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The individual and societal prices of non-adherence to continuous positive airway pressure, contributors, and strategies for improvement. 不坚持持续气道正压的个人和社会代价、影响因素和改善策略。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17476348.2023.2202853
Monique Mendelson, Jeremy Duval, François Bettega, Renaud Tamisier, Sébastien Baillieul, Sébastien Bailly, Jean-Louis Pépin
ABSTRACT Introduction Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea (OSA). CPAP is highly effective for improving symptoms and quality of life, but the major issue is adherence, with up to 50% of OSA discontinuing CPAP in the first 3 years after CPAP initiation. Areas covered We present the individual and societal costs of non-adherence to CPAP, factors associated with non-adherence to CPAP, as well as current strategies for improving adherence including telehealth, couple-based interventions, and behavioral interventions. We also report on challenges and pitfalls for the visualization and analysis of CPAP remote monitoring platforms. Expert opinion CPAP termination rates and adherence to therapy remain major issues despite technical improvements in CPAP devices. The individual and societal price of non-adherence to CPAP for OSA patients goes beyond excessive sleepiness and includes cardiovascular events, all-cause mortality, and increased health costs. Strategies for improving CPAP adherence should be individually tailored and aim to also improve lifestyle habits including physical activity and diet. Access to these strategies should be supported by refining visualization dashboards of CPAP remote monitoring platforms, and by disseminating telehealth and innovative analytics, including artificial intelligence.
持续气道正压通气(CPAP)是治疗阻塞性睡眠呼吸暂停(OSA)的一线治疗方法。CPAP对改善症状和生活质量非常有效,但主要问题是依从性,在CPAP开始后的前3年内,高达50%的OSA患者停止了CPAP。涉及领域:我们介绍了不坚持CPAP的个人和社会成本,与不坚持CPAP相关的因素,以及目前改善依从性的策略,包括远程医疗,基于夫妻的干预和行为干预。我们还报告了CPAP远程监测平台可视化和分析的挑战和陷阱。专家意见:尽管CPAP设备的技术进步,CPAP终止率和治疗依从性仍然是主要问题。阻塞性睡眠呼吸暂停患者不坚持CPAP的个人和社会代价不仅仅是过度嗜睡,还包括心血管事件、全因死亡率和增加的医疗费用。改善CPAP依从性的策略应该个性化定制,并旨在改善生活习惯,包括身体活动和饮食。应通过改进CPAP远程监测平台的可视化仪表板,并通过传播远程医疗和创新分析(包括人工智能)来支持对这些战略的访问。
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引用次数: 0
Outpatient management of pulmonary exacerbations in children with cystic fibrosis. 囊性纤维化儿童肺恶化的门诊管理。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17476348.2023.2202852
Lucy Perrem, Isaac Martin, Felix Ratjen

Introduction: Pulmonary exacerbations are common events in children with cystic fibrosis (CF) and are usually treated with oral antibiotics on an outpatient basis. Even these mild clinical events are clinically meaningful and contribute to the progression of lung disease.

Areas covered: This review discusses the challenges in diagnosing pulmonary exacerbations in children in the absence of a standardized definition. It describes an approach to the management of these events and emphasizes knowledge gaps and areas of future research directions. Information to write this narrative review was collected from 1) a PubMed search [keywords: exacerbation, children, cystic fibrosis] that was not limited by date 2) a hand search of references of retrieved literature 3) personal expertise of the literature and the management of cystic fibrosis.

Expert opinion: Pulmonary exacerbations require prompt diagnosis and management to preserve lung function. More work is needed to understand the impact of CFTR modulators on the frequency and severity of these events and how they influence approaches to management. In a new era of CF care, there is a need to incorporate sensitive outcome measures into clinical care to inform treatment decisions and track treatment response.

