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Oscillometry in severe asthma: the state of the art and future perspectives. 严重哮喘的示波测量:技术现状和未来展望。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-07-20 DOI: 10.1080/17476348.2023.2237872
Francesco Menzella, Leonardo Antonicelli, Marcello Cottini, Gianluca Imeri, Lorenzo Corsi, Fabiano Di Marco

Introduction: Approximately 3-10% of people with asthma have severe asthma (SA). Patients with SA have greater impairment in daily life and much higher costs. Even if asthma affects the entire bronchial tree, small airways have been recognized as the major site of airflow limitation. There are several tools for studying small airway dysfunction (SAD), but certainly the most interesting is oscillometry. Despite several studies, the clinical usefulness of oscillometry in asthma is still in question. This paper aims to provide evidence supporting the use of oscillometry to improve the management of SA in clinical practice.

Areas covered: In the ATLANTIS study, SAD was strongly evident across all severity. Various tools are available for evaluation of SAD, and certainly an integrated use of these can provide complete and detailed information. However, the most suitable method is oscillometry, implemented for clinical routine by using either small pressure impulses or small pressure sinusoidal waves.

Expert opinion: Oscillometry, despite its different technological implementations is the best tool for determining the impact of SAD on asthma and its control. Oscillometry will also be increasingly useful for choosing the appropriate drug, and there is ample room for a more widespread diffusion in clinical practice.

引言:大约3-10%的哮喘患者患有严重哮喘(SA)。SA患者在日常生活中的损伤更大,费用也高得多。即使哮喘影响整个支气管树,小气道也被认为是气流受限的主要部位。有几种研究小气道功能障碍(SAD)的工具,但最有趣的肯定是示波法。尽管进行了几项研究,但示波法在哮喘中的临床实用性仍然存在疑问。本文旨在为在临床实践中使用示波法改善SA的管理提供证据。涵盖的领域:在ATLANTIS的研究中,SAD在所有严重程度上都非常明显。有各种工具可用于评估SAD,当然,综合使用这些工具可以提供完整和详细的信息。然而,最合适的方法是示波法,通过使用小压力脉冲或小压力正弦波来实现临床常规。专家意见:尽管示波器的技术实现方式不同,但它是确定SAD对哮喘及其控制影响的最佳工具。示波法在选择合适的药物方面也将越来越有用,在临床实践中有更广泛的推广空间。
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引用次数: 0
The argument for utilising magnetic resonance imaging as a tool for monitoring lung structure and function in pediatric patients. 利用磁共振成像作为监测儿科患者肺部结构和功能的工具的论点。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-07-28 DOI: 10.1080/17476348.2023.2241355
Brandon Zanette, Mary-Louise C Greer, Theo J Moraes, Felix Ratjen, Giles Santyr

Introduction: Although historically challenging to perform in the lung, technological advancements have made Magnetic Resonance Imaging (MRI) increasingly applicable for pediatric pulmonary imaging. Furthermore, a wide array of functional imaging techniques has become available that may be leveraged alongside structural imaging for increasingly sensitive biomarkers, or as outcome measures in the evaluation of novel therapies.

Areas covered: In this review, recent technical advancements and modern methodologies for structural and functional lung MRI are described. These include ultrashort echo time (UTE) MRI, free-breathing contrast agent-free, functional lung MRI, and hyperpolarized gas MRI, amongst other techniques. Specific examples of the application of these methods in children are provided, principally drawn from recent research in asthma, bronchopulmonary dysplasia, and cystic fibrosis.

Expert opinion: Pediatric lung MRI is rapidly growing, and is well poised for clinical utilization, as well as continued research into early disease detection, disease processes, and novel treatments. Structure/function complementarity makes MRI especially attractive as a tool for increased adoption in the evaluation of pediatric lung disease. Looking toward the future, novel technologies, such as low-field MRI and artificial intelligence, mitigate some of the traditional drawbacks of lung MRI and will aid in improving access to MRI in general, potentially spurring increased adoption and demand for pulmonary MRI in children.

