Pub Date : 2023-07-01Epub Date: 2023-06-26DOI: 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.
{"title":"Thinking outside the box: a review of gastrointestinal symptoms and complications in cystic fibrosis.","authors":"Alexander Yule, Darren Sills, Sherie Smith, Robin Spiller, Alan R Smyth","doi":"10.1080/17476348.2023.2228194","DOIUrl":"10.1080/17476348.2023.2228194","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Areas covered: </strong>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.</p><p><strong>Expert opinion: </strong>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.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 7","pages":"547-561"},"PeriodicalIF":3.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10489955","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}
Pub Date : 2023-05-01DOI: 10.1080/17476348.2023.2213438
Malina Barillaro, Tanja Gonska
Introduction: Next to evaluating for defects in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, diagnostic guidelines for cystic fibrosis (CF) include CFTR function tests. The primarily used sweat test and genetics generally produce straightforward CF diagnoses. However, a widened CF disease spectrum and large number of CFTR gene variants with unknown or varying clinical consequences shift reliance on CFTR functional tests to assess for CF or CFTR-related disease. Recently, CFTR functional tests are used to record efficiency of CFTR modulator drugs.
Areas covered: This review provides background and accuracy of the currently used CFTR functional tests, including the sweat test, nasal potential difference (NPD), and intestinal current measurements (ICM). We summarize published evidence addressing technical and biological reasons for test variability and test result in relation to CF-associated symptoms.
Expert opinion: The CFTR functional tests demonstrate high accuracy despite biological and technical variability. Data is scarce for ICM. Each test identifies CF from non-CF but show lower accuracy for individuals not fitting the classic CF diagnostic criteria. Adherence to standardized protocols is critical to improve test accuracy across different centers. Lastly, instead of relying on the single test results, diagnostic assessment should be based on integrating multiple functional and genetic test results.
{"title":"Assessing accuracy of testing and diagnosis in cystic fibrosis.","authors":"Malina Barillaro, Tanja Gonska","doi":"10.1080/17476348.2023.2213438","DOIUrl":"https://doi.org/10.1080/17476348.2023.2213438","url":null,"abstract":"<p><strong>Introduction: </strong>Next to evaluating for defects in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, diagnostic guidelines for cystic fibrosis (CF) include CFTR function tests. The primarily used sweat test and genetics generally produce straightforward CF diagnoses. However, a widened CF disease spectrum and large number of CFTR gene variants with unknown or varying clinical consequences shift reliance on CFTR functional tests to assess for CF or CFTR-related disease. Recently, CFTR functional tests are used to record efficiency of CFTR modulator drugs.</p><p><strong>Areas covered: </strong>This review provides background and accuracy of the currently used CFTR functional tests, including the sweat test, nasal potential difference (NPD), and intestinal current measurements (ICM). We summarize published evidence addressing technical and biological reasons for test variability and test result in relation to CF-associated symptoms.</p><p><strong>Expert opinion: </strong>The CFTR functional tests demonstrate high accuracy despite biological and technical variability. Data is scarce for ICM. Each test identifies CF from non-CF but show lower accuracy for individuals not fitting the classic CF diagnostic criteria. Adherence to standardized protocols is critical to improve test accuracy across different centers. Lastly, instead of relying on the single test results, diagnostic assessment should be based on integrating multiple functional and genetic test results.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 5","pages":"337-349"},"PeriodicalIF":3.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9986605","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}
Pub Date : 2023-05-01DOI: 10.1080/17476348.2023.2210838
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
Introduction: Pulmonary arterial hypertension (PAH) is defined as a mean pulmonary artery pressure >20 mmHg and pulmonary vascular resistance >2 Wood Units (WU) on right-heart catheterization. Pregnancy is generally contraindicated in PAH, it is associated with high maternal mortality. Despite current recommendations, the number of women with PAH wishing to become pregnant is increasing. Specialist care is essential for preconception counseling, and the management of pregnancy and delivery in such patients.
