a practical summary for health professionals about how to identify, assess and manage difficult-to-treat and severe asthma in adolescents and adults. It is intended for use by general practitioners (GPs, primary care physicians), pulmonary specialists and other health professionals involved in the management of people with asthma.

The recommendations in this Pocket Guide were based on evidence where good quality systematic reviews or randomized controlled trials or, lacking these, robust observational data, were available, and on consensus by expert clinicians and researchers, where not. Development of the Pocket Guide and decision tree included extensive collaboration with experts in human-centered design to enhance the utility of these resources for end-users. This means translating existing high level lowcharts and text-based information to a more detailed visual format, and applying information architecture and diagramming principles.

2019 COPD GOLD Guidelines launched on World COPD Day

2018-11-17T10:33:00.000-08:00

World COPD Day is organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and COPD patient groups throughout the world.
Its aim is to raise awareness about chronic obstructive pulmonary disease (COPD) and improve COPD care throughout the world.
Please join us in showing your support online using #WorldCOPDDay and #COPDDay to shed light on critical issues surrounding COPD and lung health.

2019 GOLD Reports are available now on official website:

https://goldcopd.org/gold-reports/

Chronic Obstructive Pulmonary Disease and Stroke (Free full text from Journal of COPD 2018)

2018-05-11T23:23:00.001-07:00

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide.

Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.

First 50 free online copies:

https://www.tandfonline.com/eprint/pRdiFwmv3BetmbMjk7zQ/full

2018 Update of Asthma Guidelines launched on World Asthma Day 2018

2018-05-01T02:02:00.000-07:00

Today marks the 20th annual #WorldAsthmaDay!

The 2018 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.

Evidence-Based Inhaler Therapy for COPD in 2018

2018-04-28T08:46:00.000-07:00

See the winner of the 2018 Best of ATS Video Lecture Series: Penn PET Project: Evidence-Based Inhaler Therapy for #COPD

Triple versus Dual Inhaler Therapy in Patients with COPD - IMPACT Trial can change COPD Guidelines in 2019

2018-04-21T11:08:00.001-07:00

The Informing the Pathway of COPD Treatment (IMPACT) trial, now reported in the The New England Journal of Medicine, aims to fill this gap with a report on the effectiveness of LAMA–LABA–inhaled glucocorticoid treatment, contained in a single inhaler, in COPD.

Background

The benefits of triple therapy for chronic obstructive pulmonary disease (COPD) with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β₂-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid–LABA or LAMA–LABA), are uncertain.

Methods

In this randomized trial involving 10,355 patients with COPD, we compared 52 weeks of a once-daily combination of fluticasone furoate (an inhaled glucocorticoid) at a dose of 100 μg, umeclidinium (a LAMA) at a dose of 62.5 μg, and vilanterol (a LABA) at a dose of 25 μg (triple therapy) with fluticasone furoate–vilanterol (at doses of 100 μg and 25 μg, respectively) and umeclidinium–vilanterol (at doses of 62.5 μg and 25 μg, respectively). Each regimen was administered in a single Ellipta inhaler. The primary outcome was the annual rate of moderate or severe COPD exacerbations during treatment.

Results

The rate of moderate or severe exacerbations in the triple-therapy group was 0.91 per year, as compared with 1.07 per year in the fluticasone furoate–vilanterol group (rate ratio with triple therapy, 0.85; 95% confidence interval [CI], 0.80 to 0.90; 15% difference; P<0.001) and 1.21 per year in the umeclidinium–vilanterol group (rate ratio with triple therapy, 0.75; 95% CI, 0.70 to 0.81; 25% difference; P<0.001). The annual rate of severe exacerbations resulting in hospitalization in the triple-therapy group was 0.13, as compared with 0.19 in the umeclidinium–vilanterol group (rate ratio, 0.66; 95% CI, 0.56 to 0.78; 34% difference; P<0.001). There was a higher incidence of pneumonia in the inhaled-glucocorticoid groups than in the umeclidinium–vilanterol group, and the risk of clinician-diagnosed pneumonia was significantly higher with triple therapy than with umeclidinium–vilanterol, as assessed in a time-to-first-event analysis (hazard ratio, 1.53; 95% CI, 1.22 to 1.92; P<0.001).

