Pulmonary Therapy最新文献

{"title":"Post-COVID-19 Pulmonary Fibrosis: Facts-Challenges and Futures: A Narrative Review.","authors":"Sy Duong-Quy, Thu Vo-Pham-Minh, Quynh Tran-Xuan, Tuan Huynh-Anh, Tinh Vo-Van, Quan Vu-Tran-Thien, Vinh Nguyen-Nhu","doi":"10.1007/s41030-023-00226-y","DOIUrl":"10.1007/s41030-023-00226-y","url":null,"abstract":"<p><p>Patients with coronavirus disease 2019 (COVID-19) usually suffer from post-acute sequelae of coronavirus disease 2019 (PASC). Pulmonary fibrosis (PF) has the most significant long-term impact on patients' respiratory health, called post-COVID-19 pulmonary fibrosis (PC19-PF). PC19- PF can be caused by acute respiratory distress syndrome (ARDS) or pneumonia due to COVID-19. The risk factors of PC19-PF, such as older age, chronic comorbidities, the use of mechanical ventilation during the acute phase, and female sex, should be considered. Individuals with COVID-19 pneumonia symptoms lasting at least 12 weeks following diagnosis, including cough, dyspnea, exertional dyspnea, and poor saturation, accounted for nearly all disease occurrences. PC19-PF is characterized by persistent fibrotic tomographic sequelae associated with functional impairment throughout follow-up. Thus, clinical examination, radiology, pulmonary function tests, and pathological findings should be done to diagnose PC19-PF patients. PFT indicated persistent limitations in diffusion capacity and restrictive physiology, despite the absence of previous testing and inconsistency in the timeliness of assessments following acute illness. It has been hypothesized that PC19-PF patients may benefit from idiopathic pulmonary fibrosis treatment to prevent continued infection-related disorders, enhance the healing phase, and manage fibroproliferative processes. Immunomodulatory agents might reduce inflammation and the length of mechanical ventilation during the acute phase of COVID-19 infection, and the risk of the PC19-PF stage. Pulmonary rehabilitation, incorporating exercise training, physical education, and behavioral modifications, can improve the physical and psychological conditions of patients with PC19-PF.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"295-307"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/b0/41030_2023_Article_226.PMC10199290.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10055898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Corticosteroids for Treating Respiratory Diseases: Less Is Better, but… When and How Is It Possible in Real Life?","authors":"Andrea S Melani, Sara Croce, Lucia Cassai, Giusy Montuori, Gaia Fabbri, Maddalena Messina, Magda Viani, Elena Bargagli","doi":"10.1007/s41030-023-00227-x","DOIUrl":"10.1007/s41030-023-00227-x","url":null,"abstract":"<p><p>Systemic corticosteroids (CSs), a keystone in pulmonology, are drugs with strong antiinflammatory activity. They are cheap, easily available, and accessible, but with common and serious side effects. Moreover, the use of exogenous CSs may suppress the hypothalamic-pituitary-adrenal (HPA) axis, predisposing to adrenal insufficiency. Safe CS treatment is a challenge of pharmacological research. This narrative review examined the indications of CSs in some respiratory diseases, analyzing what types, dosages, and length of treatment are required as the dosage and duration of CS treatments need to be minimized. Chronic maintenance treatments with CSs are associated with poor prognosis, but they are still prescribed in patients with severe asthma, Chronic obstructive pulmonary disease (COPD), and interstitial lung diseases. When CS discontinuation is not possible, all efforts should be made to achieve clinically meaningful reductions. Guidelines suggest the use of methylprednisolone at a dose of 20-40 mg/day or equivalent for up to 10 days in subjects with COVID-19 pneumonia (but not other respiratory viral diseases) and respiratory failure, exacerbations of asthma, and COPD. Some guidelines suggest that CS treatment shorter than 10-14 days can be abruptly stopped, strictly monitoring subjects with unexplained symptoms after CS withdrawal, who should promptly be tested for adrenal insufficiency (AI) and eventually treated. CSs are often used in severe community-acquired pneumonia associated with markedly increased serum inflammation markers, in acute respiratory distress syndrome (ARDS), in septic shock unresponsive to hydro-saline replenishment and vasopressors, and acute exacerbations of interstitial lung diseases. As these cases often require higher doses and longer duration of CS treatment, CS tapering should be gradual and, when useful, supported by an evaluation of HPA axis function.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"329-344"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/9d/41030_2023_Article_227.PMC10447722.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10126286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Adherence and Asthma Control with Once-Daily Indacaterol/Glycopyrronium/Mometasone Furoate Breezhaler Digital Companion: 90-Day Analysis from Germany.","authors":"Holger Woehrle, Paul Mastoridis, David Stempel, Leanne Kaye, Vy Vuong, Karen Mezzi","doi":"10.1007/s41030-023-00225-z","DOIUrl":"10.1007/s41030-023-00225-z","url":null,"abstract":"<p><strong>Introduction: </strong>Suboptimal adherence to inhaled asthma therapy is associated with poor clinical outcomes. Digital companion paired inhaler devices record medication use and provide reminders, thereby improving treatment adherence and asthma outcomes. This analysis assessed the impact of indacaterol/glycopyrronium/mometasone furoate (IND/GLY/MF) Breezhaler^® digital companion on medication adherence and symptom control in adults with asthma from Germany.