引言:尽管在历史上对肺部成像具有挑战性,但技术进步使磁共振成像(MRI)越来越适用于儿科肺部成像。此外,一系列广泛的功能成像技术已经可用,这些技术可以与结构成像一起用于越来越敏感的生物标志物,或者作为评估新疗法的结果指标。涵盖的领域:在这篇综述中,描述了结构和功能性肺MRI的最新技术进步和现代方法。其中包括超短回波时间(UTE)MRI、无自由呼吸造影剂、功能性肺MRI和超极化气体MRI等技术。提供了这些方法在儿童中应用的具体例子,主要来源于最近对哮喘、支气管肺发育不良和囊性纤维化的研究。专家意见:儿童肺部MRI正在迅速发展,并已做好临床应用的准备,以及对早期疾病检测、疾病过程和新治疗方法的持续研究。结构/功能的互补性使得MRI作为一种工具在评估儿童肺部疾病中越来越受欢迎。展望未来,低场MRI和人工智能等新技术将缓解肺部MRI的一些传统缺点,并将有助于改善MRI的普及率,这可能会刺激儿童对肺部MRI的采用和需求增加。
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引用次数: 0
Procalcitonin as a biomarker to guide treatments for patients with lower respiratory tract infections. 降钙素原作为指导下呼吸道感染患者治疗的生物标志物。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-28 DOI: 10.1080/17476348.2023.2251394
Ouriel Saura, Charles-Edouard Luyt

Introduction: Lower respiratory tract infections are amongst the main causes for hospital/intensive care unit admissions and antimicrobial prescriptions. In order to reduce antimicrobial pressure, antibiotic administration could be optimized through procalcitonin-based algorithms.

Areas covered: In this review, we discuss the performances of procalcitonin for the diagnosis and the management of community-acquired and ventilator-associated pneumonia. We provide up-to-date evidence and deliver clear messages regarding the purpose of procalcitonin to reduce unnecessary antimicrobial exposure.

Expert opinion: Antimicrobial pressure and resulting antimicrobial resistances are a major public health issue as well as a daily struggle in the management of patients with severe infectious diseases, especially in intensive care units where antibiotic exposure is high. Procalcitonin-guided antibiotic administration has proven its efficacy in reducing unnecessary antibiotic use in lower respiratory tract infections without excess in mortality, hospital length of stay or disease relapse. Procalcitonin-guided algorithms should be implemented in wards taking care of patients with severe infections. However, procalcitonin performances are different regarding the setting of the infection (community versus hospital-acquired infections) the antibiotic management (start or termination of antibiotic) as well as patient's condition (immunosuppressed or in shock) and we encourage the physicians to be aware of these limitations.

引言:下呼吸道感染是住院/重症监护室和开具抗菌药物处方的主要原因之一。为了降低抗菌压力,可以通过基于降钙素原的算法优化抗生素给药。涵盖领域:在这篇综述中,我们讨论了降钙素原在社区获得性和呼吸机相关肺炎的诊断和治疗中的表现。我们提供了最新的证据,并就降钙素原减少不必要的抗菌药物暴露的目的发出了明确的信息。专家意见:抗微生物压力和由此产生的抗微生物耐药性是一个主要的公共卫生问题,也是严重传染病患者管理中的日常斗争,尤其是在抗生素暴露量高的重症监护室。降钙素原指导的抗生素给药已证明其在减少下呼吸道感染中不必要的抗生素使用方面的有效性,而不会导致死亡率、住院时间或疾病复发。降钙素原引导的算法应该在照顾严重感染患者的病房中实施。然而,降钙素原的表现在感染环境(社区与医院获得性感染)、抗生素管理(抗生素的开始或终止)以及患者的病情(免疫抑制或休克)方面有所不同,我们鼓励医生意识到这些局限性。
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引用次数: 0
Personalised management and supporting individuals to live with their asthma in a primary care setting. 在初级保健环境中对哮喘患者进行个性化管理和支持。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-03 DOI: 10.1080/17476348.2023.2241357
Hilary Pinnock, Mike Noble, David Lo, Kirstie McClatchey, Viv Marsh, Chi Yan Hui

Introduction: Complementing recognition of biomedical phenotypes, a primary care approach to asthma care recognizes diversity of disease, health beliefs, and lifestyle at a population and individual level.

