Expert review of respiratory medicine
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Expert Rev Respir Med · Apr 2013
ReviewThe role of desmosines as biomarkers for chronic obstructive pulmonary disease.
Since chronic obstructive pulmonary disease (COPD) has a progressive and major impact on health management, many aspects of this disorder, including development of effective and reliable biomarkers to monitor disease progression, are under intensive investigation. A huge amount of data, accumulated over the years, have provided solid evidence that two pyridinium-ring-containing amino acid isoforms, desmosine and isodesmosine (usually referred to as desmosines), unique to mature elastin in humans, are representative of the elastin breakdown occurring in chronic destructive disorders, such as COPD. ⋯ The authors have tried to emphasize that the suitability of desmosine as a biomarker for COPD increased over the years, as the techniques developed for its detection became progressively more sophisticated and precise. The authors conclude that desmosines, although not yet definitely proven, have nevertheless all the requisites to become a critical COPD biomarker.
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Expert Rev Respir Med · Apr 2013
ReviewHow can we define well-controlled chronic obstructive pulmonary disease?
The main objectives in the management of chronic disorders such as chronic obstructive pulmonary disease (COPD) are: to suppress or minimize symptoms; to prevent and reduce exacerbations; to avoid limitations in activities of daily living, and thus to enable the patient to lead a normal, or nearly normal, life. COPD has become a serious public-health concern. The disease, which may be life-threatening if not properly managed, often goes undiagnosed. ⋯ As its prevalence is expected to increase, it might become the third cause of mortality by 2030. In Spain, COPD management has recently been reviewed in the Spanish COPD Guidelines (GesEPOC). The COPD National Health System Strategy, developed by the Spanish Ministry of Health, Social Policy and Equality under the Quality Plan, aims at implementing a set of measures to improve both the efficacy and the quality of healthcare services for patients with COPD.
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Refractory dyspnea is breathing difficulty that persists at rest or with minimal activity despite optimal therapy of the underlying condition. Both endogenous (β-endorphin) and exogenous (morphine) opioids modulate the perception of dyspnea by binding to opioid receptors. ⋯ The dose should be titrated to achieve the lowest effective dose based on patient ratings of breathing difficulty. Research is needed to address clinical uncertainties and to identify genetic factors to improve the use of opioids to relieve refractory dyspnea.
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Expert Rev Respir Med · Apr 2013
ReviewStreamlining antibiotic therapy with procalcitonin protocols: consensus and controversies.
Accumulating evidence supports procalcitonin (PCT) as an accurate surrogate biomarker for likelihood and severity of bacterial infections. In community-acquired pneumonia and other respiratory infections, PCT-guided antibiotic therapy algorithms resulted in reduced antibiotic exposure while maintaining a similar or even better level of safety compared with standard care. Reductions in antibiotic use translate into lower treatment costs, decreased risk of side effects and decreased bacterial multiresistance. ⋯ Still, there is some controversy about the benefits of PCT measurement in sepsis patients in the intensive care unit and for nonrespiratory infections. Highly sensitive PCT assays are readily available in many hospitals today, and point-of-care assays with high enough sensitivity for antibiotic guidance are expected to be available soon. Herein, the authors provide an overview of recent studies evaluating PCT in different clinical situations and an outlook of currently enrolling or upcoming interventional trials.
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Expert Rev Respir Med · Apr 2013
ReviewWhat is in the guidelines about the pharmacological treatment of chronic obstructive pulmonary disease?
With the publication of the new guidelines (The Global Initiative for Chronic Obstructive Lung Disease 2011 and Guía Española de la COPD) on chronic obstructive pulmonary disease (COPD), the pharmacological treatment of this disease has changed substantially. In this article, the evidence supporting the use of pharmacological groups in COPD is summarized and the place of each of these drugs among the new therapeutic strategies is established. Although short-acting bronchodilators have been used as maintenance therapy for COPD for many years, few clinical trials are available on the efficacy and safety of these agents, whose role was defined at the very early stages of treatment. ⋯ Finally, further evidence about other therapies, such as antibiotics or mucolytics, is emerging that will help define their appropriate use in selected patients. At present, pharmacological management of COPD is being re-evaluated. As long as we are able to apply the new treatment approaches to the clinical reality of our patients we will achieve greater benefits in both the short and the long term with a reduction in potential complications.