EMJ Respiratory最新文献

{"title":"Thoracic Surgery and Transplantation","authors":"M. Migliore","doi":"10.33590/emjrespir/10310907","DOIUrl":"https://doi.org/10.33590/emjrespir/10310907","url":null,"abstract":"Major changes are bringing a new dimension to thoracic surgery and lung transplantation. This article reports the foremost recent advancements within the field. The most important advancement in thoracic surgery is certainly the widespread use of uniportal video-assisted thoracic surgery in the common practice of most thoracic operations, including major resections for lung cancer. In oncological thoracic surgery, to avoid unnecessary operations in the future, prospective randomised trials are ongoing to demonstrate why some patients with a ‘resectable’ malignancy within the chest will not survive as long as expected. Lung transplantation has progressed on multiple fronts but a significant advancement is the possibility to perform minimally invasive techniques to insert the lung into the chest of the recipient.\u0000\u0000In conclusion, the search for minimal invasiveness has a prominent role in thoracic surgery but further research is essential to demonstrate the real advantages of technological surgical innovations. Worldwide co-operation will permit the collection of data faster and allow the completion of randomised controlled studies to this end.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127598158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunomodulation for Recurrent Respiratory Tract Infections: New Insights and Perspectives","authors":"E. Legg","doi":"10.33590/emjrespir/10313745","DOIUrl":"https://doi.org/10.33590/emjrespir/10313745","url":null,"abstract":"The 1st biennial WAidid Congress held in Milan, Italy, brought together academics and clinicians from the broad field of infectious diseases and immunology. The conference was founded in order to create a network connecting this diverse field and to allow the showcasing of data and therapeutic techniques amongst specialists concentrating on different age groups and organs. Prof Roth and Conference Chair Prof Esposito presented a symposium on the use of immunomodulation for prophylaxis against recurrent respiratory tract infections on Day 2 of the conference.\u0000\u0000The symposium covered risk factors in the paediatric population and different treatment options for recurrent respiratory tract infections before focussing on the immunomodulatory prophylactic OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®). OM-85 is an orally administered immunomodulator, which has been shown to provide protection against respiratory infections of both viral and bacterial aetiologies in patients at high risk of recurrent infection. The symposium detailed the immunological mechanism of OM-85’s protective effects as well as safety and efficacy data in various patient populations.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123017185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inmunomodulación En Caso De Infecciones Recurrentes De Las vías Respiratorias: Nuevos Conocimientos Y Perspectivas","authors":"Eweng Legg","doi":"10.33590/emjrespir/10310851","DOIUrl":"https://doi.org/10.33590/emjrespir/10310851","url":null,"abstract":"El primer congreso de WAidid celebrado en Milán reunió a investigadores y médicos del amplio campo de las enfermedades infecciosas y la inmunología Este congreso se organizó para crear una red de conexiones en este campo diverso y permitir la presentación de datos y técnicas terapéuticas entre especialistas concentrados en distintos grupos de edad y órganos. El segundo día del congreso el profesor Roth y la profesora Esposito (coordinadora del congreso) presentaron un simposio sobre el uso de la inmunomodulación para la prevención de las infecciones recurrentes de las vías respiratorias.\u0000\u0000Durante el simposio se analizaron los factores de riesgo en la población pediátrica y las distintas opciones de tratamiento para las infecciones respiratorias recurrentes antes de analizar a fondo la profilaxis inmunomoduladora de OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®). OM-85 es un inmunomodulador que se administra por vía oral, que ha demostrado ofrecer protección frente a infecciones respiratorias de origen vírico y bacteriano en pacientes con un alto riesgo de infección recurrente. En el simposio se describieron el mecanismo inmunológico de los efectos protectores de OM-85 y los datos de seguridad y eficacia en varias poblaciones de pacientes.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122697807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive Pressure Therapies Used in the Treatment of Postoperative Respiratory Failure – Evidence for Use and Future Directions","authors":"A. Glossop, P. Agostini","doi":"10.33590/emjrespir/10311437","DOIUrl":"https://doi.org/10.33590/emjrespir/10311437","url":null,"abstract":"Postoperative respiratory failure (RF) is a common problem following all types of major surgery, and which has significant implications for morbidity, mortality, and cost to healthcare systems. Although postoperative RF is usually multifactorial in origin, the development of atelectasis perioperatively is a significant contributory factor. A number of different techniques and devices that apply positive pressure to patients’ airways, in an attempt to prevent development of atelectasis and RF following surgery, have been studied in this patient group. Non-invasive ventilation (NIV) is considered the gold standard management for prevention and treatment of postoperative RF and is supported by the greatest body of evidence. However, the delivery of NIV requires provision of a critical care bed, has significant economic implications, and is associated with patient compliance issues. Other techniques, such as high-flow oxygen delivered by high-flow nasal cannulae (HFNC), show some promise and are supported by evidence for benefit in related areas, but currently lack supportive evidence in postoperative patients. Positive pressure physiotherapy techniques, such as positive expiratory pressure therapy, offer an inexpensive and accessible alternative to patients, but also currently lack supporting evidence of benefit with regard to clinical endpoints. Future research in the challenging area of postoperative RF should address the potential alternatives to NIV, including the precise role of HFNC, therapies that may be utilised outside of critical care areas, and combinations of existing therapies.