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Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense?
Thorax. 2013 Mar 16;
Authors: McDonald VM, Higgins I, Wood LG, Gibson PG
Abstract
INTRODUCTION: The rising disease burden from chronic obstructive pulmonary disease (COPD) requires new approaches. METHOD: We suggest an approach based around three elements: inflammometry and multidimensional assessment to identify therapeutic targets and case management to design and implement an individualised treatment programme based on these assessments. DISCUSSION: This tailored approach to treatment would maximise efficacy, limit cost and permit a better risk-benefit ratio of treatment. The advantages include the ability to add up the benefits of individual therapies leading to a cumulative therapeutic benefit that is greater than each individual therapy alone. We can now design a multifaceted inflammometry intervention for airway diseases based on targeting eosinophilic inflammation, non-eosinophilic pathways and systemic inflammation. COPD is a complex and challenging disease. The use of inflammometry and multidimensional assessment is necessary to identify relevant treatment targets and maximise the scope of therapy while limiting unnecessary use of drugs. An individualised programme of management can be designed and coordinated by using a case manager. This new approach may provide tangible benefits to people with COPD.
PMID: 23503624 [PubMed - as supplied by publisher]
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Rationale for physicians to propose do-not-resuscitate orders in elderly community-acquired pneumonia cases.
Geriatr Gerontol Int. 2013 Mar 19;
Authors: Oshitani Y, Nagai H, Matsui H
Abstract
AIM: In many countries, do-not-resuscitate (DNR) orders were not legislated, partly because rationale for proposal of DNR orders have not been studied in elderly pneumonia patients with cognitive and physical disorders. The aim of the present study was to elucidate the factors influencing physicians' proposal for DNR orders and their validity as prognostic predictor, by comparing elderly pneumonia cases with and without DNR orders. METHODS: Medical records of community-acquired pneumonia patients aged 65 years or older were retrospectively studied (n = 641). The patients were categorized into two groups; one with DNR orders within 72 h after admission and the other without it. RESULTS: DNR was decided in 183 patients (28.5%). The DNR group, containing more elderly patients with poorer performance status, showed higher rates of malnutrition, dementia, aspiration, very severe pneumonia, respiratory failure and mortality. The choice of antimicrobials was not affected by the presence of DNR orders. Mortality rate within 30 days was higher in the DNR group than in the non-DNR group (33.9% vs 2.8%, P < 0.001), as well as total hospital mortality (56.8% vs 4.8%, P < 0.001). Multiple logistic analysis identified factors involved in the decision-making of DNR orders; that is, aspiration, healthcare-associated pneumonia, respiratory failure, intensive airspace consolidation, age 75 years and older, performance status 3 and 4, and serum albumin<2.5 g/dL were positive factors for DNR orders. CONCLUSION: The present study showed factors involved in the physicians proposal of DNR orders, demonstrating that DNR was empirically chosen based on comprehensive judgment of several prognostic predictors and it, in itself, was a good prognostic predictor. Geriatr Gerontol Int 2013; ●●: ●●-●●.
PMID: 23506111 [PubMed - as supplied by publisher]
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Targeting TRP Channels in Airway Disorders.
Curr Top Med Chem. 2013 Mar 11;
Authors: Abbott-Banner K, Poll C, Verkuyl JM
Abstract
Novel effective therapeutic agents are actively sought for the treatment of a broad spectrum of respiratory diseases which collectively significantly impact on mortality, morbidity and quality of life of hundreds of millions of people world-wide. These include asthma, allergic rhinitis, chronic obstructive pulmonary disease, cough, idiopathic pulmonary fibrosis, pulmonary arterial hypertension, cystic fibrosis and acute lung injury. TRP channels are broadly distributed throughout the respiratory tract and play an important physiological role in sensing and subsequently responding to a wide variety of stimuli, for example temperature, osmolarity and oxidant stress. In the context of respiratory disease however TRP channel function may be altered, eg: under conditions of oxidative stress, inflammation, hypoxia and mechanical stress. In addition there is evidence that the expression/activity of TRP channels can be affected in the disease setting. Modulators of TRP channel function are therefore under investigation for a range of diseases including disorders of the respiratory system. Several excellent review articles have discussed in detail evidence that modulation of specific TRP channels may be of benefit in specific respiratory diseases. In this article we have taken the approach of reviewing evidence that modulation of TRP channel function may be able to affect common and over-lapping characteristic features of respiratory diseases, for example bronchoconstriction, airways hyper-responsiveness, cough, airways inflammation, mucus hyper-secretion, exacerbations, lung injury, hypoxia and airways re-modelling. The therapeutic potential of TRP channel modulators, the status of these agents in the clinic along with the challenges posed in this rapidly advancing field are also discussed in this review.
PMID: 23506455 [PubMed - as supplied by publisher]