Related Articles

Complex Phenotypes in Asthma: Current Definitions.

Pulm Pharmacol Ther. 2013 Jul 20;

Authors: Wenzel SE

Abstract
Asthma is increasingly recognized as a heterogeneous disease. However, identification of different subgroups or phenotypes has been complex and controversial. The convergence of both clinical and statistical approaches to grouping patients and their characteristics, in association with increasing recognition of molecular patterns is now beginning to move the field forward. Integration of efficacy data with targeted molecular therapies will eventually lead to more complete understanding of these "molecular phenotypes" and eventually lead to the identification of fully defined endoytpes. This process should improve our ability to treat more complex and severe forms of asthma.

PMID: 23880027 [PubMed - as supplied by publisher]

Related Articles

Bronchial epithelium as a target for innovative treatments in asthma.

Pharmacol Ther. 2013 Jul 20;

Authors: Gras D, Chanez P, Vachier I, Petit A, Bourdin A

Abstract
Increasing evidence of a critical role played by the bronchial epithelium in airway homeostasis is opening new therapeutic avenues. Its unique situation at the interface with the environment suggests that the subtle regulation orchestrated by the epithelium between tolerance and specific immune response might be impaired in asthma. Airway mucus is acting as a physical and a biological fluid between the environment and the epithelium, synergistically moved by the cilia. In asthma, excessive mucus production is a hallmark of airway remodeling. Since many years we tried to therapeutically target mucus hypersecretion, but actually this option is still not achieved. The present review discusses the dynamic processes regulating airway mucus production. Airway inflammation is central in current asthma management. Understanding of how the airway epithelium influences the TH2 paradigm in response to deleterious agents is improving. The multiple receptors expressed by the airway epithelium are the transducers of the biological signals induced by various invasive agents to develop the most adapted response. Airway remodeling is observed in severe chronic airway diseases and may result from ongoing disturbance of signal transduction and epithelial renewal. Chronic airway diseases such as asthma will require assessement of these epithelial abnormalities to identify phenotypic characteristics associated with predicting a clinical benefit for epithelial-directed therapies.

PMID: 23880290 [PubMed - as supplied by publisher]

Related Articles

Extra-Esophageal Manifestations of Gastroesophageal Reflux Disease: Diagnosis and Treatment.

Drugs. 2013 Jul 24;

Authors: Hom C, Vaezi MF

Abstract
Gastroesophageal reflux disease (GERD) is a common disease that is often diagnosed based on typical symptoms of heartburn and regurgitation. In addition to these more classic manifestations, GERD is increasingly associated with extra-esophageal symptoms, including chronic cough, asthma, laryngitis, and dental erosions. Due to the poor sensitivity of endoscopy and pH monitoring, and the poor specificity of laryngoscopy, empiric therapy with proton pump inhibitors (PPIs) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. For those who improve with PPIs, GERD is the presumed etiology, but for those who remain unresponsive to such therapy, further diagnostic testing with impedance/pH monitoring may be necessary in order to exclude refractory acid or weakly acid reflux. In those with normal test results despite PPI therapy and continued symptoms, causes other than GERD may be pursued. Recent data suggest that in patients with extra-esophageal symptoms, objective findings of moderate-sized hiatal hernia and moderate reflux on pH testing may predict response to acid suppressive therapy. PPI-unresponsive patients usually have causes other than GERD for their extra-esophageal symptoms and continued PPI therapy in this group is not recommended.

PMID: 23881666 [PubMed - as supplied by publisher]

Related Articles

Importance of inhaler device use status in the control of asthma in adults: ASIT (Asthma Inhaler Treatment) Study.

Respir Care. 2013 Jul 23;

Authors: Yildiz F, on behalf of the ASIT Study Group

Abstract
BACKGROUND:: Proper education and training in correct inhalation technique has been reported to have a substantial role in the achievement of optimal therapeutic benefit and asthma control. The present study was designed to evaluate inhaler technique and the role of education in relation to asthma control among patients with persistent asthma in Turkey.
METHODS:: A total of 572 patients with persistent asthma (mean(SD) age:42.7(12.2) years, 76% were females) were included in this non-interventional observational registry study conducted across Turkey. Data on the effective and correct use of inhaler devices were collected via Ease of Use for the Inhaler Device Questionnaire to patients and physicians.
RESULTS:: Asthma control (overall 61.5% at baseline and increased to 87.3% during follow up) was better with significant improvement in technique and the decrease in basic errors to range of 0-1, regardless of the inhaler type. Overall, the most common basic error associated with inhalation maneuvers was failure to exhale before inhaling through the device (18.9%). There was concordance between patients and physician questionnaires in terms of ratio of correct inhaler technique only for spray type of inhalers.
CONCLUSION:: Close follow up with repeated checking of patients' inhaler techniques with correction of the errors in each time by physicians seem to be associated with a significant decrease in percent of patients with basic errors in inhalation maneuvers and device-independent errors and the better control of persistent asthma.

PMID: 23882109 [PubMed - as supplied by publisher]