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The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS).

Introduction: Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a disease phenotype that shares T helper lymphocyte cell Th1/neutrophilic/non-Type-2 Inflammation pathways thought to be key in COPD and Th2/eosinophilic/Type-2 inflammatory pathways of asthma. The pharmacology of treating ACOS is challenging in severe circumstances.Areas covered: This review evaluates the stepwise treatment of ACOS using pharmacological treatments used in both COPD and asthma. The most common medications involve the same inhalers used to treat COPD and asthma patients. Advanced stepwise ther

Effect of tralokinumab, an interleukin-13 neutralising monoclonal antibody, on eosinophilic airway inflammation in uncontrolled moderate-to-severe asthma (MESOS): a multicentre, double-blind, randomised, placebo-controlled phase 2 trial.

BACKGROUND: The role of interleukin 13 in airway inflammation and remodelling in asthma is unclear. Tralokinumab is a human monoclonal antibody that neutralises interleukin 13. We aimed to evaluate whether tralokinumab would have an effect on airway eosinophilic infiltration, blood and sputum eosinophil concentrations, eosinophil activation, and airway remodelling. METHODS: We did a multicentre, double-blind, randomised, placebo-controlled phase 2 trial at 15 centres across the UK, Denmark, and Canada. We enrolled participants of either sex aged 18-75 years with inadequately controlled modera

Biological markers in lung cancer: A clinician's perspective.

Biological markers are urgently needed to improve the early detection, diagnosis and treatment of lung tumours. Over the past several years various promising biomarkers have emerged in the field of lung cancer. The poor prognosis associated with advanced lung cancer has resulted in attempts to develop lung cancer screening programs. The role of imaging and sputum cytology in lung cancer screening is the focus of much discussion, and efforts to find a suitable blood, sputum or exhaled breath biomarker for the detection of early lung cancer are ongoing. Regarding diagnosis, immunohistochemical p

Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure.

OBJECTIVES: We have previously reported our experience with noninvasive positive pressure ventilation (NPPV) via face mask in a small group of selected patients with acute respiratory failure (ARF). NPPV was frequently effective (70% success rate) in correcting gas exchange abnormalities and in avoiding endotracheal intubation (ETI); NPPV also had a low rate of complications. We have evaluated the clinical application of NPPV as first-line intervention in patients with hypercapnic and short-term hypoxemic ARF. A dedicated respiratory therapist conducted an educational program with physicians-i

Long-term home mechanical ventilation using a noninvasive ventilator via tracheotomy in patients with myasthenia gravis: a case report and literature review.

Neuromuscular diseases (NMD) are indications for long-term home mechanical ventilation (HMV). Noninvasive ventilation is preferred to HMV. However, invasive mechanical ventilation (IMV) is more appropriate if the patient has uncontrollable airway secretions, the possibility of aspiration, failure to wean, or severe weakness of the respiratory muscles. But if the patient undergoes multiple intubation or tracheotomy, it will be more painful and unbearable. For some end-stage NMD patients who need long-term tracheostomy, HMV using noninvasive ventilator via tracheotomy may be a conservative care

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… Circuits of noninvasive ventilators Currently, the circuits used in noninvasive ventilators include single-limb circuit with a passive exhalation port (some manufacturers call it ‘the leak valve’), active exhalation port in a dual-limb circuit, active exhalation port in a coaxial circuit, active exhalation … The active exhalation valve circuit provides higher FiO 2 at lower oxygen flow rates than the passive exhalation valve circuit. 41 However, the patient in our case was not primarily hypoxic, and the patient’s dyspnea was relieved by the use of a single-limb circuit with a passive exhalation port providing …

Evaluation of clinical outcomes of implants placed into the maxillary sinus with a perforated sinus membrane: a retrospective study.

BACKGROUND: Sleep services are assigned a non-essential status during COVID-19. The American Academy of Sleep Medicine strongly urges sleep clinicians to continue postponing non-urgent care until a later date, if such a recommendation is made by state officials due to local conditions. At the same time, one cannot ignore the fact that sleep is important for people's health and wellbeing. Therefore, to protect the health of the population, it is essential to find ways and means to continue the practice of sleep medicine even during the COVID-19 pandemic. METHOD: Social environment and work eth

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… The curve of volumetric flow increases gradually until exhalation, reaching a maximum value of 0.5 L/s, and then goes down until the end of exhalation. … It shows that the cheek surfaces and air exhalation are the sources of heat, where the temperature increases from 300 to 306 K. Figure 8 b shows the temperature during the exhalation process. …

Evaluating the VOCORDER device for early disease detection through breath analysis: study protocol for a two-phase clinical study.