</p><p><strong>Methods: </strong>This retrospective analysis included adults (≥ 18 years) with asthma and prescribed Breezhaler digital companion. Assessments included: mean medication adherence (number of puffs taken/prescribed × 100) and change in Asthma Control Test (ACT) scores [well controlled (≥ 20), not well controlled (15-20) and poorly controlled (≤ 15)] at 1 month after the first ACT (second ACT). The percent of patients with ≥ 80% medication adherence (days 16-30 and 76-90) and the change in ACT (baseline and ≥ 30 days) were analysed.</p><p><strong>Results: </strong>Of the 163 patients with 90 days data, ≥ 80% medication adherence was achieved in 82.8% and 72.4% of patients at months 1 and 3, respectively. Change in asthma control was examined in ~ 60% (n = 97) of patients who completed ≥ 2 ACTs through the application. At baseline, 33.0% of patients were well controlled and 53.6% were well controlled at second ACT. Furthermore, 43.3% patients reported very poor control at baseline which decreased to 22.7% at second ACT.</p><p><strong>Conclusion: </strong>The use of IND/GLY/MF (Breezhaler) with a digital companion (sensor + application) may be associated with improved symptom control and high level of controller medication adherence in patients with asthma.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"429-434"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/fa/41030_2023_Article_225.PMC10447847.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Response Letter to: Letter to the Editor Regarding \"Anti-SARS-CoV-2 Vaccination Related Polyradiculitis Requires Early Diagnosis and Treatment to Improve the Outcome: Facts and Challenges During COVID-19 Pandemic\".","authors":"S Duong-Quy","doi":"10.1007/s41030-023-00236-w","DOIUrl":"10.1007/s41030-023-00236-w","url":null,"abstract":"","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"455-457"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/05/41030_2023_Article_236.PMC10447805.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10071083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2023 GOLD Report: Updated Guidelines for Inhaled Pharmacological Therapy in Patients with Stable COPD.","authors":"Paul D Terry, Rajiv Dhand","doi":"10.1007/s41030-023-00233-z","DOIUrl":"10.1007/s41030-023-00233-z","url":null,"abstract":"<p><p>Over the past 22 years, annual GOLD Reports have documented important changes in guidance and recommendations for uniformly treating patients with chronic obstructive pulmonary disease (COPD) with the goal of improving outcomes in patients suffering from this condition. The most recent GOLD Report, released in 2023, shows continued refinement in several areas, including more precise definitions of COPD and exacerbations of COPD, a new set of parameters to assess exacerbation severity, an updated COPD assessment tool, updated guidelines for initial and follow-up treatment, new information regarding the association between pharmacological triple therapy and reduction in mortality, and new discussions of inhaler device choice and adherence to COPD medications. Whereas we do not address all of the new or updated material in GOLD's 2023 Report, we summarize key changes in GOLD's recommendations regarding inhalation therapy for stable COPD and frame these changes in the context of previous GOLD recommendations.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"345-357"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/63/41030_2023_Article_233.PMC10447769.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10446684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Anti-SARS-CoV-2 Vaccination-Related Polyradiculitis Requires Early Diagnosis and Treatment to Improve the Outcome.","authors":"Josef Finsterer","doi":"10.1007/s41030-023-00237-9","DOIUrl":"10.1007/s41030-023-00237-9","url":null,"abstract":"","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"451-453"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/9b/41030_2023_Article_237.PMC10447650.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10060807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple Therapy with Mometasone/Indacaterol/Glycopyrronium or Doubling the ICS/LABA Dose in GINA Step 4: IRIDIUM Analyses.","authors":"Richard N van Zyl-Smit, Huib A M Kerstjens, Jorge Maspero, Ana-Maria Tanase, David Lawrence, Karen Mezzi, Peter D'Andrea, Kenneth R Chapman","doi":"10.1007/s41030-023-00234-y","DOIUrl":"10.1007/s41030-023-00234-y","url":null,"abstract":"<p><strong>Introduction: </strong>GINA guidelines recommend increasing the dose of inhaled corticosteroids (ICS) as a step-up option for patients with inadequately controlled asthma at GINA step 4 [inadequately controlled asthma on medium-dose ICS/long-acting beta-2 agonist (LABA)]. The aim of this study was to compare the efficacy and safety of long-acting muscarinic antagonists (LAMA) add-on to medium-dose ICS/LABA in patients at GINA 2022 step 4.</p><p><strong>Methods: </strong>This post hoc analysis of the IRIDIUM study evaluated the change from baseline in trough forced expiratory volume (FEV₁ ) in patients receiving medium-dose MF/IND/GLY versus high-dose MF/IND and high-dose FLU/SAL at Week 26. Other outcomes included improvement in lung functions [peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory flow between 25% and 75% of the FVC (FEF)_25-75%)], asthma control [Asthma Control Questionnaire (ACQ-7)], responder analysis (≥ 0.5 unit improvement in ACQ-7), and reduction in asthma exacerbations at Weeks 26 and 52.