Conclusions

Triple therapy with fluticasone furoate, umeclidinium, and vilanterol resulted in a lower rate of moderate or severe COPD exacerbations than fluticasone furoate–vilanterol or umeclidinium–vilanterol in this population. Triple therapy also resulted in a lower rate of hospitalization due to COPD than umeclidinium–vilanterol.

full text:

http://www.nejm.org/doi/full/10.1056/NEJMoa1713901

Higher cigarette prices would help millions avoid poor health and extreme poverty

2018-04-15T02:01:00.000-07:00

According to a study published in the these days in BMJ, a significant increase in prices of cigarette would aid millions of people at the global level to avoid poor health and extreme poverty.
Objective To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection.

Design Compartmental model study.

Setting 13 middle income countries, totalling two billion men.

Participants 500 million male smokers.

Main outcome measures Life years gained, averted treatment costs, number of men avoiding catastrophic healthcare expenditures and poverty, and additional tax revenue by income group.

Results A 50% increase in cigarette prices would lead to about 450 million years of life gained across the 13 countries from smoking cessation, with half of these in China. Across all countries, men in the bottom income group (poorest 20% of the population) would gain 6.7 times more life years than men in the top income group (richest 20% of the population; 155 v 23 million). The average life years gained from cessation for each smoker in the bottom income group was 5.1 times that of the top group (1.46 v 0.23 years). Of the $157bn (£113bn; €127bn) in averted treatment costs, the bottom income group would avert 4.6 times more costs than the top income group ($46bn v $10bn). About 15.5 million men would avoid catastrophic health expenditures in a subset of seven countries without universal health coverage. As result, 8.8 million men, half of them in the bottom income group, would avoid falling below the World Bank definition of extreme poverty. These 8.8 million men constitute 2.4% of people living in extreme poverty in these countries. In contrast, the top income group would pay twice as much as the bottom income group of the $122bn additional tax collected. Overall, the bottom income group would get 31% of the life years saved and 29% each of the averted disease costs and averted catastrophic health expenditures, while paying only 10% of the additional taxes.

Conclusions Higher prices of cigarettes provide more health and financial gains to the poorest 20% than to the richest 20% of the population. Higher excise taxes support the targets of the sustainable development goals on non-communicable diseases and poverty, and provides financial protection against illness.

What is already known on this topic

Higher excise taxes on tobacco are essential to reach the sustainable development goals to reduce mortality from non-communicable diseases by one third by 2030
Low income groups are more responsive to price increases than high income groups
There are few published studies of the distributional impact of higher tobacco taxes on health and financial outcomes

What this study adds

Despite differences in socioeconomic class and health finance arrangements a 50% increase in tobacco prices strongly favours those in the bottom income group for life years saved, out-of-pocket expenses from tobacco attributable treatment costs averted, and avoidance of catastrophic health expenditures or poverty
Higher tobacco excise taxes are a powerful but generally underused tool by most governments to reduce expenditures on treatment of diseases that are a major cause of income poverty
In 13 middle income countries studied, around 450 million life years would be saved from higher excise taxes, contributing substantially to the target of the sustainable development goals of a one third reduction in mortality from non-communicable diseases at ages 30-69 by 2030

Full text

Emerging biological therapies for treating eosinophilic COPD

2018-04-07T11:50:00.000-07:00

In Pulmonary Pharmacology & Therapeutics was published meta-analysis by great Italian team on hot topic Emerging biological therapies for treating chronic obstructive pulmonary disease: A pairwise and network meta-analysis.

Inflammation in COPD is often corticosteroid resistant and, thus, alternative anti-inflammatory approaches are needed. Since it is still not clear whether blocking specific pro-inflammatory factors may provide clinical benefit in COPD, we have performed a meta-analysis to quantify the impact of monoclonal antibodies (mABs) targeting the cytokine/chemokine-mediated inflammation in COPD.

A pairwise and network meta-analyses were performed by extracting data from randomized clinical trials on COPD concerning the impact of mABs vs. placebo on the risk of exacerbation, forced expiratory volume in 1 s (FEV₁), and St. George's Respiratory Questionnaire (SGRQ).

Data on the interleukin (IL)-1β antagonist canakinumab, IL-1R1 antagonist MEDI8986, IL-5 antagonist mepolizumab, IL-5R antagonist benralizumab, IL-8 antagonist ABX-IL8, and TNF-α antagonist infliximab were found. Overall, mAB therapy had a moderate impact on the risk exacerbation, but not on FEV₁ and SGRQ. The pairwise meta-analysis performed in eosinophilic patients, and the network approach, indicated that mepolizumab elicited a beneficial effect against the risk of exacerbation, whereas benralizumab was more effective in improving both FEV₁ and SGRQ.