INTRODUCTION: The survival rate of patients with life-threatening diseases primarily depends on the speed of diagnosis. Too often, diseases are detected only after symptoms appear, which usually occurs at later stages of a disease when available treatments may be less effective. Current detection techniques primarily depend on identifying metabolites in biofluids such as blood and urine. The analysis of these fluids is typically performed in laboratories, resulting in lengthy waiting times for patients to receive their results. In severe cases, invasive biopsies and radiative methods are used

Association between interleukin-6-174G/C gene polymorphism and asthma severity: exploring the role of total serum IgE, blood eosinophils, and FeNO as markers of type 2 inflammation.

BACKGROUND: While a connection has been established between serum interleukin-6 (IL-6) levels and the IL-6 gene (- 174G/C) polymorphism in allergic diseases such as asthma, its specific association with severe asthma remains unexplored. This study examined the relationship between the IL-6 (- 174G/C) gene polymorphism and mild and severe asthma, focusing on its influence on type 2 inflammation. METHODS: Our study comprised 98 patients with mild asthma and 116 with severe asthma. Additionally, we recruited 121 healthy participants to serve as controls for comparative analyses. The IL-6 gene (-

Sphenopalatine ganglion stimulation: a comprehensive evaluation across diseases in randomized controlled trials.

BACKGROUND: Current literature extensively covers the use of sphenopalatine ganglion stimulation (SPGs) in treating a broad spectrum of medical conditions, such as allergic rhinitis, cluster headaches, and strokes. Nevertheless, a discernible gap in the systematic organization and analysis of these studies is evident. This paper aims to bridge this gap by conducting a comprehensive review and analysis of existing literature on SPGs across various medical conditions. METHODS: This study meticulously constructed a comprehensive database through systematic computerized searches conducted on PubM

Brief Advice, Nicotine Replacement Therapy Sampling, and Active Referral for Expectant Fathers Who Smoke Cigarettes: A Randomized Clinical Trial.

IMPORTANCE: Pregnancy presents an opportunity to engage expectant fathers in smoking cessation, but evidence from randomized clinical trials is scarce. OBJECTIVE: To evaluate the effectiveness of a proactive, combined intervention for smoking cessation in expectant fathers. DESIGN, SETTING, AND PARTICIPANTS: This pragmatic randomized clinical trial in prenatal clinics in 7 public hospitals in Hong Kong proactively recruited and enrolled 1053 participants from October 10, 2018, to February 8, 2020. Included male adults were 18 years or older, smoked cigarettes daily in the past 3 months, had

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial.

BACKGROUND: Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. OBJECTIVE: This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. METHODS: From Oct

Aerosolized antibiotics in mechanically ventilated patients: delivery and response.

OBJECTIVES: To determine whether aerosolized antibiotics can be delivered efficiently to the lower respiratory tract in mechanically ventilated patients and to define possible clinical responses to these agents. DESIGN: Prospective serial study with cases as their own control. SETTING: A 10-bed respiratory care unit for patients with chronic respiratory failure in a tertiary university hospital. PATIENTS: Ventilator dependent patients who are otherwise medically stable. All subjects had a tracheostomy in place, were colonized with gram-negative organisms, and produced purulent secretions wh

The predictive value of pulmonary function test before transplantation for chronic pulmonary graft-versus-host-disease after allogeneic hematopoietic stem cell transplantation.

BackgroundPulmonary chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a devastating complication and often diagnosed at a late stage when lung dysfunction is irreversible. Identifying patients before transplant who are at risk may offer improved strategies to decrease the mortality. Bronchiolitis obliterans syndrome (BOS) is the typical manifestation of pulmonary cGVHD, which is clinically diagnosed by pulmonary function test (PFT). This study aimed to evaluate the predictive value of PFT pre-HSCT for BOS.MethodsA single center co

[Serotonin receptor 1A-modulated dephosphorylation of glycine receptor α3: a new molecular mechanism of breathing control for compensation of opioid-induced respiratory depression without loss of analgesia].

To control the breathing rhythm the medullary respiratory network generates periodic salvo activities for inspiration, post-inspiration and expiration. These are under permanent modulatory control by serotonergic neurons of the raphe which governs the degree of phosphorylation of the inhibitory glycine receptor α3. The specific activation of serotonin receptor type 1A (5-HTR(1A)), which is strongly expressed in the respiratory neurons, functions via inhibition of adenylate cyclase and the resulting reduction of the intracellular cAMP level and a gradual dephosphorylation of the glycine recepto

Pulmonary exacerbations in primary ciliary dyskinesia.

