Tuesday, December 29, 2015

Novel concepts in airway inflammation and remodelling in asthma

New article in ERJ on Novel concepts in airway inflammation and remodelling in asthma!
The hallmark pathological features of asthma include airway eosinophilic inflammation and structural changes (remodelling) which are associated with an irreversible loss in lung function that tracks from childhood to adulthood. In parallel with changes in function, pathological abnormalities occur early, during the pre-school years, are established by school age and subsequently remain (even though symptoms may remit for periods during adulthood). Given the equal importance of inflammation and remodelling in asthma pathogenesis, there is a significant disparity in studies undertaken to investigate the contribution of each. The majority focus on the role of inflammation, and although novel therapeutics such as those targeted against T-helper cell type 2 (Th2) mediators have arisen, it is apparent that targeting inflammation alone has not allowed disease modification. 
Therefore, unless airway remodelling is addressed for future therapeutic strategies, it is unlikely that we will progress towards a cure for asthma. Having acknowledged these limitations, the focus of this review is to highlight the gaps in our current knowledge about the mechanisms underlying airway remodelling, the relationships between remodelling, inflammation and function, remodelling and clinical phenotypes, and the importance of utilising innovative and realistic pre-clinical models to uncover effective, disease-modifying therapeutic strategies.

Monday, December 28, 2015

Smoking asthma phenotype: diagnostic and management challenges

Cigarette smoking and asthma interact to induce important adverse effects on clinical, prognostic and therapeutic outcomes. Please read new article from Current Opinion in Pulmonary Medicine from our Greek friends dedicated to this hot Respiratory topic. 
Purpose of review: The prevalence of active smoking in adults with asthma is similar to the general population. Smoking asthma is associated with poorer disease control, impaired response to corticosteroid therapy, accelerated decline in lung function, and increased rate of healthcare utilization. Current asthma guidelines do not provide specific treatment advice for smoking asthmatic patients. There is an urgent need for better understanding of the underlying mechanisms and effective treatment for smoking asthmatic patients.
Recent findings: An association between both active and passive smoking and adult-onset asthma is supported by many studies.
The asthma-COPD overlap syndrome (ACOS) has recently gained particular interest and smoking asthmatic patients should be evaluated for ACOS.
Treatment regimens for smoking asthma include higher doses of inhaled corticosteroids (ICS), extrafine particle ICS formulations, antileukotrienes, and combinations of these options.
Asthma is associated with increased risk of cardiovascular comorbidities whereas smoking is an additional strong independent risk factor for pulmonary and cardiovascular diseases. Tobacco smoking and not asthma per se seems to be the reason of poor prognosis, especially with regard to lung cancer, cardiovascular diseases, and mortality in asthmatic patients.
Summary: Smoking asthma represents a common challenge to the clinician both in terms of diagnosis and management. These aspects have not been thoroughly evaluated and deserve further investigation.

Thursday, December 24, 2015

Merry Christmas to all Respiratory friends!!!

Thank you for all your permanent help and support in this hard year! We realized very useful things for promotion of ALL Respiratory conditions! We are hoping that we will continue this work with your help and in 2016!

