The objective of this article was to describe a new method for assessing expiratory flow limitation during spontaneous breathing, using the negative expiratory pressure test to identify patients at risk for obstructive sleep apnea. Upper airway collapsibility is evaluated by measuring decreases in flow and in expired volume in the first 0.2 seconds after negative expiratory pressure application at 10 cmH2O. The negative expiratory pressure test is easily applied and could be adopted for the evaluation of expiratory flow limitation caused by upper airway obstruction in patients with obstructive sleep apnea. (Source: Jornal Brasileiro de Pneumologia)

New Methods of Prevention and Treatment of Allergic Diseases.

Recent Pat Inflamm Allergy Drug Discov. 2011 Oct 21;

Authors: El-Qutob López D

Abstract
Over the past decades, the increasing number of patients with allergic conditions has posed a heavy burden on health care systems worldwide. This article will review recent treatments and patented methods for preventing allergies and related inflammatory and immunologic diseases. New drugs are commonly directed to known mechanisms, but there are many other pathways on which drugs can exert their action. New drug development is expected in the future as a consequence of discoveries in the pathophysiology and mechanisms of these diseases. Pharmaceuticals which would prevent the development of atopic diseases could allow us treating patients with genetic or environmental risk factors according to their conditions. Currently, a good and effective set of treatments is available for these diseases. However, the search for new treatment modalities to improve the currently available is especially important for those patients unresponsive to current therapy. In this review we summarize anti-cytokines therapies. Toll-like receptor (TLR)-mediated treatments, anti-immunoglobulin molecules, new immunomodulatory treatments and new antihistamines. The use of probiotics remains a matter of discussion and debate, since available studies have had contradictory results. In the present article we discuss current treatments for atopic diseases such as extrinsic asthma, atopic dermatitis and allergic rhinitis and relevant patents.

PMID: 22022924 [PubMed - as supplied by publisher]

Risk Factors for Montelukast Treatment Failure in Step-Down Therapy for Controlled Asthma.

J Asthma. 2011 Oct 27;

Authors: Drummond MB, Peters SP, Castro M, Holbrook JT, Irvin CG, Smith LJ, Wise RA, Sugar EA

Abstract
Background. Leukotriene receptor antagonists including montelukast are an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Because some patients fail montelukast step-down therapy, it would be helpful for clinicians to be able to predict the risk of treatment failure. Objectives. To determine patient characteristics associated with montelukast treatment failure and develop a clinical index to predict the risk of montelukast treatment failure. Methods. Using the 165 participants in the Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial who were stepped down from low-dose ICS to montelukast, we determined associations between enrollment variables and treatment failure. We constructed a montelukast failure index to predict the risk of montelukast treatment failure during step-down. To assess its specificity for montelukast, index performance was evaluated in the other LOCCS treatment groups. Results. Characteristics independently associated with montelukast treatment failure included age of asthma onset <10 years old (OR = 2.39; 95% CI = 1.17-5.02; p = .018), need for steroid burst in the last year (OR = 2.39; 95% CI = 1.13-5.09; p = .022), and pre-bronchodilator forced expiratory volume in 1 s (FEV(1)) (OR = 1.44 per 10% lower % predicted; 95% CI = 1.07-1.97; p = .016). A montelukast failure index was generated from these three variables (range: -5 to 7 points). Scores <0 predicted low risk (<0.20) of treatment failure, whereas scores >5 predicted high risk (>0.60) of treatment failure. Conclusion. Early asthma onset, worse asthma control in the last year, and lower pre-bronchodilator FEV(1) are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation.

PMID: 22029858 [PubMed - as supplied by publisher]

Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment.

Phys Sportsmed. 2011 Oct;39(3):163-71

Authors: Pedersen L, Elers J, Backer V

Abstract
Elite athletes have a high prevalence of asthma and exercise-induced bronchoconstriction. Although respiratory symptoms can be suggestive of asthma, the diagnosis of asthma in elite athletes cannot be based solely on the presence or absence of symptoms; diagnosis should be based on objective measurements, such as the eucapnic voluntary hyperpnea test or exercise test. When considering that not all respiratory symptoms are due to asthma, other diagnoses should be considered. Certain regulations apply to elite athletes who require asthma medication for asthma. Knowledge of these regulations is essential when treating elite athletes. This article is aimed at physicians who diagnose and treat athletes with respiratory symptoms. It focuses on the pathogenesis of asthma and exercise-induced bronchoconstriction in elite athletes and how the diagnosis can be made. Furthermore, treatment of elite athletes with asthma, anti-doping regulations, and differential diagnoses such as exercise-induced laryngomalacia are discussed.

PMID: 22030952 [PubMed - in process]