This study demonstrates that targeting the pathway activated by IL-5 may have a beneficial impact in eosinophilic COPD patients.

Full text:

https://www.sciencedirect.com/science/article/pii/S1094553918300579

Its time to revise Asthma Guidelines? Single maintenance and reliever therapy (SMART) decrease asthma exacerbations

2018-03-31T07:01:00.000-07:00

Importance Combined use of inhaled corticosteroids and long-acting β-agonists (LABAs) as the controller and the quick relief therapy termed single maintenance and reliever therapy (SMART) is a potential therapeutic regimen for the management of persistent asthma.

Objective To conduct a systematic review and meta-analysis of the effects of SMART in patients with persistent asthma.

Data Sources and Study Selection The databases of MEDLINE via OVID, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched from database inception through August 2016 and updated through November 28, 2017. Two reviewers selected randomized clinical trials or observational studies evaluating SMART vs inhaled corticosteroids with or without a LABA used as the controller therapy and short-acting β-agonists as the relief therapy for patients aged 5 years or older with persistent asthma and reporting on an outcome of interest.

Data Extraction and Synthesis Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs), risk differences (RDs), and mean differences with corresponding 95% CIs. Citation screening, data abstraction, risk assessment, and strength of evidence grading were completed by 2 independent reviewers.

Main Outcomes and Measures Asthma exacerbations.

Results The analyses included 16 randomized clinical trials (N = 22 748 patients), 15 of which evaluated SMART as a combination therapy with budesonide and formoterol in a dry-powder inhaler. Among patients aged 12 years or older (n = 22 524; mean age, 42 years; 14 634 [65%] were female), SMART was associated with a reduced risk of asthma exacerbations compared with the same dose of inhaled corticosteroids and LABA as the controller therapy (RR, 0.68 [95% CI, 0.58 to 0.80]; RD, −6.4% [95% CI, −10.2% to −2.6%]) and a higher dose of inhaled corticosteroids and LABA as the controller therapy (RR, 0.77 [95% CI, 0.60 to 0.98]; RD, −2.8% [95% CI, −5.2% to −0.3%]). Similar results were seen when SMART was compared with inhaled corticosteroids alone as the controller therapy. Among patients aged 4 to 11 years (n = 341; median age, 8 [range, 4-11] years; 69 [31%] were female), SMART was associated with a reduced risk of asthma exacerbations compared with a higher dose of inhaled corticosteroids as the controller therapy (RR, 0.55 [95% CI, 0.32 to 0.94]; RD, −12.0% [95% CI, −22.5% to −1.5%]) or the same dose of inhaled corticosteroids and LABA as the controller therapy (RR, 0.38 [95% CI, 0.23 to 0.63]; RD, −23.2% [95% CI, −33.6% to −12.1%]).

Conclusions and Relevance In this meta-analysis of patients with persistent asthma, the use of single maintenance and reliever therapy compared with inhaled corticosteroids as the controller therapy (with or without a long-acting β-agonist) and short-acting β-agonists as the relief therapy was associated with a lower risk of asthma exacerbations. Evidence for patients aged 4 to 11 years was limited.

Full text:

https://jamanetwork.com/journals/jama/fullarticle/2675737

Exacerbations of COPD: prevention is still actual in 2018!!

2018-03-17T11:58:00.000-07:00

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids.

Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.

The prevention of exacerbations is one of the most important treatment goals. To achieve that goal, patient education and smoking cessation programmes as well as patient-tailored pharmacological and nonpharmacological treatments are mandatory.

Full text:

http://err.ersjournals.com/content/27/147/170103

2018 New approach for the treatment of severe uncontrolled asthma

2018-03-09T08:49:00.001-08:00

New updated approach to severe uncontrolled asthma was presented by Greek team in ERJ Open research!!!
Asthma is a common, chronic and heterogeneous disease, affecting people of all ages. It may be mild, barely noticed by the patient, or it may range all the way to very severe disease, causing constant symptoms greatly affecting the life of the patient, and may result in poor quality of life and severe, life-threatening attacks.
A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers.