肺恶化是囊性纤维化(CF)儿童的常见事件,通常在门诊使用口服抗生素治疗。即使这些轻微的临床事件也有临床意义,并有助于肺部疾病的进展。涵盖领域:本综述讨论了在缺乏标准化定义的情况下诊断儿童肺恶化所面临的挑战。它描述了一种管理这些事件的方法,并强调了知识差距和未来研究方向。撰写这篇叙述性综述的信息收集自:1)PubMed搜索[关键词:恶化,儿童,囊性纤维化],该搜索不受日期限制;2)对检索文献的参考文献进行手动搜索;3)对文献和囊性纤维化管理的个人专业知识。专家意见:肺恶化需要及时诊断和处理,以保持肺功能。需要做更多的工作来了解CFTR调制器对这些事件的频率和严重程度的影响,以及它们如何影响管理方法。在CF护理的新时代,有必要将敏感的结果测量纳入临床护理,以告知治疗决策和跟踪治疗反应。
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引用次数: 0
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis. 中央气道狭窄患者经支气管镜多重治疗的出血风险及安全性。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1080/17476348.2023.2201440
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo

Background: Central airway obstruction (CAO) are common abnormality that usually needing interventional bronchoscopy, and sometimes multiple rounds of treatment. However, there were few studies explore the safety of it.

Research design & methods: The records of patients who underwent interventional bronchoscopy because of CAO at Respiratory department between 1 January 2010, and 31 December 2020 were revised. The patients' clinical characteristics, information about bronchoscopy and incidence of complications were collected and analyzed.

Results: There were totally 1,482 bronchoscopy procedures conducted in the 733 CAO patients. And the incidence of major complications in the retreatment group was significantly lower than that in the first treatment group ((4.77% vs. 1.87%, χ2 = 9.78, df = 1, p < 0.01), so did the incidence of severe bleeding (2.46% vs. 0.40%, χ2 = 11.20, df = 1, p < 0.01). However, there was some variability between the two groups in age and anesthesia type. A short interval time, more treatment times, and general anesthesia were related to a lower incidence of hemorrhage. For patients who were previously bleeding, the incidence of hemorrhage was significantly higher than the incidence in the non-bleeding patients (42.93% vs. 16.33%, respectively; χ2 = 57.54, df = 1, p < 0.01).

Conclusion: For the patients with CAO, repeated interventional bronchoscopy treatment was safe, and it should be treated with discretion when retreat the patients once bleeding during previous therapeutic bronchoscopy.

背景:中央气道梗阻是一种常见的异常,通常需要介入支气管镜检查,有时需要多轮治疗。然而,很少有研究探讨它的安全性。研究设计与方法:对2010年1月1日至2020年12月31日在呼吸科因CAO行介入支气管镜检查的患者记录进行修订。收集并分析患者的临床特征、支气管镜检查信息及并发症的发生情况。结果:733例曹操患者共行支气管镜检查1482例。再次治疗组主要并发症发生率显著低于首次治疗组((4.77% vs. 1.87%, χ2 = 9.78, df = 1, p 2 = 11.20, df = 1, p 2 = 57.54, df = 1, p)结论:对于曹化气患者,重复介入支气管镜治疗是安全的,患者在既往支气管镜治疗中出现出血时应慎重治疗。
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引用次数: 0
Clinical controversies in the management of acute pulmonary embolism: evaluation of four important but controversial aspects of acute pulmonary embolism management that are still subject of debate and research. 急性肺栓塞治疗中的临床争议:评估急性肺栓塞管理的四个重要但有争议的方面,这些方面仍然是争论和研究的主题。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 Epub Date: 2023-03-20 DOI: 10.1080/17476348.2023.2190888
Dieuwke Luijten, Frederikus A Klok, Thijs E van Mens, Menno V Huisman

Introduction: Acute pulmonary embolism (PE) is a disease with a broad spectrum of clinical presentations. While some patients can be treated at home or may even be left untreated, other patients require an aggressive approach with reperfusion treatment.

Areas covered: (1) Advanced reperfusion treatment in hemodynamically stable acute PE patients considered to be at high risk of decompensation and death, (2) the treatment of subsegmental pulmonary embolism, (3) outpatient treatment for hemodynamically stable PE patients with signs of right ventricle (RV) dysfunction, and (4) the optimal approach to identify and treatpost-PE syndrome.

