Spirometric criteria to diagnose airway obstruction in the elderly: fixed ratio vs. lower limit of normal.

Minerva Med. 2015 Jan 14;

Authors: Sorino C, D'Amato M, Steinhilber G, Patella V, Corsico AG

Abstract
COPD is the most common chronic lung disease. It becomes more prevalent with increasing age but remains under-diagnosed in the elderly. A heated debate concerns the most suitable way to diagnose airway obstruction in this age group. Most COPD guidelines recommend to use a FEV1/FVC of 0.70 as threshold to define an obstructive ventilatory defect. While the use of a 0.70 ratio may be simple, it may result in under-diagnosis of airflow obstruction in young people and over-diagnosis in the elderly due to an age-related decline in pulmonary volumes, especially in FEV1. This might lead to unnecessary use of medications and increased risk of adverse effects. A proposed strategy for reducing the misclassification of airway obstruction include the use of the statistically derived lower limit of normal (LLN) for FEV1/FVC, calculated as the fifth percentile of the normal distribution in a healthy population. Some authors addressed the possibility to evaluate lung function through high-resolution CT. In contrast to spirometry, CT imaging may allow for regional assessment of the compartments involved (airways, parenchyma, vasculature), and may enable a phenotype-driven characterization of COPD. Bhatt et al. recently observed that a small proportion (7%) of subjects with CT-defined emphysema were identified by the 0.70 threshold for FEV1/FVC but not by the LLN. However, there is no evidence that CT-emphysema corresponds to a clinical entity that can benefit by inhaled therapy. Further studies are needed to assess the classificatory and prognostic value of the different proposed criteria to diagnose airway obstruction in the elderly.

PMID: 25586765 [PubMed - as supplied by publisher]

Respiratory Tissue Engineering: Current Status and Opportunities for the Future.

Tissue Eng Part B Rev. 2015 Jan 14;

Authors: O'Leary C, Gilbert JL, O'Dea S, O'Brien FJ, Cryan SA

Abstract
Currently, lung disease and major airway trauma constitute a major global healthcare burden with limited treatment options. Airway diseases such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) have been identified as the fifth highest cause of mortality worldwide and are estimated to rise to fourth place by 2030. Alternate approaches and therapeutic modalities are urgently needed to improve clinical outcomes for chronic lung disease. This can be achieved through tissue engineering of the respiratory tract. Interest is growing in the use of airway tissue engineered constructs as both a research tool to further our understanding of airway pathology, validate new drugs and pave the way for novel drug therapies, and also as regenerative medical devices or as an alternative to transplant tissue. This review provides a concise summary of the field of respiratory tissue engineering to date. An initial overview of airway anatomy and physiology is given, followed by a description of the stem cell populations and signalling processes involved in parenchymal healing and tissue repair. We then focus on the different biomaterials and tissue engineered systems employed in upper and lower respiratory tract engineering, and give a final perspective of the opportunities and challenges facing the field of respiratory tissue engineering.

PMID: 25587703 [PubMed - as supplied by publisher]

Related Articles

Bronchodilating Drugs for Chronic Obstructive Pulmonary Disease: Current Status and Future Trends.

J Med Chem. 2015 Jan 14;

Authors: Montuschi P, Ciabattoni G

Abstract
Inhaled bronchodilators, including long-acting muscarinic receptor antagonists (LAMA) and long-acting beta2-adrenoreceptor agonists (LABA), are the mainstay of pharmacological treatment of stable chronic obstructive pulmonary disease (COPD). Among approved LAMA, tiotropium bromide, glycopyrronium bromide and umeclidinium bromide, are administered once daily, whereas aclidinium bromide is administered every 12 hours. New LAMA are under development for COPD. Among the approved LABA, indacaterol has a 24-h duration of action, whereas salmeterol and formoterol require twice-daily administration. New once-daily LABA, including vilanterol, olodaterol, milveterol, carmoterol, and abediterol, are in development. LAMA/LABA fixed dose combinations (FDC) provide the convenience of two bronchodilators with different mechanism of action in a single inhaler. Indacaterol/glycopyrronium, umeclidinium/vilanterol and olodaterol/tiotropium FDC, have been approved or are under approval and are likely to become a standard pharmacological strategy for COPD. Dual-pharmacology compounds, combining muscarinic antagonism and beta2-agonism (MABA) in a single molecule, potentially provide additive or synergistic bronchodilation over either inhaled antimuscarinic or beta2-agonist monotherapy.

PMID: 25587755 [PubMed - as supplied by publisher]

Bronchial arteries: anatomy, function, hypertrophy, and anomalies.

Radiographics. 2015 Jan-Feb;35(1):32-49

Authors: Walker CM, Rosado-de-Christenson ML, Martínez-Jiménez S, Kunin JR, Wible BC

Abstract
The two main sources of blood supply to the lungs and their supporting structures are the pulmonary and bronchial arteries. The bronchial arteries account for 1% of the cardiac output but can be recruited to provide additional systemic circulation to the lungs in various acquired and congenital thoracic disorders. An understanding of bronchial artery anatomy and function is important in the identification of bronchial artery dilatation and anomalies and the formulation of an appropriate differential diagnosis. Visualization of dilated bronchial arteries at imaging should alert the radiologist to obstructive disorders that affect the pulmonary circulation and prompt the exclusion of diseases that produce or are associated with pulmonary artery obstruction, including chronic infectious and/or inflammatory processes, chronic thromboembolic disease, and congenital anomalies of the thorax (eg, proximal interruption of the pulmonary artery). Conotruncal abnormalities, such as pulmonary atresia with ventricular septal defect, are associated with systemic pulmonary supply provided by aortic branches known as major aortopulmonary collaterals, which originate in the region of the bronchial arteries. Bronchial artery malformation is a rare left-to-right or left-to-left shunt characterized by an anomalous connection between a bronchial artery and a pulmonary artery or a pulmonary vein, respectively. Bronchial artery interventions can be used successfully in the treatment of hemoptysis, with a low risk of adverse events. Multidetector computed tomography helps provide a vascular road map for the interventional radiologist before bronchial artery embolization. (©)RSNA, 2015.

PMID: 25590386 [PubMed - in process]