scholarly journals The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

2018 ◽  
Vol 52 (3) ◽  
pp. 1800328 ◽  
Author(s):  
Eva Polverino ◽  
Katerina Dimakou ◽  
John Hurst ◽  
Miguel-Angel Martinez-Garcia ◽  
Marc Miravitlles ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Upper Airway ◽  
Airway Disease ◽  
Chronic Obstructive ◽  
Future Directions ◽  
Obstructive Pulmonary Disease ◽  
Airway Diseases ◽  
Recurrent Respiratory Infections ◽  
Sputum Production ◽  
Syndromic Approach

Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4–72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20–30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex “mixed airway” phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.

scholarly journals Research highlights from the 2018 European Respiratory Society International Congress: airway disease

2019 ◽  
Vol 5 (1) ◽  
pp. 00225-2018 ◽  
Author(s):  
Florence Schleich ◽  
Andras Bikov ◽  
Alexander G. Mathioudakis ◽  
Melissa McDonnell ◽  
Cecilia Andersson ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Airway Disease ◽  
International Congress ◽  
Chronic Obstructive ◽  
European Respiratory Society ◽  
High Quality ◽  
High Quality Research ◽  
Obstructive Pulmonary Disease ◽  
Quality Research ◽  
Airway Diseases

The annual European Respiratory Society (ERS) International Congress (held in Paris in 2018) was once again a platform for discussion of the highest-quality scientific research, cutting-edge techniques and innovative new therapies within the respiratory field. This article discusses only some of the high-quality research studies presented at this year's Congress, with a particular focus on airway diseases including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and cough, as presented through Assembly 5 of the ERS (Airway Diseases: Asthma and COPD). The authors establish the key take-home messages of these studies, compare their findings and place them in the context of current understanding.

scholarly journals The Emerging Role of Small Extracellular Vesicles in Inflammatory Airway Diseases

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 222
Author(s):  
Katarzyna Piszczatowska ◽  
Katarzyna Czerwaty ◽  
Anna M. Cyran ◽  
Mathias Fiedler ◽  
Nils Ludwig ◽  
...  
Keyword(s):  
Extracellular Vesicles ◽  
Genetic Material ◽  
Upper Airway ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Pathogen Invasion ◽  
Airway Diseases ◽  
Airway Infections ◽  
Inflammatory Processes

Extracellular vesicles (EVs) are produced and released by all cells and are present in all body fluids. They exist in a variety of sizes, however, small extracellular vesicles (sEVs), the EV subset with a size range from 30 to 150 nm, are of current interest. By transporting a complex cargo that includes genetic material, proteins, lipids, and signaling molecules, sEVs can alter the state of recipient cells. The role of sEVs in mediating inflammatory processes and responses of the immune system is well-documented, and adds another layer of complexity to our understanding of frequent diseases, including chronic rhinosinusitis (CRS), asthma, chronic obstructive pulmonary disease (COPD), and upper airway infections. In these diseases, two aspects of sEV biology are of particular interest: (1) sEVs might be involved in the etiopathogenesis of inflammatory airway diseases, and might emerge as attractive therapeutic targets, and (2) sEVs might be of diagnostic or prognostic relevance. The purpose of this review is to outline the biological functions of sEVs and their capacity to both augment and attenuate inflammation and immune response in the context of pathogen invasion, CRS, asthma, and COPD.

scholarly journals PECULIARITIES OF BRONCHIAL ASTHMA CLINICAL COURSE IN SMOKERS WITH SMALL AIRWAY DISEASES

2020 ◽  
pp. 8-21
Author(s):  
V.V. Gnoevykh ◽  
Yu.A. Shorokhova ◽  
A.Yu. Smirnova ◽  
A.B. Peskov ◽  
V.A. Razin
Keyword(s):  
Bronchial Asthma ◽  
Clinical Course ◽  
Airway Disease ◽  
Small Airway ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Small Airway Disease ◽  
Airway Diseases ◽  
Related Phenotype ◽  
Keywords Bronchial Asthma

The literature review provides up-to-date information about the clinical course of bronchial asthma (BA) in smokers with small airway diseases. Special attention is paid to the combination of bronchial asthma and chronic obstructive pulmonary disease (COPD), namely asthma-COPD overlap syndrome (ACOS). According to literature data, in case of small airway duseases exacerbations are more often and severe in smokers with BA and ACOS. Besides, disease prognosis worsens due to reduction in the efficacy of a baseline therapy. Keywords: bronchial asthma, small airway disease, smoking-related phenotype, asthma-COPD overlap (BA-COPD phenotype). В литературном обзоре представлены современные сведения об особенностях клинического течения бронхиальной астмы (БА) у курильщиков с поражением малых дыхательных путей (МДП). Особое внимание уделено сочетанию бронхиальной астмы и хронической обструктивной болезни лёгких (ХОБЛ; COPD) – синдрому перекрёста БА-ХОБЛ (СПБАХ, asthma-COPD overlap, ACO; фенотип БА-ХОБЛ). Согласно литературным данным, в случае поражения МДП у больных БА с фенотипом курильщика и при сочетании БА-ХОБЛ чаще возникают и тяжелее протекают обострения, ухудшается прогноз заболевания, в т.ч. из-за снижения эффективности базисной терапии. Ключевые слова: бронхиальная астма, поражение малых дыхательных путей, фенотип курильщика, asthma-COPD overlap (фенотип БА-ХОБЛ).