UNLABELLED: Primary ciliary dyskinesia (PCD) is a rare inherited disorder of motile ciliary dysfunction characterized by impaired mucociliary clearance, chronic sino-pulmonary disease, and progressive bronchiectasis. Pulmonary exacerbations (PEx) are a major contributor to morbidity, lung function decline, and healthcare utilization in PCD, yet historically have been poorly defined and understudied. This review summarizes current evidence regarding the definition, epidemiology, pathophysiology, clinical impact, and management of PEx in PCD, with emphasis on recent advances that are beginning t

[Comparison of lung function and inflammatory markers and analysis of risk factors for acute exacerbations in patients with chronic obstructive pulmonary disease and persistent airflow limitation asthma].

Objective: To analyze the differences in pulmonary function and inflammatory indicators between patients with chronic obstructive pulmonary disease (COPD) and those with persistent airflow limitation (PAL) asthma, and to explore the influencing factors of acute exacerbation in patients with COPD and PAL asthma. Methods: A total of 192 patients with stable COPD and PAL asthma who visited the Department of Respiratory and Critical Care Medicine of the Shanghai General Hospital of Shanghai Jiao Tong University School of Medicine from January 2021 to December 2022 were prospectively included. Amon

Oral corticosteroid reduction and discontinuation in adults with corticosteroid-dependent, severe, uncontrolled asthma treated with tezepelumab (WAYFINDER): a multicentre, single-arm, phase 3b trial.

BACKGROUND: The SOURCE phase 3 oral corticosteroid (OCS)-sparing study of tezepelumab indicated an OCS-sparing effect with tezepelumab versus placebo in patients with OCS-dependent asthma and baseline blood eosinophil counts (BECs) of at least 150 cells per μL. The WAYFINDER study aimed to further evaluate the ability of tezepelumab to reduce or discontinue OCS use in a larger cohort of patients with OCS-dependent severe, uncontrolled asthma. METHODS: WAYFINDER was a phase 3b, multicentre, single-arm, open-label, OCS-sparing study. Adults (aged 18-80 years) with severe, uncontrolled asthma re

The Clinical Registry of Childhood Asthma (CRCA) Elucidating Early-Life Asthma: Cross-Sectional Analysis of a Prospective, Longitudinal, and Digitally Enhanced Real-World Cohort.

BACKGROUND: Childhood asthma, particularly in early life, is often underdiagnosed and poorly characterized in real-world outpatient settings due to diagnostic challenges and resource constraints. A pragmatic, scientifically rigorous, prospective cohort model is urgently needed. OBJECTIVE: We aimed to establish and present a cross-sectional baseline analysis of the Clinical Registry of Childhood Asthma, a prospective, longitudinal, and digitally enhanced cohort in outpatient settings, focusing on the diagnostic spectrum of early-life asthma. METHODS: We established the Clinical Registry of Ch

Clinically significant lung function improvement for collegiate soccer players after OMT with restrictive ribcage motion correlated with Expanded Zink screen.

CONTEXT: This study was undertaken to build upon the work of J. Gordon Zink, DO, FAAO, by developing a novel screening examination (Expanded Zink screen) that can correlate with proper identification of somatic dysfunction, the area of greatest restriction (AGR), and effective treatment in soccer players, which would elevate the osteopathic profession and advance the field of medicine. OBJECTIVES: The objectives of this study are to determine whether the Expanded Zink screen can accurately correlate with the somatic dysfunctions found in soccer players, with what ended up being treated, and w

Molecular mechanisms and therapeutic implications of the carbon monoxide/hmox1 and the hydrogen sulfide/CSE pathways in the prevention of pre-eclampsia and fetal growth restriction.

UNLABELLED: The exact aetiology of preeclampsia is unknown, but there is a good association with an imbalance in angiogenic growth factors and abnormal placentation (Ahmad and Ahmed, 2004). The incidence of preeclampsia is reduced by a third in smokers, but not in snuff users. Soluble Flt-1 (sFlt-1) and soluble endoglin (sEng) are increased prior to the clinical onset of preeclampsia. Animals exposed to high circulating levels of sFlt-1 and sEng elicit severe preeclampsia-like symptoms. Smokers have reduced circulating sFlt-1 and cigarette smoke extract decreases sFlt-1 release from placental