Areas covered: We review six aspects of personalized care particularly pertinent to primary care management of asthma: personalizing support for individuals living with asthma; targeting asthma care within populations; managing phenotypes of wheezy pre-school children; personalizing management to the individual; meeting individual preferences for provision of asthma care; optimizing digital approaches to enhance personalized care.

Expert opinion: In a primary care setting, personalized management and supporting individuals to live with asthma extend beyond the contemporary concepts of biological phenotypes and pharmacological 'treatable traits' to encompass evidence-based tailored support for self-management, and delivery of patient-centered care including motivational interviewing. It extends to how we organize clinical practiceand the choices provided in mode of consultation. Diagnostic uncertainty due to recognition of phenotypes of pre-school wheeze remains a challenge for primary care. Digital health can support personalized management, but there are concerns about increasing inequities. This broad approach reflects the traditionally holistic ethos of primary care ('knowing their patients and understanding their communities'), but the core concepts resonate with all healthcare.

引言:作为对生物医学表型认识的补充,哮喘护理的初级保健方法在人群和个人层面上认识到疾病、健康信念和生活方式的多样性。涵盖的领域:我们回顾了与哮喘初级保健管理特别相关的个性化护理的六个方面:为哮喘患者提供个性化支持;针对人群的哮喘护理;管理学龄前喘息儿童的表型;个性化管理;满足提供哮喘护理的个人偏好;优化数字化方法以增强个性化护理。专家意见:在初级保健环境中,个性化管理和支持哮喘患者超越了当代生物学表型和药理学“可治疗特征”的概念,包括基于证据的个性化自我管理支持,以及提供以患者为中心的护理,包括动机访谈。它延伸到我们如何组织临床实践以及在咨询模式中提供的选择。学前喘息表型识别导致的诊断不确定性仍然是初级保健面临的挑战。数字健康可以支持个性化管理,但人们担心不公平现象会加剧。这种广泛的方法反映了初级保健的传统整体精神(“了解患者和了解社区”),但核心概念与所有医疗保健产生了共鸣。
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引用次数: 0
Evaluating as-needed inhaled corticosteroid strategies in asthma: expanding the benefits to mild asthma. 根据需要评估哮喘吸入皮质类固醇策略:将益处扩大到轻度哮喘。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-21 DOI: 10.1080/17476348.2023.2247973
Tommaso Bigoni, Franco Alfano, Federico Baraldi, Marco Contoli, Alberto Papi

Introduction: Adherence to regular anti-inflammatory treatment is commonly low, and short-acting β2 agonist (SABA) overuse is common in patients with asthma, leading to an increased risk of asthma-related adverse events.

Areas covered: Given the pivotal role of inflammation in asthma, multiple as-needed inhaled corticosteroid (ICS)-containing therapies have been developed, leading to a reduction in asthma exacerbations and improvement in symptom control. Currently, as-needed ICS/formoterol is one of the most commonly available formulations; however, other combinations such as ICS/SABA have been shown to be superior to as-needed SABA alone. Therefore, we performed a comprehensive review of the available scientific literature to enhance the advantages and disadvantages of each combination in clinical practice.

Expert opinion: The future direction we foresee in asthma management consists in abandoning as-needed short-acting bronchodilators in favor of as-needed ICS-containing therapies. Each patient is unique and differs from others; consequently, a single option will not fit everyone. Patients' and physicians' awareness of this perspective can be reached through the development of multiple therapeutic options suitable for each condition that can be found in 'real life'.

