Update on Clinical Inflammometry for the Management of Airway Diseases

Airway inflammation is a central feature of many airway diseases such as asthma, chronic bronchitis, bronchiectasis and chronic cough; therefore, it is only logical that it is measured to optimize its treatment. However, most treatment recommendations, including the use of anti-inflammatory therapies such as corticosteroids, are based on assessments of only airflow and symptoms. Over the past 10 years, methods have been developed to assess airway inflammation relatively noninvasively. Quantitative cell counts in sputum and the fraction of exhaled nitric oxide are the most validated tests. Judicious use of currently available drugs, such as corticosteroids, bronchodilators and antibiotics, and other anti-inflammatory therapies guided by sputum eosinophil and neutrophil counts, have been demonstrated to decrease exacerbations of asthma and chronic obstructive pulmonary disease, ameliorate cough, improve quality of life in patients with these diseases and is cost effective compared with treatment strategies based on guidelines that do not incorporate these measurements. Thus, it is unfortunate that this is not used more widely in the management of airway diseases, particularly in patients with severe asthma and chronic obstructive pulmonary disease who experience frequent exacerbations.

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Faculty Opinions recommendation of Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1047545.497513 ◽

2006 ◽

Author(s):

Sanjay Sethi

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Airway Inflammation ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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Relationship among bacterial colonization, airway inflammation, and bronchodilator response in patients with stable chronic obstructive pulmonary disease

Chinese Medical Journal ◽

10.1097/00029330-200604020-00012 ◽

2006 ◽

Vol 119 (8) ◽

pp. 684-687

Author(s):

Hao-yan WANG ◽

Jian-kun LIU ◽

Hui-xue HUANG ◽

Xin-zhi WENG

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Airway Inflammation ◽

Pulmonary Disease ◽

Bacterial Colonization ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Bronchodilator Response

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Bronchodilator and anti-inflammatory therapy of chronic obstructive pulmonary disease from the position of interchangeability

Russian Pulmonology ◽

10.18093/0869-0189-2021-31-4-518-529 ◽

2021 ◽

Vol 31 (4) ◽

pp. 518-529

Author(s):

E. A. Orlova ◽

I. P. Dorfman ◽

M. A. Orlov ◽

A. K. Andreeva ◽

M. A. Abdullaev

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Generic Drugs ◽

The State ◽

Chronic Obstructive ◽

Anticholinergic Drugs ◽

Adherence To Treatment ◽

Obstructive Pulmonary Disease ◽

State Register ◽

Anti Inflammatory

The choice of drugs used to treat patients with chronic obstructive pulmonary disease (COPD) (inhaled β-agonists, M-anticholinergic drugs, inhaled corticosteroids (ICS)) in view of their interchangeability is reviewed in this article. This aspect is especially important for clinicians when choosing an effective and safe treatment for COPD and for increasing patient adherence to treatment.The aim of this study was to assess the ratio of the number of reference (original), interchangeable, and generic drugs used in COPD.Methods. In accordance with the Russian clinical guidelines 2018 and GOLD 2019, modern drugs for the treatment of COPD with bronchodilator and anti-inflammatory activity were selected. All trade names of the corresponding drugs for each international non-proprietary name (INN) In the State Register of Medicines website were considered. The information on the availability of reference (original) drugs and the corresponding interchangeable products, as well as their presence in the List of vital and essential drugs was analyzed.Results. A large number of generic prodcuts are registered in the State Register of Medicines, and only a few of them are interchangeable with the corresponding reference (original) drug.Conclusion. The analysis will help widen the doctors’ choice of interchangeable drugs in treatment of COPD with an equivalent effect and safety of reference drugs, as well as to increase the patients’ adherence to treatment.

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Appendicitis in Diabetics: Predictors of Complications and Their Incidence

The American Surgeon ◽

10.1177/000313481608200837 ◽

2016 ◽

Vol 82 (8) ◽

pp. 753-758 ◽

Cited By ~ 4

Author(s):

Lindsay Bach ◽

Andrew Donovan ◽

Whitney Loggins ◽

Stephanie Thompson ◽

Bryan Richmond

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Univariate Analysis ◽

Multivariate Regression Analysis ◽

General Surgeon ◽

Management Approach ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Cell Counts ◽

Chi Squared

Appendicitis is the most common surgical emergency encountered by the general surgeon. Literature has demonstrated that diabetics may manifest atypical signs of infection, often clouding the diagnostic picture. We conducted a 3-year retrospective analysis of adults with appendicitis to determine differences in presentation, diagnosis, treatment, and outcomes for diabetic versus nondiabetic patients. Demographics, symptoms, imaging, procedure(s), complications, and length of stay (LOS) were obtained via chart review. Factors were compared between patients with and without diabetes using chi-squared test, t test, or Mann-Whitney U test (significance at P ≤ 0.05). Multivariate regression analysis identified variables predicting longer LOS or perforation at diagnosis. Overall, 339 patients met inclusion criteria [303 were nondiabetic (ND), 36 were diabetic (D)]. On univariate analysis, diabetics were more likely to have other comorbid illnesses: obesity ( P < 0.001), chronic kidney disease ( P = 0.003), hypertension ( P < 0.001), coronary artery disease ( P < 0.001), peripheral vascular disease (PVD, P = 0.31), and chronic obstructive pulmonary disease ( P = 0.002). Diabetics presented with lower white blood cell counts (mean 14.2 ND, 11.9 D, P = 0.02), and were more likely to present with perforation (18.5% ND, 38.9% D, P = 0.008). LOS was longer in diabetics (1.0 day for ND, 3.0 day for D, P < 0.001). Complications were more frequent in diabetics (19.4% D vs 8.6% ND), which trended toward but failed to reach significance ( P = 0.066). On multivariate analysis, however, old age was the only characteristic associated with perforation [odds ratio: 1.05 (1.02–1.06), P < 0.001], whereas diabetes, chronic obstructive pulmonary disease, and older age predicted longer LOS ( P ≤ 0.001). Diabetics present a more complicated clinical picture having significantly more comorbidities and a trend toward postoperative complications necessitating a higher index of suspicion to detection complications. Further study is needed to evaluate the optimal diagnostic and management approach in this challenging population.

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