Areas covered: We cover the physiology of pregnancy, and its effects on the cardiovascular system in PAH. We also discuss optimal management based on available evidence and guidance.
Expert opinion: Pregnancy should be avoided in most patients with PAH. Counseling on appropriate contraception should be offered routinely. Education of women with childbearing potential is essential and should start at the time of diagnosis of PAH, or the time of transition from pediatric to adult services in patients developing PAH in childhood. Women wishing to become pregnant should receive individualized risk assessment and optimization of PAH therapies via a dedicated specialist pre-pregnancy counseling service, to minimize risk and improve outcomes. Pregnant PAH patients should receive expert multidisciplinary management in a PH center, including close monitoring and early initiation of therapies.
肺动脉高压(PAH)定义为右心导管时平均肺动脉压>20 mmHg,肺血管阻力>2 Wood Units (WU)。妊娠一般禁忌症在多环芳烃,它是与高产妇死亡率。尽管有目前的建议,但希望怀孕的多环芳烃妇女人数正在增加。专科护理是必不可少的孕前咨询,并在这类患者的妊娠和分娩管理。涵盖领域:我们涵盖了怀孕的生理,以及它对多环芳烃的心血管系统的影响。我们还讨论了基于现有证据和指导的最佳管理。专家意见:多数PAH患者应避免妊娠。应定期提供适当避孕的咨询。对有生育潜力的妇女进行教育是必要的,应该在诊断出多环芳烃时开始,或者在儿童期多环芳烃患者从儿科服务过渡到成人服务时开始。希望怀孕的妇女应该通过专门的孕前咨询服务接受个性化的风险评估和PAH治疗的优化,以最大限度地降低风险并改善结果。妊娠PAH患者应在PH中心接受专家多学科管理,包括密切监测和早期开始治疗。
{"title":"Management of pulmonary arterial hypertension during pregnancy.","authors":"Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos","doi":"10.1080/17476348.2023.2210838","DOIUrl":"https://doi.org/10.1080/17476348.2023.2210838","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary arterial hypertension (PAH) is defined as a mean pulmonary artery pressure >20 mmHg and pulmonary vascular resistance >2 Wood Units (WU) on right-heart catheterization. Pregnancy is generally contraindicated in PAH, it is associated with high maternal mortality. Despite current recommendations, the number of women with PAH wishing to become pregnant is increasing. Specialist care is essential for preconception counseling, and the management of pregnancy and delivery in such patients.</p><p><strong>Areas covered: </strong>We cover the physiology of pregnancy, and its effects on the cardiovascular system in PAH. We also discuss optimal management based on available evidence and guidance.</p><p><strong>Expert opinion: </strong>Pregnancy should be avoided in most patients with PAH. Counseling on appropriate contraception should be offered routinely. Education of women with childbearing potential is essential and should start at the time of diagnosis of PAH, or the time of transition from pediatric to adult services in patients developing PAH in childhood. Women wishing to become pregnant should receive individualized risk assessment and optimization of PAH therapies via a dedicated specialist pre-pregnancy counseling service, to minimize risk and improve outcomes. Pregnant PAH patients should receive expert multidisciplinary management in a PH center, including close monitoring and early initiation of therapies.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 5","pages":"413-423"},"PeriodicalIF":3.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9627726","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}
Pub Date : 2023-05-01DOI: 10.1080/17476348.2023.2208349
Arturo Casadevall, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David Sullivan, Nigel Paneth, Daniele Focosi
Introduction: When the COVID-19 pandemic struck no specific therapies were available and many turned to COVID-19 convalescent plasma (CCP), a form of antibody therapy. The literature provides mixed evidence for CCP efficacy.