The diagnosis and management of severe asthma requires specialised experience, time and effort to comprehend the needs and expectations of each individual patient and incorporate those as well as his/her specific phenotype characteristics into the management planning. Although some new treatment options are currently available for these patients, there is still a need for further research into severe asthma and yet more treatment options.

Full text:

http://openres.ersjournals.com/content/4/1/00125-2017

New study contradicts Asthma Guidelines: How efficient is escalating inhaled glucocorticoids for prevention of asthma exacerbations?

2018-03-08T00:01:00.003-08:00

Evidence indicates that substantial escalation of regularly used inhaled glucocorticoids, fails to prevent most asthma exacerbations. A small subgroup of adults and adolescents with asthma may have a response to an escalation strategy; however, their baseline and exacerbation characteristics remain to be defined.
New study was published in NEJM on Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations.

In children with mild-to-moderate persistent asthma treated with daily inhaled glucocorticoids, quintupling the dose at the early signs of loss of asthma control did not reduce the rate of severe asthma exacerbations or improve other asthma outcomes and may be associated with diminished linear growth.
Full text

More evidences for ban of e-cigarettes: prolonged exposure might result in asthma, COPD and inflammation

2018-03-03T04:06:00.000-08:00

A critical review outlining the toxicological profile and immunological consequences of e-cigarette use was published these days in European Respiratory Review!

Knowledge of the long-term toxicological and immunological effects of e-cigarette (e-cig) aerosols remains elusive due to the relatively short existence of vaping. Therefore, we performed a systematic search of articles published in public databases and analysed the research evidence in order to provide critical information regarding e-cig safety. Electronic nicotine delivery systems (or e-cigs) are an alternative to traditional cigarettes for the delivery of nicotine and are typically filled with glycerol or propylene glycol-based solutions known as e-liquids. Though present in lower quantities, e-cig aerosols are known to contain many of the harmful chemicals found in tobacco smoke.

However, due to the paucity of experimental data and contradictory evidence, it is difficult to draw conclusive outcomes regarding toxicological, immunological and clinical impacts of e-cig aerosols. Excessive vaping has been reported to induce inflammatory responses including mitogen-activated protein kinase, Janus tyrosine kinase/signal transducer and activator of transcription and nuclear factor-κB signalling, similar to that induced by tobacco smoke.

Based on recent evidence, prolonged exposure to some constituents of e-cig aerosols might result in respiratory complications such as asthma, chronic obstructive pulmonary disease and inflammation.

Future studies are warranted that focus on establishing correlations between e-cig types, generations and e-liquid flavours and immunological and toxicological profiles to broaden our understanding about the effects of vaping.

Full text:

http://err.ersjournals.com/content/27/147/170119

2018 Update: Acute Respiratory Distress Syndrome Advances in Diagnosis and Treatment

2018-02-24T10:19:00.000-08:00

Importance Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure that affects approximately 200 000 patients each year in the United States, resulting in nearly 75 000 deaths annually. Globally, ARDS accounts for 10% of intensive care unit admissions, representing more than 3 million patients with ARDS annually.

Objective To review advances in diagnosis and treatment of ARDS over the last 5 years.

Evidence Review We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 2012 to 2017 focusing on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines. Articles were identified for full text review with manual review of bibliographies generating additional references.

Findings After screening 1662 citations, 31 articles detailing major advances in the diagnosis or treatment of ARDS were selected. The Berlin definition proposed 3 categories of ARDS based on the severity of hypoxemia: mild (200 mm Hg<Pao₂/Fio₂≤300 mm Hg), moderate (100 mm Hg<Pao₂/Fio₂≤200 mm Hg), and severe (Pao₂/Fio₂ ≤100 mm Hg), along with explicit criteria related to timing of the syndrome’s onset, origin of edema, and the chest radiograph findings. The Berlin definition has significantly greater predictive validity for mortality than the prior American-European Consensus Conference definition. Clinician interpretation of the origin of edema and chest radiograph criteria may be less reliable in making a diagnosis of ARDS. The cornerstone of management remains mechanical ventilation, with a goal to minimize ventilator-induced lung injury (VILI). Aspirin was not effective in preventing ARDS in patients at high-risk for the syndrome. Adjunctive interventions to further minimize VILI, such as prone positioning in patients with a Pao₂/Fio₂ ratio less than 150 mm Hg, were associated with a significant mortality benefit whereas others (eg, extracorporeal carbon dioxide removal) remain experimental. Pharmacologic therapies such as β₂ agonists, statins, and keratinocyte growth factor, which targeted pathophysiologic alterations in ARDS, were not beneficial and demonstrated possible harm. Recent guidelines on mechanical ventilation in ARDS provide evidence-based recommendations related to 6 interventions, including low tidal volume and inspiratory pressure ventilation, prone positioning, high-frequency oscillatory ventilation, higher vs lower positive end-expiratory pressure, lung recruitment maneuvers, and extracorporeal membrane oxygenation.