引言:常规抗炎治疗的依从性通常较低,短效β2激动剂(SABA)过度使用在哮喘患者中很常见,导致哮喘相关不良事件的风险增加。所涵盖的领域:鉴于炎症在哮喘中的关键作用,已经开发出多种所需的含吸入皮质类固醇(ICS)的疗法,从而减少哮喘恶化并改善症状控制。目前,根据需要,ICS/福莫特罗是最常用的配方之一;然而,诸如ICS/SABA的其他组合已被证明优于单独的所需SABA。因此,我们对现有的科学文献进行了全面的审查,以增强每种组合在临床实践中的优势和劣势。专家意见:我们预计哮喘治疗的未来方向是放弃必要的短效支气管扩张剂,转而采用必要的含ICS的治疗方法。每个患者都是独一无二的,与其他患者不同;因此,单一的选择并不适合所有人。患者和医生对这一观点的认识可以通过开发适合“现实生活”中每种情况的多种治疗方案来实现。
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引用次数: 0
Mechanisms underlying corticosteroid resistance in patients with asthma: a review of current knowledge. 哮喘患者皮质类固醇抵抗的潜在机制:当前知识综述。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-09-04 DOI: 10.1080/17476348.2023.2255124
Javier Milara, Anselm Morell, Inés Roger, Paula Montero, Julio Cortijo

Introduction: Corticosteroids are the most cost-effective anti-inflammatory drugs available for the treatment of asthma. Despite their effectiveness, several asthmatic patients have corticosteroid resistance or insensitivity and exhibit a poor response. Corticosteroid insensitivity implies a poor prognosis due to challenges in finding alternative therapeutic options for asthma.

Areas covered: In this review, we describe asthma phenotypes and endotypes, as well as their differential responsiveness to corticosteroids. In addition, we describe the mechanism of action of corticosteroids underlying their regulation of the expression of glucocorticoid receptors (GRs) and their anti-inflammatory effects. Furthermore, we summarize the mechanistic evidence underlying corticosteroid-insensitive asthma, which is mainly related to changes in GR gene expression, structure, and post-transcriptional modifications. Finally, various pharmacological strategies designed to reverse corticosteroid insensitivity are discussed.

Expert opinion: Corticosteroid insensitivity is influenced by the asthma phenotype, endotype, and severity, and serves as an indication for biological therapy. The molecular mechanisms underlying corticosteroid-insensitive asthma have been used to develop targeted therapeutic strategies. However, the lack of clinical trials prevents the clinical application of these treatments.

简介:皮质类固醇是治疗哮喘最具成本效益的抗炎药。尽管它们有效,但一些哮喘患者存在皮质类固醇耐药性或不敏感,反应不佳。皮质类固醇不敏感意味着预后不良,因为在寻找哮喘的替代治疗方案方面存在挑战。涵盖领域:在这篇综述中,我们描述了哮喘表型和内型,以及它们对皮质类固醇的不同反应性。此外,我们还描述了皮质类固醇对糖皮质激素受体(GR)表达的调节及其抗炎作用的作用机制。此外,我们总结了皮质类固醇不敏感哮喘的机制证据,这主要与GR基因表达、结构和转录后修饰的变化有关。最后,讨论了旨在逆转皮质类固醇不敏感的各种药理学策略。专家意见:皮质类固醇不敏感受哮喘表型、内型和严重程度的影响,可作为生物治疗的指征。皮质类固醇不敏感哮喘的分子机制已被用于制定有针对性的治疗策略。然而,缺乏临床试验阻碍了这些治疗方法的临床应用。
{"title":"Mechanisms underlying corticosteroid resistance in patients with asthma: a review of current knowledge.","authors":"Javier Milara,&nbsp;Anselm Morell,&nbsp;Inés Roger,&nbsp;Paula Montero,&nbsp;Julio Cortijo","doi":"10.1080/17476348.2023.2255124","DOIUrl":"10.1080/17476348.2023.2255124","url":null,"abstract":"<p><strong>Introduction: </strong>Corticosteroids are the most cost-effective anti-inflammatory drugs available for the treatment of asthma. Despite their effectiveness, several asthmatic patients have corticosteroid resistance or insensitivity and exhibit a poor response. Corticosteroid insensitivity implies a poor prognosis due to challenges in finding alternative therapeutic options for asthma.</p><p><strong>Areas covered: </strong>In this review, we describe asthma phenotypes and endotypes, as well as their differential responsiveness to corticosteroids. In addition, we describe the mechanism of action of corticosteroids underlying their regulation of the expression of glucocorticoid receptors (GRs) and their anti-inflammatory effects. Furthermore, we summarize the mechanistic evidence underlying corticosteroid-insensitive asthma, which is mainly related to changes in GR gene expression, structure, and post-transcriptional modifications. Finally, various pharmacological strategies designed to reverse corticosteroid insensitivity are discussed.</p><p><strong>Expert opinion: </strong>Corticosteroid insensitivity is influenced by the asthma phenotype, endotype, and severity, and serves as an indication for biological therapy. The molecular mechanisms underlying corticosteroid-insensitive asthma have been used to develop targeted therapeutic strategies. However, the lack of clinical trials prevents the clinical application of these treatments.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The value of perioperative physical activity in older patients undergoing surgery for lung cancer. 老年癌症患者围手术期体力活动的价值。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-09-11 DOI: 10.1080/17476348.2023.2255133
Dan J Raz, Jae Y Kim, Loretta Erhunwmunesee, Sherry Hite, Gouri Varatkar, Virginia Sun