Areas covered: PubMed was searched using the words COVID-19 and convalescent plasma and individual study designs were evaluated for adherence to the three principles of antibody therapy, i.e. that plasma 1) contain specific antibody; 2) have enough specific antibody to mediate a biological effect; and 3) be administered early in the course of disease. Using this approach, a diverse and seemingly contradictory collection of clinical findings was distilled into a consistent picture whereby CCP was effective when used according to the above principles of antibody therapy. In addition, CCP therapy in immunocompromised patients is useful at any time in the course of disease.
Expert opinion: CCP is safe and effective when used appropriately. Today, most of humanity has some immunity to SARS-CoV-2 from vaccines and infection, which has lessened the need for CCP in the general population. However, COVID-19 in immunocompromised patients is a major therapeutic challenge, and with the deauthorization of all SARS-CoV-2-spike protein-directed monoclonal antibodies, CCP is the only antibody therapy available for this population.
{"title":"Convalescent plasma therapy in COVID-19: Unravelling the data using the principles of antibody therapy.","authors":"Arturo Casadevall, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David Sullivan, Nigel Paneth, Daniele Focosi","doi":"10.1080/17476348.2023.2208349","DOIUrl":"https://doi.org/10.1080/17476348.2023.2208349","url":null,"abstract":"<p><strong>Introduction: </strong>When the COVID-19 pandemic struck no specific therapies were available and many turned to COVID-19 convalescent plasma (CCP), a form of antibody therapy. The literature provides mixed evidence for CCP efficacy.</p><p><strong>Areas covered: </strong>PubMed was searched using the words COVID-19 and convalescent plasma and individual study designs were evaluated for adherence to the three principles of antibody therapy, i.e. that plasma 1) contain specific antibody; 2) have enough specific antibody to mediate a biological effect; and 3) be administered early in the course of disease. Using this approach, a diverse and seemingly contradictory collection of clinical findings was distilled into a consistent picture whereby CCP was effective when used according to the above principles of antibody therapy. In addition, CCP therapy in immunocompromised patients is useful at any time in the course of disease.</p><p><strong>Expert opinion: </strong>CCP is safe and effective when used appropriately. Today, most of humanity has some immunity to SARS-CoV-2 from vaccines and infection, which has lessened the need for CCP in the general population. However, COVID-19 in immunocompromised patients is a major therapeutic challenge, and with the deauthorization of all SARS-CoV-2-spike protein-directed monoclonal antibodies, CCP is the only antibody therapy available for this population.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 5","pages":"381-395"},"PeriodicalIF":3.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9986120","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}
Pub Date : 2023-05-01DOI: 10.1080/17476348.2023.2215433
Takahisa Gono, Masataka Kuwana
Introduction: Interstitial lung disease (ILD) is the leading cause of mortality in idiopathic inflammatory myopathies or myositis. Clinical characteristics, including the course of ILD, rate of progression, radiological and pathohistological morphologies, extent and distribution of inflammation and fibrosis, responses to treatment, recurrence rate, and prognosis, are highly variable among myositis patients. A standard practice for ILD management in myositis patients has not yet been established.
Areas covered: Recent studies have demonstrated the stratification of patients with myositis-associated ILD into more homogeneous groups based on the disease behavior and myositis-specific autoantibody (MSA) profile, leading to better prognoses and prevention of the burden of organ damage. This review introduces a new paradigm in the management of myositis-associated ILD based on research findings from relevant literature selected by a search of PubMed as of January 2023, as well as expert opinions.
Expert opinion: Managing strategies for myositis-associated ILD are being established to stratify patients based on the severity of ILD and the prediction of prognosis based on the disease behavior and MSA profile. The development of a precision medicine treatment approach will provide benefits to all relevant communities.