Conclusions and Relevance The Berlin definition of acute respiratory distress syndrome addressed limitations of the American-European Consensus Conference definition, but poor reliability of some criteria may contribute to underrecognition by clinicians. No pharmacologic treatments aimed at the underlying pathology have been shown to be effective, and management remains supportive with lung-protective mechanical ventilation. Guidelines on mechanical ventilation in patients with acute respiratory distress syndrome can assist clinicians in delivering evidence-based interventions that may lead to improved outcomes.

Full text

Impact of obstructive sleep apnea on chronic obstructive pulmonary disease: prospective, consecutive study

2018-02-23T09:44:00.000-08:00

What is not known yet, about the topic
Coexistent chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are insufficiently studied in terms of prevalence, frequency and spectrum of complications, health risks and impact on quality of life.

Research hypothesis
Certain clinical and demographic parameters or data obtained from nocturnal polysomnography can have significant predictive value for overlap syndrome, induced by coexistent obstructive sleep apnea and chronic obstructive pulmonary
disease.
Article’s added novelty on this scientific topic
It was established that increased body mass index and high Epworth sleepiness score have significant predictive value for coexistent OSA and COPD.

Full text

Dual LABA/LAMA bronchodilators in COPD: why? when? and how?

2018-02-18T09:10:00.000-08:00

Dual LABA/LAMA bronchodilators in COPD: why? when? and how?

Still many questions in our real everyday practice!

Read Editorial in Expert Review of Respiratory Medicine by great Italian team conducted by professor Mario Cazzola.

http://www.tandfonline.com/doi/abs/10.1080/17476348.2018.1442216

LABA/LAMA combinations induce bronchorelaxant synergistic interaction when the drugs mixture is well-balanced and administered at low isoeffective concentrations.
The overall approach of Drug Companies has been to combine in a FDC a LABA and a LAMA at the same doses for which the monocomponents were previously approved. Indeed, this practice does not permit to optimize the synergy in the final
LABA/LAMA FDCs. Conversely, dose-finding studies are required to identify the correct dose-ratio and establish the minimal doses for each monocomponent in the FDC leading to the greater synergism with regard to the improvement in lung
function, symptoms, and exacerbations.
Furthermore, although LABA/LAMA FDCs are characterized by an acceptable safety profile, the cardiovascular toxicity of LABAs and LAMAs may overlap. Thus, postmarketing surveillance and observational studies are needed to assess the real risk of rare, but potentially serious, cardiovascular adverse events associated with the dual bronchodilation therapy in COPD patients.

Full text:

http://www.tandfonline.com/doi/abs/10.1080/17476348.2018.1442216

COPD in 2018: syndrome or disease - first steps to new classification

2018-02-17T04:45:00.002-08:00

New article from ERJ Open Research by Celli and Agusti is dedicated to hot topic in COPD: new classification with absolutely fresh approach!

Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronic obstructive pulmonary disease (COPD) as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological) may negatively modulate post-natal lung development and lead to poorly reversible airflow limitation later in life, consistent with COPD.

We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who proposed that diseases can be defined by four key characteristics: 1) clinical description (syndrome), 2) disorder of structure (morbid anatomy), 3) disorder of function (pathophysiology) and 4) causation (aetiology).

Here, we propose a pragmatic approach to the taxonomy of COPD based on different processes that result in a similar syndromic presentation. It can accommodate changes over time, as the pathobiology that may lead to COPD expands. We hope that stakeholders in the field may find it useful to better define the patients now boxed into one single entity, so that specific studies can be designed and conducted for each type of COPDs.

Free full text:

http://openres.ersjournals.com/content/4/1/00132-2017

Assessment of Health-related Quality of Life in Different Phenotypes of COPD (article from 2017 Current Respiratory Medicine Reviews)

2017-07-28T10:06:00.000-07:00

Introduction: Phenotypic characterization of COPD subjects may rely on clinical and physiological manifestations, imaging, assessment of patient-related outcomes (health related quality of life), COPD comorbidities, COPD exacerbations and systemic inflammation. The aim of the study was to evaluate and to analyze the health-related quality of life (HRQL) in COPD patients classified into different phenotypes.