scholarly journals A 3D-CNN model with CT-based parametric response mapping for classifying COPD subjects

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thao Thi Ho ◽  
Taewoo Kim ◽  
Woo Jin Kim ◽  
Chang Hyun Lee ◽  
Kum Ju Chae ◽  
...  
Keyword(s):  
Neural Network ◽  
Pulmonary Function Tests ◽  
Airway Disease ◽  
Chronic Obstructive ◽  
Respiratory Disorder ◽  
Obstructive Pulmonary Disease ◽  
Response Mapping ◽  
Small Airway Disease ◽  
3D Cnn ◽  
Parametric Response

AbstractChronic obstructive pulmonary disease (COPD) is a respiratory disorder involving abnormalities of lung parenchymal morphology with different severities. COPD is assessed by pulmonary-function tests and computed tomography-based approaches. We introduce a new classification method for COPD grouping based on deep learning and a parametric-response mapping (PRM) method. We extracted parenchymal functional variables of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%) with an image registration technique, being provided as input parameters of 3D convolutional neural network (CNN). The integrated 3D-CNN and PRM (3D-cPRM) achieved a classification accuracy of 89.3% and a sensitivity of 88.3% in five-fold cross-validation. The prediction accuracy of the proposed 3D-cPRM exceeded those of the 2D model and traditional 3D CNNs with the same neural network, and was comparable to that of 2D pretrained PRM models. We then applied a gradient-weighted class activation mapping (Grad-CAM) that highlights the key features in the CNN learning process. Most of the class-discriminative regions appeared in the upper and middle lobes of the lung, consistent with the regions of elevated fSAD% and Emph% in COPD subjects. The 3D-cPRM successfully represented the parenchymal abnormalities in COPD and matched the CT-based diagnosis of COPD.

The role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation: Literature review

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Rodríguez Miguel ◽  
◽  
Chinta Siddharth ◽  
Vittorio Timothy ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Airway Disease ◽  
The Other ◽  
Beta Agonist ◽  
Beta Blockade ◽  
Chronic Obstructive ◽  
Agonist Therapy ◽  
Obstructive Pulmonary Disease

Background: New advances have been made in medicine, but the incidence and prevalence of Chronic Obstructive Pulmonary Disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and beta-receptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1-selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient. Keywords: atrial fibrillation; pulmonary disease; obstructive pulmonary disease; chronic obstructive pulmonary disease (COPD); B-Agonist; B-Block (selective; non-selective); digitalis; other antiarrhythmic.

scholarly journals Targeting Cytokines as Evolving Treatment Strategies in Chronic Inflammatory Airway Diseases

2018 ◽  
Vol 19 (11) ◽  
pp. 3402 ◽  
Author(s):  
Jaleesa Garth ◽  
Jarrod Barnes ◽  
Stefanie Krick
Keyword(s):  
Clinical Trials ◽  
Allergic Asthma ◽  
Inflammatory Marker ◽  
Interleukin 1 ◽  
Treatment Strategies ◽  
Bronchial Epithelium ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Airway Diseases ◽  
Novel Treatment Strategies

Cytokines are key players in the initiation and propagation of inflammation in chronic inflammatory airway diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis and allergic asthma. This makes them attractive targets for specific novel anti-inflammatory treatment strategies. Recently, both interleukin-1 (IL-1) and IL-6 have been associated with negative health outcomes, mortality and a pro-inflammatory phenotype in COPD. IL-6 in COPD was shown to correlate negatively with lung function, and IL-1beta was induced by cigarette smoke in the bronchial epithelium, causing airway inflammation. Furthermore, IL-8 has been shown to be a pro-inflammatory marker in bronchiectasis, COPD and allergic asthma. Clinical trials using specific cytokine blockade therapies are currently emerging and have contributed to reduce exacerbations and steroid use in COPD. Here, we present a review of the current understanding of the roles of cytokines in the pathophysiology of chronic inflammatory airway diseases. Furthermore, outcomes of clinical trials in cytokine blockade as novel treatment strategies for selected patient populations with those diseases will be discussed.