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124880941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Ambulatory Oxygen Workshop and Long-Term Oxygen Therapy in Real-Life Practice","authors":"Lucy Smithers","doi":"10.33590/emjrespir/10312177","DOIUrl":"https://doi.org/10.33590/emjrespir/10312177","url":null,"abstract":"","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131200030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term NIV in COPD – Who and When?","authors":"Tom Priddle","doi":"10.33590/emjrespir/10311625","DOIUrl":"https://doi.org/10.33590/emjrespir/10311625","url":null,"abstract":"Dr Wijkstra opened this symposium on long-term non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD). Dr Köhnlein presented data from a recent randomised controlled trial (RCT) of NIV for the treatment of severe stable COPD.1 Dr Cheval discussed the use of telemonitoring\u0000in French patients with COPD. The meeting concluded with a round-table discussion on the international practice of home mechanical ventilation (HMV) for COPD, moderated by Dr Wijkstra and Prof Windisch with contributions from Dr Köhnlein, Dr Nava, Dr Hart, and Prof Pépin.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115386016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapy for Alpha-1 Antitrypsin Deficiency: The Evidence for Efficacy","authors":"R. Stevens","doi":"10.33590/emjrespir/10311294","DOIUrl":"https://doi.org/10.33590/emjrespir/10311294","url":null,"abstract":"Prof McElvaney opened the symposium with a brief overview of the disease history and available treatments to date for alpha-1 antitrypsin deficiency (AATD). He then introduced Dr Reeves, who gave a description of the physiological function of alpha-1 proteinase inhibitor (α1-PI), specifically its effect on neutrophil function in AATD. Dr Parr then discussed the limitations of using forced expiratory volume (FEV1) to observe lung disease progression, and the development and use of measurements of lung density as an alternative. Dr Seersholm followed with a comprehensive overview of recent clinical studies demonstrating the efficacy of α1-PI augmentation therapy. Dr Chapman gave the final presentation that expanded on this by describing the findings of the randomised, placebo-controlled trial of augmentation therapy in α1-PI deficiency (RAPID) study. The meeting objectives were to present the current treatment landscape for AATD-associated emphysema and the role of α1-PI therapy within this.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128127251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Inadequately Controlled Asthma: Exploring the Potential of Phenotype-Targeted Therapy","authors":"T. Mughal","doi":"10.33590/emjrespir/10312229","DOIUrl":"https://doi.org/10.33590/emjrespir/10312229","url":null,"abstract":"Asthma is inadequately treated with the current standard of care. This session aimed to explore the potential of a phenotype-targeted approach to asthma management, which would allow a more tailored approach to treatment and result in better clinical outcomes for difficult-to-treat patients. Evidence was presented indicating that eosinophils play an important role in the pathogenesis of asthma. The importance of anti-interleukin (IL)-5 therapies, with the focus on therapies currently in development and their potential clinical benefit for the eosinophilic asthma phenotype, was also explored.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124320291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of Inhaler Use in the Treatment of Asthma and Chronic Obstructive Pulmonary Disease","authors":"F. Lavorini, Claudia Mannini, E. Chellini","doi":"10.33590/emjrespir/10311052","DOIUrl":"https://doi.org/10.33590/emjrespir/10311052","url":null,"abstract":"The mainstay of the pharmacological management of asthma and chronic obstructive pulmonary disease (COPD) is the use of inhaled drugs. This route enables drugs to be delivered to the site of their action, minimising the risk of adverse effects caused by systemic absorption. Drugs that can be administered by the inhaled route include the most commonly prescribed drugs for asthma and COPD, namely short and long-acting β2 agonists and anticholinergic drugs and corticosteroids. There are two main types of inhalers: pressurised metered dose inhalers (pMDIs) and dry powder inhalers (DPIs). pMDIs were introduced in the mid-20th century. The active drug is held in suspension or solution in a canister with a propellant. Proper use of pMDIs requires the patient to apply a series of techniques correctly: i) fire the device, releasing the aerosol very shortly after the initiation of inspiration; ii) inspire slowly and deeply;\u0000and iii) hold their breath. Many patients find this procedure difficult. Modifications and add-ons include breath-activated pMDIs and spacers and valved holding chambers; these help to obviate some of the problems with pMDIs. DPIs are breath-activated devices. Following priming, which is different for each\u0000device, the aerosol is generated by the patient taking a deep, rapid inspiration. This de-aggregates the powdered drug from its carrier. A prolonged breath-hold is then required. Many studies have shown that errors that may impair the effective delivery of the drug to the lungs, including critical errors, are very common with both pMDIs and DPIs. Such inhaler misuse has been shown to be associated with poorer symptom control and more frequent emergency department attendances. Errors in the use of inhalers can be a consequence of device-related factors, patient-related factors, and health professionalrelated\u0000factors. Minimising inhaler misuse requires the prescribing physician to choose, in cooperation with the patient, the most suitable device for the individual patient. Education and training with subsequent monitoring and re-training are thereafter crucial. There remains a need for more user-friendly devices, which provide constant doses of the active agent, in addition to built-in dose counters and patient feedback.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130522024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerves, Cough, and Idiopathic Pulmonary Fibrosis","authors":"N. Harrison, M. Pynn","doi":"10.33590/emjrespir/10312904","DOIUrl":"https://doi.org/10.33590/emjrespir/10312904","url":null,"abstract":"Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias. It has a poor prognosis with a median survival of approximately 3 years, and whilst new therapies are finally beginning to offer hope of improved survival, most patients will require palliation of symptoms as their disease progresses. Whilst all patients with IPF complain of breathlessness, up to 80% develop a distressing cough, which is detrimental to their quality of life and difficult to treat. This article examines the possible causes of cough in the wider context of current theories of the pathogenesis of IPF and its associated comorbidities, which may also cause or exacerbate cough. We examine the evidence for increased cough sensitivity in patients with IPF and neuroplasticity in animal models of lung pathology. Finally, we discuss new therapies that are becoming available to treat cough in IPF and their possible mechanisms of action, and which highlight the need for further, appropriately powered studies that include objective measures of cough as an outcome.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131406765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}