{"title":"New paradigm in the treatment of myositis-associated interstitial lung disease.","authors":"Takahisa Gono, Masataka Kuwana","doi":"10.1080/17476348.2023.2215433","DOIUrl":"https://doi.org/10.1080/17476348.2023.2215433","url":null,"abstract":"<p><strong>Introduction: </strong>Interstitial lung disease (ILD) is the leading cause of mortality in idiopathic inflammatory myopathies or myositis. Clinical characteristics, including the course of ILD, rate of progression, radiological and pathohistological morphologies, extent and distribution of inflammation and fibrosis, responses to treatment, recurrence rate, and prognosis, are highly variable among myositis patients. A standard practice for ILD management in myositis patients has not yet been established.</p><p><strong>Areas covered: </strong>Recent studies have demonstrated the stratification of patients with myositis-associated ILD into more homogeneous groups based on the disease behavior and myositis-specific autoantibody (MSA) profile, leading to better prognoses and prevention of the burden of organ damage. This review introduces a new paradigm in the management of myositis-associated ILD based on research findings from relevant literature selected by a search of PubMed as of January 2023, as well as expert opinions.</p><p><strong>Expert opinion: </strong>Managing strategies for myositis-associated ILD are being established to stratify patients based on the severity of ILD and the prediction of prognosis based on the disease behavior and MSA profile. The development of a precision medicine treatment approach will provide benefits to all relevant communities.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 5","pages":"397-411"},"PeriodicalIF":3.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629637","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}
Pub Date : 2023-05-01DOI: 10.1080/17476348.2023.2208348
Diana H Ferreira, Slavica Kochovska, Vanessa N Brunelli, David C Currow
Introduction: Persistent breathlessness (breathlessness persisting despite optimal treatment for the underlying condition and resulting in disability) is a prevalent syndrome associated with chronic and life-limiting conditions. Improving the clinical recognition and assessment of persistent breathlessness is essential to ensure people are provided with the best treatment for optimal symptom control.
Areas covered: This overview focuses on the impact of persistent breathlessness on patients, carers and the health system. It highlights the importance of identifying persistent breathlessness in clinical consultations, suggests steps to recognize this syndrome and discusses the evidence for non-pharmacological and pharmacological treatments in this context. Future research directions are also suggested.
Expert opinion: Persistent breathlessness is often invisible because 1) people may not engage with the health system and 2) both clinicians and patients are reluctant to discuss breathlessness in clinical consultations. Improving the recognition and assessment of this syndrome is critical to facilitate meaningful conversations between patients and clinicians and ensure patient-centered care. Non-pharmacological strategies are key to improving symptom management and health outcomes. Regular, low-dose, sustained-release morphine may help further reduce breathlessness in people who remain symptomatic despite disease-specific and non-pharmacological therapies.
{"title":"Understanding persistent breathlessness: impact on patients and optimal approaches to symptomatic reduction - an overview.","authors":"Diana H Ferreira, Slavica Kochovska, Vanessa N Brunelli, David C Currow","doi":"10.1080/17476348.2023.2208348","DOIUrl":"https://doi.org/10.1080/17476348.2023.2208348","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent breathlessness (breathlessness persisting despite optimal treatment for the underlying condition and resulting in disability) is a prevalent syndrome associated with chronic and life-limiting conditions. Improving the clinical recognition and assessment of persistent breathlessness is essential to ensure people are provided with the best treatment for optimal symptom control.</p><p><strong>Areas covered: </strong>This overview focuses on the impact of persistent breathlessness on patients, carers and the health system. It highlights the importance of identifying persistent breathlessness in clinical consultations, suggests steps to recognize this syndrome and discusses the evidence for non-pharmacological and pharmacological treatments in this context. Future research directions are also suggested.</p><p><strong>Expert opinion: </strong>Persistent breathlessness is often invisible because 1) people may not engage with the health system and 2) both clinicians and patients are reluctant to discuss breathlessness in clinical consultations. Improving the recognition and assessment of this syndrome is critical to facilitate meaningful conversations between patients and clinicians and ensure patient-centered care. Non-pharmacological strategies are key to improving symptom management and health outcomes. Regular, low-dose, sustained-release morphine may help further reduce breathlessness in people who remain symptomatic despite disease-specific and non-pharmacological therapies.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 5","pages":"365-379"},"PeriodicalIF":3.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9633522","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}
Pub Date : 2023-05-01Epub Date: 2023-04-26DOI: 10.1080/17476348.2023.2205127
Sadiya Bi Shaikh, Chiara Goracci, Ariel Tjitropranoto, Irfan Rahman
Introduction: Several immunological alterations that occur during pulmonary diseases often mimic alterations observed in the aged lung. From the molecular perspective, pulmonary diseases and aging partake in familiar mechanisms associated with significant dysregulation of the immune systems. Here, we summarized the findings of how aging alters immunity to respiratory conditions to identify age-impacted pathways and mechanisms that contribute to the development of pulmonary diseases.