Introduction: With a median age at diagnosis of 70, lung cancer represents an enormous public health problem among older Americans. An estimated 19,000 people age 65 and older undergo lung cancer surgery annually in the US. Older adults undergoing lung cancer surgery are often frail with limited physiologic reserves, multi-morbidities, and functional impairments. Physical function, dyspnea, and quality of life return to baseline slower in older adults compared with younger adults after lung surgery.

Areas covered: In this review, we summarize available data about perioperative physical activity interventions that may improve outcomes for older adults undergoing lung cancer surgery. We also review the limitations of existing studies and discuss emerging data on the roles of telehealth and family caregiver inclusion in peri-operative physical activity interventions.

Expert opinion: We propose that future perioperative physical activity interventions in older adults undergoing lung cancer surgery should include a comprehensive geriatric assessment to guide personalized interventions. Interventions should be conceptually based, with a focus on enhancing self-efficacy, motivation, and adherence through classic behavior change strategies that are proven to impact outcomes. Finally, interventions should be designed with attention to feasibility and scalability. Exercise programs delivered via telehealth (telephone or tele-video) may improve access and convenience for patients.

简介:癌症的中位诊断年龄为70岁,这在美国老年人中是一个巨大的公共卫生问题。据估计,美国每年有19000名65岁及以上的人接受癌症手术。接受癌症手术的老年人通常身体虚弱,生理储备有限,多发病率高,功能受损。肺部手术后,与年轻人相比,老年人的身体功能、呼吸困难和生活质量恢复到基线的速度较慢。涵盖的领域:在这篇综述中,我们总结了围手术期体育活动干预的可用数据,这些干预可能会改善老年人接受癌症手术的结果。我们还回顾了现有研究的局限性,并讨论了关于远程医疗和家庭护理者在围手术期体育活动干预中的作用的新数据。专家意见:我们建议,在接受癌症手术的老年人中,未来的围手术期体力活动干预应包括全面的老年评估,以指导个性化干预。干预措施应以概念为基础,重点是通过被证明会影响结果的经典行为改变策略来增强自我效能、动机和依从性。最后,干预措施的设计应注意可行性和可扩展性。通过远程医疗(电话或远程视频)提供的锻炼计划可以改善患者的访问和便利性。
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引用次数: 0
Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis. 跳出框框思考:囊性纤维化胃肠道症状和并发症综述。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-06-26 DOI: 10.1080/17476348.2023.2228194
Alexander Yule, Darren Sills, Sherie Smith, Robin Spiller, Alan R Smyth

Introduction: Gastrointestinal (GI)-related symptoms, complications, and comorbidities in cystic fibrosis (CF) are common and research to reduce their burden is a priority for the CF community. To enable future research, this review aimed to summarize the range of GI symptoms, complications and comorbidities seen in CF, the underlying pathophysiology, and treatments.