</p><p><strong>Results: </strong>A total of 1930 patients were included in this analysis. Medium-dose MF/IND/GLY improved trough FEV₁ versus high-dose MF/IND (Δ 41 mL; 95% CI - 7-90) and high-dose FLU/SAL (Δ 88 mL; 95% CI 39-137) at Week 26 which were sustained until Week 52. Exacerbation rates were 16% lower with medium-dose MF/IND/GLY versus high-dose MF/IND for all (mild, moderate, and severe) exacerbations and 21-30% lower versus high-dose FLU/SAL for all (mild, moderate, and severe), moderate or severe, and severe exacerbations over 52 weeks. Further improvements in other lung functions were observed with medium-dose MF/IND/GLY. No new safety signals were identified.</p><p><strong>Conclusion: </strong>Medium-dose MF/IND/GLY improved lung function and reduced asthma exacerbations compared to high-dose ICS/LABA and may be an undervalued option in patients at GINA 2022 step 4.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02571777.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"395-409"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0b/87/41030_2023_Article_234.PMC10447675.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10061295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gaps and Future Directions in Clinical Research on Obesity-Related Asthma.","authors":"Andi C Hudler, Isaías Raymundo Ramírez Díaz, Sunita Sharma, Fernando Holguin","doi":"10.1007/s41030-023-00230-2","DOIUrl":"10.1007/s41030-023-00230-2","url":null,"abstract":"<p><p>Obesity is a major comorbidity for the development and worsening of asthma. It is associated with increased disease incidence, reduced response to inhaled and systemic steroids, increased asthma exacerbations, and poor disease control. Over the past two decades, we have learned that there are clinical asthma phenotypes associated with obesity, which have unique immune, inflammatory, and metabolic disease mechanisms. The objectives of this review are to provide a brief overview of the associations and gaps between these chronic inflammatory diseases and the role that traditional therapies have on treating patients with obesity-related asthma, and to describe new clinical research of therapeutic developments targeting mechanisms that are more specific to this patient population.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 3","pages":"309-327"},"PeriodicalIF":3.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/ef/41030_2023_Article_230.PMC10447703.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis: A Narrative Review.","authors":"Hana Alsomali,&nbsp;Evelyn Palmer,&nbsp;Avinash Aujayeb,&nbsp;Wendy Funston","doi":"10.1007/s41030-023-00216-0","DOIUrl":"https://doi.org/10.1007/s41030-023-00216-0","url":null,"abstract":"<p><p>Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial lung disease of unknown aetiology. Patients typically present with symptoms of chronic dyspnoea and cough over a period of months to years. IPF has a poor prognosis, with an average life expectancy of 3-5 years from diagnosis if left untreated. Two anti-fibrotic medications (nintedanib and pirfenidone) have been approved for the treatment of IPF. These drugs slow disease progression by reducing decline in lung function. Early diagnosis is crucial to ensure timely treatment selection and improve outcomes. High-resolution computed tomography (HRCT) plays a major role in the diagnosis of IPF. In this narrative review, we discuss the importance of early diagnosis, awareness among primary care physicians, lung cancer screening programmes and early IPF detection, and barriers to accessing anti-fibrotic medications.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 2","pages":"177-193"},"PeriodicalIF":3.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/ff/41030_2023_Article_216.PMC10203082.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9907995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging Ethnically Diverse Populations in Self-Management Interventions for Chronic Respiratory Diseases: A Narrative Review.","authors":"Stacy Maddocks,&nbsp;Pat Camp,&nbsp;Clarice Tang","doi":"10.1007/s41030-023-00218-y","DOIUrl":"https://doi.org/10.1007/s41030-023-00218-y","url":null,"abstract":"<p><p>The burden of chronic respiratory diseases continues to rise globally. Comprehensive management relies on a combination of treatment approaches including patient self-management, where health professionals are required to educate and support patients to take control of their disease. When self-management interventions are suitably directed and effectively executed, outcomes point to increases in quality of life and a reduction in unscheduled or emergency consultations for people living with chronic respiratory disease. However, despite these positive gains, the literature reveals poor trends of engagement with this management approach and reduced access to appropriately designed programs for people from ethnically diverse populations, including migrants and refugees. The purpose of this review article is to discuss factors influencing engagement in chronic respiratory disease self-management among people from ethnically diverse backgrounds and to propose strategies to improve the participation of this population in these interventions in the future.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":"9 2","pages":"195-206"},"PeriodicalIF":3.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/93/41030_2023_Article_218.PMC9922039.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9766012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}