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Lung Retransplantation

Lung retransplantation comprises a small proportion of lung transplants performed throughout the world, but has become more frequent in recent years. The selection criteria for lung retransplantation are similar to those for initial lung transplant. Survival after lung retransplantation has improved over time, but still lags behind that of initial lung transplantation. These differences in outcome may be attributable to medical comorbidities.

Lung retransplantation appears to be ethically justified; however, the optimal approach to lung allocation for retransplantation needs to be defined.

Alternatives to Lung Transplantation: Lung Volume Reduction for COPD

This article summarizes the major results of the NETT and briefly reviews newer bronchoscopic lung volume reduction techniques that show promise as alternative treatments for select patients with COPD undergoing consideration for lung transplantation.

Alternatives to Lung Transplantation: Treatment of Pulmonary Arterial Hypertension

This article reviews the current evidence that supports both the use of mono- and combination therapy. The article also considers the role of atrial septostomy in the treatment of pulmonary arterial hypertension, particularly as a bridge to transplantation.

Finally, the article provides a review of the role and outcomes of pulmonary thromboendartertectomy for patients with chronic thromboembolic pulmonary hypertension.

Targeting small airways, a step further in asthma management.

During the last decade, small airway (SA) involvement in asthma and COPD have reached increasingly attention. Originally referred to as the "silent zone", SA may not be that silent after all. Important clinical correlates are asthma exacerbations and airways remodelling, exercise asthma and nocturnal asthma. Thus to control pathology in the SA has become a desirable goal in asthma management

Objectives:  The scope of this review is to give a brief overview of the current status on SA in asthma, how to monitor and to diagnose SA inflammation and finally highlight some important treatment strategies

Results / Conclusion:  New tools have been developed to monitor SA function, these implies the use of imaging techniques and respiratory physiology, targeting SA function. Fractional exhaled nitric oxide and the combined use of hyperresponsiveness testing with impulsoscillometry is another option. The introduction of ultrafine aerosols has provided new tools for to treat SA inflammation. The challenge for the future will be to define the optimal particle size and device for maximal deposition in entire lung, including the small airways. Moreover, we also need strategies for to increase the therapeutic ratio i.e. Increase lung deposition without increasing systemic side effects. Another challenge is to design and to perform clinical trials, targeting effects in SA, proving the clinical importance of SA treatment in a large number of patients. The latter also imply education of our medical authorities, communicating that asthma is more than a beta-2 agonist responsive central airway disorder of the lungs.

Comparison of health-related quality of life measures in chronic obstructive pulmonary disease.

The aims of this study were:

  1. to compare the discriminative ability of a disease-specific instrument, the St. George's Respiratory Questionnaire (SGRQ) to generic instruments (i.e., EQ-5D and SF-36);
  2. and to evaluate the strength of associations among clinical and health-related quality of life (HRQL) measures in chronic obstructive pulmonary disease (COPD).

METHODS: We analyzed data collected from 120 COPD patients in a Veterans Affairs hospital. Patients self-completed two generic HRQL measures (EQ-5D and SF-36) and the disease-specific SGRQ. The ability of the summary scores of these HRQL measures to discriminate COPD disease severity based on Global Obstructive Lung Disease (GOLD) stage was assessed using relative efficiency ratios (REs). Strength of correlation was used to further evaluate associations between clinical and HRQL measures.

RESULTS: Mean total scores for PCS-36, EQ-VAS and SGRQ were significantly lower for the more severe stages of COPD (p<0.05). Using SGRQ total score as reference, the summary scores of the generic measures (PCS-36, MCS-36, EQ index, and EQ-VAS) all had REs of <1. SGRQ exhibited a stronger correlation with clinical measures than the generic summary scores. For instance, SGRQ was moderately correlated with forced expiratory volume in 1 second (FEV1) (r=0.43), while generic summary scores had trivial levels of correlation with FEV1 (r<0.2).

CONCLUSIONS: The SGRQ demonstrated greater ability to discriminate among different levels of severity stages of COPD than generic measures of health, suggestive that SGRQ may provide COPD studies with greater statistical power than EQ-5D and SF-36 summary scores to capture meaningful differences in clinical severity.

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