The role of systemic inflammatory biomarkers to predict mortality in chronic obstructive pulmonary disease.

Expert Rev Respir Med. 2013 Feb;7(1):57-64

Authors: Kelly E, Owen CA, Pinto-Plata V, Celli BR

Abstract
The authors discuss the role of inflammatory biomarkers to predict mortality in chronic obstructive pulmonary disease (COPD) in this narrative literature review with expert opinion. The severity of COPD has traditionally been graded using the degree of obstruction as measured by the forced expiratory volume in 1 s because this variable has been predictive of outcomes. However, it is now accepted that COPD is a complex disease with important systemic consequences and that a multidimensional index such as the BMI, obstruction, dyspnea and exercise capacity index is a better predictor of outcome than lung function alone. Because inflammation is thought to play a pivotal role in the genesis of COPD, several serum inflammatory biomarkers have been investigated. Of the ones studied, C-reactive protein, IL-6, pulmonary and activation-regulated chemokine and fibronectin:C-reactive protein ratio have been observed to be independently associated with increased risk of death. When added to known clinical variables such as the BMI, obstruction, dyspnea and exercise capacity index, only IL-6 has been shown to further contribute to mortality prediction. It is likely that the use of an integrative approach combining biomarkers investigated through high-output technology with clinical parameters, combined with new information from the fields of genomics, transcriptomics, proteomics and metabolomics, will improve the authors capacity to predict mortality in COPD.

PMID: 23362815 [PubMed - in process]

Stem Cell Treatment for Chronic Lung Diseases.

Respiration. 2013 Jan 28;:179-192

Authors: Tzouvelekis A, Ntolios P, Bouros D

Abstract
Chronic lung diseases such as idiopathic pulmonary fibrosis and cystic fibrosis or chronic obstructive pulmonary disease and asthma are leading causes of morbidity and mortality worldwide with a considerable human, societal and financial burden. In view of the current disappointing status of available pharmaceutical agents, there is an urgent need for alternative more effective therapeutic approaches that will not only help to relieve patient symptoms but will also affect the natural course of the respective disease. Regenerative medicine represents a promising option with several fruitful therapeutic applications in patients suffering from chronic lung diseases. Nevertheless, despite relative enthusiasm arising from experimental data, application of stem cell therapy in the clinical setting has been severely hampered by several safety concerns arising from the major lack of knowledge on the fate of exogenously administered stem cells within chronically injured lung as well as the mechanisms regulating the activation of resident progenitor cells. On the other hand, salient data arising from few 'brave' pilot investigations of the safety of stem cell treatment in chronic lung diseases seem promising. The main scope of this review article is to summarize the current state of knowledge regarding the application status of stem cell treatment in chronic lung diseases, address important safety and efficacy issues and present future challenges and perspectives. In this review, we argue in favor of large multicenter clinical trials setting realistic goals to assess treatment efficacy. We propose the use of biomarkers that reflect clinically inconspicuous alterations of the disease molecular phenotype before rigid conclusions can be safely drawn.

PMID: 23364286 [PubMed - as supplied by publisher]

Study of Older Adults' Use of Self-Regulation for COPD Self-Management Informs An Evidence-Based Patient Teaching Plan.

Rehabil Nurs. 2013 Jan-Feb;38(1):11-23

Authors: Brandt CL

Abstract
PURPOSE: People with chronic obstructive pulmonary disease (COPD) have frequent hospitalizations and emergency department visits, often due to COPD exacerbations which worsen disease status. Recognizing exacerbations is challenging; patients must distinguish between day-to-day COPD symptom variations and exacerbation symptoms. Self-regulation theory (Bandura, 1999) is useful for understanding symptom recognition, interpretation, and response. In this article a qualitative study of self-regulation use by 28 older adults with COPD (Brandt, 2005) is summarized.
METHODS: Twenty-eight community-dwelling older adults were interviewed. Data were analyzed using the interpretive description method.
RESULTS AND DISCUSSION: Informants used self-regulation behaviors in varying degrees. Most attended primarily to their breathing, comparing their usual degree of breathlessness and intensifying their everyday self-management practices if breathlessness worsened.
CLINICAL RELEVANCE: A theory- and evidence-based COPD teaching plan for use by rehabilitation nurses is presented that includes attention to exacerbation recognition.

PMID: 23365001 [PubMed - in process]

Pulmonary Rehabilitation in COPD: A Reappraisal (2008-2012).

Pulm Med. 2013;2013:374283

Authors: Santus P, Bassi L, Radovanovic D, Airoldi A, Raccanelli R, Triscari F, Giovannelli F, Spanevello A

Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a complex pathological condition associated with an important reduction in physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life. Pulmonary rehabilitation is aimed to eliminate or at least attenuate these difficulties, mainly by promoting muscular reconditioning. The scope of this paper has been the analysis of the literature on pulmonary rehabilitation in COPD patients has appeared in the last five years, focusing on the principal outcomes obtained. The results demonstrate that pulmonary rehabilitation has a beneficial effect on dyspnoea relief, improving muscle strength and endurance. Moreover, pulmonary rehabilitation appears to be a highly effective and safe treatment for reducing hospital admissions mortality and improving health-related quality of life in COPD patients. It represents, therefore, a very important therapeutic option that, along with standard pharmachological therapy, can be used to obtain the best patient management. The favourable results obtained with pulmonary rehabilitation programs should stimulate researchers to improve our understanding of the mechanisms that form the basis of the beneficial effects of this therapeutic intervention. This would in turn increase the effectiveness of pulmonary rehabilitation in COPD patients.

PMID: 23365741 [PubMed - in process]