2016 World’s first clinical guidelines for chronic fungal lung infections

The world’s first guidelines for chronic fungal lung infections for doctors and laboratories have been published today, by the European Respiratory Society (ERS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
Published today (23 December, 2015) in the European Respiratory Journal, these new guidelines describe the important features of this disease and provide comprehensive treatment recommendations.
Chronic pulmonary aspergillosis (CPA) is a subtle and insidious problem in patients who already have damaged lungs. It kills about 80% of sufferers over five years unless diagnosed and treated with long-term antifungals. Across Europe, an estimated 240,000 people have CPA, and worldwide around 3 million. The late stages of CPA (aspergilloma) are familiar to respiratory specialists, but the early features are often missed.
Major improvements in understanding this debilitating and ultimately fatal disorder have resulted from research undertaken in Europe, India and Japan over the past 10 years. However, no therapies are approved by the European Medicines Agency (EMA) for treatment, and very few diagnostic tests and therapies have been compared. In many parts of the world, the basic tests required are not yet available.
Professor David Denning of the University of Manchester, who lead the CPA guidelines group, said: “The UK National Health Service recognised the challenges posed by these patients by setting up the National Aspergillosis Centre and its associated laboratory the Mycology Reference Centre in 2009. The experience gained from seeing hundreds of patients has contributed to the quality of care, although much more research and new oral antifungal drugs are required to reduce the marked disability caused by CPA.”
Patient Michael Miller, aged 65 years from Leeds, described his experience: “I had aspergillosis in 2006, which improved with a long course of antifungal capsules. In 2012, I started to get worse and worse, and it took 3 years to recognise recurrence of my aspergillosis. By this time, I was so breathless and my x-ray was much worse.”
ESCMID President Professor Murat Akova stated: “I am delighted that this groundbreaking clinical guideline has been published; the management of chronic fungal infection, notably CPA, is difficult, requiring a high level of laboratory and clinical expertise.
ERS Guidelines Director, Dr Marc Miravitlles, commented: “We welcome the publication of this guideline, which provides key insights into the main features of the disease and treatment recommendations. By establishing this expert consensus on the topic, we aim to improve the early diagnosis of CPA and increase recognition of the condition to ultimately improve outcomes for patients.”
The guidelines are a product of a two-year collaboration between ESCMID and ERS. In parallel to these CPA recommendations, ESCMID is currently developing wider guidelines for invasive aspergillosis in general, which will be published in due course. The latter are developed by Professor Andrew Ullmann of the Julius Maximilian University of Würzburg, chairman of ESCMID’s fungal infection study group EFISG.
Professor Ullmann commented: “This is the first guideline on chronic pulmonary aspergillosis worldwide. It is the result of another joint effort of ESCMID and ERS experts who, in a truly interdisciplinary collaboration, prepared and published guidance for colleagues on a group of complex diseases that is difficult to manage. Aspergillosis is more than chronic lung infection and a larger document addressing all aspects of aspergillosis infections is under preparation by EFISG.” 

Wednesday, December 16, 2015


Dear Respiratory friends today online is appearing
Current Respiratory Medicine Reviews, Volume 11 - Number 4 - See more at: http://benthamscience.com/journals/current-respiratory-medicine-reviews/volume/11/issue/4/#sthash.EB2jbZQb.dpuf

our proposed hot-topic issue of Current Respiratory Medicine Reviews, Volume 11, Number 4: is an update on the assessment of the main comorbidities and management of patients with OSAS and comorbidities (hypertension, obesity, diabetes, stroke, heart failure, COPD, chronic kidney disease).
Guest Editor: Alexandru Corlateanu
Editor-in-Chief: Joseph Varon
9 articles + Editorial from Guest Editor! 
1. Alexandru Corlateanu. Editorial from Guest Editor: Current Management of Sleep Apnea and Comorbidities