Expert opinion: Outside clinical trials, hemodynamically stable acute PE patients should not be treated with primary reperfusion therapy. Thrombolysis and/or catheter-directed therapy are only to be considered as rescue treatment. Subsegmental PE can be left untreated in selected low-risk patients, after proximal deep vein thrombosis has been ruled out. Patients with an sPESI or Hestia score of 0 criteria can be treated at home, independent of the presence of RV overload. Finally, health-care providers should be aware of post-PE syndrome and diagnose chronic thromboembolic pulmonary disease (CTEPD) as early as possible. Persistently symptomatic patients without CTEPD benefit from exercise training and cardiopulmonary rehabilitation.

引言:急性肺栓塞(PE)是一种临床表现广泛的疾病。虽然一些患者可以在家接受治疗,甚至可能不接受治疗,但其他患者需要积极的再灌注治疗。涵盖的领域:(1)被认为具有失代偿和死亡高风险的血液动力学稳定的急性PE患者的高级再灌注治疗,(2)亚节段肺栓塞的治疗,(3)有右心室(RV)功能障碍迹象的血液动力学稳定PE患者的门诊治疗,以及(4)识别和治疗PE后综合征的最佳方法。专家意见:在临床试验之外,血液动力学稳定的急性PE患者不应接受一次再灌注治疗。溶栓和/或导管导向治疗只能被视为抢救性治疗。在排除了近端深静脉血栓形成后,选定的低风险患者可以不治疗亚段PE。sPESI或Hestia评分为0标准的患者可以在家接受治疗,与RV超负荷无关。最后,医疗保健提供者应该意识到PE后综合征,并尽早诊断慢性血栓栓塞性肺病(CTEPD)。没有CTEPD的持续症状患者受益于运动训练和心肺康复。
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引用次数: 1
Robotic bronchoscopy: potential in diagnosing and treating lung cancer. 机器人支气管镜:诊断和治疗肺癌的潜力。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17476348.2023.2192929
Jennifer D Duke, Janani Reisenauer

Introduction: Lung cancer remains the deadliest form of cancer in the world. Screening through low-dose CT scans has shown improved detection of pulmonary nodules; however, with the introduction of robotic bronchoscopy, accessing and biopsying peripheral pulmonary nodules from the airway has expanded. Improved diagnostic yield through enhanced navigation has made robotic bronchoscopy an ideal diagnostic technology for many proceduralists. Studies have demonstrated that robotic bronchoscopes can reach further with improved maneuverability into the distal airways compared to conventional bronchoscopes.

Areas covered: This review paper highlights the literature on the technological advancements associated with robotic bronchoscopy and the future directions the field of interventional pulmonary may utilize this modality for in the treatment of lung cancer. Referenced articles were included at the discretion of the authors after a database search of the particular technology discussed.

Expert opinion: As the localization of target lesions continues to improve, robotic platforms that provide reach, stability, and accuracy paves the way for future research in endoluminal treatment for lung cancer. Future studies with intratumoral injection of chemotherapy and immunotherapy and ablation modalities are likely to come in the coming years.

肺癌仍然是世界上最致命的癌症。通过低剂量CT扫描进行筛查,可以提高肺结节的检出率;然而,随着机器人支气管镜检查的引入,从气道获取和活检周围肺结节的范围扩大了。通过增强导航,提高了诊断率,使机器人支气管镜检查成为许多手术医师理想的诊断技术。研究表明,与传统的支气管镜相比,机器人支气管镜可以到达更远的远端气道,并且机动性更好。涵盖领域:这篇综述文章重点介绍了机器人支气管镜检查相关的技术进展,以及介入肺领域可能利用这种方式治疗肺癌的未来方向。在对所讨论的特定技术进行数据库搜索后,由作者自行决定纳入参考文章。专家意见:随着目标病变定位的不断提高,机器人平台提供的范围、稳定性和准确性为未来肺癌腔内治疗的研究铺平了道路。未来的肿瘤内注射化疗、免疫治疗和消融方式的研究可能会在未来几年进行。
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引用次数: 1
Alpha-1 antitrypsin deficiency: current therapy and emerging targets. α -1抗胰蛋白酶缺乏症:目前的治疗方法和新出现的靶点。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17476348.2023.2174973
Oisín F McElvaney, Daniel D Fraughen, Oliver J McElvaney, Tomás P Carroll, Noel G McElvaney

