Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 6 Articles
Background: To analyse the efficacy of fluticasone propionate (FP) alone and combined with salmeterol (SAL)\nin achieving guideline-defined asthma control in Asian patients.\nMethods: A post hoc analysis of the GOAL study in which patients were stratified by prior-medication use\ninto inhaled corticosteroid (ICS)-na�¯ve (Stratum [S] 1), low-dose ICS (S2), and medium-dose ICS (S3), and\nrandomised to receive FP/SAL or FP. Doses were stepped-up every 12 weeks until Totally Controlled asthma\nor maximum dose was reached (PhI) and then maintained until study end (PhII). The primary endpoint was\nthe proportion of patients achieving Well-Controlled asthma during PhI. Additional endpoints included Total\nControl and adverse events. Asian and non-Asian patients were analysed separately.\nResults: In Asian patients in PhI, 74% (n = 87/118) in S1 achieved Well-Controlled asthma with FP/SAL versus\n74% (n = 89/121) with FP alone (p = 0.839); corresponding values were 76% (n = 81/107) versus 60% (n = 62/\n104; p = 0.005) in S2, and 58% (n = 59/102) versus 43% (n = 41/95; p = 0.015) in S3. More patients in all three\nstrata achieved Totally Controlled asthma with FP/SAL versus FP alone. Control was achieved more rapidly\nand with lower ICS doses with FP/SAL versus FP. A high proportion of patients who achieved control during\nPhI maintained control during PhII. Similar trends were found in non-Asian patients. No new safety concerns\nwere identified.\nConclusions: A greater proportion of Asian patients (S2 and S3, for Well-Controlled; all strata, for Totally\nControlled) achieved guideline-defined asthma control with FP/SAL versus FP alone. High proportions of Asian\npatients in S1 achieved Well-Controlled asthma in both treatment groups....
Background: Asthmaââ?¬â??COPD overlap syndrome (ACOS) prevalence varies depending on the studied population\nand definition criteria. The prevalence and clinical characteristics of ACOS in an at-risk COPD primary care population\nfrom Latin America was assessed.\nMethods: Patients ââ?°Â¥40 years, current/ex-smokers and/or exposed to biomass, attending routine primary care visits\ncompleted a questionnaire and performed spirometry. COPD was defined as post-bronchodilator forced expiratory\nvolume in 1 s/forced vital capacity (FEV1/FVC) < 0.70; asthma was defined as either prior asthma diagnosis or wheezing\nin the last 12 months plus reversibility (increase in post-bronchodilator FEV1 or FVC ââ?°Â¥200 mL and ââ?°Â¥12%); ACOS was\ndefined using a combination of COPD with the two asthma definitions. Exacerbations in the past year among the\nsubgroups were evaluated.\nResults: One thousand seven hundred forty three individuals completed the questionnaire, 1540 performed acceptable\nspirometry, 309 had COPD, 231 had prior asthma diagnosis, and 78 asthma by wheezing + reversibility. ACOS prevalence\nin the total population (by post-bronchodilator FEV1/FVC < 0.70 plus asthma diagnosis) was 5.3 and 2.3% by postbronchodilator\nFEV1/FVC < 0.70 plus wheezing + reversibility. In the obstructive population (asthma or COPD), prevalence\nrises to 17.9 and 9.9% by each definition, and to 26.5 and 11.3% in the COPD population. ACOS patients defined by postbronchodilator\nFEV1/FVC < 0.7 plus wheezing + reversibility had the lowest lung function measurements. Exacerbations for\nACOS showed a prevalence ratio of 2.68 and 2.20 (crude and adjusted, p < 0.05, respectively) (reference COPD).\nConclusions: ACOS prevalence in primary care varied according to definition used. ACOS by post-bronchodilator FEV1/\nFVC < 0.7 plus wheezing + reversibility represents a clinical phenotype with more frequent exacerbations, which is\nprobably associated with a different management approach....
Background: Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is a fatal condition without an\nestablished pharmaceutical treatment. Most patients are treated with high-dose corticosteroids and broad-spectrum\nantibiotics. Azithromycin is a macrolide with immunomodulatory activity and may be beneficial for treatment of\nacute lung injury. The objective of this study was to determine the effect of azithromycin on survival of patients\nwith idiopathic AE of IPF.\nMethods: We evaluated 85 consecutive patients hospitalized in our department for idiopathic AE of IPF from April\n2005 to August 2016. The initial 47 patients were treated with a fluoroquinolone-based regimen (control group),\nand the following 38 consecutive patients were treated with azithromycin (500 mg/day) for 5 days. Idiopathic AE of\nIPF was defined using the criteria established by the 2016 International Working Group.\nResults: Mortality in patients treated with azithromycin was significantly lower than in those treated with\nfluoroquinolones (azithromycin, 26% vs. control, 70%; p < 0.001). Multivariate analysis revealed that the two variables\nwere independently correlated with 60-day mortality as determined by the Acute Physiology and Chronic Health\nEvaluation II score (p = 0.002) and azithromycin use (p < 0.001).\nConclusion: Azithromycin may improve survival in patients with idiopathic AE of IPF....