Methods: 395 consecutive COPD patients were enrolled into the study. Spirometric data were analyzed (FEV1, FVC, FEV1/FVC). HRQL was assessed by the St. George Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ).

Results: The cohort consisted of 395 COPD patients with mean age 62.7 ± 9.4 years, 79 % were males. Patients were divided in 4 groups according to phenotypes: 44% of the patients were nonexacerbators, 35% frequent exacerbators with chronic bronchitis (CB), 12% frequent exacerbators without CB, and 8% were patients with asthma-COPD overlap syndrome (ACOS). There were statistically significant differences in HRQL and lung function between COPD phenotypes. Frequent exacerbators with chronic CB and without CB had the similar total SGRQ scores, CCQ scores and CAT, and these scores were worse in comparison with HRQL of non-exacerbators and patients with ACOS.

Conclusion: Frequent exacerbators with chronic CB and without CB have a more severe deterioration of the HRQL and worse lung function then non-exacerbators and patients with ACOS.

full text:

http://www.eurekaselect.com/154321

Pulmonary rehabilitation and cardiovascular risk in COPD: a systematic review (Free Full text from 2017 COPD Research and Practice)

2017-07-08T12:05:00.000-07:00

Introduction

Pulmonary Rehabilitation (PR) is an effective intervention in COPD however the value of PR in reducing cardiovascular risk in COPD (measured by aortic pulse wave velocity, PWV) is unclear and there is no existing systematic review.

Objectives
To conduct a systematic review examining whether PR results in alteration of CV risk in COPD (as measured by aPWV).

Methods

An electronic systematic search concordant with PRISMA guidelines was conducted. The search was complete to the 27th of May 2017. Six databases were examined: Embase, Medline, AMED, Web of Science, Cochrane clinical trials, and CINAHL.

Results

This study generated 767 initial matches, which were filtered using inclusion/exclusion criteria. Three studies (201 COPD participants) were included. Our analysis does not confirm that PR affects aPWV but studies were heterogeneous.

Conclusion

There is currently insufficient information on the effect of PR on reducing CV risk in COPD. Therefore controversy remains, with the possibility that there might be some subjects who benefit and others who might experience an increase in CV risk in response to PR. These results will be of value to those interested in gaining a better understanding of the benefits of PR on CV risk in COPD.

Free full text:

https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0026-9

Adherence to COPD treatment: Myth and reality (article from 2017 Respiratory Medicine)

2017-06-24T07:51:00.001-07:00

Great Respiratory article from our Italian Friends!!!

Highlights

The level of medication adherence in COPD patients is very low
Approaches to assess adherence of COPD are burdened with important limitations.
Patient views on therapy effectiveness are powerful predictors of reported adherence.
The physician can affect adherence in COPD with his/her prescription.
In COPD, adherence to inhalation medication is device-related.

COPD is a chronic disease in which effective management requires long-term adherence to pharmacotherapies but the level of adhesion to the prescribed medications is very low and this has a negative influence on outcomes. There are several approaches to detect non-adherence, such as pharmacy refill methods, electronic monitoring, and self-report measures, but they are all burdened with important limitations. Medication adherence in COPD is multifactorial and is affected by patients (health beliefs, cognitive abilities, self-efficacy, comorbidities, psychological profile, conscientiousness), physicians (method of administration, dosing regimen, polypharmacy, side effects), and society (patient-prescriber relationship, social support, access to medication, device training, follow-up). Patient-health care professional communication, especially that between patient and physician or pharmacist, is central to optimizing patient adherence. However, the most realistic approach is to keep in mind that non-adherence is always possible, indeed, probable.

Article is HERE!!!

To sleep, or not to sleep – that is the question, for polysomnography (Free full text from Breathe)

2017-06-08T12:36:00.000-07:00

As the English dramatist Thomas Dekker wrote, “Sleep is that golden chain that ties health and our bodies together”. One of the most frequently sleep-related disorders (SRD) is obstructive sleep apnoea syndrome (OSAS). OSAS is a relatively “young” disease and at the same time, one of the most important respiratory conditions discovered in the last 50 years due to its incidence, prevalence, health-related impact on the patient’s life and economic burden.