Areas covered: The current review examines the impact of age-related molecular alterations in the aged immune system during various lung diseases, such as COPD, IPF, Asthma, and alongside many others that could possibly improve on current therapeutic interventions. Moreover, our increased understanding of this phenomenon may play a primary role in shaping immunomodulatory strategies to boost outcomes in the elderly. Here, the authors present new insights into the context of lung-related diseases and describe the alterations in the functioning of immune cells during various pulmonary conditions altered with age.
Expert opinion: The expert opinion provided the concepts on how aging alters immunity during pulmonary conditions, and suggests the associated mechanisms during the development of lung diseases. As a result, it becomes important to comprehend the complex mechanism of aging in the immune lung system.
{"title":"Impact of aging on immune function in the pathogenesis of pulmonary diseases: potential for therapeutic targets.","authors":"Sadiya Bi Shaikh, Chiara Goracci, Ariel Tjitropranoto, Irfan Rahman","doi":"10.1080/17476348.2023.2205127","DOIUrl":"10.1080/17476348.2023.2205127","url":null,"abstract":"<p><strong>Introduction: </strong>Several immunological alterations that occur during pulmonary diseases often mimic alterations observed in the aged lung. From the molecular perspective, pulmonary diseases and aging partake in familiar mechanisms associated with significant dysregulation of the immune systems. Here, we summarized the findings of how aging alters immunity to respiratory conditions to identify age-impacted pathways and mechanisms that contribute to the development of pulmonary diseases.</p><p><strong>Areas covered: </strong>The current review examines the impact of age-related molecular alterations in the aged immune system during various lung diseases, such as COPD, IPF, Asthma, and alongside many others that could possibly improve on current therapeutic interventions. Moreover, our increased understanding of this phenomenon may play a primary role in shaping immunomodulatory strategies to boost outcomes in the elderly. Here, the authors present new insights into the context of lung-related diseases and describe the alterations in the functioning of immune cells during various pulmonary conditions altered with age.</p><p><strong>Expert opinion: </strong>The expert opinion provided the concepts on how aging alters immunity during pulmonary conditions, and suggests the associated mechanisms during the development of lung diseases. As a result, it becomes important to comprehend the complex mechanism of aging in the immune lung system.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 5","pages":"351-364"},"PeriodicalIF":3.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10330361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9772008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Background The right time of high-flow nasal cannulas (HFNCs) application in COVID-19 patients with acute respiratory failure remains uncertain. Research design and methods In this retrospective study, COVID-19-infected adult patients with hypoxemic respiratory failure were enrolled. Their baseline epidemiological data and respiratory failure related parameters, including the Ventilation in COVID-19 Estimation (VICE), and the ratio of oxygen saturation (ROX index), were recorded. The primary outcome measured was the 28-day mortality. Results A total of 69 patients were enrolled. Fifty-four (78%) patients who intubated and received invasive mechanical ventilatory (MV) support