Introduction: Alpha1 antitrypsin deficiency (AATD), a common hereditary disorder affecting mainly lungs, liver and skin has been the focus of some of the most exciting therapeutic approaches in medicine in the past 5 years. In this review, we discuss the therapies presently available for the different manifestations of AATD and new therapies in the pipeline.

Areas covered: We review therapeutic options for the individual lung, liver and skin manifestations of AATD along with approaches which aim to treat all three. Along with this renewed interest in treating AATD come challenges. How is AAT best delivered to the lung? What is the desired level of AAT in the circulation and lungs which therapeutics should aim to provide? Will treating the liver disease increase the potential for lung disease? Are there treatments to target the underlying genetic defect with the potential to prevent all aspects of AATDrelated disease?

Expert opinion: With a relatively small population able to participate in clinical studies, increased awareness and diagnosis of AATD is urgently needed. Better, more sensitive clinical parameters will assist in the generation of acceptable and robust evidence of therapeutic effect for current and emerging treatments.

Alpha1抗胰蛋白酶缺乏症(AATD)是一种常见的遗传性疾病,主要影响肺、肝和皮肤,在过去的5年里,它已经成为医学上一些最令人兴奋的治疗方法的焦点。在这篇综述中,我们讨论了目前针对AATD不同表现的治疗方法和正在开发的新疗法。涵盖领域:我们回顾了AATD个体肺、肝和皮肤表现的治疗选择,以及旨在治疗这三种疾病的方法。随着人们对AATD治疗的兴趣重新燃起,挑战也随之而来。AAT如何最好地输送到肺部?血液循环和肺中AAT的理想水平是多少,哪些治疗方法应该提供?治疗肝病会增加患肺病的可能性吗?是否有针对潜在遗传缺陷的治疗方法,可以预防aatd相关疾病的所有方面?专家意见:由于能够参与临床研究的人群相对较少,迫切需要提高对AATD的认识和诊断。更好、更敏感的临床参数将有助于为当前和新出现的治疗方法产生可接受和有力的治疗效果证据。
{"title":"Alpha-1 antitrypsin deficiency: current therapy and emerging targets.","authors":"Oisín F McElvaney,&nbsp;Daniel D Fraughen,&nbsp;Oliver J McElvaney,&nbsp;Tomás P Carroll,&nbsp;Noel G McElvaney","doi":"10.1080/17476348.2023.2174973","DOIUrl":"https://doi.org/10.1080/17476348.2023.2174973","url":null,"abstract":"<p><strong>Introduction: </strong>Alpha1 antitrypsin deficiency (AATD), a common hereditary disorder affecting mainly lungs, liver and skin has been the focus of some of the most exciting therapeutic approaches in medicine in the past 5 years. In this review, we discuss the therapies presently available for the different manifestations of AATD and new therapies in the pipeline.</p><p><strong>Areas covered: </strong>We review therapeutic options for the individual lung, liver and skin manifestations of AATD along with approaches which aim to treat all three. Along with this renewed interest in treating AATD come challenges. How is AAT best delivered to the lung? What is the desired level of AAT in the circulation and lungs which therapeutics should aim to provide? Will treating the liver disease increase the potential for lung disease? Are there treatments to target the underlying genetic defect with the potential to prevent all aspects of AATDrelated disease?</p><p><strong>Expert opinion: </strong>With a relatively small population able to participate in clinical studies, increased awareness and diagnosis of AATD is urgently needed. Better, more sensitive clinical parameters will assist in the generation of acceptable and robust evidence of therapeutic effect for current and emerging treatments.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9256558","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
Relationship between patient functionality impairment and caregiver burden: is there a cut off point for the severe COPD patient? 患者功能损害与照顾者负担的关系:重度COPD患者是否存在一个临界点?
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17476348.2023.2190887
María Granados Santiago, Ramón Romero Fernández, Andrés Calvache Mateo, Alejandro Heredia Ciuro, Javier Martin Nuñez, Laura López López, Marie Carmen Valenza

