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A Study to Assess Inhaler Technique and its potential impact on Asthma Control in Patients attending an Asthma Clinic.

The aim of this study was to evaluate inhaler technique and symptom control in patients with poorly controlled asthma at baseline and at follow-up in a dedicated asthma clinic in a tertiary hospital. We also investigated the impact of asthma on these patients' quality of life.

Methods: Patients referred to a newly established asthma clinic in Cork University Hospital were prospectively recruited over a 6 month period. Their inhaler technique was assessed by a pulmonary nurse specialist using a validated scoring system. They received instruction on inhaler usage when scores were suboptimal. Patients completed a validated asthma control questionnaire (ACQ) and asthma quality of life questionnaire (AQLQ). At follow-up 3-4 months later, inhaler technique was reassessed and the ACQ questionnaire repeated.

Results: 46 patients were recruited (female=74%), and 40/46 were followed up. Mean[SD] FEV1 % predicted at baseline = 76.5%[21.5]. 63% of patients were classified as incorrectly using their inhaler at their initial assessment.This decreased to 20% at follow up, indicating an overall significant improvement in inhaler usage post-training (p=0.003). ACQ scores improved significantly from median[interquartile range] 2.70[1.66] to 2.00[1.90], (p=0.002). Baseline measurement indicated that patients' quality of life was moderately affected by asthma, with a median AQLQ score of 4.75 [1.97]

Conclusion: This study demonstrates the importance of educating and formally assessing inhaler technique in patients with asthma as part of their ongoing clinical review.

Sphingolipids in lung growth and repair.

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Sphingolipids comprise a class of bioactive lipids that are involved in a variety of pathophysiologic processes, including cell death and survival. Ceramide and sphingosine-1-phosphate (S1P) form the center of sphingolipid metabolism and determine proapoptotic and antiapoptotic balance. Findings in animal models suggest a possible pathophysiologic role of ceramide and S1P in COPD, cystic fibrosis, and asthma. Sphingolipid research is now focusing on the role of ceramides during lung inflammation and its regulation by sphingomyelinases.

Recently, sphingolipids have been shown to play a role in the pathogenesis of bronchopulmonary dysplasia (BPD). Ceramide upregulation was linked with vascular endothelial growth factor suppression and decreased surfactant protein B levels, pathways important for the development of BPD. In a murine model of BPD, intervention with an S1P analog had a favorable effect on histologic abnormalities and ceramide levels. Ceramides and S1P also regulate endothelial permeability through cortical actin cytoskeletal rearrangement, which is relevant for the pathogenesis of ARDS. On the basis of these observations, the feasibility of pharmacologic intervention in the sphingolipid pathway to influence disease development and progression is presently explored, with promising early results.

The prospect of new strategies to prevent and repair lung disease by interfering with sphingolipid metabolism is exciting and could potentially reduce morbidity and mortality in patients with severe lung disorders.

Current and Novel Bronchodilators in Respiratory DiseaseCurrent and Novel Bronchodilators in Respiratory Disease

Get up to date on current novel targeted therapy developments in the fields of asthma and COPD. Current Opinion in Pulmonary Medicine (Source: Medscape Today Headlines)

Six New Cases of MERS Virus Hit Saudi Arabia, UAESix New Cases of MERS Virus Hit Saudi Arabia, UAE

Another five people in Saudi Arabia and one in the United Arab Emirates have become infected with the potentially deadly Middle East Respiratory Syndrome (MERS) virus. Reuters Health Information (Source: Medscape Medical News Headlines)

Community-acquired Pneumonia Among Smokers.

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Community-acquired Pneumonia Among Smokers.

Arch Bronconeumol. 2013 Dec 30;

Authors: Almirall J, Blanquer J, Bello S

Abstract
Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities.

PMID: 24387877 [PubMed - as supplied by publisher]

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