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Pharmacologic approaches to life-threatening asthma

Following a peak in asthma mortality in the late 1980s and early 1990s, we have been fortunate to see a substantial decrease in asthma deaths in recent years. Although most asthma deaths occur outside the hospital, near-fatal events are commonplace, with anywhere from 2–20% of patients with acute asthma admitted to intensive care, and 2-4% intubated for respiratory failure. Standard therapies for acute severe and near-fatal asthma include administration of systemic corticosteroids, and frequent or continuous inhaled beta agonists. Controversy remains regarding the optimal therapy of those who fail to respond to these initial treatments, those who remain at risk of acute respiratory failure, and patients requiring mechanical ventilation. There remain significant gaps in our knowledge ...

The role of anti-infectives in the treatment of refractory asthma

Refractory asthma not only has a significant effect on quality of life, but also imposes an economic burden on society. Increasing evidence suggests that there is a pathophysiologic interaction between infection and allergic disease in patients with severe or refractory asthma. Therapeutic trials of macrolides and azoles are being utilized in some patients with refractory asthma who fail to respond to standard therapy. In this article we review the definition of refractory asthma and the potential pathophysiologic interactions between infection and allergic disease. Emerging data suggest that microorganisms and their byproducts may be a therapeutic target in the therapy of patients with severe or refractory asthma. (Source: Therapeutic Advances in Respiratory Disease)

Advances in the diagnosis of pleural disease in lung cancer

Pleural disease in lung cancer can be benign or malignant with the latter carrying a grave prognosis. In this review, we describe and discuss the advances in pleural imaging, procedures, and biomarkers for the diagnosis of pleural diseases in lung cancer. Ultrasound and computed tomography are increasingly applied in the planning of pleural procedures to enhance diagnostic accuracy and safety whilst pleuroscopy gives excellent yield in excess of 93% in the evaluation of cytology negative pleural effusions. Invasion beyond the elastic layer of the visceral pleura upstages lung cancer, and may indicate a need for adjuvant chemotherapy. Biomarkers isolated from pleural fluid or tissue may aid in diagnosis and guide treatment in the future. Magnetic resonance imaging, positron emission tomogra...

Combination therapy for the treatment of pulmonary arterial hypertension

Multiple medical therapies have been developed for the treatment of pulmonary arterial hypertension (PAH) over the last decade and a half. Unfortunately, none of these medications is curative and the majority of patients develop disease progression despite treatment. Presently available medications target one of three known pathways that have been implicated in disease pathogenesis. The multiplicity of pulmonary vascular abnormalities identified in PAH provides the rationale for a therapeutic strategy that targets more than one mechanism at a time. Although a handful of studies have demonstrated clinical improvement in PAH patients who have a second medication added to stable background therapy in a randomized, placebo-controlled fashion, it is unclear whether the derived benefit is due to...

Effectiveness of exercise training in patients with COPD: the role of muscle fatigue.

The improvement in exercise performance in response to exercise training varies highly from one patient with chronic obstructive pulmonary disease to another. It is possible that in a portion of patients the muscle stimulus applied during exercise training is insufficient to elicit training effects.

We investigated whether patients presenting quadriceps contractile fatigue after training have more favorable effects of a rehabilitation program.Forty-six patients followed a three-month high-intensity exercise training program. Exercise capacity, quadriceps force and quality of life were measured before and after the program.

Exercise training-induced quadriceps contractile fatigue was assessed after one month of rehabilitation with magnetic stimulation. A ≥15% fall in quadriceps force 15 minutes after training was considered as significant fatigue.Twenty-nine out of 46 patients (63%) developed significant fatigue. Patients with fatigue had a higher increase in six-minute walking distance (+57[+47,+103] vs. +17[-7,+46] m, p=0.0023) and Chronic Respiratory Disease Questionnaire score (+22±12 vs. +14±12 points, p=0.028) after the training program compared with patients without fatigue. Improvements in quadriceps force and maximal exercise capacity were similar in both subgroups.

Patients who develop quadriceps contractile fatigue during exercise training show greater training effects in terms of functional exercise capacity and health-related quality of life.

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