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Analysis of the exhalome: a diagnostic tool of the future.

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Analysis of the exhalome: a diagnostic tool of the future.

Chest. 2013 Sep;144(3):746-9

Authors: Martinez-Lozano Sinues P, Zenobi R, Kohler M

Abstract
Investigations on breath analysis have provided preliminary data on its potential in the noninvasive diagnosis of lung diseases. Although the conventional comparisons of exhaled breath in study populations (ie, diseased vs healthy) may help to identify patients with various lung diseases, we believe that the analysis of exhaled breath holds promise beyond this scenario. On the basis of preliminary findings, we hypothesize that breath analysis (1) could be applied not only to identify patients with lung disease but also to better phenotype healthy subjects at risk and patients with a particular disease, which is in-line with current efforts toward individualized medicine; (2) could be useful in estimating internal body time to determine the optimal time of drug administration, thereby maximizing drug activity and reducing toxicity (chronopharmacology); and (3) could be applied to monitor drugs or drug metabolites, thus, enhancing adherence to prescribed medications and enabling studies on pharmacokinetics.

PMID: 24008952 [PubMed - in process]

Mechanisms of airway remodeling.

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Mechanisms of airway remodeling.

Chest. 2013 Sep;144(3):1026-32

Authors: Hirota N, Martin JG

Abstract
Airway remodeling comprises the structural changes of airway walls, induced by repeated injury and repair processes. It is characterized by the changes of tissue, cellular, and molecular composition, affecting airway smooth muscle, epithelium, blood vessels, and extracellular matrix. It occurs in patients with chronic inflammatory airway diseases such as asthma, COPD, bronchiectasis, and cystic fibrosis. Airway remodeling is arguably one of the most intractable problems in these diseases, leading to irreversible loss of lung function. Current therapeutics can ameliorate inflammation, but there is no available therapy proven to prevent or reverse airway remodeling, although reversibility of airway remodeling is suggested by studies in animal models of disease. Airway remodeling is often considered the result of longstanding airway inflammation, but it may be present to an equivalent degree in the airways of children with asthma, raising the necessity for early and specific therapeutic interventions. In this review, we consider the factors that may contribute to airway remodeling and discuss the current and potential therapeutic interventions.

PMID: 24008953 [PubMed - in process]

Role of support measures and palliative care

imagePurpose of reviewThe care of patients with idiopathic pulmonary fibrosis is challenging at a time when there are no medications with proven efficacy in extending patient survival or quality of life. However, a number of recent studies suggest that patients participating in clinical trials including the placebo arm have improved outcome. This suggests that there are elements of supportive care which may prove beneficial to IPF patients. Further, control of patient symptoms should be a critical goal in care of patients with IPF. Recent findingsA number of both pharmacologic and nonpharmacologic therapies are available to reduce symptoms in patients with IPF. These include low-dose narcotics, pulmonary rehabilitation and oxygen therapy. Further, addressing issues of depression may be beneficial for symptom management. Palliative care can and should be more fully integrated in the care of patients with IPF. SummaryIncorporating supportive and palliative measures in the care of patients with IPF may improve both quality of life and survival, but far more research is needed in this fledgling field.

Multinational evidence-based World Association of Sarcoidosis and Other Granulomatous Disorders recommendations for the use of methotrexate in sarcoidosis: integrating systematic literature research and expert opinion of sarcoidologists worldwide

imagePurpose of reviewAlthough glucocorticosteroids are considered the first-line treatment in sarcoidosis, refractory cases require alternatives, such as methotrexate (MTX). The aim of this study was to develop, on behalf of the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG), multinational evidence-based recommendations for the use of MTX in sarcoidosis for routine clinical practice. Recent findingsA systematic literature search was conducted and combined with the opinions of sarcoidosis experts worldwide to formulate the recommendations. An online survey concerning 10 clinical questions was sent through the WASOG newsletter to sarcoidosis experts. Agreement about the recommendations amongst the world's leading sarcoidologists was evaluated. A total of 237 articles were identified, 43 of which were included. Randomized controlled trial evidence supporting the use of MTX in sarcoidosis was limited. Forty-five per cent (113 of 250) of the sarcoidosis experts contacted completed the survey (Europe 55%, North America 26% and Asia 12%). Ten recommendations were formulated concerning the indications for use, starting dose, folic acid, work-up, contraindications, monitoring, administration options in case of adverse gastrointestinal effects, hepatotoxicity, long-term safety and use during pregnancy and breast feeding. SummaryTen multinational evidence-based recommendations for the use of MTX in sarcoidosis were developed, which are supported by the world's foremost sarcoidosis experts.

Identification and treatment of comorbidities in idiopathic pulmonary fibrosis and other fibrotic lung diseases

imagePurpose of reviewThe interstitial lung diseases (ILDs) frequently result in considerable disability and reduced survival in affected patients. Unfortunately, they are often poorly responsive to available therapies. Comorbidities, both pulmonary and nonpulmonary, frequently accompany ILDs and contribute to adverse outcomes. Recent findingsMultiple comorbidities, including gastroesophageal reflux disease, venous thromboembolism, coronary artery disease, sleep-disordered breathing, depression, emphysema, pulmonary hypertension, and lung cancer contribute to the morbidity and mortality of fibrotic lung disease. SummaryThe identification and treatment of comorbidities may improve morbidity and potentially impact mortality in patients with ILD. A high index of suspicion and an awareness of the spectrum of comorbidities are important in optimizing outcomes in this group of patients.

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