Background: Chronic obstructive pulmonary disease (COPD) patients experience a progressive limitation of their functionality accompanying their clinical evolution. Concretely, severe COPD patients usually require the figure of a caregiver. Caregiver burden has yet to be explored in other similar chronic diseases. The objective is to propose a cutoff point in different functional impairment aspects, to predict the presence of caregiver burden.

Methods: Severe COPD patients were divided into two groups according to the caregiver burden, measured with the Zarit Burden Interview (ZBI). The patients were assessed with the London Chest Activity of Daily Living (LCADL) scale, the Functional Independence Measure (FIM), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).

Results: 70 COPD patients and their caregivers were included in this cross-sectional study. The ROC curve indicated a cutoff point of 19 in the LCADL scale (AUC = 0.722). Dependence in daily life activities had a cutoff point of 123 in the FIM (AUC = 0.776). Social participation in activities of daily living had a cutoff point of 37 in the WHODAS 2.0 (AUC = 0.739).

Conclusion: Dyspnea related to functional status, dependence in daily life activities, and social participation in activities of daily living of severe COPD patients can predict caretaker burden.

背景:慢性阻塞性肺疾病(COPD)患者的功能随其临床发展而逐渐受限。具体来说,严重的慢性阻塞性肺病患者通常需要照顾者的身影。照顾者负担在其他类似的慢性疾病中还有待探索。目的是提出一个截止点在不同的功能障碍方面,以预测照顾者负担的存在。方法:采用Zarit负担访谈法(ZBI)对重度COPD患者按照顾者负担分为两组。采用伦敦日常生活胸活动量表(LCADL)、功能独立性量表(FIM)和世界卫生组织残疾评估表2.0 (WHODAS 2.0)对患者进行评估。结果:70名COPD患者及其护理人员被纳入本横断面研究。ROC曲线显示LCADL量表的截止点为19 (AUC = 0.722)。在FIM中,日常生活活动的依赖性截断点为123 (AUC = 0.776)。社会参与日常生活活动的截断点为37 (AUC = 0.739)。结论:呼吸困难与重度COPD患者的功能状态、日常生活活动依赖性、日常生活活动的社会参与相关,可预测照顾者负担。
{"title":"Relationship between patient functionality impairment and caregiver burden: is there a cut off point for the severe COPD patient?","authors":"María Granados Santiago,&nbsp;Ramón Romero Fernández,&nbsp;Andrés Calvache Mateo,&nbsp;Alejandro Heredia Ciuro,&nbsp;Javier Martin Nuñez,&nbsp;Laura López López,&nbsp;Marie Carmen Valenza","doi":"10.1080/17476348.2023.2190887","DOIUrl":"https://doi.org/10.1080/17476348.2023.2190887","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) patients experience a progressive limitation of their functionality accompanying their clinical evolution. Concretely, severe COPD patients usually require the figure of a caregiver. Caregiver burden has yet to be explored in other similar chronic diseases. The objective is to propose a cutoff point in different functional impairment aspects, to predict the presence of caregiver burden.</p><p><strong>Methods: </strong>Severe COPD patients were divided into two groups according to the caregiver burden, measured with the Zarit Burden Interview (ZBI). The patients were assessed with the London Chest Activity of Daily Living (LCADL) scale, the Functional Independence Measure (FIM), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).</p><p><strong>Results: </strong>70 COPD patients and their caregivers were included in this cross-sectional study. The ROC curve indicated a cutoff point of 19 in the LCADL scale (AUC = 0.722). Dependence in daily life activities had a cutoff point of 123 in the FIM (AUC = 0.776). Social participation in activities of daily living had a cutoff point of 37 in the WHODAS 2.0 (AUC = 0.739).</p><p><strong>Conclusion: </strong>Dyspnea related to functional status, dependence in daily life activities, and social participation in activities of daily living of severe COPD patients can predict caretaker burden.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9256573","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
Understanding and managing respiratory infections in children and young adults with neurological impairment. 了解和管理神经功能障碍儿童和青年呼吸道感染。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17476348.2023.2192483
Marijke Proesmans, Francois Vermeulen, Mieke Boon