on day 1 were enrolled in the MV group. The remaining fifteen (22%) patients received HFNC initially (HFNC group), in which, ten (66%) patients were not intubated during hospitalization were belong to HFNC-success group and five (33%) of these patients were intubated later due to disease progression were attributed to HFNC-failure group. Compared with those in the MV group, those in the HFNC group had a lower mortality rate (6.7% vs. 40.7%, p = 0.0138). There were no differences in baseline characteristics among the two groups; however, the HFNC group had a lower VICE score (0.105 [0.049–0.269] vs. 0.260 [0.126–0.693], p = 0.0092) and higher ROX index (5.3 [5.1–10.7] vs. 4.3 [3.9–4.9], p = 0.0007) than the MV group. The ROX index was higher in the HFNC success group immediately before (p = 0.0136) and up to 12 hours of HFNC therapy than in the HFNC failure group. Conclusions Early intubation may be considered in patients with a higher VICE score or a lower ROX index. The ROX score during HFNCs use can provide an early warning sign of treatment failure. Further investigations are warranted to confirm these results. Plain Language Summary High flow nasal cannulas (HFNCs) were widely used in patients with COVID-19 infection related hypoxemic respiratory failure. However, there were concerns about its failure and related delayed intubation may be associated with a higher mortality rate. This retrospective study revealed patients with higher baseline disease severity and higher VICE scores may be treated with primary invasive mechanical ventilation. On the contrary, if their baseline VICE score is low and ROX index is high, HFNCs treatment might be safely applied initially. The trends of serial ROX index values during HFNC use could be a reliable periscope to predict the HFNC therapy outcome, therefore avoided delayed intubation.
背景:新冠肺炎合并急性呼吸衰竭患者应用高流量鼻插管的时机尚不确定。研究设计与方法:本研究以低氧性呼吸衰竭的covid -19感染成人患者为研究对象。记录患者的基线流行病学资料和呼吸衰竭相关参数,包括COVID-19通气率(VICE)和血氧饱和度(ROX指数)。测量的主要结果是28天死亡率。结果:共纳入69例患者。54例(78%)患者在第1天插管并接受有创机械通气(MV)支持,被纳入MV组。其余15例(22%)患者最初接受HFNC (HFNC组),其中10例(66%)患者住院期间未插管,属于HFNC成功组,其中5例(33%)患者因疾病进展后插管,属于HFNC失败组。HFNC组死亡率较MV组低(6.7% vs. 40.7%, p = 0.0138)。两组患者的基线特征无差异;而HFNC组的VICE评分(0.105[0.049-0.269]比0.260 [0.126-0.693],p = 0.0092)低于MV组,ROX指数(5.3[5.1-10.7]比4.3 [3.9-4.9],p = 0.0007)高于MV组。HFNC治疗成功组的ROX指数在治疗前(p = 0.0136)和治疗12小时时均高于HFNC治疗失败组。结论:对于VICE评分较高或ROX指数较低的患者,可考虑早期插管。hfnc使用期间的ROX评分可以提供治疗失败的早期预警信号。有必要进一步调查以证实这些结果。
{"title":"Predicting the successful application of high-flow nasal oxygen cannula in patients with COVID-19 respiratory failure: a retrospective analysis.","authors":"Ping-Tsung Yu, Chao-Hsien Chen, Chieh-Jen Wang, Kuan-Chih Kuo, Jou-Chun Wu, Hsin-Pei Chung, Yen-Ting Chen, Yen-Hsiang Tang, Wen-Kuei Chang, Chang-Yi Lin, Chien-Liang Wu","doi":"10.1080/17476348.2023.2199157","DOIUrl":"https://doi.org/10.1080/17476348.2023.2199157","url":null,"abstract":"ABSTRACT Background The right time of high-flow nasal cannulas (HFNCs) application in COVID-19 patients with acute respiratory failure remains uncertain. Research design and methods In this retrospective study, COVID-19-infected adult patients with hypoxemic respiratory failure were enrolled. Their baseline epidemiological data and respiratory failure related parameters, including the Ventilation in COVID-19 Estimation (VICE), and the ratio of oxygen saturation (ROX index), were recorded. The primary outcome measured was the 28-day mortality. Results A total of 69 patients were enrolled. Fifty-four (78%) patients who intubated and received invasive mechanical ventilatory (MV) support on day 1 were enrolled in the MV group. The