Areas covered: This was a rapid systematic review undertaken using the recommendations from the Cochrane Rapid Reviews Methods Group. We searched databases including PubMed, Embase, Medline and the Cochrane database and identified those studies reporting GI-related symptoms, complications, or comorbidities in CF or their treatment. Our searches identified 2,930 studies and a total 119 studies met our inclusion criteria. Where a prevalence could be determined, GI symptoms were reported in 33.7% of study participants. The range of symptoms reported was broad and the highest median prevalence included flatulence (43.5%), bloating and abdominal distension (36%), and fatty stool (36%). Meconium ileus was reported in 12% and distal intestinal obstruction syndrome in 8.5.

Expert opinion: GI-related symptoms, complications, and comorbidities in CF are common. More consistent characterization and recording of these symptoms in clinical studies may help achieve the priority of reducing the burden of GI disease in CF.

引言:囊性纤维化(CF)的胃肠道(GI)相关症状、并发症和合并症很常见,减少其负担的研究是CF社区的优先事项。为了便于未来的研究,这篇综述旨在总结CF中出现的胃肠道症状、并发症和合并症的范围、潜在的病理生理学和治疗方法。涵盖的领域:这是一项使用Cochrane快速审查方法小组的建议进行的快速系统审查。我们搜索了包括PubMed、Embase、Medline和Cochrane数据库在内的数据库,并确定了那些报告CF或其治疗中胃肠道相关症状、并发症或合并症的研究。我们的检索确定了2930项研究,共有119项研究符合我们的纳入标准。在可以确定患病率的情况下,33.7%的研究参与者报告了胃肠道症状。报告的症状范围很广,最高的中位患病率包括胀气(43.5%)、腹胀和腹胀(36%)以及脂肪粪便(36%)。12%的患者报告了胎粪性肠梗阻,8.5.报告了远端肠梗阻综合征。专家意见:CF中常见的胃肠道相关症状、并发症和合并症。在临床研究中对这些症状进行更一致的表征和记录可能有助于优先减轻CF中胃肠道疾病的负担。
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引用次数: 0
Diagnosis and management of pulmonary veno-occlusive disease. 肺静脉闭塞性疾病的诊断和治疗。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-21 DOI: 10.1080/17476348.2023.2247989
Sabina Solinas, Athénaïs Boucly, Antoine Beurnier, Mithum Kularatne, Julien Grynblat, Mélanie Eyries, Peter Dorfmüller, Olivier Sitbon, Marc Humbert, David Montani

Introduction: Pulmonary veno-occlusive disease (PVOD) is an orphan disease and uncommon etiology of pulmonary arterial hypertension (PAH) characterized by substantial small pulmonary vein and capillary involvement.

Areas covered: PVOD, also known as 'PAH with features of venous/capillary involvement' in the current ESC/ERS classification.

Expert opinion: In recent years, particular risk factors for PVOD have been recognized, including genetic susceptibilities and environmental factors (such as exposure to occupational organic solvents, chemotherapy, and potentially tobacco). The discovery of biallelic mutations in the EIF2AK4 gene as the cause of heritable PVOD has been a breakthrough in understanding the molecular basis of PVOD. Venous and capillary involvement (PVOD-like) has also been reported to be relatively common in connective tissue disease-associated PAH (especially systemic sclerosis), and in rare pulmonary diseases like sarcoidosis and pulmonary Langerhans cell granulomatosis. Although PVOD and pulmonary arterial hypertension (PAH) exhibit similarities, including severe precapillary PH, it is essential to differentiate between them since PVOD has a worse prognosis and requires specific management. Indeed, PVOD patients are characterized by poor response to PAH-approved drugs, which can lead to pulmonary edema and clinical deterioration. Due to the lack of effective treatments, early referral to a lung transplantation center is crucial.