Introduction: Patients with neurocognitive impairment (NI) have multiple medical needs, with respiratory problems leading to an important reduction in quality of life and life expectancy. We aimed to explain that the origin of chronic respiratory symptoms in patients with NI is multifactorial.

Areas covered: In people with NI there is a high prevalence of swallowing dysfunction and hypersalivation inducing aspiration; cough efficacy is decreased resulting in chronic lung infection; sleep-disordered breathing is frequent and muscle mass is abnormal due to malnutrition. Technical investigations are not always specific and sensitive enough to better diagnose the causes of the respiratory symptoms; moreover, they can sometimes be difficult to perform in this vulnerable patient population. We provide a clinical pathway to adopt to identify, prevent, and treat respiratory complications in children and young adults with NI. A holistic approach in discussion with all care providers and the parents is highly recommended.

Expert opinion: The care for people with NI and chronic respiratory problems is challenging. The interplay between several causative factors may be difficult to entangle. Well-performed clinical research in this field is largely missing and should be encouraged. Only then, evidence-based clinical care will become possible for this vulnerable patient group.

神经认知障碍(NI)患者有多种医疗需求,呼吸问题导致生活质量和预期寿命显著下降。我们的目的是解释NI患者慢性呼吸道症状的起源是多因素的。研究领域:NI患者中,吞咽功能障碍和唾液过多导致误吸的发生率很高;咳嗽疗效下降导致慢性肺部感染;睡眠呼吸紊乱频繁,肌肉质量因营养不良而异常。技术调查并不总是足够具体和敏感,无法更好地诊断呼吸道症状的原因;此外,在这一脆弱的患者群体中,它们有时很难执行。我们提供了一种临床途径来识别、预防和治疗患有NI的儿童和年轻人的呼吸系统并发症。强烈建议与所有护理人员和家长讨论一个全面的方法。专家意见:对NI和慢性呼吸系统疾病患者的护理具有挑战性。几个致病因素之间的相互作用可能很难弄清楚。在这一领域进行良好的临床研究在很大程度上是缺失的,应该鼓励。只有这样,循证临床护理才有可能针对这一弱势患者群体。
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引用次数: 0
Mesenchymal stromal cell therapy for chronic lung diseases: experimental and clinical evidence. 间充质间质细胞治疗慢性肺部疾病:实验和临床证据。
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17476348.2023.2196015
Monique Martins Melo, Fernanda Ferreira Cruz, Patricia Rieken Macedo Rocco

Introduction: Cell therapy has emerged as an alternative option for chronic lung diseases with the highest rates of morbidity and mortality rates worldwide.

Areas covered: This review addresses the definition of mesenchymal stromal cells (MSCs), their properties, mechanisms of action, as well as preclinical and clinical studies that have used cell therapy in chronic lung diseases such as asthma, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, pulmonary arterial hypertension, and silicosis. Ongoing clinical trials are also presented.

Expert opinion: Experimental evidence has shown that MSCs have immunomodulatory and regenerative properties that could rescue impaired lung function and histoarchitecture. Their beneficial effects have been mainly associated with their ability to communicate with target cells through the secretion of soluble mediators and extracellular vesicles or even through transfer of organelles (e.g. mitochondria). MSC-derived conditioned medium, extracellular vesicles and mitochondria induce beneficial effects in selected scenarios. The initial results in clinical trials were modest compared with the experimental results, therefore researchers were encouraged to move from bedside back to bench to develop new strategies able to potentiate the effects of MSCs.

