Dose response of inhaled corticosteroids in children with persistent asthma: a systematic review.
To assess the dose-response relationship (benefits and harms) of inhaled corticosteroids (ICSs) in children with persistent asthma.
Sté Tunisienne des Maladies Respiratoires et d'Allergologie
Cercle des Bureaux - Appartement B 5-3 . 1082 Centre urbain Nord Tunis
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Interleukin-33: a novel mediator with a role in distinct disease pathologies.
Interleukin-33 (IL-33) is a novel member of IL-1 cytokine family. It can act both as a nuclear factor and as a soluble mediator; however, the precise role of IL-33 within the nucleus is still not clear. As a cytokine, IL-33 is suggested to function as an alarmin that is released upon endothelial or epithelial cell damage. As such, IL-33 targets multiple cell types thereby alerting the immune system to endogenous trauma such as physical stress or infection. However, a dysregulated release of IL-33 has a potential to drive distinct pathologies.
In this review, we discuss the contribution of IL-33 to the pathophysiology of asthma, arthritis, obesity and atherosclerosis as well as the potential of IL-33 for therapeutic intervention.
Clinical immunology review series: an approach to desensitization.
Allergen immunotherapy describes the treatment of allergic disease through administration of gradually increasing doses of allergen.
This form of immune tolerance induction is now safer, more reliably efficacious and better understood than when it was first formally described in 1911.
In this paper the authors aim to summarize the current state of the art in immunotherapy in the treatment of inhalant, venom and drug allergies, with specific reference to its practice in the United Kingdom. A practical approach has been taken, with reference to current evidence and guidelines, including illustrative protocols and vaccine schedules.
A number of novel approaches and techniques are likely to change considerably the way in which we select and treat allergy patients in the coming decade, and these advances are previewed.
Advance care planning for patients with COPD: Past, present and future.
To discuss the importance, current status and directions for improvement of advance care planning and communication about end-of-life care for patients with Chronic Obstructive Pulmonary Disease (COPD).
METHODS: Narrative review of the currently available literature regarding advance care planning and communication about end-of-life care in COPD.
RESULTS: Advance care planning, including patient-clinician communication about end-of-life care, can improve outcomes for patients and their families and may be particularly important for patients with COPD. Patient-clinician communication is needed to inform and prepare patients about their diagnosis, treatment, prognosis, and what dying might be like. It is necessary to help patients and their clinicians understand patient preferences for life-sustaining treatments. Despite these advantages, advance care planning and conversations about end-of-life care in current practice are limited and their quality is often poor.
CONCLUSION: Advance care planning can improve outcomes for patients and their relatives. Recent studies provide directions for how to facilitate advance care planning for patients with COPD.
PRACTICE IMPLICATIONS: Advance care planning ought to be part of care for patients with advanced COPD. Future studies should focus on interventions to facilitate advance care planning in patients with COPD with the goal of improving the quality of end-of-life care.
Overlap Syndrome of Asthma and COPD Predicts Low Quality of Life.
In clinical practice, patients whose airway disease shares features of both asthma and chronic obstructive pulmonary disease (COPD) remain poorly recognized.
Material and methods. The study population consisted of 1546 patients with a diagnosis of asthma or COPD or both. Based on patient-reported outcomes and retrospective medical record data, the study population was divided into three groups: ( 1 ) asthma only, ( 2 ) COPD only, and ( 3 ) both asthma and COPD (overlap syndrome group). We evaluated patient characteristics associated with health-related quality of life (HRQoL).
Results. In many respects, the overlap group fell between the asthma and COPD groups. In the overlap group, however, HRQoL was the poorest of all. In the logistic regression model, with the asthma group as the reference, both the overlap and the COPD group showed higher risk for low HRQoL [odd ratio (OR): 1.9; 95% confidence interval (CI): 1.2-3.2; and OR: 1.8, 95% CI: 1.0-3.2; respectively]. In addition, female gender, obesity, duration of disease, disability pension, and coexisting cardiovascular disease were associated with low HRQoL across the study population.
Conclusions. Patients with overlapping asthma and COPD differed from those patients with asthma or COPD only. Overlap syndrome was associated with low HRQoL.