remaining fifteen (22%) patients received HFNC initially (HFNC group), in which, ten (66%) patients were not intubated during hospitalization were belong to HFNC-success group and five (33%) of these patients were intubated later due to disease progression were attributed to HFNC-failure group. Compared with those in the MV group, those in the HFNC group had a lower mortality rate (6.7% vs. 40.7%, p = 0.0138). There were no differences in baseline characteristics among the two groups; however, the HFNC group had a lower VICE score (0.105 [0.049–0.269] vs. 0.260 [0.126–0.693], p = 0.0092) and higher ROX index (5.3 [5.1–10.7] vs. 4.3 [3.9–4.9], p = 0.0007) than the MV group. The ROX index was higher in the HFNC success group immediately before (p = 0.0136) and up to 12 hours of HFNC therapy than in the HFNC failure group. Conclusions Early intubation may be considered in patients with a higher VICE score or a lower ROX index. The ROX score during HFNCs use can provide an early warning sign of treatment failure. Further investigations are warranted to confirm these results. Plain Language Summary High flow nasal cannulas (HFNCs) were widely used in patients with COVID-19 infection related hypoxemic respiratory failure. However, there were concerns about its failure and related delayed intubation may be associated with a higher mortality rate. This retrospective study revealed patients with higher baseline disease severity and higher VICE scores may be treated with primary invasive mechanical ventilation. On the contrary, if their baseline VICE score is low and ROX index is high, HFNCs treatment might be safely applied initially. The trends of serial ROX index values during HFNC use could be a reliable periscope to predict the HFNC therapy outcome, therefore avoided delayed intubation.","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 4","pages":"319-328"},"PeriodicalIF":3.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9819775","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}
Pub Date : 2023-04-01DOI: 10.1080/17476348.2023.2205125
Grace Oscullo, David de la Rosa, Marta Garcia Clemente, Rosa Giron, Rafael Golpe, Luis Máiz, Miguel Angel Martinez-Garcia
Introduction: Bronchiectasis is a very heterogeneous disease. This heterogeneity has several consequences: severity cannot be measured by a single variable, so multidimensional scores have been developed to capture it more broadly. Some groups of patients with similar clinical characteristics or prognoses (clinical phenotypes), and even similar inflammatory profiles (endotypes), have been identified, and these have been shown to require a more specific treatment.
Areas covered: We comment on this 'stratified' model of medicine as an intermediate step toward the application of the usual concepts on which precision medicine is based (such as cellular, molecular or genetic biomarkers, treatable traits and individual clinical fingerprinting), whereby each subject presents certain specific characteristics and receives individualized treatment.
Expert opinion: True precision or personalized medicine is based on concepts that have not yet been fully achieved in bronchiectasis, although some authors are already beginning to adapt them to this disease in terms of pulmonary and extrapulmonary etiologies, clinical fingerprinting (specific to each individual), cellular biomarkers such as neutrophils and eosinophils (in peripheral blood) and molecular biomarkers such as neutrophil elastase. In therapeutic terms, the future is promising, and some molecules with significant antibiotic and anti-inflammatory properties are being developed.