Editorial from Guest Editor: Current Management of Sleep Apnea and Comorbidities - See more at: http://benthamscience.com/journals/current-respiratory-medicine-reviews/volume/11/issue/4/#sthash.EB2jbZQb.dpuf
Editorial from Guest Editor: Current Management of Sleep Apnea and Comorbidities - See more at: http://benthamscience.com/journals/current-respiratory-medicine-reviews/volume/11/issue/4/#sthash.EB2jbZQb.dpuf
Editorial from Guest Editor: Current Management of Sleep Apnea and Comorbidities - See more at: http://benthamscience.com/journals/current-respiratory-medicine-reviews/volume/11/issue/4/#sthash.EB2jbZQb.dpufOana Claudia Deleanu, Ana-Maria Nebunoiu, Miruna Mihaela Micheu, Andra Elena Malaut and Florin Dumitru Mihaltan.2. Oana Claudia Deleanu, Ana-Maria Nebunoiu, Miruna Mihaela Micheu, Andra Elena Malaut and Florin Dumitru Mihaltan.
Relation between Obstructive Sleep apnea Syndrome and Resistant Hypertension - the Tip of the Iceberg
3. Victoria Chatzimavridou Grigoriadou, Alexander Mathioudakis, Alexandru Corlateanu, George Mathioudakis, Efstathia Evangelopoulou.
Obstructive Sleep Apnea and Hypertension: A Bidirectional Causal Relation
4. Stefan Mihaicuta, Izabela Anita Toth, Sorin Paralescu, Carmen Ardelean, Stefan Marian Frent and Oana Claudia Deleanu
Obesity and Body fat Distribution as Predictors for Obstructive Sleep Apnea Syndrome
5. Marius Balint Gib, Christophe Aron, Svetlana Ilie, Frederic Wallyn, Macha Tetart, Dumitrita Balint Gib.
The links between Sleep Apnea and Chronic Kidney Disease
6. Mastrodima-Polychroniou Sofia, Panoulis Konstantinos.
Pregnancy and Sleep Apnea
7. Alexandru Corlateanu, Victor Botnaru, Victoria Sircu, Serghei Covantev, Gloria Montanari.
Obstructive Sleep Apnea and Type 2 Diabetes: Dual Interaction
8. Andriana Papaioannou, Konstantinos Kostikas, Spyros Papiris.
Sleep Apnea and Coronary Heart Disease: from Dusk Till Dawn and Further
9. Silvia V. Dumitru, Epameinondas N Kosmas.
Stroke as a Consequence of Sleep Apnea: Epidemiology, Pathophysiology and Treatment Strategies
10. Alexandru Corlateanu, Victor Botnaru, Alexander G. Mathioudakis, Victoria Sircu, Nikos Siafakas.
Overlap Syndrome of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnoea: A two-faced Janus


Tuesday, December 15, 2015

Predictors of daytime sleepiness in patients with obstructive sleep apnea (fulltext from Pneumologia)

Background. The main symptomatic criterion to diagnose obstructive sleep apnea (OSA) is the level of daytime sleepiness. The Epworth Sleepiness Scale is a simple, self-administered questionnaire which provides a measurement of the subject’s general level of daytime sleepiness.
The aim of this study was to investigate the factors that can predict daytime sleepiness in patients with sleep apnea.
Methods. 50 consecutive patients with obstructive
sleep apnea were enrolled into the study. Age, gender, anthropometric and polygraphic data were
thoroughly analyzed. In all subjects daily sleepiness was assessed by Epworth Sleepiness Scale.
Results. The mean age of the subjects was 54.7±12.8 years, 82% males. The mean BMI was 31.9±6 kg/m2. Pearson correlation coefficient analysis demonstrates a significant positive correlation between the Epworth Sleepiness Scale and the desaturation index (r=0.31, p<0.01) and arterial hypertension (r=0.32, p<0.01). The forward stepwise regression analysis shows that the apnea hypopnea index and desaturation index are important predictors of daytime sleepiness in patients with obstructive sleep apnea which explains 40% of the Epworth Sleepiness Scale score.
Conclusion. The desaturation index showed the
strongest correlation with the Epworth scale. According to the results of the backward stepwise multiple regression and logistic regression, the predictors for the level of daytime sleepiness are oAHI and index of desaturation. According to the analysis of the ROC curve, desaturation index is a predictor of a high specificity.

Saturday, December 12, 2015

2015 Official ATS/ERS Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation

Rationale: Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients.
Objectives: The objectives of this document are to enhance implementation, use, and delivery of pulmonary rehabilitation to suitable individuals worldwide.
Methods: Members of the American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly and the European Respiratory Society (ERS) Rehabilitation and Chronic Care Group established a Task Force and writing committee to develop a policy statement on PR. The document was modified based on feedback from expert peer reviewers. After cycles of review and revisions, the statement was reviewed and formally approved by the Board of Directors of the ATS and the Science Council and Executive Committee of the ERS.

Main Results: This document articulates policy recommendations for advancing healthcare professional, payer, and patient awareness and knowledge of PR, increasing patient access to PR, and ensuring quality of PR programs. It also recommends areas of future research to establish evidence to support the development of an updated funding and reimbursement policy regarding PR.
Conclusions: The ATS and ERS commit to undertake actions that will improve access to and delivery of PR services for suitable patients. They call on their members and other health professional societies, payers, patients, and patient advocacy groups to join in this commitment.
Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201510-1966ST#.Vmvjnr_eqUk