Nevertheless, 50 years is still a large amount of time and our understanding of OSAS has grown significantly over these years. The first reports discussed how to diagnose this rare condition. Later, it was demonstrated that the disease itself is not that rare and is extremely underdiagnosed. This was only the tip of the iceberg, since it was furthermore discovered that OSAS is linked to multiple comorbidities and is a major healthcare problem. Now, we are moving further forward, and discussing more efficient ways to diagnose and manage this condition.

Free full text:

http://breathe.ersjournals.com/content/13/2/137

Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions (Free Full text from 2017 COPD Research and Practice)

2017-05-31T07:14:00.000-07:00

Chronic obstructive pulmonary disease and asthma are the most frequent chronic respiratory diseases that affect the general population. For a long period of time these two conditions were considered to be separate diseases. However, it became evident that some patients share symptoms and clinical findings from both diseases.

These patients are considered to represent a distinct phenotype, called asthma-COPD overlap syndrome (ACOS). However, since approximately the one third of the asthmatics smoke the ACOS may primarily define those patients. This is a relatively newly defined clinical syndrome whose underlying mechanisms and most appropriate management remain to be confirmed. In this review, we summarize current knowledge on this syndrome, aiming to update clinicians and help their daily practice.

Free full text:

https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0025-x

Oral Glucocorticoid–Sparing Effect of Benralizumab in Severe Asthma (free full text from 2017 NEJM)

2017-05-27T22:36:00.000-07:00

Many patients with severe asthma rely on oral glucocorticoids to manage their disease. We investigated whether benralizumab, a monoclonal antibody directed against the alpha subunit of the interleukin-5 receptor that significantly reduces the incidence of asthma exacerbations, was also effective as an oral glucocorticoid–sparing therapy in patients relying on oral glucocorticoids to manage severe asthma associated with eosinophilia.

In a 28-week randomized, controlled trial, we assessed the effects of benralizumab (at a dose of 30 mg administered subcutaneously either every 4 weeks or every 8 weeks [with the first three doses administered every 4 weeks]) versus placebo on the reduction in the oral glucocorticoid dose while asthma control was maintained in adult patients with severe asthma. The primary end point was the percentage change in the oral glucocorticoid dose from baseline to week 28. Annual asthma exacerbation rates, lung function, symptoms, and safety were assessed.

Results

Of 369 patients enrolled, 220 underwent randomization and started receiving benralizumab or placebo. The two benralizumab dosing regimens significantly reduced the median final oral glucocorticoid doses from baseline by 75%, as compared with a reduction of 25% in the oral glucocorticoid doses in the placebo group (P<0.001 for both comparisons). The odds of a reduction in the oral glucocorticoid dose were more than 4 times as high with benralizumab as with placebo. Among the secondary outcomes, benralizumab administered every 4 weeks resulted in an annual exacerbation rate that was 55% lower than the rate with placebo (marginal rate, 0.83 vs. 1.83, P=0.003), and benralizumab administered every 8 weeks resulted in an annual exacerbation rate that was 70% lower than the rate with placebo (marginal rate, 0.54 vs. 1.83, P<0.001). At 28 weeks, there was no significant effect of either benralizumab regimen on the forced expiratory volume in 1 second (FEV₁), as compared with placebo. The effects on various measures of asthma symptoms were mixed, with some showing significant changes in favor of benralizumab and others not showing significant changes. Frequencies of adverse events were similar between each benralizumab group and the placebo group.

Conclusions

Benralizumab showed significant, clinically relevant benefits, as compared with placebo, on oral glucocorticoid use and exacerbation rates. These effects occurred without a sustained effect on the FEV₁.

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http://www.nejm.org/doi/full/10.1056/NEJMoa1703501#Top

Imprecision in the Era of Precision Medicine in Non-Small Cell Lung Cancer (2017 Frontiers of Medicine free full text)

2017-05-20T10:55:00.000-07:00

Over the past decade, major advances have been made in the management of advanced non-small cell lung cancer (NSCLC). There has been a particular focus on the identification and targeting of putative driver aberrations, which has propelled NSCLC to the forefront of precision medicine. Several novel molecularly targeted agents have now achieved regulatory approval, while many others are currently in late-phase clinical trial testing.