The aim of this pilot study was to determine Clara cell protein (CC16) concentration in bronchoalveolar lavages (BAL) fluid from\nfull-termand preterm(<37weeks� gestational age) neonates requiring respiratory support, having symptoms of neonatal respiratory\ndistress syndrome, and at risk of bronchopulmonary dysplasia (BPD). We hypothesized that CC16 may be predictive of BPD\ndiagnosis regardless of gestational age. BAL fluid CC16 was measured by ELISA at birth and at day 7 of life. Both groups that\ndeveloped BPD showed significantly decreased BAL fluid CC16 levels compared to those infants that did not develop the disease.\nCC16 positively correlated with diagnosis of BPD and negatively with the severity of the disease. These results suggest that BAL fluid\nCC16 levels may have a diagnostic value at day 7 for BPD in both term and preterm infants. This study demonstrates the potential\nutility of BAL fluid CC16 levels as a biomarker for BPD in term infants....
Background: Bronchopulmonary dysplasia (BPD) is a strong risk factor for respiratory morbidity in children born\npreterm. Our aims were to evaluate lung function in adolescents born preterm with and without a history of BPD,\nand to assess lung function change over time from school age.\nMethods: Fifty-one individuals born in Stockholm, Sweden between gestational ages 24 to 31 weeks (23 neonatally\ndiagnosed with respiratory distress syndrome (RDS) but not BPD, and 28 graded as mild (n = 17), moderate (n = 7)\nor severe (n = 4) BPD) were examined in adolescence (13ââ?¬â??17 years of age) using spirometry, impulse oscillometry\n(IOS), plethysmography, and ergospirometry. Comparison with lung function data from school age (6ââ?¬â??8 years of\nage) was also performed.\nResults: Adolescents with a history of BPD had lower forced expiratory volume in 1 s (FEV1) compared to those\nwithout BPD (âË?â??0.61 vs.-0.02 z-scores, P < 0.05), with lower FEV1 values significantly associated with BPD severity (P for\ntrend 0.002). Subjects with severe BPD had higher frequency dependence of resistance, R5ââ?¬â??20, (P < 0.001 vs. non-BPD\nsubjects) which is an IOS indicator of peripheral airway involvement. Between school age and adolescence, FEV1/FVC\nz-scores decreased in all groups and particularly in the severe BPD group (from âË?â??1.68 z-scores at 6ââ?¬â??8 years to âË?â??2.74\nz-scores at 13ââ?¬â??17 years, p < 0.05 compared to the non-BPD group).\nConclusions: Our results of spirometry and IOS measures in the BPD groups compared to the non-BPD group suggest\nairway obstruction including involvement of peripheral airways. The longitudinal result of a decrease in FEV1/FVC in the\ngroup with severe BPD might implicate a route towards chronic airway obstruction in adulthood....
Background. Transbronchial lung cryobiopsies (TBLCs) are a promising diagnostic tool in the setting of diffuse parenchymal lung\ndiseases (DPLDs).However, no comparison with surgical lung biopsy (SLB) in the same patient is available.Methods.Thediagnostic\nyield and safety data of TBLCs, as well as the result of SLB performed after TBLCs, were analysed in a multicentric Belgian study.\nA SLB was performed after TBLCs in absence of a definite pathological diagnosis or if a NSIP pattern was observed without related\ncondition identified following multidisciplinary discussion. Results. Between April 2015 and November 2016, 30 patients were\nincluded. Frequent complications included pneumothorax (20%) and bleeding (severe 7%, moderate 33%, and mild 53%). There\nwas no mortality. The overall diagnostic yield was 80%. A SLB was performed in six patients (three without definite histological\npattern and three with an NSIP). The surgical biopsy changed the pathological diagnosis into a UIP pattern in five patients and\nconfirmed a NSIP pattern in one patient. Conclusion. TBLCs are useful in the diagnostic work-up of DPLDs avoiding a SLB in 80%\nof the patients. However, surgical biopsies, performed as a second step after TBLCs because of an indefinite diagnosis or a NSIP\npattern, provide additional information supporting the interest of a sequential approach in these patients....
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