细胞疗法已成为慢性肺部疾病的另一种选择,在世界范围内具有最高的发病率和死亡率。涵盖领域:本文综述了间充质间质细胞(MSCs)的定义、性质、作用机制,以及使用细胞疗法治疗慢性肺部疾病(如哮喘、慢性阻塞性肺疾病、特发性肺纤维化、肺动脉高压和矽肺)的临床前和临床研究。还介绍了正在进行的临床试验。专家意见:实验证据表明,MSCs具有免疫调节和再生特性,可以挽救受损的肺功能和组织结构。它们的有益作用主要与它们通过可溶性介质和细胞外囊泡的分泌,甚至通过细胞器(如线粒体)的转移,与靶细胞进行通信的能力有关。msc衍生的条件培养基、细胞外囊泡和线粒体在特定情况下可诱导有益作用。与实验结果相比,临床试验的初步结果比较温和,因此鼓励研究人员从床边回到实验室,开发能够增强间充质干细胞作用的新策略。
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引用次数: 1
Efficacy and safety of tiotropium bromide inhalation in symptomatic patients with chronic obstructive pulmonary disease: A multicenter, prospective, and observational study. 吸入噻托溴铵治疗有症状的慢性阻塞性肺疾病患者的疗效和安全性:一项多中心、前瞻性和观察性研究
IF 3.9 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17476348.2023.2171990
Yue Liao, Hao Wang, Ke Wang, Kai Zi, Yongchun Shen, Lei Chen, Tao Wang, Jun Chen, Fuqiang Wen

Objectives: Treatment guidelines have recommended tiotropium bromide inhalation (TBI), a long-acting muscarinic antagonist, for chronic obstructive pulmonary disease (COPD); however, its efficacy in symptomatic Chinese patients with COPD remains uninvestigated.

Methods: This multicenter, prospective, observational study enrolled patients with COPD assessment test (CAT) scores exceeding 10 points from 19 hospitals spread across China. All patients received TBI and underwent follow-up for 3 months. The demographic and clinical information were assessed.

Results: The final analysis included 378 patients. The forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) of all participants improved markedly after 3 months of treatment (FEV1: mean 1.33 L versus 1.61 L, P < 0.001; FEV1/FVC: mean 0.53 versus 0.62, P < 0.001). The mean CAT scores decreased from 26.56 to 16.28 (P < 0.001). Patients classified into group D based on the Global Initiative for COPD guidelines showed greater improvement in FEV1 and FEV1/FVC than that in patients in group B. The proportion of patients with acute exacerbations also declined from 28.6% in the first month to 4.2% in the third month.

Conclusion: TBI for 3 months could effectively and safely attenuate symptoms and airflow obstruction in symptomatic Chinese patients with COPD.

目的:治疗指南推荐使用噻托溴铵吸入(TBI)治疗慢性阻塞性肺疾病(COPD),这是一种长效毒蕈碱拮抗剂;然而,其对有症状的中国慢性阻塞性肺病患者的疗效尚未研究。方法:这项多中心、前瞻性、观察性研究纳入了来自中国19家医院的COPD评估测试(CAT)评分超过10分的患者。所有患者均接受脑外伤治疗,随访3个月。评估了人口统计学和临床信息。结果:最终纳入378例患者。治疗3个月后,所有患者的1秒用力呼气量(FEV1)和FEV1/用力肺活量(FVC)均较b组显著改善(FEV1:平均1.33 L对1.61 L, p1 /FVC:平均0.53对0.62,p1和FEV1/FVC),急性加重患者比例也从第一个月的28.6%下降到第三个月的4.2%。结论:脑外伤治疗3个月可有效、安全地减轻有症状的中国慢性阻塞性肺病患者的症状和气流阻塞。
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引用次数: 0
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Expert Review of Respiratory Medicine
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