引言:肺静脉闭塞性疾病(PVOD)是一种孤立性疾病,也是肺动脉高压(PAH)的罕见病因,其特征是大量小肺静脉和毛细血管受累。涵盖的领域:PVOD,在当前ESC/ERS分类中也称为“具有静脉/毛细血管受累特征的PAH”。专家意见:近年来,PVOD的特定风险因素已被认识到,包括遗传易感性和环境因素(如接触职业有机溶剂、化疗和潜在的烟草)。在EIF2AK4基因中发现双等位基因突变是可遗传PVOD的原因,这是理解PVOD分子基础的突破。据报道,静脉和毛细血管受累(PVOD样)在结缔组织疾病相关的PAH(尤其是系统性硬化症)以及结节病和肺郎格汉斯细胞肉芽肿等罕见肺部疾病中也相对常见。尽管PVOD和肺动脉高压(PAH)表现出相似之处,包括严重的毛细血管前PH,但有必要区分它们,因为PVOD的预后较差,需要特殊的治疗。事实上,PVOD患者的特点是对PAH批准的药物反应不佳,这可能导致肺水肿和临床恶化。由于缺乏有效的治疗方法,尽早转诊到肺移植中心至关重要。
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引用次数: 0
Pharmacotherapy for obstructive sleep apnea: targeting specific pathophysiological traits. 阻塞性睡眠呼吸暂停的药物治疗:针对特定的病理生理特征。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-30 DOI: 10.1080/17476348.2023.2241353
Elisa Perger, Simona Bertoli, Carolina Lombardi

Introduction: The pathophysiology of obstructive sleep apnea (OSA) is multi-factorial and complex. Varying OSA's pathophysiological traits have been identified, including pharyngeal collapsibility, upper airway muscle reactivity, arousal threshold, and regulation of the ventilatory drive. Being CPAP of difficult tolerance and other interventions reserved to specific subpopulations new pharmacological treatments for OSA might be resolutive.

Areas covered: Several existing and newly developed pharmacological drugs can impact one or more endotypes and could therefore be proposed as treatment options for sleep disordered breathing. With this review we will explore different pathophysiological traits as new targets for OSA therapy. This review will summarize the most promising pharmacological treatment for OSA accordingly with their mechanisms of action on upper airway collapsibility, muscle responsiveness, arousal threshold, and loop gain.

Expert opinion: Only understanding the pathophysiological traits causing OSA in each patient and placing the disease in the framework of patient comorbidities, we will be able to evolve interventions toward OSA. The development of new drug's combinations will permit different approaches and different choices beside conventional treatments. In the next future, we hope that sleep specialists will select the treatment for a specific patient on the base of its pathophysiology, defining a precision medicine for OSA.

引言:阻塞性睡眠呼吸暂停(OSA)的病理生理学是多因素和复杂的。OSA的各种病理生理特征已经被确定,包括咽部塌陷、上呼吸道肌肉反应性、唤醒阈值和通气驱动的调节。作为难耐受的CPAP和保留给特定亚群的其他干预措施,OSA的新药物治疗可能是可行的。涵盖的领域:几种现有和新开发的药理学药物可以影响一种或多种内型,因此可以作为睡眠呼吸障碍的治疗选择。通过这篇综述,我们将探索不同的病理生理特征作为OSA治疗的新靶点。这篇综述将相应地总结OSA最有前景的药物治疗方法,以及它们对上呼吸道塌陷性、肌肉反应性、唤醒阈值和环路增益的作用机制。专家意见:只有了解每个患者引起OSA的病理生理特征,并将该疾病置于患者合并症的框架中,我们才能发展针对OSA的干预措施。新药组合的开发将允许在传统治疗之外采用不同的方法和选择。在未来,我们希望睡眠专家能够根据特定患者的病理生理学来选择治疗方法,从而为OSA定义一种精确的药物。
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引用次数: 0
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Expert Review of Respiratory Medicine
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