scholarly journals Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 31-36
Author(s):  
Ioana Cojocaru ◽  
Livia Luculescu ◽  
Daniela Negoescu ◽  
Irina Strâmbu
Keyword(s):  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Respiratory Infections ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Male Predominance ◽  
Number Of Patients ◽  
Lower Intestine

Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

scholarly journals Shall We Focus on the Eosinophil to Guide Treatment with Systemic Corticosteroids during Acute Exacerbations of COPD?: PRO

2018 ◽  
Vol 6 (3) ◽  
pp. 74 ◽  
Author(s):  
James Camp ◽  
Jennifer Cane ◽  
Mona Bafadhel
Keyword(s):  
Precision Medicine ◽  
Corticosteroid Treatment ◽  
Airway Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Correct Identification ◽  
Obstructive Pulmonary Disease ◽  
Peripheral Blood Eosinophil ◽  
Increased Risk ◽  
Oral Corticosteroids

In an era of precision medicine, it seems regressive that we do not use stratified approaches to direct treatment of oral corticosteroids during an exacerbation of chronic obstructive pulmonary disease (COPD). This is despite evidence suggesting that 40% of COPD patients have eosinophilic inflammation and this is an indicator of corticosteroid response. Treatments with oral corticosteroids are not always effective and not without harm, with significant and increased risk of hyperglycemia, sepsis, and fractures. Eosinophils are innate immune cells with an incompletely understood role in the pathology of airway disease. They are detected at increased levels in some patients and can be measured using non-invasive methods during states of exacerbation and stable periods. Despite the eosinophil having an unknown mechanism in COPD, it has been shown to be a marker of length of stay in severe hospitalized exacerbations, a predictor of risk of future exacerbation and exacerbation type. Although limited, promising data has come from one prospective clinical trial investigating the eosinophil as a biomarker to direct systemic corticosteroid treatment. This identified that there were statistically significant and clinically worsened symptoms in patients with low eosinophil levels who were prescribed prednisolone, demonstrating the potential utility of the eosinophil. In an era of precision medicine our patients’ needs are best served by accurate diagnosis, correct identification of maximal treatment response and the abolition of harm. The peripheral blood eosinophil count could be used towards reaching these aims.

Abstract P073: Co-morbidities and Cardiac Associated Mortality in Smokers

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Gregory L Kinney ◽  
Kendra A Young ◽  
Katherine Pratte ◽  
Elizabeth A Regan ◽  
Lindsey Duca ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Latent Class ◽  
Proportional Hazards ◽  
Airway Disease ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Longitudinal Assessment ◽  
Vascular Effects ◽  
Obstructive Pulmonary Disease ◽  
Cvd Mortality

Background: Chronic Obstructive Pulmonary Disease (COPD) is a complex syndrome involving all aspects of the lungs which is strongly associated with cigarette smoking. Parenchymal destruction and remodeling are disease processes involving inflammatory pathways likely to have systemic vascular effects outside of the lungs. Indeed cardiovascular disease (CVD) is a leading cause of mortality in people affected by COPD and many co-morbid conditions are also associated with the disease. We explored CVD mortality in smokers considering aspects of COPD as well as co-morbidities in the longitudinal follow-up of the COPDGene study. Methods: The COPDGene study includes baseline and longitudinal assessment of mortality for 8,157 participants with (3,604) and without COPD (4,553) all of whom reported >10 pack-years smoking exposure. Aspects of COPD including CT phenotyping and pulmonary function were combined using Principal Components Analysis (PCA), co-morbidities were combined using Latent Class Analysis (LCA) and cause specific mortality was assessed using study center reports, SSRI searches and single clinician adjudication. Cox Proportional Hazards models accounting for the effects of competing risks were used to assess the association between PCA factors and CVD mortality and PCA factors plus LCA classes and CVD mortality. Results: PCA analysis resulted in 5 factors describing emphysema, airway disease, gas trapping, BMI and its effect on CT measurement and hyperinflation and LCA analysis identified 7 classes of co-morbidities. CVD associated mortality occurred in 128 participants and competing causes of mortality occurred in 605. The PCA factor describing airway disease predicted CVD mortality in the PCA only model (HR 1.8, 95%C.I. 1.4-2.3,p<0.0001), as well as in the LCA model (HR 1.7, 95% C.I. 1.3-2.2, p<0.0001). LCA classes associated with CVD mortality include a class describing diabetes, high BP and high Cholesterol (HR 3.5, 95% C.I. 1.8-6.8, p=0.0003) and a class describing known CVD (HR 2.9, 95% C.I. 1.3-6.7, p=0.01). Conclusions: Co-morbidities of COPD represent independent predictors of CVD associated mortality in smokers accounting for pulmonary disease and competing mortality risks. Clustering of comorbidities using LCA is an approach that may be informative in complex diseases.

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