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Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both.

Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome.

RECENT FINDINGS: The severity of obstructive ventilatory impairment and hyperinflation, especially the inspiratory capacity to total lung capacity (TLC) ratio, correlates with the severity of sleep-related breathing disturbances. Early treatment with continuous positive airway pressure (CPAP) improves survival, reduces hospitalization and pulmonary hypertension, and also reduces hypoxemia. Evidence of systemic inflammation and oxidative stress in COPD and sleep apnea provides insight into potential interactions between both disorders that may predispose to cardiovascular disease. Long-term outcome studies of overlap patients currently underway should provide further evidence of the clinical significance of the overlap syndrome.

SUMMARY: Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.

Montelukast: more than a cysteinyl leukotriene receptor antagonist?

The prototype cysteinyl leukotriene receptor antagonist, montelukast, is generally considered to have a niche application in the therapy of exercise- and aspirin-induced asthma. It is also used as add-on therapy in patients whose asthma is poorly controlled with inhaled corticosteroid monotherapy, or with the combination of a long-acting beta(2)-agonist and an inhaled corticosteroid.

Recently, however, montelukast has been reported to possess secondary anti-inflammatory properties, apparently unrelated to conventional antagonism of cysteinyl leukotriene receptors. These novel activities enable montelukast to target eosinophils, monocytes, and, in particular, the corticosteroid-insensitive neutrophil, suggesting that this agent may have a broader spectrum of anti-inflammatory activities than originally thought. If so, montelukast is potentially useful in the chemotherapy of intermittent asthma, chronic obstructive pulmonary disease, cystic fibrosis, and viral bronchiolitis, which, to a large extent, involve airway epithelial cell/neutrophil interactions.

The primary objective of this mini-review is to present evidence for the cysteinyl leukotriene-independent mechanisms of action of montelukast and their potential clinical relevance.

TB rises in UK and London

London is “the TB capital of Europe”, The Daily Telegraph has reported. The newspaper says that Britain is now the only nation in Western Europe with rising levels of tuberculosis, with more than 9,000 cases diagnosed annually. In London, where 40% of UK cases are reportedly diagnosed, the number of cases has risen by almost 50% since 1999, up from 2,309 in 1999 to 3,450 in 2009.

The Guardian has also discussed the rising prevalence of the disease, which was detailed in a report on the modern TB situation in London, as well as the UK as a whole. The report’s author, Professor Alimuddin Zumla of University College London, attributes the rise to people living under “Victorian” conditions, with poor housing, inadequate ventilation and overcrowding in certain deprived areas of London...

[Chronic obstructive pulmonary disease and cardiovascular disease].

In the last decade, various studies have suggested that chronic obstructive pulmonary disease (COPD) could favor the development of ischemic heart disease.

Several observational and case-control studies have confirmed that patients with COPD have a higher risk of cardiovascular disorders. However, this increased risk could be largely explained by a greater prevalence of classical risk factors. Currently, there are no data to indicate a causal relation between COPD and cardiovascular disease and the concept of systemic inflammation as a common pathogenic mechanism has not been demonstrated.

Equally, there is insufficient evidence to conclude that some drugs, such as statins or inhaled corticoids, could decrease cardiovascular risk in patients with COPD by reducing sys...

[Chronic obstructive pulmonary disease and sleep apneas].

Sleep quality is lower in patients with chronic obstructive pulmonary disease (COPD) than in healthy individuals.

Hypoventilation during sleep is the most important cause of hypoxemia and the presence of ventilation/perfusion alterations and reduced functional residual capacity probably also plays a significant role. Although episodes of nocturnal saturation can reasonably be supposed to increase morbidity and mortality in these patients, the diagnostic importance of these desaturations has not been demonstrated. However, desaturation episodes must be detected in patients with COPD and sleep apnea-hypopnea syndrome (SAHS), since morbidity and mortality are higher when these two entities are combined than when they occur separately...

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