{"title":"The role of precision medicine in bronchiectasis: emerging data and clinical implications.","authors":"Grace Oscullo, David de la Rosa, Marta Garcia Clemente, Rosa Giron, Rafael Golpe, Luis Máiz, Miguel Angel Martinez-Garcia","doi":"10.1080/17476348.2023.2205125","DOIUrl":"https://doi.org/10.1080/17476348.2023.2205125","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchiectasis is a very heterogeneous disease. This heterogeneity has several consequences: severity cannot be measured by a single variable, so multidimensional scores have been developed to capture it more broadly. Some groups of patients with similar clinical characteristics or prognoses (clinical phenotypes), and even similar inflammatory profiles (endotypes), have been identified, and these have been shown to require a more specific treatment.</p><p><strong>Areas covered: </strong>We comment on this 'stratified' model of medicine as an intermediate step toward the application of the usual concepts on which precision medicine is based (such as cellular, molecular or genetic biomarkers, treatable traits and individual clinical fingerprinting), whereby each subject presents certain specific characteristics and receives individualized treatment.</p><p><strong>Expert opinion: </strong>True precision or personalized medicine is based on concepts that have not yet been fully achieved in bronchiectasis, although some authors are already beginning to adapt them to this disease in terms of pulmonary and extrapulmonary etiologies, clinical fingerprinting (specific to each individual), cellular biomarkers such as neutrophils and eosinophils (in peripheral blood) and molecular biomarkers such as neutrophil elastase. In therapeutic terms, the future is promising, and some molecules with significant antibiotic and anti-inflammatory properties are being developed.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 4","pages":"279-293"},"PeriodicalIF":3.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9802705","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}
Pub Date : 2023-04-01DOI: 10.1080/17476348.2023.2199156
Alessia Comes, Giacomo Sgalla, Simone Ielo, Tonia Magrì, L Richeldi
Introduction: The diagnosis of Idiopathic pulmonary fibrosis (IPF) requires the careful exclusion of secondary causes of interstitial lung disease (ILD), and the collaboration among different specialists is considered paramount to establish a diagnosis with high diagnostic confidence. The multidisciplinary discussion (MDD) has assumed an increasing importance over the years in the different phases of the IPF diagnostic work-up.
Areas covered: The role of MDD in the diagnosis and management of IPF will be described. Practical insights will be provided into how and when to perform MDD based on the available scientific evidence. Current limitations and future perspectives will be discussed.
Expert opinion: In the absence of high diagnostic confidence, agreement between different specialists during MDD is recognized as a surrogate indicator of diagnostic accuracy. Often, despite a lengthy evaluation, the diagnosis remains unclassifiable in a significant percentage of patients. MDD therefore appears to be pivotal in attaining an accurate diagnosis of ILDs. The discussion among different specialists can also include other specialists, such as rheumatologists and thoracic surgeons, in addition to the core group of pulmonologists, radiologists, and pathologists. Such discussions can allow greater diagnostic accuracy and have important effects on management, pharmacologic therapies, and prognosis.
{"title":"Challenges in the diagnosis of idiopathic pulmonary fibrosis: the importance of a multidisciplinary approach.","authors":"Alessia Comes, Giacomo Sgalla, Simone Ielo, Tonia Magrì, L Richeldi","doi":"10.1080/17476348.2023.2199156","DOIUrl":"https://doi.org/10.1080/17476348.2023.2199156","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of Idiopathic pulmonary fibrosis (IPF) requires the careful exclusion of secondary causes of interstitial lung disease (ILD), and the collaboration among different specialists is considered paramount to establish a diagnosis with high diagnostic confidence. The multidisciplinary discussion (MDD) has assumed an increasing importance over the years in the different phases of the IPF diagnostic work-up.</p><p><strong>Areas covered: </strong>The role of MDD in the diagnosis and management of IPF will be described. Practical insights will be provided into how and when to perform MDD based on the available scientific evidence. Current limitations and future perspectives will be discussed.</p><p><strong>Expert opinion: </strong>In the absence of high diagnostic confidence, agreement between different specialists during MDD is recognized as a surrogate indicator of diagnostic accuracy. Often, despite a lengthy evaluation, the diagnosis remains unclassifiable in a significant percentage of patients. MDD therefore appears to be pivotal in attaining an accurate diagnosis of ILDs. The discussion among different specialists can also include other specialists, such as rheumatologists and thoracic surgeons, in addition to the core group of pulmonologists, radiologists, and pathologists. Such discussions can allow greater diagnostic accuracy and have important effects on management, pharmacologic therapies, and prognosis.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":"17 4","pages":"1-11"},"PeriodicalIF":3.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9511356","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}