A lower level of forced expiratory volume in 1 second is a risk factor for all-cause and cardiovascular mortality in a Japanese population: the takahata study.

PLoS One. 2013;8(12):e83725

Authors: Shibata Y, Inoue S, Igarashi A, Yamauchi K, Abe S, Aida Y, Nunomiya K, Sato M, Nakano H, Sato K, Nemoto T, Kimura T, Watanabe T, Konta T, Daimon M, Ueno Y, Kato T, Kayama T, Kubota I

Abstract
Chronic obstructive pulmonary disease is a known risk factor for cardiovascular death in Western countries. Because Japan has a low cardiovascular death rate, the association between a lower level of forced expiratory volume in 1 s (FEV1) and mortality in Japan's general population is unknown. To clarify this, we conducted a community-based longitudinal study. This study included 3253 subjects, who received spirometry from 2004 to 2006 in Takahata, with a 7-year follow-up. The causes of death were assessed on the basis of the death certificate. In 338 subjects, airflow obstruction was observed by spirometry. A total of 127 subjects died. Cardiovascular death was the second highest cause of death in this population. The pulmonary functions of the deceased subjects were significantly lower than those of the subjects who were alive at the end of follow-up. The relative risk of death by all causes, respiratory failure, lung cancer, and cardiovascular disease was significantly increased with airflow obstruction. The Kaplan-Meier analysis showed that all-cause and cardiovascular mortality significantly increased with a worsening severity of airflow obstruction. After adjusting for possible factors that could influence prognosis, a Cox proportional hazard model analysis revealed that a lower level of FEV1 was an independent risk factor for all-cause and cardiovascular mortality (per 10% increase; hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.82-0.98; and HR, 0.72; 95% CI, 0.61-0.86, respectively). In conclusion, airflow obstruction is an independent risk factor for all-cause and cardiovascular death in the Japanese general population. Spirometry might be a useful test to evaluate the risk of cardiovascular death and detect the risk of respiratory death by lung cancer or respiratory failure in healthy Japanese individuals.

PMID: 24349548 [PubMed - in process]

Persperctives in Immunopharmacology: The Future of Immunosuppression.

Immunol Lett. 2013 Dec 11;

Authors: Boraschi D, Penton-Rol G

Abstract
Modulation of immune responses for therapeutic purposes is a particularly relevant area, given the central role of anomalous immunity in a wide variety of diseases, from the most typically immune-related syndromes (autoimmune diseases, allergy and asthma, immunodeficiencies) to those in which altered immunity and inflammation define the pathological outcomes (chronic infections, tumors, chronic inflammatory and degenerative diseases, metabolic disorders, etc.). This brief review will summarize some of the most promising perspectives of immunopharmacology, in particular in the area of immunosuppression, by considering the following aspects: molecular pathways: investigating the fine mechanisms of immune modulation, to define novel targets and new clinical applications, with particular emphasis to approaches for re-education of anomalous immunity, including induction of tolerance; personalized medicine: how pharmacogenomics can help in selecting the optimal treatment for each patient, focusing on human immunology for obtaining relevant information that animal models cannot provide; microbiome: considering immune responses as the result of the interaction between human cells and commensal bacteria, for a new perspective in the use of immunosuppressive treatments; natural products: providing a scientific basis to the huge body of pharmacological knowledge and products of traditional medicine for identifying new active molecules and new treatment concepts; nanomedicine: exploiting the intelligent design of engineered nanoparticles offered by nanotechnologies in tailoring shape-, size-, surface-controlled carriers for targeted delivery of drugs.

PMID: 24333342 [PubMed - as supplied by publisher]

Bronchial thermoplasty: interventional therapy in asthma.

Ther Adv Respir Dis. 2013 Dec 10;

Authors: Kaukel P, Herth FJ, Schuhmann M

Abstract
Bronchial thermoplasty is a new treatment option for patients with severe bronchial asthma who remain symptomatic despite maximal medical therapy. The aim of this interventional therapy option is the reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction via the application of heat. A full treatment with bronchial thermoplasty is divided into three bronchoscopies. Randomized, controlled clinical trials have shown an increase in quality of life, a reduction in severe exacerbations, and decreases in emergency department visits as well as days lost from school or work. The trials did not show a reduction in hyperresponsiveness or improvement in forced expiratory volume in 1 s. Short-term adverse effects include an increase in exacerbation rate, an increase in respiratory infections and an increase in hospitalizations. In the 5-year follow up of the studies available there was evidence of clinical and functional stability of the treated patients. Further studies are necessary to identify an asthma phenotype that responds well to this treatment.

PMID: 24334336 [PubMed - as supplied by publisher]

Clinical Utility of Computed Tomographic Lung Volumes in Patients with Chronic Obstructive Pulmonary Disease.

Respiration. 2013 Dec 7;

Authors: Lee JS, Lee SM, Seo JB, Lee SW, Huh JW, Oh YM, Lee SD

Abstract
Background: Published data concerning the utility of computed tomography (CT)-based lung volumes are limited to correlation with lung function. Objectives: The aim of this study was to evaluate the clinical utility of the CT expiratory-to-inspiratory lung volume ratio (CT Vratio) by assessing the relationship with clinically relevant outcomes. Methods: A total of 75 stable chronic obstructive pulmonary disease (COPD) patients having pulmonary function testing and volumetric CT at full inspiration and expiration were retrospectively evaluated. Inspiratory and expiratory CT lung volumes were measured using in-house software. Correlation of the CT Vratio with patient-centered outcomes, including the modified Medical Research Council (MMRC) dyspnea score, the 6-min walk distance (6MWD), the St. George's Respiratory Questionnaire (SGRQ) score, and multidimensional COPD severity indices, such as the BMI, airflow obstruction, dyspnea, and exercise capacity index (BODE) and age, dyspnea, and airflow obstruction (ADO), were analyzed. Results: The CT Vratio correlated significantly with BMI (r = -0.528, p < 0.001). The CT Vratio was also significantly associated with MMRC dyspnea (r = 0.387, p = 0.001), 6MWD (r = -0.459, p < 0.001), and SGRQ (r = 0.369, p = 0.001) scores. Finally, the CT Vratio had significant correlations with the BODE and ADO multidimensional COPD severity indices (r = 0.605, p < 0.001; r = 0.411, p < 0.001). Conclusion: The CT Vratio had significant correlations with patient-centered outcomes and multidimensional COPD severity indices. © 2013 S. Karger AG, Basel.

PMID: 24334816 [PubMed - as supplied by publisher]