Challenge models to assess new therapies in chronic obstructive pulmonary disease.
 |
Related Articles |
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Current therapies confer partial benefits either by incompletely improving airflow limitation or by reducing acute exacerbations, hence new therapies are desirable. In the absence of robust early predictors of clinical efficacy, the potential success of novel therapeutic agents in COPD will not entirely be known until the drugs enter relatively large and costly clinical trials. New predictive models in humans, and new study designs are being sought to allow for confirmation of pharmacodynamic and potentially clinically meaningful effects in early development. This review focuses on human challenge models with lipopolysaccharide endotoxin, ozone, and rhinovirus, in the early clinical development phases of novel therapeutic agents for the treatment and reduction of exacerbations in COPD.
Updates on the COPD gene list.
|
Related Articles |
A genetic contribution to develop chronic obstructive pulmonary disease (COPD) is well established. However, the specific genes responsible for enhanced risk or host differences in susceptibility to smoke exposure remain poorly understood. The goal of this review is to provide a comprehensive literature overview on the genetics of COPD, highlight the most promising findings during the last few years, and ultimately provide an updated COPD gene list. Candidate gene studies on COPD and related phenotypes indexed in PubMed before January 5, 2012 are tabulated. An exhaustive list of publications for any given gene was looked for. This well-documented COPD candidate-gene list is expected to serve many purposes for future replication studies and meta-analyses as well as for reanalyzing collected genomic data in the field. In addition, this review summarizes recent genetic loci identified by genome-wide association studies on COPD, lung function, and related complications. Assembling resources, integrative genomic approaches, and large sample sizes of well-phenotyped subjects is part of the path forward to elucidate the genetic basis of this debilitating disease.
Tiotropium for Asthma — Promise and Caution
Anticholinergic agents have been available for the treatment of airways obstruction for many decades. For patients with chronic obstructive pulmonary disease (COPD), many practitioners believe that these drugs have become the bronchodilator of choice. For patients with asthma, anticholinergic agents are less popular, probably because of their slower onset of action as a reliever medication and their generally inferior effect on lung function and symptoms, as compared with inhaled beta-agonists.
Not surprisingly, long-acting beta-agonists (LABAs) in combination with inhaled glucocorticoids have become standard treatment for patients with asthma that is poorly controlled while receiving inhaled glucocorticoids alone. Although this treatment is effective in a majority of patients, many patients have poor asthma control despite taking LABAs combined with high doses of inhaled glucocorticoids. For these patients, there are few therapeutic options. Most of them have already been treated with leukotriene modifiers; the addition of oral glucocorticoids may be effective but is associated with severe side effects, and the addition of anti-IgE treatment is expensive and elicits a response in only a small subpopulation. Long-acting anticholinergic agents are not mentioned in treatment guidelines, despite their availability since 2004. ...
Fuzzy rule-based expert system for evaluating level of asthma control.
 |
Related Articles |
Fuzzy rule-based expert system for evaluating level of asthma control.
J Med Syst. 2012 Oct;36(5):2947-58
Authors: Zolnoori M, Fazel Zarandi MH, Moin M, Taherian M
Abstract
Asthma control is a final goal of asthma therapy process. Despite outstanding progress in discovering various variables affecting asthma control levels, disregarding some of them by physicians and variables' inherent uncertainty are the major causes of underestimating of asthma control levels and as a result asthma morbidity and mortality. In this paper, we provide an intelligent fuzzy system as a solution for this problem. Inputs of this system are composed of 14 variables organized in five modules of respiratory symptoms severity, bronchial obstruction, asthma instability, current treatment, and quality of life. Output of this system is degree of asthma control defined in the score (0-10). Evaluation of performance of this system by 42 asthmatic patients at asthma, allergy, immunology research center of Emam Khomeini hospital, Tehran, Iran reinforces that the system's results not only correspond with the evaluations of experienced asthma physicians, but represents slight differences in the levels of asthma control between asthmatic patients.
PMID: 21912973 [PubMed - indexed for MEDLINE]
Diagnostic oral food challenges: procedures and biomarkers.
 |
Related Articles |
Diagnostic oral food challenges: procedures and biomarkers.
J Immunol Methods. 2012 Sep 28;383(1-2):30-8
Authors: Järvinen KM, Sicherer SH
Abstract
Oral food challenge (OFC) is the gold standard for the diagnosis of food allergy. They are conducted to confirm whether an allergy to food exists (initial challenge) or to monitor for resolution of a food allergy. The history of an immediate allergic reaction, when supported by positive tests for specific IgE antibodies to the suspect food, is often sufficient to establish a diagnosis without OFC. Additionally, higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Although these food-specific IgE tests are helpful biomarkers of allergy, their limited sensitivity and specificity often necessitates the use of OFC to establish reactivity. Furthermore, the pathogenesis of non-IgE-mediated food allergy, such as food protein-induced enterocolitis (FPIES) or proctocolitis and food allergy due to mixed IgE and non-IgE mediated processes, such as atopic dermatitis or eosinophilic gastroenteropathies may not be assessable with specific IgE tests, also warranting OFCs. This review provides an overview on the technique and interpretation of OFCs, use of food-specific testing to predict whether OFC is warranted and to predict OFC outcomes. Additionally, biomarkers that correlate with OFC outcomes will be discussed, as well as future diagnostic tests promising better predictive value.
PMID: 22414488 [PubMed - indexed for MEDLINE]