These antitumor therapies have significantly impacted the clinical outcomes of advanced NSCLC and provided patients with much hope for the future. Despite this, multiple deficiencies still exist in our knowledge of this complex disease, and further research is urgently required to overcome these critical issues. This review traces the path undertaken by the different therapeutics assessed in NSCLC and the impact of precision medicine in this disease. We also discuss the areas of “imprecision” that still exist in NSCLC and the modern hypothesis-testing studies being conducted to address these key challenges.

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Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations (Hot topic article from Journal of COPD 2017)

2017-05-17T10:42:00.000-07:00

Chronic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an increasing problem worldwide. Many patients with severe COPD develop hypoxemic respiratory failure during the natural progression of disease. Long-term oxygen therapy (LTOT) is a well-established supportive treatment for COPD and has been shown to improve survival in patients who develop chronic hypoxemic respiratory failure. The degree of hypoxemia is severe when partial pressure of oxygen in arterial blood (PaO₂) is ≤55 mmHg and moderate if PaO₂ is between 56 and 69 mmHg.

Although current guidelines consider LTOT only in patients with severe resting hypoxemia, many COPD patients with moderate to severe disease experience moderate hypoxemia at rest or during special circumstances, such as while sleeping or exercising. The efficacy of LTOT in these patients who do not meet the actual recommendations is still a matter of debate, and extensive research is still ongoing to understand the possible benefits of LTOT for survival and/or functional outcomes such as the sensation of dyspnea, exacerbation frequency, hospitalizations, exercise capacity, and quality of life. Despite its frequent use, the administration of “palliative” oxygen does not seem to improve dyspnea except for delivery with high-flow humidified oxygen. This narrative review will focus on current evidence for the effects of LTOT in the presence of moderate hypoxemia at rest, during sleep, or during exercise in COPD.

Full text link:

http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1319918

Respiratory Decade

2018 GINA Severe Asthma Pocket Guide: Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients

2019 COPD GOLD Guidelines launched on World COPD Day

Chronic Obstructive Pulmonary Disease and Stroke (Free full text from Journal of COPD 2018)

2018 Update of Asthma Guidelines launched on World Asthma Day 2018

Evidence-Based Inhaler Therapy for COPD in 2018

Triple versus Dual Inhaler Therapy in Patients with COPD - IMPACT Trial can change COPD Guidelines in 2019

Higher cigarette prices would help millions avoid poor health and extreme poverty

What is already known on this topic

What this study adds

Emerging biological therapies for treating eosinophilic COPD

Its time to revise Asthma Guidelines? Single maintenance and reliever therapy (SMART) decrease asthma exacerbations

Exacerbations of COPD: prevention is still actual in 2018!!

2018 New approach for the treatment of severe uncontrolled asthma

New study contradicts Asthma Guidelines: How efficient is escalating inhaled glucocorticoids for prevention of asthma exacerbations?

More evidences for ban of e-cigarettes: prolonged exposure might result in asthma, COPD and inflammation

2018 Update: Acute Respiratory Distress Syndrome Advances in Diagnosis and Treatment

Impact of obstructive sleep apnea on chronic obstructive pulmonary disease: prospective, consecutive study

Dual LABA/LAMA bronchodilators in COPD: why? when? and how?

COPD in 2018: syndrome or disease - first steps to new classification

Assessment of Health-related Quality of Life in Different Phenotypes of COPD (article from 2017 Current Respiratory Medicine Reviews)

Pulmonary rehabilitation and cardiovascular risk in COPD: a systematic review (Free Full text from 2017 COPD Research and Practice)

Adherence to COPD treatment: Myth and reality (article from 2017 Respiratory Medicine)

Great Respiratory article from our Italian Friends!!!

Highlights

The level of medication adherence in COPD patients is very low

Approaches to assess adherence of COPD are burdened with important limitations.

Patient views on therapy effectiveness are powerful predictors of reported adherence.

The physician can affect adherence in COPD with his/her prescription.

In COPD, adherence to inhalation medication is device-related.

To sleep, or not to sleep – that is the question, for polysomnography (Free full text from Breathe)

Ashtma-Chronic obstructive pulmonary disease overlap syndrome (ACOS): current evidence and future research directions (Free Full text from 2017 COPD Research and Practice)

Oral Glucocorticoid–Sparing Effect of Benralizumab in Severe Asthma (free full text from 2017 NEJM)

Results

Imprecision in the Era of Precision Medicine in Non-Small Cell Lung Cancer (2017 Frontiers of Medicine free full text)

Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations (Hot topic article from Journal of COPD 2017)